Latest Likes For alibee

Latest Likes For alibee

alibee 2,741 Views

Joined May 18, '11 - from 'New Jersey'. alibee is a Registered Nurse. She has '2' year(s) of experience and specializes in 'Surgical/Stepdown, Home Care'. Posts: 49 (35% Liked) Likes: 29

Sorted By Last Like Received (Max 500)
  • Sep 21 '15

    Hi there! I started as a new grad on a surgical/step down unit and I love it (it's been eight months now that I've worked on my floor). It can be extremely overwhelming at times, especially working day shift, but you will learn a lot and your organizational skills really pick up. There is so much that you'll learn, but I'll try to give you a couple of the routine things that I've learned in my short time

    1) The incentive spirometer is one of the most important pieces of equipment that you'll see. Post-op patients need to be using this every six to ten minutes (or one a commercial) while awake. This machine helps to keep the lungs strong and prevent fluid from settling and causing pneumonia. I'd say about 95% of the time when patients on our floor develop a fever, it's because they're not using their IS enough. Reinforce teaching and encourage use, and temps will usually return back to normal. This little device is an integral part of surgical recovery.

    2) Ditto flowtrons. Generally, if they're in bed and it's not contraindicated for some reason, flowtrons are on. Period. If a patient doesn't like them, just educate them on how it's for DVT prophylaxis - they're usually amenable after that (no one likes blood clots!), and if they're not, you just put in your note that you educated the patient on flowtron use and they refused.

    3) Triple check your PCAs. This is one thing that I've become neurotic about. If I have patients with a PCA, I'll grab the narc keys and verify the syringe and rates first thing. When I hang a new syringe or change the rate, I always have another nurse double-check me. We recently had a nurse on our floor mistakenly hang a Dilaudid syringe instead of Morphine in a PCA (and the hourly lockout was entered at the morphine rate of 7mg/hr) - the patient ended up having to be Narcan'ed and the RN was suspended. It's real easy to overlook things when you're on a busy floor, but PCAs are one thing to definitely take the time to triple check.

    4) Your fresh post-op bariatrics are going to be nauseous. This is normal. However, if they vomit, that's bad. Call the doctor right away.

    5) Try to get a pain management routine down. Surgical patients are generally in a lot of pain. You can't completely get rid of their pain most of the time, but we want them to generally be at a 3 to 4 at most ideally on a scale of 1 to 10. Also, an hour or two prior to change of shift, check your patient's pain levels, explain that change of shift is coming up, and medicate if needed prior so that the oncoming nurse isn't slammed with 6 people asking for pain meds at once. Your change of shift RNs will appreciate it!

    6) A good brain sheet is going to help you out so much. Esme has some awesome ones that she links if you do a search, but organization is huge on a med/surg floor.

    7) Finally, being empathetic and working hard for the patient can help make up for your lack of experience. Show caring and kindness, and help that patient as much as you can through their recovery. Go that extra mile. Even though you don't have the experience that other nurses have, that patient will think that you're a great nurse.

    All in all, it's a very hectic job, but I personally love it and I think you'll learn a lot working on a surgical floor. Hopefully some of the more experienced nurses can offer some more tips - and utilize the experienced nurses at your jobs, too! They know a hell of a lot, and if you can find your "Yoda," learn everything that you can from them. If you're concerned about something, but not sure whether it's a definite cause for concern, have someone with more experience come in and give their opinion. Best of luck to you!

  • Jul 12 '15

    I can provide some input into surgical nursing. The majority of my patients fall into four categories: Surgical/Oncology (ie: masectomies, ostomies, thoracotomies, etc. related to cancer diagnosis), vascular surgery, bariatrics, and every other surgery is lumped into General Surgery. I also see a lot of potential problems that could escalate into surgeries (ie: partial bowel obstruction). My wound care skills are pretty awesome at this point. Med passes aren't terrible unless a patient also has high blood pressure/blood sugar issues (usually just lovenox/heparin, protonix, colace, and pain meds). You manage a lot of chest tubes, NG tubes, and drains of various types. I occasionally get people with DVTs who need a heparin drip. I don't see a lot of trachs. But for the most part, you help get your patients recovered and ready to go home, while monitoring for any potential post-op complications (Is there an infection? If they had their gall bladder taken out, is there a bile leak?).

