Info for senior students in the ED

[MesaRN]

I have been putting together an information packet for students who are doing thier senior practicum or capstone experience in the ED. I am looking for help and advise in what to put in it. The goal is to lay out expectations and give them a list of vital items to review. Not so they are masters of material, but so things like s/s of an MI or basic cardiac rhythms are reviewed and learning can be reinforced in the clinical setting.

What do you think would be good to include?

Do you have any helpful hints (ie acronyms) that you use in your practice to pass on to a nearly finished student?

Any other nearly new grad pearls to pass along?

Below is an outline of what I have so far, any feed back would be great!!! I don't need it to be exhaustive, I just want them to review vital and commonly experienced item we see in the ER everyday.

Items to Review

Skills

Whether you have done a ton of IV starts or none at all, don't worry about how well you can do any skill, that is what the rotation is for! I just want you to be familiar with the procedures so you know how to measure the NG tube before we place it. Don't be nervous about skills, there will be ample opportunities to practice in a safe environment. Review these skills:

IV starts

Venipucture

NG tube placement

OG tube placement

EKG lead placement

3 lead (red, white, black)

12 lead placement

Foley catheter placement

Straight catheter placement

ABG collection

Medications:

Remember, just a few important points about each. Why would it be used it in the ER?:

Morphine

Ativan (lorazepam)

Haldol (halpradol)

Benadryl (diphenhydramine)

Solumedral

Metoprolol (Lopressor)

Nitroglycerine

Versed (midazolam)

Albuteral

Magnesium (what type of dysrythemia is it used to treat?)

Zofran (ondonstrone)

Phenergen (promethazine)

Cardizem (diltizem)

Dilaudid (hydromorphone

Compazine

Protonix

Xanax (alprazolam)

Valium (diazapam)

Pepcid

Lidocaine

Amiadorone

Adenosine

Atropine

Dopamine

Propofal (diprivan)

Normal Saline

Dexamethazone (decadron)

Heparin

Lovenox

Vicodin

Percocet

Tordal (ketoralac)

Ancef

Rocephin (ceftriaxone)

Activate Charcoal

What drug do you use to reverse opioid overdose?

What drugs on this list are narcs?

What drug do you use to reverse benzodiazapine overdose?

What drug on this list or benzos?

Systems Review

Keep pathos short, I mean 10 words or less!!! Think about assessment!! You will be doing a lot of focused system assessments while in the ER.

Cardiac:

Common signs of an MI

Remember MONA??

Be familiar with the following rhythms:

Atrial fibrillation

What does supraventricular tachycardia (SVT) mean?

Normal Sinus Rhythm

Ventricular Tachycardia

Ventricular Fibrillation

Sinus Tachycardia

Cardiovascular:

What is shock?

What are the four types of shock?

Renal:

How do the kidneys regulate BP? (no long patho, just the big picture in 10 words or less)

Common signs of a kidney stone

Hepatic:

How does the liver effect clotting (in 10 words or less!)

GI/ Abdomen:

Common signs of appendicitis

Endocrine:

What is DKA? What are the common sign and symptoms?

Neuro:

Common signs of a stroke

Differences in treatment of hematic stroke vs ischemic stroke

Common signs of herniation

What is involved in a nuero assessment?

What is a Glascow Coma Score?

Respiratory:

Common signs of pneumonia

Common signs upper respiratory tract infection

Croup, RSV, bronchitis, pharyngitis (we see a LOT of these!)

[nedlloyd]

i think it would be a good idea for you to include the protocols of your ED, for example chest pain protocol where i worked you give 02, chewable ASA, get a line in and then give nitro etc. once you've been doing it awhile it just comes to you, but for some of the students it seems to help to see it written down. then if there is any down time (ya right) they can review it. also anaphylaxis and stroke protocols

and do a demonstration on how to operate the monitors! when i first started out i knew how to read them but i couldn't work some of the controls. so a monitor would be beeping and i couldn't figure out how to adjust the parameters...

and also add epi to your list of meds.

what items would you expect to find in a crash cart? hands on activities such as stocking the (already stocked) crash cart, check to make sure all supplies are there, ask students to explain their uses.

[tyvin, BSN, RN]

Narcan (naloxone) not listed for reversal of opioid overdose?

[MesaRN]

I will add monitor use to my clinical check off list, great idea! I have now added epi to the med list, thanks!

I imply narcan and flumazenil on the questions below the list, it would indeed be a bad one to leave off! I do have a module that runs through each proctocal/ standing orders while in clinicals as well as the crash carts (and we have "stat" drug boxes as well). Really makes a good intro to cardiac and ACLS for the student.

The sheet itself is to give to the student before they come to the ER.

Thanks for all the ideas! I will keep check back for more!

[GM2RN]

I would add kidney stones and cholecystitis to your GI/Abdomen systems; we see lots of those.

They should know that magnesium is also used to treat acute asthma.

As for peds, they should know how to dose tylenol and motrin, and they should have a cheat sheet they can refer to for peds vitals.

[littlemammanurse, BSN, RN]

This is a great list!I was actually interviewed for an RPN position in the ED and I would love to have something like this to help me out!

[HiHoCherry-O]

I would also include knowing some labs:

Cardiac markers: what are they and what do they indicate? Why do they have to measured over a period of time?

CBC: What are some things that may be going on with my patient i.e. Hgb/Hct?

Chemistries: Why is a high/low potassium a problem?

The suggestion of having some of the ED's protocols to review is excellent especially in regard to abd pain, GI bleed, chest pain, and stroke. Going over some of the tests involved with those workups will help the students have a better idea of what is going on with the patient, where the doctor may be headed treatment wise and how to educate patients and families.

[hearts895, RN BSN]

As a nursing student, I will be saving this list and reviewing for my rotation in ED. Thank you! :)

[brwneyedRN]

I would add something about care of the trauma pt, include trauma criteria for alphas/bravos. Also about RSI including drugs used and the different types of airways pt's come in with when they are placed by ems.

[Janedough]

Placement of the Leads: White on the right grass under clouds (white and green leads), smoke over fire (Black and red leads) poor brown in the middle (brown lead) :)

12lead is another story but the placement in important so just memory with those.

Maybe add what to give for an anaphylaxis reaction.

GREAT LIST!!!

[studystudy]

I start my senior preceptorship in the ER tomorrow, I've been reviewing a lot of stuff, but this is a great list and I wish I'd found it sooner! :)

[studystudy]

What about adding IV drip calculations to practice?