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- Aug 6 by SubSippiThanks for all the great advice, keep it coming! After my first couple weeks with my preceptor, I haven't made a (major) mistake, but right now I'm so paranoid I'm quadruple checking everything I do. I did incorrectly connect a syringe of morphine to my patient's IV and pushed it out all over him, but luckily he was nice and my preceptor is amazingly calm and patient.
- Aug 6 by Clementine1Great thread! Applying to jobs now so will reply soon.
- Aug 6 by newkidnurseDepending on how report is done on your unit, these things may/should already be givens... But these are a few things that I've come to find realllly important.
1) check the I/Os. First, see that they're appropriate (regarding mL/kg/hr for output) and second, that they were actually documented. My real life learning situation: RN giving report says "yea he's been eating and drinking well". But not until a few hrs later did I see intake for that shift was recorded as ZERO. Way easier to rectify when the off-going RN is still on the unit!!
2) check the most recent vital trends. Off-going RN says "yea she's been afebrile, signs stable". Until you go to chart and see that the HR has been stable, at 130s...for a 13yr old... (was he agitated? upset? in pain? tell me more so I can appropriately assess his next set of VS...)
3) check the meds. even if you can just eyeball them at this point. Find out why anything was held (off-going RN: he's been having diarrhea all day, so we're holding miralax) or see if anything was missed. Sometimes it wasn't charted correctly (we've had increasing problems with the computer either not saving or running out of power mid-med admin... problematic? yes!), or was accidentially skipped. If it's a fresh post-op, double check whether the off-going nurse has already retimed any meds (ie-the antibiotics)--if not, find out when it was given intraop. Easier to get this info from the RN who learned it in report than by sifting through the file yourself...
4) For peds, is the family there? Are they helpful/hands on?
Ugh-As much as I love giving this advice, I hate that it reminds me how report on my unit tends to be/IS way less organized than it should be!!! Mid-New years resolution = improving that. Stat.
Other advice not tied to report: Get a full set of signs EVERY TIME you call a doc for a concern or semi-concern. Not for a "your fluid orders are conflicting" kinda call, but then again, you might wish you had a fresh set of vitals then, too
PS- pretty much every shift I do, I learn something that changes the way I practice, even in just a tiny way! Good luck!Last edit by newkidnurse on Aug 7 : Reason: added
- Aug 17 by SNB1014I had coke sitting In a peg for hours and it wouldn't unclog. So I called the attending to notify of my interventions and still no luck. So an hr later she makes rounds and if I see the a DR go in my pt room I always try to follow in. So this pt is mrsa+ and thank god we gown up.
We are hovered over the bed and I go to " show her" just how clogged this peg is by attempting to flush it. Well I had it clamped below and it bulged badly just like before.....except this time it bursted wide open showering me, the attending, the pt, the clean sheets, walls, cabinet and mirror with exploded peg gunk and flat coke.
We had a laugh about it , after I screamed and ummm she agreed for. GI consult to fix the peg.
Tips: -when " playing with/ fixing" a peg, wear a mask!!!
- make sure the clamp is clamped before you withdraw a syringe and unclamped when delivering Rx/ bolus cuz it will back flow/ burst.
Feeding by gravity gets dangerous.....I had a pt cough while the gravity feeding ( how they * tell you* is best practice* and it overflowed all over.
- keep a big towel/ pad to cover the pt and your clean sheets just in case
:-)Last edit by SNB1014 on Aug 17
- Aug 17 by calivianyaIf you are putting crushed meds in water/whatever through an NG, OG, or PEG... for god's sake hold on to the tube and the syringe together! If you just have the syringe sitting in the tube, and the crushed meds clog up the tube and you apply extra pressure to the syringe, the force of the pressure WILL separate the tube and syringe and send the contents of your syringe flying all over yourself and your patient. Just remember that you want the meds to be in the patient's stomach, not all over your scrubs...
- Aug 17 by FutureCRNA?Quote from calivianyaI JUST did that while filling the balloon on a Foley. I sprayed saline all over my face & the patient. I very quickly reassured him (and myself) that it was just saline and not urine lol. But I learned my lessonthe force of the pressure WILL separate the tube and syringe and send the contents of your syringe flying all over yourself and your patient.
- Aug 17 by janfrnQuote from FutureCRNA?Please don't use saline to inflate the balloon on a Foley. Use sterile water. If the Foley is in for even a couple of days the salt in the saline will crystallize inside the balloon, making it difficult or perhaps impossible to get it back out. Having had a urethral injury from a Foley myself, I can testify that it's no fun. For a long time.I JUST did that while filling the balloon on a Foley. I sprayed saline all over my face & the patient.