MickeyMarieRN

I'm preparing to transfer to a new hospital and will be joining the float team. I do not have any telemetry experience, but will become Tele / ACLS certified as part of my training on the float team. I will orient to all of the tele floors, including cardiac telemetry and the Covid Respiratory stepdown floor. Ohhh and an inpatient psych floor. I have three years of experience working at the med surge level on a very busy ortho/neuro/trauma floor. I also worked as a tech on an ICU stepdown floor for one year prior to obtaining my RN license. Have I bitten off more than I can chew? I hope not. Please tell me all the drips, IV meds, skills, and telemetry advice / lessons that you have learned over the years. Aside from the basic tele rhythms and ACLS drugs, what else should I be studying? Thanks in advance!

I feel that this is exactly why the night shift RN who admitted the patient from the ER should have called the ortho doc and had the dose changed and then asked for a hospitalist instead of passing it on to me. Only to repeat administration and have the same effects. I dont know why I didnt listen to her, I guess it's because I felt that she wasnt sound in her judgement. Yes, he was in fact "snowed" from the dilaudid. My question is... where was the documentation and intervention from that reflected in the chart from the previous shift? If your patient is "snowed" for 8 hours, wouldnt you want to do something about it?

*I gave him NARCAN because I felt his airway was compromised and he had AMS s/p dilaudid administration. Sorry for the typo.

I feel that had I known he had an AKI i would have given him a lower dose. Perhaps the AKI played into his ability to clear the dilaudid, which may have been why he was "snowed all night long" according to the night shift nurse. I gave the dilaudid primarily because I felt he had an altered mental status and was not able to cough up secretions, which is an airway patency issue.

Have you ever done this? How could I have had better judgement. I I was assigned a new admit that came to my unit, an ortho floor, from the ER the previous shift. The patient had a fractured tibia that was awaiting placement of an external fixator. The Ortho doc did not write for a hospitalist consult, and the patient clearly needed one. He had a long list of general medical history that no one paid attention to... cancer, copd, ect. The patient was given 15mg of ketamine in the ER and 0.5 of dilaudid at 11:30pm. At 7:50 am I go in the patients room to reposition him and he is screaming out in pain. The night shift RN said that she didnt give any more dilaudid because that evidently snowed the patient "all night". But here he was at 7:50 screaming in pain. I didnt do a full assessment before giving him his pain med. I administered 0.5 of dilaudid. I come back 30 minutes later to do the prn response, it looks like he is sleeping and more comfortable. Two hours later I walk in and he has mucus and froth around his mouth and will barely wake up to a sternal rub. His pupils are 2mm and he has a glazed look on his face. His 02.was 96% on 2L, but i wasnt confident about his respiratory effort. It appeared shallow, even though his 02 sat was fine. The new hospitalist that I requested from Ortho asked that I give Narcan after I called to report symptoms, the patient was given 0.4 and then woke up. He was again in severe pain, but able to answer questions appropriately. After several lab tests and a pan scan CT he was found to have an acute kidney injury, pneumonia, and his external fixator surgery was delayed by a day. I feel responsible for making a mistake because I had to give Narcan two hours after giving a PRN med to a patient that I hadn't fully assessed. What would you have done differently?