    "Ideal" day goes:

    - Get there a little early and check 6am vital signs and patient summary.
    - Get report
    - Quickly go into each room and introduce yourself, check pain levels, and make sure your patient is breathing Let them know you'll be in soon to see them. Do blood sugar coverage as needed for breakfast.
    - Check labs and orders while pharmacy restocks the omnicell between 7:30 & 8:00.
    - Assess your patients and do your morning med pass. Make sure lines are patent by flushing, check your dressings, wounds, and drains.
    - Discharge rounds with the MDs/NPs, home care, PT, pharmacy, and social work, where you update them on patient progress, figure out who needs consults where, and approximate discharge date.
    - Chartchartchartchartchart.
    - Lunch insulin coverage. Review labs, orders.
    - Afternoon med pass
    - Dinner insulin coverage
    - ALWAYS check your patients pain levels, but be sure to do it around 6:00 pm so they're okay during change of shift. Hang new bags of fluids for night shift so they don't hate you.

    In addition to this, you'll be juggling patients on the call bell needing everything from pain medications (after surgery, patients HURT!) to assistance getting up to the chair/to the bathroom/etc. A lot of patients will be very anxious and need more education/reassurance. You'll have admissions and discharges throughout the day because surgical patients usually don't stay long unless it's a major surgery or there are complications. You become a master of multitasking as a surgical nurse.

    The downside? Dealing with gods--I mean, surgeons. (actually tbh, they're pretty good at my hospital--especially the residents). Hopefully someone else can come on here and give you a medical nursing perspective -- I'll get the occasional stage IV bedsore overflow onto my floor, but it's rare.

  • Jul 1 '15

    I can provide some input into surgical nursing. The majority of my patients fall into four categories: Surgical/Oncology (ie: masectomies, ostomies, thoracotomies, etc. related to cancer diagnosis), vascular surgery, bariatrics, and every other surgery is lumped into General Surgery. I also see a lot of potential problems that could escalate into surgeries (ie: partial bowel obstruction). My wound care skills are pretty awesome at this point. Med passes aren't terrible unless a patient also has high blood pressure/blood sugar issues (usually just lovenox/heparin, protonix, colace, and pain meds). You manage a lot of chest tubes, NG tubes, and drains of various types. I occasionally get people with DVTs who need a heparin drip. I don't see a lot of trachs. But for the most part, you help get your patients recovered and ready to go home, while monitoring for any potential post-op complications (Is there an infection? If they had their gall bladder taken out, is there a bile leak?).

    "Ideal" day goes:

    - Get there a little early and check 6am vital signs and patient summary.
    - Get report
    - Quickly go into each room and introduce yourself, check pain levels, and make sure your patient is breathing Let them know you'll be in soon to see them. Do blood sugar coverage as needed for breakfast.
    - Check labs and orders while pharmacy restocks the omnicell between 7:30 & 8:00.
    - Assess your patients and do your morning med pass. Make sure lines are patent by flushing, check your dressings, wounds, and drains.
    - Discharge rounds with the MDs/NPs, home care, PT, pharmacy, and social work, where you update them on patient progress, figure out who needs consults where, and approximate discharge date.
    - Chartchartchartchartchart.
    - Lunch insulin coverage. Review labs, orders.
    - Afternoon med pass
    - Dinner insulin coverage
    - ALWAYS check your patients pain levels, but be sure to do it around 6:00 pm so they're okay during change of shift. Hang new bags of fluids for night shift so they don't hate you.

    In addition to this, you'll be juggling patients on the call bell needing everything from pain medications (after surgery, patients HURT!) to assistance getting up to the chair/to the bathroom/etc. A lot of patients will be very anxious and need more education/reassurance. You'll have admissions and discharges throughout the day because surgical patients usually don't stay long unless it's a major surgery or there are complications. You become a master of multitasking as a surgical nurse.

    The downside? Dealing with gods--I mean, surgeons. (actually tbh, they're pretty good at my hospital--especially the residents). Hopefully someone else can come on here and give you a medical nursing perspective -- I'll get the occasional stage IV bedsore overflow onto my floor, but it's rare.



close
close