Wednesday March 23 2022

Tweety, BSN, RN · Mar 23, 2022

Good morning!

Joe, hope you have a good day.

(((Stars))) So sorry you're dealing with this painful time.

Back in the dark ages when there were no case managers, we had a nurse that would help set up home health. They were starting a program where RNs would take a group of patients and do some case management but we would also have a full assignment that often wasn't our patients because our case management was assigned by rooms. We would analyze their needs for discharge, order teaching for them such as from a Diabetic teacher. It was a huge hospital and had resources but it was a bit much, plus LPNs didn't do this so we had to look at a group of LPNs patients as well. Surely by now they've gone to the current system of having separate RN case managers.

Some of the case managers have interesting jobs that I wouldn't mind that entail visiting patients, and talking to people. Others sit behind a desk all day. There's a nurse whose office is on my floor and he stays in there and looks at all of the observation patients, and reads what's going on to decide if they qualify for inpatient or observation. Others due reviews to try to make sure their admission is legally justified and to get the insurance companies to pay us if the insurance company has decided they aren't paying if they overstay observation. I'd rather flip burgers it sounds so numbingly boring. But who knows as I age, I might get into it.

I had an appointment at 7:00 for car maintenance and I canceled it. What was I thinking having it so early when I'm off. As it was I've been up since 6:00 anyway so I'm doing chores. I'm having breakfast now but already cleaned the bathrooms and folded a load of laundry I left in the dry last night. Two more loads to do and need to dust and mop the floor. I will get all of this done before I decide to sit down again.

Tomorrow have the car appointment at the more reasonable hour of 11:00 AM. LOL

Have a great day.

No Stars In My Eyes · Mar 23, 2022

Deep breath. I took Ozzie to the vet's office around 11 AM. Donated the harness and leash, which he's had from the very beginning. Washed, they look like new. Also had some flea-tick med that was not used. That and the dog-foods I donated had expiration dates a year away, so I know someone can use all of that.

When I got home I broke the news to Nannie. She probably won't remember and we will hear her questions that she always asks: Where's the puppy, is he upstairs, did he eat his supper last night, etc. And her other comments: "he's so precious, such a good looking boy, so cute..."

I gathered up the 15 year old dog bed and tossed it, his water bowls, we'll keep and use when we decide to get another pet, etc. Gonna be weird not to have to put the baby-gate across my bedroom door at night to keep him in with me. He was getting so he'd only pee or poop if *I* took him out. Hubby said he felt bad that I had to hobble up and down stairs, day and night to take care of Ozzie's needs and demands. He also thanked me for being the one to carry out our decision, because he couldn't face it.

This is the first time in over 36 years that I have been without a pet. We decided we'd take our time about getting another pet or two. Hubby wants a cat and I do, too. I haven't had a cat for at LEAST 25 years if not longer, and I do love cats! Have really missed having a purring bundle of fur curled up in my lap. Not sure Nannie likes them too well; she doesn't understand cats, I think, never having had any in her life. But, we'll see, because there is no rush.

Anyway, I am going to be 'slothful' today and not do much except launder my comforter and pillow.

Decompression time!

nursej22, MSN, RN · Mar 23, 2022

{{{Stars}}} Run free, lil' Ozzie! ?

Youngest son was broken out in hives this morning as I was getting ready for work. Said they started about an hour after dinner. I am guessing it was the soy in the stir fry. Of course, we had no benedryl in the house. He ran down to 7-11 to get some and took it as soon as he got home. I warned him don't plan to drive. The hives started to fade in about 10 minutes, and he texted me after I left to the sleepy was setting in.

Case management is definitely an art. Something that seems straightforward gets real complicated. I've noticed what patients and families say in the hospital is sometimes what they think you want to hear, not always based in reality. We make home visits for TB and get some interesting surprises. Providers can prescribe, but that doesn't mean people take the drugs or get the equipment. Or they get meds and say, oxygen from well meaning friends.

Its raining, and about 45 degrees. It got up to 58 yesterday! I kept throwing off the bed covers last night and had the window wide open thinking I was having hot flashes. I got up and dh was in the recliner in the living room, with the gas fireplace on and it was 70!

I was captivated by the confirmation hearing yesterday. Judge Jackson seems like a pretty sharp cookie.

Take care all.

Tweety, BSN, RN · Mar 23, 2022

Of the three dogs that I've had that died, I only had to put one asleep as she was suffering and actively dying. It's agonizing. (((Stars))) and family.

I used to take Benadryl to make me sleep and it didn't seem to help. I have a friend that told me he's been immune to all efforts and all kinds of meds to help with his insomnia over the course of many years. Maybe I'm just one of those.

I'm so glad I don't have any allergies. I would have a hard time being a primarily plant based person without tofu. ?

