Good Effective Nursing

By: Maged Taman

The things I learnt through the years from good nurses are the follows:

1- Defining emergencies and calling physicians early: as patients with chest pain, low blood pressure, significantly high blood pressure, bleeding, GI bleeding and so forth. Calling early and quickly in emergency can make a big difference. Patient with short of breath easier to treat if attended to early and effectively while let go until he in respiratory failure lead to hectic intubation and less rewarding results.

2- Aspiration is a common problems in hospitals, be careful not to feed patient or do that meticulously if has dementia or impaired mental status, commonly speech therapist define if patient can eat or need to be NPO and if he is quite high risk of aspiration that he needs NG tube feeding and ultimately GI feeding.

3- Aspiration should be dealt quickly and accordingly with mild aspiration patient can cough up the aspirate, if not able to cough well and congested duoneb nebulizer treatment can help to open airway and get him to cough up the staff, Suction though nasotracheal tubing may help to get patient secretions up, however it may induce vomiting and make things worse and in patients with coagulopathy can lead to nasal bleeding and aspiration of blood that make things worse. A lodged piece of meat in the airway is usually dramatic and patient point to where the food is stuck, many times can be successfully expelled through Heimlich maneuver or manual dislodging during process of intubation, Not all patients with aspiration will require intubation, many times with the things done above and giving enough oxygen patients may turn around. Some physicians prefer to give antibiotics early since pneumonia is quite likely after aspiration. Patient after aspiration should be watched closely for 24 hours, particularly those with significant aspiration need to be in the ICU.

4- To Foley or not to Foley is important point for nurses: Patient who does not need it the best thing is not to put Foley. Patient who are quite immobile, has urine retention or in acute critical state commonly need Foley. Early removal of Foley is usually the way to go since prolonged Foley would cause infections and urine retention post-Foley removal. Patient with excoriation around peri-area and those with decubiti in sacral buttock are may need Foley to prevent contamination.

5- Early cleaning after bowel movement is very important since if delayed cause fungal infection in periarea, then excoriation and decubiti. Thus early cleaning and using appropriate creams or powders prevent fungal infection and excoriation. It is good for patient comfort and also for nurses since early cleaning is much easier than dealing with fungal infections and excoriations.

6- Similarly repositioning patient will prevent bed sores, which is happens cause more nursing efforts to deal with bed sores which is more time consuming and prolonged process.

7- Quite effective when call an attending to order a medication over the phone is to know the allergy of the patient.

8- Knowing what is the lab reporting to the Doctor before is important so blood test reporting from today say a low hemoglobin but stable for 1 week of 10 gram is not a news which a patient who had hemoglobin of 14 gram yesterday and he is 10 gram today is an important news he may be actively bleeding.

9- Reporting the vomitus and diarrhea colour is important, if there is coffee ground or black stools or blood in either doctor should be called immediately and vomitus or diarrhea kept for him to see, he is likely will test them for blood and check vitals and hemoglobin to see who actively and severely patient is bleeding.

10- Patient who is weak and decondition in the hospital may get orthostatic on walking or sitting, if feels dizzy or pale checking blood pressure quickly should be done and then putting patient on supine position delay in doing that may cause patient to fall and have injuries.

11- Good nurses usually try to define patients who are at high risks for fall and use the appropriate hospital protocol to prevent falls.

12- Although a good practice to check CBC and basal metabolic in hospitals alert doctors in change of patient health and became two simple blood tests that can help in detecting many of changes in patient status, we commonly end finding no further veins in patients when we need them. Nurses may ask doctors if can do blood testing less often in patients with poor veins.

13- Intravenous fluids replacement usually would be written on daily basis or not to exceed 3 days in some hospitals in some hospitals there is no protocols. Good nurses usually alert doctors if the patient is eating and drinking well and does not need intravenous fluids.

14- For patients needing prolonged blood work withdrawal or continuous intravenous antibiotics for weeks insertion of PICC line is advised. Nurses sometime alert doctor if they want to pursue PICC lines.

15- Good nurses are very well oriented to hand washing, using sterile techniques with all procedures, wand cleaning and even inserting intravenous line.

16- Good nurses try to assure patient has good pain control 0-10 scale of pain assessment is usually done and patient get pain medicine accordingly.

17- good nurses chart patient urine and bowel movements they try to be sure patient urine output not significantly declined and has regular bowel movements. Waiting for patient to have one week with no bowel movement ends to be both quite harsh on patient and time consuming for the nurses from enemas to even disimpaction.

18- Though a good practice for doctors to use parameters for blood pressure medications. Good nurses when they find no parameters ask doctors if they want to use parameters and many times they hold blood pressure medications if the blood pressure is low until they speak to the physician. Similarly with patient with low blood sugar they hold anti-diabetic medicine until they find out from the doctor if they need to cut down on the medications.

19- Good nurses try to be sure patient gets enough sleep, a sleeper is not bad idea particularly in hospitals where noise, light and new environment make them unable to sleep.

20- On calling doctor for Coumadin order good nurses find the INR from today and the last time before and the dose of Coumadin used in between so the doctor can establish a right dosing for Coumadin .