1. If a patient exhibits say a 10 beat run or less of vtach overnight and already has labs for the morning, should I wake up the cardiologist or primary doctor if they don't have a cardiology consult to let them know? if they don't have labs, should I still call if the patient is asymptomatic or can this wait until the morning?
-I would first check the patient and see if they were symptomatic. If they were asymptomatic, I would be concerned with their electrolytes and want to make sure that they have a BMP and a mg scheduled for the morning. If it were to happen more frequently I would definitely call the doctor and let them know.
2. If a patient is on isolation precautions, how do I maintain safety from transmission of diseases when the patient is going for a test. obviously with airborne I would put a mask on the patient, but what about if they are contact or droplet and have to go for a test or procedure?
-I would alert the procedure room or surgery, etc and let them know what type of precautions the patient needed and make sure that the transport team takes adequate precautions as well.
3. If a patient had surgery or a procedure and it is in the middle of the night and they start having profuse bleeding, would I call a rapid response to get a doctor right away rather than the surgeon?
-during the day I feel like it is a lot easier because the doctors are always accessible (haha), however I would maintain pressure on the area myself and enlist the help of my fellow nurses to complete any other tasks such as calling the doctor or obtaining supplies to get the bleeding under control.
4. HIPAA-How exactly should we be handling phone calls in order to maintain HIPAA? For example, if a patient is from another facility like a nursing home or group home and the nurse for the night calls to ask for an update, what exactly can I tell them without breaking HIPAA? Is discussing test results or medication the patient is on and any change in their status breaking hipaa?
-I am unsure on this one, obviously I would not give any personal information such as address, ssn, etc and sometimes I would say that the results are still pending or to call the doctor directly to discuss those with them because I am not able to go into detail over the phone, but this is something that I am working on to better educate myself to make sure I always maintain HIPAA for my patients. I try to err on the side of caution with this one but want to know the actual laws pertaining to it and plan to look specific things up relating to HIPAA.
5. if a patient is scheduled for surgery and is NPO, should you give any insulin coverage if they have a "high" blood sugar for their accucheck , or not because they are NPO and will not be eating anything?
-I would think to hold prandial insulin if they are NPO but if it is a sliding scale..I would think to give it unless ordered otherwise, but if I was unsure I would call the physician.
6. When giving meds for a patient on a kangaroo pump, do I hold the feeding, disconnect the feed, administer the medications by pushing them into the tube, and then flushing and reconnecting and restarting the feed? I will ask to see a demonstration before having a patient with a feeding tube, I just wanted to have a better idea before I started.
Is there anything else you could add to help me better understand my responses or what I could do differently in each situation? Thank you for your help :)
