tasking vs thinking...eh critically that is

[lulu rn]

im a new rn in the er. i feel im doing fairly well, however i feel like i cant get away from tasking. i would like some suggestions on thinking more about my patients and anticipating their needs.

sometimes i feel im so deep into trying to get all the orders done that i cant think about why im doing what im doing or if i should do something not ordered but a nursing intervention.

a very simple example: at what point to ask the dr for iv fluids when a non urgent pts bp drops say from 120/73 to 92/65 without a significant reason... not an mi or bleeding

should i not worry, it will just come in time or is there something i can do?

[nursemeow]

are they septic? CHF? SOO many questions.... go with your gut and ask...speak up... that's how u learn!!! Good luck!!!!!!!!! Trust me...everytime u don't ask and should have... u miss a learning oppt...

[marjie322]

Always look at your patient...assess if in doubt..prioritize and always think of A-irway, Breathing, Circulation..and delegate.. as what my instructor told me:cool:

[buttercup99]

Like marjie322 said, look at your pt not just the BP or heart rate -you're looking at the whole pt rather than parts and it means you will catch things quicker. Plus, over time, you will learn what pts look like before they crash.

Don't ever doubt yourself - if you think the pt needs fluids or an immediate review, don't be too shy to bring it to the doctor's attention. With the fluids, if there is any reason why the pt MIGHT need fluids in the future, I get an order written up just in case. Your workplace should have protocols for when fluids are given and when low BPs are acted upon.

In the case where a BP goes from 120/73 to 92/65, I would request fluids as soon as I was satisfied that there was a downward trend, especially if there was no good reason for it or the pt is symptomatic. Make sure you gather the whole picture before you speak to the doctor. So you think what will the doctor want to know and have that information ready. So if the doctor asks what was their pulse or are they febrile, you don't have to say hang on, I'll check. You basically spell out the whole picture step by step and then ask for the fluids.

It is so easy to focus on tasks because you usually don't have time to read through the pt's past history and connect all the dots. I think you should not be so hard on yourself. You are probably comparing yourself to experienced nurses - just use your common sense when deciding on nursing interventions. Go back to basics and think what does this person need? What is actually going on in their body? Is their increased heart rate due to low oxygenation? Is their high glucose level causing fluid deficit? and go from there.

buttercup99