Published Apr 27, 2018
Sometimes I find myself going blank as what I should do for care. Obviously chocking, and unresponsive comes easy. But I wish there was a quick reference book of what I should do if someone is more lethargic than normal. Stuff like that..
Farawyn
12,646 Posts
Recent grad
This will click. I promise you. Just keep reviewing stuff and going to work. It will click, Nurse.
brownbook
3,413 Posts
I work in LTC. Sometimes when a resident is acting lethargic, I forget what should I do. I mean I realize that maybe I should see if they're on a narc, if they've eaten, maybe blood work, but I wish I had a lay out, like a check list of things to do
In addition to Rocknurses ideas, especially the basic ABC's, what you "realize", seems very good to me. Write them down on a small card you can refer to in your pocket.
Let co-workers know you need help, "patient X is lethargic, I need some help", is a very reasonable thing to do. I know LTC's often don't have a lot of staff per patients, but a CNA, MA, even a unit clerk, can help out, act as a gofer, etc
hdrn90
22 Posts
the saunder's nclex review is my favorite!
wondern, ASN
694 Posts
Is it called Lippincott Manual of Medical Surgical Nursing?
They may make flash cards.
Susie2310
2,121 Posts
To increase your knowledge I suggest studying the pathophysiology, causes/contributing factors, signs and symptoms, lab values, diagnostic tests, emergency care, and treatment for the following, all of which can cause a change in LOC, lethargy, etc: Sepsis/Severe Sepsis/Septic Shock (commonly caused by a urinary tract infection or pneumonia); respiratory depression/respiratory failure; asthma/COPD; stroke - due to a clot/embolism or bleeding (hemorrhage); respiratory infection, i.e. flu and pneumonia; hypoglycemia/hyperglycemia; MI - which can have a different presentation in the elderly; arrhythmias; bleeding problems or hemorrhage for different body systems, and possible causes, e.g. blood thinners, stroke; acute renal failure (due to a variety of causes, i.e. a kidney stone causing a ureteral obstruction, or medication toxicity) or further deterioration of chronic renal failure; side effects of medications, particularly new medications (be alert to renal or neuro toxicity or renal injury in the elderly) - the elderly have decreased renal and cardiac function and can suffer severely toxic side effects of medications that require dose adjustments or discontinuation; fluid and electrolyte imbalances, e.g. dehydration/hypovolemia and fluid overload. All of the above problems are common in the elderly.
Davey Do
10,608 Posts
all of us have wished for a nursing for dummies "save me now" quick reference guide.
Supposedly, there's some books and magazines published whose aim is to simply the nursing process. I looked through some of them and the only difference I could determine was that there were cartoons in the margins that just had a drawing of a nurse summarizing what was in the text.
Big deal.
So I emailed the company a cartoon that I thought had more information that would help students an others remember some symtoms.
Their cartoon:
[ATTACH=CONFIG]26807[/ATTACH]
My edited version of their cartoon:
[ATTACH=CONFIG]26808[/ATTACH]
I never did heard anything back from them.
Their loss.
Have Nurse, ADN, RN
3 Articles; 719 Posts
Well, there's something called RN Pocket Guide. I have the 3rd addition. It's small, but packed.
by Paula Derr, RN, BSN,CCRN, CEN
I got it from Barnes and Noble. Hope this helps.
Kareegasee
44 Posts
Have you done BLS? What was the first thing they taught you? ABCs! Airway, Breathing, Circulation.Are they breathing on their own? No --> Start CPR
Are they breathing on their own? No --> Start CPR
Just to be clear, never perform compressions on a person who is not breathing but has a pulse, unless you are unable to ventilate them manually. Proper ventilation for an apneic adult includes use of a BVM (ideally with 100% O2) once every 5-6 seconds. In a LTC setting, I'm guessing the most appropriate response is a 911 call, unless someone around knows how to intubate.
A couple of years ago, this was an internal conversation I had with a newly admitted psych patient:
That conversation motivated me to come up with a dummies manual:
The manual had all sorts of good information for psych patients:
For more, here's a link:
https://allnurses.com/psychiatric-nursing/jacob-rockstar-rn-979458-page116.html
RNJenn47201
17 Posts
I've been working in LTC for nearly 8 years now. I will re-iterate what some have said before, reach out to your supervisor and/or coworkers. In our facility I have a binder of random policies and training handouts for situations that may come up. I've included everything from admissions, drains & tubes policies, how and when to fill out incident reports and what to do if someone dies. Maybe your facility has something similar that you're just not aware of.
CharleeFoxtrot, BSN, RN
840 Posts
Yup, OP ask around as most LTC have flowcharts for just such an occasion. The assessment skills will come in time, but until then use a reference and/or ask a more seasoned nurse for an opinion
angeloublue22, BSN, RN
255 Posts
RNnotes clinical pocket guide is what I use. It works great.