Simple things new nurses or experiece nurses are not doing?

Specialties Med-Surg

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:confused:new nurse has a post op patient who is running a fever, she/he gives patient tylenol for it. But experience nurses say a blood culture should be drawn. Why are the new nurses not doing this. Does this happen at your hospital that new nurse are forgetting to do. But not only new nurses I have seen this happening with experience nurses too.

As a new grad nurse who hasn't yet started a job, I find it really interesting to read all these posts. I feel like by reading what everyone writes, maybe there will be a lesser chance of making mistakes when I start. Keep 'em coming!!

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how do you guys address constipation?

given the amt of narcs most of these pts are on, do you give anything to prevent it?

or ask pt if they have gone?

leslie

We give Colace if they are on any narcotics, and oh yup, we ask every shift change "have you had a bowel movement".

No BM in three days gets you a DDF. Or if discharged before then we have it on the discharge instruction sheet "no bowel movement within three days contact your doctor"

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We give Colace if they are on any narcotics, and oh yup, we ask every shift change "have you had a bowel movement".

No BM in three days gets you a DDF. Or if discharged before then we have it on the discharge instruction sheet "no bowel movement within three days contact your doctor"

thanks for your reply, fiona.

i'm finding that in general, hospitals do very little in addressing these very real complications.

impaction, obstipation, ileus/obstxn are very real problems.

i receive so many pts to my hospice facility, from the hospital, that are screaming for relief.

sluggish to absent bowel sounds, distention, even vomiting and pt c/o not having bm for a week.

you just wouldn't believe how much stool i have removed.

i mean...

you.just.wouldn't.believe.it.

so for all you new nurses, when your pt is receiving opioid analgesia and has remained relatively immobile, please, get them colace bid or even senna bid.

until you've been through it, it's painful and dangerous to just let it slide.

leslie

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Earle58, I so know what you are talking about. Many of our patients have been on heavy duty opiods and let's just say the results can be large. Distention and vomiting on my unit will pretty much get you an NG within four hours.

Some units and some nurses are better at asking than others. Hell, at my age, I have no problem asking but some of the newer grads figure the patient will tell them if they need assistance.

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You guys make a great point. At the place I use to work most of the post op pts got colace BID and senna BID together. Some pts even complained that these two didn't help and we had Lactulose PRN. I never understood that pain of constipation even when I thoght what it was untill I had a baby. OMG! THe pain! Never again I let anyone go through this pain ever again.

Great chats keep it coming

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I totally agree that nursing students are not as well prepared as they should be for the simple cares. But I don't think that we can completly blame the nursing students either. They don't teach you the simple things.. . .aside from making a bed and giving a bed bath and positioning the client. I was never instructed on how to take accurate I&Os (in particular the IV bags. . I didn't know for the longest time that their was a way to see how much was infused thru an IV or how to clear the IV). . over time I figured it out but I think that the simple things obviously aren't covered in class because apparently there are more important things to learn and when there is one clinical instructer for 8-10 students and students are just starting out it is really hard. . .and some are too scared to ask because it seems like a dumb question to say "how do you do I&O's?" and some nurses are not easy on new students and can be very intimidating. Hopefully, nurses will become better when they have a brand new nurse at explaining the simplest of things if they see a new nurse that needs help.

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But that is what orientation is for. A time to learn the unit and it's habits. We routinely demonstrate to new hires how to do I/Os, clear an IVAC, mark an NG, read the measure of a chest tube. We stand there and ask the patients about bladder and bowel with the new hires and students right by us. They KNOW we ask these questions and when they come back to work on their own it's totally out of the window for some of them. I've lost track of the times patients have told me "it's only you older nurses that ask about my bowel and bladder"

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Specializes in Ortho/Uro/Peds/Research/PH/Insur/Travel.
how do you guys address constipation?

given the amt of narcs most of these pts are on, do you give anything to prevent it?

or ask pt if they have gone?

leslie

I work in ortho and many of our patients have lived (for reasons I cannot understand) with chronic pain for months and years. As a result, their tolerance for narcotics is often VERY high. In addition, 90% of our postop patients come to the unit with either a morphine or Dilaudid PCA and then, after 24+/- hours, to oral pain medication. So, we educate our patients on the reason(s) for constipation and how to alleviate it ALL THE TIME. Most of our postop patients receive Colace BID and Senna at bedtime. In addition, barring any cardiac or nephro history, we push the fluids (both IV and oral). We also HIGHLY encourage patients to ambulate as soon as they are ready. We emphasize to patients that the constipation is secondary to anesthesia, decreased activity, decreased fluid and fiber/food intake), and narcotics. It's important to note that not all patients have bowel movements daily. As a result, we HAVE to ask them what is normal for them. Good luck!

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Specializes in Ortho/Uro/Peds/Research/PH/Insur/Travel.
But that is what orientation is for. A time to learn the unit and it's habits. We routinely demonstrate to new hires how to do I/Os, clear an IVAC, mark an NG, read the measure of a chest tube. We stand there and ask the patients about bladder and bowel with the new hires and students right by us. They KNOW we ask these questions and when they come back to work on their own it's totally out of the window for some of them. I've lost track of the times patients have told me "it's only you older nurses that ask about my bowel and bladder"

While I respect the experienced nurses, a few of them on my unit are terribly disorganized and no one is assertive enough to say anything to them. My pet peeve is when nurses do not give pain meds at the end of their shift. I love being asked for pain meds as soon as I hit the floor.

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PRN meds are exactly that. Patients turn them down, deny pain. We just don't give pain meds automatically. So if at 2245 a patient declines meds and rings and wants them at 2310, it's totally out othe previous shifts control.

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Specializes in Ortho/Uro/Peds/Research/PH/Insur/Travel.

Yes, they are PRN meds, but knowing this particular nurse, she's not inclined to do much beyond the minimum. In addition, there's a reason we consider ourselves to be drug dealers with retirement plans...we admin oodles of pain meds. OODLES!

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My foundations clinical instructor must have done a decent job then. She drilled the importance of assessing bowel and bladder and also the importance of I & O. We did not cover how to interpret I & O for IV's since it was 1st semester...but we will be doing a lot of that in fall semester and I will be sure to ask about that. This has been a really good thread and I appreciate the input from everyone.

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