Latest Comments by bethisonline

bethisonline 901 Views

Joined: Sep 5, '10; Posts: 7 (29% Liked) ; Likes: 7

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  • 0

    Quote from CrazyheadSN
    I'm a student. I was in my last Med/surg rotation (telemetry floor). I went to get pt. vital signs in the morning and she wanted her BP taken on her forearm. So, I did. She said it was due to her very large arms and it pinched when you take it on her upper arm. I got a BP of 163/87 (dynamap). BP was slightly high so I wanted to give her 9AM meds which included some BP meds before any other intervention. I administered her medication and I went back at about 1130 and did her VS again and her BP(forearm-dynamap) was 166/91 this time.

    I checked her PRN and she had an order of hydralazine 10mg (0.5ml) IVP. So, I administered the hydralazine @1245 IVP. I went back around 130PM and took her BP on her forearm. It was 198/100. I was thinking OMG how the heck is it that high after administered her hydralazine. At the time the nurse was coming into the room so I showed the nurse the vitals on the dynamap. The nurse questioned it and thought "that's not right." I told the nurse I was taking her BP on her forearm because the pt. felt like it was more comfortable. The nurse found a larger BP cuff and took the BP on the upper arm. BP this time was 139/93. Nurse said, "that's better." and that was it....and I went home.

    Soooo, basically, 3 days later I'm freaking out because I could have caused my patient's BP to drop. I was probably getting the wrong BP reading the entire day by taking it on the forearm, and then I go and push hydralazine!! I feel so bad about doing that. Here I thought, I'm doing great in clinical, and I go and do this.......I emailed my instructor b/c she doesn't know what happened and I didn't really worry about it or even THINK about taking the BP on the forearm as a big deal, until now. Could 10mg (0.5ml) of hydralazine really cause my patient's bp to drop to the point that she could die? I feel so bad......I think I might get kicked out of school b/c of this mistake......I'm waiting to hear back from my instructor....
    First of all the BP of 139/93 is NOT a low blood pressure, so you cannot say that you
    did anything unsafe. AND alot of women who are larger or who have fibromyalgia do experience pain from BP cuffs on their upper arms regardless of the size. I work with pain management patients and on occasion have taken their BP on the radial artery on the lower arm, just like we take the BP on the leg for breast cancer pts. AND by the time the larger cuff was put on the upper arm the hydrazaline could have started working. The other thing that needs to be realized is that patients who have high BP that goes untreated will probably not respond very quickly to medications for BP. Chronic high blood pressure is a viscious cycle and it just takes time for meds to kick in and probably repeated doses.
    It would behoove us all to do some research and comparison of radial artery BP and Brachial artery BP, because I guarantee that another patient you will come across will complain the same as your pt did and you will want to place the BP cuff elsewhere so you do not cause pain in the upper arm.

  • 5

    Bad experiences do and will occur as a result of poor management and weak leadership. If you ever have a really good nurse manager and effective leadership, do not ever quit that job! Effective leadership in healthcare is very difficult to find.
    Your article is EXCELLENT Thanks for posting it.

  • 2
    DizzyLizzyNurse and lindarn like this.

    Customer service in the healthcare industry INCLUDES patient safety. Instead of nurses wearing do not disturb
    signs, why not have nurses that ONLY pass medications that cannot be interupted while passing meds? Nursing
    professionals and managers and supervisors need to learn to think outside of the box, use logical and critical thinking skills PLUS innovative thinking. What would be wrong with teams of nurses that just pass medications?
    I see this as answer to a complincated work environment. During high med volumes the med nurses would not be available, thus would be become more efficient at passing meds, would get the job done faster then be available to answer call lights, enter orders etc. This is flexible thinking and innovation. Unless the patients are coding or falling or some other critical event the designated med nurse would not be allowed to get interupted, the patients would get their meds on time and it would be a safe, solid measure. The floor nurses could alternate the duty of medication nurse on a day to day or week to week basis.

  • 0

    Naomi Judd

  • 0

    nursing practice is almost as diversified as the people we care for. Just because someone does not work in the ICU or ER does not mean a darn thing. Let's
    say we put an ICU nurse on med/surg? We all know that they may have a difficult time functioning. Or how about we put a labor and delivery nurse on med/surg
    and certainly there would be issues. A med/surg nurse may not function well
    in the labor and delivery area as well. Y'all need to realize that with each area of
    care there is special knowledge needed in order to function properly. Put an ER nurse on med/surg that has no prior knowledge or experience on med/surg and
    he/she will have difficuty and vice/versa. Some nurses get big headed and think they know it all. WRONG ANSWER! Just when you think you know it all
    put up the red flag and giveyourself a warning.

  • 0

    I was reading craigslistpotings for medical assistants and they all want 5 years experince, so where is a new medical assistant supposed get experience? They do 4 weeks of externship
    where they do not get paid anything and then, where do they go from there?

  • 0

    Medical Assistants can work in settings where there is a physician present always. Outpatient and ambulatory care centers DO like to hire Medical Assistants, especially pain management clinics and these places are on fire!
    They have SO MANY patients and they will hire a medical assistant versus a CNA because the patients do not stay long and only need discharge instructions, monitoring of vital signs and assistance to stand and get to a wheelchair and into a car. So there is a place for medical assistants. They learn excellent customer service skills
    and how to deal with people. They do not get hands on training for patients that are bedbound or wheelchair bound, but they can learn as much as they want to learn in these settings.