Trixyp

I work in an adult day care center, and I am one of the newer nurses on staff, and I'm also pretty new to the nursing world. All the nurses there share all of the patients, and we each do part of the paperwork. Many of the patients there are able to self medicate, and a few give their own insulin. So one patient came in to check her blood glucose level so she could administer her insulin. She said she felt a little tired, and her level read 51. This was unusually low for her, so I rechecked it, and it read about the same, this time 56. Her sugar is usually around 130-140 before she gives herself insulin. She asked if she should still give herself the insulin. I began to question her as to what she had eaten that day and how unusual it was for her sugar to be that low. She said today was different, as she only had a little bit of oatmeal for breakfast (4 hours prior) . I asked if her insulin had a sliding scale, and she said no, she just gives herself regular insulin 3 times a day, and her doctor never told her to do anything different if it gets very low or very high. (She did not keep with her the packaging for the insulin that states the dosage, only the insulin vial, and in our records, all it states is she is on insulin because it is expected that she administer herself.) At this time, my nurse supervisor came in and overheard the conversation, and began to question her. I recommended she go get something with sugar to drink so she could get her blood glucose closer to its usual level, and let us test again in 20 minutes so she could give her insulin as usual and have her lunch in a little bit as she usually does since her doctor has not told her to hold her insulin. (Our protocol for sugars under 60 is to give something to eat or drink anyway) My supervisor said "no, because then it would be wrong". So then i recommended we call her physician and ask what he would like us to do as he prescribed the medication. My supervisor denied that recommendation as well. She then instructed the patient to give herself 'less" insulin than usual, and find out from her doctor later what she should do if it gets to low in the future. Then the patient asked if having low blood glucose could hurt her, and my supervisor replied "Oh its nothing you'll just feel tired and have no energy." This nurse is above me, so I could not say otherwise unfortunately. Then my shift was over, so I left. So last i heard (Via a staff member who stayed later than me), the woman was being given juice and cookies because she started to feel very shaky and started acting lethargic. Then she had lunch as usual...(im assuming her sugar shot way up as well.) I have not been back to get the full story with all the numbers yet. So now I'm completely confused as to what should have been done in this situation instead? What would have been the proper way to handle this?

I began working in a nursing home in Los Angeles after my only experience was an adult day health care center. After orientation, I began my first day as charge nurse in a 159 bed facility. I hated it more than anything and I quit after one day. I could not believe how ridiculous and unorganized this facility was. I had 40 patients to care for, 16 diabetics, 4 breathing problem/asthma patients, 2 actively dying hospice patients, a few surgery rehab patients for broken hips, falls etc, and 2 HIV positive patients, the rest were there for reasons I am unsure of because I did not have time to look at the charts. Most of my patients had narcotic pain meds PRN Q4H, except my hospice patients whom were Q2h, and they wanted the pain meds as soon as they could get it. In addition to PRN pain meds, there were PRN sleeping meds, PRN anxiety meds, PRN itching meds, PRN everything meds. To start my shift, we were called to an inservice meeting, where the DON began to complain about how the dialysis dressings weren't being removed 4 hours after returning from dialysis, and that a patient got an infection and the shunt was now useless and the family is threatening to sue. This went on for about 50 minutes. Im already behind on my 2 hours to pass meds, so i begin. probably every 5 minutes, a patient bugs the cna for a PRN med. So i must stop what im doing continuously and get it for them. Then I notice there are a lot of ordered meds not even inside the cart, but they're signed for! and the supplement drawer is full of a bunch of empty containers! and some of the meds are in the wrong places. I am already past my 2 hours limit. Also a lot of meds in the cart, but not in the MAR. Many of my patients were not in their rooms and nobody knew where they were, if they were out on pass or what. I am constantly checking sugars, preparing 2 types on insulin, heparin, some insulins aren't in the cart or in the facility, medications have the wrong bed numbers, and charts have the wrong bed numbers, the patients aren't wearing their identification bands or the bands have no info on them, a ton of orders are hand written in the MAR to the point that I cannot read them, and they have the wrong mcg ordered than what is in the bubble pack. I have quite a few confused patients whom are unsure of what they are to do with the pills i just handed them, and it takes 10 minutes for them to understand they need to swallow their pills, assuming they even agree, and i am required to watch my patients take their pills, as i cant leave the med cup in the room. I had a lot tell me no they didnt want to take their seizure meds, or their insulin, or their digoxin at the moment, and had to waste a lot of time convincing them. Then one of my patients refuses his seizure medication, and his insulin. HE WILL NOT TAKE IT. So i leave and he disappears, apparently "out on pass" as some of the residents are allowed to leave as they please i guess. So when he comes back, a cna tells me someone fell outside, and i run out there and its him. He is on the ground with an empty bottle of vodka, and is so drunk he cannot walk. He denies that booze is his, and says he fell because he didn't get his medication that day. Then starts cussing out my CNA calling him a snitch. The RN took over because I was so behind. Then i go back to passing meds, and the cna tells me one of the patients arms feel hard and if I can look at it. I pull back the blanket and this guys arm is FIVE TIMES THE SIZE OF THE OTHER ARM!! I dont know the patients, so I ask if he always has this and the CNA didnt know. So I alert the RN because I dont know the patients, and the RN says no, he has dialysis, and there was a hematoma the day before, and they're going to have to send to the hospital. Then, i learn that for 3-11, im also the Tx nurse, and I have treatments to do. I still haven't finished passing my 5 pm meds, and its almost 11pm, so i had to pass my 5pm and 9pm meds together, and do my insulins and 9pm blood sugars and give the rest of the heparins. Some of my meds were in the fridge, but there was nothing to inform me of the meds being in the fridge. The whole time I have to keep stopping to give pain meds and anxiety meds and breathing treatments, and patients are asking for things they apparently get daily that are not ordered, and i'm supposed to answer phone calls and family members AND do my charting. My patients on thickened liquid had their liquid thickened until it was SOLID as in i could turn the cup upside down and nothing would happen. The patients constantly tell the cnas that they want to talk to me, and when I enter, its about something insignificant like why can't they have another ensure shake, or if i can leave their prn meds in their room for when they want to take them. Then I have a few rooms that I have to do from the other station, and their meds are in the other cart, so I have to hunt down the nurse with the key to that cart every time I needed to give a PRN, or their routine meds. The charts all say the same thing every shift unless something big happens, and they are illegible. All the nurses clock out for lunch, but keep working, and there are no breaks, and then the nurses clock out and finish working for about another hour and a half. They said it was low census, the day was uneventful, and when the facility is full they stay on average an extra 3 hours unpaid. Now I know why those dialysis dressings are going un changed. Are all nursing homes like this? I thought I would be ok with working in one, but not if this is how they operate.

