brandinalove

When addressing medications in my weekly summaries I will usually state "no adverse reactions to current medication regimen noted" if this is true, I always speak on use of PRN medications especially if they are behavior modifying medications as well as their response to them, if a new medication has been started since the previous weekly summary I will address it and also if they are on ABTs or recently have been I would address the medication and what it is treating. If I speak about the use of PRN medications that modify behavior I always chart what non-pharmacological interventions have been attempted first.

I've only worked with a few residents who were actively dying but all of them had the "picking" symptom, they would pick at things on their clothing, their skin, even my skin when I held their hands and whatnot. It wasn't always immediate to their passing, one of my residents started this a few months ago and just passed a couple nights ago (). Very weird.

In a facility I worked in about a year ago two decent nurses were terminated and reported to the BON for this exact situation. I've been in ltc as a CNA and now LPN about 4 years and each facility's policy has been to initiate CPR if they are a full code even if it's obvious they've been deceased for awhile. This is in Florida.

Thanks for all the replies, I'm happy to hear this is the way it's done at most facilities and it does make sense to me now.

At my facility the process is to take a resident's BP prior to administration of their anti-hypertensives x 7 days when they're first admitted. If the 7 days show they have normal or high BP ranges then it goes to a weekly BP check and the nurses are no longer required to take their BP before administering scheduled BP meds. Just wondering if this is the policy at any other facility. The reason I can't comply with the policy is I'm convinced that the one time that I don't take someone's BP before medicating them that their BP will already be low and they'll bottom out.

That definitely changes things...in this case I most likely would have done the same thing.

Definitely wouldn't have written that order, even though I would've been 99% sure that the route on the Tylenol only not being changed was an oversight, I wouldn't want to risk my license over the 1% chance that there was a reason for it. In the nursing home where I currently work I feel that nurses sometimes get a little too comfortable writing TOs without actually speaking to the MD. Say something adverse happened after the PO Tylenol, do you think the MD would've taken the fall? Nope, he would've denied giving the order (he really didn't) and you'd be in front of the BON attempting to explain why you acted beyond the scope of your license. Sorry if that came off as lecturing, just my humble

This is one of my BIGGEST pet peeves. Please do not give me an insane set of vitals if you haven't rechecked them MANUALLY. One of my CNAs told me the automatic BP cuff showed HR 206 and she rechecked it 3 times (all with the same cuff). When I asked if she took it manually she said she didn't know how. I showed her how to check HR manually (actually was 86) and explained to her reasons why the automatic cuff isn't a good option for some patients.

Some days it's a miracle to even get vitals in a timely fashion and sometimes you have to wonder if they're not made up when you see the condition the patient is in. I would educate the CNA on the importance of reporting ALL vitals even if they improve after interventions are implemented.

The elderly residents in the LTC facility where I work keep me laughing on a daily basis, one of my residents who is very confused, HOH, and loves men is known to see a male walking by in the hallway and yell out rather loudly "come here you sexy man, oh the things I could do to you!". Oh, his wife is with him? She says, "well she should understand, it's not my fault he's so "d**n sexy!". However, recently in one of our meetings we were informed that it was emotionally abusive to laugh at the funny things the residents say. We're in our state window so all sorts of stupid unheard of rules are coming out of the woodwork.

Wow, Ashley, your message provided invaluable measures for which I can provide care, children and the older adult are very much alike in the instance of pain and I had not considered that they may be expressing pain to their family member instead of the nurse due to their level of comfort. You have really given me a new outlook on the situation. Thanks!

How do you guys handle it when your resident has a very pushy family member that insists on treatments and interventions that do not seem necessary? For instance, family member insists that resident needs a pain pill or "nerve" pill immediately and when you enter the room the resident is sitting calmly in bed sometimes even sleeping. This has also gone the other way for me when I had a resident who was literally crying from pain (she was 2 days post-op back surgery) and the daughter was upset at me for giving Mom the prescribed Norco 5/325 instead of Tylenol because she doesn't want her mom to get addicted to the pain meds. I know we are supposed to be advocates for our residents and do what's best for them after OUR assessment, but how do you gently and professionally explain to a family member that you are not going to do what they feel is best?

Thanks for your replies, very helpful. Up until last night I'd never done an admission start to finish because usually the admissions nurse would come in and take over at 3. It is a long process and lots of little things to remember but definitely seems doable. At our facility the admissions nurse is also responsible for labs for the building (120 beds) and writing out the new orders. This is especially tough on Mon and Thurs when we do PT/INRs. Yes, the admissions nurse is expected to do the full body assessment, this is the most important part and the part they found unsatisfactory in the previous nurses. I'm definitely up for the challenge and look forward to it. Oh, and I didn't wanna know about labs bc I'm expected to order them, I was just curious about what meds are known to affect certain labs. Thanks again!

Hi all, I'm presently an LPN in LTC and have been for about 5 months (spent a year in mental health). I was recently given the opportunity to become admissions nurse for my facility which I took because the M-F 3-11 schedule is perfect for my school schedule. Any tips from my fellow nurses on completing a thorough admission? Since I've been at my facility 3 nurses have failed at adequately completing admissions to administration's liking. Also, does anyone know of a common list of labs that certain medications affect? For example, we also ask for a BMP for residents on diuretics? Any little piece of info helps! Thanks in Advance!

I received my AA this past summer as well, only been an LPN about 10 months, congrats on your degree and your acceptance :-). Yes our orientation is the 2nd as well, 9am-12noon.