janleb

Boy I got reamed for this one, looking back I can finally laugh. Well the end of my first yr I was getting ready to discharge a pt, and she needed something for heartburn, well the packaging was the same, but I should have know something was wrong when the dosage was different and gave my pt a little to much of MOM. Well she pooped her whole way home. I had to tell the pt. and call the doctor to get order for lomotil. and had to write a paper about the dangers of giving the wrong medication. And another one as a student I accidently took the narcotic keys almost home, they got a hold of me on my cell. I felt like a real idiot. But I can honestly say any error I have ever made I reported it. Administration can get testy but at least they know I will report what I have done wrong. Ahhhhhhh the memories:)

When I was a new nurse, and even now I repeat the order back to the physician. I write up a list of topics I want to cover with the doctor, being a pt condition abnormal labs, concerns ect. Because some doctors talk and give orders so fast you can't get a word in edge wise. I wouldn't worry to much about aggravating some doctors time, a wrong order that could hurt a pt is a worse scenerio. Ask them to repeat the order. Better to repeat than to have to have them paged again for the same concerns. When I was orienting as a new nurse A lab or procedure was not done, And a physician almost had me in tears, he was just having a bad day. He felt so bad that after that he was hi Janice , how are you ect ever since then. So just remember the most important is the pt.

We did somthing similar. We wore bathing suits or sports bra and heavy duty undies. Just get over it, and do it. The reason why they are doing this is to put you in the position of the pt. Let me tell you an experience I had. I was working one day I am an RN and had a student nurse under me this particular day. I walked in the room she had my pt laid out nude no bath blanket or anything. exposed to the world. I helped the student nurse, but after this experience I asked if she thought she gave good care to her pt. so I went on to tell her that what if you were my pt and I had you laid out for the whole world to see exposed, whether or not the door is closed. Laying naked with nothing on relying on your caregiver to keep your dignity intact. So when giving your classmates a sponge bath, keep in mind respect for the individual, cover up body parts not being washed, and keeping pt warm and dry. also when putting on a new night gown I always unsnap the old one and lay the new one on top, and put the new one on and pull the old one from underneath. If you just remember one thing the pt you are caring for , you treat them how you would want yourself or loved one cared for and I can guarantee a happy pt and family. preserving a pt dignity is just as important as any nursing duty.

I work on a med surg floor/tele. I was working tele last night a 22 yo male admitted to etoh detox, MI from cocaine abuse, On the third upon admission he tested positive urinalysis, for cocain, marijuana, barbituates, neg for etoh. I looked at the last labs on the sixth still positive for the cocaine. Very manipulative. Late night visistors I escorted out but I am sure they left something behind. The paper they handed him looked similar to what I would say blotter acid would look like. very strange behavior. He is noncompliant. The previous day they used narcan on him. We are not a lock down unit , we are not a drug detox unit. what are my boundaries as far as searching the room . I sent the paper to the local police to be tested still awaiting results. As far as safety issues with security do you think I had the right to search the room? I asked lab the urinalysis lab the cocaine is notdetectable 24-48 hours after admisssion if not using. The doctor only wrote pt not allowed to leave the floor. I told him if he kept up with his lifestyle that explicitely what would happen to his heart, his lungs and his liver and he would be lucky to see 30. But like most 22 yr old risk taking males with psych issues are invincible to everything that the normal population are not. we have no real protocol concerning this kind of issue. As far as I was concerned his third set of CE were negative, SR, using and his BP would be hypotensive, use narcan send him to a psych lock down unit. It is not my job to babysit, he actually had the nerve to ask for a sponge bath, so I told him that I would get Bob the tech to help him if he felt he needed that much help. I had one othe pt cp and on cardiac gtt, pt with CT, confused pt pulling out lines left and right. I think I am angry that a 22 yo has the nerve to throw away a life God gave him so sorry for him that he just doesn't get it. A very bad night thank you for listeningJanice

yes definitely for a yr or two. you arenvolvrd in a lot of different procedures. And th e expertise you learn is involuable. Learning procedures are important but also is time management and prioritizing. Which you hear over and over in nursing school but the thing is it is the truth. I fugure if I can walk on a floor and handle 6-8 pt and do my best. Sometimes its eating on the run and holding your bladder for 12 hours. If you get comfortable with that crosstrain telemetry which is also a wonderful experience. Never be afraid to ask for help.

after surgery, especially with the use of general anesthesia. It slows down peristalsis. In a way your body is in a state of shock. think about how traumatizing abd surgery is. Without peristalsis fecal matter cannot move through the intestines. Therefor if you were to eat a full meal you would be sorrry you did along with vomiting, nause, and feeling your going to pull out the stiches put in. Your bowel has to have enough time to heal.. Most of the time start out on ice and sips move up to clear liquids, soft diet bland and so on as well as the pt tolerated it. So to keep your pt comfortable there are mouth washes, ice chips to keep the mouth moist and vaseline lip therepy. But bowel sounds eventually come back but you have to listen for more than two seconds. Janice

