nursegreenbean

I was just wondering what other facilities policys are regarding obtaining urine for US/C&S. I looked in my facilities policy/procedure book and it didnt have anything regarding this. I have had several nurses at my facility tell me different ways to get it and I just want to know the right way. 1st resident only uses bed pan or urinal he does not get up to use the commode. I was told by 1 nurse to get a new urinal and obtain the sample from it but another nurse said you couldn't gat it that way that he would have to be staight cath'd, 2nd resident can use a bedside commode and I was told to put a hat in it. So why could you use a new clean hat but not a new clean urinal. 3rd resident has a foley cath and i was told to hang a new bag and when there was enough in it to obtain it from the bag. When I got home i researched it and what i found was that it should have been obtained from the foleys port. So anyways when does a person have to be straight cath, can you get a sample from a hat and a urinal. I thought it was suppose to be a sterile sample so if it comes from a hat or urinal how do you make sure it stays sterile. Thanks

P.S. even though I was not annoyed I do not think it was professional for the other nurse to speak to me in that way and to involve an aide. The nurse is experienced and I am new it was definetly a teaching moment. If new nurses can't depend on the seasoned nurses for help and for them to do it nicely then where do we go. Maybe that is why so many new nurses quit in their 1st year. Telling me it was ridiculous and common sense only knocked me down a few notches maybe an explanation into the right way to do it with the whys and hows would have taught me something and I could have been better prepared. But instead I turned to all of you to teach me. Many big thanks :tku:

Thank you for all your answers it has given me alot to think about. Special thanks to Michelle 126 I think you understand where I am coming from. LTC with 30 residents no head to toe assessment done daily. NO standing orders. Could not find a P&P book. On this shift there is no charge nurse.This was a 4 hour shift my aide was doing her job which was a q2h check and change when the area was noted. The resident was clean/dry and put on her side to relieve pressure. Since i was questioning the order and was limited on resourses The next best thing was to ask another nurse who was to busy to help which I dont hold against her. Yes I know all wounds are cleansed with someting normally normal saline. If they use silver cell in that facilty they usually cover with some type of dry dressing. This praticular residents family is very involved and particular. The nurse who wrote the order is an RN of 20+ years and I am a new nurse. I have done treatments at this facility before but they were "complete" orders so this one I questioned that maybe they could have wanted it open to air because it did not say otherwise. And we found the resident with no dressing on. Like i said I am also PRN so if they don't tell me in report and something like this comes up it is sometimes harder for me to figure out.I tried to use my critical thinking there was no order for a dressing and there was no dressing on the area so does that mean not to apply one. It was 10 pm and did not seem like something the doctor wound want called about. I do wish I had remembered to bring it up in report then the issue would have been taken care of the 1st night. Now i know that everyone is human and we've all forgotten to tell something in report at sometime. I don't remember 1 time saying I was annoyed. I only asked so that I can learn. My abbreviations are standard that I learned in nursing school I am sorry if you did not learn the same ones :) I didn't get orientation with the wound nurse and since hired we no longer have a wound nurse we do it ourselves. Thanks again

I am a new nurse I work part-time float PRN any shift. When getting report I was told that all charting and treatments were done. When we were going over the residents I was told that rsdt. x was fine. About 1 hour before my shift was up the aide asked me to come look at rsdt x's bottom that there was an open area that was bleeding. I found a pressure ulcer about the size of my palm on the coccyx area with minimal bleeding. I asked the aide if she took any bandages off of it and she said there was none on it. I checked the tx book and the only tx for it said " apply silvercell". It didnt say to clean it with anything or to apply a dry dressing. It was only to be changed on one shift which was the next shift in 1 hour. I wasnt sure what to think so I tried asking another nurse but the nurse was to busy to help. I decided to hold off doing anything since the order did not seem complete and i knew the nurse taking over for me wrote the order so that nurse would know why it was written that way and it was due to be done on that shift. i explained all this to the aide. What I forgot to do which I will be the first to admit I should have was ask about it in shift report. The next day when getting report from the off going nurse I asked about the tx and was told they new nothing about it but it didnt sound right to them either so i made a note to ask the nurse when i gave report bc it was again the same nurse who wrote the order. when giving report that evening i was not given the chance to ask. The oncoming nurse asked the aide if rsdt x had a bandage on that it was ridiculous that the rsdt had been left without 1 the night bf. Now we all new the comment was directed at me. I explained myself and was told that the order didnt come from the WCC and that is why it wasnt detailed that it was just common sense to clean with NS and apply a dry bandage. Now if I had wrote the order I would have wrote all the details bc to me that is common sense but i didnt write it and that is not how it was written. I didnt know if there could have been a reason that they werent putting a dressing on it like location. But again I was told that it was absolutely ridiculous of me. So i was wondering what some of you would have done.

