Bec717

Thanks so much for your help! When you place the tubing where the bulb stopper is and set it to wall suction do you compress the JP bulb like you would normally or leave the bulb inflated while set to wall suction?

And no, only output blood- procedure hernia repair.

I've never seen it either......... MD order--- actually PACU reported 5 cc output prior to transfer & on unit hourly measured and reported at 30 cc.... then shift change.

Have you ever set a JP drain to wall suction- low intermittent? If so how? One nurse cut to plug off the JP bulb system, placed a connector where the plug was and set up tubing to wall suction. My concern when the physician d/c'd wall suction then there was no plug remaining to seal off bulb to form suction needed. Another cut off (not disconnected) the bulb, used a connector and set up tubing but then again no bulb remained to set up future use. One thought you somehow left the bulb, should compress it and tape tubing to the bulb plug............ How do you properly set up a JP drain to wall suction please? Thanks!

I actually had an order yesterday, rectal tube with LIS! I used the Flexi-Seal and set up suction to the irrigation port. The MD wanted to decompress all of the abdominal gas. I was quite nervous, as I didn't want to damage the mucosal lining, nor did I really have a way to know if the abdominal gas was being suctioned per say. I did ask the physician if there was a less invasive method, ex. Gas-X/simethcone & he insisted on a rectal tube with LIS. I will be curious to see if this system indeed make a difference!

Thanks & glad to know our hospital runs 24/7 and has thus far been very accommodating to our patient's needs, no matter how big or small. A PICC RN was great about coming to the unit at 5pm on a Friday for a difficult IV stick and even offered to stay and place a PICC fi MD okay'd & family consented which ended up being a start to finish 2 hr vs 30 minutes due to MD call, family call, etc and then to some small complications at bedside! She rocks!!

Great adivce above- I wear gloves when I open the package-- a few patients have mentioned they appreciate it, as they have seen others touch their pills & don't forget your patient education- the drug name, is this a home medication for you,what the meidcation is given for, any questions, any common side effects or call the RN if..............

Checked in and MD actually cut about 2 1/2 inches off tubing- he still can't explain why we could get a brush through, place H20 to a certain point, see no residue, etc, could not aspirate but hey it worked and so far saved having to undergo surgery! I was not there today, just called to check but let's hope he wrote some orders to flush q 8 vs the Kangaroo Pump flush!! Thanks all!!

I simply state, " I will not jeopardzie my nursing licensure by providing care that I feel and know is substandard for the patient's care and safety" and walk away. I have also used, "The patient is the MD's patient and he was the right to make any decisions in regards to his patient's care & it's my place to call the MD and give him the opportunity and information to treat his patients as he deems neccisary." Good Luck~ why can't some just go with the flow and take care of their paitents- that's our real job in the end- keep the patient comfortable, safe, and as well as we can!

Thanks- tried that- the fluid would go about 2 inches into the tubing- so placed Coke for 20 minutes- the brush would go to the bumper and of course I did not go any further. At one point when the Charge RN was trying- about 2 inches closest to the syringe placement the tube actually started to balloon- really weird- brush would go through with no resistance- no flush and when we tried to pull residual the tube would collapse- we rolled the tube, tried to gently milk it, there was no hard areas of tube feed- The MD came in an adjusted the bumper- gently moved the tube up and down- he was even baffled as to why the tube would not flush or aspirate- as the tube was clean and clear from the bumper out- so thinking either a SBO or the tube had compressed somewhere? He was planning a CT and at that point a new PEG placement- just wish for the patient we could have found a better solution to get the PEG to work again! The patient had a Kangaroo pump set the do a 125 ml flush every 8 hours, however I don't trust those, so glad I took the time to actually stop the TF and check for flush/residual, as the PM RN told me she had not done this, since the Kangaroo was set to flush- I prefer a hands on for PEG rather than the Kangaroo!!

Yesterday, at 1400 went to change TF and plan flush/residual check. Tube would do neither. Tried the Coke, ordered a PEG brush from central, repositioned patient. Nothing worked- Charge RN came in worked with the PEG- nothing. Called the MD- he could not get the PEG to work- ordered KUB- only showed gas present. I completed shift as he was ordering a CT scan. Patient had AM BM and another during KUB- checked for impaction, denied any n/v/pain. At AM assessment, checked for placement and BS- all good, abdomen round, soft. Did note at 1400 abdomen becoming distended and firm on side with PEG tube. When you have a clogged PEG, any other suggestions on what to do, other than what I did? Thanks!!!

I write down everything!! But here are some others for you! MTPMedSurg (1).doc 1 patient Float.doc 5 Pt. Shift.doc FinalGraduateShiftReport.doc horshiftsheet.doc

Winter months tops--> 425 however the low this week 194!! Not good at all- not sure what's going to happen other than no $$ in paychecks for anyone!

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Except the floor RN is the scapegoat for the MD's mistake of using abbreviations!

One RN suggested, if pre-op meds are not given then just tell them in report the patient has questions, document the consent has not been witnessed, tell them in report the consent has not been witnessed b/c the patient has questions, and put the responsibility on the Pre-OP RN each and every time....... let the MD and Pre-OP RN take responsibility for the consent and leave the unit RN out of the situation altogether.

An OR nurse wanted to write up a unit nurse because the informed consent, signed by the MD and the patient had abbreviations that were written by the MD. Is it the witnessing RN's responsibility to inform the MD what and what he cannot write on his surgical informed consent? And the witnessing RN, the PM nurse witnessed and signed the consent, passed the chart over to the day shift RN who sent the patient to OR and now OR nurse wants to write up an incident on the day shift RN. What is the RN's responsibility in regards to informed consent?

I follow my pocket brain Rm #, Pt name, Age, MD, Code status, admit date/dx/ PMH, allergies, IV site/fluid, AAO x ___, Cardio/Tele,O2 status, Wound care/skin, GI/BS, GU/Foley/color,activity/assist/ Labs/AM Labs, V/S, Accucheck/Pain & meds given, drains/ procedures and upcoming procedures, and anything else needed to continue care for the patient.

1:1 or 2:1 @ our facility!

Wound 1 and then wound 2 is what I would do.

On average, what amount of drainage is cause for alarm over an hour time frame for a new post-op? I know to monitor the patient + BP, fluid intake, foley output, however no one could give me an idea as to what amount I need to keep in mind and could lead to an unstable situation ........ and wouldn't the MD put a parameter as to how much and when to contact him if Hemovac output > xx? Thanks!!!

So no N/S with sodium bicarb, diazepam~

Crystals will form~

Hi all and thanks for the info in advance. For IVP, do you prefer to dilute the N/S to admin or do you flush, push meds, flush? Are they any meds you would not be able to dilute with N/S to admin? And my coach told me if I need to give Ativan,IVP, I should admin fast (less than 30 seconds) and with sterile water. I thought you never pushed an IVP med fast unless it's during a code for ACLS? Thanks!

Question #1--> A. Serous b/c the question asked to describe the liquid and to describe it as CSF you would need to send it to the lab to determine if it indeed is CSF- we have been taught the bedside ring test is no longer the best and most accurate way to DX CSF of not- but to send the sample to the lab!