Maddy_Rose

Oh I feel a bit silly now, I remember someone telling me that ICUs don't broadcast their codes for that same reason. Thanks very much for your answer, it didn't realize that most codes would be airway issues. Is that because of sedation and artificial airway use?

Hello all, I'm a med-surg nurse hoping to move into the PACU as soon as I finish critical care courses. I was curious how many code situations happen in a given PACU? I work nights mostly so I don't hear the PA system announce codes in PACU/PAR during operating hours. I was also wondering if in your hospitals ICU patients go through PACU after surgeries or do they go straight back to ICU? Thanks!

Thanks for the responses. The sense I'm getting is that, in general, if a patient has new onset of either symptom (aka they're not a known GI bleed already) I need to call even during nights.

I understand that passing any frank blood is a very urgent concern and I would need to call the doc stat (thank goodness none of my patients have encountered that yet!). But what about melena (or coffee grounds emesis) in an otherwise stable patient? I work nights mainly, does allnurses consider that more of a...wait-until-morning-and-inform sort of concern? Thanks for any input :)

Does anyone have any rules of thumb/tips on how to titrate down a CBI systematically and effectively? We get a lot of TUPRs on the floor I work on presently, and often the doctors write only "wean CBI" as an order to start turning it down. I know I'm observing for clots/flow and hopefully seeing lighter rose to clear returns as time and healing goes on. My inclination is to turn down the CBI and leave it until it becomes clear again, turn it down more then wait until it clears again, ad etc until its totally clamped off. Is this reasonable or can I be turning the rate down even if the returns are still light rose? I'm just looking for any signs/thinking processes to help me with these.

Another kind of tangential question that occurred to me...on the floors I'm working on we do (or try to fit in) a morning "bed meeting" with both members of the team and our patient care coordinator. What are the most important things to communicate in those meetings, besides general patient condition and any obvious discharge planning problems? We weren't really included in those meetings as students so it's hard to get the hang of them now!

Thanks for all the replies guys! It helps to get some context behind your opinion of what you would do.

Thanks very much for the reply! From what you said here I think we probably should have been suctioning him more often, I could definitely hear what you described that vibrating or audible air moving in and out.

Regular, normal sinus as far as I know patient wasn't on telemetry.

Yes thinking back I should have given something for pain and see if that helped or calmed him down, he had tylenol and ibuprofen. How much of a difference in HR do you monitor before calling the doctor? for example if someone went up by 10 beats/min, 20 beats/min, without immediately obvious reason. Couldn't really find a policy at my site.

I had a trauma/head injury patient these last 2 shifts with a spike in their vitals signs and wanted to get another opinion - This patient's baslines usually ran between 120-130 for heart rate, I can't remember what it was in the morning but normal or I would have made note. I checked it again in the afternoon (just scheduled neurovitals, nothing had happened) and the heart rate was going 143-145, all other vitals normal, BP was fine. What do you guys consider a significant change from normal when talking about heart rate? Would you have informed the Doc even though other vitals were normal, or monitor? This patient could only make incomprehensible sounds so I was unable to ask if they felt symptomatic of it.

Hey everybody, Does anyone have wisdom they can share with me regarding how they decide when to suction? I suctioned my first tracheostomy this past 2 days after watching my buddy nurse (I'm on orientation) do it. She explained that it's a good idea to suction when the patients breathing/secretions start to sound pretty wet (I mean what you hear from the tracheotomy opening), but you shouldn't do it too often or the patient will just produce a an excess of fluid again - then it will have to be done more often. Do you guys suction as soon as the patient sounds a bit wet, or do you wait until they sound a bit coorificer? How do you judge if they have a good cough?

Good point MGoldRN! I feel kind of silly when I list of a bit of a patients medical history then realize halfway through I don't really need to when they can just read. Would you (or any other repliers) say this would be a the most important information to communicate: Admitting diagnosis/surgery Code status Orientation Pain Tubes (IV, feeds, chest drains) Dressings/ulcers Ambulation - anything else notable (ex. critical labs and treatment, etc.)

Hi there, I'm a new grad that will be starting on a orthopedic/vascular surgery floor very soon. I feel...OK about my ability to communicate the most important information about a patient to another nurse, but I want to get better at giving a more thorough and logical report (I mean not jump around in my thoughts as much). We use kind of a combination of verbal and written report on the floor - if nothing notable happened with a patient we might just write a little blurb about them for the nurse coming on to read. But if a patient is new or had a lot of stuff go on a verbal report is usually done. Do you guys have any tips or strategies for organizing your thoughts, or the best way to give a thorough picture of a patient? What's the most effective order of information you find works? Any input is much appreciated! :)

Hmmm now that you mention it she may have done that in case we had to to give those medications. So as long as you flush with NS before and after giving meds like that there should be no compatibility issues where the double extension sets come together? Thank you everyone for clarifying, I feel picky asking so many questions but it's been very clarifying!