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Our employers told us you do not need all 5 whys filled out to come up with an answer. Another poster was correct, you sometimes will find no reason for the fall. I would have put after he is unable to use callight, it's because he has poor safety awareness and why that is because he has dementia then stop. This would only be used if no other problems could be found like if he could be helped by a scheduled tolieting program.

Well I am a nurse on an Alzheimer/Dementia unit and I love the Exelon patch! It does not help everyone, but it takes place of Namenda and Aricept, so that helps with the residents that hate taking pills. Also we have found it helps with the "want to go home" behavior that so many of our dear residents have. I currently have 5 people on it right now (we have suggested it after other treatments fail) and it helps calm them but it doesn't effect their ambulation or participation in activities.

Well found out that they are eliminating a full-time 1st shift position on my floor when they go to 8hr shifts. I don't have seniority so I'm probably out. I'm not the only one either. There are probably a dozen or so people, maybe more, that will be looking for new jobs. They say its cost effective and will save time finding replacements for call offs, but I think they are just weeding out the people they don't like. I can't go back to 2nd shift. I have 4 kids and its hard enough to spend time with them as it is with school and sports. Can't take a part time shift, wouldn't be able to afford health insurance and buy food at the same time. I think if I don't get the position (even though it's my position to begin with), it's time to pull out the old resume. Thanks for all the replies.

Has anybody ever worked in a facility that had 12 hr shifts, but then changed them to 8 hr shifts? How did it affect all the personnel involved? I also heard that you could apply for unemployment if you got bumped from your job or offered another shift you could not work.

Yes my facility also started this about 6 months ago. It took awhile to get things started and get paperwork for it, but it does get easier. The only complaint I have is that Hospice people are suffering when they get a new order for Roxanol or Ativan or is a brand new resident, I have to track down the Doctor on the weekend for him to call in the scripts to the pharmacy. And yes that is what we did, but he got upset and told us to have the pharmacy call him. We waited 5 hours before we got the ok to pull it from our C-box.

HaHa I have to laugh because on a weekly basis I'm always looking for something, may it be glasses, teeth, hearing aids, canes, jewelry. Now for some, we nurses and aides have to actually sign off in our books that we took whatever and locked it up at night and then give it back in a.m. But this doesn't help when they throw their teeth away after lunchtime huh! Make it known to family right away that this is part of the process sometimes and you will do your best to keep track of the item, but don't promise anything.

Thanks all for giving us the reassurance we need. He has had a rough childhood and is doing better so my husband thought with his mother now. Now we aren't so sure. I think we will have to have a heart to heart with his mother and talk her into him seeing a counselor before going to a psychiatrist, to see why he is having outbursts besides being 13.

My 13 year old step son was at the pediatrician's office for an illness and only after 15 minutes he was back with a prescription for Depakote with a diagnosis of bipolar. He said he told the Dr. he couldn't control his anger sometimes and his mom told him it ran in the family so he prescribed it. Isn't that a little soon to diagnose someone so young so fast? He just turned 13 and he seems fine to me except having teenage hormone fits. I would hate for him to take Depakote if not needed but his mom thinks it's just great. It's just sad that teenagers can't be teenagers anymore without us dianosing them with a mental disorder and giving them medicine to make them "behave" the way we want them too.

Are you sure you are closed to ALL Medicare admissions? A couple months ago my facility learned that we couldn't accept certain admissions that we normally would have due to a change in Medicare reimbursement. There wasn't anything that we did wrong, just we wouldn't get paid for it anymore so we had to turn away admissions even though we were low census.

How sad this story is about the long journey of Alzheimers. I will be posting this on my own dementia unit to remind others how our beloved residents see things and how we seem to them. Thank you for sharing.

We just had our survey and the nursing part went pretty smooth, they were really nit picky and cited us for maintenace things. When they have to watch my med pass I make sure to use the resident with the most meds that takes them whole and won't refuse them. That way the surveyors get their quota on meds to watch and leave. This has worked for me twice.

Social Security told him he could not refuse and they just added it to his normal check.

My brother has had a dx of Schizophrenia for about 20 years now and I'm just so sick of the government changing Medicare and Medicaid so much, I swear it's just to drive sane people insane! It all started 5 years ago when my father died, since my brother is on SSI he got an increase as a benificary from my father. Well the increase kicked him off of Medicaid, so he had to start paying 750.00 a month for Zyprexa. Finally we got him on a Medicare plan for him to pay only 15.00 a month. Flash to today...... He went to pick up his supply and he was told that he now has to pay 380.00 copay each year to receive his meds? Of course no one will talk to my mother or me due to HIPPA and he won't let us look at any Medicare books he may have received because he is paranoid. He only has 150.00 left after rent and groceries each month and we are hoping that the pharmacy will take payments because they have before. It's just crazy that they do this to people in need. Now he will literally be wild for a couple months until it's paid. Anybody have suggestions? Please don't suggest to try to have him declared incompetent or be his POA. Been there done that, judge denied it. I know stupid huh!

The simplest things are great activies for dementia pts. Singing is the number one for us. Another could be tossing a ball around the room to music. It's a great rom excercise and it's alot of fun in which most of them think it's hilarous when they hit me with the ball on accident. Crayons and books are also a great "quiet" activity, just watch for the pts that don't know what it is and try to eat them.

