iamoph

Thank you all for your comments. I have discovered that it IS corporate just making things up as they go. During a meeting one of the higher ups actually said to disregard what the state surveyer said (we had a surveyer in to clarify) and continue doing things like we've doing them. I want my residents safe but this is overkill and its actually hindering the care they receive. It may be time for a new job.

I've searched all over and can't quite seem to find what I'm looking for.... I need something from a reputable source that talks about the timeline (particularly healing time) of a bruise. I've go higher ups with no medical degree, just "experience", that think no bruise lingers past 7 days. Please help

We've got everything under the sun careplanned! For the people that ambulate on their own we have restoritve and therapy working with them on gait and balance. For those in wheelchairs we have restoritve and therapy working with them on w/c mobility. We even have postures careplanned! (Mr. Smith sits with his hands under the table and has been observed bumping the edge of the table when when raising hands above table to eat: staff to encourage resident not to rest hands in lap while at dining room table) It feels like the higher ups are making new rules whenever the mood strikes them. We were just told that careplans require a doctors order.... I've never heard that ever before..so, do they require a Dr order and I just missed that somehow? We've done transfer check offs, and in services, and I've told staff to come get ME if they need assistance with a resident and can't find help.

Hi all! Ill give you a bit of a back story then the questions. you can jump right to the questions if youd like. BACK STORY: We have a census that averages about 70. Of those 70 people 3/4 are incontinent or have periods of incontinence. We have very few who are independent with ADLs and transfers. more than half of the residents require full assist to get in and out of bed....which is: up for breakfast, in bed after, up for lunch, in bed after, up for supper, in bed after. Then, they are also gotten up for activities in between meals but have to be laid down to be cleaned up. Thats a lot of handling!!!!!!!! Last DON got so sick of bruises that he started making up causes for them instead of actually investigating their cause. For instance, if a resident was on coumadin, he wouldnt even go assess the bruise. Instead, he'd say, "they're on coumadin they're going to bruise" That would be the end of it. The admin and D-op figured out what was happening and now the entire facility is freaked out over every single little bruise...to the point where even residents that get insulin injections are having multiple assessments and investigations done and they're being monitored for 72h after each bruise is found. There is no "official" written policy on how to handle bruises, just "events". We dont even remember how we used to do it before the DON screwed us all. It may sound stupid, but I swear the staff has a touch of PTSD over this issue. People will actually start sobbing if they realize they forgot to mention or chart a bruise that was found....even if its easily explainable! I have found that this is causing more harm then good. the nurses time is now spent filling out paperwork and making notifications for even the tiniest of bruises. something has got to give. HOW WE DO IT NOW: bruise is found on mr. smith on lower abd. the nurse fills out report and calls the DON - even if its 3am - A fax is sent to the doctor and the family will notified of the finding of a bruise. Mr. Smith is added to the 72h assessment sheet where his vitals will be taken qshift for the next 3 days. The DON then has to "investigate" and sees that Mr. Smith gets insulin - usually in the abdomen - The DON then makes a nurse note that states this information and then writes a one page summary of findings to keep in the residents file. OR Mr. Smith had a fall on 10/12 that was unwitnessed. he was found on his L side and was placed on 72h neuro checks. on 10/16 there is a bruise noted to his L elbow. The paperwork is filled out and notifications made and hes back on 72hour monitoring from this bruise that was likely from the fall that he was already monitored for. OR Mr. smith takes coumadin and sits with hands in his lap at the dining table until his food comes. Hes constantly bumping things and then bruising because of his thin skin and coumadin use. Basically hes on neverending monitoring because we arent allowed to bubblewrap him. QUESTIONS: 1) how do you handle bruises in your LTC facility? 2) If the bruise is found on an insulin dependent resident in an area that they get injections how is that handled? 3) Do the nurses investigate anything at all or just report it and let the DON do everything?? 4) How many bruises does your facility typically have? 5) is there ever an instance where you would just put a nurse note in about the bruise and call it done? 6) Our D-op says we have too many bruises by any standard (she gets notified of all of them) how do we keep elderly people that are lifted and moved and dressed, etc. and have tissue paper thin skin from bruising without just throwing everyone in a padded room and never touching them??

Sorry so late in responding...I am now a 4th semester nursing student!!

