kayvary

I feel the same way as you, I'm still on orientation but everyday when I go home I obsess over things I should have done differently. Though I do feel like the whole npo thing isn't a problem, I've noticed most surgeons order "npo except meds" so it is usually ok to give important meds.

I am a new grad on orientation and I already know I am going to be posting on here a lot. My first question to those with more wisdom... I had a patient who had IV BP medication ordered every 6 hrs for SBP > 160... It was NOT prn but was specifically ordered to only be given if it met BP parameters. The patient's BP was 158/90, so I did not give the medication. My preceptor was busy helping another nurse with a patient that was getting violent so she wasn't with me at that time. After she was done she told me she would have given it but she doesn't fault me for not giving it. She also said ideally I could have asked the doctor what to do about it but realistically most people would give it in the situation and most of the doctors would get annoyed if asked that. We re-checked the BP an hour later and it was really high, can't remember the exact numbers. So we wound up giving it... I just thought it was simple, didn't meet the parameters so it shouldn't be given I didn't think to question it... I'm wondering what others would have done in this situation...

I am looking at a picture in my book for the placement of electrodes for a 12 lead ekg and it only shows 10 leads! But it specifically says 12 lead ecg, which I always assumed meant 12 electrodes. There is 1 on each wrist, 1 on each ankle, 5 on the left side of the chest, and 1 on the right side of the chest. It only adds up to 10, where do the other 2 leads go? Thank you

Thank you for the responses. This happened in the morning around 7:30 am - the patient already had his breakfast in front of him but I did later find out his appetite hasn't been good lately but we were still using the same sliding scale on him that is normally used in the nursing home he lives at. Of course after the hypoglycemic incident the doc changed the sliding scale. I was told what to look for immediately following the event, but not much about potential longer lasting effects.

I was at the hospital today and had a diabetic patient who I gave insulin to according to a sliding scale. The glucose was high, almost 400. But later on the patient was cold clammy and unresponsive. The glucose was so low the meter couldn't even read it it just said "lo error". It must have been below 11 because someone else said they once saw an 11 register on the same meter. The patient got a vile of dextrose IV push. Within a minute he woke up and asked what was going on. Re-checked glucose, checked vitals, notified physician, checked orientation, neuro assessment. Did I forget something? What should I look for/assess for more long term?

Congrats! Thanks for sharing your story

Hello. I need to pick a topic on post-op complications. A lot of people are already doing pneumonia, incision infections. I recently encountered an elderly patient whose baseline is a&o x 3 who, 2 days after surgery pt started becoming disoriented on and off. I was told this was a big problem with elderly patients. I wanted to look into this more but haven't found much on the topic. So I am trying to see if it isn't really that common. I am wondering how many others have encountered something like this?If you have can you describe the behavior (how often confused, which post-op day did it start, how old was the pt, did they get over the delirium, etc.). Also if you know of a good recent article on the topic that would be very helpful.

Hello, I am not an NP but I stumbled across this thread while researching info about RNFA's. The AORN website has a salary survey from 2012; only 3.4% of the survey respondents were RNFA's so it was roughly 82 RNFA's that responded and they report an average salary of $82800. Unfortunately there isn't a breakdown of years of experience, type of degree. Also they show geographic spread and it was pretty limited. Maybe let the surgeon be the first to bring up salary. It sounds like a great position, best of luck to you and please do keep us updated! http://www.aorn.org//uploadedFiles/Career_Center/2012%20salary%20survey.pdf

I have a question about IV infiltration. I saw a patient who had IV fluids running. The IV was in the forearm. The hand was swollen and cold. I have only learned about edema happening at or above the site of the IV, not below. When the IV was flushed, no "bubble" formed, seemed like it flushed okay. Is is possible the hand edema was from the IV infiltrating? The patient did have her arm angled down. Also I am looking for a picture with a good example of phlebitis, anyone know where I can find one online? I have only seen one pic before and it wasn't very helpful. Thanks