Sharing Helpful Hints in 2002

  1. I was posting a reply on another thread and thought this might be a helpful idea for a new thread. The reply was something a cardiologist told several of us nurses twenty years ago. Standing at the CCU bedside, the doc asked, "what do you see wrong with this patient?" We all looked and really tried to find something amiss. The patient was awake and alert. We didn't see anything out of order. The doc said "Look at his face, especially his forehead (hairline). He is perspiring. It is not normal to perspire in an air-conditioned building. Anytime you see a patient who is indoors and perspiring, they are ill and you should suspect cardiac involvement. Although this patient denies chest pain, he is having an M.I. You are witnessing an M.I. in progress." This simple lesson has been very beneficial to me and to a lot of my patients over the years. They do not have to be soakin wet diaphoretic...which would be kinda obvious. If your patient is sitting or lying with beads of perspiration--- re-assess! I'd love to hear your helpful hints...one of my resolutions for 2002 is to be a more knowledgeable nurse by 2003. And where better to learn and share than on this BB?
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  2. 8 Comments

  3. by   prn nurse
    Another bit of information that has been useful to know is: Several docs in MICU discussing IDDM with the nurses, they said: "" 50% of all insulin dependent diabetics will have adverse consequences of their disease regardless of what they do. Even if they keep their blood sugars at normal levels -- 24/7 365 days a year, eat right, exercise, monitor their glucose, see their doctors----do all the right stuff...50% WILL STILL have complications.""
  4. by   Rustyhammer
    When a bilateral bka goes out on a date... he almost ALWAYS gets stood up!
  5. by   dawngloves
    Oh Rusty!!! GROAN!!!!!!!!!!!
  6. by   nightingale
    I really love starting IVs and am so proud of myself when I have suceeded with a difficult one the first stick. I get all my equipment in easy reach, prefer using a chair and get up close, take my time, and look at both arms... one of my favorite tools for relaxing a patient is telling them how much I enjoy doing these and ease into a conversation about their history with IV starts and I learn a lot about the patient this way...

    I have recently run into (because I work Agency and float to different hospitals) those needles that have a button release on them for when the needle is in and you can remove the sharp. Does anyone have any tips on how to remove the sharp successsfully keep the IV start in? Do you float the remainder of the needle in without the sharp? When I pierce the full sharp and needle in I think I inadvertantly poke through the other side of the vein and infilltrate. I did ask a nurse on the floor for help but was basically poo pooed and told "they didn't have a problem with them". Well... I do.. any suggestions?

    B.
  7. by   Harleyhead
    When you have entered the vein and get a flashback insert a little more then advance the rest of the cannula while the tourn. is still inplace. Then make a peace sign put pressure with the 3rd finger just beyond the cannla tip. Take the 2nd finger and hold down on the hub of the cannula. At this point push the button to release the neddle back into its protectve sheath.The 3rd finger keeps the blood in the vein and cannula and not on the bed, the 2nd finger keeps the cannula from being pulled out during the release of the needle. I hope this helps.
  8. by   nightingale
    Thanks Harley: Can't wait to try your tip... I knew I had "probably" dislodged the sharp (from the movement which is beyond your control when the button is pushed).... cool tip thanks again! B.
  9. by   dbscandy
    I am one of the nurses in my NICU who is inserviced to try these new catheters..I LOVE them! But they do take a bit of practice to get the feel for them.

    Once I have the flash in the catheter, I advance the needle just a fraction more to insure having a portion of the catheter in the vein, then I gently begin slipping the cath in and holding back the needle. When the catheter is all the way in, I hold the cath with my left hand and as I'm withdrawing the sharp, i snap the button to retract it. I can then just toss it aside as I reach for my extension set.

    The nurses having trouble with these seem to be retracting the sharp too soon and not having the cath into the vein far enough yet.

    I've only missed one stick since I started using this wonderful invention 3 months ago....absolutely hated the one with the little house that closes over the end of the sharp as it comes out.

    Hope this will help.
  10. by   mattcastens
    One of our cardiac surgeons gave an informal talk on how to identify shock states without the handy monitors that we critical care nurses love so much. I was just a new ICU nurse listening to him and his information has helped a couple of times when "numbers" weren't available. This is by no means a fool proof system, but it can certainly guide you in the right direction:

    1. Feel the big toe, if it's warm, think septic shock.
    2. If the big toe is cool, grab the legs and lift them in the air. If BP improves, think distributive shock (i.e hypovolemia)
    3. If BP does not improve with elevated legs, think cardiogenic shock.

    Not definitive by any means, but as I said, it can guide you in the right direction.

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