I'm still working in a special care unit. So I was working this evening with a lady who gets a scheduled Seroquel 25mg tab and a 50mg (I think) tab of a sleeping medication (trazadone). This lady was sleeping in her wheelchair after supper, had little intake at supper as per CNA. In report it said that she was slowly declining.
She was able to wake up for me for a while. I decided that I would hold off on giving the seroquel and trazadone, as she was already so sleepy. Another tine she was with a volunteer who stated that she was tired at 1830 so the cnas put her to bed early. I didn't have a chance to give her her medications because she was sleeping. When she didn't have her medications, she was up at 0200 but she was helped back to bed again with no issues.
If I was on another unit (not special care) in the facility, I would have held the antipsychotic and sleeping medication and that's what myself and other nurses were instructed to do?
I only the held the meds tonight because I was afraid that this lady would be over-sedated??
2) I don't know how your EMAR works, I assume there is some way to note why a med was held? I cannot assume that the EMAR has some way to notify the doctor that a med wasn't given...but computers are pretty amazing these days!
2) THERE IS NO SUCH THING AS A DUMB QUESTION. You can be "super" LPN with 40 years of experience. There will always be changes in protocol, changes in EMAR'S, changes in policy, new meds, new treatments, etc. The SMARTEST nurse is the one who asks dumb questions.
3) Everything a doctor orders must be done or the doctor must be notified. A minor order like a laxative, getting the patient up to a chair, giving the patient a snack...if it is written as a doctor order you have to do it or tell the doctor why you didn't. If it's not an emergency you don't call the doctor at 2:00 am, but I repeat, there HAS TO BE A WAY to let the doctor know an order was not done.
4) Please find a way to get something in writing from your facility. Find your facility policy about holding medications and notifying the doctor. (Honestly I find most policies NEVER seem to be very helpful or specific.) If that's the case ask to meet with your charge nurse or nursing director. Even come in on your day off. Simply say you want to be clear on the policy of holding meds or treatments, when, how, who, to tell. Get this in writing if possible.
PS Diarrhea isn't just one lose bowel movement. Diarrhea is several....more than 3 - 4, depending on the patients age, condition, etc., loose bowel movements in 24 hours. Patients can have diarrhea and still be impacted. If you had to call or talk to a doctor about diarrhea be prepared...how many loose bowel movements, how often, when was their last "normal" bowel movement, what laxative's are they on, etc.
BUT this "advice" about diarrhea is for the the general population. Elderly debilitated patients in a skilled nursing facility are not the general population so please don't take what I wrote as medical advice.
Sorry if I'm telling you thins you already know. Just trying to cover all my bases, as you can see your "dumb" questions can be really complicated.
I think you're a super nurse for coming here and asking such intelligent questions.
2) I don't know how your EMAR works, I assume there is some way to note why a med was held? I cannot assume that the EMAR has some way to notify the doctor that a med wasn't given...but computers are pretty amazing these days!
2) THERE IS NO SUCH THING AS A DUMB QUESTION. You can be "super" LPN with 40 years of experience. There will always be changes in protocol, changes in EMAR'S, changes in policy, new meds, new treatments, etc. The SMARTEST nurse is the one who asks dumb questions.
3) Everything a doctor orders must be done or the doctor must be notified. A minor order like a laxative, getting the patient up to a chair, giving the patient a snack...if it is written as a doctor order you have to do it or tell the doctor why you didn't. If it's not an emergency you don't call the doctor at 2:00 am, but I repeat, there HAS TO BE A WAY to let the doctor know an order was not done.
4) Please find a way to get something in writing from your facility. Find your facility policy about holding medications and notifying the doctor. (Honestly I find most policies NEVER seem to be very helpful or specific.) If that's the case ask to meet with your charge nurse or nursing director. Even come in on your day off. Simply say you want to be clear on the policy of holding meds or treatments, when, how, who, to tell. Get this in writing if possible.
PS Diarrhea isn't just one lose bowel movement. Diarrhea is several....more than 3 - 4, depending on the patients age, condition, etc., loose bowel movements in 24 hours. Patients can have diarrhea and still be impacted. If you had to call or talk to a doctor about diarrhea be prepared...how many loose bowel movements, how often, when was their last "normal" bowel movement, what laxative's are they on, etc.
BUT this "advice" about diarrhea is for the the general population. Elderly debilitated patients in a skilled nursing facility are not the general population so please don't take what I wrote as medical advice.
Sorry if I'm telling you thins you already know. Just trying to cover all my bases, as you can see your "dumb" questions can be really complicated.
I think you're a super nurse for coming here and asking such intelligent questions.
Thank you! I gotta ask because not everything is taught to us in nursing school ?
I was the same as you. Maybe I was worse! I thought I was supped to know everything after graduating from nursing school,....every medication, it's side effects, dose, etc.......how to operate a blood pressure machine or other basic bedside equipment, (there can be many different types of "basic" equipment),....when to call the doctor....I could go on and on.
It took several encounters with nurses and doctors I highly respected who, when asked, "What is that machine for, how does it work, what is this medication for, is this the correct dose?", etc., they'd say, "I don't know".
Nothing wrong with you saying "I don't know", adding when appropriate..."I will find out".
Seroquel isn't a med that should be held because its an antipsychotic and doing so can cause recurrence of symptoms. You would have needed to contact the MD to hold it for sedation.
Trazodone I one I feel comfortable holding per nursing judgement.
brownbook
3,413 Posts
1) It is not an unrelated question.
2) I don't know how your EMAR works, I assume there is some way to note why a med was held? I cannot assume that the EMAR has some way to notify the doctor that a med wasn't given...but computers are pretty amazing these days!
2) THERE IS NO SUCH THING AS A DUMB QUESTION. You can be "super" LPN with 40 years of experience. There will always be changes in protocol, changes in EMAR'S, changes in policy, new meds, new treatments, etc. The SMARTEST nurse is the one who asks dumb questions.
3) Everything a doctor orders must be done or the doctor must be notified. A minor order like a laxative, getting the patient up to a chair, giving the patient a snack...if it is written as a doctor order you have to do it or tell the doctor why you didn't. If it's not an emergency you don't call the doctor at 2:00 am, but I repeat, there HAS TO BE A WAY to let the doctor know an order was not done.
4) Please find a way to get something in writing from your facility. Find your facility policy about holding medications and notifying the doctor. (Honestly I find most policies NEVER seem to be very helpful or specific.) If that's the case ask to meet with your charge nurse or nursing director. Even come in on your day off. Simply say you want to be clear on the policy of holding meds or treatments, when, how, who, to tell. Get this in writing if possible.
PS Diarrhea isn't just one lose bowel movement. Diarrhea is several....more than 3 - 4, depending on the patients age, condition, etc., loose bowel movements in 24 hours. Patients can have diarrhea and still be impacted. If you had to call or talk to a doctor about diarrhea be prepared...how many loose bowel movements, how often, when was their last "normal" bowel movement, what laxative's are they on, etc.
BUT this "advice" about diarrhea is for the the general population. Elderly debilitated patients in a skilled nursing facility are not the general population so please don't take what I wrote as medical advice.
Sorry if I'm telling you thins you already know. Just trying to cover all my bases, as you can see your "dumb" questions can be really complicated.
I think you're a super nurse for coming here and asking such intelligent questions.