Inquisitive one

I may have found what you're looking for. Try googling - obra scheduling tool. Hope this helps.

What is the definition of external catheter length? I would think it means from insertion site to hub of the Picc. Does the length of the catheter from insertion site to the IV connection ever need to get measured? Do all Picc brands have a hub? Is the usage of a stabilization device like Statlock recommended by manufactures? There is some confusion at my workplace because the IV documentation sheets we utilize use the words measure migration in one area and external cath length in another. Wouldn't they be the same thing? Isn't just different terminology to describe both? Thanks for your input.

In Massachusetts LTC'S a RN can pronounce death and CPR can be withheld in a person who is a full code provided certain criteria are met: decapitation, decomposition, rigor mortis, dependent lividity. There must be a very specific assessment done and documented. Here's the link from the Mass BON- http://www.mass.gov/?pageID=eohhs2modulechunk&L=5&L0=Home&L1=Provider&L2=Certification%2C+Licensure%2C+and+Registration&L3=Occupational+and+Professional&L4=Nursing+Home+Administrators&sid=Eeohhs2&b=terminalcontent&f=dph_quality_boards_nursing_p_long_term_care_ruling&csid=Eeohhs2

My DPH survey manual is about 5 years old but there is a section under Medication Errors, F332 and F333 that talks about med errors with enteral formulas and enteral formulas with dilantin administration. You may want to check this out.

Your welcome. Sometimes free water is ordered in between feedings so you may want to include that. Also there is one medication, Tegretol or Dilantin I believe, which the TF needs to be held for a certain amt of time before administering. I'd have to look that one up.

Just a few things off the top of my head. You may want to add residual checked, amount of residual, MD orders to hold TF for whatever time presecribed if residual is greater than____ (whatever the order states), TF intake if it's not recorded somewhere else, HOB elevated. Some facilities pH test the residual to check correct placement. Hope this helps.

The nursing process which drives the careplan can be applied to any life situation/problem. It can be used for personal long and short goals. I haven't used it formally as in a written plan for myself but tend to use the process daily for whatever without thinking about it. I would bet that most nurses do, it's how we've been taught to critically think. A visual, such as the ones descibed in the link provided, is a great tool. Try 'processing' an issue out with your child, first with discussion and then assisting him/her with making a visual as a reminder to achieve whatever the goal is. Having the child come up with the 'interventions' to meet the goal may contribute to greater compliance to solving the issue. Give it a try. Right now I'm thinking about setting New Year's resolutions which are usually broken soon after they're set. If you address the resolution using the nursing process and come up with a visual type careplan whether in traditonal form or with pictures etc. and use it daily, I'm willing to wager you'll have a greater conviction to achieving the desired resolution. Try it.

So, think a bit further. You got what witch hazel does, the end result, but how does it do this? What's the body's physiological response to get relief? This may get you started but I know there's more information available on other sites http://www.globalherbalsupplies.com/herb_information/witch_hazel.htm

I have a coworker that will be interviewing for a staff development/infection control position with the company we work for (long term care). We are trying to practice interview questions to prepare her for this. Could someone detail the role of the SDC nurse during the yearly survey process? What has been your experience? Thanks in advance.

http://wiki.answers.com/Q/What_is_Depakote_and_how_does_it_work

http://wiki.answers.com/Q/What_is_Depakote_and_how_does_it_work

here's another link that may help you pdfhttp://www.npuap.org/pr2.htm

Perhaps this link will help you. It's the 2004 CMS guidelines regarding presssure ulcers. I don't know if there is a more recent update. Pagse 19-20 go over staging. http://www.cms.hhs.gov/transmittals/Downloads/R4SOM.pdf

You could mix mineral oil and alcohol free mouth wash 1:1 ratio and swab with toothette every 2 hours. Sometimes we add hydrogen peroxide in the same ratio. There's a product called OASIS that I believe is over the counter.

Just wondering if there are LTC RN/LPN nurse managers out there who are classified as exempt (salaried) employees? How does this status work in your facility? (regarding holidays (worked/not worked), leaving work early. flexibility in your schedule, docked time etc.) Is it possible for an LPN NM to be considered exempt? (This is not meant to be a RN/LPN debate) Thanks

You may want to call the facility's pharmacy to guide you on this. Our pharmacy supplies us with protocols to use. I believe accuchecks are done 4x/day with sliding scale insulin. Sometimes insulin is added to the TPN bag. Also know what to hang and at what rate in case the TPN needs to be stopped for any reason. Usually it's 10% dextrose at the same rate as the TPN was running at. Monitor the residents temp at least every shift. 2 nurses need to check the order against what's in the bag. Some meds/vitamins need to be added by nurses prior to hanging. The bag needs to be taken out of the fridge one hour before hanging. Your dietitian may also become involved to ensure that the residents nutritional needs are being met, example percentage of amino acids and fats in the TPN. These are things I can think of off the top of my head. Good luck.

This is not something new and you should have been oriented properly from the beginning. From your resident responses it seems that this protocol isn't followed by staff on a daily basis. You will get dinged by the state if you're noted to do fingersticks, injections, eye drops, inhalers, gtube meds/flushes etc in public areas. An ombudsman may take notice as well and report it. It's a dignity issue and I'd assume an infection control issue as well especially if they're being administered in a dining area. I would like to hear the states response to your question but I'm wiling to bet you don't get one. All g-tube meds need to be crushed and given separately by gravity method not pushed. I don't think po meds need to be crushed separately unless it's contraindicated. Make sure that you're disinfecting your hands after each patient and washing them after every 3-5 patients I believe. Always wash after eye drop administration. I've also seen resident's Roxanol syringes (labeled with their name) being kept together in a cup on the med cart. This to me is a big infection control issue and I do my best to keep educationg staff on this. Always keep your cart drawers locked as well as the cart's wheels, no meds on top, all drinks and food are covered. labeled and dated. No personal drinks on the cart, sharps containers not over the fill line, Keep the MAR closed or covered when you walk away. Identify your residents and follow all parameters before you draw up and administer the med. Don't crush meds unless there is an order to do so and there is no contraindication. Give each med in the form as indicated on the MAR, capsule, tab etc. Oh there's so much!!! Any other suggestions?

When narcotics are received they need to be signed for by the nurse who received them. The signature is written on a carbon copylike invoice, one copy is left with the facility and one goes back to the pharmacy. If the med was delivered the pharmacy will be able to track who signed for it and that nurse will be held accountable because it would have been that nurse's responsibility to log it in the narcotic book. Where I work 2 nurses need to sign the narcotic book when it's entered. This may be an honest mistake. I would let those in charge deal with it for now.

Active charts in LTC can become very 'thick' quickly and legally there's only so much that can be pulled out and filed. Since PT/INR's are drawn so often, how many weeks/months worth of PT/INR's do you keep in the active charts? These results are faxed to us separate from any other labs drawn that day and I'd like to thin them out a bit. Thanks

http://www.medicinenet.com/tuberculosis_skin_test_ppd_skin_test/page2.htm Dose should be 0.1 ml intradermally

If before you leave means at the end of your shift vs. when you leave the room..... Would it be clock out?

Thank/praise the CNA for bringing the issue to the nurse's attention?

Don't leave the patient alone?

http://www1.us.elsevierhealth.com/Evolve/Ackley/NDH6e/Constructor/A-B.html

In my note, I always include tourniquet removed. This is a double check for me to ensure that I did remove it.