Latest Comments by Lev <3

Latest Comments by Lev <3

Lev <3, BSN, RN 40,723 Views

Joined Jun 3, '11 - from 'Another planet'. Lev <3 is a ED Registered Nurse. She has 'A few' year(s) of experience and specializes in 'Emergency - CEN, upstairs, troll bashing'. Posts: 2,529 (52% Liked) Likes: 4,673

Sorted By Last Comment (Past 5 Years)
  • 0

    Quote from tolojede1
    1.Acute pain secondary underlying infection
    2.pain subside,fever also subsided,able to communicate well with nurse and family etc
    What is priority? There is no specific mention of pain.

  • 0

    Quote from pkleespie
    Thank you for replying. I'm sick over it all right now. For tests, will I be given random symptoms and have to know whats wrong? Or lab values and know whats wrong? I know I could learn many but I am scared that I will be thrown random information (symptoms) and know whats wrong with someone. I'm mainly scared about Health Assessment right now. When you took health assessment, did you attain all the sounds, values, vitals, and more and know what could be wrong with someone based on a cluster of cues?
    Sometimes questions will be in the form of scenarios sometimes, straight out questions such as signs and symptoms of a particular electrolyte imbalance. As nurses we do not diagnose in the medical sense. I would focus on knowing signs and symptoms of common disease state such as pneumonia or kidney stones. It's important to understand the pathophysiology of the disease state. This will help you remember the associated signs and symptoms and lab abnormalities. Health assessment class is more about memorization than practical application. You learn lung sounds best by listening to an actual patient. It is important to know your vital signs inside and out especially for different age population groups. Some knowledge will come with practice and with your specialty.

  • 0

    Practice issues, new staff greets, review of new policies, reminders for education that is due, communications from management/higher ups etc etc.

    What did you talk about at the staff meetings at your old job?

  • 2
    Rose_Queen and poppycat like this.

    What are your thoughts on this case?

  • 0

    I worked on a post surgical floor and really enjoyed my time there and learned a lot! Our floor had a little bit of everything. Ortho, plastics, GI, GYN, Bariatric etc. Once you get the hang of it you will find comfort in the familiarity of post surgical care for various types of surgeries. Once I reached a comfort level and things started feeling routine I left because I crave the new and interesting and get bored quickly, but some will find comfort in the routine. The floor will definitely be busy. You will have to walk patients, deal with their pain, give blood transfusions, manage NG tubes (if you get the GI issues). It is a great place to learn.

  • 1
    NurseEmmy likes this.

    You will learn as you go along and practice as a nurse. You will not have to know it all for nursing school. Typically the teacher will focus on certain disease states at a time and may mention specific lab values which will be off. I wouldn't worry. Just do your work, read your book, and study what you are told to study and you will be fine.

  • 1
    Dunkingirl likes this.

    You will have an orientation to teach you the basics. You have another year of school left to interact with patients. You will not be a master of anything when you graduate. Mastery takes years of practice. Being scared is normal and accepted. With competence comes comfort. Keep doing what you're doing and you will be fine.

  • 0

    I agree with the above posts. Consider speaking with a therapist and also try to desensitize yourself by using the supplies or playing with them. Take home a foley kit or straight cath kit, get some IV supplies, play with some NG tubes. That is what they do with the little kids. Let them play with the syringes and stuff.

  • 0

    Ask for daily and weekly feedback from your preceptor so there will be no surprises.

  • 0

    I think triage time can depend on what is going on and how detailed you want to go with your questions to figure out what the "real" problem is.

    Some nurses include one sentence (or just a phrase) in the chief complaint. Others have details like denies xy&z. Sometimes you have to probe beyond the "story" to figure out how to accurately triage the patient. That can take more than 3 minutes.

    Sometimes a patient can't talk.

    Also, do you do assessments as part of triage - i.e. listen to lung sounds?

