July 11, 2011

Critical Care Dosage Calculations

Complete Medication Order

SBAR (Nurse Reporting Tips)

Updated: December 21, 2016

Assess the patient. 

When you're calling the physician, you will need the most recent evidence to present your case. Introducing a blood pressure reading you obtained six hours ago will not give the proper clinical picture. Providers expect the data you are giving to be "real-time." If labs help to support your recommendation, by all means, use them. But, the physician will need evidence (documented issues or patient's history/background) to support the current problem you're calling about. Yes, you are calling about an acute episode, but an investigation is needed for the proper picture to be painted.

Call the RIGHT physician. 

Is it nephrology or critical care? If you don't know, ask your charge nurse for direction. Nothing is more annoying than wasting your time paging a doctor, and then you’re told, he or she isn't the person managing that particular aspect of the patient's care. For example, you want to use the patient's hemodialysis catheter to draw blood. You have no other lines, and the patient is hemodynamically unstable. You then call the critical care provider for approval. This action would be in incorrect as the nephrologist is the only specialist who could give you approval for this request.

Know the admitting diagnosis.

The providers you're calling on have multiple patients on various floors. Familiarity is not the standard. Just because the patient has MRSA now, doesn't mean that was the reason for the initial admission. Check the chart and come prepared! A hyperkalemia admission can turn into respiratory failure, with acute renal failure manifesting itself during the shift. Healthcare is tricky, and the transmission of proper information is necessary. Don't assume the current issue is the reason for the patient's admission.

Review the progress notes.

Yes, you're the patient's nurse for that day. But, to get the complete picture, you need to examine the progress notes. Progress notes help you to develop a plan of care or the recommendation needed in the SBAR report. Plus, this will help you to be proactive in finding any problems your patient might soon face. For example, your patient had hip surgery two days ago. You would typically make sure the patient is using an incentive spirometer and possibly call about ordering DVT prophylactic methods. With the knowledge of operation comes standards in care, and you wouldn't know what the standards are unless you have the framework (often in progress notes).

Have resources available.

When you're calling a physician, have a computer next to you (with the electronic chart open), hard-copy chart (if applicable) and any notes in case the physician has any follow-up questions. Yes, the blood pressure was low but were orthostatics previously completed? What is the patient's H&H? Have all aspects of information available at the time of the call. Preparation will keep you calm and allow you to present your evidence in an organized and professional manner.

How To Organize Your Day (Preparing For Your Shift)

Updated: November 3, 2016

Being a new nurse is stressful, but my employer has provided me with some great tips for success. These tips can also be used during clinical rotations. This plan will help you to be organized and give you the ability to create an efficient plan for your shift.

1. Door assessment

Introduce yourself to the patient and explain you're going to get the shift report. Make the conversation short and sweet, don't dwell. This introduction will allow you the ability to "see" your patient (aka door assessment). You CAN'T ask questions if you DON'T know the inconsistencies. If you see a wound at the time of introduction, you can ask follow-up questions during the report. Shift reports are usually based on the patient's medical chart, the nurse's notes, memory, and/or experiences during the shift. Sadly, sometimes specifics are omitted (not intentionally). The shift report should include physical findings, surgical details (if applicable), physician notes, and/or diagnostics details. These topics will give you the full picture of your patient's medical condition. Once you have this picture, you can then determine if the information given during report matches the clinical picture you initially observed.

2. Critical is the name of the game

After you have the visual (door assessment) and have obtained the shift report, it's time to find out which patient is MOST CRITICAL. Which patient do you want to perform the assessment on first? The patient that presents as hemodynamically unstable (remember, ABCs). Your first hour should be centered around doing your assessments and finding out your patients' needs. Airway, breathing, and circulation (ABCs) are priorities within inpatient medical care. But as we all know, there are primary and secondary surveys that also need to be addressed. Work your way down the alphabet, making sure you've addressed all areas of concern. Oh and don't forget those five, or seven or whatever P's (HCAHPS style). Safety is of the highest importance, don't forget.

