dumb questions - page 2
Hi I have a few dumb new grad questions. So if lab calls you at 3am and says a patient has gram positive cocci in their blood, and they all ready have it in their urine, which the MD's know about,... Read More
Nov 12, '05My philosophy is: When in doubt....CALL!!! Better to call and get yelled at for calling, than NOT to call and get yelled at for NOT calling. Either way...always take the route that BEST protects your license and the patient.
Nov 12, '05Quote from purplemaniaUnless I am mistaken the culture and sensitivity report will not be back for another 2-3 days after the initial report which can identify the type of bacteria but not the resistance or strain. We all remember microbiology where we had to gram stain and identify crap which just entails looking under a microscope but it took days to identify the exact strain and see what antibiotics it didnt grow around.Check the culture sensitivity report. If the patient is on the WRONG medicine I would call. Otherwise, I would not.
Different people will make different decisions but there really isnt enough information to make an accurate assessment.
In nursing school you are often told, you will be alone and you have to make your decision completely by yourself but in reality you usually have another rn, charge nurse or nursing supervisor you can confer with ALTHOUGH you retain the responsibility for the decision if it is your patient.
Nov 12, '05Quote from Mediatix8As to the C/S report, luckily, most of the time the micro dept. will not read the follow up culture until the microbiologist comes in at 0900 in the am. So,,, you probably won't need to be faced with this one.Hi I have a few dumb new grad questions. So if lab calls you at 3am and says a patient has gram positive cocci in their blood, and they all ready have it in their urine, which the MD's know about, and are on antibiotics, do you call the MD at 3am and tell him? Do you wait until later or do you not have to call at all?
Also, as far as MRI's and CT scans go, what does a pt have to be NPO after midnight for? What if CT scans do you need consents for?
Unfortunately, most new grads get put on nights when they have to begin to make decisions about when to call the doc. When in doubt, call. You can always go through your charge nurse or supervisor when you need a second opinion. But remember, the doc can't make a decision about information he doesn't have, so if something goes wrong, you will be the one with the problem.
Nov 12, '05I work days so I don't have this issue but I do know that when I tell a physician that the blood was postive for gram+cocci they are like "ok they're already on antibiotics, lets wait and check the sensitivity.
Nov 12, '05RE, the labwork. . .I would call the doctor as the last thing I did before leaving at 7am or 7:30am (the doc will be awake by then). If these blood cultures were done just before antibiotics were started and the patient's v.s. are otherwise stable, notifying the MD can wait a couple of hours until the sun rises.
RE: MRI's and CT scans. . .it is very easy to make a patient NPO during the night time. By 7am there will be someone in radiology who can answer your questions. Generally, patients need to be NPO for 4 hours before these scans if they are going to be injected with contrast or the abdomen is being scanned.
RE: consents for MRIs and CTs. . .same as above, call radiology after 7am. When in doubt, get a consent signed.
Look around on your unit for a radiology manual that might have the answers to your questions on MRIs and CTs
Nov 12, '05Your assessments count very much! And true if the patient is on ATB, perhaps the doc will give a stronger or combo of ATB's. Sometimes you will have pt's who are asymptomatic and will think not to call, but to be on the safe side, I would call at just to cya. Don't worry doc's already have in mind that they would be called in AM, PM or in the middle of their dreams. If you are in a situation like this, call because most likely you will go home thinking why i didn't call and if anything happens, you will be questioned on you judgement ability. Is better to be safe because when in court the MD would state "you should've called me and let me decide". Just be safe. Noc shifts are always an issue because the AM shift comes and have a lot of issues because they didn't want to wake up the doctor. So doctors take it out on the next shift. But then you have great night nurses too that really care about the patient.
Is not just "they are on ATB", it depends on what kind of infection. This one that you are talking about is very risky. Plus treat your patients and do what you would like to be done for your loved ones.
Nov 12, '05This is important for the physician to consider but not at 3am. If the patient is sleeping just fine, and I would assume nothing was wrong or you would have mentioned it, having him paged at 7am would be right. If the physician had not called back by the time you were ready to leave, just pass this on to the nurse taking the patient to report when they call in. And of course DOCUMENT!
Nov 12, '05I agree with those that have said that there are no dumb questions...
That said, I would not call for that report...Waiting for 4 or 5 more hours for the doc to show up isn't going to make a change in the patients outcome...even if they are on the wrong abx (and you don't have another one due), I wouldn't call...even if they had another due, I still probably wouldn't call...but that is me- as someone else said it is better to call than not to if you feel you should (or, of course, if there is a direct order to call results). Each situation is independent of other though, and most of it for me relies on how the patient looks, what my vs are, etc...never forget to look at your patient and not just the "numbers" ....and if you do call, make sure it is a new situation- not one they have been monitoring for a week... I would call if someone was showing obvious signs of sepsis and that lab happended to back up what clinically was going on (pt. shocky, hypotensive, fever, etc)...