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How does your facility prevent falls?
We put on yellow socks, yellow arm band, and a light on above their room- as well as reading the room number in huddle. Bed alarms are utilized as appropriate. This all is totally ineffective as most of our falls are from patients that aren't even deemed fall risks!! One lady walked the halls alone but was given ambien which made her confused and she fell.. Another was a 25 year old who tripped over her own feet with the nurse in the room.. Another was bleeding internally and passed out post op.
- What's the funniest most unusual baby name?
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Stupid things that nurses say
I had a pt in A.Fib and had orders to administer PO diltiazem (Cardizem), then in the next few hours call the MD on call and let him know if it's improving. Now, I don't work on a cardiac unit so it isn't super common to give that medication. I call the on-call physician (mind you he didn't prescribe the med) And tell him, "... The diltiazem is working fairly well her HR is consistently below 115." The doctor is silent for a few minutes and had me repeat what I just said. Finally after I repeat the medication 10 times he says "OHHHH Ok, perfect thank you", laughs and hangs up. Seriously confused, I just brushed it off. Later I realized I had pronounced diltiazem totally wrong as "die-al-ah-ta-zem" not "dil-tye-zem" Horrified.
- What color scrubs do you wear?
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I was reported for something I didnt actually do. Help.
That was extremely rude. He/she is asking for advice- don't respond if you don't have constructive input.
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When do you know to call the doctor?
I work on day shift, and labs are drawn early morning so that when our doctors round, they are able to see them. I never call the doctor prior to rounds (unless very serious obviously!!) because they will be up on the unit (always prior to 8am). I call for the following reasons *if ordered after rounds or results after rounds completed* -results from a lab (only if abnormal) -results from a study (ct, X-ray, etc) -requesting a medication or care (inserting/removing foley, for example) -change in patient status (increase in BP, LOC, etc) -if family or pt is asking questions I can't answer and requesting I ask a doctor -if my task list says notify Md It's really on a patient to patient basis though..
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Stethoscope/clinical supplies
I've had a littman classic II since nursing school (2012). I do not wear mine around my neck (only for my morning assessments and then PRN) but it serves it's purpose well and I don't see getting a new one any time soon! Love it! I also tied a ribbon around the tubing so I can distinguish it from my co-workers :)
- What was the MOST ridiculous thing a patient came to the ER for?
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Heparin
I work on a post surg unit (we obviously get preop too!) and we do hold anticoagulants prior to surgery, even aspirin most of the time.
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TV shows and movies that are ruined, because you know better
My favorite was one time on Greys, I think it was Arizona, told a patient they had "psoriasis" of the liver instead of "cirrhosis." I cracked up..
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Fear of making med error as a nurse?
In my nursing program- in order to pass the first semester we were required to make 100% on a med-math exam. We had 3 tries, and all of us were successful. The pressure to start our program off with a good foundation in med-math makes being an RN much easier That being said- I work at a large hospital and almost ALL med math for medication dosing is done and calculated by pharmacy. There is almost none that I have to calculate on my own. Obviously we have to check the math though. Relax- it all comes with the training and experience. Ask questions when you don't know and have a coworker double check Even if you are totally sure.
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Heparin
And it's not that heparin affects hgb.. But if a patients hgb is trending down and below 8.0.. It could possibly be a bleed.. Which heparin would make worse. This was Atleast how I understood the rationale..
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Heparin
At our facility YES! Always hold heparin/lovenox if platelets are less than 100 (and call MD), and hold if hgb is 8.0 or less (ESPECIALLY if that is trending down from previous lab draws and call MD). BUT if the patient has anemia or sickle cell and an HGB that stays consistent at 8.0 or below, it's usually given.. Situation depending.
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Preparing for the 1st Day
Best advice- get to the unit about 15 minutes early and review your patients for the day. When your day starts, sometimes it can get hectic and you aren't able to read up on their history or progress and key information can be in there. (ALWAYS CHECK LABS AND RADIOLOGY).I also ALWAYS make it a point to read the "physician progress" note sometime during the day because many times they will write a plan there but will neglect to give those orders. Brain sheets- using a few different and seeing what works best for you is my best advice.
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insulin question
I always check the day priors glucose levels and see how they did with their long acting and sliding scale. I know with new admits this isn't always possible, but it helps see the trend the patient is following. Typically, my rule of thumb is, If the patients levels are below normal (less than 70 at my facility), I will usually hold long acting just to be on the safe side (especially if they are NPO or something). If it's normal, between 70-110 I will give the long acting.