From the mouths of Senior Citizens

One of our residents is out of it most of the time. They chatter and what they say goes together, but it's not relevant to the moment. They will recite prayers or talk about what their favorite foods are. You have to get their attention and ask them a direct question to get an answer and sometimes you have to ask them more than once to bring them back from wherever their mind has wandered.

On occasion, this resident will ask for something: pop, water, bananas. Or they'll tell you they want to get up or go to bed, but this is rare at best. The other day, however, the resident looked at one of our male aides and said, "You need a shave." And he did. I told him he'd better go shave because if the resident commented on it, it needed to be done. He promised the resident he'd shave before coming to work again.

I hope I never stop being amazed.

"Sometimes they think you're crazy...

...when you wet," she said to me.

"But you can't help it," I said.

"No. You can't."

"They should go to hell and mind their own business," I said.

She laughed. "Yeah. They should."

I'd like to know who made her feel bad about being incontinent. Don't they think she feels bad enough about it? Who wants to be wet all the time? Who wants to smell like urine until someone comes to clean them up? Who wants to have someone else clean them up?

This is another one of those Karma issues. I wonder if they'll remember how bad they made her feel when they're lying in their own urine, waiting to be cleaned up.

Slightly O/T-Be careful what you pet.

Apparently the charge nurse on third shift went out to have a smoke the other night. In our courtyard, we have some raised flower beds with a two foot brick wall around them. She was sitting on one, enjoying her cigarette when Bubba, the resident cat, came up to her. She reached down to pet him. Good thing she looked before she touched him. It wasn't Bubba. It was Pepe LePew. She said she froze in place and waited until he wandered off.

I don't know how it normally is, but all my experiences with skunks have been just like that. They don't seem to be afraid of humans. They aren't aggressive toward them, but it doesn't seem to bother them that we share space with them. I've even had them continue walking toward me after they've seen me instead of walking away. My understanding is that if they stamp their feet at you, you'd better head for the hills, though.

Best way to exit a room

Before you exit a resident's room, do the following:

• Take a deep breath
• Make sure their call light is easily reachable.
• Make sure their water/other drinks/snacks are easily reachable.
• Make sure their telephone is easily reachable.
• Take out any dirty clothes or trash.

Resident's can fall out of a bed trying to reach for things that are too far away or they can trip over a sock dropped on the floor. You would be amazed at how easily they can hurt themselves doing things that you do without thinking. Sitting up in bed is sometimes a huge challenge in itself. I think we all learn this stuff the hard way, but it would be better for all involved if we didn't.

Do Not Resuscitate v/s Do Not Treat

If you have a resident who is on a DNR (Do Not Resuscitate), does that mean that you do not treat them for infection or other illness? Or is it limited to life-saving measures? My understanding is that the whole point of my job is to keep my residents as happy, comfortable and healthy as possible. If I have a resident on a DNR, doesn't that mean that if their heart stops, we don't try to restart it? But if they have an ear infection, shouldn't we treat that so they aren't in pain?

I'm only thinking about this because some nurses seem to think that they shouldn't give antibiotics to a DNR. Sorry, I call bullshit. DNR doesn't mean that the resident has to suffer. DNR means that if they are crossing over, we don't try to stop them.

The Dying Patient's Bill of Last Rights

When I was in CNA class, the last chapter of the book was about dealing with the dying and recently deceased resident. I copied this: http://www.geocities.com/hotsprings/5120/bill.htm
verbatim into my notes. It made me think real hard about how it is to deal with someone who's dying and may or may not acknowledge the fact.

No excuses

It wasn't a full moon and the weather wasn't wild, but man, the residents were. One was convinced we were killing people, chopping them up and putting them in the freezer. One was in such pain that she was begging for help. One was taking swings at other residents. One was refusing to eat. One thought his roommate was going to kill him. One resident, who has aphasia, was trying to tell us something and we could not figure it out. Whoa. In addition to that, we were short handed so all we did was run around and put out fires. I was glad to get home.

The worst thing is trying to calm a resident who's convinced we're doing nefarious deeds behind closed doors. What do you say? They think you're lying when you tell them that you're not making hamburger out of people and serving it to them for lunch. What ended up happening is that the charge nurse called the doctor who allowed the resident to have a pill for agitation. Two hours later, the resident was in bed. I hope they slept through the night and are feeling better today.

It's like a domino effect. One falls, tipping the next one over until eventually they're all lying flat. I wonder if by medicating that resident we broke the chain. I hope so. We don't need two nights in a row like this.

O/T - Reprieve

Andrew is not leaving for Iraq until sometime after September 30. Not sure exactly what happened, but there it is. Maybe he'll get lucky and they'll decide not to send him at all. Will keep you updated.

Date set for CMA test.

I finally have my date set for my Certified Medication Aide test. September 2. I'd love to score 100% on it. I got a 96% on my CNA test. I've read my Medication Aide book and my notes over so many times that I feel like it's ingrained into my brain.

O/T - I can't believe I sang the whole thing.

Rock Band.

Patrick on Guitar, me singing.

