icuRNallie

Ahh I did not realize that. Does it make a difference regardless?

I'll be accepting my first travel assignment with Stanford University Hospital in Palo Alto, CA. I'm working with a subcontractor of American Mobile known as Onward Healthcare. What do you MAKE SURE to put in your contract when doing travel nursing? Most important things to look out for in a contract? Thanks!

Patients can certainly be on it for longer than 24hrs. If you have a pt with a subarach or a post-IR coil or clipping or something similar and they HAVE to have strict blood pressure control, it is much more important that their blood pressure is controlled than that they are off the medication. You do need to switch peripheral sites every 12hrs, but it can run continuously through a central line as needed. The bag is typically only good for 24hrs. I've had patients on it for greater than a week. I'm not sure of any actual limit. Otherwise you are risking a bleed/re-bleed.

Congrats on the offer! Very exciting. I always thought home-health nursing would be one of the more difficult areas to go into. Putting symptoms together to form a big picture can be difficult and easy to miss. Having that experience will really help you. Honestly, in the hospital it is similar in that you can walk into a room and immediately start assessing the situation, before you even pull that stethoscope out. Are they awake and talking, are they engaged in the situation, do they track you with their eyes, how fast are their respirations, pain complaints, etc etc. Be familiar with general med-surg medications. That will help with your comfort level. Take ACLS if you haven't already.. It will make you feel much more comfortable in a critical situation than just having BLS. You can arm yourself with that knowledge and feel more prepared for a patient crashing on you. With excellent assessment skills, many times you can beat a code to the punch and get the help you need (although it's not always possible). I always arrive 20 minutes before report and get a quick idea of my patients. Look up most recent labs/medications and then I can ask any questions I have during report. I generally try and filter my questions during report however...if it's something I can easily look up myself, I'm not going to peg the previous nurse with a billion unnecessary questions. Your home-health skills will definitely help you! The pace is different but in the end you are assessing and implementing in order to prevent further decline/promote health. Same end goal. Good luck and have fun!

Make sure you ask questions. Other nurses will typically not trust you if you aren't asking questions. There are many things you can't possibly know till you start working and other nurses understand that. Most nurses love to help! Find a few nurses who are good resources and people you can rely on. When I first started, I had a nurse who had me come talk to her before I'd call the doc. We would go over every possible way to solve the problem before I'd call. That way I wouldn't make any unnecessary calls and wind up getting yelled at. Very helpful! Although I remember one time I felt particularly brilliant for noticing a patient didn't have any colace ordered post-op and I figured I'd call the hospitalist...I worked nights and it was 2am. TRUST ME...do not call about stool softeners in the middle of the night. I would have been mad at me too if I was that doc hahaha. If I ever need a dose of humility, I go back to that memory (and praise the Lord I've become a more prudent nurse since then). Ask other nurses how they set up their report sheets and then pick and choose how you want to set up your own. It's helpful to see other examples. I arrive 20 minutes before report to look my patients up and get an idea of their most recent labs/medications they are on. Then I'm prepared to ask questions in report if needed. Take advantage of every opportunity to start IVs and work on lab draws. That is an invaluable skill. Don't be afraid of it. You don't necessarily need to make your own mistakes to learn. Learn from others mistakes or situations as well! That will make up a huge part of your knowledge base! Med/surg can become somewhat routine once you get the hang of it. You will feel comfortable and look forward to new situations to learn from. It's a great place to become a strong nurse! Good luck!

I'm trying to understand the relationship of hyperglycemia and sodium. I had a patient with blood sugars q4 with nothing below 280...typically in the 300s. I drew his sodium (on a 3% drip) and came back 156. That made his corrected sodium about 159. Called the doc...3% turned off of course but she said it was "kind of ominous" referring to his sugars being so high consistently as well as his sodium spiking up (previous was 153 and no adjustments were made to the drip for it to go higher). First of all...it's my understanding that higher glucose would cause a lower sodium d/t dilution in the ECF as water comes in. Why then is the sodium higher? Second, what is it that makes this ominous? Pt was a stroke and had a history of well-controlled DM type 2. Thanks for the help!