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Hospice Nurse

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  1. Jensmom7


  2. Jensmom7


    Awwww (((((((((((((Far))))))))))) you are NOT a nuisance.
  3. Jensmom7


    That must be why you didn't se my PM...[emoji26]
  4. Jensmom7

    Skin Changes At Life's End (SCALE)

    Kennedy Terminal wounds are a big indicator of impending death, as has already been pointed out. The phenomenon was named after the Hospice nurse who first put two and two together and described the correlation between appearance of the wound and death within two weeks (my experience with them has been death within 48-72 hours, but I do know of some Hospice nurses who had patients who followed the two week scenario). Ms. Kennedy first described the phenomenon in the early 80s, but because of the prevailing thought that "all pressure wounded are due to negligence", it took awhile before the medical community even started to turn their thinking around, and the State agencies still haven't, for the most part (I have run into a few enlightened inspectors recently). Most of my patients are in facilities, and as they decline, staff and family education regarding skin issues is imperative. If they have foreknowledge that skin issues will happen, I have found that they are even more diligent with skin care. The "7-3" phenomenon is generally the most distressing part, and that is when I work hard to nip the gossip in the bud. When my mom was in ICU, she developed a Kennedy wound in just a few hours. The nurse was upset and almost in tears. I wound up giving an impromptu inservice about skin health at EOL in general and Kennedy wounds in particular to the staff, including a few docs who were sitting nearby lol. I suspect a few visitors also listened in. Not one staff member had heard of them, and they thanked me for the information. My mom was admitted to Hospice that day.
  5. Jensmom7

    2/13/16 What I Learned This Week: Discipline is King

    I learned that even when I don't play the nurse card in the ER and on the floor, other nurses can tell within a very short time that I'm a card carrying member of the club. I guess after 4 decades, "nurseness" ("nursiosity"??) is so much a part of me I don't even notice it anymore.
  6. Jensmom7

    The Slow Code: Justified?

    Are you talking about a Hospice patient who has a g-tube and is no longer responding? If so, then no, you generally wouldn't continue tube feeds-if they were unresponsive and didn't have a g-tube they wouldn't be eating or drinking, right? At that point it's meticulous mouth care, for comfort. And a Hospice patient with a g-tube who is still responsive, albeit possibly confused, could still continue feeds and flushes-what we do in that case is decrease the amount they get over time, which mimics the gradual appetite decline that patients without g-tubes experience. Also, the majority of Hospice patients have a DNR (not a requirement, but recommended). In that case, there wouldn't be ANY code response, slow or not.
  7. Jensmom7

    Don't Be SAD! - Seasonal Affective Disorder

    It's weird, but I've actually noticed more of an upswing in my mood over the last 7 years or so during the winter months. That's also how long it's been since I hit menopause, but I don't know if there is a relationship or not (keep meaning to research it but never get around to it). I do know that my Vitamin D level was in the sewer a few years ago, and taking it has stopped the weird toe and ankle cramps I used to get. I also crave citrus during the winter months. Bless Cuties lol. I can go through a 3 pound bag in a couple of days. P.S. Dogen, ramble all you want. You are a fountain of knowledge and we can all use a good drink now and then.
  8. Jensmom7

    General Noise Discussion

    I don't either, but it reminds me of conversations we used to have in college after a few bottles of Annie Green Springs. Don't judge. It was the '70s and none of us were 21 yet.
  9. Jensmom7

    General Noise Discussion

    "Walk this way...no, really, like this..."
  10. Jensmom7

    General Noise Discussion

    Head Shakingly Dumb Post Man, it's Hell when ya gotta 'splain them lol
  11. Jensmom7

    General Noise Discussion

    Lol actually I was thinking less along the lines of TOS violation and more just head-shakingly dumb posts. Like the one who, when her HSDP was pointed out to her and corrected, giggled and said "Y'all know what I meant!" Change of shift report from her must be a barrel of laughs.
  12. Jensmom7

    General Noise Discussion

    Seriously, some of the threads that ARE nursing related deserve to be yanked.
  13. Jensmom7

    General Noise Discussion

    I must have a massive case of the stupids today. I'm totally lost, and have no idea what's happening here. But the artwork is really cool, so I'm just going to sit quietly in the corner, eat the last of my pumpkin pie, and enjoy the pretty pictures...
  14. Jensmom7

    General Noise Discussion

    I thought it was a reference to "This is Spinal Tap"...
  15. Jensmom7

    Our Death-Defying, Death-Denying Society

    Ok, a little education seems to be required here, because you have some serious misconceptions about Hospice. I'm not sure why you put Hospice in quotes, but people aren't just put on Hospice. They are evaluated, the family and patient (if they are able to understand) are given the information they need for an informed consent. It's not a surprise to anyone. Also, people DO NOT starve in Hospice care. Families are never told that their loved one can't eat. They can actually eat whatever and whenever they want; that's why they're called "pleasure feeds". However, we do caution them that the patient had to be awake enough to follow prompts to chew and swallow. They understand there's a risk of aspiration-that's what Atropine drops and scopolamine patches are for. The human body is a miraculous machine. As you progress toward death, food is no longer needed for fuel. Matter of fact, as the gut attempts to shut down gradually, being forced to eat can cause nausea, vomiting, pain and diarrhea. Yes, people do experience a slow dehydration as they decline. It's normal, and also helps the body to shut down. The brain releases endorphins and there is no suffering. Many don't even feel thirsty. Good oral care helps keep the mouth clean and moist. Decreased food intake is normal, and one of the signs of decline. It always bothers me when I hear health care professional basically accusing Hospice of torturing people. Torture is having IV hydration every other week-causes more discomfort and people feel like crap if their body is trying to shut down naturally. And don't get me started on g-tubes for the terminally ill.