What's your best 'Nurse Hack'?

PeakRN · Nov 21, 2017

Do you mean positive MRSA swabs IN the ED, or some time later in admission? Also, I wonder what was being used to cut the prongs with (if it was sterile, or clean but used).

When they were in the PICU after admission from the ED. She was using the scissors out of a suture removal kit.

PeakRN · Nov 21, 2017

For me, the point of cutting off the prongs is so they don't go in the nose, and the kid gets blow by. What do you do to keep O2 on if they don't tolerate the prongs as is, or a mask?

Oxytyke, oxykid, or oxyadult mask. Or you can use a venturi mask.

Guest1053148 · Nov 21, 2017

I'm confused. Shouldn't "whats left" be nothing, since all the meds need to go in? What am I missing?

So if you have a ton of meds to crush its hard to keep track of how much fluid you give, our policy is to crush and administer each med separately and flush in between. This way you don't have to fuss over how much is in each med cup, or if you need a bit extra to get the meds down. Really helpful for strict I&O - it's not so tough to remember fluids with a few meds but upwards of 10-15 and before , between , and after flushes along with the meds that have special instructions - potassium, mirilax, phoslo - if you filled the graduate to 400 at the beginning of meds and there's 125 left you have 275 for your fluids - may sound stupid but with pt and family talking it's one less thing to think about

Julius Seizure · Nov 21, 2017

So if you have a ton of meds to crush its hard to keep track of how much fluid you give, our policy is to crush and administer each med separately and flush in between. This way you don't have to fuss over how much is in each med cup, or if you need a bit extra to get the meds down. Really helpful for strict I&O - it's not so tough to remember fluids with a few meds but upwards of 10-15 and before , between , and after flushes along with the meds that have special instructions - potassium, mirilax, phoslo - if you filled the graduate to 400 at the beginning of meds and there's 125 left you have 275 for your fluids - may sound stupid but with pt and family talking it's one less thing to think about

You must mean just 400 of the H20 flush after the meds then, I see. Thanks.

Guest1053148 · Nov 22, 2017

You must mean just 400 of the H20 flush after the meds then, I see. Thanks.

I'm terrible at this, I think I may surrender. On my floor we have to account for ALL fluids - even the amount mixed into the crushed meds - the before flush - meds themselves , flushes between each med and end flush. Give all of the meds ( usually more than 10) then try to remember how much fluid you just gave- keep in mind our policy states best practice is all oral meds must be crushed and dissolved separately and flushed in between. The point I wAs trying to make was when doing set up , fill the cylinder to a set point and then take all water for dissolving and flushing from there. You will have exact I&O when done.

If this is still confusing I quit as it is obviously an inability to communicate the concept properly.

brillohead, ADN, RN · Nov 22, 2017

I'm terrible at this, I think I may surrender. On my floor we have to account for ALL fluids - even the amount mixed into the crushed meds - the before flush - meds themselves , flushes between each med and end flush. Give all of the meds ( usually more than 10) then try to remember how much fluid you just gave- keep in mind our policy states best practice is all oral meds must be crushed and dissolved separately and flushed in between. The point I wAs trying to make was when doing set up , fill the cylinder to a set point and then take all water for dissolving and flushing from there. You will have exact I&O when done.
If this is still confusing I quit as it is obviously an inability to communicate the concept properly.

I think the problem was that it wasn't spelled out in the original post to mean "how much fluid is used to mix and flush each medication individually" -- people were thinking that all of the meds were poured into the graduated cylinder, and so in order to give all the meds, you would have to give the entire contents of the graduated cylinder.

Very few facilities have the time/staffing to crush and administer and flush each med individually (there's actually a thread on that subject right now, in fact), so most places simply have a pre-administration flush, then the amount of liquid with the all-crushed-together meds, then the post-administration flush.

In your case, however, you have to do a pre-administration flush, then crush and mix and administer Med 1, then another flush, then crush and mix and administer Med 2, then another flush, then crush and mix and administer Med 3, then another flush, then crush and mix and administer Med 4, then another flush, and on and on until all meds have been individually administered. Using your graduated cylinder water as the source for all your flushes and med administrations gives you the total amount of fluid used without having to write it down and keep track of every flush and every med administration.

It makes sense now, knowing that each med has to be crushed and administered separately. But since that's not the common practice for most nurses here (even though it is considered the best practice, there simply isn't enough time to do it that way in most facilities), it wasn't commonly understood the way it was initially posted.

dec2007 · Nov 22, 2017

See below. I forgot to quote.

Smart!!!

dec2007 · Nov 22, 2017

Nursing hack?
I assume you mean an un orthodox short cut.
Suction.
Depending on the breathalyzer unit- PT too hammered to blow. Place mouthpiece in pts mouth. Have somebody manually squeeze lips to create seal. Put suction on exhaust end, pulling a breath through the breathalyzer.
I can't advocate this next one, but the person who passed it on said it works.
Obese male needs a foley, but you can't find Waldo. The gopher isn't sticking his head up. You know it has to be in there somewhere, but you can't find it.
60 cc cath (not Luer) syringe. Remove plunger. Hook suction to small end of syringe. Place other end on the gopher hole. Apply suction. Grab that thing by the neck as soon as it sticks it's head up.

Smart!

ladyandthetiger · Nov 22, 2017

Research shows that using cola actually makes blockages reoccur more quickly and worse. Current best practice is hot (not boiling) water and patience. Hold tube up, sryinge in hot water, lower end and drain, repeat until cleared.

SkaterGurl · Nov 22, 2017

1-At bedside report, flush all IV's so you know they work. If they need to be removed, you will know and can plan accordingly.

2-Plan your shift appropriately: if you are able to, write down the med schedule for each patient on a single sheet of paper. You can also schedule in tasks needed (new iv's, baths, emptying drains, hanging new iv bags, etc.)

3-For new admissions, I give each family member our unit card with my name written on it. I tell them they can call anytime, and I would be more than happy to talk with them and give them updates. I also ask who is staying overnight (I work nights) and I plan to get them a sleeper chair and linens. It makes them feel wanted and welcome and eases the way in an unfamiliar environment.

4-When spiking a piggyback bag, first roll the clamp all the way to the top and tighten it. Spike the bag, fill the chamber, and unroll the clamp. The fluid will fill the tubing with no air bubbles.

5-When hanging fluids or piggybacks, program the pump to slightly less than the volume in the bag and note how long the fluid will run. Write this down on your schedule so you know when to return to shut it down/switch bags, etc. (of course you are still popping in to check that all is running well). Tape some iv plugs onto the pump and you will be ready to cap off when the fluids are done. Your fellow nurses will love you for this if they have to go in and saline lock your patient if you are busy.

7-If you don't know something, ask. If you need help, ask. If someone needs help, pitch in. We are supposed to work as a team.

6-Be kind to everyone, even if they rub you the wrong way. They will remember your kindness.

JimmyMac · Nov 22, 2017

Here's one if you work in a busy ER or pre-hospital. But many physicians will order 1 liter of normal saline over an hour. And we will be short infusion pumps. Well, if you remember IV math, just use the roller clamp but make sure you remove all air out of the saline bag. Thus, your line won't go dry.

kiszi, RN · Nov 22, 2017

Way to quickly prime IV tubing without using the roller clamp: Spike bag upside down. Squeeze drip chamber, flip right side up, release. No bubbles! Also, when priming with a glass bottle, squeeze and fill the drip chamber before opening the air vent. The fluid won't flow till the vent is opened.