You will be amazed how fast a head to toe gets when you have been doing it for al while. fore example as soon as you walk into the room. Introduce yourself dialogue might go as such hi I m your nurse today my name is Janice and you are.......... Don't say are you mary smith I have had confused pt say yes I am. Boy ms Smith how many days have you been here???? are you feeling better than yesterday (that opens up dialogue to any subjective changes that the pt may have. When I ask about where a person is I usually say I ask these questions because some of the meds you are taking can cloud your thinking, Especially with the elderly that are completely alert and oriented are not affended by there mental status being scrutinized. just look around the and get a eye vew of iv infusing any swelling and fluids at the right ratet rate. Foley andy other tubes ect by just glancing as you are talking. Mind you there are certain days when a "comlete" head to toe are not like in the morning so I sometimes listen to lungs , mental status, major reason why pt it here. dsg dry and intact, do any central line dsgs need to be changed, check I & O for the last few days to reduce risk of overload and check for edema in lower extremities. One thing I always do at first thing is check the pt histroy and physical for previous conditions.

not to much. Just enough so I don't look as bad as my pt. :) base, blush and eyeliner just a little color. With three kids and a twelve hour shift to go it kind of falls to the back burner.

I would recomment at least 2-3 yrs med surg experience for every new grad. You get to learn new skills, and practice skills you already learned in nursing school. A typical med surg day is very tiring, but I feel if you can get a good hand on med surg nursing you can learn just about anything. Along with nursing skills , time management, being in charge, it builds a back bone. A wonderful base for any type of nursing.

also don't forget labs and compare to the previous day. Any thing that is abnormal report. Many time I will call the physician just to give him a heads up on the pt condition even if nothing is ordered. Most docs appreciate this.

One thing that is not routine is your patients. I usually work 3 twelve hour shifts in a row and most of the time have the same pt. I always assess my pt as if it is the first time I have taken care of them. Pt conditions can change very quickly. 1. Get report I keep my previous report from the following shift I worked for comparison. (I usually xerox the kardex and write in red the report I get and in green anything I want topass on to the next shift, saves me time. ) 2. My most serious pt I assess first, fresh postop ect. by just going in and saying hi, get a look at the fluids running Ivsite , foley output good , pain level and concerns pt may have, any mental status change ect. 3. Take a look at the mars 4 report to my nursing tech any concerns I have and to make sure we are on the right page as far as pt care , accuchecks ect. 5. I found trying to be proactive , saves a lot of complications. Know a pt history , for instance I don't know how many times I have had pt with a hx of CHF and had fluids running 125, and out put not good and respiration becoming labored, ect. things that are very preventable. 6. Just don't get in the habit of just because you have the same assigment the asssessment will be the same. We assess pt every 6 hours. With that kind of thinking you are putting your pt and your license at risk. 7. And inbetween all the routine things expect new orders so make sure you check, also make sure equipment that is ordered is in use. Long winded I am but I hope this helps

Hi, before you know it you will have seen so many bare behinds it will be old hat for you. But until then, just remember your pt is the one in the buff. Respect their privacy with doors shut curtains drawn, and warm bath blankets over the areas not being cleansed. Usually if you onlyl expose area that you are working on it goes quicker and more painfree. Throw in a back massage at the end and you will have a fan for the rest of the shift. Sometimes some chit chat will make the time go quicker. Hope this helps;janleb

hi Tonya, Long time no see. It has been a while. I am also a new nurse. The best advice I have gotten so far is use all of your resources. Pharmacy, respiratory, dietary, ICU residents, RN's that have been doing this job for many years.

I have been a practicing RN for about 9 months now. Still just a baby. I went Med-Surg to get the most experience and get a wide variety of patients as possible. I am very fortunate to work on a floor where many nurses have 10 yrs plus experience. Prior to working as a nurse I worked as an Tech on that same floor. So I know everyone I work for. They realize that I am a hard worker and will help them whenever I can. I appreciate their experience and expertise. I have learned so much practical experience. And getting some experience that I can pull from finally. My next step is to get ACLS certified within this next year. Yes it can be hectic, some days better than others. But I am still learning probably always will be I hope. Where I work I feel very supported by the others I work with. Couldn't be in a better environment.

Everyone in our class is pretty close. Before every exam one girl brings in peppermints and hands them out to everyone. I have to have three pencils sharp and have to sit in the same seat. I also pray for good recall, or excellent guessing abilities:)