Wednesday, May 29, 2013

Day one

Of the couch to 5K exercise program. supposedly I will be able to run 5k or 3.2 miles in 8 weeks. At the moment I would like to just go to sleep. But as soon as my daughter gets done with her homework, its off we go. I keep telling myself its only 25 minutes. I can handle anything for 25 minutes right?

Thursday, April 11, 2013

The Life of a Dementia Care Nurse.

I was recently asked why I wasn't out on the floor more. I did my best to explain the massive amounts of paperwork that is required and my behind the scene contributions, but it seemed lame, even to me. I think every nurse would rather be “out on the floor” with the patients they are in charge of.  So after a particularly busy day, I decided to write how my day went and the responsibilities I am in charge of.


Today started off with five residents experiencing severe behavior problems. They each needed their care notes, behavior charting, regular and "as needed" meds reviewed, as well as interviews with caregivers to know what to report to the doctor of each resident. As I am faxing off the third evaluation, an answer comes in to the first one. I must then make sure that the order is transcribed correctly and see that the med that has been discontinued has been pulled from the medication cart so it will not be given accidentally. I also write a note in the Medication Aide communication book about the changes and I start to head back to my office to evaluate more residents, but as I pass by the desk, a resident wants to know why they haven't received their medication. I explain that their medication is not due for 2 hours. Another resident is screaming for coffee with 2 sugars. And a third resident wants to know what they can do. After I get the coffee and I show the resident who wants something to do to activities, I get stopped by a family member who is upset and I talk with them till they feel better about the situation. They happen to be a family member of one of the residents I am working on, so I also update them on the situation. I stop on my way back to my office to check a resident’s feet that we have been doing soaks on, and note that her feet look great and I will chart on them when I get a chance. I instruct the treatment aide to continue the treatment till all calluses are gone. As I continue on, I find a resident walking down the hall without their walker. I hold onto them and call for someone to get their walker. A few more feet and I hear an alarm sounding. I enter that resident’s room to find they are up walking and their personal alarm is sounding because they are not steady. I sit them back down in a chair before the staff arrives to take care of them. I finally reach my office door to find a group of 3 residents with questions ranging from "When is the ship going to dock?" to "why am I here? And “Where can I find a car to take me to my brother’s house?" I reassure the residents and make sure they are smiling and satisfied before I enter my office. I sit down to write more evaluations and I hear a familiar tune being played at the piano. It’s only a few bars and it’s the same tune over and over, every day the same thing. First the tune gets played, then the resident stands outside my door and stomps his feet till I look up and smile and he says "thank you honey" then I go back to my work. It is similar to the "Groundhog Day" movie. Every day, over and over, it’s the same routine. I hear another familiar sound coming down the hallway. This happens several times a day as well. First there is the sound of shuffling feet then a stop at the doll house and the sound of the pieces been hit together, but today the dollhouse is gone because the resident’s hands were bruising and it is thought it could be from the doll house and banging the pieces together. I hear banging anyway. He is banging his hands on the shelf because that is his routine, so I make a note to write in his service plan that he is now banging his hands on the shelf, and I think it might be better to bring the doll house back. He then comes and tries to shut my door. But he has difficulty because of the door stop, so I get up and take the door stop out so he can close the door. This door has been closed in years past before it was my office, so this resident wants it to be the same as it used to be. I glance at the time. It is time for the shift to change, so I wait till the resident is down to his room and I open the door so I can talk to the staff on their rounds. I tell them what I would like them to concentrate on this evening. I tell them which residents I am working on and the doctor responses. They are encouraged because they get beat up every shift. They get kicked, hit, pinched, grabbed, strangled, bit, head butted, yelled at, and cursed at, I give them encouragement for doing such a great and selfless job. The day is winding down and I have 2 evaluations left to go. The Manager hands me a response to another of my evaluations and the medicine ordered is one that the resident cannot tolerate. I call the doctor and he decides to make changes to the existing medications. I finish my remaining 2 evaluations, make 6 notes for things to start on tomorrow and I go home. However I am on call 24/7 so I keep my phone by me at all times. I do have some days where I might not be called, but the average is 2 to 12 calls or texts per weekday evening/night. Weekends average 6 to 36 calls and texts. I have had times where I was mowing the lawn and had to stop every few feet to answer a text or call. Tomorrow will be another day with other responsibilities.


