What info should be "tattooed" on a nurse's brain?

[rloh961]

For those of you with nursing experience, I was wondering what knowledge you rely on all the time at work. This would be info that comes up so often you know it cold, without ever having to look it up, and which most non-medical people wouldn't necessarily know. Anything from knowing that PRN means 'as needed' to normal WBC values to typical side effects of a medication you administer often.

I just thought it would be interesting to see what actual working nurses find necessary to know, and having a list like this might be a neat reference for nursing students and new nurses.

[murphyle, BSN, RN]

From the emergency side of the tracks...

What to do for new-onset or worsening chest pain. (Sit 'em up, 2-4L O2 NC, repeat vital signs and put on the monitor if they aren't already, order 12-lead ECG. If non-reassuring VS or ECG changes, order CK/trop, grab assigned MD for further orders.)

What you can and can't advance order as an RN - i.e. what your Advance Treatment Guidelines cover.

Phone numbers for Triage, ECG, Radiology and Respiratory Therapy.

The Glasgow, NIHSS, and CIWA scales.

[Fribblet]

Nothing.

A tattoo (for all intents and purposes) is permanent. Healthcare is always changing.

Keep your mind open, and be willing to adjust your knowledge base when presented with evidence that suggests that the "way I learned it," or "the way we've always done it" is wrong.

[nightengalegoddess]

...look at the patient, trust your gut, search your memory for what may be the reason this pt. is changing in condition, google your hunches, look at the labs, just know how to round out the whole picture when the patient is different now than last time you looked. Take vitals the second you have that gut feeling, start assessing the possibilities....just act when you see a change....Please do not just let it go on all shift until the next RN comes on....I do hate it when I come in the morning and the RN giving me report says something like..."well, his B/P has been 70/40 for eight hours, he is becoming unresponsive, his urine output has been 100 cc's in the last 24 hours, ....oh gosh....."did you call the doc?...."...." oh no,, they hate it when we call at night!!!!".............ARGH!!!!! Good Morning Nurse!!!!!!

[colzanurse]

Always come to work prepared: clean scrubs, appropriate foot wear, calculator, good pens, stethoscope, pen light, patient reports sheets, drug book or PDA with drug/disease info, scissors, clipboard (if allowed by your agency), hemostats, healthy snacks. Clean your personal equipment between patients, i.e. wipe down with alcohol swabs or bleach wipes as needed. Know where to find and print out patient education materials. Keep a list with you at all times of important phone numbers, including your nurse managers, pharmacy, resident physicians, rapid response, etc. Learn your medical facility policies and if not sure, print them out for review. Every chance you get to learn something, do it. Volunteer to assist other nurses with patients who have numerous medical needs so you can learn how to manage "challenging" patients and learn about their disease processes. Make sure you make a point of learning something new every day! Develop a binder to include info about frequently dispensed meds, policies, lab value ranges, wounds and wound care, frequently used phone numbers and any other info you need on a daily basis. Keep it in your locker or on a shelf in your work area. I will post more later.

[joanna73, BSN, RN]

Right med

Right time

Right dose

Right patient

Right route

Right documentation

Right reason (as in.,.why are they receiving this med?)

We learned 7 rights, according to the Canadian Nurses Association (2010)

[mkatts19]

I tried skimming through all the old posts so I don't re-post anything, so apologies in advance if I do. (No, I'm not a nurse yet but the following info is just my opinion and what I hope I'll be doing in the future as well).

Although most people say you don't have to memorize lab values, it's probably cool/helpful to know them by memory, especially K, blood values, Na etc so you don't have to rely on checking on the info. For example, if a Dr. or lab person whoever reads to you some info (or maybe you're even getting a phone report), and you hear a lab value that's off you can either ask about it right away or check into it fairly quickly--it'll just click in your head "that's not right."

As with many said, (goes for NCLEX and real life), check the patient before checking the machinery.. if beeping, malfunctioning etc happens.. Maybe the patient just took off their 02 Sat to reposition, and you're instead freaking out that their 02 is dropping to 85% or something. Also, who cares if the alarm is going off when your patient is blue or unresponsive... and you happen to still be trying to figure out why the machine is beeping.

Always respect positions above AND below you. Just because you/I don't have to clean up a patient's #2, doesn't make us any better than the person who does. If it weren't for them, our jobs would probably be a lot tougher. Even though a Dr. may be mad/overwhelmed in speaking with you, always speak up if you feel that something is wrong with an order or what was said regarding the patient's care.

Some random ones:

Before you give a patient food or liquids, etc.. make sure you know their diet restrictions!! Just because they ask for ice chips doesn't mean the last shift gave it to them while their NPO.

Try to have everything in the room before a procedure... and it's also helpful to have it ready for the next shift as well (and let them know when you give report). As a nursing student, that's one of the extra things I'd do to hopefully help the nurses out and they always seemed to appreciate it even if it's small.

Though not super medical tips, hopefully some of this helped. :)

[canesdukegirl, BSN, RN]

Oh lordie, this is a hard question to answer. There are so many things that are tattooed on my brain that I would be a spectacle at Bike Week in Myrtle Beach if they split my cranium!

Pathophysiology and the mechanisms of disease process

Lab values-CBC, Chem 10, tox screens

Lethal rhythms and the treatment of them

PCO2 and CO2 values along with baseline tidal volumes for each pt population

Safe and most appropriate mechanisms to achieve hemostasis

Which ABX are most appropriate for which infections

Immediately assessing the pallor, condition of the skin, eyes, speech, body mechanics and respirations of my pt.

Knowing which medication is most appropriate in an emergency and at what dose-using my 5 rights.

Knowing which day is payday

Understanding reasons for anxiety and remembering to comfort my pt in the way that is helpful to THEM, not to ME.

There are really too many to list. Over time, nursing becomes second nature. My only wish in my lifetime is that I can hold on to the knowledge that I have been honored to gain in relation to caring for patients.

[evilolive, BSN, RN]

Never stop asking questions

[CCL RN, RN]

Right Med

Right Consistency

Right Dose

Right Time

Right Route

Right Patient

Right Position

Right Documentation

hmmm...what are the others?

The right to refuse. They were adding that to our list when I was in school...

[RescueNinja]

The very first thing you need to know about every single patient is their code status. Nothing is stopping pts from going downhill at 7:01 and it often happens FAST.