New Grad

My two concerns as a new employee of a nursing home are:
1.Chest pain.

2.Respiratory distress.

I wonder if anyone out there would like to tackle the following scenarios.

Scenario A.

You are the charge nurse (lpn), at the rehab unit of a nursing home.

You are athe nursing station and the alarm goes of for room 25.You go to the room and the resident says he is experiencing very bad chest pain.

You are alone. What should the LPN do?

Scenario B.

You respond to a resident that says he cannot breathe. The resident is sitting up and gasping for air. He has no order for any respiratory med. There is no order for nebulizer either.

What should the LPN do?

Scenario A

Administer nitro under mucosa membrane; must have an order. If this does not work you know that resident is having an MI. Oxygen should be administered and 911 should be called, you do not want to mess with anyone who has chest pain, they could drop any second if precautions are not taken.

Scenario B

This is also an indicator of oxygen administration. Usually in long term care facilies they have standing orders and you need to take the time out the read all facility manuals and standing orders to take care of situations promptly.

Thank you so much. your the only person that responded. That is one reason i dont like Nursing-Many Nurses have this pseudo-professional attitude that forbids them from passing information along.I thank you for helping me and not being like them.

I thank you again.ill analyze your response and print it.Thank you and have a great future.

Is oxygen administration something you can do whithout an order?

I have seen Nurses administer oxygen for both scenarios whithout checking to see if there is an order-usually 3liter/min.

Yes O2 does requie and order, but in emergency situations you can administer O2 and then get a written order....you cant wait for a dr order in an emergency unless there is a dr around you or in the facility.

Wow! tahnk you for your help.it is greatly appreciated.

i do believe this is the first thread i ever posted in a nursing forum that got a response.

You should try canadian nurses forums, Canadians seem to be quite nice....I am Canadian. If you need help with any other questions let me know. My email is sabitas604@hotmail.com. I do not have any problems spreading the education.

Thank you. Its nice to know the canadians still have their civility.Something long lost in my neck of the woods.

Thank you again-most kind.

Rudy Rudy in Union, New Jersey said: My two concerns as a new employee of a nursing home are:
1.Chest pain.

2.Respiratory distress.

I wonder if anyone out there would like to tackle the following scenarios.

Scenario A.

You are the charge nurse (lpn), at the rehab unit of a nursing home.

You are athe nursing station and the alarm goes of for room 25.You go to the room and the resident says he is experiencing very bad chest pain.

You are alone. What should the LPN do?

Scenario B.

You respond to a resident that says he cannot breathe. The resident is sitting up and gasping for air. He has no order for any respiratory med. There is no order for nebulizer either.

What should the LPN do?

In both cases, sit the patient on the bed ask him to lie back, raise the head of the bed approx. 45 degrees and apply a nasal cannula of o2 at 2-4 Lpm, get a set of vitals....ask a CNA to stay with the patient and run like hell to the desk to call 911...call the nursing supervisor on duty to your floor...have her stay with the patient and inititate CPR if needed until the 911 unit arrives....while you make a copy of the patients face sheet, Med Sheet, DNR if available, and call patients family...all this should be in an envelope ready for the 911 staff when they hit the door...

Nursing Student in Richmond, British Columbia said: Scenario A

Administer nitro under mucosa membrane; must have an order. If this does not work you know that resident is having an MI. Oxygen should be administered and 911 should be called, you do not want to mess with anyone who has chest pain, they could drop any second if precautions are not taken.

Scenario B

This is also an indicator of oxygen administration. Usually in long term care facilies they have standing orders and you need to take the time out the read all facility manuals and standing orders to take care of situations promptly.

most rehab facilities do not have a standing order for Nitro for Chest pain if there is none ordered already

Wow! This is awesome.I really appreciate the responses, and I am sure it is a good way for all of you to stay mentally tuned on the fundamentals. i just got back from a 22 mile bike ride.i had some questions pertaining to this thread on the way home, but i forgot.Maybe it will come back to me.nonetheless, I am ingratiated to you.Have a pleasant day.

i think that many nurses who refrain from answering LPn and perhaps CNa questions on the basis that they want the Nurse to "do the research," may be inadvertantly injuring patients.