I'm with all other posters that to not mix Lantus with any other insulin. Also as an FYI the new insulin that is out Symlin, also cannot be mixed with any other insulin. I had a pt that had Symlin, Lantus and Humalog. Poor thing had to have 3 shots. I learned not to mix Lantus when I was orienting and the nurse I was with mixed them and taught me to mix them until another nurse told us it was wrong.

I have a couple of comments. First I work in an Alzheimer's unit and I love it dearly. I have noticed that all my patients receive the same care because the nurses and cnas do not know who is on medicaid/medicare or is private pay. Secondly the family members who do not come to visit and do not involve themselves into their loved ones care are the ones who do not think ltc is acceptable and think their loved ones are getting the raw end of the deal. Even the family members who live far away yet call frequently and visit once a year think we are doing a good job. My third comment is that I would keep my family at home as long as i could,but would not hesitate a second to put them in nh if it had to be. I of course would shop around for the best care, which would probably be my nh! I told my children the other day, that if I had alzheimers they better take care of me if they can for awhile at home then take me to an alzheimers unit so I can enjoy the rest of my life with other people my age and like me. If you feel the nh is bad for your loved ones then look for a new one and keep looking if you need to, it doesnt have to be close to you for you to still be a part of them and your loved ones with think more of you if you find them a nh that cares properly for them.

I had a small one the other day. We have a very restless resident that was out like a light so we put him to bed and placed the usual wedges, body pillows and mats to the floor because he falls alot. He started snoring right away so about 15 minutes later I was charting when I felt the need to check on him and sure enough he was sitting straight up in bed getting ready to topple over onto the floor. Whew!!! my intuition saved all those neuro checks.:w00t:

At the ltc facility I work at, lpns do all admission assessments and all assessments thereafter. The rns then sign off making sure we have all info recorded in the chart.

I currently work in a locked alzheimer/dementia unit. It is the best and the worst job I have ever had, but I wouldn't change it for the world. We too have a lot of former nurses and reasearchers, teachers and nuns. It saddens me when family members miss the good few minutes that their loved ones had that day and when they are able to visit, the resident isn't talking, smiling, or they are having behaviors. We hear the funny things they say, we think that their actions are funny when the family is apalled, we see the smiles and get all their hugs and kisses. I hope I never have to be on the family side.

I live in fear every day I work. I too work in a ltc facility and in my time there I have been "verbally coached" and wrote up for the silliest things I have ever heard of and none of them has to do with my actual job! The last one being that I supposedly said something about someone else that of course doesn't like me so I got wrote up for it even though they couldn't prove it was even said. Yet another more popular nurse throws chairs and cusses at other staff in front of patients but she just gets a talking to. I don't leave this facility because I truly love my patients and my hours and with small children that is the main part of my staying. Of course I am working contingent at another facility to have a back up just in case.

At my nursing home we had a concoction made up called "power pudding" its a mix of prunes, whip cream, applesauce, bran in equal parts and blended into a pudding mixture. It is supposed to help regulate their bowels. I think we started residents out on 2-3 tsps daily until regular the cut them back (depending on the resident) to 1/2-1 tsp daily. We give this to residents who are regularly constipated, it could be worth a try. you might want to do some research just in case i forgot an ingredient. (our kitchen mix it up) I hope this helps.

Well there was the time I had started having diarrhea before I went home and had that and vomiting for the next 8 hrs so I called in for the next morning. The supervisor said Well do you think you could at least work part of the shift? This was 3am my shift starts at 5:30am, when I said no she got all huffy, thank heavens that I took that opportunity to vomit right next to the phone.:chuckle Then there was the time that I fell AT WORK and thought I broke my wrist. They didn't get me a replacement until 3 hrs after it happened and then yelled at me for not passing my medications. Do you know how hard it is to open those little pill packages with one hand?

I agree on checking urine and blood work to rule out anything. We had a resident that did the exact same thing day after day. She ended up being harmful to herself and other residents and staff. She was moved to a geriatric/psych facility that has a smaller unit with more 1:1, which did help some from what I heard. Sometimes nothing is going to help and all you can do is keep her safe from harm.

Yes it is a big problem and we were cited for ted hose not on when they should be. I have a habit of checking those who have the order for them, as they come into the dining room and if they don't the cna/stna can turn them around to their rooms to apply them. We also have the problem of aides applying the tedhose and taking off the bandages completly and I catch it when i see blood seeping out of the nice new white hose I just got in. It has gotten better but it is a never ending job.

I keep a log of all the stuff I have to do, because even though I am young in age, my brain feels old. :chuckle I get interrupted so many times a day and usually during med pass, so I right it down to accomplish later. I do take it home and keep it usually a month then shred them. They have no names on it, just numbers and some pertinent things I receive in report. Last week I was called by a higher up that I didn't do something and I was told in report about it. I was able to pull it up and prove that I wasn't told anything about it. Of course the main reason to keep notes is to make sure everything at the end of the day is charted and all paperwork is filed properly to CYA.:wink2: