Nursing Interventions...

Ivanna_Nurse, BSN, RN · Dec 11, 2009

Chances are, when they come to you, if they are admitted, those labs will be drawn, cxr done and O2 needs evaluated before they even come to the floor. If there is a change in status that warrants starting fluids, drawing cultures or a sudden, substantial increase in 02 demand, those are things that the doc will want to know about, which means you'll be calling him anyhow for orders. Hope this helps. :) Ivanna

sunnycalifRN · Dec 12, 2009

If a patient came to you with fever, chills, weight loss, cough, and fever what can you do to the patient without asking the doctor for permission?
Can you start them on NS and put them on O2? Or do you need to ask doctor first? Can you order chest xray or sputum culture without doctor permission?

As an RN, you do not have order writing authority, so you cannot order anything. However, some hospitals have protocols for certain types of admissions, so there may be an "order set" for all the interventions that you mentioned.

However, a nurse practitioner does have order writing authority and could write those orders, though he/she would probably not be at the bedside to implement them.

mamamerlee, LPN · Dec 12, 2009

Where is the patient? Why are they coming to you without orders? I am not wanting to be mean, but are you really a nurse? Nurses don't write their own orders, but sometimes there are protocols that can be followed.

RedhairedNurse, BSN, RN · Dec 12, 2009

If a patient came to you with fever, chills, weight loss, cough, and fever what can you do to the patient without asking the doctor for permission?
Can you start them on NS and put them on O2? Or do you need to ask doctor first? Can you order chest xray or sputum culture without doctor permission?

No, not without an order. You can put O2 on them only without an order, but then you need to obtain an order afterwards.

scg08rn · Dec 12, 2009

If a patient came to you with fever, chills, weight loss, cough, and fever what can you do to the patient without asking the doctor for permission?
Can you start them on NS and put them on O2? Or do you need to ask doctor first? Can you order chest xray or sputum culture without doctor permission?

With fever you can put a cool rag on the forehead, encourage po fluids. But if these symptoms are presented to you by a patient, you need to call the doctor for further orders to find out what is going wrong. If o2 sats are low, put on o2 and obtain order after. Weight loss is something that a patient doesnt come up to you with unless they stated they have lost weight-doctor needs to order dietary consult. You compile all your informations, call the doctor and suggest anything you feel is important for the patient if the doctor didn't order it. Nursing interventions you learn in school.

Blackheartednurse · Dec 12, 2009

Sounds like he has a case of pneumonia or tuberculosis (haha weight loss caught my attention), yep you can definitely put the patient on o2 by nasal cannula max 2-3 liters (independent nursing interventions) but first assess pt oxygenation level (pulse ox,skin,SOB?) You dont put oxygen on a patient just because he has chills,fever etc..you need to ASSESS first,I also think in emergency situation like pulmonary embolism nurse can titrate oxygen up 4 L. Also dont forget to change patients position (sit them up) and start IV.Take their vitals.

roser13, ASN, RN · Dec 12, 2009

"Also dont forget to change patients position (sit them up) and start IV."

I would never start an IV without a protocol or order set in place. That is definitely not considered an independent nursing intervention. Nor is placing or titrating 0's.

OP, your questions are very facility-specific.

shoegalRN, RN · Dec 12, 2009

The only thing I would do is put on oxygen and get an order afterwards. If there is not standing orders or protocols, I'm not doing it without a doctor's order. That includes starting an IV and starting fluids. If the pt came from the ER, I would think they would have inpatient orders and already have O2, IV started with fluids running. Chest xray and blood cultures may have already been done in the ER prior to transferring to floor.

sunnycalifRN · Dec 12, 2009

If a patient came to you with fever, chills, weight loss, cough, and fever what can you do to the patient without asking the doctor for permission?
Can you start them on NS and put them on O2? Or do you need to ask doctor first? Can you order chest xray or sputum culture without doctor permission?

Is this a 1st yr nursing school question? :smokin:

SharonH, RN · Dec 13, 2009

If a patient came to you with fever, chills, weight loss, cough, and fever what can you do to the patient without asking the doctor for permission?
Can you start them on NS and put them on O2? Or do you need to ask doctor first? Can you order chest xray or sputum culture without doctor permission?

Nursing Interventions:

History: how long has the patient had the symptoms? Ask about additional symptoms like night sweats, amount and character of sputum, dyspnea, any chest pain, appetite, exposure to others with similar symptoms or TB, vaccinations for pneumonia, last PPD, any chronic illnesses, how has he or she been treating the symptoms?

Assessment: Perform vital signs, baseline weight, assess breath sounds, pulse oximetry

Education: Advise patient to report worsening symptoms, blood in sputum, chest pain etc.

Other: Provide reassurance. Keep HOB elevated. Be prepared to collect sputum specimens. If possible admit patient to private room until it is determined if he will need isolation.

Good luck, there's a lot more to it than tasks like starting IVs and looking at cardiac monitors. Please don't get into the habit of thinking that we have nothing to contribute until the physician writes orders. We don't just stand around waiting on them to tell us what to do, if you do you are short-changing your patients.

lm8539 · Dec 14, 2009

Thanks for the help with the questions....this question was given to me in an interview that did not take place in a hospital setting where I would have been the first person seeing the patient and no orders would have been previously given.

Also, I have not worked as a nurse yet. Long story short, I graduated a couple years ago and got a DUI right before I graduated so the BRN would not let me get my license until now. SO I am a bit rusty on some stuff but I'm working on it. Waiting this long to find a job wasn't my choice.

Thanks for the help :)