ED practicum

  1. I'm going to have my practicum at an ED both peds and adults.
    I would appreciate it if anyone would please let me know things that I have to be knowledgeable about to be a good standing student.
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    About nursing.mypassion

    Joined: Mar '11; Posts: 42; Likes: 17


  3. by   jammin246RN
    Learn the signs of a drug abuser lol. Seriously only about 5-10% of the patients that come through the ER are emergencies. Things to study up on are S/S of MI and acute cardiac symptoms, also abdominal pain and the possible triggers for it. For example Apendix, Abdominal Aortic Anyerism (misspelled sorry), Ischemic Bowel, Colitis, gallbladdar problems, pancreatitis. The two things that get patients admitted the most are abdominal pain and chest pain. Many of these problems are nothing to sneeze at, a triple A can rupture and the patient die before they know what's happening. You will see some kidney stones as well. CVAs are also a good thing to study on. Hope these help!

    P.S. Things I have seen come into the ER that you don't need to study on. Sneezing (sneezed 3 times and called the ambulance), physical (figured he hadn't seen the doc in a year and it was time to come into the ER), sun tan, meth mouth, taking the wife's trazadone to go to sleep after being up for a week on meth... made him feel funny, and a few other things lol.
  4. by   LoveMyBugs
    I did my practicum in the ED, seek out as much learning opportunites as you can. I was able to follow a STEMI into the cath lab and observe, got to participate with a concious sedation.
    I told all the nurses in the area, not just my preceptor that I wanted to practice my IV skills, so they all would come get me to start their IVs, and if they had anything interesting then they would pull me in to see
    One thing that my preceptor told me, was in practicum you are there to learn to be a nurse to learn the skills, when you are hired you will learn the job (as in the paperwork)
  5. by   MikeyBSN
    Jammin pretty much covered the basics, but since you are seeing peds as well you will encounter various types of fever babies. 95 percent will be simple viral syndromes. A few parents will bring their kid in during a blizzard because he "felt out" at home. You will also learn that no parent in the world owns a thermometer, I'm not sure how the thermometer companies stay in business. The thing you do want to brush up on is septic kids, so you can identify that 5 percent. FIB (fever in baby) under 12 weeks is a red flag for a septic kid.

    You also want to screen kids with lower belly pain for appendices. You can do this with the classic rebound tenderness, but another good non-text book clinical test is to simply ask the kid to jump up and down. Kids with an acute abdomen won't jump. You also want to keep meningitis in mind for a kid who only complains of fever, headache and neck pain.

    You will also likely see a lot of asthma in kids. You should listen to the lungs of every person you triage. Most of the time you will be giving nebulizer treatments to these kids so this will give you a good chance to learn how to set them up. Also, remember that respiratory is the leading cause of cardiac arrest in children. So you want to do a good breathing assessment on kids. You need to brush up on signs of RSV and pneumonia. You should pull up the shirt of every baby to look at how they are breathing and look at their nose to make sure they are not in distress.

    Lately, please, please learn pediatric vital signs and their values. If you work in a mixed ER, you really need to know this and unfortunately many nurses who work in mixed ED's and dread they days they are put in peds don't pay much attention to these differences and it makes that nurse and the hospital look really, really bad.
    Last edit by MikeyBSN on Mar 19, '11
  6. by   nursing.mypassion
    thx so much for all the helpful advice. I'm very thankful.
  7. by   ImThatGuy
    Be an ACLS kingpin and know how to throw a good right cross.
  8. by   Pixie.RN
    Quote from ImThatGuy
    ACLS kingpin
    Hahaha! I need that on a t-shirt for a friend of mine. Hilarious!
  9. by   nursing.mypassion
    thx so much for all the helpful pieces of advice I have received so far. I'm very thankful.

    I've asked my instructor about what to do for the first day of ED practicum but I received very vague answers. I've emailed and asked my preceptor a lot of questions and she appears to be a very nice lady. I don't want to annoy her too much by keeping spam-emailing her.

