bebop1

ok....I work in LTC On a friday I told the staff to get the patient to the hospital, or call the doctor due to his "black toes" were no longer hard and black. they were "wet and black" we know what that means. they said ok...we will do that. I left thinking they were on the phone due to they were talking to someone about the patient. I was gone the next week because I am currently in the clinical portion of obtaining my WOCN so I was gone all week. I came back on tuesday...the patient is still there...now you see bone...the patient is so confused he is walking into patients rooms and actually crawling into their beds! So the staff said the bone was not noticed until that day i came back. but the black was "wet, spongy...not hard anymore I told them. they had "faxed" the doctor. He ordered labs. well I sent him out to ED yesterday...they will now have to perform a BKA. this poor guy is 90 already! but they I believe should of done something way before...? I am not sure...like I said I am still in the process of learning. what do you do usually for necrotic dry toes? he had arterial disease. and then once you see they are "wet".....what do you do? I am very glad this LTC has hired me due to a lot has changed already due to what I have learned! its great and I love seeing the results. but what should i have done? and what should I do in the future. I called and talked to the doctor, and he states we did things correctly...even though I think we should of sent him a week before. ?????

I have just asked for a pre-albumin, so i will see.....it is drainig a mod-large amount. it is a wound that dehisced from a gastric bypass. so yes we are packing the wound with the "wet 4x4's" from the smith and nephew NPWT system. she has so much pain that does not make sense with her actions, ie...playing Wii in the rehab gym, walking down the street with family to the local mexican resturant...and such. yet no infection, just had a ct no evidence of abcess or anything seen. anyideas?

I have a Young 28 y/o female living in a LTC due to an open abd wound. it tunnels over 15 cm from 8-11 oclock.....this wound l and w is getting smaller but not the tunnel. the "weekend" manager ordered the smith and nephew for her over two or three months ago. this tunnel or what ever you want to call it...has NOT gotten better. this manager used to be the DON, so its like they do not want to listen to anyone. and it really makes me mad. I finally got the doctor to order TLC and pre-albumin....the levels where horrible. so we are starting with supplements and increase in protein. no infection. she is obese. what would you do? My facility wants to use the smith and nephew because it is cheaper. I have "fought" for KCI at times. I think smith and nephew works for some wounds...but not all...like for KCI works for some but not others....I am in school at the moment becoming a WOC, and they are finally listening to me, but there has been two times I order a KCI on like wednesday, and when i get back on monday this weekend nurse has changed it out to smith and nephew!!!!!!!!!!!!!!! suggestions for this patients wound? should I try another dressing? would KCI work?...the other measurements are 8X5.8X1.2 granulation...but as I see with the S&N...It looks "slick"...not the bumpy like with the kci.......what should I do? or suggest?

I have a patient that has a huge stage IV on her sacral area. She is hospice, and we are using w/d on her, due to the doctor states, we do not intend it to heal, so keep the wound care products at a minimal. Which I understand, but....ya know! the patient does not eat, only drinks small amounts of water. we have to give her a lot of meds before the procedure. she also has wound to her heal, that pretty much is down to bone...that again is w/d. what you ya all suggest is a..."more humane" treatment. This patient is very close to the end of her life, but we need to keep her comfortable. and this wound is getting so deep that soon it will prob open up into the rectum! The sacral wound does not seem to 'hurt" her as much as her heel wound. What would you suggest that would not be as painful as w/d....but also cost effecient? since the doctor really doesn't want anything else? He wound has granulation tissue...and bone present...no slough.....and High exudate. what is a better alternative?????/ thanks! I want to go to this doctor with some information to help with dressing changes to be less painful!

