dumb questions

[mediatix8]

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?

[HappyJaxRN]

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?

YOU can call the MD at 3am...he he he...No. Don't call the MD unless you need an order for something that can't wait until they arrive the following morning...or it's a reasonable hour. I would also make sure what the policy is that the facility that you're working on. But 9 times out of 10, you wouldn't call.

As for MRI's and CT's, your facility should have a protocol as to which procedures the pt is to be NPO for. If someone is having an MRI or CT of the ABD, you can count on that they will be NPO. If they are going to have an MRI of the leg, most likely not. But it's up to your facility.

At my hospital, you need a consent for everything. Our patient's consents are signed at admission, however, if they are going to have an invasive procedure like placement of a JP (Jackson-Pratt Drain), then yes, they will need a new consent. Your facility may be different.

[Noryn]

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?

That scenario requires a bit more information I would think especially the patient's condition, how long they have been on the antibiotics (and if it was IV or PO) and the capability of your institution. If the patient came in and was diagnosed with a UTI, was put on antibiotics 5 days ago and now has either bacteremia or sepsis then I would probably call.

The biggest factor though in my opinion would be the patients condition--if they had a fever, tachycardia, or hypotension I would be on the phone in a heartbeat. Septic shock hits fast in my experience. Also I have worked in hospitals in which I was not able to get a broad range of antibiotics in the night.

Some doctors make rounds later in the day so the doctor probably needs to be called--whether or not you can wait a few hours just depends.

In my experience with CT scans you need consent usually for the contrast although facility policy will differ.

The answer to your first question can go either way. A lot of times in the medical field there is no right or wrong answer. Chances are you can start an IV antibiotic now or wait 10 hours with no real harm. In my mind though it will be at least 5 hours if you wait for dayshift to call and I would feel a lot better knowing that this problem was taken care of completely by me. Also most labs now chart that they notify you by name and time, if the patient were to develop septic shock the lawyers would have you, if you waited. You were notified of an infection in the blood at 3am yet you didnt call until 7am.

UTI's dont scare me like sepsis does.

[General E. Speaking, RN, RN]

there is no such thing as a "dumb question" especially when nursing is concerned! I agree with the other posters above

[Jolie, BSN]

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?

Gram positive cocci in the blood would warrant a 3am phone call in my mind.

[elkpark]

Bacteremia is a much more serious problem than a UTI, esp. if the patient has already been on antibiotics for the UTI for a while and the bacteremia is a new development (i.e., the abx aren't helping the UTI and the problem is getting worse instead of better ...).

[nurse_clown]

:uhoh21: i've been working in a hospital for three years. i think i'm still asking dumb questions. i also think i've been asking the same questions three times.

[unknown99, BSN, RN]

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?

#1. There are NEVER dumb questions!! The questions are how you learn.

#2. No, no need to call the doctor at that hour, unless you have a deathwish!! Already on ATB's... can wait until the doc does rounds later.

[Bipley]

#1. There are NEVER dumb questions!! The questions are how you learn.

#2. No, no need to call the doctor at that hour, unless you have a deathwish!! Already on ATB's... can wait until the doc does rounds later.

Well, no need to call the doc at 3AM unless it is a creepy resident with an attitude about nurses. Then you ALWAYS call!

[purplemania, BSN, RN]

Check the culture sensitivity report. If the patient is on the WRONG medicine I would call. Otherwise, I would not.

[BeenThereDoneThat74, MSN, RN]

you're probably even more confused now, as half of the respondants said yes and half said no. i would go with 'yes', only b/c in my experience i've been on the day shift side of a nurse not calling about a situation (fever in a severely neutropenic pt). the doc had a cow, an started babbling about gram negative sepsis (which is worse that gram +). and i agree with the point that whatever the pt. is on already is probably not working (or he wouldn't have it in the blood now).

cts and mris that require pt being npo are usually for contrast and/or sedation.

[Audreyfay]

Check the culture sensitivity report. If the patient is on the WRONG medicine I would call. Otherwise, I would not.

I agree with this one.