Sjade

Hello, I am a nursing student and have noticed on the palliative care ward I am on has a way of prescribing that I'm not sure on. For example a PRN dose of ondansetron for nausea and for the route they write PO/subcut. My understanding however is that an oral dose would not be equivalent to a subcut dose? I am right to believe that and where could I find more info on this? Should these be charted separately for example: Ondansetron subcut Xmg Q3hrs blah blah Ondansetron PO Xmg Q3hrs blah blah Also, while trying to find info on this I came across that ondansetron doesnt seem to be commonly given as a subcut injection rather an infusion in pall care? Does anyone have any evidence on best evidence practice for administering it? Obviously in nauseated pts PO isnt very feasible.. Thanks in advance.

Where I work currently as an assistant nurse there is one ward for acute care of the elderly we get majority of dementia patients a lot of which are agressive. I have always though I am a good judge and know how to react if one becomes agressive and therefor with all my interactions with previously agressive patients I have never been assaulted. Tonight I was on this ward, and it happened. it was 8PM at night and my behavioural patient had been asleep when an emergency call went off waking her up. The nurses all ran to the room where the emergent was happening and I thought I'll just pop my head in to reassure her everything's okay. She was just climbing out of bed as I reassured her and she turned and began to abuse me. Again, standing in the door way I tried to let her know you're in hospital everything is okay there's just a patient who is sick the alarm will stop shortly. She continues to verbally abuse me and tells me to get out of her house. "Okay" I say as I start to walk down the corridor away from here, but she's behind me. Before I can even realise she grabs hold of my hair and I turn instinctively, she swings her hand up and hits/grabs onto my face. I grab hold of her hands and eventually get away, and turn to see the RN coming to intervene. I ask I'll call a code black (agressive patient) but she tells me to wait so I do. Eventually the patient calms down and goes back to bed. The RN comes and asks if I'm okay, and I say yes I'm just shocked and explain what exactly happened. That was it, that was end of that conversation and it never happened.. my heart was racing, it's so normal on this ward that it's as if it's just part of their job. I tell 3 other AINs and all they can say is "oh hope I don't have her tomorrow". This is the same ward where I once called a code black on a patient who was hitting and kicking a nurse IN another patients bed, once he stopped she cancelled the code and went along as if nothing had happened. I cant help but have on the back of my mind that I didn't fill out any report, I was just in shock and honestly feeling defensive as I had to go back and sit outside her room to 1:1 nurse her. I wrote the incident in the behaviour chart of the patient but the nurse in charge was in the room where emergency was so I couldn't notify her. i feel as if I needed to debrief but no one was there to support me.

Hi all, Unsure where exactly to put this question feel free to move please! :) I am currently working on a case study where my "patient" has new finding of Pulmonary Oedema - not reason for admission. I am required to discuss interventions that I would anticipate to manage and treat the Pulmonary Oedema and I am finding it hard to get any sourceable guidelines or journal to assist with my rational for her treatment. I am finding that medication wise generally treatment consists of Diuretics to remove the excess fluid. However the patient has been hypotensive and received several IV boluses to maintain her MAP above 65 mmHg. Therefor I would assume diuretic would be contraindicated as it will drop her BP even further.. Am I correct to assume this? And do any experiences nurses have suggestions on treatment and/or or good Australian guidelines to follow. PS. I have gone down the O2 therapy to maintain SpO2, just trying to find appropriate pharmacological treatment. Any help is much appreciated.

This is such a great point, prevention first! Enema is generally the last option, especially for patients such as this? Thanks so much for your input! :)

I honestly don't know. I queried the RN on this, but as an AIN not everyone thinks your opinion or advice is relevant.

I am a final year nursing student working in a hospital as an assistant nurse. I was asked by an RN to assist with an enema for a patient. On entering the room this little old lady was so confused as she has advanced Alzheimer's and was admitted for increased confusion/carers stress. She has just had a just had a large BM, and I tried explaining to her that we needed to clean her up but I still had a hard time getting her pants down as she couldn't understand why we were doing it no matter how much I tried to reassure her. You can only imagine trying to give the enema she just about jumped out of the bed and I swear half of it ended up on the bed rather than intended place. We sat the poor little thing on the toilet and she sat there shaking asking why we would do that and saying she's calling the police. She felt violated, and I felt horrible for it and couldn't calm her down. Anyway long winded but my question is how do you go about an enema in the very confused patient? And where is the line draw for them to be able to refuse when they're that confused?