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What are you most vigilant about?

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by lynns75 lynns75 (New Member) New Member

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annie.rn has 21 years experience and works as a RN.

1 Like; 12,338 Visitors; 546 Posts

Wasn't my patient but CLS drew ABG on a guy in the AC without following up with pressure.

HUGE hematoma... entire upper arm blew up like a balloon... bordered on compartment syndrome...

Dude would've been d/c'd home that day... ended up staying for another week...

Holy Moly!!! How awful!

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Muser69 has 42 years experience and works as a Staff nurse.

1 Like; 5,383 Visitors; 176 Posts

Getting out on time.

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firstinfamily has 33 years experience and works as a RN.

5,362 Visitors; 790 Posts

This is a really good post. It brings up all the little things that can amount and be the cause of a big thing!! All nurses need to be diligent about everything!! If you have an aide who is not carrying their load or who you are not sure can take vital signs correctly you need to address them directly. I also prefer to take my own vital signs. I like to verify the automatic b/p with a manual b/p and I might bring up that if a pt has a history of Atrial Fib and is currently having Atrial Fib the automatic b/p cuff may not sense the rhythm and be able to correctly measure the b/p, so perhaps in anyone with A. Fib a manual b/p needs to be taken. My priorities when I first walk into a patient's room are to do a quick visual head to toe, ask about pain, get vitals, verify that IVs and catheters are located where they have been reported and are patent. (IVs with fluids running need to verify the fluid is the correct solution or medication and infusing at the correct rate, is there a spare maintenance IV fluid waiting for when this runs out? Is the tubing dated and current?) Flush g-tubes, NG tubes and check for returns. Dressings need to be assessed for any drainage. The off-going shift may say they changed it, but what does it look like when you come on?? Sometimes we come on to a train wreck and we are left to fix it. If the train wreck is the first patient you see, you need to prioritize. Is there anyone in your assignment who was reported as unstable?? That pt should be your first one to check and go from there. IF the train wreck is one of many train wrecks attack the one that has the most urgency. It can be difficult and very time consuming and lets face it, there is not always help available. Sometimes we just have to suck it up and do what is the best for that patient at that time. It may mean you are with one patient for 20-30 minutes before you see all of your patients. You could peek in at the others and inform them "you will be with them in --------minutes, you have an urgent need to take care of." I find as long as the patient and their families can see a face and attach it to a name, they are more satisfied than if they were left waiting for some type of service. Their needs are just as urgent to them as any other patients, but if you explain that you have to spend time with one patient they usually understand. It takes time to really learn how to prioritize and attack our challenges!! But it can be done and done well and professionally.

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firstinfamily has 33 years experience and works as a RN.

5,362 Visitors; 790 Posts

This is for Big Goose concerning restraints, when I was working ICU in Virginia the use of restraints as a routine for intubated patients was revoked by the state inspectors. We had to learn how to use other items not considered restraints. There were many emergency extubations because of this ruling, we were lucky that those patients were able to be reintubated without any trauma or increase in airway edema. You are fortunate you can still use restraints with intubated patients, I have worked both areas where they are allowed and not allowed and I personally would prefer my intubated patients to be restrained for their protection and to prevent any extubation trauma.

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firstinfamily has 33 years experience and works as a RN.

5,362 Visitors; 790 Posts

nurn---Yes, it seems turning is not always encouraged!! When I would get patients on the sub-acute unit they would say, "I cannot turn on my operative side." At which point I would educate them and also inform them of the hazards of not turning. (skin breakdown, lung congestion----pt education!) I had one patient who had chest tubes who was post day #1 and told me he "couldn't get out of bed." At which point I told him how we were going to do it and why he needed to do it and how the chest tube set up would not interfere." The sooner they are moving the faster they recover!!!

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ChristineN works as a RN.

28,195 Visitors; 3,464 Posts

Checking drug levels prior to administration. Also, checking any labs that go hand in hand w/ certain meds (i.e., Lasix/K+ levels). As a new nurse I saw a 20 year old post-knee arthroscopy pt. end up on dialysis after receiving several doses of Gentamycin after a critically high trough had been overlooked. I had always been quite vigilant but that cemented my habit.

Stopping to look up drugs I don't know no matter how much of a time crunch I am in.

There's others but that's the one that comes to mind immediately.

This. I am a big on drug levels and if it isn't ordered I will ask for it to be ordered. Several years ago my mother was hospitalized following an overdose and no one checked drug levels for over two weeks. By that time they had restarted her meds and even titrated the dose up. By the time they checked she was in acute kidney failure. Fortunately didn't need dialysis but still very scary

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4,089 Visitors; 180 Posts

Drip concentrations.... we get different concentration when the pt comes up from OR that are different that what we stock/mix on the floor. I once had a very unstable patient on 3 pressors, one of which was signed off by the previous nurse as a certain concentration and programmed in the pump as said concentration but was a completely different concentration hanging, so they were getting double the amount. I always check at the beginning of the shift during my assessment. It only takes a minute.

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Christy1019 has 9 years experience and works as a Clinical Nursing Supervisor.

17,692 Visitors; 870 Posts

Drip concentrations.... we get different concentration when the pt comes up from OR that are different that what we stock/mix on the floor. I once had a very unstable patient on 3 pressors, one of which was signed off by the previous nurse as a certain concentration and programmed in the pump as said concentration but was a completely different concentration hanging, so they were getting double the amount. I always check at the beginning of the shift during my assessment. It only takes a minute.

That sounds like an unsafe pharmacy practice! Different volumes of medication like 250ml vs 500ml but the concentrations being different can lead to so many errors!

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4,111 Visitors; 47 Posts

I'm very vigilant about making sure I keep an eye on any weird maintenance fluids running (stuff we don't keep on the floor) especially pressors and sedatives. i make sure to order the next bag from pharmacy before i run out.

Had a lady once on a neosynephrine drip and she was REALLY sensitive to it. The new bag had come up and was hanging on the pole. while waiting for the old bag to finish my preceptor called me over to do trach care on my other pt. Had quite a bit left in the bag so I think, "why not?" In the amount of time it took for us to do trach care the Neo finished, and this lady's BP dropped! Couldn't hear the alarm in the other room. Luckily I work with some amazing folks and another RN and her orientee saw it on the monitor, went in and switched out the bags but my mind kept running through scenarios where I hadn't ordered the new bag, it hadn't come up yet, or the other RN hadn't noticed/ responded to the alarm. I always note how much is left in a bag and I always take the second or two to check any alarms that I hear, whether its my room or not!

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4,111 Visitors; 47 Posts

oh I forgot, I don't let anyone make me feel rushed when giving a med and i label any IVPush drugs before taking them in the room.

I also make sure to get ALL the air out of pressure bags for Art -lines etc. before pumping them up. I've had other nurses not believe me when I said this could cause an air embolism if the bag gets accidentally laid down.

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stevengarbs has 4 years experience and works as a Registered Nurse.

2,667 Visitors; 29 Posts

Knowing first the patients recent medical records, and always making sure you have entered the correct information about him. It could be useful if the patients comes back again.

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