Published May 24, 2002
Hi every one. I have been a nurse just for a few months and I am about to get off orientation. God there is so much to learn and so much experience to acquire. I need some info or teaching please. What is the difference between giving PO meds to a pt who will be going to dialysis in a few hours and giving IV fluids, antibiotics or cardiac drips? Don't they all go into the system and will gel wasted with dialysis? That is the way I learned in school, but is it different if it is IV? I am not sure about this. Should I hold IV fluids and IV meds as well as I do the PO? Thank you for your info. Have a great holyday weekend. Monica:chuckle
I'm not really sure, but maybe because the IV gets into the system faster, it is allright to go ahead and give them. But I would sugest you check with your supervisor or the patient's doctor to see exactly what to hold.
The nephrologist and pharmacy can usually tell which meds can and should be held til after dialysis; or you can check with the dialysis nurse and she will let you know what to worry about. We don't hold foods or fluid (although most dialysis pts. are on some type of fluid restrictions) before dialysis and many can even get their trays during the run; I guess that depends on how sick they are and the program you are in.
Oh, and wrkoutgirl, good luck in your new profession! Welcome to the world of nursing!
During hemodialysis, usually hold a.m. anti-hypertensive and antibiotic meds (some exceptions are vanc and levaquin) before dialysis. Pt will usually return with nitropatch removed also. Some meds that don't readily dialyize are steroids, GI meds, insulin, and narcotics, to name a few. Always give electrolytes. If albumin or mannitol is ordered, give them before tx, but we may also give them additional doses during the procedure.
During ultrafiltration treatments only (no dialysis..just fluid removal) only need to hold anti-hypertensives.
Plasmapharesis treatments filter most meds away, Calcium is given throughout the tx. During C.V.V.H. and C.V.V.H.D give meds as ususal. Peritoneal dialyis doesn't change med administration times either.
At our facility, no one is fed a meal during hemo treatments. Early tray is needed.
Hope this is helpful.
wrkoutgirl, I agree with checking with the dialysis nurse. Any IV fluid would probably be lost thru the dialysis itself. Some meds are absorbed faster than others. Our facility not only sent the patients chart to the dialysis unit but also sent the med draw so that when the patient was finished and waiting to return to the floor that the dialysis nurse would give it. Congrats on joining one of the best professions there are. WELCOME. If you feel you could use a bit more time for orientation ask for it. Usually there is no problem doing it if you are showing positive signs in learning. If the time is granted than work with your preceptor to focus on the major things u need help with. And remember we were all there at one time so don't let anyone put anything over on you as they are only smarter because they have learned through the years as you will also. Then some time from now you will be preceptoring a new nurse and can relay your horror stories to put him/her at ease. Sometimes the stupidest mistakes we make are the most hilarious in times to come. I noticed you are a guy but I don't know how sensitive you are but you will find that there are days that you should never had done this but then there is the day a child who wasn't suppose to live is now a thirteen year old and beginning her adolescence. The day you hold someone in your arms as they take their last breath so that they know that they weren't alone that someone cared, Or the first time you see a baby born if you don't have any of your own as yet. Is is the amazing resilience that people have that will make your day worthwhile. I have told students all along that you can learn so much out of a book but your patients will teach you more than you will ever comprehend. I have stayed nights when and admission came up at 10:30p and of course nights would have a face if the admission wasn't done. So I did it an the women was not long for the world and her family walked in as we transfered her to the bed from the stretcher. She was so diaphoretic that she was soaking wet. We changed her gown and I called the doc for some lasix. I got an order for 80 IV push to try to make her a bit more comfortable and the respiratory therapist stayed with me. The clock continued to tick and then we were both on overtime and I still hadn't opened anyones chart. On evenings we usually had 8 patients. And I have seen over the years what most will now tell you that people are more sick now than they ever were. Well, the patient started to choke so we set up suction and it was pure serous. The family was a bit more upset as if they weren't already so I went to get some fresh sheets as the ones that were on the bed were saturated. I also grabbed a couple of towels. The patient continued to go down hill and we kept suctioning her. I was so afraid that we were going to have to change the canister and have the family ask about it. A prayer was answered. There was no urine output with the lasix and about 2 hours she had passed. I think it also would have been harder for the family to deal with another group of nurses when we were there. It also gave the night shift a chance to get organized and go over their cardexes and med sheets. By the time they were finished all they had to do was shroud the body. I don't know if you have done it before if you worked as a tech or not but the first time I had to help shrouc it was difficult for me to bull it over the person's head and face. I worked primarily med/surg and the focus of the floor was respiratory, diabetes and we had the reverse flow air rooms for isolation. With most of these patients they became known as "repeat offenders" and they new it. Each time they would come in it was harder and longer to get them home. They almost became family as well as their families. They would bring stuff in for the staff. If I thought it was okay with a patient I would ask them if they had their hug today as I hadn't had mine yet and would they mind giving it. Most of the time the older women would smile and that would make that day all worth while. The women who I had known became mum and the older men pops. I saw so many patients wait till their loved ones had left and then pass away quietly with members of the staff. We tried to have someone in their for a while after family had left. This is all very true with holidays and anniversaries, and birthdays. Those you have to watch out for.