Endless setlist.

58 songs. (I sang all but one.)

On Hard.

4 1/2 plus hours.

Finished at 1:00 a.m.

Only missed getting 25 stars.

We have Legendary Status now.

If you see me online, Fear Me.

Don't know if I can talk today because I haven't tried yet. I couldn't last night.

"I don't know why we don't lose weight."

Someone said this to me last night. With all the rain and the full moon and being short-staffed, we were running around like headless chickens.

My answer was "I have."

Fifteen pounds so far. Another fifteen and I'll be at my goal (which is still on the heavy side for my height, but I think I need a little extra weight to do this job. Being a CNA requires a power lifter's body, not a fitness model's.)

The key is not taking in too many calories and getting exercise outside of work. This job will help you lose weight, but it won't do all the work for you.

Lucid conversations

It always makes me nervous when I start having lucid conversations with people who are normally wallowing in dementia. I worry that it might be a precursor to a change for the worse in their condition.

I had one of these conversations last night and I went ahead and reported it to the charge nurses. They told me the resident had been having chest pains the night before and that the last time they had the angina, two days later they were sent to the ER. Could be a connection... or it could just be the full moon.

Another entry to the "Things I have learned" list

Among the list of things I've learned at the nursing home, I'd have to put this one on the top of the list:

• Don't ever wish that a difficult resident would change.

Because the truth is that they will change, but it will not be for the better and likely it will be a precursor to their death. They may be easier to handle and less combative or they may not. In any event, wishing for that kind of change in another person is counter productive. Big changes in nursing home residents seem to lead to their ultimate demise. Wish for more patience and knowledge to deal with the devils you have rather than wishing for the devils that you don't.

O/T - Deployed to Iraq

Patrick's best friend, Andrew Haden, is being deployed to Iraq on Saturday with the National Guard.

Please send up prayers for his safe return next July or August.

Conversation overheard

"How're you doin'? You look good."

"Well, I had a bath today."

The pot calls the kettle black...

I had one more set of vital signs to record last night. It was one of our residents with dementia. There's a group of them that hang out together and rarely go to their rooms. I found the resident and two of the six sitting together by the nurse's station.

"Hi," I said. "Can I take your vital signs?"

"Well, sure," says Resident A.

"You can take mine, too," says Resident B.

"OK," I said. "I'll take Resident A's first so I can keep them straight."

"She's gonna keep us straight," says Resident A. "She's gonna make us walk the line."

"Resident A, are you teasing me?" I asked.

Resident B looks at me and says quietly, "No, she's not teasing you. She's just..." and shakes her head, tapping the side of it with her index finger.

New Recruit

At a meeting the other day, the facility administrator passed around a copy of an application we had received. The person was applying for a CMA position. They were willing to work "8 hours a day, 8 days a week" for a ridiculously low wage because they "didn't want to make too much money".

It was from a resident.

The two best parts of the story?

• The administrator initially gave them an application for a CNA instead of a CMA. After the resident filled it out, they realized it was the wrong form. So, they read the administrator the riot act. "How can you run this facility if you can't even read well enough to hand out the correct applications to people?"
• The reason for leaving their last job. "I had a stroke and lost my memory."

Priceless.

O/T - How do they know???

So, we get an extra paycheck this month. Well, I don't, but my husband does. And somehow the machinery in my life KNOWS THIS and takes advantage of it. Both my car and my washing machine need work. I TRY to be thankful about it and think, well, at least we can get one of them fixed this month, but all I really want to do is scream and pull all my hair out.

Sigh.

Back to CNA blogging tomorrow.

106 degrees in the shade

That's what it's supposed to be today. The nice thing about working second shift is that I'm in the air-conditioning during the hottest part of the day (about 5:00 pm).

On the other hand, some of the residents LOVE it. At least the ones without breathing problems. The one's with breathing problems stay in their rooms with the doors closed and the air conditioning full blast. The rest of them open their windows and let the heat in. For a little while, they're not cold. That is until it's time for supper and we have to go down "freezing alley" to get to the dining room. Traveling down the hallway always gives them the shivers.

Despite the heat, I have some residents who just can't get warm. One of the ladies had two sweatshirts on yesterday. Meanwhile, my hair was wet with sweat when I took it down after work last night. After a couple minutes, I had to go sit outside to wait for my ride because it was too cold to stay indoors.

Phew. Made it.

Well, I made it through the month of July with only four days off. I had two days off in a row and then was back at it yesterday.

Surprisingly, I'm not really sore this morning. Usually after a couple days off, that first night of work makes me all crunchy the next morning.

Bunches of stuff on my mind. I am going to make myself a list since I can't ever seem to remember any of it when I sit down to blog.

A few of them:
Do Not Resuscitate v/s Do Not Treat
The Dying Person's Bill of Rights
Some nurses need to take customer service training

Random thought to end this post:

Dear God,
I've been really good today. I haven't sworn, lost my temper, had a beer or eaten too much. But in a few minutes, I'm going to get out of bed and then I'm really gonna need your help.