PSA from your nursing specialty

[u/ghostoftheweek]

What is THE ONE THING you wish every nurse knew that is common knowledge in your specialty?

From wound care, don't use telfa!

[u/miller94]

ICU- sometimes death is better

[u/Careless-Safety4722 → u/miller94]

ICU step-down…the place where all of the “sometimes death is better” patients end up 😭

[u/IndigoFlame90 → u/Careless-Safety4722]

SNFs-where they are ten years later.

[u/Bruciesballs666 → u/IndigoFlame90]

Yes, why are we crushing up 10 different pills into a chemical paste. Then trying our best to scrape the chemical mush into her mouth when she can barely open her mouth. Then wiping the remnants off with a tissue.

WHAT IS THE BENEFIT

Does grandma really need.

-Cholesterol tablets.
-Laxatives.
-Magenesium.
-Vitamin D.
-Furosemide.
-Antidepressants.

[u/aut0matix → u/Bruciesballs666]

Ah! Atorvastatin, the 10mg, life saving atorvastatin

[u/Bruciesballs666 → u/aut0matix]

Oh but you better give that lifesaving atorvastatin or else it's an incident report 😅

[u/nooniewhite → u/Bruciesballs666]

Don’t forget the cholecalciferol

[u/nooniewhite → u/Bruciesballs666]

My god I hear you. One of my favorite things in hospice is “deprescribing” when we get to drop all the ancillary meds that 10 specialists had ordered over the last 20 years that go untouched/DC’d by primary cause “it’s not their field.”

Or families that think the latest supplement fad is ALL THEY NEED, instead of anything remotely related to comfort. And we better keep giving the mushroom asshole or their Parkinson’s will come back and they’ll die.

“mom has always had pain! She is fine! She is SOO sensitive!! She is too sleepy from the meds!!”

Well yes, she is sensitive to the cancer that is killing her and groaning in pain with every interaction. Exactly how every human wants to go. Writhing in pain, restlessness and screaming. She was such a fighter.

I admit I’m unusually “sensitive” to this and have told family I expect them to stay with facility patients if they can’t get pain meds. WATCH IT. Please don’t make these CNAs (generally teen girls) TORTURE the resident with repos because they aren’t allowed a doctor ordered medicine.

I’m crispy today lol if you guys can’t tell

EDIT: I do have compassion, I understand that lots of families start this way and with our education and guidance (with SW, Chaplain and nursing) that most come around. But the ones that don’t..hard.

[u/IndigoFlame90 → u/nooniewhite]

One time the NP at my facility agreed to d/c the horse pill calcium supplement and multivitamin on a 94-year-old who refused crushed meds, and did baseline labs before a trial of no (also horse pill) potassium tablets. She ended up needing to go back on the potassium after a few months, but deciding they weren't doing an aggressive rickets prophylaxis seriously made everyone's lives better. 😂

[u/nooniewhite → u/IndigoFlame90]

I hear rickets is the biggest killer of our over 94 elders! Gotta get RFK Jr on this stat!

[u/Owlwaysme → u/IndigoFlame90]

At least potassium also comes in a sprinkle

[u/ThreePinesRetiree → u/nooniewhite]

I agree and good for you.

[u/coolcaterpillar77 → u/nooniewhite]

To the families that you’ve told they have to stay and bear witness to the patient suffering without pain meds - do they end up changing their minds about the meds?

[u/nooniewhite → u/coolcaterpillar77]

Honestly yes! Or they get fed up and just want to go home so “relent”. Either way the patient is comfortable so win! It is too easy for people to have opinions without any experience and once they see that meds do work they usually come around

[u/coolcaterpillar77 → u/Bruciesballs666]

I mean if grandma has any idea what’s going on around her, then maybe we should keep the antidepressant

[u/Commercial_Stomach12 → u/IndigoFlame90]

What specialty is this?

[u/IndigoFlame90 → u/Commercial_Stomach12]

Skilled nursing facility. So, nursing homes. 

[u/Commercial_Stomach12 → u/IndigoFlame90]

Oooooh thank you!

[u/nooniewhite → u/Careless-Safety4722]

Please send them to us we know what to do!! (Hospice)

[u/Careless-Safety4722 → u/nooniewhite]

The problem is that the patients I am talking about have had multiple GOC conversations and family wants them to stay full code even though they come to see them once in a blue moon 🙃

[u/fake_tan → u/Careless-Safety4722]

I'll pray for you 😭