jonamb

Spontaneous fractures, unfortunately, do occur. We had a LOL once who was just walking down the hall, went to the floor for no apparent reason, and BAM...broken femur. And she had been a good walker...steady, good posture...it was the craziest thing. On the other hand, staff do need to be careful with care giving on fragile residents. Way back when, when I was a CNA, I was trying to put a pull-over sweatshirt on a res. I had to reach through the sleeve to pull her arm through, and when I did, her arm jerked, I lost my grip, and somehow my arm flew back and smacked her right in the face . She ended up with a HUGE black eye. Needless to say, there was an investigation and it was found to be an accident, but I still felt awful. Sometimes it's almost impossible to dress/undress people who are contracted, resistive, etc. Who's idea is it anyway to buy these residents pull over tops and snug-fitting clothing? Anyway, I'm rambling...back to the subject. Yes, it is possible for injuries to "just happen". And sadly, it is common for "nothing" to be done, since sometimes the residents condition does not make repair possible. The most we can do is try to keep them comfortable.

Definitely sounds like verbal abuse. Just because the res. was showing no s/s of SOB does not mean she did not feel like she was SOB. How many times have we seen res. c/o something while showing no symptoms (think pain -- I've seen people say they are having pain rated at 10 while smiling and laughing -- who are we to judge?)? The nurse could have done a few simple things that may have helped, like elevating the HOB, repositioning, or just talking with the res. Sometimes just doing something simple and saying, "Let's try this...I think it might help" is all it takes. I think that nurse was out of line. Just my opinion.

Where I work, we also just have a rolling cart with a lock box and sign out sheet for narcs. A waste must be witnessed by someone with a license. It doesn't seem like good company policy to allow a waste to be witnessed by someone not familiar with the drugs. For your own protection, I would seek out another nurse to witness for you. You might want to ask your DON or someone else to clarify this policy for you.

In the LTC where I work, the max dose of acetaminophen was decreased from 4000mg/day to 2500mg/day several years ago. We need to get an order from the doc if the pt. requires more (sometimes they will write for a max of 3000mg, sometimes 4000mg). Most often, we are able to get a different pain med all together. Have they considered Fentanyl transdermal patches? Some elderly pts. cannot tolerate, but others do very well with them.

Sorry, I just reread your original post, and realized the order says she can have one or two Vicodin every four hours, meaning that she can have up to 1000mg acet. In this case, she could technically receive Vicodin and Tylenol within four hours of each other, as long as you didn't go over the 1000mg. However, giving her that much in that short of a period of time would mean she would have to wait longer between doses so as not to exceed the daily limit. My advice, talk to the doctor. Apparently, she is not receiving adequate pain relief.

I would take the order to mean that she can have up to 650mg acetaminophen q4 hrs, whether it be Tylenol or Vicodin. Therefore, if she had Vicodin, I don't believe she would be able to have Tylenol for another four hours, and vice versa. However, if she is consistently requiring more than the recommended daily dose of acetaminophen, maybe the doctor needs to prescribe something different for pain, as this doesn't seem to be effective for her. If for some reason the doc can't or won't do that, sometimes they will raise the max daily dose to 4000mg (depending on the pt. and her medical condition). You need to be careful not to go over the max prescribed dose -- you could be opening yourself up for trouble. I would discuss this pts. pain management with the doctor -- there are many other options for pain relief meds. Good luck!

I'm an LPN, not an RN, but I do know that where I live in Michigan nursing homes do pay more than hospitals. RNs that I've spoken to have told me that starting wages in our three nearest hospitals average about $17-$18/ hr. and it's close to if not more than $20/hr. in most nursing homes. As an LPN, I am currently making $22/hr. (with shift differential and insurance waiver -- I believe base pay is about $17.50/hr for experienced LPNs). I've been fortunate, for the nursing home that I work in is one of the top-ranked in the state. Patient care and living conditions are excellent there. As far as your license being at risk, in the thirteen years that I've worked in this facility, I've only known of one case where a nurse's license was in jeopardy, and that was due to neglect on the nurse's part. However, where you choose to work should not be based on pay alone. If you're not sure where you want to work, check out different types of facilities and see which suits you. Keep in mind that nursing homes are basically designed for long-term care of patients (that's why we call them "residents") and hospitals are geared toward acute care. Remember, you won't be happy with more money if you don't enjoy what you do. Whatever you decide, good luck to you.