Thankyou!

Perhaps I should clarify my question. My question is if the height measurement on axillary crutches has always ended up being correct for your patient on the pre-set "height" printed on the crutches in your experience, or if you have had to change them to something different than the patients charted measured height. As in, If the patient is 5'7, have the crutches you have measured for patients always been perfect when set at the 5'7 measurment printed on the crutches, OR have you ever had to place them at 5'6 measuremnt, etc.

There is a height measurement already on most crutches. A friend of mine recently hurt his leg and went to the ER. An EMT gave him crutches and a straight leg knee brace. The EMT set the height to 5'11, his height (His self proclaimed height, nobody measured him) On the first day, he was walking with the crutches so under his arms had all the weight, but his arms were still at the correct angle. He complained it was hurting under his arm, so I told him they were too tall. I said he needs to make them shorter, and he said no they're measured for his height. I told him they need to be 2-3 inches under his arm, and he said he would move them later. Point being, I was taught that the crutches should be 2-3 inches below the armpit, NOT TOUCHING, while the arms should also have a 30 degree bend (And I have a very un happy nursing school story for why I remember this haha) However, on him, his crutches still touch under his arm when he is standing normally, so he has self adjusted the handles so now, they do not touch his armpit. This causes his arms to be at no angle. They are straight. He has to lift his shoulders up to walk with out them touching his arm pit, while leaning forward and curving over his upper back, causing bad posture. He also walks with them about 8 inches away from his feet. I have told him they are too tall for him, but he gets angry and starts saying it was measured for his height, and he only has to adjust the handles and it will adjust it to either touch or not touch his armpit (However this will clearly require him to hold his shoulders up or down obviously) So when he walks, he lifts his shoulders so they dont touch the crutch, and has the handle positioned to his arms are straight. Can you picture this clearly? He has zero medical training and says he would rather listen to the EMT (Most likely because he is so incredibly stubborn that it makes him ignorant..For example, he is so adamant on being correct, I told him I would show him why he is using them incorrectly and he snapped back with "NO you can't". Then he just ended it with I would rather listen to the EMT. He was complaining of hand and wrist pain, but said it isn't because of the crutches. I just am curious on what is the right answer here. Is the height measurement always correct? I was taught it was just a reference point so you're not way off when measuring for crutches, and the crutches should be 2-3 inches under the arm, elbows slightly bent, and crutches wide enough apart to let your hips pass through. However I have also read that you set the crutches to the height, and then offers no further explanation or anything about it. Which one is correct.

