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hospice, home care, LTC
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nhelkhound specializes in hospice, home care, LTC.

married mother of 2 beautiful daughters

nhelkhound's Latest Activity

  1. nhelkhound

    So disgusted

    Holy crap!!
  2. nhelkhound

    The hardest thing

    God bless you for your loving heart.
  3. nhelkhound

    Can a physician deny an order to transport from LTC?

    I once had a physician refuse to give me an order to transfer his Pt to ER after the Pt had fallen on the floor in the bathroom, had a large hematoma on his head, was complaining of acute abdominal pain, and had diarrhea for 48hours. The Dr yelled at me on the phone. I sent the Pt out anyway. The ER reported he was dehydrated with electrolyte imbalances (duh). The Dr called me later and apologized. I'm sure he was pleased I had "disobeyed" his order.
  4. nhelkhound

    So who do nurses marry or have as civil partners???

    The man I adore and I met in church when I was 14. He's an IT guy
  5. nhelkhound

    The right to refuse has so many interpretations

    I had a hospice patient living in an ALF. Pt was bedbound, on scheduled morphine. Facility policy was repostion Q2 hr, Pt consistently refused in spite of education. I directed LNAs to stop repositioning attempts (some had been repositioning against Pt's wishes). Administrative Director insisted nursing MUST reposition because it is policy. I had quite the discussion with her. She just wouldn't budge. I refused to assault the Pt.
  6. nhelkhound

    Cry for help: I don't think I can do this.

    It will get better. During nursing school I was on the Dean's list every semester, and most of my clinical instructors disliked me. I dreaded clinicals. Mean nasty instructors. Never worked in medsurg. Been an RN for 6 years and love it. You will find your niche..keep calm and carry on!
  7. nhelkhound

    new grad/ltc

  8. nhelkhound

    Diabetic wound care to heel and toe

    Why are you expecting to have improvement? I would be thrilled that the wound(s) are not deteriorating. Dress for comfort, i.e. as few painful dressing changes as necessary to keep dressings clean, dry and without foul odor.
  9. nhelkhound

    Question about breathing at end of life

    I have never seen apnea only during sleep at the end of life, but I'm always surprised by the things I haven't seen (yet)! I would try repositioning this Pt when she exhibits apnea during sleep; if this stimulates breathing she may have had a blockage (like her tongue).
  10. nhelkhound

    drug diversion

    I had a case where the Pt's daughter told me that someone had broken into their apartment and stolen her morphine. Even showed me where the thief had entered; only problem was that the screen was pushed out from the inside!
  11. nhelkhound

    Non Hospice RN

    I'm sorry that your father is so ill. My opinion is that if you can you should go to your father as soon as possible and spend as much time as you can with him now. Don't wait until he is so close to death that he may not be able to communicate with you. It is not possible to say how your father's dying will occur, I explain to my patients and their families that death is like birth; a child is born in his/her own time and in his/her own way, and death is much the same. I personally feel that spending time during the "living" is better that spending time during the dying.
  12. nhelkhound

    Evening Med Pass Question

    This was the same at every LTC facility that I have worked at, a heavy pass between 4and 5P and another heavy pass between 7 and 9P. I was also exhausted. I had between 25 and 40 patients. Just shoot me. And of course everyone wanted their pills at exactly the same time, NOW!
  13. nhelkhound

    Rusty skills/burned some bridges. what to do?

    Sorry to hear of your misfortunes. I recommend that you stay away from nursing. Are you able to collect disability? You really need to secure health benefits (possible thru disability) and get your health on track before you're able to safely re-enter nursing. Good luck.
  14. nhelkhound

    Discharge a patient because they go to er?

    As far as I know, this would not be grounds to discharge. A patient has the right to seek medical care. In this instance the patient will be held financially responsible for charges incurred d/t the ER visits IF he did not inform hospice of the visit prior to or during its occurrance. To address the Roxanol issue, you could prefill syringes so he could self administer in the future.
  15. nhelkhound

    Whose patient is this???? assistance please

    What a mess. I hate this type of situation. Clearly the scope of services was not clearly discussed and/or understood by the Patient/family. I like the idea of tossing the ball to the PCP.
  16. nhelkhound

    Aspiration risk, Hospice and SNR

    Let's keep in mind the goals and desires of the Patient, who is saying she's hungry and wants to eat. The aspiration risk should be explained to her and her family and they should be the ones to decide if the aspiration risk should or can be diminished and to what extent. Some risk has already been diminished by the consistency of her diet. Even if the Patient was willing to have a PEG, even that would not totally negate all aspiration risks, as eventually she will even aspirate her own oral secretions. Most victims of Huntington's die of pneumonia.