Pearls of Wisdom.....share yours

[DayDreamin ER CRNP]

I had a really great clinical day today. This is my Med-Surg II or what others may call Critical Care. I have a tough-as-nails instructor that really pushes us and expects a lot from his students. I really NEED this type of teacher this year.

He came to a student today and asked her to tell him what might be happening to the following patient. He was basically trying to illustrate a point about why we do Q4 vitals and why "trending" is so important.

1200 vitals

Temp: 99 oral

Resps: 24

HR: 99

BP: 96/58

O2: 96% on room air

1600 vitals

99.9

28

HR: 130

BP: 88/48

96% on room air

The student really struggled to come up with a diagnosis. I felt pretty proud of myself to know what was up but it was killing me because I was unable to help her.

His pearl of wisdom was that, while the BP was decreasing, the resps & temp was increasing because the brain could be beginning to swell. The brain is the priority and will pull as much available fluid up there causing everything else to begin to shut down.

Of course, we have all probably heard a little about dehydration a million and one times but knowing WHY those things were happening really stuck with me this time.

He also asked if we treat a potassium level that was 3.3. Answer: YES! We definitely treat that.

He asked WHY?

Answer: a decrease in potassium can lead to heart dysrhythmias but then he asked what kind.

We were all stumped. The answer is: V-fib. I had no idea. He said that the lack of potassium disrupts the normal muscle activity and causes it to pump irregularly and w/o much strength.

I thought these were pretty good pearls of wisdom today. This is all stuff we typically know but can't exactly explain WHY to people.

I am keeping a notebook of my little Pearls of Wisdom I've picked up in class and clinicals.

What are your Pearls of Wisdom you can pass to fellow students?

meredith

[diane227, LPN, RN]

1. ALWAYS touch the patient. You can tell a lot by touching the patient.

2. When you have a patient that you think is taking a turn for the worst and you don't have the ability/ equipment to do vital signs right away, check skin and pulse. If you can find a radial pulse, the blood pressure is at least 80, if you can get a brachial, the blood pressure is at least 70 usually.

3. Oxygen won't kill anyone. When someone is SIB, start them on O2 then call someone.

4. When you have a patient who has acute onset of altered mental status, check vitals including pulse ox and check a glucose. Even if the patient is not diabetic, check the glucose.

5. Patients with abdominal trauma are assumed to have bleeding until proven otherwise.

6. All women with abdominal pain should get a pelvic.

7. If your male patient has bleeding from his member DO NOT insert a foley until you check with the doctor.

8. Watch your elderly patients for swallowing problems. Aspiration precautions.

[queenjulie, RN]

:frantically taking notes

What a brilliant idea for a thread! This should be pinned to the top of the page.

I just started school, but I got one last week: Treat oxygen as if it were a medication. It has a dosage, and a time, and a route that are correct.

Also, remember the difference between a problem with ventilation, which is mechanical (like in an asthma patient) and oxygenation, which is biochemical (like a COPD patient). The treatments are very different, and it's important to know which problem your patient has.