MunoRN 27,737 Views
Joined Nov 18, '10.
Posts: 7,365 (68% Liked)
A 10 ml size plunger is only required when assessing patency, once patency has been established any size syringe can be used.
Unlike women's shoes, there aren't many mens shoes that come in all-white, so for nursing schools I got the shoes I need for my back in mostly white, and a can of white spray paint that works on leather and plastic.
Drugs that contain unstable chemicals often require glass ampules because the rubber cap of a vial with interact with the chemicals in the drug. Some chemicals are best stored hermetically (completely airtight) and while vials are generally considered 'sealed', they aren't truly hermetic.
I break the vial at it's neck with an alcohol swab or two, then draw it up using a filter needle.
I'd say in general that if you're worried about liability, then being too eager to hand the kid off to someone else isn't necessarily the best way to protect yourself or the facility liability-wise. Just because you get a-hold of someone claiming to be the kids uncle, and who enthusiastically says "I'd love to have an 8 year old girl spend the night at my house", doesn't make that a wise move in terms of liability.
Every place that I've worked has had some way of boarding both parents and kids. Typically, there is a unit or nearby units where one takes peds and the other takes adult medical patients. We don't board the kid directly, technically we refer the kid to CPS who then places the kid with us.
Anything tied to my patient is my responsibility? Their lack of insurance? Their inability or refusal to fill their scripts? Their lack of education? Their lack of housing? Their dog? Their utility bills? Their kids?
Nope, my role is to carry out the legitimate orders of the physicians and help the patients help themselves. Watching their kids, though? Nope, that's what CPS is for... Child ** Protective ** Service... which role requires education and experience very different than nursing.
When I had a mom brought in for meth psychosis, her kid was not my problem... and I refused any attempts to make it so.
While a peripheral may have two ports that doesn't mean it has two separate lumens, those two ports enter the same lumen.
I think someone may not be familiar with central line policies. Manufacturers for years have said that only 10 ml syringes or greater should be used for injections on central lines. The rational being that the smaller diameter syringes generate far more PSI than the larger ones, increasing risk for line rupture, and if a thrombus is occluding the line, blasting that thrombus straight into the patient.
PS - Personally I feel this is an out of date practice, and with the new lines someone should design a research study, and get some grant money to disprove it.
5.4 Assess central line patency using at a minimum, a 10 mL diameter-sized syringe filled with preservative- free 0.9% sodium chloride. Once patency has been confirmed, IV push administration of the medication
can be given in a syringe appropriately sized to measure and administer the required dose.
Discussion: Care should be taken when assessing for central line patency to avoid possible catheter rupture.
Manufacturers recommend using at a minimum, a 10 mL diameter-sized syringe for assessing patency because a
syringe of this size generates lower injection pressure. After patency has been established, however, medications
can be administered in a syringe appropriately sized for the dose of the IV push medication required.18 Many
facilities have created policies stipulating that a 10 mL syringe be used for all procedures involving a central line,
when in fact, it is not necessary to introduce risk through a syringe-to-syringe transfer in order to administer
Nurse's aren't generally allowed to strike either, at least not without certain restrictions. Legally, nurses have to provide adequate notice prior to going on strike to allow for temporary staff to be put in place, for patients to be moved elsewhere, or a combination of the two.
For jobs that aren't considered "safety sensitive", a drug test that is positive for drug but a valid prescription exists will be resulted as negative. Direct care nursing however is classified as a "safety sensitive" position, which means employers can test for certain drugs and be notified of a positive result with or without a valid prescription. So regardless of whether or not your employer chooses to actually prohibit certain medications even with a prescription, there is no requirement that prescribed medication use be kept secret from them which is the purpose of allowing a prospective employee sufficient time to present a valid prescription to an MRO. The test can be resulted as positive immediately, and then later clarified to be either with or without a valid prescription.
This illustrates exactly why Joint Commission strongly frowns on range orders.
IMO, your interpretation is incorrect. The order, such as it is, contains only dose but also frequency - and that frequency is every 4 hours.
I try really hard not to give either in the ICU, the use of benzos is strongly linked to ICU delirium, versed in particular should be avoided. It is tempting because you do get a period of calm, but then right back to the delirium and potentially making it last longer and be more severe. If the patient is vented we use primarily opiates, sometimes propofol, sometimes precedex, with a dash of benzo here and there if needed. For both vented and non-vented patients with delirium we usually use seroquel for hyperactive delirium, zyprexa for hypoactive delirium, haldol for when those two aren't cutting it, and we've started adding melatonin as well. Benzos certainly aren't completely avoidable, but we do try to minimize them.
There are certainly patients coming to the ED that need IV fluids, but a lot of it seems to come from the old ED wisdom that IV fluids and O2 can cure just about anything.
I have worked with an ED physician who claimed they get pressured by the inpatient docs to order IV fluids since that helps justify them ordering IV fluids which is one way to bump a patient's status from observation to full inpatient (so long as the fluids are ordered to run at 100 ml/hr or greater). Basically, this means that the physician who has to do the same H&P either way, can significantly increase what they get reimbursed for that H&P by justifying inpatient status instead of observation.
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