    I don't think triage should take more than 10 minutes. Sometimes I spend 2 minutes triaging a patient, sometimes 15. It really depends on what else is going on. I have gotten patients with a 5 word chief complaint who had a ton more going on and should have been triaged higher. Maybe if the triage nurse had probed a little more they would have gotten back sooner.

    My 2 cents.

  • 0

    We treated one of our former nurses and she ended up dying later from complications.

  • 0

    Quote from jgardner
    Aside from mental status, those questions all relate to changes in vital signs. That is a tremendous waste of time for an RN to fill that out for each patient. However, if you could create a computer program that looked at those trends and then "popped up" with a box that alerted the nurse to a change, then that *might* be helpful. The vitals are already in the computer so it seems like it might be pretty simple to just design a program that could look at those trends instead of creating additional workload for an already overloaded nurse. You basically want the RN to re-enter info that is ALREADY in the computer. Ummm....not helpful.

    What would be very helpful would be getting behind legislation that set mandatory RN-to-patient ratios. It's been done in CA. And there are other states where even though there isn't a set ratio across the board, there is a statute in place that requires that a panel of RNs set a realistic ratio in each facility--I believe WA state participates in ratios in that manner.
    Most of the basic questions do relate to vital signs - however, there are many sub questions which would pop up to determine if there is a quick treatable reason to the changes in vitals signs and to determine if these are truly "danger signs" or just the patient's baseline. It uses more nursing judgement than just a computer program spouting out abnormal vital signs. It also incorporates urine output. A computer program would depend on a CNA documenting I&O in a timely fashion which as we know does not happen as frequently as it should in real life. Is is easier for the nurse to ask the patient if they have used the bathroom in the past 6 hours.

    I am all for better nurse to patient ratios, however it took California 20 years to get those ratios and that was in just one state!

    It is designed to take about 10 minutes or less to fill out once the nurse gets the hang of it. Like I said, some other form of "petty" documentation should be taken away before implementing this.

  • 0

    Quote from DeeAngel
    The solution to the issues you describe is a simple and basic one that can be easily remedied if the powers that be were only willing to do so.
    But they aren't....that is the story of nursing.

  • 0

    This is the algorithm I came up with. It is not indended for use in the critical care setting. It is indended more for adult med-surg and telemetry units. It does not replace a nurse's knowledge, it encourages it. Critical thinking is meant to be used along with it. I'm not saying that anyone needs to be told to do simple things like "treat fever" just because it is included as an option in the algorithm. However, there are some things we can do before notifying a provider - either the attending, surgeon, PA, NP, resident, or rapid response team. Note: in some situations - depending on the facility- the rapid reponse team is supposed to be activated. The idea is that someone should be notified right away and if you can't get ahold of Dr. Hoity Toity - then a rapid response should be called. The nurse should use their clinical judgement to decide if the rapid reponse team should be called NOW or if the patient can afford to wait till a provider is reached. Please let me know your thoughts.



    1. Has the systolic blood pressure (BP) increased or decreased by 40 mmHg in the past 12 hours?
      • If YES, answer the following question:
        1. Is this an expected response from administration of medication (i.e. antihypertensives, antioxiolytics, or analgesics)?
          • If YES, continue to monitor patient.
          • If NO, notify provider IMMEDIATELY.

      • If NO, move on to the next question.

    2. Is the systolic BP less than 90 mmHg
      • If YES, answer the following question:
        1. Is the patient experiencing dizziness, lightheadedness, or decreased mental status?
          • If YES, lower head of bed if tolerated and notify provider IMMEDIATELY.
          • If NO, answer the following question:
            1. Has the patient’s systolic BP consistently been between 87 and 90 mmHg in the last 12 hours (view trend)
              • If YES, continue to monitor patient.
              • If NO, notify provider IMMEDIATELY.

      • If NO, move on to next question

    3. Is the systolic BP greater than 160 mmHg or diastolic BP greater than 100 mmHg
      • If YES, answer the following questions:
        1. Does the patient have a headache, trouble breathing, chest discomfort, blurry vision, lightheadedness, or dizziness?
          • If YES, notify provider IMMEDIATELY.
          • If NO, answer the following question:
            1. Is the patient experiencing pain other than chest discomfort or headache?
              • If YES, administer pain medication and reassess blood pressure or notify provider.
              • If NO, move on to the next question.

