MunoRN 31,996 Views
Joined Nov 18, '10.
Posts: 7,588 (69% Liked)
I've only ever gotten report from the anesthesiologist, I'm not sure the OR nurses' report would be all that useful (no offense to OR nurses). What I need are general idea of what drips they've been requiring, any significant issues, etc. The doc shows up around the same time as the patient and that's where I get the details of what was done, getting that sort of information through what's more comparable to hearsay is just prone to errors.
I'm not getting the premise for arguing that ACLS is not within a nurse's scope. Generally, scope of practice is defined as a broad description of potential scope with exclusions specifically listed, is there anything that says ACLS, which falls under all state's broad scope definition, is excluded from nurse's scope?
I'm also not sure why people think an MD must be present, that's the whole point of ACLS is that a physician does not need to be physically or otherwise present.
Usually when the ER docs I work with get upset that a patient was sent in from an LTC it's because the patient had clear directives that they were not to be sent to the hospital. We also have a couple of nursing homes in the area that refuse to have any sort of bowel care protocol, so they end up coming to the ER for basic bowel care. Otherwise I think what you did was appropriate, whether an ED doc gets upset without reason isn't really your concern, your concern is your patients, not the Doc.
I don't think there's any reason to assume it had something to do with hanging a new bag, the patient's death was expected and progressing normally from what you described. On any palliative patient on a continuous morphine gtt, they will pass within some timeframe of a new bag being hung, there's no reason to correlate the two without an actual reason to do so.
Tegaderm is an occlusive dressing that allows for osmotic transfer of moisture and gasses through the dressing. It is "breathable", but does not actually allow for the free flow of air through the dressing, so for the purpose of preventing air embolism through an intact tract and open insertion site it is occlusive.
There is little true evidence on the subject, recommendations are based on 'expert' opinion which varies widely on this subject. The INS recommends using a petrolatum based ointment on/in the insertion site to prevent air embolism, opposing opinions point out that all petrolatum products carry an FDA warning that they should never be placed over an open wound or tract to a vein or artery, there have been reports of petrolatum emboli that have entered the vascular system through a central line insertion site, with at least on case resulting in death, so the balance of the evidence would appear to oppose putting ointment directly on, and therefore into, an insertion site.
Advertise With Us