Learning Thread: Med/Surg

I'll get back to the dialysis question after some thought. I had an interesting pt last week. She is diabetic, she presented in the E.R. with a blood glucose of 15- amazingly she was still responsive; however she became hypothermic and then went into afib. Can anyone guess why this all happenend?

We are expected to do so no matter what and no matter where the infection is. If it's in a wound that is covered, and I'm going in just to pass meds, I am expected to wear full PPE. I actually had a CNA tell on me the other day for not doing so!

Of course I wear full PPE when coming in close contact with any "contact" isolation patient, but I still fail to see the point when passing meds and NOT coming in close proximity with the patient. I love this idea that the door-way is some sort of magical barrier...

:innerconf I used to think this way too, and still occasionally go into a contact iso room w/o PPE, but it's become the exception--like the night my guy was choking while I was still getting report & I almost had to do the Heimlich. I didn't think he'd appreciate me taking 30+ seconds to glove & gown while his eyes were bulging & his face was turning purple. We gown & glove, not to protect ourselves, but to protect our other patients who may have compromised immune systems. Studies have been done on the thoroughness of cleaning ISO rooms after the patients are d/c'd, and VRE and MRSA have been found on door knobs, bed rails, IV poles & pumps (there goes my excuse that I'm just going to hang a new bag of fluid, 3 feet away from the patient), thermostats, chairs, walls, computer keyboards, you name it. If it's a surface, it's been infected. Think about the patient w/ MRSA in his nares. He sneezes or simply blows his nose, doesn't wash his hands, can't reach the trash, so he leaves the tissue on his tray table & then steadies himself on the bedside rail to get out of bed. He then grabs his IV pole by the pump, walks with it to the bathroom & opens the door, flushes the toilet, (hopefully) turns on the faucet to wash his hands, but then doesn't use a towel but his bare hand to turn off the faucet. Grabs the same door handle & bed rail on his way back to bed. I come in the room to hang a new bag of fluid and accidentally brush up against the pole & the bathroom doorknob (our rooms are small). I'm gloved, so my hands don't come in contact with his equipment, but my scrubs do. So even though I wash my hands thoroughly before heading in to see my next patient, I've still got MRSA on me. And for some people, that's all it takes.

I do often wonder if the cloth gowns are totally effective, especially after being washed a million times & getting thing, but at least they have some protection. If someone has an oozing wound or has VRE in their urine & they're incontinent, I order the paper gowns, which are thicker and offer more barrier between the germs and me.

What really grosses me out is when the all the various doctors come and go from these rooms, touch the patient and their wounds, and then use a little alcohol foam before sitting down at a computer to type up their notes. I always wipe down the keyboards and mice before using them! Call me a germophobe, but I have kids at home and my own health to think of. And if I'm ever hospitalized, you can bet I'll be there with my own bottle of Quat to have someone wipe down my bedrails & call light!:chair:

I am new to this site and love these trivia threads. I am a new nurse with 1.5 years behind me. I love looking for new ways to explain things to patients. I will think of a question to post.

I'll get back to the dialysis question after some thought. I had an interesting pt last week. She is diabetic, she presented in the E.R. with a blood glucose of 15- amazingly she was still responsive; however she became hypothermic and then went into afib. Can anyone guess why this all happenend?

Possibly insulin shock? (could cause low temp and irreg heart rhythm among a boatload of other things)

I learned the other day that if the mag level is abnormal then the K level is probably abnormal, too. And vice versa. I had a pt come to the floor from the ed the other day with a K of 3.3 and mag was infusing (no mag level even drawn). Confused and had to ask a good MD friend. Also don't give MS (morphine) prior to HIDA scan or gallbladder U/S. MS causes spasms of the sphincter of Oddi (Forgot that one from school).

I thought in CO poisoning that the skin usually never presents as cyanotic, but cherry-red or pink and flushed?

That is correct. I have seen a CO poisoning and they were flushed and red.

Each patient and seizure is different. Assessment and documentation of each stage, specific symptoms, length, must be documented. A pt is asked questions to determine postical LOC to assess/monitor length of each stage and may be asked question during seizure to determine - real seizure or not

Wow I can't believe this post didn't continue, well here is another.

When taking a pts pulse ox, and it shows a 98% saturation but patient looks blue what do you thing this means?

And what do u do when a Doctor orders a walking spo2 assessment on a pt with chronic afib, chf and copd prior to discharge?

I am still just a RN student but I work as a tech. . I have been wondering if anyone had a great responses to the question, "When will the Doctor get here?" . . . . the responses I am using aren't always well recieved and I end up with a frustrated patient.

I am still just a RN student but I work as a tech. . I have been wondering if anyone had a great responses to the question, "When will the Doctor get here?" . . . . the responses I am using aren't always well recieved and I end up with a frustrated patient.

I usually tell them that they can come anytime throughout the day - they can easily get stuck on another floor or with another patient for a while so we don't know an exact time that the doctor will be seeing them. I also reassure them that a doctor will be seeing them every day.

I just learned a neat trick for removing tape easily from skin. I was trying to remove a saline lock from an elderly gentleman with VERY hairy arms. It was such a struggle to get all the tape off and it was very painful for him to have so much hair get pulled off (though I was as careful as possible), it caused him almost more pain that starting the IV in the first place. The Tegaderm was easier to get off, but all the "reinforcing" tape was a nightmare. Anyway another nurse told me his trick. Smear the tape with petroleum jelly and let sit for a minute or so. It sinks right through (this was the plastic micro pore type tape but would probably also work on others if they were somewhat porous). The tape came right off, leaving the hair intact and the patient pain free. The petroleum dissolves the adhesive completely. Wow, what an easy solution, but I had never heard that before!