ceebeeRN

..hmm...second time this has happened so by now, I should known better lol. I posted a wound care issue in the wound care nursing section with no avail. Since I'm genuinely concerned and am seeking advice..I decided to repost here. I serve primarily as a wound care nurse on a rehab floor of a LTC facility and I have one resident who some how developed what was diagnosed as a decubitus on his scrotum/member (to me it actually looks more like a laceration from friction/force possibly from his foley cath). The resident is on quite obese and his stomach overhangs on his scrotum causing the wound environment to be really warm and humid and in turn quite smelly. Right now, the order is just for cleansing with normal saline, patting dry, and applying a dry dressing. The wound didn't get worse but it sure doesn't look like its getting better and the odor...phew! Any suggestion for a new treatment and/or some kind deodorizing cleanser since Dakins is probably out of the question due to the location? Ouch!

I serve primarily as a wound care nurse on my floor and I have one resident who some how developed a decubitus on his scrotum. The resident is on the obese side and his stomach overhangs on his scrotum causing the wound environment to be really warm and humid and in turn quite smelly. Right now, the order is just for cleansing with normal saline, patting dry, and applying a dry dressing. The wound didn't get worse but it sure doesn't look like its getting better and the odor...phew! Any suggestion for a new treatment and/or some kind deodorizing cleanser since Dakins is probably out of the question due to the location? Ouch!

I know dansko sizes are in European sizing (EU) but that's where my problem lies:for some reason, its always tricky for me to pinoint what my EU size is. According to most conversion charts, a US womens shoe size 10, which is my size, is supposed to be equivalent to EU 40. However, in the past when I've purchased shoes in EU sizes, 80% of the time, dependent on the style or brand, the size 40 is too small and I have to get a 41. I've never owned a pair of danskos, but from the reviews I've read, It seem that dansko clogs run a half to full size small. Is that pretty accurate? If it is, I'm thinking that a EU 40 is totally out the question for me ans that I should aim to buy a 41 or even a 42. I know the most ideal way to find my proper size in this brand is to find a store to try on the dansko clogs since I've never owned a pair, but as of now, Im planning on chancing it and buying Dansko clogs online following the input of the allnurses community of course lol. so my question for all you faithful dansko wearer is should I get the 41 or 42?

we may need an ostomy nurse consult after all. we have a wound doctor but honestly, he's not that effective when it comes to ostomies lol

just when i was about to try your hydrocollloid suggestion, i went back to work only to find that the resident out to the hospital because of how aggravated the area became. now that he;s back we're really trying to nip this issue in the bud, so what I did is used Duoderm instead of hydrocolloid (we are out of that at the moment). do you think that duoderm is a suitable temporary subsitute for the hydrocolloid? I've only used it a couple times and it seems to have helped to a degree. the leaking is minimized but since we are using the one piece pouches we have to be very diligent about changing the bags and keeping the area as dry as possible. Even with the lessened leaking, I can already see his skin getting a bit red but its not nearly as bad as before. Hopefully the added barrier of the hydrocolloid or duoderm keeps the leaking at a minimum. it would be wishful thinking to think it would stop it all together! =/

I've seen another nurse use the skin prep + nystatin powder method on a patient, however, that patient's site was no where as irritated as my resident's is. I actually tried using the skin prep once and he let out a scream so loud, I practically fell backwards, so I Know not to do that again. Oops! lol We have been leaving the site open to air from time to time, with just a towel against it to absorb the drainage, but the DNS was not so happy about that. I, however, do think my patient would benefit from having the pouch off for a bit and the application of some type of dressing.

I will try this tomorrow...I know we have hydrocolloid and we should have calmoseptine. If not, I'll put in an order for it. Thanks for the advice. For my patient's sake, I hope it works!

