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My mother was very confused when I saw her four days ago. I had the nurse check her vitals after mom said she didnt feel well. She was found on the floor the next night and dry heaving the next day. I asked them to collect urine to test. "No, we cannot do that we have to wait three days" I replied so she has to suffer 3 days before you even TEST for UTI? "antibiotic over use blah blah blah" My dad suffered because of UTI's and developed sepsis - "gee sorry about that" . "Your mother doesnt have a temperature and we dont know where she hurts, but she is sleeping now nice and comfortable" Grrrr!!! Called last night to hear "Sheesh! I am busy, the head nurse saw her and left for the weekend, she said to keep an eye on her and to do "UTI protocol" your mother is sleeping on the couch "Called this morning = "She is nice and comfortable sleeping, we will call you if any changes" - I truly hate that they *like* it when the people are sleeping because they require less care. The head nurse refused to even test urine and left for the weekend. Sorry, had to vent somewhere.

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Iike DeeAnna said, RNs are not always hands on, mostly their jobs are paperwork but facilities have to have them on call. My daughter is in Administration, but many a time she has had to report in for RN duty because she couldn't find someone to fill the shift.
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The head nurse scheduled bloodwork today ( wed) but not testing her urine. She is active and now on allergy meds.
I know she has had her urine collected by a "hat" in the past- i dont know whether their rules have changed or what but it is yet another question i have to ask someone - the person I used to talk to about mom isnt there anymore :-/
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Micalost, how was your Mom today? Are the UTI symptoms decreasing or escalating? I was 99% sure Mom had one 2 weekend ago, and got a lame excuse why they couldn’t test on the weekend. Grrr. But by Monday she was doing better and I called off the test (they were going to straight-cath her for the sample). The bloodwork that they did came back a little dehydrated, so I’ve been really pushing fluids like pedialyte. So it worked out this time, and I’m just writing to encourage you to work on her fluid intake if appropriate.

The other thing to follow up on for future episodes, is their claim that only the head nurse can do a urine test?  Huh?  At Moms NH, the LPNs do a straight-cath collection, and the CNAs do it if the resident is well enough to do it on the potty.  So I would verify their policy when the dust settles.  
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Hello Mica, hope you're having a better day today.

While I am, in no way, experienced in facility care, I do hawk UTI testing. After seeing what it did to my Mom, I stay right on top of that. Since a UTI is simple to verify and easily cleared up, it's something I can be proactive with. Sadly there so many thing going on with our LO, that can only be managed, this should be squashed immediately. IMO.

I'm going to suggest adding a box of Azo test strips in with Mom's personal care items.

When you suspect an infection, whip one out and test her, right there. Then you have proof to show HN. If she fails to grab a sample for lab test, call an ambulance. I would NOT take her out myself to ER. I would absolutely make a big show of it! Staff refused to act and everyone will see it. It would go into her chart for later review by higher-ups. And I'd make damd sure they'd be seeing it!

I really have zero patience when it comes to my Mom's health carer's dropping the ball, and worse yet her NEEDLESS suffering as a result!

I was even like this with my sons, add their problems were always curable. But Mom already has so much she just has to "live With", that anything fixable should be done so right away.

Look everyone right in the eye when talking and listening. It's harder for them to try to sell you the BS, and let's them know you are dead serious. Plz keep us updated.
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My dad had continuous UTI's through out his life and while he was in a nursing facility, it wasn't any different. I often had one heck of a time getting them to do a culture unless he had a fever.

He was seen by the facility MD at one time when I suspected a UTI and nothing was done. Several days later he spiked a fever, was confused, etc. Took him to the ER and of course, he had a UTI ALONG with Sepsis.

Lucky to survive that bout..I was always religious about having cultures done on a regular basis through an MDs order.

With that..I will tell you that they don't do much in a nursing facility without an order. Every time I asked if my dad had a culture done lately (or anything else for that matter..INCLUDING him being a fall risk and 15 minute checks), they always asked, "Does he have an order?"

My reply was always, "Yep" as I had to call his MD FOR that order.

It stinks that as a caretaker for a loved one you have to be so on top of things all the time!! I loved 10% of the staff that took care of my dad there..and the rest, I had to nag at all the time. Hated being that way, but there was no choice. This was my dad and not some random stranger!!

So with that, I didn't work for the entire time my dad was in a nursing facility as I had to be on the ball and proactive regarding his healthcare constantly. Staff will tend to slip up all the time if they don't think you're watching. There were times I'd find dirty Depends in his garbage can, extra Depends laying around his room (it only takes ONE to change him), dirty clothes laying in his recliner lift chair, and even broken family valuable such as a broken family picture behind the couch in his room that nobody had bothered to clean up; along with broken things in the drawers next to his bed.

These things came from careless staff for one, whipping around the mat laid at the bottom of my dad's bed that knocked many things over; and the other one was slamming his drawers shut with their feet!! Yep..caught one red handed doing that one day when they didn't realize I was in the room sleeping on the couch in his darkened room.

While my dad spent thousands and thousands of dollars out of pocket for quite a few years at $5700 a month..I wasn't going to put up with any crap. Many respected me for it as I was always thankful for what they did; yet let them know or went above their head when they didn't.

As the previous post states, please learn as much about your family member's medical history as possible. The more you know..the more beneficial it will be to you if you need to take your mom to her MD, ER, etc., as the medical professionals look to you as the expert. Nobody will know your family member's health history better than you!!

