jeepluv818

I have a patient that has s/sx of pseudomonas infection to the venous ulcers on his lower extremities. Patient has lymphedema. He is very non-compliant, does not elevate his legs, does not follow dietary restriction, is non-compliant with his wound care and takes his dressings off often. Previous orders were for maxorb AG to the open areas cover with ABD pad, unna Boots, cast pad, Coban. They were doing the wound care twice a week. He has been saturating the dressing in less than 24 hours. He is starting to have macerstion to his surrounding skin including the base of his feet from the MASSIVE amount of drainage. He does not tolerate the dressing well. This was the first time I have seen this patient and immediately recognized the pseudomonas. The doctor has not ordered wound cultures but I'm going to call and ask for them. With the wounds being on his legs and in the home health setting, I thought I would get some pointers on suggestions for the wound care. Most Physicians, expecially VA Physicians, want wound care suggestions. The research Im seeing shows that acetic acid has used a lot for cleansing the wounds but I also saw that it is cytotoxic and delays healing. It also showed that patients need to be soaked for like 15 minutes twice a day and that's not optional in the home setting. Ive used dakins on a patient in the past but again was in the hospital setting twice a day. Primary goal is to keep patient at home but I'm wondering if he wouldn't be more appropriate in LTAC. Any pointers appreciated. Thanks

Does anyone know anything about Kindred? A new office opened locally

We have 6 LPNs, I'm only doing oasis assessment s and sup visits only. They had to down grade the patients but the lpns starve so they increase again. I'm paid per visit. That helps with some of the conditions because it's larger checks. However, I'm working ave 120 hours biweekly so it doesn't quite balance. I keep my head up as much as I can but have moments where I just need to vent for a minute. Thank you for your comment

I've been working in HH for 5 years now. I worked the baylor position for the 1st year. I've worked M-F for 3.5 years. Now I work Tue-Sat to try to alleviate the weekends for the new people. The turnover in my office is horrible. We are supposed to have 6 RNs and only have 2. We rotate call. It was me and another RN that had been there for many years for about 6months being promised new hires were coming as we are dragging by our fingernails to finish the day. The other RN put in her notice and that left me alone. My office has about 350 patients. 350 patients... let that sink in. She stayed long enough for them to hire two new RNs that had absolutely no home health experience. I had to train BOTH of them at the same time. They were damn near thrown to the wolves. Fast forward 4 months. One has already been fired for fraud..(awesome). The other threatens to quit everytime she goes on call. I'm about to be the only RN again. Now, again, they are promising help is coming, we(managment RNs) will help you in the field, we'll slow down the admits..blah blah. Nothing. We have a morning meeting every Wednesday that lasts till 10am. They have me scheduled to see 1admit, 2rocs, 1sn eval, 4regular visits with sups. Its like this every.single.day. 10-12 hour work days in the field. 2-6more hours of charting every single night. I've told them I cant keep doing this. More promises that never happen. No help. I average 6-9 patients a day most of the oasis assessments. Our oncall weeks are 7 days and you have at least 3 admits and 1 roc every weekend day. You work 12 days in a row when you are on call. They have had 6 clinical managers and 4 DOOs since I started 5 years ago. 3 Regional directors. 2 CEOs. i absolutly love home health. This is my area of nursing I was made for. However, I have three kids 4, 2 (autistic), and 1. There are many times I don't see my kids awake for DAYS! Thank God my husband is a SAHD and a great husband too. I'm totally exhausted and in tears as I write this. I just don't know what to do anymore. I'm the sole provider for my family and I make 70-75k a year with this company. All the other companies around here only pay 50-55k. I can't take the pay cut but this company is killing me. If I say NO to visits then there isn't anyone else to do them. I just really need some encouragement and a