Nursing Tid Bits

[widi96]

Thought it would be fun / interesting to do a threat of one to two line facts about things in nursing . .

I'm talking educational little tidbits that people may have forgotten / never learned in school etc. Everyone can always use a little refresher.

Ex. Never push IV Lasix faster than 10mg/min.

If someone is on Tube Feeding, there HOB must be elevated.

[island40]

precipitate is when a solute (crystals) falls out of a solution. When the dilantin is added to LR chloride crystals form and it looks like it is snowing in the tubing. Not to pick on you personally but this is why nurses need to have a college chemistry course.

[NURSE2306]

-Patients should be laying flat when given demerol

-ABX (Such as Ancef/Merrem) to be prepared with Sterile water not Saline

[liveyourlife747]

These are great! Especially the tid bit about leaning the pt forward to hear the heartbeat better.

With a tube feeding via G-tube:

*When inserting an extension tube to the G-tube button, hold the edges of the button so you are not pushing in on the pts stomach.

*When disconnecting the extention tube, be sure to have a tissue (or wipe/guaze pad) right there in case stomach contents leak out before you have time to replace the button cover.

[RN2B123]

whats a bed roll? is that when you take all the sheets off the bed and bunch them up in the middle then get the pt to turn and remove the sheets and change them?

[RN1982]

No. My bedroll consists of a fitted sheet then a draw sheet and two blue pads on top roll it up on both sides and fold it and when you turn the patient to change the linen you roll the old linen underneath the patient and then roll on the bedroll.

[nrsang97, BSN, RN]

I think your explanation is better than mine was. I can't believe they never showed us this in nursing school. I don't know of any other area hospitals that make a bed roll either. How wierd. So So easy to change the bed that way.

[liveyourlife747]

we had to master the bedroll in nursing school because it was part of making an occupied bed

[nrsang97, BSN, RN]

We weren't taught that at all. We had to make a occupied bed with flat not fitted sheets for lab. I thought there had to be a easier way to do this. I never learned this technique until I transferred to the ICU.

[sailornurse]

For a patient with a laceration near the eyebrows, NEVER shave eyebrows. They don't always grow back.

[care4you]

precipitate is when a solute (crystals) falls out of a solution. When the dilantin is added to LR chloride crystals form and it looks like it is snowing in the tubing. Not to pick on you personally but this is why nurses need to have a college chemistry course.

not sure where you went to college but we had to take chemistry

[Morettia2, BSN, RN]

HA I use the bed roll all the time. I was the bed roll queen in Nursing school. But I must say that my CNA's on my floor are the Bed Roll masters:yeah:. I remeber in school it took forever to master the bed roll, the pad would always be in an odd position and you wouldhave to reposition the pt. over and over. The best is the bed roll with the DIAPER and get it in the right position. HAHA I look back and laugh b/c it was so darn difficult to figure out..

Here's one...when you have an obese pt. and there is no sliding board in sight use a clean heavy duty disposable linen bag, like the big blue plastic linen bags, place it under the pt. half way and transfer is a breeze!!! Although my hosp. dosen't use them, we used to do it in nursing clinical all the time and I showed a few nurses at other hosp. how to use them, they hugged me and said how did you come up with that...I said, "My instructor showed us b/c she was in a bind once with a morbidly obese pt. and had no sliding board and grabbed the best thing she could find and well it worked.":idea:

Another one is always dilute IV protonix in a bag of 100cc NSS.

If your IV vanco dosen't break the seal when you try and dilute it, twist the bottle, and push down the 250cc bag towards the bottle with the undiluted vanco and it should dilute with no problem. we had a problem with the seal on the bag attached to the vial of vanco, you would break the seal but no fluid would dilute the ATBX. Yill one day I took the entire thing apart, amde a mess but found the problem. :w00t:

I had the Lovenox drug rep. in Nusring school tell us that it should be given in the love handles. He said always remember, "Love the lovenox".

IV benadryl can affect the pt's. platelets.

If your pt. is allergic to PCN, they are most likely allergic to ANCEF. Ancef can cause the anaphalytic reaction that PCN does. Always double check.:caduceus:

If you pt. is allergic to eggs, they probably won't be getting the flu shot.