Your kind assistance ensures the probability that a life may be saved. I and all those possibilities thank you in advance.

I will build on this.Good to have a response plan set ahead of time. im actually printing all of this in edited form.

I sure could use a refressher from someone experienced on how to administer nitro. i mean is there a standard way to administer it?

I will definitely find out related to where I work.

Trying to stay in touch with you guys.

I mean are there people for whom the nitro protocol would not apply during chest pain?

Yes, you need to asset the type of chest pain. It could be coming from a respirory condtion.If they can answer you, askthem if it hurts when they breathe. not talking,listen with stechoscopefor a sound like pulling the top of a ballonand let the air escape.this could be an acute condtionof the lung.AS with cardic pain, call 911!

great info.thank you.

Hi:

i would like to be an LPN. Pesently am a HS/RCA with 2 years of good experience in long term care and home support also.
I am applying for funding from EI to go to an Access college for LPN Full Scope. The E.I. people are telling me that they cannot support my application because, THERE IS NO DIFFERNCE BETWEEN LPN AND HS.RCA! How can I get material, government or otherwise to convince them that they are very wrong?

Thanks

Marion

Asking for medical help from strangers on the internet (whose credentials you are unable to verify) in cases of possible life/death situations?

Are you insane? Have you no doctors to consult? Each of you should lose your certifications. Ask the nearest doctor if it isn't so.

Next time try this.... call 911 first and ask them. At least you can be assured they will connect you with a person with proper credentials.

To senior citizen.Perhaps if you used your brain you could think before you open your reactionary mouth and spew unfounded accusations.

The issues being discussed here are routing in nursing homes. Asking someone how to administer nitro is soliciting a response that can be crossed referenced using tools such as the internet, other nurses and so forth.Obviously you are not acquaited with the internet (senior citizen).

FYI tools such as google and so forth require specific keywords that we are specifically discussing.To make suggestions that one would attempt something whithout an order or supervisory assistance is irresponsible and shows a narrowness of thought that is perplexing , frustrating, and insulting.

Please use your brain before you make accusations.
No one is asking for medical help you blitering idiot.We are discussing medical help-quite a different issue.

So go away to your trailer and have some donuts.

To the rest please excuse me , but idiocy angers me.

Additionally, we are not lay people here -mostly, we are a variety of healthcare related professions.Healthcare professionals are encouraged to discuss the myriad of healthcare related issues that they may confront.

Wouldnt it be nice if the typical layperson took a course in logic? Senoir please go to the library and consult any of the volumes dealing with logic and or the art of reasoning before making your idiocy known to everyone.

To the rest i have found the information quite usefull.I consulted my supervisor at a nursing home concerning nitro policies and got the skinny.Thank you again for letting me know that there are specific policies for specific substances and specific facilities.

Rudy in Union, New Jersey said: Many Nurses have this pseudo-professional attitude that forbids them from passing information along.

Logical that "many nurses" might agree with the gentleman is it not? Is the term "typical layperson" not actually that of a "pseudo-professional?"

The statement, "So go away to your trailer and have some donuts." is not "reactionary?"

I have to say, physician heal thyself. You don't have a lot of leg to stand on there in my opinion.

I my self find the internet very useful in many ways. I am a nursing student about to finish in just a week. I have used the internet many times to reasearch and i do go to online forums for help. I find the information very useful and educational. This is the 20th centery...our main tool is the internet and we use it for many things.
I find articles on certain situations in which senarios that have popped up at work and these articles are very educational. This forum has been very useful and if other do not agree then so be it. The old days they had books and no we have the internet...we still use our book as our main resource of informtion...but the internet is by far full of information for us stundent and young nurses.
Everyone is untitled to their own opinion.

Ok so go away and let people discuss what they may.Last I heard its a liberty we still have in America to speak freely.If you dont like our discussion then go away.That simple.

