Help with care of 2 patients!!!!

Hello! I can totally relate to you! I remember the first time I was assigned 2 patients and I got so overwhelmed that I thought I gave pt. 1 the other pt's med and vise versa! It was so scary and I panicked! I couldn't keep them straight, but luckily, I did give them the correct meds.

Since then, I have been interning on an orthopedic floor where my preceptor has worked me up to taking care of 4 patients at a time. I always go in right away at the beginning of the shift and introduce myself, ask them if they need anything, have pain, etc. and then prioritize from there. If one patient has c/o pain, then I start there. I will go get pain meds along with all of their other scheduled meds. While I am in the room giving meds, I will do my assessment and write down specific things to my pt. on the chart while I am in the room looking at him/her. (Fluids, dressings, wounds, ID band, IV sites, equipment, etc.) If nothing is abnormal, then I will go back to the chart and finish all the "norms" after I have seen all of my patients. I have found that this saves a ton of charting time and gets you going right away with getting meds to your patients and helps familiarize yourself with what all your patients have going on with them.

If you come across that both of your patients have c/o pain at the same time, then start with the one who has a higher rating, or who may appear to be in more distress from the pain. Also, another way you can figure out who to start with is by looking at their scheduled meds- if one pt. has BP meds, needs insulin, etc. whereas the other just has scheduled colace and pepcid, then I'd pick with the BP pt. You can also prioritize based on diagnosis. If a patient has been there for 4 days post-op and your other is pod 2, I'd pick the pod 2 pt because there is a big chance that your pod 4 pt is going to be dc'd and really doesn't have many needs.

I hope this helps you! I'm not too sure what type of floor you are on, so hopefully my orthopedic floor experience relates to where you are a little bit. Just remember to take one pt. and one task at a time or you will get confused! Relax and always remember to breathe!!! You will do great.

Let me know how it goes for you.

Unfortunately I haven't gotten that far yet! I've only taken care of 2 patients one time and that was last Saturday and my 2nd patient was discharged early in the day.

My instructor has to be with us when we give meds and everyone doesn't give meds every time.

Sorry I wasn't specific enough to begin with, but where I'm having trouble now is - the basics...

organizing linen changes, AM care, initial assessment, V/S, & documenting (which includes the assessment, intervention, & evaluation that have to be done)!

Really not sure how I'm going to handle it when I have to add meds to the equation (which could be this week)!!

And I'm usually a very organized person...**sigh**

Unfortunately I haven't gotten that far yet! I've only taken care of 2 patients one time and that was last Saturday and my 2nd patient was discharged early in the day.

My instructor has to be with us when we give meds and everyone doesn't give meds every time.

Sorry I wasn't specific enough to begin with, but where I'm having trouble now is - the basics...

organizing linen changes, AM care, initial assessment, V/S, & documenting (which includes the assessment, intervention, & evaluation that have to be done)!

Really not sure how I'm going to handle it when I have to add meds to the equation (which could be this week)!!

And I'm usually a very organized person...**sigh**

I would suggest you go in & do you initial assessment of both pts first, including your V/S. Then looking @ labs, etc. Be sure to pick whoever needs you more first... use maslow's hierarchy to help you figure out who is basically "sicker." Then once they are both assessed & you've ensured they need nothing else at the moment you will want to chart while it's fresh in your mind... & instructors usually prefer you chart sooner rather than later, it helps the nurses on the floor as well. Then you can go back & complete your cares & linen changes. Of course, things may change & may need to change depending on what is happening with your pts... you really have to be flexible... hope this helps... Good luck!!

You kinda have to play around to find out what works for you. The first 2 or 3 hours in the morning are the toughest. This routine has worked for me so far (with up to 5 patients):

Get report, then do a quick chart check (labs, orders, etc)

Decide which patient is most acute/will need the most work, then go see them first, then move to the next most acute pt.

While I'm in the room for the first time I introduce myself, get morning vitals and start an assessment. Also do things like blood sugars, empty-stomach meds, etc.

Then I usually get some time to chart while they're eating breakfast, and pull meds.

Then moving in the same acuity order I give meds, finish assessments and work out a plan with the pts to do linen changes, baths and whatever else needs to get done.

The rest of the day depends on med and treatment schedules, patient needs, and the wonderful suprises nursing can bring. :anbd:

Things I found helpful:

Having a really good report sheet to help keep track of meds and stuff.

Getting my patients involved with their care, like keeping track of their pain meds or I & Os (they love tracking I&Os for some reason).

Just cause its grouped under "morning care" doesn't mean you have to absolutly get it done before 1100. Work with PT/OT and do linen changes and other tasks while they have the pt. out of bed. Also, lots of patients I've worked with prefer baths/showers in the afternoon to help them relax.

Talking to nurses, getting their opinion, how they plan their day, etc has also been really helpful.

Group your care and try to do more than two seperate things whenever you are in the room. If you are going in to change linens, bring along a new IV bag if needed.

ALWAYS ask if there is anything else you can do before you leave the room.

I appreciate you guys' advice! Thanks so much!