Clinical Pearls of Wisdom for Floor Nurses

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I'm a pretty good nurse, but I sure don't know everything.

Won't you share your clinical pearls of wisdom with us? Please keep it brief; some of us are at work. ;)

Here's something I didn't know. Must've been absent that day.

If your patient has a low potassium level and a low magnesium level, you have to fix the Mag level first. Otherwise, the K+ level can't be corrected.

Specializes in ICU, Surgery.

Removing jewelry before surgery is NOT because the staff might steal it or lose it while patient is under anesthesia.

There is the possiblity of swelling and/or a burn from the electrocautery.

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If the pt has been NPO, and will remain NPO after surgery, you can bottom out their blood sugar by giving them their "diabetes meds."

Not necessarily, as the stress of surgery will actually increase their blood glucose levels. Elevated blood glucose also increases risks of post op complications and can impair or delay healing.

I'd like to see one of our diabetic educators weigh in on this; I worked a diabetic unit for a couple of years and that is something the docs and educators drummed into our heads... Often the patient will have their doses adjusted pre-op, but I've actually had patients receive a greater than (their) usual insulin dose pre-op.

http://www.aafp.org/afp/20030101/93.html

When insulin requirements are in doubt, it is better to err on the side of providing rather than withholding insulin. The administration of adequate glucose in conjunction with the judicious use of insulin will prevent hypoglycemia. Diabetic ketoacidosis or hyperosmolar states, which may result from inadequate dosing of insulin, are not so easily managed. The key to success of any perioperative management plan is frequent monitoring of glucose, electrolyte, and fluid levels, and acid-base status. Prevention of surgical complications as a result of hyperglycemia is possible with meticulous perioperative glucose management.

http://www.jeffersonhospital.org/news/2006/article12922.html

http://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/ImprovementStories/ReducingMortalityThroughAggressiveBloodSugarControlatSSMHealthCare.htm

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Specializes in Cardiology, Oncology, Medsurge.
ok, i know this is not a thread on kcl boluses but since it has been brought up i have a question.

when a patient is npo for surgery and they have a low k+ level the surgeons always bolus them iv preop and the infusions are never finished by the time the surgery starts. could the po potassium be given with a sip of water or is it likely to cause vomiting?(not the water but the k!)

thanks

sharann, i posted your question at sdn (student doctor's network) under the clinicians (rn, np, pt) forums.

curious hear the docs have to say on this one!

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sharann, i posted your question at sdn (student doctor's network) under the clinicians (rn, np, pt) forums.

curious hear the docs have to say on this one!

liquid k+ has to be diluted with about a cup of water or juice; seems that would rule out its use pre-op.

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I will share some things I have learned, some are common sense but it still took me time to figure out:

Look at the pt, not the pulse ox and other technical info. Granted, both are important, but just because a pulse ox is 88 % doesnt mean they are dying, they may run that at home.

Gather all pertinent info before calling a Dr, nothing worse than feeling like a dork when they ask for a blood pressure or something else you should have gathered before calling and oyu dont have it.

Ask your coworkers for advice, but take it with a grain of salt.

Ask Drs things you want clarification or to be taught about, they are a wealth of info (as are your coworkers)

Jessica

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Specializes in Telemetry, Oncology, Progressive Care.
I will share some things I have learned, some are common sense but it still took me time to figure out:

Look at the pt, not the pulse ox and other technical info. Granted, both are important, but just because a pulse ox is 88 % doesnt mean they are dying, they may run that at home.

Gather all pertinent info before calling a Dr, nothing worse than feeling like a dork when they ask for a blood pressure or something else you should have gathered before calling and oyu dont have it.

Ask your coworkers for advice, but take it with a grain of salt.

Ask Drs things you want clarification or to be taught about, they are a wealth of info (as are your coworkers)

Jessica

On the flip side if a pt has an oxygen sat of 98%, denies SOB, and appears SOB something may not be right. I was admitting this pt as a transfer from another hospital (they swore up and down this pt was stable and being the new nurse I was I trusted them). Pt couldn't even give me hx thank goodness family was there. I had accepting doc paged and didn't get any return calls. I then had the house doc come and see pt cause something just didn't seem right. We transferred pt to the ICU, did stat ABG, and they were talking about intubating the pt. I never saw such poor ABGs. I was taught that those levels aren't compatible with life but this pt was still breathing. Learned to not believe those pulse ox's all the time.

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On the flip side if a pt has an oxygen sat of 98%, denies SOB, and appears SOB something may not be right. I was admitting this pt as a transfer from another hospital (they swore up and down this pt was stable and being the new nurse I was I trusted them). Pt couldn't even give me hx thank goodness family was there. I had accepting doc paged and didn't get any return calls. I then had the house doc come and see pt cause something just didn't seem right. We transferred pt to the ICU, did stat ABG, and they were talking about intubating the pt. I never saw such poor ABGs. I was taught that those levels aren't compatible with life but this pt was still breathing. Learned to not believe those pulse ox's all the time.
A pulse ox isn't the end all, be all. A slew of problems can be occurring with a "good" sat reading. It also doesn't tell you when the patient is acidotic and in need of vent support.

Oh. One other thing, regarding those portable sat machines...

One of our RTs explained to me that in CO poisoning, you subtract the CO from the sat reading to get the true O2 saturation. For example, a sat reading of 95% with a CO of 14 = O2 saturation of 81%.

I think I got that right. It comes from personal experience, btw :stone

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Specializes in Behavioral Medicine.

We had an in-service recently on pulse ox. One thing I never learned or thought about was how ambient light in the room can give off a false read. The rt told us if we are getting an iffy read to cover the hand with the pulse ox on it with a washcloth. Might be common knowledge but no one ever told me that.

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A pulse ox isn't the end all, be all. A slew of problems can be occurring with a "good" sat reading. It also doesn't tell you when the patient is acidotic and in need of vent support.

i use pulse ox's on a minimal basis.

i've had too many pts who were bottoming out on me, with readings of 90+%.

there's so much of the story they don't tell.

leslie

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Specializes in Hem/Onc.

a spoonful of applesauce helps it slide right down. Those pills don't taste so bad, but the do stick as they begin to disolve, especially if you've broken them in two peices.

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Specializes in Neuro ICU, Neuro/Trauma stepdown.
a spoonful of applesauce helps it slide right down. Those pills don't taste so bad, but the do stick as they begin to disolve, especially if you've broken them in two peices.

not only that but the cold sensation in the mouth stimulates swallowing...

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sharann, i posted your question at sdn (student doctor's network) under the clinicians (rn, np, pt) forums.

curious hear the docs have to say on this one!

thanks!

i was not referring to the liquid type though. just the horse pills by the way.

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