What CNAs need to tell the nurse

[UM Review 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.)

[KLYx0327]

I'm getting CNA certified sometime in the middle of Feb. 07. Thanks for this thread--- I'd like to get as much input as possible about what the nurses I am going to be working with are probably expecting of me.

Happy Thanksgiving everyone!!

[Marie_LPN, RN, LPN, RN]

Let us know if a bandage has fallen off or needs retaped.

If the IV beeps for a new bag and you're the first to notice it, don't just hit 'silent' and not say anything. Inform the nurse that a new bag is needed.

If you find any pills in the sheets, on the floor, etc. tell the nurse. Those pills could be for cardiac or BP reasons, and may make a huge difference n the vital signs, and may explain why a BP is elevated.

On a post-op hysterectomy pt., if you help change their peri-pad, inform the nurse of how much blood on the pad and what it looked like (or better yet, keep it in the trashcan where the nurse can see it if necessary). This may be part of the documentation, plus if the pad is soaked, it's an indicator that the pt. might need to go back to the OR.

If the pt. pees, the nurse needs to know, and how much.

[Marie_LPN, RN, LPN, RN]

Patients are highly intuitive of their caregivers' emotions and patients don't do well with unhappy, frustrated, hostile caregivers.

I second this. And pts. will either feel like a burden (i.e. may not report the smallest problems, or ask for anything), or angry.

[UM Review RN, ASN, RN]

When you feed someone, if you notice the patient constantly clearing the throat, coughing, sudden nasal drainage while eating, pocketing food, or not moving the food back easily, please stop feeding the patient immediately, clear the food, and tell the nurse asap.

This could mean that there's some weakness or paralysis of the mouth and throat and the patient may need thickened liquids or pureed meals.

[bethin]

Wonderful! Sounds like you will be a nurse with both feet and both hands in the action.

God's Speed!

Thanks. I needed that little boost.

Now, what else do CNA's need to tell nurses? I'm all ears (or eyes in this case).

[rags]

I'd like to add something to this thread but it isn't actually something the CNA needs to tell the RN but rather what the CNA can do in certain situations.

After graduating from nursing school and working on figuring out the NCLEX I have been working as a CNA for the past few months for the first time in my life. I have to say I honestly feel I needed to experience this in order to be a more productive, competent and caring nurse (which hopefully will be some time in December, if I come up the money for another round of testing by then... another story with that though)

back on topic... We use automatic machines that some call 'slaves' 'eagles' or other various names that we drag around with us from room to room to obtain vitals. If I get a BP that I feel is out of range I take it manually. Many times the machine doesn't pick up the weaker pulses very well and an auto BP reading is lower than it really is. Manually taking it will tell you this. I also will take a pulse manually if I find it to be out of range or notice fluctuation (sp?) on the machine while I am waiting for the BP or if I got in report that a pt has an irregular HR. Also NEVER place the O2 sensor on the same side you are taking the BP unless you get the reading before or after you do the BP. That is just silly (and I've seen some do it) besides, when that cuff squeezes the machine is going to beep on you and we don't like beeping machines. pt's done either, it makes them wonder what is wrong. I will also take a temp from another location if possible if that comes up low/high. I have even found a pt to have a consistently higher temp ax than orally. Had we not discovered this with him (he was NPO so no ice or cold drink prior) we may not have treated his 104 temp so quickly. I got a reading of 99.? orally but knew the pt 'felt' hot so chose to take another route and it made a difference. It ended up in report and others found it to be true for this pt as well.

I also 'get to know' my pt prior to beginning my rounds. I am constantly floated from one unit to the next (sometimes several times in a shift) and am not always there for report so I pick up the cardex and get my own. I jot down important info ® hip; call for SBP>?; NPO; pt confused; past VS; etc.. It helps me to know what to look for when I enter each pt's room.