I originally posted in the wound/ostomy section to no avail...go figure! since I work in a post acute unit in a SNF, I figured I'd try my luck here. I am the treatment nurse on my unit on a pretty consistent basis and we recenty admitted a patient with both an ileostomy and a colostomy. The colostomy site and the skin around it is fine but its the product from th ileostomy site that leaks through the skin barrier and his skin is now as raw,red, and angry looking looking as this bird-->. The site is so irritated:arghh:, that one MD saw it and suggested maybe we send him back to the hospital or at least follow up with the doctor who did the surgery to see what can be done about resolving the irritation. we've tried multiple pouches and multiple skin barriers, including the presized 1 pieces and the 2 peices that need to be measured and cut to size. Nothing seems to be sticking...literally or figuratively! hence the leaking and further irritation. the rawer his skin gets, the less the skin barriers are adhering. the drainage from the stoma just breaks the seal of the skin barrier and the acidic drainage gets everywhere. To relieve a bit of the discomfort, the MD ordered mylanta to be applied to the irritation skin but it seeems like the mylanta further weakens the seal and once again, it doesn't really solve issue or provide a great amount of relief. I feel so bad for my patient!! any suggestions for what we should do to help?

I am the treatment nurse on my unit on a pretty consistent basis and in the last two months, we have had 2 patients with ileostomies. We were ill equipped and only had the premeasured 1-piece colostomy bag available for the first patient, which were way too big for his stoma. Needless to say, the drainage got under the seal of the colostomy bags and there was a lot of leaking and not before long his skin became irritated. Our wound doctor ordered zinc oxide for around the stoma but that made it even worse because the adhesive would barely stick and the leaking and subsequent irritation was just as present as ever. Before long, that patient was transfered to another floor and I was never sure if the irritation issue was resolved. Now we have another patient with both an ileostomy and colostomy and it looks like its just as bad, if not worst than the 1st patient. The site is so red, that one MD saw it and suggested maybe we send him back to the hospital or at least follow up with the doctor who did the surgery to see what can be done about resolving the irritation. The colostomy site seems to be fine but once again its the ileostomy site that leaks through the skin barrier and his skin is now as raw and red looking as a lobster. we've tried multiple pouches and multiple skin barriers, including the presized 1 pieces and the 2 peices that need to be measured and cut to size. Nothing seems to be sticking...literally or figuratively! hence the leaking and further irritation. the rawer his skin gets, the less the skin barriers are adhering. the drainage from the stoma just breaks the seal of the skin barrier and the acidic drainage gets everywhere. To relieve a bit of the discomfort, the MD ordered mylanta to be applied to the irritation skin but once again, it doesn't really solve issue or provide a great amount of relief. I feel so bad for my patient!! any suggestions for what we should do to help?

Yea..I always add negotiable.you're absolutely right about the experience pay scale...so i never understand why employers even ask about a salary requirement. just another thing for applicants to stress about I guess lol. Even though the company knows how much they are willing to offer, I don't want to appear as if I GROSSLY underestimate or underestimate the value of my work by putting down some inane number

Thanks for the great advice! This would be a change of pace for me so I am not extensively experienced in the area that I am applying for since I currently do home care as well as as Long term care, so I guess There was no formal application form..The office just asked for a resume along with a salary requirement. Some places go so far as to write sometime like: "applicants who do not include a salary requirement will not be considered" etc, so that's why I usually try to come up with some kind of reasonable figure.

I don't know about you, but I know always hate the salary requirement part because I don't want to shoot myself in the foot by either lowballing or highballing it. I don't want to be taken advantage of financially or appear uninformed if I put in a salary that is too low and I dont want to be overlooked if I put one that is too high. What I usually do is put a range and then I would also imply that I am flexible. So for example, I would write: $35-$40/hour but open to negotiation. In the NYC metropolitan area, what would be an acceptable range for a RN in a ambulatory care center? I know a regular office RN would make about $25 an hour, give or take, so I suppose a RN in an ambulatory care center would make more than that? maybe $30? I don't know. Also, I always wonder, what is the proper place to include your request? .Since I don't always include a cover letter, I usually put it at the very end of my resume for the jobs that ask for a salary requirement.

