Nursing Pearls of Wisdom

SOME PEARLS OF WISDOM: SOME THINGS EVERY NEW NURSE SHOULD KNOW

  1. Insulin generally lowers potassium and so does albuterol treatment
  2. Accurate I/O means literally just that
  3. Anuric is general < 100 cc a day & Oliguria <500 cc day. Measurement: 30 ml (cc) = 1 oz. A typical hospital patient pitcher is usually 800-1000 cc
  4. If patient gets SOA and is on IV fluids– stop IV fluids and call on call provider
  5. COPD tend to have chronic higher C02 levels
  6. Chronic kidney disease patient are often (almost always) anemic because of the lack of production of erythropoietin (hormone that stimulates RBC production) from kidney.
  7. Sodium bicarbonate helps to neutralize the body when it has become acidotic
  8. Renal patients taking calcium carbonate (tums) near meals- this is actually to help decrease the phosphorus as it attaches to phosphorus containing food. Phosphorus does not dialyze off
  9. If a renal patient has a fistula or AV graft- always assess the bruit (auscultation) & thrill (feel) to make sure working. This is their lifeline to remove toxins from their body!
  10. Steroids (solumedrol, prednisone, methyprednisolone) can cause insomnia, agitation, weight gain, lower extremity swelling, increased hunger.
  11. Have to be very cautious using norvasc (CCB) and steroids in patients with CHF as this can potentially cause this a patient with this diagnosis to go into exacerbation. Both of these meds can increase fluid retention.
  12. Alcoholics often have low magnesium and low platelets
  13. If giving Vancomycin & patient suddenly gets flushed – stop infusion call on call provider. It is likely that Redman syndrome is happening and that the infusion needs to be slowed
  14. Head of bed should always be at least 30 degrees if patient has peg tube feeding
  15. If patient has diarrhea or suddenly has diarrhea- they really should be tested for C-diff
  16. No sticks, IV insertion, draws, blood pressures on arm of dialysis access (AV graft, fistula)
  17. Don’t go outside of a contact precautions room with the protective gear on. You must take it off before going out of the room
  18. If patient nose dries out from nasal cannula do not put Vaseline (can potentially cause a flame) in their nose instead get a bubbler to humidify the air
  19. Consents: The provider needs to be the one to explain the procedure
  20. Do not wipe finger with alcohol pad right before taking a glucose (at least allow it to dry) as this may falsely elevate glucose due to the ETOH. Wiping finger with water & drying immediately after is best
  21. Best place for absorption of insulin is in abdomen (but make sure to rotate sites)
  22. Normal ejection fraction 55-60% but someone can still have a normal EF and have hx heart failure
  23. It is ideal that a patient is NPO for an abdomen ultrasound
  24. Metformin needs to be held if contrast is given (for 48 hrs after)
  25. Fluoroquinolones (levofloxacin, ciprofloxacin,) are antibiotics often given in hospital. It is important to watch for muscle pain ache as this may be a sign of the black box warning of tendon rupture. This adverse reaction is more common in patients >55 years old
  26. Do not be afraid to clarify an order..it is your license!
  27. Stress tests: patient should not smoke the day of the test. The patient should not have any caffeine 24 hrs before the test. Patients should also not take beta blockers, nitroglycerin, and some other heart medications on day of the test (nurse should always clarify with cardiology if any questions on this)
  28. If you did not witness a fall you should not technically chart that the patient fell. You must chart what you actually witnessed and notify on call provider immediately
  29. Blood should be transfused within 4 hours (no longer). In general PRBC transfused is transfused under 2 hours. Exception include CHF & ESRD..both have to be ran closer to the 4 hrs due to risk of pulmonary edema
  30. Sickle cell crisis pain is REAL and can be SEVERE!
  31. If a patient begins to have confusion, in addition to a neurological exam a glucose should also be checked
  32. Often the better report you receive, the better shift you will have (not always but more likely). So the point is, ask questions, get details, clarify
  33. LPN’s generally do not do: IV pushes, administer blood products, admission assessment, IV insertion (allow I have heard of certification to do this). These are general and may possibly change so if anyone has any update on this info is always welcome!
  34. Chest pain: If an MI is suspected general orders include EKG, cardiac enzymes, EKG, CBC, BMP, Morphine, oxygen administration, nitroglycerin, aspirin
  35. Blood cultures should ideally be drawn before antibiotic administration
  36. If a patient suddenly develops severe headache or abdomen pain let on call provider know this!! Don’t just give pain medication available. Imaging may be needed. If it is truly severe, we need to know what is causing these severe symptoms
  37. Many hospitals require a second nurse to verify insulin dosage before being administered
  38. CHF and Renal patients need to have accurate intake and output along with daily weights
  39. Consider asking for a catheter if risk for skin breakdown likely, need accurate I/O but unable to obtain, and/or comfort measures
  40. If suspect urine retention– bladder scan before calling on call provider
  41. If a patient seem lethargic and or not as responsive always think about pain medication build up in system (especially with renal patients). They may need narcan. Many nurses miss this.

NOTE: The above is not intended as medical advice for patients. This is simply for educational purposes for medical professionals only. All patient should ALWAYS check with their primary care provider with any questions that they may have. This informational sheet does not serve as medical advice. As always, medical professionals should always call the on call provider if any clarifications are needed. State and hospital protocols should always be followed accordingly

 

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s