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J-tube. RN/LVN

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by cjkekoa cjkekoa (New Member) New Member

951 Visitors; 12 Posts

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Hi all,

I am an Lead LVN in a facility and I am the one who has to train all new nurses. RN and LVN alike. I have a new grad RN and we have some disagreements on a few things. I could definitely be wrong so I wanted to clarify.

For J-tube I had informed her that we do not check placement, aspirate, or put air in the j-tube. She said she checks placement by putting air.

For bradycardia, would a pacemaker be beneficial? She has informed me that they are only for people who's hearts stop beating.

I try my best to help anyone new and let them know to ask me any questions if they are unsure, and help them do things accordingly to protocol if I see it is being done incorrectly, sometimes I feel that because I am an LVN they refuse to listen to what I have to say. I have been with this company for over 5 years as a lead.

I understand in the medical field, we are constantly learning new things or new ways of doing things. I just want to be sure I'm training the nurses correctly, if I am incorrect I would want to make sure things are being done the right way. Thanks in advance for any advice.

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CalicoKitty has 6 years experience as a BSN, RN and works as a Med-Surg Nurse.

67 Likes; 1 Follower; 15,108 Visitors; 541 Posts

You don't need to check residuals for post-pyloric (past the stomach) feeding tubes (J-tubes). They often are kept in place with a balloon, and that may need to get checked weekly.

Pacemakers are often used for symptomatic bradycardia. They give the electrical stimulation to a heart if it doesn't beat within it's time frame (often 60-70 bmp). It can pace the atrium, ventricle or both. It should pace a heart before it stops beating. If the heart doesn't beat after being paced, well.. That's a problem.

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4 Likes; 961 Visitors; 62 Posts

I would look it up on our facility's medical website,that they pay for, and also the facility's policies. I would print them out and provide them to the new RN. Not to be snarky but for reference. Then explain that those are places to verify correct practice for your facility. This will help with your credibility in her eyes, hopefully, and humble her enough to be open to constructive criticism.

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DextersDisciple has 5 years experience.

26 Likes; 3,305 Visitors; 202 Posts

Why is a new grad telling an experienced LEAD nurse how nursing works? I'd watch her closely if I were you, she's bossy and way too overconfident. Her answers were wrong anyway.

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traumaRUs has 25 years experience as a MSN, APRN and works as a Asst Community Manager @ allnurses.

466 Likes; 14 Followers; 127 Articles; 184,825 Visitors; 20,485 Posts

Moved to Pt/Colleague Relations

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41 Visitors; 1 Post

Yes you check residual. Make sure their digesting the contents. Just a small pullback.

To me it feels like you have some resentment towards training new nurses. Are you assuming some new grads are judging you by your title? It's probably not the case. Being new is scary and intimidating. You appreciate the experienced nurses no matter what their degree. Make sure your not reading into things too much. It's not about proving who's right and who's wrong, it's about safety. Pull up the policies and procedures for her.

In my eyes the best nurses are the ones with work experience, the title is just that. Think of all the lives you have changed and are changing by sharing your knowlege. It can be frustrating I'm sure, lol, but know that you wouldn't be teaching them if you werent a expert.

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River&MountainRN has 3 years experience.

137 Likes; 1,611 Visitors; 155 Posts

From the Cleveland Clinic: "It is NOT necessary to check residuals on postpyloric feeding tubes (nasoduodenal, nasojejunal, or jejunostomy tubes)."

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1,646 Likes; 4 Followers; 16,967 Visitors; 2,517 Posts

Yes you check residual. Make sure their digesting the contents. Just a small pullback.

Can you enlighten us how, anatomically, the jejunum holds enough fluid to aspirate? Also, "checking residual" means to measure the remaining gastric contents to ensure digestion. How would this be accomplished by a "small pull back"? I'm pointing this out because I do not believe at all that the OP has any resentment regarding training new nurses. She has a new nurse telling her stupid things and she wants to verify information that is not making sense or may be new EBP. To me that sounds like a conscientious preceptor wanting to provide her orientees with accurate information. In contrast this new nurse sounds like an insufferable know-it-all who resents being trained by an LPN.

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4 Likes; 8,922 Visitors; 385 Posts

Yes you check residual. Make sure their digesting the contents. Just a small pullback.

To me it feels like you have some resentment towards training new nurses.

Make sure your not reading into things too much.

Betty- with all due respect, I see no evidence of resentment. To the contrary, this is someone who I think I would like very much to have as my preceptor.

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DextersDisciple has 5 years experience.

26 Likes; 3,305 Visitors; 202 Posts

Can you enlighten us how, anatomically, the jejunum holds enough fluid to aspirate? Also, "checking residual" means to measure the remaining gastric contents to ensure digestion. How would this be accomplished by a "small pull back"? I'm pointing this out because I do not believe at all that the OP has any resentment regarding training new nurses. She has a new nurse telling her stupid things and she wants to verify information that is not making sense or may be new EBP. To me that sounds like a conscientious preceptor wanting to provide her orientees with accurate information. In contrast this new nurse sounds like an insufferable know-it-all who resents being trained by an LPN.

THIS! she clearly does NOT resent new grads since she is willing to listen to their (mostly unwanted/unnecessary) opinions on how to be a nurse.

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DextersDisciple has 5 years experience.

26 Likes; 3,305 Visitors; 202 Posts

Yes you check residual. Make sure their digesting the contents. Just a small pullback.

To me it feels like you have some resentment towards training new nurses. Are you assuming some new grads are judging you by your title? It's probably not the case. Being new is scary and intimidating. You appreciate the experienced nurses no matter what their degree. Make sure your not reading into things too much. It's not about proving who's right and who's wrong, it's about safety. Pull up the policies and procedures for her.

In my eyes the best nurses are the ones with work experience, the title is just that. Think of all the lives you have changed and are changing by sharing your knowlege. It can be frustrating I'm sure, lol, but know that you wouldn't be teaching them if you werent a expert.

This is wayyy off base.

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Kallie3006 has 6 years experience as a ADN and works as a Jack of all trades, master of none.

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It is NOT necessary to check residuals on postpyloric feeding tubes (nasoduodenal, nasojejunal,

or jejunostomy tubes). Residuals are checking the content remaining in the stomach. Jejunostomy tubes are placed past the stomach and into the small intestines. Placement should be checked weekly, or according to your facilities policy, there is a balloon that is filled that keeps the j tube in position, this balloon is similar to a Foley balloon. For more clarification you could always ask the patients doctor on how to proceed with the patients that have j tubes.

The patient would need more than a pacemaker for asystole. A pacemaker mimics the natural pacemaker of the heart. Pacemakers are used in patients with symptomatic bradycardia, and can be used to help with heart failure. The specific function the pacemaker does depends on whether it is a single, dual or biventricular pacemaker.

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