Hi all! we have a project on delegation for school and I am a bit confused and already stressing out and Im not even in charge of real people! I think its an interesting project and Im not looking for answers to it just some guidance on how things work. Here is the scenario: I am the charge nurse. I have no patients assigned to me. I have 4 RNs and 1 LPN. I have 26 patients on my floor. One of the patients codes and the RRT, which consists of 1 ICU RN, 1 ED RN, a pharmacist, a physician, and a resp. therapist, is called. The primary nurse is gone for 1.5 hours during the code along with 2 other RNs off my floor. That leaves 25 patients and 1 RN and 1 LPN to take care of them. What I'm wanting to know is if float nurses could be called to my floor to help with the patients? I'm also wondering why 3/4 of my nurses need to be in the room and if i can pull the two who arent the pts primary nurse out of there. Obviously I would take on patients during this time even though im not *assigned* any but if split as equally as possible that would still leave me with 8 pts, the LPN with 8, and the other RN with 9. However, I do realize that I cant just split things down the middle. I have to utilize the 5 rights of delegation. I am still a student and havent seen that many codes but the ones i have seen it was only the primary nurse and the RRT in the room...as well as us students. The other floor nurses didnt come in. Thank you for any help you can offer.

♪♫ in my ♥, we had our last medsurg test on monday, or last maternal test on friday and then our medsurg final is on monday and our maternal final on Wed. I have actually been doing what Episteme suggested and going through my syllabus and sticking to those topics where as before I was just trying to read anything and everything I could about medsurg and I actually do feel a bit better about monday! Thank you guys for your advice!

We are her first class ever. Her first day of orientation was the day before we started class this semester. She has written one other exam which we all did pretty poorly on because she absolutely refuses to lecture stating that its "boring". Anyway, she likes to add things to the syllabus so im not real sure what else will be added. On a positive side note: we got an email tonight with 13 drugs on it and those are supposed to be the only drugs on the final so Im pretty excited about that! My first and second semester I had a test average of 90 before taking the finals and now I only have an 83 so Im not processing that very well! lol. The layout for lesson one looks like this: Metabolism All physical and chemical changes that take place to sustain life and conditions that contribute to imbalances. Acid/Base Regulation of acidity and alkalinity in body fluids and conditions that contribute to imbalances. Learning Competencies: 1. Incorporate evidence based practice to develop a holistic plan of care for medical surgical patients with problems of metabolism. a. Diabetes: Type 1 and 2 (DKA, HHNS) b. Liver Diseases (Hepatitis, Cirrhosis) c. Osteoporosis d. Thyroid Diseases e. Adrenal Diseases (Cushing's, Addison's) 2. Incorporate evidence based practice to develop a holistic plan of care for the medical surgical patients with acid-base imbalances. a. Respiratory acidosis/alkalosis b. Metabolic acidosis/alkalosis 3. Evaluate the use of pharmacological interventions for persons experiencing metabolic and acid-base imbalances. 4. Discuss the nutritional needs of patients with metabolic disorders. I will def take your advice and go through and hit the outlined topics hard. its 3am and ive been hard at it since 10am and will continue tomorrow! thank you.

Hi all! This is my first post and I'm pretty desperate. I am a 3rd semester nursing student and my medsurg final is on monday (its saturday now) and I am freaking out because I have no clue what to study. A little background: Our instructor quit in the middle of second semester and thats never happened at my school so we got tossed around quite a bit. There were about four other instructors that quit at the end of our second semester so For third semester we got a brand new instructor...meaning she has NEVER taught before. She was a nurse in a wound clinic for 5 years before deciding to teach and is very honest about not knowing much of anything about maternal or medsurg. The problem is: she doesn't "lecture". She assigns group projects where each group draws and colors ONE topic from our lesson. Therefore, I have no notes to go back on..just pictures of the color pages we did. We were told to send her 4 questions each on every lesson. That gave a total of 148 nclex questions. We had a "final review" and what it consisted of was the 148 nclex questions and we were told that TEN of them would be on the test...so basically, "memorize them all and hopefully you will remember the ten I add to the test". Nothing else was gone over. As most of you know, medsurg covers a LOT of topics. I am freaking out and at a loss as to what to study. The final consists of 100 questions and with my current grade I can miss 35 and still pass the class. That may seem like a cake walk but when there are 30000 different topics that COULD be on the test where do I start? I made nclex cards during every lesson and Ive been studying those but there are about 2000 total! I have about 20 different tabs open right now with different nclex questions on them and its all just so overwhelming because there is no way i can get through all that in time! Any advice is greatly appreciated on how or what to really study for. I know I have to brush up on ABGs and Rhythm strips (which i dont get AT ALL) but other than that Im lost.