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Multiple Questions

Posted
Lyn56 Lyn56 (New) New

Hi Everyone,

I am a new nurse and have some questions that I wanted to clarify before going into the field. I know some of them seem self explanatory, but I just need validation because I have been taught conflicting things and wanted to know the right thing to do in each circumstance. Thank you in advance for your help!!

1. If a patient exhibits say a 10 beat run or less of vtach overnight and already has labs for the morning, should I wake up the cardiologist or primary doctor if they don't have a cardiology consult to let them know? if they don't have labs, should I still call if the patient is asymptomatic or can this wait until the morning?

2. If a patient is on isolation precautions, how do I maintain safety from transmission of diseases when the patient is going for a test. obviously with airborne I would put a mask on the patient, but what about if they are contact or droplet and have to go for a test or procedure?

3. If a patient had surgery or a procedure and it is in the middle of the night and they start having profuse bleeding, would I call a rapid response to get a doctor right away rather than the surgeon?

4. HIPAA-How exactly should we be handling phone calls in order to maintain HIPAA? For example, if a patient is from another facility like a nursing home or group home and the nurse for the night calls to ask for an update, what exactly can I tell them without breaking HIPAA? Is discussing test results or medication the patient is on and any change in their status breaking hipaa?

5. if a patient is scheduled for surgery and is NPO, should you give any insulin coverage if they have a "high" blood sugar for their accucheck , or not because they are NPO and will not be eating anything?

6. When giving meds for a patient on a kangaroo pump, do I hold the feeding, disconnect the feed, administer the medications by pushing them into the tube, and then flushing and reconnecting and restarting the feed? I will ask to see a demonstration before having a patient with a feeding tube, I just wanted to have a better idea before I started.

Thank you for your time and I look forward to your responses!

OrganizedChaos, LVN

Specializes in M/S, LTC, Corrections, PDN & drug rehab. Has 10 years experience.

First tell us what *you* think & why.

sallyrnrrt, ADN, RN

Specializes in critical care, ER,ICU, CVSURG, CCU.

Yes what are your and for your question, what would your critical thinking skills have you do in those situations

1. If a patient exhibits say a 10 beat run or less of vtach overnight and already has labs for the morning, should I wake up the cardiologist or primary doctor if they don't have a cardiology consult to let them know? if they don't have labs, should I still call if the patient is asymptomatic or can this wait until the morning?

-I would first check the patient and see if they were symptomatic. If they were asymptomatic, I would be concerned with their electrolytes and want to make sure that they have a BMP and a mg scheduled for the morning. If it were to happen more frequently I would definitely call the doctor and let them know.

2. If a patient is on isolation precautions, how do I maintain safety from transmission of diseases when the patient is going for a test. obviously with airborne I would put a mask on the patient, but what about if they are contact or droplet and have to go for a test or procedure?

-I would alert the procedure room or surgery, etc and let them know what type of precautions the patient needed and make sure that the transport team takes adequate precautions as well.

3. If a patient had surgery or a procedure and it is in the middle of the night and they start having profuse bleeding, would I call a rapid response to get a doctor right away rather than the surgeon?

-during the day I feel like it is a lot easier because the doctors are always accessible (haha), however I would maintain pressure on the area myself and enlist the help of my fellow nurses to complete any other tasks such as calling the doctor or obtaining supplies to get the bleeding under control.

4. HIPAA-How exactly should we be handling phone calls in order to maintain HIPAA? For example, if a patient is from another facility like a nursing home or group home and the nurse for the night calls to ask for an update, what exactly can I tell them without breaking HIPAA? Is discussing test results or medication the patient is on and any change in their status breaking hipaa?

-I am unsure on this one, obviously I would not give any personal information such as address, ssn, etc and sometimes I would say that the results are still pending or to call the doctor directly to discuss those with them because I am not able to go into detail over the phone, but this is something that I am working on to better educate myself to make sure I always maintain HIPAA for my patients. I try to err on the side of caution with this one but want to know the actual laws pertaining to it and plan to look specific things up relating to HIPAA.

5. if a patient is scheduled for surgery and is NPO, should you give any insulin coverage if they have a "high" blood sugar for their accucheck , or not because they are NPO and will not be eating anything?