Well the economy is "changing" home health in ways like, patients are more and more being taken care of by family members, and not by nurses. Or a lot of the insurances do not approve home health, or even LTC for patients to help. The home health company it self cuts back on nurses, goes more with the benifited people, than what I was the per diem because i was paid a lot more. I was paid per visit. I made a lot of money, because I could see a lot more people a week, and get paid for each visit, than get paid by the hour. Even where I am now LTC is hurting. insurance is cutting back and not even letting residents stay who need to be there. The paperwork. let me say, the OASIS is about 14 pages long. yes..... it is hard...at first. I do say my first month or two I would spend 1.5 to 2 hours on an "packet" as we would call them. but then you get them, you know the questions, you know how to ask them, you know where to mark them. You do oasis for mainly medicare, some insurance. a different smaller one for medicaide and other insurances..... you do these packets on Admit, recertifications (every 60 days) and anytime the patient is admitted to hospital and then you resume care again in home. At first admits would sometimes take me 2 hours. but you then get into a routine. you get into a conversation, you get into a "groove" if you will to get just about all your questions answered that are in your 14 pages of questions within 10 mins of your visit. maybe the longest part of your admit will be writing down all their medications they are on. Of course admits are the longest visits...a lot of questions. But if you cannot tell I am very passionate about home healt. I love it...I am not in it any longer, and I miss it. I am very happy where I am, but My "True love" is home health. It just doen't work out for me at this time. please let me know if you have any other questions!!!!

I was told by a nurse to let the MD know when a patients wound was ready for a muscle flap. the patient has bilateral isch tub wounds on a wound vac. they are doing well, and progressing wonderfully. How, or what criteria am I supposed to look at to let the md know that this patient is ready for muscle flap surgery on these wounds? I really do not know how that surgery will work for this patient, but what do I look for ...or what other information do you need from me to help me determine this for the md? I work in a LTC facility and the MD does not want to see him until ready for muscle flap surgery? what do I do? thanks!!!

Home health is wonderful. But you have to be ready for a lot of paperwork...if you are a RN. OASIS!!!! a lot of paperwork. But you get to become a "part of the family" a lot. you get to know your patients. You can walk into a patients home, say hello and know right away if something is wrong. I have worked in home health for 4.5 years. and loved every min of it. And then maybe you have only 5 visits that day, I could go to the store between visits, go to lunch..etc...it was wonderful. But yes....as mentioned before look into what they are saying..I was perdiem at my new home health. I was at one time 30-40 visits a week...and then all the suddent they told me they could not give me up 7 visits a week. This was for a Huge nation wide company that I no longer work for. I did not like this company. I used to work in Louisiana for a wonderful company and that was the best. I will never regret working home health, and know I will go back once this "economy" changes. Really the only place it has hurt has been home health so far. ....anyways...Home health is GREAT!!!!! enjoy! I am jealous! I work in LTC, and doing Wound care also, I am happy but my heart still lies in home health!

Hi....I work in a LTC unit, and have a pt with a pacemaker. she has afib, and she is "going all over the place". at one moment her heart rate will be 40, but most of the time her heart rate is in the 110-130's. the md states the pacer will not kick in unless the heart rate is less than 50. I thought ( please tell me if I am wrong) there are pacers that will "make the heart increase and decrease" if you will. I asked the doctor and he said no. but he wants a pacemaker check anyways by phone. can anyone help a little LTC nurse here? or what do I need to look at or assess? please help me..... Pt does c/o of sob when the hr gets high, but after rest it goes down???what do I need to look at? I have contacted her cardio md and have gotten an appt for her over the "house doctors" head. because I think something is going on. I told the house md...he said..."whatever" any suggestions?

I was just writing to tell ya all...I am a military wife. My husband has been "in the sandbox" as they say. He is very aware of this, and he knew how to pronounce this...I had no clue! he said ya...we all just about get this and get bit by the sand flies. so this is an everyday occurance for our young men and women in the service! there is also a horrible "flesh eating" something or another that many of the service people are coming back with, and there is really no antibiotic that touches it and it just needs to be cut out...does anyone know what this is? I want to say it starts with "A"......I know that is not a help.... But the conditions our military service people are subjected to are horrible!!! and they do it day to day anywho.....