It is so dissapointing that we get these types. As for your comments of pseudo-professionals.Perhaps you are in the business of bestowing professional titles.Most of these titles you refer to are healthcare related and administered by the state.So until you become some legislator, I fear you will just have to take your stupidity elsewhere.Please leave us alone!

And stop denegrating the effort of so many kind people that struggle to take care of people like yourself.As i have said before , this is a forum for discussion, and that is precisely what we are trying to do.So if you do not mind take your negativity elsewhere.

Could this scenario happen?

Sally is 18, unemployed and as a result, is living with her grandfather and grandmother and frequents this job search website. Grandfather has emphysema and a bottle of oxygen is close-by to his bed. Sally loves her grandfather but unfortunately Sally isn't the brightest of individuals.

One day, Grandfather clutches his chest in pain and Sally panics. She remembers reading somewhere that oxygen is helpful in such a situation and sure enough, she finds the bottle is empty. She rushes to the closet to retrieve a fresh bottle and in desperate hurry, swaps out the bottle. Sure enough, Grandfather seems by this time to be feeling much better and she figures she may have saved his life.

Later that evening, Grandfather has another attack only bigger and he dies before the ambulance arrives. Sally didn't call 911 on the first attack.

Unlikely? Sure, but why post such things on a public forum without making it clear it is not for public consumption? Use the internet to research all you wish and discuss such matters between peers privately but my opinion is, it isn't appropriate in this particular situation.

Nurse in Richmond.I agree whith you.The internet is a great place to discuss things and learn.Often times i will throw out a question, not so much to get a direct response , but to stimulate discussion.unfortunately we still have the narrowminded person who is not sufficiently acquainted witht the ways of the internet. many of these types do not understand that we are simply researching information-the internet being a tool of research.

What more do you want then to get responses from your peers?

Important information.Consider the information concerning the care of a person with respiratory distress. I took the information gathered here and the information i gathered in many other places including books, google, yahoo, and several supervisors and policy manuals to synthesize an approach to emergency situations.

Only to have this blithering fool interject with all kinds of assumptions and imputations ( I fear the person may run for a dictionary).

I cannot say how much I value the opinions submitted here.
And I would add, erase even the most cursory inclination to become intimidated by this person.

A nurse is a professional, just like a Doctor, a lawyer, or any other.

And my apology to all those wonderful people who although not having a professional title, nonetheless perform their duties in a professional manner. Forgive the stupidity of some for like jesus is reputed to have said " throw not thy pearls before swine."

Forgive me for my intolerance to the uncooth.

For like brash and barbarous fools they run to and fro with boisterous babble.

Rudy in Union, New Jersey said: ...let people discuss what they may.Last I heard its a liberty we still have in America to speak freely.

You are correct, but the same applies to my freedom to post my opinion. Freedom of speech does not cover all cases, especially when your speech could result in danger to other people, like yelling FIRE! in a crowded theater.

If you are not a certified health professional. Call 911 first in a medical emergency...

even if you are a student who has not graduated nor been certified. There is a reason for certifications.

By the way, I know its off topic , but id like to recommend a great site to you all.

www.thepositivemind.com/HTML/archive.html

Courtesy of yours truly. Now dont go playing Doctor or brain surgeon.Avoid using the kitchen knife to perform surgery on Phido.Ok?

?????

Okay. Let's analyze this conversation..

We have the people who are discussing it:

"new employee of a nursing home" (admitted newbie)
"Nursing Student" (a student without certification)
"stechoscope" (a person who can't even spell stethoscope)
"i would like to be an LPN" (a wannabe nurse)

Then we have the only person who states they are a Licensed Nurse say, "...run like hell to the desk to call 911."

I am simply agreeing with the REAL Nurse.

I am an LPN for 6 months.I also am a business owner. I do LPN part time in New York where I live. I have a professional banker for a wife, and I own 2 birds and a BMW. Now are you through trying to make people feel bad? Sounds like you have some real issues of insecurity.

In any case I am through with this thread.

Please instead of making hard working people feel bad , maybe you should do something constructive-like weaving or something. Get a life.My last post here folks. I appreciate the hard work that people do.You do not have to know how to spell to try and learn. I suggest you see a therapist.By the way I speak 3 languages.Je parle trois langue : Yo hablo varias lenguas.

