"Behind the scenes" nursing q

[ToxicShock]

I am currently taking my pre-reqs to hopefully get into nursing, but I have a question that I have always wanted to know the answer to, and never knew how to word it in google so as to get an answer.

So here goes: when in an emergency situation, the doctor tells the nurse to get Xmg of ABC drug, where does the nurse go to get the medication? Are certain medications "prepackaged" in a syringe with the right dose? For example, Ativan?

When a nurse needs to administer an IV bag (emergency or not), where does she go to get that bag? Same place where she got the IV meds? Does the doctor tell her how many mg to administer? Is there ever a situation where a nurse can administer a drug without the doctor's permission? What if the math is wrong, and you give too much (or too little) to the pt? Does the nurse check the math mentally, or on a calculator?

Thanks in advance for indulging in my silly questions

[RN1989]

Each of those answers depends on lots of things.

Medications may be in the room, in a crash cart (emergency cart), in the medication room, in the hospital pharmacy.

Bags of IVs might be in a supply room, in the medication room, or in the pharmacy.

You might have to use a medication vending machine to get medicines or IV bags.

Sometimes medications are dispensed in the dose that is needed, other time you have to use multiple bottles, draw up what you need out of a bottle. Medicines even come in syringes but you don't always have the ordered dose and have to do calculations to get the right dose. And with Ativan - almost NEVER do you have the prescribed does because Murphy's law reigns with meds like this that have to be refrigerated, wasted and witnessed by another nurse, and diluted because it is too thick.

Yes, there are times that nurses can give medications without the doctor telling them the dosage. In emergency situations, nearly every hospital has emergency protocols for the staff to follow. The protocols are pre-approved by the medical director's staff. The nurses actually are "told" what to give and how much, but the doctor may not be right there or on the phone or writing them an order on paper.

In a cardiac arrest situation, protocols are followed and people who are trained in ACLS know the "correct" dosages to give and they may start the ACLS protocols, including giving drugs and shocking people without a doctor present.

Giving too much or too little? You never know what might happen. Anything could happen or nothing could happen. If the nurse screwed up, she/he may or may not get in trouble.

Nurses use calculators as well as their brains to calculate dosages. High risk medications often require 2 nurses to check the calculation and make sure that the amount that is given is what is ordered.

No, this stuff doesn't happen magically or as quickly as TV shows. You will learn all this in school.

[ToxicShock]

Haha cool, thanks so much for the answers! Silly TV medical shows!

What is the difference between a supply room and a medication room? And a medicine vending machine?? Is that just how it sounds, pop in a quarter and there ya go?

Thanks again :)

[jjjoy, LPN]

RN1989 - I like your explanation! I wish they did teach nursing that way! In lecture, there's often so much focus on covering content and on learning how to think for the NCLEX that what a nurse is to expect or do in the real world is often neglected. You either get a complex med calc question without any context of when or what you would need that med for or you get a multiple choice test that tells you that XX amout of drug YY had already been drawn up. And if asked these types of questions in class, the instructors would say "you'll learn that on the job." So even a graduate of a nursing program might not have a clue about how such things really work! Of course, one can't learn everything, but it would seem like graduating with a degree in a foreign language but you can't speak it! "School is for learning the language, you'll learn how to communicate with it after you graduate!"... hmm, come to think of it, I do know some folks who graduated with a foreign language degree who weren't very fluent in it...

[jjjoy, LPN]

Vending machines... no need to pop in a quarter, but you do need to type in the patient's ID number so that their account will reflect what supplies were used for them. Someone else should refill the machine regularly so you don't run out of this or that.

[ToxicShock]

That's awesome, I never knew such a thing existed!