My school doesnt have the same rules. We arent allowed to take a review course somewhere else we have to attend every day of the 6 week course there.And my issue is i cannot attend my school anymore as its too far away from meAnd i wasnt aware it was more than 12 months. Unfortunatly Since i cant attend anymore i need myDiploma and transcripts or i just wasted 20 thousand that i have no way to pay back.

sorry! lol did not know I could reply directly to a post! ha anyway I am in Los Angeles, California I tried researching for this information but I could not find anything on it. If i call my board they should know right?

Oh i really hope the bon has those rules! Im in california! Los angeles!

I started my 12 month LVN program in June of last, year. I officially graduated of June of this year. My school then informed us of a page in the catalog that requires mandatory NCLEX review. 6 weeks long. We were all very upset but they kept telling us we wouldnt get our things. We did our loan exit counseling and we our interest is already adding up. I have to start paying my loan in 5 months. They got paid. I have no outstanding debt. They are telling me if i do not finish attending the review, i will not get the "second part" of my application sent (Our actual school work? do they really send that? its packets we did each term) and I wont get my att. Its been 13 months now, and i have to start on other things i need to do. I have been without a job for a year and this school is an hour away from my house. I cant go there anymore. The school catalog says the review is supposed to be before the comprehensive exam, and if you dont go then you cant take the final comprehensive exam. I took the exam and passed. They didnt schedule nclex review until after the exam. now theyre saying we signed the contract and we have to follow it but they are not...does this seem fair to you? are they allowed to hold my transcripts or my 20 thousand dollar diploma and not send my application in even though i have loans due because i didnt complate the nclex review? They keep making things up too. what do you think about htis.

Yes my entire class is at the same clinical facility. We also spent the first 3/4 terms at the same facility, and we have never been anywhere where except at a nursing home. They are accredited, and they have a 96% Nclex pass rate, but I feel like the clinicals are just worthless. The classroom lectures are great, I'm sure I'll pass the nclex, but we never get to apply what we've learned in skills or theory in our clinicals. It's a complete waste of a day. I was just curious if this is what ll the schools were like or just mine. Apparently it's just mine.

Im about to graduate from my one year lvn program, I only have about 3 months left. The only procedures I have done, are blood sugar checks (twice), given medication by G-tube, and given a sub Q injection. My clinicals usually consist of sitting in the break room with my class,until the teacher calls one of us out to either give medication to one patient, or do a blood sugar check on one patient. ( Usually he will only call out 7 people to do something out of the entire class) Then we go back to the breakroom until its time to pass out meal trays. Then we pass meal trays, sometimes feed a patient if they need it, and go back to the break room, and do nothing. Sometimes, all we do is go to clinicals, take vital signs, and then go to the break room. No wound care, trach care, IM injections, ID injections, catheter insertion, NG tube insertion or care, no G-tube care, or priming, no dressing changes, NOTHING except medication pass or blood sugar check for 7 students. I feel like clinicals are a huge waste of time because we don't learn anything, or do anything. Is this normal? Am i just supposed to learn on the job later?

Im a student, and i was assisting another patient with feeding(Pt B). The patient sitting on the other side of me (Pt A) was scraping his plate with his fingers and trying to get the last bit of food. He was watching me feed pt B, and commenting on how good the food was, and how good that food im feeding to pt B looks. My fellow classmate asked him if he enjoyed his food and if he was full. He said the food was great, but no he's definitely not full! He showed her the plate with his shakey hands and asked he he could maybe have a little more. This is a nursing home, so this man is almost 90. It was so sad seeing him still hungry, so she set off to see if he could have more food. After determining that he was on a regular pureed diet with no calorie restrictions, she asked the CNA if it was ok to get him another serving. She told her no, because they were low on pureed food. So she asked another CNA, and she said no as well. So then she asked the charge nurse, and he said "no, he always asks though so dont worry about it". Then she came in and tried to tell the man his nurse said no more food. Then the CNA comes in with another plate, grabs his other plate and drops the new one in front of him, tosses his spoon on the table and says "Your always asking for more food!" and a rude and annoyed tone, then leaves. He is pretty old, and didnt realize what she had just done, so he just said "oh wow thankyou so much! This looks delicious im so hungry! yum!" as she was walking out the door. He then ate everything off that plate too. The portion they expected to satisfy this tall 6'5 170 pound mobile man was the same amount of food given to the 5'0, 70 pound wheelchair bound woman sitting next to him. Please tell me this is not the way things are supposed to be run in a facility. Is this justified in any way? In any circumstance? It was so sad that I wanted to cry. This man is the sweetest politest man and after she did that my classmates and i sat there with a shocked look on our faces for a good couple minutes.