Many people have the fallacious perception that the nursing process in a facility is different compared to home care nursing. Some have the novel illusion that the care provided in the latter may be lesser than the former.
Working as a licensed practical nurse (LPN), I have the fortunate experience of being in both environments. While the majority of my experiences are in a nursing home, two recent experiences, one in the facility, and one in the home, illustrate the similarities of working in either environment; and that the nursing process and care is the same regardless of the surroundings.
Environment and scenario #1
Recently, a certified nursing assistant (CNA) advised me at 7:30 in the morning that one of her patients “is not himself” and that I should look in on him. This patient gets up in the morning and spends the day in his wheelchair on the floor. Upon observation, the patient is not capable of getting out of bed to go anywhere on the unit nor within the facility.
After performing an assessment, his vitals are all seemingly within range. His respiration rate is within normal parameters, but his respirations are shallow in nature and he is lethargic. His Pulse Ox is 96%. He is not alert; nor is he oriented. I angle the head of the patient’s bed up, and notify my supervisor to come take a look.
Eventually, the supervisor comes and assesses the patient. I have already put the resident on oxygen, 2 liters/per minute. The conversation is brief and succinct, I want to send the patient out to the hospital, there is mutual agreement. A call is placed to the doctor, an order for evaluation is received, 911 is called.
Shortly thereafter, I am guiding two groups of EMTs approximate to the patient’s bed. Do they fight over the incoming calls and business? Having taken the patient’s vital twice, both groups are puzzled as to why I want to send the person out to the hospital. All six aren’t quite questioning me nor my judgment, as it is a fine line in etiquette; and although they are just short of that line, they are definitely inquiring. My response is that the resident is not responding to tactile stimulation (when I pushed him on his chest, he did not respond). My reply and rationale is “Altered Mental Status.” The patient is sent out to the hospital for evaluation.
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