What CNAs need to tell the nurse

[UM Review RN, ASN, RN]

in a postop, i want to hear about:

pain level (could indicate compartment syndrome or that dose needs adjusting)

c/o nausea/vomiting (could indicate an ileus)

bp over 140/80 or under 90/50 (lots of reasons, but needs treatment)

temp over 100.4 (some temp is expected in a postop patient, but after a certain point, the doc will want stat blood cultures)

but in the stroke patient, a temp over 99 needs to be reported (stroke patients need treatment for any temp over 99f)

a previously alert, oriented patient becoming confused. (could be an infection, a stroke, low o2, or a low blood sugar, but needs immediate investigation)

please save or show me any bleeding, any diarrhea, any discharge, any vomitus, and any urine that is not clear yellow or stool that is not soft, formed and brown.

if you notice any change in temperature or color of the skin of an extremity, please tell me. (a cold, white extremity could mean a clot and is an emergency)

if you find any pills in the bed, save them and tell me.

(some patients carry their own stash and can od themselves by accident)

please let me know if anyone has any trouble breathing or if their o2 sats are 92% or less or if their respirations are over 23. (the patient may need o2)

please let me know if the patient's heart rate is not regular or if it's over 100 bpm. (patients with an irregular heart rate might have a more accurate blood pressure when taken manually.)

[bethin]

Question: worked in ICU with post op open appy and who 12 hours later had a bowel obstruction. Morphine PCA. Took vitals and got resp. of 9, BP low and hr high (don't remember numbers). Reported it to the nurse, who looked at me like I was invisible. Is this not a concern with a pt who is on Morphine PCA? I thought if resp were below 12 and BP low that PCA was to be d/c and narcan given. Remember reading that somewhere in our policy book.

Great list btw.

[augigi, CNS]

Depends on the patient's baseline BP, HR etc as to how urgently I'd look at that patient. Your instincts were correct, and as long as you act in accordance with your facility's policies and procedures you'll be good. The nurse should never treat you that way, should just say "thanks for the update" regardless of how urgent it is.

[UM Review RN, ASN, RN]

Question: worked in ICU with post op open appy and who 12 hours later had a bowel obstruction. Morphine PCA. Took vitals and got resp. of 9, BP low and hr high (don't remember numbers). Reported it to the nurse, who looked at me like I was invisible. Is this not a concern with a pt who is on Morphine PCA? I thought if resp were below 12 and BP low that PCA was to be d/c and narcan given. Remember reading that somewhere in our policy book.

Great list btw.

I can't say for certain about that patient--and they are all different--but because the patient was in ICU, I would have to assume that there was a respiration monitor on the patient and the nurse was able to keep a close eye on him. (How was his O2 sats?) I would've counted myself for a few minutes at intervals and possibly made sure that no one was pushing the button for the patient.

Narcan'ing a patient is something that we try to avoid if possible, and it is quite possible that either there were other explanations for those numbers or that the nurse assessed the patient after you did and got a different result, or decided to wait and see. Patients are able to be observed better in ICU.

[TazziRN, RN]

Low BP and high HR actually can mean bleeding. Or dehydration, depending on the reason for the illness. With narcs you would expect low BP and low HR. But yes, low RR with narcotics and a low BP is not a good thing. The nurse should have been thanking you.

My feelings: I would rather my CNA tell me things that end up being unimportant than risk ignoring something I should know about.

[bethin]

I can't say for certain about that patient--and they are all different--but because the patient was in ICU, I would have to assume that there was a respiration monitor on the patient and the nurse was able to keep a close eye on him. (How was his O2 sats?) I would've counted myself for a few minutes at intervals and possibly made sure that no one was pushing the button for the patient.

Narcan'ing a patient is something that we try to avoid if possible, and it is quite possible that either there were other explanations for those numbers or that the nurse assessed the patient after you did and got a different result, or decided to wait and see. Patients are able to be observed better in ICU.

There was a resp monitor on him but I counted resp for a minute the way they taught us to do them: raise is a resp. I don't remember O2 sats, I think they were in the low 90's (and on 2L)- not good considering this pt is 16 yo.

Sorry, didn't mean to hi jack your thread.

[TazziRN, RN]

There was a resp monitor on him but I counted resp for a minute the way they taught us to do them: raise is a resp. I don't remember O2 sats, I think they were in the low 90's (and on 2L)- not good considering this pt is 16 yo.

Definitely sounds like the nurse needed to know. You can come work with me anytime.

[Marie_LPN, RN, LPN, RN]

If you saw an NPO pt. eat or drink anything, including a piece of candy, a sip of water or coffee, please tell me. They might be NPO for surgery and that little sip or piece of candy can make a difference on whether they go ahead with it or not.

[texas_lvn]

If the pt falls. Period. Even if you did catch her on the way down. And, tell me why you are getting the pt up day of post op a total knee replacement, when she has a foley in????? When I already told you she can not have any weight bearing on her l leg?????????????????

[UM Review RN, ASN, RN]

If the pt falls. Period. Even if you did catch her on the way down. And, tell me why you are getting the pt up day of post op a total knee replacement, when she has a foley in????? When I already told you she can not have any weight bearing on her l leg?????????????????

It sounds like you're venting about an incident involving a particular CNA, Tex. I would probably have to write an incident report and write up the CNA involved rather than blow off steam on an informational thread.

Most CNAs who come here are going to nursing school and would not have done that.

They're looking for ways to help, not looking to get vented on.

I hope others will consider those things as they contribute information to the CNAs. :)

[texas_lvn]

It sounds like you're venting about an incident involving a particular CNA, Tex. I would probably have to write an incident report and write up the CNA involved rather than blow off steam on an informational thread.

Most CNAs who come here are going to nursing school and would not have done that.

They're looking for ways to help, not looking to get vented on.

I hope others will consider those things as they contribute information to the CNAs. :)

Sorry, how about if I say, a pt falls.

And, it didnt happen to me, but it happened in NA school years ago, and it was a big lecture for all of us. He was let go from the program.

[UM Review RN, ASN, RN]

It's good that you were able to move on from there, Tex. I guess it just really underscores how important our CNAs are to our patients, doesn't it.

:)