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ClaraRedheart BSN, RN

Med-Surg Tele Nurse

Content by ClaraRedheart

  1. ClaraRedheart

    Was I wrong?

    If it is a patient that generally takes their pain medication as soon as it's available, it's polite to assess the patient prior to your leaving to see if they need the medication.
  2. ClaraRedheart

    Nights vs. Days

    This is an older post... but I've worked both nights and days on the same unit. Here's what I've noticed. On nights, you hit the ground running. People want to get their last walk in. You have one more patient than the day shifters have, so you still have to medicate and assess 6 patients within two hours. Not really possible to do a thorough job and chart in the room, so usually I assessed, then charted later when the lull came (assuming you have no gremlins). Ah, the lull... that's nice. You can catch up on charting, power walk around the hallway and get your steps in early, review charts.. that DOESN'T happen during the day. If you don't chart as you go, you're behind and will be hanging out for two hours after shift is over. Mornings also (usually) start out slower on days. You have time to get report, review your charts, then get started on med pass where you chart as you go. Just don't expect things to slow down, because many doctors will waltz through, sometimes multiple on one patient and place orders... more orders. Better not miss any in the onslaught or lab will be calling you or night shift will be asking why you missed that CBC that was due. You also have discharges, admits, transfers. Overall, I think days are a lot more busy, but I've never felt the need to come in early and review charts on days. Nights start faster, and you need to know whats going on BEFORE you hit the ground running or things could get dangerous real fast, so I always came in an hour early to look at charts. Probably depends on your unit what the differences are, but this is what I've observed on my unit.
  3. https://www.cnn.com/2019/01/30/health/ohio-fentanyl-death-employees-on-leave/ A quick summary: Several employees are on leave for giving lethal and potentially lethal doses of medication to dying patients. Just curious what hospice nurses think of this! I thought that large doses and morphine drips were fairly common for dying patients. It's not something that I feel comfortable with, I'm med-surg and not hospice, so a bit out of my familiarity and have to seek advice when I get a hospice patient... but thought that it happens fairly frequently. What do you guys think?
  4. ClaraRedheart

    Repositioning end stage of life hospice pts

    Thank you! Good to hear this from a hospice patient! I am not a hospice nurse, but I had a patient that would be transferring to hospice the next day. The patient would scream any time you tried to turn her from side to side and would not stop until you returned her to her back. I had asked "since the patient will not be going until tomorrow, do you think it would be wise if I obtained a pressure relief mattress so that her skin doesn't break down? The nurse replied something to the effect of "Well, when she goes to hospice, they're not going to reposition her anyways. She's not eating anything, so she's going to get pressure sores, and if the natural death process doesn't kill her first, she'll get an infection in her pressure sore and die from that". He seemed like a nice guy, but I was kind of horrified at the honesty.
  5. Your story sounds like my sons, up until his first dr's appointment. He was crying at the breast, latching, but acting like he wasn't getting enough or couldn't stay latched. I was determined to make this work after feeling like I gave up too soon with my daughter so he was constantly feeding, or trying to for the first 5 days. His urine was dark orange, and just a little stain on each of his diapers, and he was jaundiced by his first doctors appointment. His pediatrician said to feed him formula Q2 for 24 hours and pump and store the milk each time I fed him. He was SO much happier, as was I. He started peeing like a normal baby and wasn't constantly crying. I tried to go back to the breast, briefly, but the crying and struggle started again. I gave up and was ashamed, cried for a day. I don't really care now. I've been pumping and giving him bottles. It's worked great for almost two months, but now my supply has dwindled to where I feel like he's getting half/half. That's ok too. My daughter was almost completely formula fed and is one of the least sickly children that I know, unlike my SIL's two young children that were exclusively breastfed. I don't really think being breastfed or not has anything to do with how healthy or intelligent a child will become. It's great for bonding, sure. The immune benefits are also great, but how long does it take breastfeeding for the immune benefits to transfer from mother to child? I am up right now with a sleepy, contented and full baby on my lap who just ate from a bottle. It takes more time to pump, and pumping is quite honestly a pain in the butt, but at least he's fed and healthy. Stories like baby Landon's and that of the physician that is one of the founders of the "Fed is Best" movement are heartbreaking and so sad. Should NEVER have happened! That could have been my story had our pediatrician not encouraged us to try something different when breastfeeding wasn't working. Grateful for her.
  6. ClaraRedheart

    Challenging Your Own Beliefs

    Beautifully written! I loved the contrast between aiding a patient between transition in their lives as a doula in birth, and then in palliative care. It takes a very mature individual to work in palliative care without it rattling them. You either have to be calloused, good at not bringing work home, or know yourself... VERY well. I admire those in the latter category, which... I think most are. It is hard. As a nursing student working as a PCT, I got asked to sit on various floors occasionally at nights. I remember one patient who was dying who I really wished I could have done more for... He kept saying "it hurts, it hurts, help... please help". I asked about his pain control and was told that his respiratory condition was such that they were worried that he would quit breathing. He was in and out of coherency, but I think, looking back, that THAT was the time for someone to talk with him about a living will and palliative care, he had refused it prior. I'm sure that was in the works and I just didn't know about it. Sitting with him though I remember the helplessness that I felt. All I could really provide was human presence and sympathy. But the pain and despair in his voice was just so sad. Many nurses that I know, especially older ones have living wills and DNR's. I haven't drafted one yet, but it is on my to do list. Seeing what we DON'T want in death is fairly common in our profession I think. Meanwhile, we must respect our patient's wishes on death.