[Fiona59]

But that is what orientation is for. A time to learn the unit and it's habits. We routinely demonstrate to new hires how to do I/Os, clear an IVAC, mark an NG, read the measure of a chest tube. We stand there and ask the patients about bladder and bowel with the new hires and students right by us. They KNOW we ask these questions and when they come back to work on their own it's totally out of the window for some of them. I've lost track of the times patients have told me "it's only you older nurses that ask about my bowel and bladder"

[AWanderingMinstral]

Originally Posted by earle58

how do you guys address constipation?
given the amt of narcs most of these pts are on, do you give anything to prevent it?
or ask pt if they have gone?

leslie

I work in ortho and many of our patients have lived (for reasons I cannot understand) with chronic pain for months and years. As a result, their tolerance for narcotics is often VERY high. In addition, 90% of our postop patients come to the unit with either a morphine or Dilaudid PCA and then, after 24+/- hours, to oral pain medication. So, we educate our patients on the reason(s) for constipation and how to alleviate it ALL THE TIME. Most of our postop patients receive Colace BID and Senna at bedtime. In addition, barring any cardiac or nephro history, we push the fluids (both IV and oral). We also HIGHLY encourage patients to ambulate as soon as they are ready. We emphasize to patients that the constipation is secondary to anesthesia, decreased activity, decreased fluid and fiber/food intake), and narcotics. It's important to note that not all patients have bowel movements daily. As a result, we HAVE to ask them what is normal for them. Good luck!

[AWanderingMinstral]

Originally Posted by Fiona59

But that is what orientation is for. A time to learn the unit and it's habits. We routinely demonstrate to new hires how to do I/Os, clear an IVAC, mark an NG, read the measure of a chest tube. We stand there and ask the patients about bladder and bowel with the new hires and students right by us. They KNOW we ask these questions and when they come back to work on their own it's totally out of the window for some of them. I've lost track of the times patients have told me "it's only you older nurses that ask about my bowel and bladder"

While I respect the experienced nurses, a few of them on my unit are terribly disorganized and no one is assertive enough to say anything to them. My pet peeve is when nurses do not give pain meds at the end of their shift. I love being asked for pain meds as soon as I hit the floor.

[Fiona59]

PRN meds are exactly that. Patients turn them down, deny pain. We just don't give pain meds automatically. So if at 2245 a patient declines meds and rings and wants them at 2310, it's totally out othe previous shifts control.

[AWanderingMinstral]

Yes, they are PRN meds, but knowing this particular nurse, she's not inclined to do much beyond the minimum. In addition, there's a reason we consider ourselves to be drug dealers with retirement plans...we admin oodles of pain meds. OODLES!

[Quidam]

My foundations clinical instructor must have done a decent job then. She drilled the importance of assessing bowel and bladder and also the importance of I & O. We did not cover how to interpret I & O for IV's since it was 1st semester...but we will be doing a lot of that in fall semester and I will be sure to ask about that. This has been a really good thread and I appreciate the input from everyone.

[kcalohagirl]

how do you guys address constipation?
given the amt of narcs most of these pts are on, do you give anything to prevent it?
or ask pt if they have gone?

leslie

I work on a CTS floor. Our patients come out of the ICU on some pretty heavy-duty narcs.

If they haven't had a BM by the early morning of post op day 3, we do things like. . . .

Milk of mag + warmed prune juice + a splash of either coke or coffee.

disgusting, I know, but it generally works.

Or we have a PRN order for a dulcolax suppository.

If all else fails, we call in the Mag Citrate.

Since we are a post-op floor, our surgeons give us pretty much a free rein with what we think will make our patients poo.

One of the things I think new nurses should know is that a lot of "older" patients take laxatives, etc on a regular basis.
If they do on a regular basis, and you aren't giving them laxatives or stool softeners when they are in the hospital, bad things will happen.

And people may not be completely honest when you first ask them about their bowel habits.

(I think that is probably one of the first and most valuable lessons I learned. LOL)

[Ruffles 1]

Most fevers for postops are related to pulmonary, not infection. I&O's are never accurate, and most nurses don't worry about clearing pumps for IV's. Never enought time to do all the tasks when you have 5-6 patients.

[WDWpixieRN]

Originally Posted by Ruffles 1

Most fevers for postops are related to pulmonary, not infection.

Really? So if there's a fever and it's pulmonary-related, what else do we look for? And what gets done usually for this?

Originally Posted by Ruffles 1

I&O's are never accurate

Yeah, even as a student I had problems getting answers for how are accurate I & O's collected? My instructors had a difficult time with this one as it seems with various folks collecting food trays and water mugs being filled at various times, who knows who/when these are documented?

Originally Posted by Ruffles 1

and most nurses don't worry about clearing pumps for IV's

"Clearing" pumps? As in -- when? This might be a terminology thing, so pardon me if I'm sounding ignorant. I am just getting ready to hit the floor for graduate nurse training, so any and all help is appreciated!!

[litbitblack]

Originally Posted by WDWpixie

Really? So if there's a fever and it's pulmonary-related, what else do we look for? And what gets done usually for this?



Yeah, even as a student I had problems getting answers for how are accurate I & O's collected? My instructors had a difficult time with this one as it seems with various folks collecting food trays and water mugs being filled at various times, who knows who/when these are documented?



"Clearing" pumps? As in -- when? This might be a terminology thing, so pardon me if I'm sounding ignorant. I am just getting ready to hit the floor for graduate nurse training, so any and all help is appreciated!!

low grade fevers are usually helped with encouraged cough, deep breathing and repositioning. and ambulating. VIS is usually increased to every hour. The purpose is to continue clearing the lungs and keep them improving. Fevers that are higher usually the docs will order blood cultures

accurate i &o's are a little harder when the pt is eating and people keep filling their mugs. I usually tell the family that we are keeping track of what goes in and out and they are usually more than willing to help. Clearing the pumps is done at the end of shift or whatever the docs order for accurate IVF intake.