In the course of my practice I recieved a couple of letters that women had wished they had a daughter like me. I do believe in going to funerals especially someone you have known for sometime Well, once again welcome and I am sure you will do fine and you know why? Because you are not afraid to ask for help so JUST DO IT
Our policy is to give all meds unless specified otherwise. We even send meds to dialysis with the patient to be given at required times. IV meds are the only thing NOT sent with the patient. Each hospital has it's own policy on this, so best to check with the dialysis team before sending your patient. Also check with other Nurses on the floor to see what the routine is.
As stated above, there are some drugs that are dialyzed out and others aren't. I would never give HTN meds prior to or during dialysis because hyptoension is so common. I work ICU so dialysis comes to us and they will usually hang the antibiotics at the end of the treatment.
There is a lot to learn and you will. Don't try to learn everything all at once, ask questions and keep your eyes and ears open for leaning experiences. Find a colleague you like or admire and have that person mentor you.
You'll do fine!
:kiss Hi everyone, thank you so much for your answers and your support. It is immensely important and valuable to have you all to listen, encourage, and help me. Some of your words even made me cry and feel that I am not alone in this difficult career. For you who ask me if I think may be I can use longer orientation, the answer is not. I feel comfortable by myself most of the time and I find that I use critical thinking very often. Another reason is that my preceptor does not really act as a preceptor, unfortunately it is more like us sharing the # of patients an once in a while she will share her knowledge with me. There was one day when she called in sick and I had someone that I requested since I admire her a lot. I felt that I learned more with her in one day that I learned with me regular preceptor in months. I requested a change but unfortunately she is one of those people who creates a reputation of being good but talking loud, yelling @ doctors, nurses from our unit and from other departments who are about to send us a transferred pt and o on. My unit manager thinks the world of her and when she is not around she goes on the phone to catch up with friends. Goes on a cigarette or coffee break or sits down just chatting, She looks pretty busy when the manager is around, raises her voice and starts explaining something. I have to play alone and act as if I did not know that and I thank her for telling me. I know that would be much better prepared to go on my own if I had have the other young lady as a mentor and I even mentioned it to my boss and the nurse educator but they did not think so. I plan to ask a lot of questions when I am alone, try to schedule my days as close to the ones of this young lady so that I can ask her or even watch her, and I am planning to double check everything. I am still trying to prove my self to a few nurses who are very hard on me. My preceptor told me that they are often hard on new nurses and that I have to prove my self to them," overtime". It is also difficult because I am minority by being Latina, I have and accent when I speak, I am very friendly and kind of humble and tolerant. I became a nurse at 40. I could not go to school before b/c I was a single mom for 15 years, was working on improving my English and did not have a green card that would allow me to go to college. Although I am proud of myself and my daughter thinks the world of me I noticed that I am not treated equally at work by some people perhaps b/c of what I mention before and/or b/c I am a new kid in the block. I promise you all that I will do only my best to be the greatest nurse I can be. Thank you for listening and for being there for me. monica:kiss
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