HELP- new job

[TexasLVN516]

I have started a 2-10 shift in LTC and after 3 days of orientation I am already on my own. I am doing well with accuchecks and PRN narcs but the paperwork is all new to me. Also, I have noticed in the charting that a resident isn't being given his coumadin and when I asked, the nurse I was shadowing said "because he is refusing his labs to be done". So that is confusing. I feel like I am getting no explanation and have no idea if this is a safe environment for me to be working in.

Also during my insulins one of my pts has Novolog but is ordered Humalog and the other nurse told me its the same thing but when I googled it, it doesn't say anything about them being equivalents.

HELP PLEASE what would you do?

[rvd4now]

there both rapid acting insulin

[mluvsgnc]

Can you do some patient education with this person? Go see him and, after asking how he's doing, find out what HE thinks about what's going on or what needs to happen. Why is he refusing his labs? Perhaps the pt. doesn't know what to expect so isn't cooperating, maybe there's a misconception or miscommunication... point being, go find out. Talk with the him for a minute or two and see if you can encourage him in the right direction

As for the insulin, like pp stated, they are both rapid acting, but I don't think it's prudent to interchange the two w/o an order- can you call the physician?

As for the Coumadin, is he taking it for heart-related reasons? Why is he taking it? Some more pt. education- does he know what could happen by not taking it?

[lpnpgh123]

Also, the MD probably needs to be notified that this patient is not taking his Coumadin. There are other anticoagulants that don't need the frequent labs that Coumadin does. Perhaps an order to change to something else? The MD may not even be aware that this patient hasn't had his Coumadin in x amount of days!

As for the insulins, they are both DIFFERENT rapid acting insulins, not the same. The above poster was correct, that you should get a formal order for the use of whichever insulin is accessible.

Hope this helps.

Good luck to you.

Sometimes people just perpetuate things without addressing them, due to time constraints or the view of " this is the way we have always done things..."

You, with your fresh, new eyes have noticed some things, that need to be addressed.