So please do not insult the intelligence of people by making them feel unworthy.Evryone is worthy.Perhaps someday you will learn respect.I fear youll be soon dead, and I can see you have wasted your life.Because at your senior age, you should have more wisdom than trying to bring people down.

Had a rough life aye? upset and bitter aye? Well I feel truly sad for you. I really am.Because i have been exposed to the great Psychologist Armand for some 20 years.I can tell you have some great issues. I am sorry you did not accomplish very much in life.Perhaps you can make things better by overcoming that useless ego of yours and humbling yourself.maybe then you will learn empathy and compassion.Something Im sure you have not learned.

Go out and get some air.Stop being such a bitter old hag.

Rudy Rudy in Union, New Jersey said: My two concerns as a new employee of a nursing home are:
1.Chest pain.

2.Respiratory distress.

I wonder if anyone out there would like to tackle the following scenarios.

Scenario A.

You are the charge nurse (lpn), at the rehab unit of a nursing home.

You are athe nursing station and the alarm goes of for room 25.You go to the room and the resident says he is experiencing very bad chest pain.

You are alone. What should the LPN do?

Scenario B.

You respond to a resident that says he cannot breathe. The resident is sitting up and gasping for air. He has no order for any respiratory med. There is no order for nebulizer either.

What should the LPN do?

RESPONSE TO SCENARIO A:CALL 911, ER DEPT OR PHYSICIAN ON CALL, CHECK FOR SUPERVISOR ON ANOTHER FLOOR.

SAME RESPONSE TO SCENARIO B.

Rudy in Union, New Jersey said: Thank you so much. your the only person that responded. That is one reason i dont like Nursing-Many Nurses have this pseudo-professional attitude that forbids them from passing information along.I thank you for helping me and not being like them.

I thank you again.ill analyze your response and print it.Thank you and have a great future.

I AGREE WITH YOU 100%, I BEGAN TO QUESTION MY CAREER CHOICE DURING NURSING SCHOOL WITH MY FELLOW STUDENTS' ATTITUDES

Rudy in Union, New Jersey said: Is oxygen administration something you can do whithout an order?

I have seen Nurses administer oxygen for both scenarios whithout checking to see if there is an order-usually 3liter/min.

IN NURSING SCHOOL, MY INSTRUCTORS TAUGHT US THAT YOU CANNOT ADMINISTER OXYGEN WITHOUT A PHYSICIANS' ORDER, STATE REGULATIONS MAY VARY THOUGH AND FACILITY POLICIES ALSO VARY I KNOW FROM MY CLINICALS.

sabita in Richmond, British Columbia said: You should try canadian nurses forums, Canadians seem to be quite nice....I am Canadian. If you need help with any other questions let me know. My email is sabitas604@hotmail.com. I do not have any problems spreading the education.

IAM GLAD YOU ARE WILLING TO BE SO HELPFUL!I KNOW ALOT OF LPNS' NOT WILLING TO EDUCATE OTHERS!!!

Marion in Qualicum Beach, British Columbia said: Hi:

i would like to be an LPN. Pesently am a HS/RCA with 2 years of good experience in long term care and home support also.
I am applying for funding from EI to go to an Access college for LPN Full Scope. The E.I. people are telling me that they cannot support my application because, THERE IS NO DIFFERNCE BETWEEN LPN AND HS.RCA! How can I get material, government or otherwise to convince them that they are very wrong?

Thanks

Marion

I WOULD SUGGEST CONTACTING YOUR STATE BOARD OF NURSING, OR SPEAK TO YOUR INSTRUCTORS OR DON WHERE YOU ATTENDED SCHOOL.

Senior Citizen in Atlanta, Georgia said: Asking for medical help from strangers on the internet (whose credentials you are unable to verify) in cases of possible life/death situations?

Are you insane? Have you no doctors to consult? Each of you should lose your certifications. Ask the nearest doctor if it isn't so.
Y
Next time try this.... call 911 first and ask them. At least you can be assured they will connect you with a person with proper credentials.

