sis14rn

One way I have used in the past is to get others involved. If there is an activity going on, encourage fluids then. If residents are in therapy, make sure therapists offer fluids.

I had a patient that was getting a 12-lead EKG, I left the room while the tech did the test, came back in while he was unhooking the patient. i was looking at the strips when i noticed that all I was reading was pacer spikes. I then looked up at the patient and noted that he was gone (he was DNR), I asked the tech if he noticed that the patient was dead. I will never forget the deer in the headlights look I got!:uhoh21: :uhoh21: :uhoh21:

I was working on an acute rehab unit with SCI patients. Most patients were on a "bowel program" which involved giving a routine dulcolax supp. My patient wanted his while he was sitting up on the shower chair. so, here I am, crawling on the floor to get the best view I could. that didn't work so well so I thought I'll just feel my way, the patient's a man, should be easy right? wrong. I begin trying to insert the supp, thinking I'm putting it where it needs to go, wrong again. he says "honey, I hate to tell you, but that isn't it". Somehow, well, suffice it to say I lost the supp, it melted all over the place.

In a LTC facility I worked in, I received an order for a Resident to have an EKG done. The tech came and began doing the EKG, I left the room. I came back a little later and the tech gave me reading. I'm looking at this reading, the tech is removing the leads. I used to work in telemetry. Looking at the reading, I notice pacer spikes then I can see where all there is are pacer spikes. :uhoh21: I look up and see that the Resident has expired. I asked the tech if he noticed that the Resident had expired. The vague realization is observed on his face. The Resident was DNR.

I'm ready to pull my hair out! I'm the nurse manager in a 108 bed SNF. In July, we had noticed nurses giving liquid nutritional supplements to Residents that should be on thickened liquids. Boy did this open a can of worms! We are now starting an Advanced mechanical soft diet. We had regular consistency, mech soft and pureed. Now, we have added the advanced mech soft. this is based on the National Dysphagia Diets. The diet we previously called mech soft was more of an Advanced MS. Our dietician is saying that because of this, the residents with orders for MS should just be changed to the Advanced because they've pretty much been getting that consistency anyway. Our speech therapist says no, because the order says mech soft and now we have mech soft, the resident should get the mech soft, not the consistency they were getting previously. this has started the discussions of quality of life. I can see both sides of the issue-quality of life vs. risk of complications/litigation/state deficiency for not following the ST recommendations. Whew! Help! Have any of you adapted the Dysphagia Advanced diet? How do you make the decision of which way to go?

Sometimes, depending on the subject matter, I play games. I have done infection control jeopardy. Getting the inservice to be more interactive helps I think.

Are your tube feeders dumping? I think you need to get your dietitian involved, maybe it's the feeding. How are the nurses giving meds via the tube? Is it drug interaction? Are you keeping the HOB up? Putting them on ABX could be increasing your vomiting and diarrhea. Hope this helps :) :)

I'm currently reviewing some of our policies. Some basic nursing skills are being reviewed and I am finding discrepancies between nurses. for example. Our current policy on IM administration does not say anything about limiting the amount of med injected i.e. 3ml limit. In nursing school, I was taught that you can only give 3ml per injection. So, if giving Rocephin and it is reconstituted to 5ml, we had to give it in 2 shots. I graduated in 1987 and some of the nurses that graduated near me agree with this but the more recent grads said they never heard that. Any opinions? Also, does anyone know where I could locate "Standards of Practice". I perform risk management for the facility also and need some guidance for Standards of Practice. I was informed that if a Resident falls, you need to assess the Resident, including vital signs every shift for 3 days. What do others do? Thanks in advance

I am the nurse manager for a SNF. Your Medicare charting can be dependent on your FI and their guidelines. Essentially your Medicare A & B charting must reflect what dx you are skilling the Resident under. If they are in for a fx hip, you need to document ADLs, transfers, Wt bearing status, pain, ambulation. Think system specific. If your documentation does not support the skilled service, your payment can be denied.