Yes, I know combining med pass is tricky. However when there is only one nurse to 40 patients, I don't know how 2 med passes can be done especially when new orders, new admissions, falls, etc are subject to happen at any time. I would hope facilities that use eMAR take into consideration their nurse to patient ratio.

No. You're reading way too much into it. If I were an LPN, I would've written the same thing. point being if you are any sort of licensed nurse, you have patients AND a license to protect, so I'm sure you would assess no matter what letters follow your name.

Please do not take offence, I was just stating my title. My facility does not really make a differentiation between LPNs and RNs, so I have no reason to make this a LPN vs RN thing.

ok..I admit I combine med passes BUT I am a RN, so i assess, assess, assess. I space out bp meds, depakote doses, put IV ABTs on time, etc. However, some patients have like 2 meds, maybe a shot of insulin at 4:30 and then a coumadin at 9. all coumadin is scheduled for 9pm and it may be silly of me to ask this, but is there any particular reason, coumadin is scheduled so late? is there any reason medically/ heathwise I couldnt give it at 4:30 so that person can be done with their meds and I dont have to bother thm while they are in bed later? The only practical reason I could think of scheduling coumadin late is so that it gives the staff time to reieve the results of the PT/INR and hold/change coumadin orders in case the results are out of range,

My facility must be very informal because they did not ask me to commit to X amount of days or anything. out of courtesy, i always put down at least one weekend and i decided to work the 4th of july. As for being on call, There was no discussion of being on call. 99% of the time, I am scheduled with a day or 2 notices. Only once had I been called in the day off, but I couldnt go in because I had already accepted to work a double at my other job. The supervisor at my PRN job seemed understanding of this, so I suppose I am not expected to be on call. You are so right...I should treat the days I put down as days I WILL get. It was my mistake in assuming I would only get a few days scattered, but the damage is done for the month of July so I can only keep my fingers crossed there are not many call outs!

I do not believe I had any specific scheduling commitment. I simply put down when I am available (barring any unforeseen circumstances off course) and my employers seem okay with that. I guess next time I do my availability sheet I should think of it as those days are days I WILL work to avoid the run-on work week !

Ok..I work in a long term care facility and I am Per diem/PRN. I do not have a fulltime schedule neither do I have benefits, health coverage, etc. I have another primary job, so of course, . Every month, I have to do a staff availability form where I write down the times I would potentially be able to work. So a few days ago, they told me ahead of time, I would end up getting all 3 days I had put down for the week, which was a bit of a shock to me because I only expected a day here and there. Because I got all 3 days I put down, coupled with my other job, it made me have to work 5 days straight, which as any nurse knows, is exhausting! =/ ,so I really wanted to call out because I felt like I was getting burnt out, but I didn't because I thought it may look unprofessional or even lazy of me, especially since I had written that I was indeed available. I worry that not having enough availabilities and/or declining work looks bad. So my questions are: 1. As a per diem, can I actually call out ? 2. If I had previously written I was available, but then they end of calling me in with very short notice ( like less than 2 hours), can I decline, especially of I am in a situation where I am far from home, not feeling well, etc. or is it expected of me to be staying home and waiting in the event they do need me on those days I told them I was free. Essentially I am asking, do they expect me to be somewhat "on-call" on the dates I provided them with. 3. In august, I plan on going on vacation, so when my August availability sheet is due, I thought I would simply leave those days I want to go on vacation blank, however I fear it may look unprofessional because by then I will only have been working for them a bit over 2 months and that even if I am PRN, I am still in some sort of 'probationary' period so that may be frowned upon or even not allowed.

Thanks so much for taking the time to give advice...I believe I have found the resolution,,I wrote it below!