Someone was passing this around work the other day and it made me smile... Stephanie was so happy. She was young, healthy, successful, and she was about to wed the man of her dreams. She was happily planning the wedding she had always fantasized about. Everything was falling into place perfectly. Nothing could get her down, not even her parent's recent nasty divorce. Just two weeks before the wedding, she was visiting with her mother when mom showed her the dress that she had bought to wear to Steph's wedding. The dress made her mother look twenty years younger and just radiant. Both were excited for the upcoming event. The next day, Stephanie was at her father's house, when his new, younger, beautiful wife modeled the dress that she had bought for the wedding. To her horror, Stephanie realized it was the same dress that her mother had bought, and her new step-mother looked ravishing in it. She told her step-mother the situation and begged her to wear a different dress. "After all," Stephanie told her, "you have so many beautiful clothes already that look great on you." But her step-mother refused, saying, "This dress makes me look fabulous. I'll be the envy of everyone there." Heartbroken, Stephanie went to her mother and told her about the dresses. Her mother told her not to worry. She would just buy a different dress to wear to the wedding. She said, "Sweetie, this is your day. It's only a dress." That weekend, Stephanie and her mother went shopping for a new outfit for mom to wear to the wedding. After her mother found a nice, albeit less fabulous dress to wear, they decided to go out to lunch together. As they were chatting over their entrees, Stephanie told her mother, "Thank you for being so great about all of this. But where is the other dress? I thought you were going to return it. There are no other special occassions coming up where you'll be able to wear such a fabulous dress." Her mother replied, "Oh, Darling, but there is. I'm going to wear it to the rehearsal dinner." :wink2:

One of the residents at the LTC where I work told us this joke the other night.... Why don't witches have babies? Because warlocks have hollow-weenies. :thankya: I know, I know, cheesey. But I have to tell you a little bit about this res... He's been depressed and pretty much has kept to himself since being admitted a couple of months ago. He's polite and compliant, but he's obviously wanting to be anywhere else. Anyway, he rarely initiates any conversation. So, imagine our surprise when he walked to the nurse's station in the middle of the night and said, "Since it's almost Halloween, I was wondering why..." It caught us so off guard that at that moment, that lame joke was the funniest thing we had ever heard. He then said good night and went back to his room. Just wanted to share.

Have you tried turning the pt. on her side with her knees bent (imagine the position her legs would be in if she were sitting in a chair)? A veteran nurse taught me this, and sometimes it makes things easier to see. I work in LTC, and the landmarks are often very hard to find on elderly women. Quite often, I could not find the "flower" and would have sworn I was cathing the lady parts, only to be pleasantly surprised to find I was indeed in the right place. And don't worry, I'm sure we have all tried to cath a privy parts or a lady parts. I had to smile when I read about the "flower". That's what I always referred to it as (I've gotten some strange looks from co-workers, but that is what it looks like). I, too, have never seen the "wink". I thought I was really missing something -- glad to know I'm not the only one. Everyone had good advice! I'm going to keep in mind the one about the bedpan. Always glad to learn something helpful!

These posts made me think of my mother-in-law. She had some good ones.... 1) For teething pain, give the baby a chicken bone to chew on. She did this with my son once and I about freaked! She apparently wasn't the only one who did this, though. I was telling some co-workers about it (because I could not believe she had done that) and several of the older ladies said that they had done that with their kids! 2) Another cure for teething pain -- whiskey. Give the baby enough, and he feels better and goes to sleep . I also had an aunt who would crush aspirin and put it in her baby's bottle to "help them sleep". 3) Mother-in-law also believed that pouring rubbing alcohol into your childs ear would cure an ear infection. But, if by some off chance that didn't work, you could take a lit cigarette and stick the filtered end into the kid's ear. The cigarette would "draw out" the infection. No health risk there. 4) My husband still believes that rubbing alcohol is the absolute cure-all. Whatever ails you, rub alcohol on it, pour alcohol into it, whatever. Except for an abscessed tooth -- then you pop the abscess with a needle and swish and spit with peroxide . Wonder where he got these ideas? You know, I'm sure my M.I.L. meant well, but.......YIKES!

Thought this was interesting, so I just wanted to relate my experience with soy based formula. Both of my babies were formula-fed. My first baby did just fine with regular formula. The second one, however, had a terrible time with it. The biggest problem she had was constipation. I can still see this little two-week old baby trying to poop what looked like adult turds (hard and formed). They were huge, caused rectal bleeding, hard as a rock. I can remember holding her up over a potty as an infant, hoping gravity would work. I can also remember one time when she was laying on her back trying to pass one, and I was flexing her knees up to her tummy, and every time she would yell, it would poke out, but as soon as she took a breath, it would go back in. I ended up just grabbing it and pulling it out:stone. Anyway, as you can imagine, this was very scary. I took her to her doctor well before her 6-wk. check, and there was nothing physically wrong with her. She (doctor) suggested trying soy-based formula. It worked wonders. My baby finally started pooping baby poop (and I considered this a good thing? ). She never had another problem. As far as the allegations of soy formula causing problems later in life, I can tell you that both of my kids are normal and healthy. My "soy baby" is a pre-teen, and as far as I can tell, seems to be developing at the same rate as her peers. No sociopathic tendencies. And if she turns out to be homosexual, so be it. Soy the origin of sexual orientation:uhoh3:? Anyway, too much information on my part -- sorry. Just wanted to share my experience.