Sending blessing and hugs.
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She seems to be rallying this evening, hopefully it isnt uti.... And yes, I cared 100% for my father till he passed and at the same time my mom. From their separate homes to nursing homes for over 10yr
My father died from UTI sepsis complications so i am really going to put my foot down about this.
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sorry but no. The "three day UTI protocol " is that they observe them for three days after a person appears to be acting abnormal.  They said they could not take the urine, only the head nurse could- and she refused to
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Jeanne, your comment on explanations and understanding is so true, and I think perhaps is a function of the knowledge gap between medical professionals and patients and patients' families.

That's a very good reason for patients' families to learn as much as they can so they can converse as close to possible on the same level as the medical pros. The same knowledge gap occurs in law as well.
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Sendhelp, I like your explanation of the urine sample and the 3 days it takes to for urine culture results to processed.

JoAnn29, I agree with you that ''micalost" needs "to go to the facility and see how her Mom is doing. If she doesn't look well YOU call an ambulance. Mom is a resident not a patient. She has rights and you have a right to call an ambulance... UTIs kill if not taken care of."

In regards to the "RN should be on duty in a NH all 3 shifts", that is true. However, the RN does NOT have to be performing resident care, she/he can be doing office work while at the nursing home. .
FYI: The RULE is that there needs to be an "RN IN THE BUILDING" 24 hours a day /7 days a week. There were times that I was working in my office doing Medicare paperwork and not doing patient/resident care. I was counted as "the RN in the nursing home" during the hours that I worked.

micalost, Please go to the nursing home and visit your Mom. If she isn't feeling well, then CALL for an ambulance to take your Mom to ER Dept NOW.
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You need to go to the facility and see how Mom is doing. If she doesn't look well YOU call an ambulance. Mom is a resident not a patient. She has rights and you have a right to call an ambulance. And, an RN should be on duty in a NH all 3 shifts. An AL, they are on call 24/7. UTIs kill if not taken care of.
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The world is upside down.
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The 3 day wait misinterpreted and misunderstood!
A urine sample is taken
If positive, it is sent for a culture to determine the correct antibiotic.
The culture may take 3 days.
In the meantime, a broad spectrum antibiotic is started immediately to treat.

Anyone professional caring for elderly KNOWS that a urinary tract infection does not present or show the usual symptoms of fever, but instead, major behavior issues a n d illness.

Do not wait to get care. It can be life threatening when it rapidly turns to sepsis.
Go to the E.R.
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jeannegibbs Jun 9, 2018
I wondered also, Sendhelp, if the 3 day wait referred to the lab results, not to drawing the blood and urine. Without knowing all the details it is hard to judge this situation. And I'll bet micalost doesn't know all the details because often care center personnel are not good at explaining things.

My sisters and I were very disturbed about what looked to us to be a very haphazard approach to Mom's new symptoms. Only after I had a uti myself, and had a doctor who could and did explain the whole process did I look back and understand what the NH was doing with our mom. If we'd understood it then we would have been a whole lot more patient and less disturbed.
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I share your pain. Getting Moms old Nurse Practitioner to order a urine test was always a battle (actually brought me to tears once, and I’m usually a battle ax) and had to go over her head sometimes. But I never heard of the 3 day wait...they wanted a few symptoms to appear like delirium, fever, dark urine, etc. The new NP is a little more relaxed about ordering it and accompanying bloodwork. 3 times I have been right, once wrong and it turned out to be dehydration. If her symptoms don’t get worse or even improve while you’re waiting for the big blessing for the test, you may want to try to pump some fluids like pediayte into her just in case it’s dehydration. Just a thought.
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Mica, I think an in person visit is in order, even though it's a weekend. I've never heard of waiting 3 days to do a UTI test. In my experience, it's done quickly so the antibiotics can be started.

Do you like this place otherwise? If not, you might hint at reconsidering the placement. If you mention contacting an ombudsperson, they'll circle the wagons.

You could mention that you're documenting though, or just take notes every time you go there. That usually raises the attention level and things improve.

Being found on the floor with dry heaves is to me a potential emergency and should have been addressed immediately. I get the impression this place doesn't have the best policies and that's reflected in the attitude of the staff. Anyone rude enough to tell you "I am busy" might not be very pleased with the facility, with her salary or with management. That's not an excuse though.

When you do get in touch with the DON or SW, ask for a care conference to discuss these issues AND develop alternate methods of dealing with them, methods that truly address your mother's health.
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Maybe the facility was short handed when you called. The industry does have a very high turnover rate.
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Micalost, your profile says you are caring for a friend who has diabetes. Are you also responsible for your mothers care? Wow.

Anyway, in my humble opinion, you are being blown off by your mother’s facility and you need to do something NOW. Facilities are open 24/7. My mom’s had a policy that people could visit all day and all night. Her care or lack thereof is not acceptable. This is not why you had her placed there. If she was on the floor dry-heaving and all they did was wipe her up and put her back in bed, that is not acceptable. How do they know “she is nice and comfortable “? I’m not a nurse, but I’ve never heard of a 3-day non-test rule.

You are your mother’s advocate. I know this is Saturday, but there still has to be a Charge Nurse on duty. Go to the facility and calmly but firmly ask, in person, whether the facility’s house doctor has been notified of what’s going on. How often are they checking on Mom? Ask them to check in with you on her condition every few hours. If they don’t, return in person and ask why you haven’t been called. No one, in a weakened and ill state, should be dry-heaving on the floor of their room. Do you know how long she was there? Had she rung for the nurse and no one showed? Is she eating? Communicating? How long is she awake? They can only blow you off if you let them. Don’t be afraid to speak up.
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