Thank you all for your responses..but in this situation I couldnt help but to think of what an old prfoessor used to say: "when you hear hooves, think horses, not zebras" meaning that sometimes the answer to your question, is the simplest one. When priming IVs, I aim the IV down (usually into the garbage or an empty container), because thats what common sense would dictate, But apparently with the tubing for the feeding bag, its counter-intuitive, because you have to keep the champer right side up and hold the tip up towards the cieling. When i aimed the tip of the tubing down (the tip that I would insert into the Gtube) is caused the nutrition to I guess back flow in the tubing thats when large spaces of air in the tubing,

I am no longer a nursing student but I am a New RN, but I couldn't figure out under which thread to post my question...I guess this is a good of a place as any. I spike IV bags, prime, and then hang IVs all the time that contain medicine and/or just fluids with no problem, but my homecare patient receives Jevity (liquid nutrition) through a Gtube and of course its a lot thicker than Normal saline, but my issue is that when I try to prime the line HUGE gaps of air appear in the line )i hope u can imagine what im talking about). This is such a simple task so I dont know why this is happening and/or how to prevent this...it happens almost daily and I can't figure out why? could it be because of the thickness of the liquid? how do I resolve this issue?

I've had those phone recruiters contact me too...I'm pretty sure they got my contact information from the resume I publicly posted on Monster (which clearly shows I'm a new grad), so when I would get calls or emails, I assumed they know that I don't have hospital experience...Obviously based on our experiences, that is not the case! It just boggles my mind because I would think that as a recruiter, a possible candidate's resume would the first thing I'd read and read carefully at that!

I have a job assignment at a local home health agency and I really feel like its sink or swim. I was not naive and I wasnt expecting a grand 6 week orientation or anything but I did expect more than 1 hour! I had to ASK for some kind of orientation even though the coordinator knew I was a new grad and that this was my first case with the agency! after I asked, they told me I could meet with the current nurse on the case to get a feel for what was going on. If i hadn't had enough foresight to request some kind of orientation, I would have just been going to my patient visit totally blindsided! Luckily the family seems to be easy going and very helpful and they know Im new, so they step in to help. I just wish I was more prepared so I can look more competent in their eyes! I know agencies aren't the best or the most instructive places for an inexperienced nurse to start but right now,you have to take what you can get. And I also suppose, I guessed they would put a bit more effort into prepping their employees. I was just wondering if anyone has had similar experiences with home health agencies? or was your experience more positive? is this typical behavior for dealing with their employees, even those who are new grad nurses?

So I posted previously under another topic and didn't get any responses, but Im sure this thread would be more appropriate. any advice would be greatly appreciated. Thank you in advance As we all know the job market in general is tough out there and it seems extra tough for nurses. At the moment, I am NOT giving up on getting a RN position or the field in general, but In the meantime, I need a job to pay the bills and who knows, I may like my potential new job so much I might end up staying. I opted to stay in a health related field, so I often apply to medical assistant or medical receptionist jobs, and many times I get the reaction: "oh maybe you misread the listing, but we're not looking for a nurse" or "you're overeducated/ dont have the right kind of education/expereince for this position" Sometimes during the interview, i get asked: "are you working/have you worked as nurse?" or the toughest one "How do we know if a better employment opportunity more in your field arises, you will not just promptly leave?" From the perspective of a potential employer, I can see why all of these are fair questions. That is always the most uncomfortable part of the interview for me when questions like that come up. What should I say when asked about potentially leaving if a nursing opportunity comes along? I don't want to seem like I'm deflecting the question but the best I've been able to come up with is to say that I am very success-oriented and that I would and do give 100% to any job I am offered, whether it was in my specific area of study or not. I then mention skills and qualities I've developed as a result of my healthcare background that ARE applicable to the position. More often than not, I.. So not to look "over qualified" , I do Include that I have a bachelors but I don't always add that my major was nursing and/or I completely omit the fact that I have a RN license on resumes I submit to nonnursing jobs..something I shutter at considering how hard I worked for it lol! What do you guys think about that? (Of course, if during the interview, I'm asked directly about my major, I'll say I studied nursing.) What are some of your opinions/ideas/experiences? Has anyone successfully broken into another career path after getting their nursing degree/license and not being able to get a RN position? were you able to do it even with including your nursing background on your resume?