rachelgeorgina 5,874 Views
Joined: Apr 9, '09;
Posts: 412 (26% Liked)
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On my last clinical I was in the ICU. Tubes were aspirated for residual sixth hourly (patient's are on 24hrly continuous feeds. If there was more than 60mL of residual (i.e. the syringe capacity) it went into a fresh kidney dish (sterile/straight out of the packet, found in the ICU bedside cupboards so no leaving the bedside) so more residual could be aspirated. A max of 200mL was returned. Anything in excess of 200mL was disposed of.
I've just done a placement in one of the biggest and most specialized, well regarding neuro ICUs in the country. They leveled their art transducer at the tragus. With regard to the EVD/ICP these were most often open to the drain (& therefore the icp on the monitor would be grossly inaccurate) and clamped hourly to transduce an accurate ICP. obviously drainage orders were per neurosurg however.
Sometimes it depends on what sort of what you're on, the nurses that you're working with, the shift you're on and just.. the patient census that day. Also probably depends on the level of supervision you need, how far along in your course you are...
I've found that each clinical picked up a bit more in terms of what I was able to do as I learnt more skills and had more confidence to jump in and do things.
It sounds like a lot of you are in pretty slow paced places though!
I would have thought that it's not a clear cut issue and would depend on a multitude of factors beginning at least with the patient's condition, what the drug is/why it's running in the first place. I wonder if it might be slightly too black and white to have a cut and dry answer without considering individual situations.
If I were a new student I would have been hesitant to do that by myself for fear of dislodging the catheter or breaking something/causing pain. Nurses often have little tricks of the trade for sorting out small but inconvenient issues like IV lines in sleeves. I probably would have asked the patient how it was generally done - or asked my nurse how she would approach it. Once I'd asked once, I'd know how to do it for next time!
Yes, they certainly do.
The things that come to mind for me are the unsafe hours, particularly for junior medical officers and the ten odd years of education to work up the ladder to independent practitioner that involve the difficulty and competition of first getting into a training program, the deadliest exams that are rarely passed first time around to get through the training program and the excruciating amount of work and extra curricular activities that one needs to be involved in to get seen and heard and known to get through the training program and keep a job.
It's also part of the job of a RN to work through problems with students, not just be rude to them.
4.3 Contributes to the professional development of others
● demonstrates an increasing responsibility to share knowledge with colleagues
● supports health care students to meet their learning objectives in cooperation with other members of the health care team
● facilitates mutual sharing of knowledge and experience with colleagues relating to individual/group/unit problems
● contributes to orientation and ongoing education programs
● acts as a role model to other members of the health care team
● participates where possible in preceptorship, coaching and mentoring to assist and develop colleagues
● participates where appropriate in teaching others including students of nursing and other health disciplines, and inexperienced nurses
● contributes to formal and informal professional development
It's an Aussie show but 'RPA' is a real life, real time show portraying all sorts if cases that happen in the hospital. From major trauma to transplant surgery. It's a great show and really shows it how it is, nursing too.
Sometimes things as simple as letting a child take mum's temperature or your temperature is a good way to let you take THEIR temperature!
Thank you very much for your responses. They were really helpful going in to my first few days. I still have a lot to learn (counting a RR on a writhing, screaming child, a HR on a teeny baby... I never would have thought I'd have trouble doing a simple nursing task like taking observations!) but so many people in the hospital have been willing to point me in the right direction. & I appreciate it so, so much.
Wow. The American programs are really different to ours here in Australia.
- In first semester we did very basic manual handling, basic patient care (bed baths, showers, making an occupied bed, mouth care) and vital signs.
- Second semester we did oral medications and any other meds that weren't sub-q, IM or IV, we did IV fluids (without infusion pumps), sterile fields and basic wound care and we very briefly touched on caring for a patient with an IDC, NG tube or colostomy bag. We didn't cover inserting them, just the care of them.
- Third semester we covered injectable medications via sub-q and IM routes
- Fourth semester the major skills we focused on were IV medication administration via burette, blood transfusion and inserting an IDC.
I'm currently in my fifth and second last semester and I'm not sure what skills we'll be learning this year. In third year we take an elective in first semester plus an advanced med surg subject. I'm currently doing my elective in critical care and I'm on placement in a tertiary referral neurosciences ICU where I've been able to do everything from taking ABGs, suctioning traches & ETTs, inserting IDCs and pushing meds via CVCs. I'm doing my major (i.e. my whole last semester) in paeds so I don't know what that will entail yet. I think we cover chemo drugs in final semester though.
In Australia nurses don't insert IVs or take blood typically. Those are advanced practice skills that you need extra qualifications in. & other skills like inserting NG tubes or an IDC on a male often require you to be signed on to a register at the hospital you work at saying you've been assessed and are competent in that skill.
For those of you who say you learnt every single nursing skill there is to learn in the first semester, what did you do for the rest of your course?
Do your vented patients not have an airway certified doctor with them for all transport? Perhaps they should be bagging in the absence of the portable vent, which really, seems silly not to have
Use your clinical judgement. Do you think pushing a bolus of fluid on every single patient you come across who is hypotensive is a good idea? It's already been mentioned above several times but you need to look at more than simply the numbers. Look at the patient, look at their history and their medical conditions. Are you really going to push a big fluid bolus on a CHF patient or on a patient who has had fluid boluses after every set of obs that have been done on them for the last eight hours?
I went to an interesting talk the other day on fluid responsiveness in the hypotensive patient. If you're pushing fluid and the blood pressure comes up with no change in CVP then you're patient is fluid responsive and you're doing the right thing. If the blood pressure doesn't come up with a fluid bolus or it goes up and the CVP is jumping up your patient is likely not fluid responsive and the situation needs to be reassessed. You can wear out the welcome of a fluid bolus and tip the Frank Starling curve the wrong way leaving your patient in a worse position than they were to start with.
Use your clinical judgement.
I'm on clinicals in the ICU at the moment and would never, ever want to be a patient after seeing how patients, in particular our sedated and vented and brain injured/lowered GCS/non responsive patients are treated. It's almost like our patients are people in the bed and just work... I don't know.
I was the relative from hell when my grandma was unwell and later dying in hospital. I was the relative who the nursing staff complained about at handover. & I didn't care. If it meant my gran got a bed pan when she needed one, her pad changed when it was dirty and had her non-invasive ventilation hooked up appropriately (not mask on her face with no oxygen or air going through or mask not connected to the tubing or something equally as awful that happened more than once, seeing her sats drop down into the 40s with no nurse rushing to the alarms) then I stayed and did whatever I could to keep her safe and comfortable. I know I was a nurse's nightmare but I was my grandma's god sent.
I'm sorry to hear about your little patient.
I am really interested in the convo that's going regarding the paedi centres in the area though! If anyone else has anything at all to add to it I'm keen to read it. I'm an Aussie third/final year student and really keen on paeds. I'm interested to hear/learn as much as possible about anything at all related. I've been really interested in how things work in those major centres in the US. It's interesting to be hearing from nurses that actually work there.
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