Simple things new nurses or experiece nurses are not doing?

What are some signs of infection? Look at the wound is it red, swollen,is there any drainage? Is the patient coughing up sputum, what color is it? Are they turning on their own or do they need help? Encourage coughing and deep breathing. Use IS every hour while awake. Ambulate as soon as possible. Are they voiding, what color is the urine? Are they able to drink fluids? You can give Tylenol for fever above 101.0. Call the doctor and sometimes they will order blood cultures but usually it is related to not turning or using IS.

Pumps should be cleared every shift, depending on the shift ,12 hours or 8 hours.

[quote=WDWpixie;2946201]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?


This was one of my biggest question. At my first clinical site the patients and/or family had access to the kitchenette and would get sodas, water, coffee and jello whenever they felt like it. I thought this would play havoc with I & O's and never understood how they were expected to be accurate.

Interesting to read the things that you are saying nurses aren't doing. It's been eight years since I've worked but I hope to be back on the floor within a few months. At my last job, I worked on a pretty busy surgical unit. The nurses there pretty much all considered themselves to be "old school" and paid very close attention to detail, and I have to say, trained me pretty well. Our nurses were all about "taking the extra step", and went so far to make sure that their patients got a wet wash cloth to freshen up before dinner and were set up to brush their teeth before bed. Needless to say, I and Os were accurate for the most part, and IV pumps were cleared, or you heard about it.

Well, I had exposure to "clearing the pumps" this week, although I'm still a little vague. I also got big exposure in training classes to "all the little things" that leave us wide open to liability. Things that we wouldn't have to worry about if we're paying attention to "detail".

Thanks for enforcing that jandk!!

[quote=Quidam;2947101] I worked on a CV surgery step down and I&O was extra important. What I found was that the patients and families who use the snack and drink facilites the most are also more likely to keep track if they know better (i.e. you tell them to keep track). Some are happy to make a list, talley sheet, or keep containers for you. (Of course, confused patients and assistants who refill water pitchers too much can be quick path to a disaster)

We kept an I&O sheet in the room that techs and nurses could write on throughout the day- this can be a great system, if everyone is working together.
Make sure if you have assistants they understand why I&O is important and that they know the fluid levels for your facilities containers.

OK. I totally disagree with this entire response. I know opinions are like buttholes, but I gotta share my on this one.

First of all, a low grade temp is common in the first 24 hours post-op. It is your body's natural response to invasive procedures and stress. In my facility, we don't even treat with Tylenol until 100.5. The first temp, I don't treat at all. I monitor it. I don't want to be treating it if it's going to mask a problem. The first one should be left alone. If it creeps up over 101.5, start assessing your basics: are they using the IS, do or did they have a f/c, what does thier urine look like, have they been up yet? And for a temp of 101.5, our docs wanna know. And most of the time, they will order Blood Cultures, UA, CXR, and CBC. Cover the basics. Most post op temps are a body response.
As far as the I&O comment in this post, I would hope that you strive to make your I&O accurate. Telling your patients to save their beverage containers and monitoring how many times you fill a pitcher is easy to do. I would also HOPE that you clear your pump. Fluid balance or more importantly IMBALANCE is essential to be aware of. It is a HUGE part of post op care and monitoring. If you are not keeping accurate I&O you are doing your post op patient an injustice. It may not seem all that important, but ask a surgeon. If he's a good doc, he will tell you that he looks at his patients I&O and fluid balance daily. And he would probably not appreciate it if you told him that you "don't bother" clearing your pumps. If he didn't care how much fluid went in, why would he order IVF's????
And LASTLY, there is ALWAYS time for quality care. If there's not, you MAKE it. I take care of 7-10 post op patients 3 nights a week. These are Bowel resections, joint replacements, hysterectomies, heart caths. Serious surgeries, time consuming patients. And I ALWAYS have time to clear my pumps and do an accurate fluid balance assessment.