-I would think to hold prandial insulin if they are NPO but if it is a sliding scale..I would think to give it unless ordered otherwise, but if I was unsure I would call the physician.

6. When giving meds for a patient on a kangaroo pump, do I hold the feeding, disconnect the feed, administer the medications by pushing them into the tube, and then flushing and reconnecting and restarting the feed? I will ask to see a demonstration before having a patient with a feeding tube, I just wanted to have a better idea before I started.

Is there anything else you could add to help me better understand my responses or what I could do differently in each situation? Thank you for your help :)

1. If a patient exhibits say a 10 beat run or less of vtach overnight and already has labs for the morning, should I wake up the cardiologist or primary doctor if they don't have a cardiology consult to let them know? if they don't have labs, should I still call if the patient is asymptomatic or can this wait until the morning?

-I would first check the patient and see if they were symptomatic. If they were asymptomatic, I would be concerned with their electrolytes and want to make sure that they have a BMP and a mg scheduled for the morning. If it were to happen more frequently I would definitely call the doctor and let them know.

2. If a patient is on isolation precautions, how do I maintain safety from transmission of diseases when the patient is going for a test. obviously with airborne I would put a mask on the patient, but what about if they are contact or droplet and have to go for a test or procedure?

-I would alert the procedure room or surgery, etc and let them know what type of precautions the patient needed and make sure that the transport team takes adequate precautions as well.

3. If a patient had surgery or a procedure and it is in the middle of the night and they start having profuse bleeding, would I call a rapid response to get a doctor right away rather than the surgeon?

-during the day I feel like it is a lot easier because the doctors are always accessible (haha), however I would maintain pressure on the area myself and enlist the help of my fellow nurses to complete any other tasks such as calling the doctor or obtaining supplies to get the bleeding under control.

4. HIPAA-How exactly should we be handling phone calls in order to maintain HIPAA? For example, if a patient is from another facility like a nursing home or group home and the nurse for the night calls to ask for an update, what exactly can I tell them without breaking HIPAA? Is discussing test results or medication the patient is on and any change in their status breaking hipaa?

-I am unsure on this one, obviously I would not give any personal information such as address, ssn, etc and sometimes I would say that the results are still pending or to call the doctor directly to discuss those with them because I am not able to go into detail over the phone, but this is something that I am working on to better educate myself to make sure I always maintain HIPAA for my patients. I try to err on the side of caution with this one but want to know the actual laws pertaining to it and plan to look specific things up relating to HIPAA.

5. if a patient is scheduled for surgery and is NPO, should you give any insulin coverage if they have a "high" blood sugar for their accucheck , or not because they are NPO and will not be eating anything?

-I would think to hold prandial insulin if they are NPO but if it is a sliding scale..I would think to give it unless ordered otherwise, but if I was unsure I would call the physician.

6. When giving meds for a patient on a kangaroo pump, do I hold the feeding, disconnect the feed, administer the medications by pushing them into the tube, and then flushing and reconnecting and restarting the feed? I will ask to see a demonstration before having a patient with a feeding tube, I just wanted to have a better idea before I started.

Is there anything else you could add to help me better understand my responses or what I could do differently in each situation? Thank you for your help :)

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

A whole bunch of what you're asking would be facility-specific. P&P's will cover a whole lot of your questions. That's what orientation is for. Even the things that seem to simply be nursing judgment, such as holding insulin in an NPO patient, will have a policy directing you.

Personally I would not feel comfortable taking an online respondent's advice as appropriate for my job in my facility. Every management team in every facility wants employees to do things their way.

Coffee Nurse, BSN, RN

Specializes in NICU. Has 10 years experience.

1. If a patient exhibits say a 10 beat run or less of vtach overnight and already has labs for the morning, should I wake up the cardiologist or primary doctor if they don't have a cardiology consult to let them know? if they don't have labs, should I still call if the patient is asymptomatic or can this wait until the morning?

-I would first check the patient and see if they were symptomatic. If they were asymptomatic, I would be concerned with their electrolytes and want to make sure that they have a BMP and a mg scheduled for the morning. If it were to happen more frequently I would definitely call the doctor and let them know.