Thanks to everyone who has replied positively. Didn't know we were suppose to only ask hard questions. I came here to ask the question first- because I thought this was allnurses.com where a nurse could come to ask questions from other people who might be more knowledgeable. Secondly- because the person who asked me this question is going through a rough time, they are scared for their loved one, have alot of hard decisions to make right now. I am a relatively new nurse who wanted to answer their questions correctly. I read about the scans in my medical books and did research but sometimes its better if it comes from an actual person. Yes there is information out there for the public but this is a family member I am dealing with, they didn't want to have to go look up info on top of dealing with a crisis. They look to me now "as the nurse" in the family and again being a new nurse I don't feel quite comfortable in this role yet so its nice to come here when I need clarification.Their doctor ordered a CT scan but someone who is not a medical professional told them that an MRI is the same thing as a CT scan only better so why waste time and money on a CT scan. To see if they could skip it and do an MRI since they felt in the end an MRI would be ordered. While doing my research I read everything you all said except I did read somewhere that an MRI did not show bones because an MRI uses water in you body to make images and it said your bones do not contain enough water that they would show up as a black spot on the MRI. Maybe this was not an accredited site? Anyways thank you for all the positive answers.`

Someone asked me recently what the difference is between a CT scan and an MRI and I couldn't answer them. I am a relatively new grad working in LTC. I haven't had any exposure to these tests except what we went over in school. I've been studying on it and this is what I've come up with. A CT scan is cheaper, faster, and it uses radiation . It will show bones where an MRI will not. An MRI uses magnetism and radio waves.It shows the same thing as a CT scan except it will not show bones. Is there anything else I should know when explaining the difference to someone? If some one is having neurological problems why would a CT scan be ordered before an MRI? The person who asked me the difference thought that the 2 tests showed the same thing but that an MRI was better so they wanted to know why you wouldn't start with an MRI if the test wasn't needed to show bones.

I appreciate all of your responses. I feel like I should clarify some. At our facility we do not check ph, the only way to check placement is by ausculation and residual. From everything I have read it sounds like ausculation is not very reliable. When checking residual I have gotten nothing, no residual, which I take it means that the stomach is empty, I've gotten clear liquid which I think is water left over from the flushes, and then I've gotten a brownish/green that I am assuming is stomach contents. So I am confused, if you can use residual to check placement how will I know by the residual that it is know longer in the stomach? What exactly should I see?

when checking for residual, in regards to a g tube,l I would expect it to be green, clear, the color of the last feeding,or meet resistance right away meaning there is no residual. If the gtube has migrated out of the stomach what could I expect to see when I check for residual. Any tips for getting the residual into cups without making a mess. The P &P book at my LTC facility says to verify placement by either ausculation or checking residual but that you only have to measure residual if there is a doctors order- any thoughts? Are a g tube and a PEG tube the same thing?

I am also a new nurse of about 3 months. I am also miserable. I come home from every shift feeling dumber than when I went in and like I know less than the last time I worked. I keep telling my husband I don't want to go back but he thinks I should give it a while longer and that with time and experience it will get better which I know but I have to survive it first. He also said there will come a day when I will be the one answering questions for the new nurse. Anyways I had had some work related questions that had been bothering me so I decided the next time I worked I would ask the other nurses who had always been willing to help. I work 11p-7a so it is slower and more relaxed. We tend to talk and help each other. I had worked with this nurse several times b/f, she is an RN and has been at the facility for awhile, we had always gotten along in the past. Sometimes she made me feel dumb like when I asked for help giving an enema b/c I had never even seen one but I thought oh well I can't help my inexperience. Anyways over about a 2 hour period I think I had asked her 3 questions when she told me to back off that i could give her a list of my questions when she wasn't so busy shed look at them. She sounded pretty nasty when she said it but if she was that busy I understood. Problem was that she then called a family member on her phone and was laughing and playing with the aides. Then i had a real problem that i needed her help with and in front of all the aides she turned around and said look i already told you once to back off, you need to leave me alone and give me some space. Completely took me off guard and totally embarrassed me. Next thing I know I'm in the bathroom crying. It was a miserable night. Well the next morning I was so ready to get out of there and wouldn't you know it there was a brand new nurse on her 1st day taking over for me and do you know what there were things I was explaining to her just like my husband said. They were minor things mind you but it was a start and I know i'm scared when I go to work or when the phone rings for that matter b/c i am prn but i don't have that total look of fear like she did so I guess I am learning and getting better. Just so you know I am slower than dirt, I have to ask the same questions over and over, most the time I have to physically be shown how 2 do something 2-3x b/f I remember so you are not the only one. But you know what we are slow b/c we are new we've never done this b/f i couldn't walk in to McDonalds, get behind the desk and fix someone lunch either. I think it feels worse b/c we are talking about live people and it is fast paced.

Thanks for replying so fast. I have not been shown a policy/procedure book but I am going to have to ask b/c I have other questions too.I guess I can understand both sides. I personally know people who are on BP meds at home and they don't take their BP b/f taking their meds. So why would some residents have the order and others not. Maybe their pressure is known to flucuate with highs and lows and the other residents are known to stay high? If I didn't have an order to take the BP b/f administering the med and it was low would I have to call the doctor before holding? Just want to make sure I am doing it right and we are due for state to come in. I wasn't sure if they would site me for not taking the BP if there was no order?

I am a new LPN working in a LTC facility. In school we learned that you are suppose to take the residents BP before giving any medication for HTN. I've noticed though in our MAR that for some residents there is an order written to check the BP b/f giving, a place to document it, and parameters for when to hold it but for other residents this is not in the MAR. So my questions are: do you as the nurse just know to take the BP b/f giving all HTN meds using your judgement as to when to hold it , if it was low would you call the doctor b/f holding it OR are we only responsible to take the BP, record it, and hold it if there is a written doctors order in the MAR.I tried to ask this question and a couple others to an RN whose been at the facility for several years but it didn't go so well ( thats a whole other thread in itself) so I thought I would turn to you. Thanks for your input:)