Old 06-02-2010, 05:04 PM #1 (permalink)
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Question Protocol/Responsibilities of Home Nurse

Perhaps someone that has experience with home nursing care or that has a nursing background can answer my question.

When a home nurse visits the patient in his/her home, what is she expected to do besides take vitals?
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Old 06-02-2010, 05:32 PM #2 (permalink)
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Default Re: Protocol/Responsibilities of Home Nurse

I think it would depend on what the physician ordered when he/she ordered home health such as dressing changes, monitoring wounds or surgical sites for signs/symptoms of infection, intravenous antibiotics, injections, trache care, change foley, medication review and set up, lab work, education, education, education, etc.
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Old 06-02-2010, 06:18 PM #3 (permalink)
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Default Re: Protocol/Responsibilities of Home Nurse

Thank you Dana! So what I need is a copy of the doc's orders!

The nurse asked me to show her how I cared for the PEG/site. I got out the silver nitrate sticks and told her first I use these for the granulation. I asked her to show me how she would use the stick to cauterize the granulation, as I wanted to make sure I was doing things properly, since things have been so going wrong with the PEG site. She told me they were not allowed to "touch those." Then she wanted me to give her the package of sticks to look at. She further told me she had never seen a feeding tube site that looked like "that."

I got the feeling she had no clue what silver nitrate sticks were, nor what granulation was. My whole reason for having a nurse sent out was to help with the PEG site.

How do I get a copy of the doc' orders? Ask the doc or the home nurse agency?
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Old 06-02-2010, 07:43 PM #4 (permalink)
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Default Re: Protocol/Responsibilities of Home Nurse

Which doc wrote the HH orders? Was it different than the doc that originally ordered the silver nitrate to "cauterize the granulation?" Hopefully it was the same. The doctor's office or the home health agency both have copies so either could/should give it to you or at minimum review it with you.


What did she mean the feeding tube site looked like "that?" Was the area around it worse than she had seen or had she just not seen that type of feeding tube? Did she say she was going to call the doc to clarify what he/she wants her to do?

I am not sure the qualifications for silver nitrate for HH nurses so I sent an email to a couple of nursing friends to see if they know of any restrictions. I think you can get silver nitrate at a pharm without a script but I am not sure.
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Old 06-02-2010, 11:12 PM #5 (permalink)
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Default Re: Protocol/Responsibilities of Home Nurse

The nurse had the original orders from the doc at Emory and the agency insisted on contact with his local GP, which I complied with. Sigh...I will contact Emory in the morning to see what the doc ordered.

Emory doc was to give me some sticks, but we got lost in the shuffle while at the clinic, so GP prescribed them when I took him in for the problem.

Then to ER after fever and really scary looking site. That's when Emory doc wrote orders for home nurse.

For God's sake, the whole reason they were to come out is for the PEG site problem!

Screw vitals, just help me with the PEG site!

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Old 06-02-2010, 11:34 PM #6 (permalink)
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Default Re: Protocol/Responsibilities of Home Nurse

I wonder if the HH agency you are using has an Enterostomal Therapy (ET) Nurse. This nurse would specialize in abdominal stomas. Sounds like you need a consult on whether or not what you are doing is working or if there are better recommendations. Obviously the nurse that came out does not have any better ideas or she would have made them. Maybe the next nurse will be more resourceful and call the Emory doc and tell him/her what she sees, make recommendations based on what she sees and the orders can be adjusted from there if needed.
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Old 06-03-2010, 10:21 AM #7 (permalink)
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Default Re: Protocol/Responsibilities of Home Nurse

Thank you so much Dana!
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Old 06-03-2010, 11:10 AM #8 (permalink)
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Default Re: Protocol/Responsibilities of Home Nurse

Why do people lie? Why can't they just tell the honest truth and then deal with it? I would respect their honesty and character. Do I have DUMBA$$ written on my forehead?

Another nurse called me this AM to come out and I point blank told her what happened with the first nurse. I told her that was the whole reason we needed help in the first place (problems with PEG site - infection and granulation). She told me that is why they are there...to help the caregiver and patient...they have no restrictions with use of silver nitrate sticks. I further asked her about the exact application, which the first nurse told me I was doing wrong (as she had "not seen it done that way"). Turns out I was applying the stick properly to begin with.

God Help Me! I'm really losing patience with some of these healthcare "professionals!"

Y'all don't be afraid to check things out, if you feel you are being lied to or given the run around! Jump up and down and scream if you have to! Our pALS lives are already turned upside down enough without the ones we rely on for help to screw with them further!

Think I'll take my big tall glass of iced tea (with sprig of mint) and go outside and scream now...
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Old 06-03-2010, 12:31 PM #9 (permalink)
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Default Re: Protocol/Responsibilities of Home Nurse

I feel your frustration but your husband is one lucky guy to have you in his corner.
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Old 06-03-2010, 05:13 PM #10 (permalink)
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Default Re: Protocol/Responsibilities of Home Nurse

CJ you are one he** of a caregiver! I will meet you on your back porch for tea minus the mint!
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Old 06-03-2010, 06:16 PM #11 (permalink)
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Default Re: Protocol/Responsibilities of Home Nurse

Well, I just might have to Yankee-up and have a Long Island Iced Tea! It's a tad humid here for my liking and that would be really refreshing! Y'all come on down!

Seriously, when another nurse comes out tomorrow I will ask her the same thing I asked the one that called today. I assume I will get the same answer, since the nurse I talked with today put me on hold just to make sure there wasn't some weird policy in place she didn't know about. I will later call the agency and kindly tell them not to bother sending the very nice nurse they originally sent out - ever again. I will explain exactly what was said to me and exclaim that she must be misinformed and perhaps not educated with the skills needed for a patient with a PEG.
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