Bad Preceptorship Expirience

[svito1005]

As a student nurse, I had four patients. Two of them were really confused.

One tried to pull all tubes she had: IV, NG, foley, and took her midabd dressing off. Another tried to get out off the bed all the time being on falls precaution. Third pt had bowel problem, and constantly needed help out of bed and cleaning. And the last one had really bad headache. What would you do to keep confused pts safe, problematic pt clean and calm, and not neglect the pt with pain?

[meownsmile, BSN, RN]

I dont know that this had anything to do with a bad preceptor. You as a student should be able to implement ideas and rational to address your patients.

First off,, what do you do with your confused patients?

The one pulling the tubes gets priority. Usually some imaginative tucking and covering will keep a confused patient from yanking things between checks. Check comfort,, is there a reason the patient is pulling at the foley, is it pulled and causing bladder spasms, is it pinching,is it draining properly, try removing the water from the balloon and repositioning the foley, push it a little farther in and then reinstill the water,, maybe it was pulled against the sphincter and causing her to feel like she needed to urinate. Wrap IV sites with Kerlex and thread tubing up the gown sleeve so tubing isnt draped over the patient or the tubing isnt hanging over their hands where they can see it. Give them something to hold,, a washcloth,, pillowcase to keep the hands busy.

Next the roamer. Is there a geri chair you can get them out of the bed into? Sometimes just getting them out of the bed will satisfy them but dont leave them without the table top. I know it is technically a restraint, but if the patient is willing to sit and look at a magazine for a while,, they need the table up to rest the magazine on right? No one can call it a restraint if the patient is actually using the table portion of the chair. If the patient refuses to have the table up then it must stay off.

Medication for the one with bowel problems? Is there something ordered you can give them. Let them sit on a bedside commode for a while. If they are having that bad a problem it is only healthy for them to be on the commode to keep the feces off their skin and be in a different position than they would be in bed. Saves them the embarressment of not getting up in time also. Maybe a hourly commode assist until they get past the worst of it.

Pain medication as ordered for the headache patient. As long as neuro checks are unchanged, they are A&O x3 and not in danger of stroke or something a darkened room and quiet is the best medicine. Check in on them frequently and let them rest.

Without knowing the patients dx, these are just senerios. Just a for instance in prioitizing and remedy to some little difficulties we come across daily. It gets easier and I guess if there was a person that was assigned to precept you, they should have had some general ideas and helped with solutions.