        2. Is the patient due for scheduled BP medication or is a PRN blood pressure medication ordered?
          • If YES, administer BP medication and reassess blood pressure. Notify provider if BP does not decrease to systolic BP less than 160 mmHg or diastolic BP less than 100 mmHg.
          • If NO, notify provider and request medication management.

      • If NO, move on to the next question.

    4. Is the heart rate between 100 and 125 beats per minute (BPM)?
      • If YES, answer the following question:
        1. Is the patient having pain, discomfort, or anxiety?
          • If YES, treat pain or discomfort otherwise notify provider.
          • If NO, notify provider IMMEDIATELY.

      • If NO, move on to the next question.

    5. Is the heart rate greater than 125 BPM?
      • If YES, notify provider IMMEDIATELY.
      • If NO, treat discomfort if present and monitor patient.

    6. Is the heart rate less than 50 BPM?
      • If YES, answer the following questions:
        1. Did the patient take a beta blocker (i.e. Metoprolol or Coreg) in the past 12 hours?
          • If YES, move on to the next question.
            1. Is the patient exhibiting any other signs of clinical deterioration?
              • If YES, notify provider IMMEDIATELY.
              • If NO, continue to monitor patient unless heart rate is below baseline.

          • If NO, move on to the next question.

        2. Does the patient have stable baseline bradycardia which is above 40 BPM (view trend)?
          • If YES, move on to the next question.
          • If NO, notify provider IMMEDIATELY.

      • If NO, move on to the next question.

    7. Is there an increase or decrease in heart rate of at least 40 BPM which cannot be explained solely by expected effects of medication administration or evidence of patient discomfort?
      • If YES, notify provider IMMEDIATELY.
      • If NO, continue to monitor patient.

    8. Is the respiratory rate less than 12 breaths per minute especially after opiate or sedative administration or suddenly greater than 24 breaths per minute?
      • If YES, notify provider immediately.
      • If NO, move on to next question.

    9. Has there been a temperature greater than 38C (100.4F) or less than 36C (96.8F) in the last 4 hours?
      • If YES, treat temperature greater than 38C or 38.5C per order with antipyretic and notify provider.
      • If NO, move on to the next question.

    10. Has the oxygen saturation dropped below 93% in the last 4 hours?
      • If YES, and this is not the patient’s baseline (view trend) on current oxygen settings or room air, notify provider IMMEDIATELY.
      • If NO, move on to the next question.

    11. Has there been decreased or absent urine output in the last 6 hours?
      • If YES, perform bladder scan and notify provider IMMEDIATELY if the patient does not have end stage renal disease (ESRD) with anuria.
      • If NO, move on to the next question.

    12. Has the patient had decreased mental status, increased confusion, or increased anxiety or restlessness, even mild, in the last 4 hours?
      • If YES, answer the following question:
        1. Does the patient have any other signs of clinical deterioration?
          • If YES, ensure blood glucose level is within normal limits and notify provider IMMEDIATELY.
          • If NO, continue to monitor the patient’s mental status.

      • If NO, continue to monitor patient.

  • 1
    NursesRmofun likes this.

    What a great discussion! The things everyone mentioned is what I feared, that nurses are just too busy to fill out another checklist and we just need to hire more staff. Unfortunately, hiring more staff is less likely to happen than more things for us to document. Some people have mentioned that the nurses assessment is more important than vital signs and even the vital signs alone don't mean something is wrong. For example, with baseline bradycardia or hypotension. The tool incorporates that. I made up the tool sort of like an algorithm. It is pretty complex but could take 10 minutes to fill out once someone is used to filling it out. However, some other form of "petty" documentation would have to removed before another form of documentation is added. I will post the tool when I am not typing on the phone.


close
close