Ado Annie, ASN, RN · Mar 23, 2022

Good boy, Ozzie. ?

Hubs keeps saying that when these pets are gone there will be no more. I understand, but not sure I can do it. One cat is only 2.5 but he should go with Twin A if Twin A ever moves out.

Benadryl knocks me out.I'd hesitate to take it for insomnia because I'd probably go to sleep alright but then have a really hard time waking up. With working night shift, I've had occasional problems with not being able to sleep when I should be sleeping, but not to the point where I needed to do something about it.

I slept through Gma getting up and wanting to escape last night. Hubs says she was sure she needed to go to her car (she doesn't have one, no longer drives, but if we tell her that she'll argue and get mad at us for selling her car) and get to her husband (who died in 2012).

I don't remember my grandparents. My maternal grandmother died when my mother was a child and the other 3 all died between my 2nd and 6th birthdays. But at least I don't have a memory of my grandmother call me an asshole. That's what my kids get to remember ? I hope they can remember the good times with her, too. My stepkids adored her (and still do, because they remember the Gma she was) but my kids didn't have the same relationship with her.

Editorial Team / Admin · Mar 24, 2022

(((((((((((((((((((( Stars ))))))))))))))))) It's always difficult, even when done the "right" way for the "right" reasons. I am sad for/with you. Hugs. Good of you to donate his leash and food to pets who might need it.

Ado, good GMA didn't escape last night! I don't know if I could do without a pet (or two or three or four...). Our count now is seven cats and one chihuahua-pomeranian mix. They are all our babies.

nursej22, good the benadryl helped your son's hives! A small dose wings me up, rather than makes me sleepy. Larger dose (50mg) makes me sleepy. I always recommend ppl carry benadryl with them, to chew if they develop a new, surprise allergy. It can happen any time. One of my patients when I was a Radiology Nurse, had had seven CT scans, with contrast, in the past few years. No problems at all. Except when we gave him contrast for this eighth scan: HIVES. Scary.

It was a smooth morning. I took 45 min out of the morning to call the health insurance company to inquire about a switch to a senior plan that I THOUGHT I had initiated a month ago. I did fax the required paperwork back then, both for dh and me. Dh has since received notification that the change was in progress. I have heard nothing. So I finally called. Outcome: re-faxed paperwork for the change, plus one more sheet I hadn't faxed before, and then also faxed my Medicare Part B bill to a different department, as proof that I do indeed have Part B (health insurance will reimburse us for monies spent on Part B).

Then for the first part of lunch break, I walked to a Mail Choice nearby, to send the Medicare Part B payment via express mail, to ensure it arrives on time.

I felt like I accomplished a lot! AND, when I got home, dh got the mail and I finally received a packet of information re: part of my retirement fund. Yes folks, it's getting down to the wire. I was told not to eat breakfast tomorrow, that the department is holding a farewell/retirement breakfast. Then I will work out the day in the Stress Lab. Friday I will mainly go from department to department to turn in keys, etc, as part of the final exit check-out.

Didn't sleep well last night, probably thinking about the insurance situation. Felt like the bedcovers and I wrassled all night long. I hope I sleep better tonight.

Have a good evening!

No Stars In My Eyes · Mar 24, 2022

What a day.

Nannie had a choking spell during supper. She sits down in the den and eats from a tray in her lap; she doesn't climb up stairs anymore...or the few she does, she has someone beside her so she can hold onto their arm.

So, hubby and I are upstairs in the kitchen and I hear her make an odd sound. I went to the top of the stairs and said, "Nannie, are you okay?" and she was coughing so she couldn't talk. Well, I started down the (carpeted) stairs quickly, and on my third step down, my feet decided to slide down the next three stairs and since I was hanging onto the railing, I landed on my orifice instead of falling forward. Meanwhile hubby is freaking out about both of us. I was okay, though, and Nannie was able to take a deep breath and cough, so I knew I didn't have to Heimlich her, thank goodness. I have told her numerous times that leaning back in the recliner with her legs up is not a good position for eating....because one can easily choke when in that position. (d'OH!) She was actually fine, but scared, so maybe next time I tell her to eat with her feet DOWN on the floor, take smaller bites, chew thoroughly! Don't put another hunk of food in your mouth until you've swallowed what you just chewed up. Honestly, though, you should see her tear through food, not chewing enough, and taking big bites of, say, a sandwich and talking while she has all that food in her mouth. OY! It doesn't sink in, really, but I still have to say something.

It's a weird evening without the Oz-man. I do feel sad and a bit heavy-hearted, but I know we did right, and Ozzie is not suffering through old age any longer. And, yes, j22 ---he is running free.

Thank you everyone for your support and understanding.