I have to add to the grumpy CNA poster... I don't understand the reason for your post but I DO understand the frustration of feeling like everyone is expecting too much from you as a CNA and RN's tend to at times forget you have several pt's and several RN's to attend to. I had some problems with this and kept my smile on for my pt's (because they will ALWAYS be my #1) and continue to do what I know is right. When asked to do something as I pass the nurses station on my way to do 10 other things I smile and say, "you bet! But I am on my way to get 2 pt's off the commode, one the bathroom and one just called and is ready for his shower. As soon as I can I will get to that..." It usually comes across that I am busy, but I still want to help. If what they need is urgent, they will either ask me to do it first (usually followed by a smile and a please) or they will do it themselves. I have also found that even the tough nasty RN's (which are out there) tend to come around after they realize their pt is being cared for and the other RN's trust you and the care you are giving to the pt's.

Just some ideas. Sorry to be windy. I have a problem with that.

[twotrees2]

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.

)[/i]

this one drives me nuts - and i dont know any other ways to say it to them but i find often they "oh sorry i forgot you want tio see it - noone else ever does" ugghhh - i have even made them dig in laundry or garbage to get the item in question out if i know they just took care of it and can find it - youd think theyd learn.

[twotrees2]

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. :)

actually i thought this was a nursingboard so we CAN vent - if cna's read it and learn from it great. they should realize even though we may be venting about it , they need not get upset as we are not venting about them personally but the event -

i am sure somewhre there is a nice cna board where there are all kinds of vents about nurses - as a matter of fact from a cna point of view i could also vent for them about some nurses .

that is just my opinion though.

[twotrees2]

Is there anything CNA's can do for nurses in these situations (besides vitals - that's what I'd do first while I send someone else to get the nurse). Sometimes in these situations I feel useless and that I should be doing something.

I love my job, but hate being a CNA. Sometimes you just feel useless because you can't help the nurse pass meds, call dr's, do assessments, etc.

ahhhh but you can stay with that resident whilst we run around and do what we gotta do and for the aides that help that person not feel alone is awesome in my book

[twotrees2]

Yeah. So you collect the big bucks for assessment, care planning, and delegation--and you expect the CNA to do it for you.

Get a grip.

You know why you don't get abnormal data ASAP in the middle of the CNA taking vitals?

Because it takes 15 minutes to find you which she can't afford even when she's only vitaling half the floor, let alone the whole floor by herself, and you're not helping by not carrying your pager.

Because every other RN on the floor is hollering for (1) their vitals and (2) come here NOW and help me/do this/do that.

Because she's WAY overloaded before anyone starts hollering: if you took total care of your pts, you'd find yourself spending half your night on changing, cleaning, and bathing, yet with 5 RNs for 1 aide, you expect all that done "and where are my vitals and I's and O's?"

Because she knows what normal is, and not only that but what floor policy is, but so many times she's gone hunting for an RN with data that's out of limits and been told, oh I don't worry until it's X or Y or Z, or, did you really have to wake up the pt for a BP and anyway that's normal for him -or- leave him alone, he's dying.

But mostly she doesn't do your assessments, plan your care, do critical thinking, and do your delegations because she doesn't have RN training.

wow - whered that come from???

[twotrees2]

When something goes wrong with one of my pts, *everyone* knows, like it or not. What we are looking for is ways to bulletproof things in the general interface between RNs and sitters. RNs, not aides, manage sitters, so it falls to them to ensure reliability. How many RNs assess their sitters for competency? Brief them on expectations? Or just say, oh good, there's a sitter in the room, then take off for hours. That's scary. Yeah, I'm dead paranoid about falling asleep and betraying my trust, but I've seen many asleep and know some even plan to sleep. Hostile? Seething is more like it. Monitoring and maintenance of UAPs is awful. Do you know if the aides on your unit always mark axials AX when they chart? Do you look in the basket on the vital signs machine that an aide is rolling down the hallway and say something if know you have an obese pt down the hall and you see only one size of cuff in the basket? Even if floor policy tells 'em to notify the primary when temp's 100.4 or over, do they know what it means when a 90-year-old hits 99? Dismiss it all as hostility, that's the ticket.

what is a sitter - we have nothing like that here that i know of - at least nowhere i have worked around here. are they volunteers or paid? i would love to have sitters for some of my one on ones that take away from good care to the rest of the residents - and yes if we had them i would give them report and expectations just as i would a cna- but what is their actual role? are they just there to sit with the resident of so for what? appreciative to learn more about these.

[Chaya, ASN, RN]

Nothing to add at this time but just wanted to say this is a great idea for a thread, Angie.