oopps...I see I did my title wrong too....sorry!!!!!!! Please I need help and feed back. I work in a LTC facility, and I am currently going through webwoc program to attain my WOC nurse. I am totally torn on the KCI and the new smith and nephew? is it...used to be the blue sky. I am getting very angry at the facility. there is a nurse there that used to work for smith and nephew that it seems each time i turn my back he switches the kci to the s&n. and I do not like it. I have not had good out comes yet with the s&n one. I have had it heal one, and it was on the Abd. he is using it on everything, and I do not like it. it is macerating the wounds, on some patients they are changing it daily. and no one will listen to me....because they had a bad experience with the rep from KCI. that is not fair. I had one wound almost healed...and he went and changed it from kci to s&n...and it is worse.??? Hello? does that not say anything? I need proof...I need back up..........help! I am all for healing...if the s&n healed...the wounds I would not have a problem...and when I look on here everyone says the same thing. and then too they say the s&n does good on anterior wounds but nothing else. so Please can someone give me feed back? can someone give me proof? or can someone give me some words of advice that I can go to my DON and talk to her. I am the unit manager, and member of the wound team. I believe this nurse maybe getting a "cut" if he brings in these wound vacs? is that a possibility too? I do not know. this is making me angry. I want wounds to heal. all these wounds he changes are healing. aaahhhhh......"don't mess with my healing wounds" :wink2:

I wanted to leave the home health company I was with because, I pretty much did not like the "politics" in the office. It was horrible. It was like high school, and everyone trying to be the best, most popular and not listening to the field staff. I had a wonderful home health experince for 4 years in Louisiana and I loved it. This "big company" home health was nothing I stood for, and they did things that I did not agree with. And they changed their mind when I came back from medical leave, I was per diem, and I went from seeing 30-40 patients a week!!!! talk about over load...to them telling me I may have only 3-7 visits a week now. so...whatever...I didn't cry at all leaving that job. And I am very happy to far at the LTC, its great! and I don't mind the work. the only thing I miss is being out on my own, and getting to 'shop, go to the doctor, leave when patients done.....cause now I am here at work from 8 -4:30...so thats different. anyway! good luck!

I thought somewhere I have either place adaptic or was told to do that if bone. thanks! I will try and contact KCI and ask them!! thanks...anyone have any info on xcell? the wound product thanks!!!

Hi. I am a student in the webwoc program. I am very excited, and love it. I have a few questions that I have not had answered, maybe they are wanting me to wait until clinicals for this...but I want to know NOW!!! LOL... wound vacs. who likes KCI, and who likes the blue sky? I like KCI, but my facility wants to change to blue sky because the DON does not like the rep. I told her that is not fair to not choose a product because you do not like the rep. but a question is patient had a woundvac, but found out has osteo in the bone. so it was removed before he came to us, (ltc) now we are treating him with antibiotics. I know you cannot place a wound vac on untreated osteo, but he is being treated. can we ever put the wound vac back on? his wound does show his bone also. another question. The LTC wants me to use some xcell....they ordered it. I have never worked with it...has anyone ever worked with this product? I am the "head" of the wound team, taking over from some LPN's who have done great, but looking to me for more information. thanks!!!!!

Thank you thank you thank you. I was like....how in the world did my 4.5 years working in home health did the rest of the world go crazy! lol...... the same I found out with the blood sugars! I was down a nurse yesterday so I did the med cart. and I went to check blood sugars. and maybe this is wrong too...I clean their dirty little hands with alcohol...wiped it with a 2x2 and allowed it to dry. then I poked their finger to check it? is that wrong? or to give them all the shots? its crazy. I will going into the direct tomorrow. because know I feel better that ya all are out there telling me I am not crazy. thank you!!!!!

make sure you dust off any excess powder, the eakins seals are wonderful, or especially with the ileostomy I love using the moldable wafers. its from convatec, its great. it doesn't need any kind of past or anything the wafer itself is like the paste, you roll back the middle of the wafer, place it over the stoma, and when the moisture, or the liquid hits the wafer, it will swell and then turtle neck up a bit towards the stoma. and create a wonderful seal. the bag has to be vertical. this patient is in ltc right? is the patient going to go home? is the patient in rehab? the goal? the goal needs to be to empty the bag in the bathroom, if the patient wants a normal life again, and if the patient wants to "go out" and needs to empty the bag, where is she going to lay down to empty it? I would focus the patient on her long term goals to let her see that the bag needs to be up and down, maybe change the kind of bag, make sure the excess powder is off, see what kind of diet she is on that can change the output she has and then her bag can not last long. you can place the wafter under her to make it warm, so when you finally apply it, it may stick better! these are all little things ya can try...hope something works. but my last ileostomy patient that was changing hers 2-4 times a day switched to the moldable wafer now has hers on for usually a week at a time!!!!