JamiRN

i can relate. i once had a patient of a certian religion that i have issues with. i had such a hard time personally with it. i felt for his soul. i worried about his soul. i questioned my own beliefs. i think hospice nurses have a huge challenge in this area to go beyond and look beyond this. it is very tough. i don't know if there is an easy answer to it. my belief is thati have a lot to learn about spirituality. and maybe, maybe i can learn from each death. that maybe i can expand my 'shallow' views and be more open. but it is not an easy task. :) peace :)

When I worked in LTC, we used to irrigate pond scum bladders with Renacidin solution. 20-50cc in, clamp 20min then release. Often with the thick urine that you describe...we'd see results in just 2-3 irrigations (one a day), then could cut back to PRN, usually about once a week. :)

Clean stuff on the outside... Clean to sterile stuff on the inside. Never on the floor. A clean drape if there isn't a clean area to set it on. Should be set preferrably on a chair. Once a week, take out everything, restock. Clean the bag with germacidal wipe, then wipe down equipt. IF your equipt ever gets soiled at a visit, germacidal wipe ASAP. Never reach into your bag without washing your hands first. THose are the highlights of our policy:)

Home Care Patient; MS. Spouse does Renacidin irrigation BID. She had been using a glass jar of the irrigant. Drawing it up via needle/syringe, disposing of the needle and then using the syringe over and over for the week. Home care just came into the picture. I can order Renacidin in a plastic jug with a screw cap. I provided her with an irrigation tray which includes a cup to pour the soln in, and a 60cc syringe. Our policy is tucked away in a box as our company is relocating. I came from LTC where we were able to use the tray for three days. This being a home care patient...The environment is different. She keeps her supplies in a neat and tidy corner on the shelf in the bathroom. She wears gloves for the procedure. They have 3 big dogs in the home, don't seem to be near the supplies. Thanks :)

Can anyone tell me what policy you follow regarding cath. irrigation. I've heard mixed things. Some say change the irrigation kit daily. Some say every three days. Wash with soap and water between use or rinse with vinegar? Thanks

I agree 100%. Darvocet is worthless. Sometimes, with hospice patients, there is not enough time to 'change' the deep set beliefs they (families/pts) have. Thanks:)

Thanks for the input.I saw this patient yesterday and without any c/o pain, at rest 106/78. I guess it just seems odd to see such a little gap (10) between systolic and diastolic with pain. He is a fairly big man too. :)

Can anyone tell me what may possibly be going on with a patient of mine who's normal BP is around 110/70 110/78 but occasionally will have pain and readings go to 100/90. MD has no concern. No tests ordered. No current medications in use.

First used DCN, then switched to oxycodone. She was reluctant to take anything for pain but did use the oxycodone, then used oxycontin bid with oxycodone for breakthrough pain. For nausea, we used the ativan with compazine q 6 hours. The compazine was a godsend:) She was reluctant to use oxygen, but did in the final day. Bowels were moving each day... I guess, it is so difficult when you can't find the 'answers' to all the issues. Sometimes, I feel like I am the 'trial and error' queen. :)

Somedays are really long. I average 5 visits a day. I have been doing home care for 6 months. My goal is to be at 6 in about 8 hours. We do all our documentation on the computer and it is MUCH LESS paper work than were I worked before in Long Term Care nursing. We see homecare and hospice patients, and an admit is counted as 2 visits. I LOVE IT!

Can anyone give me any suggestions for dealing with agitation with dying patients. I have had three such patients where nothing seemed to help. One gentleman had not experienced any pain throughout his dying process, no pain meds were used. He was not on any medications his last few days. He began hallucinating. His family was at his bedside 24/7, "fixing the plow...getting the parts...etc" His family did not want any narcotics. We used Benadryl the last day to help him rest for brief moments. A middle aged woman with ovarian cancer. She had pain control with DCN until the final week in which her pain became more intense, tried oxycodone, Morphine (threw up) and Fentanyl (rash). She could only sleep for a few hours at a time, then was just wild. Hallucinations, anger, bound and determined to get up and get somewhere yet too weak to lift her head from the pillow. We tried Lorazepam, Haldol, scents of lavender, pastor care... What have you used to help? Thanks:)

I have had this conversation with a few families. It is never an easy thing to talke about. I find that it helps if 1). you make sure you have TIME to spend with the family, 2). sit down at eye level to them, 3). Involve the dying patient in the conversation with the family...even if they cannot respond. This conveys compassion and caring. Explain to them that Morphine does not end someones life but that it will RELAX the body and all its systems. With this deep relaxation, the loved one will not have to fight to stay alive but that only GOD really knows when death will actually come. (WATCH FOR APPROPRIATENESS with spirituality). Best of luck in your position. I too, feel pulled to work with hospice/death...it is a passion for me. But my passion, also has a spiritual aspect, not all do.