Like the above post said, you would think the docs would look at the I&O's. I just had a patient with an intake of 8100 and output of 3000 from the previous shift. I called the doctor and got no new orders. What's wrong with this picture?
I agree that I&Os are very important, whether you are on cardiac or not. I work neurology at a clinic and do a few med-surg shifts when my check book looks a little low.
My big thing too is when TEDs are not taken off for days even if they " look " clean!!!!
Or my favorite is when you have a CNA sitting with a patient and you go into the room and see the CNA sound asleep!!!! Yeah, like the CNA is going to put the NG back into my pts. nose.
I'm still a newbie but I do know the importance of I&Os, and how much the " little things " can do to improve patient outcomes. I was an LPN before. I know someone is going to say ther is no such thing as " little things".

As a new RN though I do value it very much if and when the more experienced RNs give advise/constructive criticism, let me know if I forgot something or did it wrong. Otherwise, you'll see me do it over again.
How will I grow as a new nurse without the wisdom of those with experience?

I am a wound and ostomy nurse. Things I see not done:

1. Patient comes in from (nursing home/other hospital/outpatient/whatever). There is an icky dressing on wound. Nobody takes it off to check it because "we thought you would want to see it". See what? A dirty dressing? This response has even come from ICU nurses, who have not touched a dressing for 3 days.

2. Patient has ostomy. It is leaking. RN or tech tapes it down to try to contain the leakage. I know that nursing schools don't teach ostomy care too much, but if you don't know how to change the pouch, ask somebody or ask me. I will be happy to show you.

3. Garbage all over the room. Can't somebody tidy up a little (RN or tech). WHen I was on the floor, I tried to tidy up and would take out icky garbage.

4. Foley catheters with stool on them, nobody is cleaning them off.


There. I feel better now.

Oldiebutgoodie

As a new nurse still precepting, I thought I had done the right thing in prioritizing my pts. Pt #1- having worsening CHF was having SOB needed Lasix but no order yet. Night nurse did not call MD. ( I did not say anything )Pt #2 - stable, Pt.#3 - pain issues, new for this pt. , Pt #4 - combative, yelling, ( has Down's syndrome ), going to surgery but nothing done ( came in day before ), pt#5 - has a blood sugar of 58 ( gave OJ and a breakfast tray ) recheck after 15 minutes blood sugar is 210 ????? ( pt has no hx in chart of high or low blood sugars ) So I put chart in staff support room to call MD , then my CNA comes to notify me that Pt# 1 has a respiratory rate of 35 and is c/o hard to breath ( I focused on that pt. and forgot about the blood sugar on pt #5 )By now it is 1030am. I get report on a pt#6 who " just had a lap-appy "- PACU says her behavior is a little off, well pt. comes up and is obtunded, responds only to a very firm sternal rub. I was one on one with this patient for almost 3 hours. I get out of that room and family wants to talk about Pt. # 1 change of condition. By now, it is almost dinner time so I have CNA recheck the blood sugar because trays are up and I might need to call the MD. ( I mistakenly heard the CNA say it was 108 ) She got called away and did not chart it right away. When I looked at the chart at end of shift, I saw blood sugar was 180. Darn!!!! So I am responsible but I wish that when nurses follow a new RN, that instead of yelling and making us feel 1 inch tall , that more experienced nurses would use constructive criticism instead.
I am new, not perfect. I will make mistakes and own up to them, but I don't think yelling or making someone feel like crap is the way to go.
Sorry for the long-windedness. Yes, shame on me for not calling, but I was taught that airway, breathing, and circulation was a priority. And that is what I did. Yet, my preceptor did nothing to back me up. No, I am not usually sensitive. I am only writing or as a reminder that when you come onto a shift and not everything is done, well, there might be a reason, so ask. If a new RN has made an err in judgement, give constructive criticism so we can grow and learn from your experience.

it never fails....and then you feel like a slacker.....