In our facility, we have a variety of dressings to choose from. Most nurses opt for transparent dressings (Tegaderm, Bioclusive) that can be changed every 3-5 days for skin tears. I have found that these dressings are usually good for small tears on people who have fairly good skin. However, most of our residents have very fragile skin, and often the transparent dressings will make the tear worse or cause another tear when they are removed. Personally, I prefer to use vaseline gauze wrapped in Kerlix. It needs to be changed at least daily, but the gauze will not stick to the wound and the healing time seems to be faster. Also, geri-gloves (sleeves) and long-sleeved shirts can be very helpful in deterring "pickers". And I have to agree with wocnnurse: antibiotic ointments usually aren't necessary. Most wounds will heal fine without them if they are kept clean. We only use ATB ointment if there is definitely an infection present. With the problem of over-use of ATB's in this country, why use ointment unless it is clearly needed? Just my opinion.

I know what you're going through, and I'm sorry to say, these two CNAs that you are talking about are not going to change. And I'm assuming going to your supervisor won't help either, since they are both long-termers and obviously have been getting away with being ugly for years. The best thing that you can do is just keep plugging away and doing your best. I can bet that in time, they will leave you alone. If not, ignore their nasty comments and kill them with kindness. Be professional, thank them if and when they do help, and know that you are doing your job to the best of your ability. Stick with it, and you will get faster, you will get to know the residents, and life will get easier. Just be glad that you don't have to go home with these two nasty people (pity their families). Just some advice for your back, please use the lifts. If a resident is a two-person transfer, don't even attempt it. I know the lifts take more time and can be a general pain in the a**, but trust me, in 10 years your back will thank you for it. When I first started out, I was young and strong and didn't have time to use the lifts. Now my back is very angry with me. Back problems usually just don't happen, they come from wear and tear and abuse that you don't even know is happening at the time. And one more thought on "the nasties" -- have you ever confronted one of them on their comments? Sometimes that's all it takes. They are just bullies, and are probably insecure themselves, as most bullies are. You don't need to be rude or harsh (after all, you don't want to be them), just be firm and confident and keep your sentences simple and to the point (so they will understand). When they learn they can't intimidate you, they will leave you alone. I know their comments and attitudes hurt, but just keep in mind that it's not personal. It's just their way of welcoming new people. By the way, I was wondering if these people also complain about working short staffed? Where I work, there are a couple of CNAs who gripe almost every day about "being short again", but these are the same ones who are nasty to new people. Go figure.

In our facility, all baths are sceduled on 7-3 and 3-11. 11-7 will occasionally do a bath if the resident has been refusing on other shifts, if they (resident) is awake and agreeable at the time, and if there is time (and of course the occasional "too messy for a bed bath"). What other shifts seem to not realize is that 11-7 has much less staffing than the other shifts. Granted, there are no meals, appointments, activities, etc., but they have 3-4 times as many residents to care for. And contrary to popular belief, the residents do not sleep all night. Our dementia unit is especially active at night. Another thing that concerns me -- how do two CNAs get 30 residents up and dressed in just two hours? How can they possibly be giving proper AM care to that many residents in that short of time? On our dementia unit, (40 residents) about half of them are total care, requiring mechanical lifts to get out of bed, incontinent, combative, etc. We get the majority of them out of bed before day shift arrives, but some of them are just in a robe and slippers until after breakfast. Total AM care is done for the "quick" ones, but some of these people take a while to wash and dress. My other concern is this: how long are the non-ambulatory residents sitting in their wheelchairs waiting for breakfast? Does 7-3 shift come on and immediately start toileting and repositioning the residents that have already been up for several hours before serving breakfast? This just seems like skin breakdown and pressure ulcers waiting to happen. Maybe I'm misunderstanding what you mean by "up and dressed". If not, my heart goes out to you guys for having to run yourselves ragged every morning. What do you do when something unexpected happens that requires extra time? It sounds to me like they need to get more help on your unit if they're expecting you to do all of these things. Good luck to you. P.S. I know what you mean by not being able to help out like you would like to. I also work 11-7 and have 2 units to cover with med pass, dressing changes, prn meds, and all the other things that go bump in the night. Good thing we were born with super-human powers.