Wonderfully said needler. Hope people don't bash your belief in GOD. It does provide huge comfort.

I have also worked with an LPN in the LTC setting who firmly believes that everyone needs to poop on a daily basis. That makes me laugh. She is always dishing out the MOM if they did not go that day!!! God help me if I ever end up living in an institution with one of these loverly ladies....EVERYONE GOES DIFFERENTLY!

I had an interview on Monday for a Home Care position. The first 20 minutes was answering multiple choice questions. "Do you like people: strongly agree, agree, neither disagree or agree, disagree, strongly disagree". Yep, about 6 pages of this. THEN I had to watch a 20min. video about the 'corporation'. Then I had to write an few sentences about my interpretation of the video:uhoh3: . THEN I met a person to interview. :) Turns out she was the one to see, before I see... They checked my references, called back today and on Friday all am I am "shadowing" a nurse "to be sure I really want the job". THEN AFTER that, I am meeting with THREE people for an interview. I was kind of nervous, but now after seeing 70min!!!! I am scared to death. I'll probably be one bit armpit sweat...:uhoh21: :uhoh21: :uhoh21:

I wonder if it varies state to state... Not much for antipsychotics here, however, we are seeing some use of "Namenda" 1. Calcium with Vitamin D 2. Zoloft 3. DSS 4. Zantac 5. Digoxin

As a nurse who had to write ALL the care plans for a 119bed facility....Care plans have positives and negatives. The good: when the next person comes on, they know what problems the patient has and what we are currently doing for them. IF they have a better intervention, they can add it to the care plan. It is a way for everyone to see what is working, what isn't and what has been tried. The bad: They can be SO time consuming that in the REAL world of nursing, they are thrown together half*** and sometimes you don't even have enough time to read the highlights of the pt's problems. What really gets me, is that the higher ups...they seem to focus on the paper work becuase it is something they can read into AND it takes less time for them to criticise a careplan than it would for them to get out of their offices and see what the nursing team is really doing out on the floor.

Hope we get some more input here. I would like to know too. When I was in school I bought the cheapest one I could find for $11. I actually prefer it to the soft squishy earpiece ones.

Very interesting....Where I live (WI) some facilities have the "ok to use" and mine, is a "NO rails up" place. We don't need a dr. order to use them but we do have to explain the risks and hazzards of siderail use to both the patient and the family and have them sign a consent before we can use them. At our LTC facility, it is almost funny the things we do to prevent falls--bells, alarms, pullaparts, thick mats on the floor at the bedside, and beds that go right down to the floor. YET...those siderails, they are dangerous...:) So, when I step out of pt's room, I have to remind myself...alarms all on? Patient safety:)

When charting a procedure - I always remember to include "who, what, when, where, why, and how." So, an example would be "April 2nd, 2003 @ 1100 - Pt. requested and received i po percocet tablet for 7/10 breakthrough back pain as per physician's prn order and hospital policy." And then (because you should chart results), "April 2nd, 2003 @ 1140 - Pt. states pain relieved to 1/10." I like that. WWWWW&H. When I started out, I used the SOAP method, it was a way to get your thoughts organized. Some say, I chart too much. I have to admit, I'd rather chart a little heavy than miss something. I once had someone tell me after reading my charting, "hey, I'm not buying the book". AND on the other side, I sent my nursing assessment note to the MD because overall, the pt was a mess. The MD called me, thanked me for my "excellent and descriptive information". Goes both ways.

I can still remember hitting the bone in a frail little lady...I felt absolutely sick. I worried about it for a long time...all the what if's. What if it hurt and because she was so sick she didn't react, what if I caused some sort of bone damage, etc. Have never done it again, am so so careful to use a big cushy spot or a smaller needle:)

We are taught not to use peroxide on any wound because it affects the healthy tissues (cytotoxic). Use normal saline for cleansing most pressure ulcers. If you can irrigate the area with a 35mL syringe and a 19 gauge needle or angiocath it should remove bacteria without causing trauma to the wound bed. We have used a product by 3M ... I can't think of its name....

Iv'e been in LTC as an RN for 11 years. I have had to actually clean up poo...maybe two or three times. As an RN, you do assessments, you start IV's and monitor them. You learn about the nursing approach=assessment, plan, intervention, and evaluation. You work with doctors, you are the patient advocate, a team member, not a poo cleaner...

I am taking a vacation (six weeks) because I have so much vacation time built up I need to use it or lose it...I have been working in long term care since the day I graduated (BSN). Same place. I have been a floor nurse, charge nurse, admission nurse, MDS coordinator...you name it. I keep thinking it is time to see if the grass is greener somewhere else...but everything I have checked out is a pay cut. Not only that, most places want experience... I feel like a new grad again when I put together that resume. Should I go or should I stay...