2. If a patient is on isolation precautions, how do I maintain safety from transmission of diseases when the patient is going for a test. obviously with airborne I would put a mask on the patient, but what about if they are contact or droplet and have to go for a test or procedure?

-I would alert the procedure room or surgery, etc and let them know what type of precautions the patient needed and make sure that the transport team takes adequate precautions as well.

3. If a patient had surgery or a procedure and it is in the middle of the night and they start having profuse bleeding, would I call a rapid response to get a doctor right away rather than the surgeon?

-during the day I feel like it is a lot easier because the doctors are always accessible (haha), however I would maintain pressure on the area myself and enlist the help of my fellow nurses to complete any other tasks such as calling the doctor or obtaining supplies to get the bleeding under control.

4. HIPAA-How exactly should we be handling phone calls in order to maintain HIPAA? For example, if a patient is from another facility like a nursing home or group home and the nurse for the night calls to ask for an update, what exactly can I tell them without breaking HIPAA? Is discussing test results or medication the patient is on and any change in their status breaking hipaa?

-I am unsure on this one, obviously I would not give any personal information such as address, ssn, etc and sometimes I would say that the results are still pending or to call the doctor directly to discuss those with them because I am not able to go into detail over the phone, but this is something that I am working on to better educate myself to make sure I always maintain HIPAA for my patients. I try to err on the side of caution with this one but want to know the actual laws pertaining to it and plan to look specific things up relating to HIPAA.

5. if a patient is scheduled for surgery and is NPO, should you give any insulin coverage if they have a "high" blood sugar for their accucheck , or not because they are NPO and will not be eating anything?

-I would think to hold prandial insulin if they are NPO but if it is a sliding scale..I would think to give it unless ordered otherwise, but if I was unsure I would call the physician.

6. When giving meds for a patient on a kangaroo pump, do I hold the feeding, disconnect the feed, administer the medications by pushing them into the tube, and then flushing and reconnecting and restarting the feed? I will ask to see a demonstration before having a patient with a feeding tube, I just wanted to have a better idea before I started.

Is there anything else you could add to help me better understand my responses or what I could do differently in each situation? Thank you for your help :)

Your answers don't really answer the questions you asked.

Is this homework or NCLEX prep questions?

As a pp noted, each facility has their own policies and procedures. You should look at them, know them. Also, know your resources. Nursing is a team sport, therefore, don't ever not ask for help when you need it.

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

4. HIPAA-How exactly should we be handling phone calls in order to maintain HIPAA? For example, if a patient is from another facility like a nursing home or group home and the nurse for the night calls to ask for an update, what exactly can I tell them without breaking HIPAA? Is discussing test results or medication the patient is on and any change in their status breaking hipaa?

-I am unsure on this one, obviously I would not give any personal information such as address, ssn, etc and sometimes I would say that the results are still pending or to call the doctor directly to discuss those with them because I am not able to go into detail over the phone, but this is something that I am working on to better educate myself to make sure I always maintain HIPAA for my patients. I try to err on the side of caution with this one but want to know the actual laws pertaining to it and plan to look specific things up relating to HIPAA.

If the patient came from a group home or a nursing home, don't you think said homes already know the person's address? Since he lives at their facility? I doubt anyone is calling at 2am to say "we sent Mr. Smith to the ER with SOB, can you tell me where he lives?" The nursing home or the group home are members of the patient's care team. They need to know what's going on with him to anticipate his needs when he returns. If a charge nurse is calling at night, she's trying to anticipate whether or not he will be returning to the home the following day so that adequate preparations can be made for the patient to be cared for. And they'd need to know if anything changed.

1. If a patient exhibits say a 10 beat run or less of vtach overnight and already has labs for the morning, should I wake up the cardiologist or primary doctor if they don't have a cardiology consult to let them know? if they don't have labs, should I still call if the patient is asymptomatic or can this wait until the morning?

-I would first check the patient and see if they were symptomatic. If they were asymptomatic, I would be concerned with their electrolytes and want to make sure that they have a BMP and a mg scheduled for the morning. If it were to happen more frequently I would definitely call the doctor and let them know.

I would call. We call with runs over 6 beats. We usually get orders to check Mag and K even if ordered in am.