Some of the other things I do are listen to lungs to check for pneumonia, stomachs to check for constipation, skin breakdown to develop a treatment plan, ears for excessive wax and evaluate residents after a fall if they have an injury. I evaluate pain, swelling in the legs and if a resident is confused more than usual. I do a neurological assessment if it appears the resident has had a stroke. I do TB tests, Flu vaccines and pneumonia vaccines. I evaluate dip sticks on resident’s urine and report to the doctor if there is an increase in confusion or falls in a resident. If a resident is having surgery I make a plan so that the pre-surgical showers and special soaps get completed. I practice “diffusing an angry person” when I get yelled at by doctors because some of the paper work didn’t end up at the resident’s appointment. I talk with family members who have nursing questions. I investigate complaints. I review the pharmacy recommendations every 3 months and audit to ensure the necessary changes were completed by staff. I coordinate care with hospice, speech therapy, physical therapy, occupational therapy, and home health when they are ordered. I evaluate weight loss and gain and make recommendations. For new residents I am required to evaluate them for appropriateness for this level of care. Sometimes they are not able to come to the facility, so the Administrator and I go to visit them where they are living.  I complete a five page pre-admit assessment, a care plan, and a psychoactive medication assessment if they are on any psychoactive meds for each new resident. This assessment has to be updated in 30 days and then with each service plan meeting. Every 3 months I audit the charts, service plan and psychoactive meds for the effectiveness and any side effects.  I attend Service Plan meetings. I review all incident reports daily and write any additional recommendations to keep the resident safe. Physician’s orders for the residents are sent out every 4 months for the doctor to review and sign. Before they go out, I review them and make corrections. I fill out the lab protocol for all of the in-house doctor's residents per his instructions depending on the medications the residents are receiving and I review the labs and contact the doctor for orders if needed once the results are back. For residents who are not with the in-house doctor, I contact the primary Care Physician to make sure the labs that are needed for certain medications are being completed at the office or if they want us to do them here at the facility. I review the Medication records to make sure each medication has the reason it is given and side effects to watch for. I review the Level of Care assessments that are completed every 3 months on each resident to look for any changes in the resident that may not have come to my attention another way. I hold monthly meetings with the medications aides and treatment aides to go over what we are doing right and what we can improve upon. I evaluate the Medication aides to make sure they are passing medications in a safe manner. I train staff to take care of catheters, oxygen, do blood glucose checks, eye drops and blood pressures. I make sure they know how to do the Heimlich and know standard infection control. And sadly, I attend funerals.

I am sure there are responsibilities I have forgotten, but this is a fairly good picture. I couldn’t possibly get everything done for each of the 50 residents that live here without the assistance of my RSC, Shift Managers, Med Aides, Treatment Aides, floor staff, Assistant Administrator for helping me with lists and forms and last, but definitely not least, my Administrator for handling staff issues, family concerns etc. In addition to nursing responsibilities, I help out by answering phones, answering a call light or personal alarm, grabbing a walker for the resident who has forgotten it, walking a resident down the hall and helping them get into bed, cleaning up cat hair, sweeping, taking out trash, feeding and watering the animals, watering plants, getting coffee and /or snacks for the residents who have forgotten they have already eaten or giving emotional support to a resident who realizes his wife has passed away for the 100th time. I also look for lost items, audit the facility for any dangerous items and have them locked up. I am in charge if the Administrator and Assistant Administrator are out of the building. In that case it is my responsibility to take care of any administrative issues. I work through almost all my breaks and lunches. I do my best to complete these responsibilities within my scheduled 30 hours a week.......I am a Dementia Nurse and I love my job.


