Clinical Pearls of Wisdom for Floor Nurses

[UM Review RN]

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.

[sharann, BSN, RN]

Ok, my clinical pearl which has no doubt been stolen from somewhere is that when you smell something bad or suspect bleeding under the covers, for gosh sakes take the time to slip on some gloves! You KNOW you are going to find something under there

[EmmaG, RN]

Thanks!

I was not referring to the liquid type though. Just the horse pills by the way.

If you're referring to those big white KDur tabs, they're extended release. May as well give it IV.

[Elvish, BSN, DNP, RN, NP]

My clinical pearl:

Babies of moms who got Nubain prior to delivery are more often than not going to scream like banshees and nothing will quiet them down....until they stop breathing.

[kanzi monkey]

My clinical pearl:

Babies of moms who got Nubain prior to delivery are more often than not going to scream like banshees and nothing will quiet them down....until they stop breathing.

uhhhhh.....why?

that was my first IM inj. as a student--will never forget it. Nubain is one of those meds that I don't quite understand--given to a new mom in L&D for labor pain; or, given to a post-op with narcotic itchies.

Anyway, I'd like to know more about it if you've got a mo' to share :)

-Kan

[CaLLaCoDe, BSN, RN]

When giving a subcue Lovenox shot, pinch the site before giving. A patient taught me this one; prevents the bee sting effect pain associated with giving this medication. Oh, and make sure the CO2 bubble has drifted to the top of the syringe (where the tip of the black plunger is), so that way it can help seal in the Lovenox. Also helps to ask a silly question prior to giving any shot! I have had clients tell me that they did not feel a thing! Try it, your clients will think you're the cat's meow and will beg you to be their nurse next time around. Or if not this, possibly some magician who lost her calling.

[Elvish, BSN, DNP, RN, NP]

uhhhhh.....why?

that was my first IM inj. as a student--will never forget it. Nubain is one of those meds that I don't quite understand--given to a new mom in L&D for labor pain; or, given to a post-op with narcotic itchies.

Anyway, I'd like to know more about it if you've got a mo' to share :)

-Kan

Hi Kan,

I love Nubain for post c/s moms for itching. Works like a charm. I hate getting a baby in the nursery when mom has gotten it for pain control in labor. It's a really interesting drug, as it is used for pain relief but can also be used to counteract some other effects of pain meds (n/v, itching).

Anyway, it crosses the placenta really fast and affects baby almost instantly. Pretty much the same things it can cause in mom it can do to baby. The crying bit I think comes from its action in the CNS...for whatever reason it stimulates them to cry. After doing it a while, you can tell just by the kid's cry whether Mom got Nubain, seriously!

The apnea, cyanosis, & bradycardia are pretty well-known effects on newborns. Here is some really good info that I found. Hope it helps.

[Elvish, BSN, DNP, RN, NP]

Also, another tip: (completely unrelated to the first one)

Change needles before injecting IM if you've already used the current one to draw something out of a vial c a rubber stopper. That stopper dulls the needle & the injection hurts really hard. Sharper needles make so many injections less painful. Many pts tell me I have a 'good hand'. Not really. Just a good needle.

Obviously, I'm not talking about prefilled syringes here.

[leslie :-D]

Change needles before injecting IM if you've already used the current one to draw something out of a vial c a rubber stopper. That stopper dulls the needle & the injection hurts really hard. Sharper needles make so many injections less painful.

that was one of the first things we learned in nsg school.

always, always, always change needles before giving im.

when i did this in the real world, nurses looked at me as if i was crazy.

but it's a practice that i faithfully use to this day.

who wants a blunted needle to be injected?

yowza.

leslie

[EmmaG, RN]

that was one of the first things we learned in nsg school.

always, always, always change needles before giving im.

when i did this in the real world, nurses looked at me as if i was crazy.

but it's a practice that i faithfully use to this day.

who wants a blunted needle to be injected?

yowza.

leslie

Yeah. Also, it is 'coated' with the med and will cause increased pain from that as well.