By: Maged Taman
I learnt from good nurses over years these good nursing tips:
1- Reconize emergencies and move fast. Code Blue for life threatining conditions while rapid response for less acute cases.
2- Patient with quite low BP have to have IV normal saline wide open. Other measures like IV levophed less so dopamine should be considered as well.
3- Keep intravenous line for each patient while in hospital except in rare cases.
4- When you put IV: put tourniquet, see and palpate the vien, recognize the anatomy of the vien the size, how deep and what is its direction. Commonly you need to hold the arm as well the skin to fix the vien in position.
5- If nurse unable to do the IV line or blood drawing should not attempt more than two times to give chance to other skilled nurse or physcian to do that and not to ruin all the viens.
6- Know when Foley is important as in acute emergencies, urnie retention, less mobile patient and so forth. Many times the foley is needed for few days and can be dicontinued.
7- Early Foley discontinuation help with cutting in urinary infection.
8- Foley could be important in patients quite less mobile where urine incontinance will cause more problems with fungal rashes, skin breakdown and bed sores.
9- Foley ballon has to be inflated after urine comes out to secure position and deflated before pulling out the catheter.
10- Before calling the doctor for a new medicine for a patient over the phone she should be having in front of her the list of allergies. Both should insure not giving a medicine that listed on the allergy list or have cross reactivity.
11- For nurses particularly in rehabs and nursing home patient need further evaluation is sent to the hospital came from or in emergency to the nearest hospital otherwise to hospital came from.
12- Follow up imaging studies are done in same hospital patient has the original study done if possible.
13- Always check every patient have DVT prophylaxis arixtra, heparin, lovenox or coumdin. Additionally high thigh TEDs and IPC boots may help. The latter can both be used for people who we can not be anticoagulated, we have to document why we can not anti coagulate.For patients can not be anticoagulated and will likely to be immobile IVC filter is commonly done temporary for patients who will likely be mobile in few months or permemnat filter for patients who will be mobile for long time. Risk for anticoagulation is taking individually for each patient.
14- Common meds for DVT prophylaxix are heparin 5000 units q8 hours, arixtra 2.5 mg sq`daily or lovenox 40 mg sq daily. Coumdin also can replace these injections for cost reason and these injections are discontinued until INR is > 1.8. Target coumdin in most these cases is 2-3
15- Patients tend to fall in first day in rehab were patient saftey may not be assessed well yet. It is important to assesss fall risk early in admission so patient can have appropriate saftey measures.3- Saftey measure against fall are: Tab sitter, raising side rails of bed and seat belt. Ensure as well that patient recognise how to use the call button for nurses.
16- Dysphagia is assessed by speech therapist who usually determine the need for MBS (modified barium swallow) and the type of diet or its change.78- For Dysphagia Diet can be or advance to : NPO------level 1 (puree)----level 2 (ground/mashed)----level 3 (soft,bite size)---mechanical soft----regular.79- For dysphagia: Liquids can be or advance to: NPO---pudding------honey----nectar-----thin. Patients in pudding or honey may need IV fluids daily to meet fluids requirments, less so with nectar. Patients in thick fluids usually need their laxis held.80- Other aspiration percausions: OOB all meals, chin tuck, head turn to right or left, rehab dinning, crush meds in applesauce or pudding, HOB 30 degrees all times, no straws.81- Patients with dysphagia who cough after meals need close observation. Some particualrly with underlying airway disease may benfit from vent-neubilize of Duoneb nepulizer after meals.
17- After surgery consider incentive spirometer for patients who has lung disease or coughing. Ventolin inhaler with spacer or nebulizer BID, QID or QID prn to consider. Many times inhalers would be the best to get rid of secretions particularly in patients with airway disease. Mucinex 1 tab Q 12 h will lossen secretions and allow expectotarions. CXR if pnumonia is suspected.
18- Respect low O2 sat many times it is your first clue to a serious pulmonary embolism. So the later could occur with normal O2 sat. Chest pain, SOB, new arrhythmia particularly supraventricualr......are other manifestations of PE.
19- Check with nurses bowel movements constipation can cause urine retention, hemorrhoids, if severe Ogilvie ' syndrome (acute colonic pseudo=obstruction may occur and cause cecal perforation).
