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woundnurse4u

woundnurse4u

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  1. woundnurse4u

    Would you report possible diversion?

    It happened to me. In one instance, it was a nursing supervisor who would offer to give pain meds when rounding. We were so understaffed and of course we would accept the offer because we trusted her and we wanted to make sure our patients didn't have to wait even longer for pain meds. In the other instance, we would be asked by a coworker to punch in our code for a waste but she wasn't wasting. Again, understaffed and everyone trusted each other. We genuinely loved that nurse and when she voluntarily went into treatment after getting caught, we prayed for her recovery. Of course when she returned to work, we all had to take turns passing out her pain meds for her. As a part of her arrangement she could no longer pass narcotics. What did I learn from these cases? Mostly that addicted nurses can slip under the radar and more so when the staffing is stretched to the max. In both cases, nobody knew what was going on until it was too late. None of us were reprimanded or punished for not knowing what had been going on. Unfortunately, there was also no debriefing or post-incident education for us. Knowing what I know at this point in my career, I would discreetly speak up to a manager if I suspected that a fellow nurse was diverting. You aren't doing anyone any favors by remaining silent or trying to make it another nurse's problem. And if you suspect diversion but are a willing participant in waste, then you are a silent accomplice to the problem. If anything, the hospital will check the records and if nurse X is constantly "wasting", he is going to end up giving a random sample. If your suspicions are unfounded then great, now you know. Something tells me that won't happen though.
  2. woundnurse4u

    ileostomy output

    Pasty output is typical for an ileostomy. The dangers with an ileostomy are dehydration and electrolyte imbalance (more likely to occur with diarrhea). Also be aware that there are dietary restrictions with ileostomies to prevent food blockage. Many ostomy supply companies offer tip sheets and some have free CEUs for nurses on their websites.
  3. woundnurse4u

    Help!! Wound disagreement

    While it is possible to have superimposed candidiasis to an open wound to the natal cleft/gluteal fold, I would not consider every wound to this anatomical location to be candidiasis. Candidiasis has symptoms that include redness, pruritis, yeasty odor, yeasty crusting or drainage, and satellite lesions. However, you could try a combo product that includes a zinc oxide barrier with an antifungal medication (like Baza anti-fungal cream). Another possible cause is ulceration caused by inner gluteal pressure (gluteals are pulled together and pressure is not offloaded/dispersed). Those patients benefit with pressure redistribution devices to beds and chairs and proper repositioning on a routine basis.
  4. woundnurse4u

    Career Change to Wound Care

    Just a quick word about one of your comments. You describe some frustration with the "needy" patient. If that is one of the things that you are seeking to get away from, you will still encounter such patients in wound care. It never ceases to amaze me- I have wound care patients who have terrible, extensive wounds and they are rather quiet yet appreciative. I have wound patients who scream if you make a move toward them without ever touching their body (and some who should get an Academy Award). I have wound patients who ensure that I spend a great deal of additional time adjusting the thermostat, positioning their fan just so, changing the television channel, getting them a cup of ice, going for some extra blankets, and adjusting the blinds in the windows. And closing the door but leaving the door open at a 15 degree angle. No matter where you go in nursing, you are going to deal with reactive and needy patients. In wound care, you will deal with patients who refuse to listen to patient education, refuse to be engaged in their own care, refuse to comply with the treatment recommendations, refuse to follow up with their physician, and refuse to take their medication. I have had wound care patients try to change the settings on their wound vacs and turn their vacs off. I have had wound care patients insist that "their way was better"- whether it is a homeopathic treatment that isn't working or some crazy concoction of multiple dressings that serves no real purpose. Wrap it tighter (until my circulation is cut off). Wrap it loosely (so that it falls down to my ankle). It takes a great deal of patience to work with wound care clientele.