If your pt. is allergic to latex, they are also allergic to banannas, avacado's, chestnuts, passion fruit and kiwis.

Never pt. a COPD pt. on high flow O2. And when a COPD pt. is recieving a breathing tx. always know when it started and make sure you are standing there when it finishes. I saw a COPD pt. once placed on a neb tx. by the respiratory therapist at the change of shift, and the nurse and the therapist never checked to see when the tx was finished before their shift was over and the pt. was found semi-conscious. on 10L O2 via face mask with the tx finished and the 10Lof O2 just flowing in the face mask. I was the one who found the pt. 1.5 hours after the initial tx was given. I was in my last semster of Nursing school school at the time in my clinical rotation, I had gotten my pt. assignment from the clinical instructor and began my round and it was the first room I walked into and it was the first time I ever called a RRT..:hdvwl:

Always take the pt's socks off when doing your initial admission assessment. A pt's Feet can tell you if they are diabetic or have a DVT , PVD or just don't pay attention to their feet. UGH..I can' tell you how many times I have had an admission and just taking off the pt's socks I can see necrosis that wasn';t picked up before they arrived on my floor. I HATE FEET...

Heartburn in males that is worse then normal that isn't relieved x's 2 days and keeps them up at night at home is most likely cardiac related when they show up the ER.:loveya:

Chest heaviness and a weighted feeling, "I feel like someone is sitting on my chest", in females that radiates to both extremities and is usually thought of as stress, is usually indicative of a cardiac problem and is brushed off by many females. Hence the red dress campaign. Cardiac health in females is overlooked and fatal.:redbeathe

If you have a pt. on integerllin s/p cardiac cath, always check the pt's platelets. If the plt's are low call the MD ASAP.

If you have a pt. with a chest tube or s/p chet tube extraction always have petro gauze taped to the wall, call it a ICE and a CYA. Don't want to hear a whisteling sound comming out of the pt's posterior when chest tubes are involved.

If your pt. is normal sinus rhythm druing the day, and at night brady's down a few times during deep sleep...CHECK on the Pt., check their breathing and wake them up, and after they are awake, ask if they have a HX of OSA. Most of the pt's I have encountered that brady down in deep sleep say, "Oh yea, I use a c-pap/bi-pap at home." Inform the MD ASAP. If the MD isn't available I always put my pt's on 2l O2 NC and it seems to help.

Never give a OSA pt. anestesia, sedatives or hypnotics. And if you do, make sure it is about 5 hours before they fall asleep. Always put a OSA warning on the chart.

Any time a pt. comes from the OR/PACU/Cath Lab, make sure the pt. voids with in 6 hours of arriving to your unit.

Always ask your male pt's if they have any problems voiding, and look at their med list. I can't tell you how many times I have asked my male pt's if they have any problems voiding, they say no and then I see they are on avodart or flomax. I say do you have BPH? they say..."Ohhh yea I do." It may no longer be a problem for them anymore, it's just WNL to them, but when in the hosp. it's no longer WNL to us the nurses.

Always inspect your complete pt's from head to toe when they are admitted to your floor. Any decubitis, document it right away and fill out an incident report to CYA. YOu don't want to be responsible for pressure ulcers that developed before the pt. arrived on your floor and was now in your care. Never EVER let it go to the next shift, b/c once shift changes you are no longer responsible for that pt. the next nurse is and any undocumented decubitis now becomes the hospitals problem. Initial assessment is KEY. It saves you from any finger pointing and also saves you from any liability post admission. If you document and fill out an incident report on pressure ulcers upon admission to your floor it is legally documents that the pt. arrived with decubitis. This has been drilled into my head since becomming an RN...can you tell?? Maybe just a little bit. Plus I hate when I recieve pt's with pressure ulcers, they hurt the pt. and once they are there, espically in the sacral region they are so hard to manage. :idntdt:

I am full of things to share but I am tired. I love giving tips and tricks to nurses. And as an RN I am all about learning new tips and tricks. I hope I shed some light on some things...and PLEASE of you have any kick butt tip or trick please share!!! :lvan:

[leslie :-D]

it used to make me cringe, but our techs put the beds in trendelenburg pos when needing to boost an obese pt up in bed.

leslie