Wednesday, April 10, 2013

Spring Meme

I usually do a New Years Meme and looking over the past Meme's I realized they told me a lot of things I may have forgotten otherwise. The last two years have been over the top stressful so I decided to put them together in this Spring meme for 2011 and 2012 

Spring Meme

1. What did you do in 2011/2012 that you’d never done before?

Lived in a travel trailer from April 26th 2012 to Nov 4th 2012 

2. Did you keep your new year’s resolutions, and will you make more for next year?

 I believe I gave it my best shot

3. Did anyone close to you give birth?


4. Did anyone close to you die?

Residents at the facility I work at

5. What countries did you visit?

None for these two years

6. What would you like to have in 2013 that you lacked in 2011/2012?

More peace, time with God, and my kids

7. What dates from 2011/2012 will remain etched upon your memory, and why?


March 18 Kiara turns 18 and 19!
April 30 Braden turns 20 and 21

8. What was your biggest achievement of the year?
I went two months with no sugar, no diet sugar and no bread!

9. What was your biggest failure?

My marriage which fell apart early 2012

10. Did you suffer illness or injury?


11. What was the best thing you bought?
Back massager and hair straightner.

12. Whose behavior merited celebration?

Squirty for pulling through a very severe illness after I fed her crushed bone instead of serving it whole. It got stuck in her throat but wasnt discovered by the emergency clinic and later she went into shock. With lots of prayers she made a full recovery in early 2012

13. Whose behavior made you appalled and depressed?

My husband who chose drugs that changed his personality and made him very mean over his own family

14. Where did most of your money go?

God (tithe, church budget and other)

15. What did you get really, really, really excited about?

Answers to prayer. For Squirty, for places to live, for car repairs, for many many things

16. What song will always remind you of 2011/2012?

"The Warrior is a Child". Old song but reminds me of myself alot and "What doesnt kill you makes you stronger"
17. Compared to this time last year, are you:

a) happier or sadder? Happier. I would like to think I get happier with each passing year
b) thinner or fatter? Thinner YAY!!!!!
c) richer or poorer? Poorer but better off

18. What do you wish you’d done more of?

More helping the less fortunate. I would like to do a little more each year

19. What do you wish you’d done less of?

Crying. Cause its all good. God has so many blessings for us if we just look for them

20. How did you spend Christmas?

With my family

21. Did you fall in love in 2011/2012?

No I actually fell out of love for the first time in 32 years. Never thought it would happen but when the verbal abuse gets bad enough the feelings are just gone. 
22. What was your favorite TV program?

Hardly watch TV but when I do I like HGTV and Biggest loser

23. Do you hate anyone now that you didn’t hate this time last year?

I try not to hate anyone. I hate some of the things they do however

24. What was the best book you read?

Greater by Steven Furtick

25. What was your greatest musical discovery?

Josh Groben

26. What did you want and get?

I wanted to have better pain control and I am doing pretty good. Pain is around a 4 to a 5 instead of 6 to 9

27. What did you want and not get?

To fix my marriage. I even did Marriage Fitness Program.

28. What was your favorite film of this year?

I dont think I saw any.

29. What did you do on your birthday, and how old were you?

I dont remember 2011 , in 2012 I turned 50 and I remember my husband being very loud and trying to be the center of attention at every birthday we went to not just mine. That is kinda his personality but this was over the top rudeness

30. What one thing would have made your year immeasurably more satisfying?

If I could always trust in God and not worry. Ever!

31. How would you describe your personal fashion concept in 2010?

Anything my daughter approves  of gets me lots of compliments everywhere I go!

 32. What kept you sane?

Dawn and praying

33. Which celebrity/public figure did you fancy the most?

I do not fancy people if I do not know what values they hold.

34. What political issue stirred you the most?

I dont get stirred by politics

35. Who did you miss?

My friends

36. Who was the best new person you met?

Mr Right! Love talking to him

37. Tell us a valuable life lesson you learned in 2011/2012.

That no matter how small the problem may seem to me God cares and will help me with that problem if I just ask and believe.

38. Quote a song lyric that sums up your year.

When a problem comes along you must whip it!

39. Favorite quote of the year?

Sir, my concern is not whether God is on our side; my greatest concern is to be on God's side, for God is always right.
Abraham Lincoln
40. Favorite new blog discovery this year (and how did you discover it?)
Proverbs 31 Ministries. I discovered it through a class I took with my sister.

Wednesday, January 30, 2013

God is my rock at the bottom

I saw this saying today. And I thought it very true. Even my son says that he feels like God is going to keep taking things away till we have no choice but to rely on him even for food. The great thing is that God has been providing. Just in the last week friends have given us bunk beds and a refrigerator. Also my parents are giving me a new queen size mattress as the one I have is all crushed in. There are many more ways we have seen God work but I will save those for other posts.