Rach823RN

Although I cant speak for how the orders were handled in your case, Tamiflu for everyone is actually quite common. We treated all 350 of our facility's residents with it prophylactically when we only had a few confirmed cases. No they don't swab everyone, but yes "URI-like symptoms" are considered "flu-like symptoms" in LTC when it comes to the CDC... Check with your facility's policy (there should be a standing flu outbreak/tamiflu policy), and ask your facility's infectious control/nurse educator questions to educate yourself. They'll appreciate your initiative to learn, after all that's what nursing is all about!

Also, just remembered... Tube clogging could be due to decreased peristalsis. But really there are many variables about the specific resident... Check that bowel movements are frequent enough. If the resident is end-stage, like mine, we do rectal tubes and tap water enemas to clear him out constantly. Avoids frequent aspiration pn as well!

I have a resident who constantly pulls his out. The RN does replace it, then we must send him to the ER (literally across the street) for a gastrograph aka X-ray to check for placement BEFORE feelings resume. But please CYA and double check your policy! And, FYI keep a spare in the fridge, they go in easier when they're cold and firmer! HTH!

First and foremost I'd like to say, I really do love my residents! But I often wonder, what is considered professional and what is not, where do we draw the line? I give hugs often when one of them is feeling down, a pat on the shoulder/back/arm (can you imagine the kids you raised just dropping you off one day and only visiting for 15 min once a week-month?!). I try to say goodnight to everyone when they get "tucked in"/with HS meds (3-11 shift), and honestly sometimes even finding myself saying things like "if we didn't love you we wouldn't need to do this" (safety issues, IVs, medications etc.). Hoping I'm not alone here, but def curious where you all consider that magic line is drawn. And I don't mean a DOH/state survey line, I mean a warm comfortable home-like atmosphere while still being a professional nurse - line?

Thanks for the responses... I'm not quite sure of the cause of his pain, he reports it's in his back, but I haven't discovered anything more than osteoarthritis in his history/md assessment (if he did have something like ca, i wouldnt feel this way). He also gets Bengay/Voltaren gel. I think some of it has to do with his positioning in bed, which he refuses to change (always holds the right side rail facing the hallway, won't let go. If I turn him or block the rail he screams till I put it back). He is in his late 70s, not possible to DC, has been to a few other facilities. Was separated from his wife because of their vodka binges (40 bottles were removed from his house, where he thought "little men that weren't quite human were taking care of them!!!). He def has an addiction, but some of my colleagues don't see the need to change that at his age, we're not that kind of rehab facility! He even admits that his behaviors "work" to get him what he wants (screaming and throwing himself on the floor). And that's where I tend to lose my patience! And I see visions of The Boy Who Cried Wolf story being played in my head...I will try to suggest a fentanyl patch, I do think he needs something long term. But I know I will meet resistance because the MDs don't like "sloshing" the residents. More then anything though, he needs some vitamin H or Ativan!!! Because along with throwing himself on the floor like a toddler, he threatens to kill himself when he doesn't get what he wants (another thing documented in his history upon admission). All of our nursing staff knows how he is and what he's capable of, but the MDs aren't on the unit long enough to see him in action... it seems to be all about the documentation

Hello, Long-time reader/first-time poster here... I am a new grad (May '11) RN, but have been a CNA at my job for 3+years prior. I work in a Veteran's LTC SNF. I am the 3-11 FT charge nurse for my unit, so luckily I don't float and have a great relationship with my 30 residents & families. Many know me from my CNA days before graduating, which really helps. And yes, I chose to stay with the population I love over transferring to our big university medical center! But, I have one resident I seriously don't know what to do with! He is perceived as the "celebrity" on our unit, very needy, and the ETOH dementia has gotten the best of him. Constantly screaming for help (forgets the call bell), and is disruptive to his peers (I have to break up fights when another resident is offended by the verbal abuse he spews out!). Then, when we walk in the room he usually doesnt know what he wants, and then continues to call out again a minute after we leave. Trust me, I have plenty of experience with dementia/Alzheimer's, but he's different. He does have some expressive aphasia, but I can usually determine what he's asking. Most of the time I know he's just bored/lonely, and that I really do empathize with. Hx of very recent substance abuse is known, which leads me to the drug seeking... He is constantly begging for "pills," namely "percocets and sleeping pills". He knows the magic words... I always try non-pharmaceutical interventions first, but he is very noncompliant. And when he doesn't get what he wants, he literally throws himself on the floor! He currently gets oxy5mg BID, but has Tylenol and more oxy5s available as PRNs (in addition to his many antipsychotics/mood stabilizers). Problem is, after he does get his pain meds, he forgets, and continues to scream for help. I go home hearing him for hours after my shift ends! Clearly, what's going on right now isn't working. And while I don't want to see anyone agitated, it urks me to think he's hanging out waiting for his next fix. I know pain is what the patient says it is, but what would you do in this situation? If it were as easy as just giving him what he wants, I would. But I question this when he doesn't even remember when he has just taken the pills. Sometimes I leave him notes to read that explain when he got his last, and when the next is - but no, he continues to call out. Clearly he has a high tolerance, but does that really mean we should just give him more?! Any advice would be appreciated! Even if I don't agree with the treatment, I can't have the constant disruption to the unit anymore!