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SammieRN940 SammieRN940 (New Member) New Member

Specific Questions

Med-Surg   (591 Views 4 Comments)
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I would love to see everyone's nursing brain sheets and what they love about their set ups.

Tips to feel less overwhelmed managing patients with lots continuous IV meds running, maintenance fluids, piggyback abx, PCA, PCO2, epidural, etc?

Who carries a clip board?

Is there a good compatibility cheat sheet?

Is there a good "what to dilute" cheat sheet?

We use a lot of maintenance fluids, morphine, dilaudid, toradol, rocephin, zosyn, amp, etc... Are there any common interactions between any 2+ of those meds?

Or between any of those meds and common maintenance fluids?

How do you know what IV push meds to dilute? Is there a way to look at the med in the pyxis for dilution/administration instructions?

Sorry for the barrage of questions. I am trying to figure all of this out since I am already on week 4 of orientation and I have my own low acuity patients so I don't get to follow my preceptor and learn all of this.

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I would love to see everyone's nursing brain sheets and what they love about their set ups.

I use a sheet of white paper, fold it in four. Put a patient sticker on each corner for identifiers. I write down pertinent labs on the top right side, and any other very important information on the bottom right. The rest of the space is for new verbal or telephone orders from doctors before i put them in the computer. I try to keep things very minimal. If I need other info I can read it off the SBAR.

Tips to feel less overwhelmed managing patients with lots continuous IV meds running, maintenance fluids, piggyback abx, PCA, PCO2, epidural, etc?

To be honest if you have alot of patients running continuous fluids, it's almost impossible to keep up with everything when you are busy. What I do (depending on your facility policy) is I get an extra bag of fluid ready on the IV pole. So when the patient's call light goes off for the beeping IV, I can easily swap it out (and replace the extra bag before end of shift for the next nurse). PCA pumps are always a headache in my facility because they keep all the syringes in the ortho unit. I'm glad I rarely deal with them in my unit.

Who carries a clip board?

Not me.

Is there a good compatibility cheat sheet?

On our unit we have this posted on the wall

Y-Site Compatibility Wall Charts – King Guide to Parenteral Admixtures

there may be better ones out there.

Is there a good "what to dilute" cheat sheet?

Not sure what you mean. When we have to dilute meds the pharmacy will usually let us know via the pyxis or the EMAR what to dilute the medication with.

We use a lot of maintenance fluids, morphine, dilaudid, toradol, rocephin, zosyn, amp, etc... Are there any common interactions between any 2+ of those meds?

Not too sure. But what I can tell you is not to give too many narcotics at the same time (especially IV) or it will decrease respiratory drive/lower BP of the patient. Some chronic pain patients will have alot of PRNs. Regarding interactions, I always call pharmacy and check our drug resource from our charting system when I have doubts.

Or between any of those meds and common maintenance fluids?

It was a while back but there was a certain medication that pharmacy told me should not be given since the patient was on maintenance fluids with potassium added. Can't recall what it was though.

How do you know what IV push meds to dilute? Is there a way to look at the med in the pyxis for dilution/administration instructions?

Typically the order should tell you what to mix a med with if it needs diluting. If you have questions your pharmacy should be able to help you.

To be safe, you should ask your preceptor. Everything will always differ from one facility to another. Best of luck.

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The Ultimate Nursing Brain Sheet Database (33 nurse report sheet templates)

I got mine from this site, downloaded it and printed on bright colored cardstock, front and back. I laminated it and use ultra fine tip sharpies, 1 color for report and labs, and another color for prn mends given ,changes or new orders with the patient and new labs resulted above the original labs I started with. The sharpie is erased with using an expo and paper towel. 1 sheet has room for 6 patients, 3 on each side.

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