1. If a patient exhibits say a 10 beat run or less of vtach overnight and already has labs for the morning, should I wake up the cardiologist or primary doctor if they don't have a cardiology consult to let them know? if they don't have labs, should I still call if the patient is asymptomatic or can this wait until the morning?
Some hospitals have policies for this, but at my hospital it's more of a use your judgment kind of thing. Generally we already know that the patient is having these runs of VT and that's why they're in the hospital anyway. So if the patient's asymptomatic, it can probably wait til morning. I might ask to have their morning labs drawn early if I'm really concerned and then go from there based on what the labs show. Or if the patient is having consistent runs of VT and there's no known history of it, I'll probably go get a pressure to see if it's worth waking up the doc over. Either way I'd say check on your patient and give the doc a call in the morning just to let him know what was going on.
2. If a patient is on isolation precautions, how do I maintain safety from transmission of diseases when the patient is going for a test. obviously with airborne I would put a mask on the patient, but what about if they are contact or droplet and have to go for a test or procedure?
Pretty sure there are different policies at different hospitals for this too. Our patients have to put on a clean gown before they leave the room, and anything they touch gets wiped down really well. If it's airborne they have to wear a mask when they leave the room too. That's about it.
3. If a patient had surgery or a procedure and it is in the middle of the night and they start having profuse bleeding, would I call a rapid response to get a doctor right away rather than the surgeon?
Depends on what kind of surgery/procedure it is and what's going on. Did they have a cath and now they're bleeding from the groin but otherwise stable? I'd apply pressure and call the doc. Did they have a cath start bleeding from the groin and now SOB low spo2 with a pressure of 60/30? Call the RRT. Same thing with a surgical patient. Just depends on how stable they are really. If it can wait for you to call the surgeon, call the surgeon. If the patient's critical, call the RRT.
4. HIPAA-How exactly should we be handling phone calls in order to maintain HIPAA? For example, if a patient is from another facility like a nursing home or group home and the nurse for the night calls to ask for an update, what exactly can I tell them without breaking HIPAA? Is discussing test results or medication the patient is on and any change in their status breaking hipaa?
At my hospital they have to sign a release stating who can get information, so if they came in from a nursing home, we ask if it's OK. But in such a case, they're usually going to return to the nursing home anyway, so for continuum of care purposes, it's pretty important for the people at the nursing home to understand what's going on so we encourage the facility to be added to the list. I've never had anyone say their nursing home can't get information.
5. if a patient is scheduled for surgery and is NPO, should you give any insulin coverage if they have a "high" blood sugar for their accucheck , or not because they are NPO and will not be eating anything?
At my hospital our parameters say hold the metered dose and give the sliding scale coverage for NPO. If I know this patient pretty well and I was concerned about the patient's sugar dropping too low with the ordered sliding scale dose, I'd probably hold both and let the doc know what I was doing. We aren't supposed to hold basal insulin for NPO either, but sometimes, again, if I know the patient tends to drop when they're NPO I'd discuss it with the doc and maybe decrease the Lantus dose. I'd never hold/decrease an insulin dose without discussing it with the doc first though.
6. When giving meds for a patient on a kangaroo pump, do I hold the feeding, disconnect the feed, administer the medications by pushing them into the tube, and then flushing and reconnecting and restarting the feed? I will ask to see a demonstration before having a patient with a feeding tube, I just wanted to have a better idea before I started.