I AM TOTALLY FLABBERGASTED BY YOUR COMMENTS!!!WE AS LPNS WORK VERY HARD MORE THAN RNS' AND GO THROUGH A TOUGH PROGRAM!!! GET A LIFE!!!

Rudy Rudy in Union, New Jersey said: To senior citizen.Perhaps if you used your brain you could think before you open your reactionary mouth and spew unfounded accusations.

The issues being discussed here are routing in nursing homes. Asking someone how to administer nitro is soliciting a response that can be crossed referenced using tools such as the internet, other nurses and so forth.Obviously you are not acquaited with the internet (senior citizen).

FYI tools such as google and so forth require specific keywords that we are specifically discussing.To make suggestions that one would attempt something whithout an order or supervisory assistance is irresponsible and shows a narrowness of thought that is perplexing , frustrating, and insulting.

Please use your brain before you make accusations.
No one is asking for medical help you blitering idiot.We are discussing medical help-quite a different issue.

So go away to your trailer and have some donuts.

To the rest please excuse me , but idiocy angers me.

I agree 100%, and felt totally insulted by "senior citizens'" comments, I feel this forum is extremely helpful and it's nice to hear from other LPN's since I lost tract of alot of my classmates who I am sure as you know, you become close to in school. I appreciate you writing in.

Call me Carlie in Atlanta, Georgia said: Logical that "many nurses" might agree with the gentleman is it not? Is the term "typical layperson" not actually that of a "pseudo-professional?"

The statement, "So go away to your trailer and have some donuts." is not "reactionary?"

I have to say, physician heal thyself. You don't have a lot of leg to stand on there in my opinion.

that wasn't a very nice response to Rudy. I feel all comments are welcome here, and obviously she felt very strongly about senior citizens' comments. opinions are opinions, you were a little harsh!. LPNS' in general I feel get a bad rap especially in Massachussetts. We are misled in school alot with jobs being available here, etc. I was older when I was finally able to go to nursing school and have many years experience in the medical field and also am planning on going on for my RN, don't know who you are, or your qualifications, etc. and i am certainly not bragging but you need to know about other professionals on this forum, and you are not being very fair!!!

Rudy Rudy in Union, New Jersey said: My two concerns as a new employee of a nursing home are:
1.Chest pain.

2.Respiratory distress.

I wonder if anyone out there would like to tackle the following scenarios.

Scenario A.

You are the charge nurse (lpn), at the rehab unit of a nursing home.

You are athe nursing station and the alarm goes of for room 25.You go to the room and the resident says he is experiencing very bad chest pain.

You are alone. What should the LPN do?

Scenario B.

You respond to a resident that says he cannot breathe. The resident is sitting up and gasping for air. He has no order for any respiratory med. There is no order for nebulizer either.

What should the LPN do?

Scenario A: First action is to assess the pain; GERD can cause epigastric distress. Crushing pain, or radiating to back, arm or jaw is indicative of an MI. Instruct the patient to cough as hard as he can, repeatedly. Research this to affirm it's veracity. Assuming that you do not know the patient, you must first find out their code status; you cannot admin CPR to a no code. Find out if they have an order for nitro. If not, and they are a full code, call 911. If they have nitro, admin 1 tab SL every 3 min X 5 doses (that is standard here in Mich, may be different there) Return to patient and reassess. Too many variables to cover all scenarios here.

Scenario B:
Nursing judgement in emergency situations usually falls under the good samaratin laws unless negligence is exhibited. If patient has no orders for respiratory meds, then there is little chance of established history of respiratory problems. Administer oxygen at 3 - 4 liters via mask, then call 911 if code status is full, otherwise call doctor and wake his butt up; this new development is just the thing he will yell at you for if you don't call him right away. (usually) Also, breathing can often be eased by having the patient lean slightly forward onto a bedside table

Go with what you know the first priority maintain ABC admin o2 and never play with chest pain, check up on standing orders and most LTC facilities have standing orders. When in doubt ship pt out