    I'm a little worried however in terms of what to prepare for the 1st day of ED practicum. Do you here have any ideas? I'm planning to bring with me my stethoscope, penlight, a small bag, an objective sheet, anything else to add? How should I present myself to my preceptor?

    thx so much ^__^
  10. by   Armygirl7
    When I did mine I also had bandage scissors, tape, my cheat sheet of normal lab values, different colored pens, and a big bottle of water! Stay hydrated!

    Just go ready for anything and follow directions! I loved the ED, it really felt like the RNs were in charge.
  11. by   nurse2033
    Don't forget trauma shears, very useful. I also carry my ipod which has epocrates drug reference. Just be ready to be flexible and expect to be overwhelmed. Good luck!
  12. by   Larry77
    A good preceptor will not expect too much from you...first shift should really be about observing how the ED works. So my personal advice would be to stay out of the way the first day and ask questions only when it's appropriate (do not interrupt pt care). Most important thing you can bring the first day is comfortable shoes :-)
  13. by   MesaRN
    This is what I send out to our senior students before their ER rotation:

    Items to Review

    Whether you have done a lot of IV starts or none at all, don't worry!! Learning is what the rotation is for! I just want you to be familiar with the procedures so you know how to measure the NG tube before we place it. Don't be nervous about skills, there will be ample opportunities to practice in a safe environment. Review these skills:

    IV starts
    NG tube placement
    OG tube placement (with a ventilated patient)
    EKG lead placement
    3 lead (red, white, black)
    12 lead placement
    Foley catheter placement
    Straight catheter placement
    ABG collection

    Remember, just a few important points about each. Why would it be used it in the ER?:

    Ativan (lorazepam)
    Haldol (haloperidol)
    Benadryl (diphenhydramine)
    Metoprolol (Lopressor)
    Versed (midazolam)
    Magnesium (what type of dysrhythmia is it used to treat?)
    Zofran (ondonstrone)
    Phenergan (promethazine)
    Cardizem (diltizem)
    Dilaudid (hydromorphone)
    Xanax (alprazolam)
    Valium (diazepam)
    Propofal (diprivan)
    Normal Saline
    Dexamethasone (decadron)
    Tordal (ketoralac)
    Rocephin (ceftriaxone)
    Activate Charcoal

    What drug do you use to reverse opioid overdose?
    What drugs on this list are narcs?
    What drug do you use to reverse benzodiazepine overdose?
    What drugs on this list are benzos?

    Systems Review
    Keep pathos short, I mean 10 words or less!!! Think about assessment!! You will be doing a lot of focused system assessments while in the ER.
    Common signs of an MI
    Remember MONA??
    What is Troponin? What does it mean if it’s elevated?

    Be familiar with the following rhythms:
    Atrial fibrillation
    What does supraventricular tachycardia (SVT) mean?
    Normal Sinus Rhythm
    Ventricular Tachycardia
    Ventricular Fibrillation
    Sinus Tachycardia

    What is shock?
    What are the four (major) types of shock?
    What is anaphylaxis?

    How do the kidneys regulate BP? (no long patho, just the big picture in 10 words or less)
    Common signs of a kidney stone

    How does the liver effect clotting (in 10 words or less!)

    GI/ Abdomen:
    Common signs of appendicitis
    Common signs of cholecystitis

    What is DKA? What are the common sign and symptoms?

    Common signs of a stroke
    Differences in treatment of hematic stroke vs ischemic stroke
    Common signs of herniation
    What is involved in a nuero assessment?
    What is a Glasgow Coma Score?

    Common signs of pneumonia
    Common signs upper respiratory tract infection
    Croup, RSV, bronchitis, pharyngitis (we see a LOT of these!)
  14. by   nursing.mypassion
    wow, thx so much for all the helpful and thoughtful advice. I'm so thankful.