3. Two-hour short term goals

Once you have your assessments and the medication schedules in order, start to plan your day. Make SHORT TERM GOALS in two-hour increments. For example, from 8:00AM-10:00AM: I will do all my assessments, assessment charting, and give my morning medications. If you don't have goals, you'll continue pushing incomplete tasks further and further behind. As there is no timetable to reflect and reassess upon. It is in my opinion that small amounts of pressure are healthy. They allow you the ability to motivate yourself. It will be overwhelming at first, but you'll get into a rhythm and find your groove. Throughout your day, keep planning events in two-hour segments. This strategy will keep your organized and prepared. We all know nursing isn't this simple but with a plan of action, your won't have to depend on your memory resulting in things falling through the cracks.

4. Documentation sheet

Creating a proper documentation sheet is of the utmost importance. You can't track your short terms goals without it. When you're scrambling around, doing your assessments, administering medications, giving baths, and performing tracheostomy care, you will need an old-school method of tracking your progress. Yes, electronic charting of these interventions will need to be done too. But this approach is for personal tracking, not legal documentation purposes. Cellular phones, computers, and smart watches are exceptional devices that do an abundance of tasks. But, nothing beats paper, pen, and checkboxes. People underestimate the power of utilizing pen and paper. For documentation sheet examples, click here.

July 10, 2011

Know Your State Practice Act & Expectations

Updated: November 4, 2016

Every state has its own form of a practice act. It spells out what you need to know and what you're expected to do as a licensed, registered nurse. I know what you're thinking, I've already learned that in nursing school, right? Wrong! I just read, you could get fined and your license suspended if you misrepresent yourself. For example, if you're a registered nurse (with no certifications) but you advertise yourself as a diabetes nurse, that's a violation. Something simple as that could get you into a pickle. To be a specialized nurse of diabetes, you have to be certified, and that requires additional training. There are rules to nursing and going over the rules BEFORE you hit the floor is a good idea. Don't sweat the legalities word for word but, know what is expected of you. I've had many situations where things weren't clearly defined. You think you're doing something helpful or righteous when in reality it's unlawful. I'm not a lawyer nor do I advocate breaking the law but I do understand the human condition. The condition of assumption. You assume if you're trying to help, it has to be legal. This is not the case. I urge every medical professional to read their state practice act and understand their boundaries and professional responsibilities. Nursing is a passion of mine and I will not allow assumptions or ignorance to prevent me from helping my community.


NCLEX-RN Practice Question Challenge!

Correct Answer: 3

1: Assessment: Outcome expected but not priority, could be due to appetite issue. No time frame given
2: Assessment: Outcome expected but not priority, could be due to other causes such as change in position
3: CORRECT | Assessment: Outcome priority, reason for diuretic therapy. Diuretics reduces alveolar edema and pulmonary venous pressure
4: Assessment: Outcome expected but not priority, will increase but may not change heart failure

July 9, 2011

NCLEX-RN Practice Question Challenge!

 Correct Answer: 3

1: Assessment: Outcome not priority, heart failure and weight gain seen with chronic bronchitis. The highest priority is oxygenation
2: Assessment: Outcome not priority, dysrhythmias occur due to right heart failure. Priority is oxygenation
3: CORRECT | Assessment: Outcome desired, priority is to establish oxygenation status
4: Assessment: Outcome not priority, common reason for worsening status is respiratory infection, more important to establish respiratory status first

June 30, 2011

I Passed The NCLEX-RN Exam!

It's official, spread the word! I checked my exam status on Pearson VUE and I PASSED. I had 75 questions and the screen went blue, totally thought I failed. I mean come 'on now, who get's the minimum questions? Not little ol' me. This road has been a long one and I can't believe I made it. I've been fighting for so long, it feels weird to have made it. Can't wait to see that license number pop up. Now, the real fun begins. Strap on your seat belts people, the nursing profession is going into over drive!

June 18, 2011

Book Recommendations | Nursing & Pharmacology Made Insanely Easy!

Pharmacology Made Insanely Easy!
ISBN: 097610296X | 978-0976102960

Nursing Made Insanely Easy! 
ISBN: 9780976102939 | 978-0976102939

I was looking through the books in my bookcase and stumbled across these two books. These books got me through the last semester of nursing school. And now, they're going to get me through the NCLEX-RN exam. My favorite one is the pharmacology book. There are tons of medications (ones that, I've seen and was questioned on in Kaplan), that I know I will see on the NCLEX-RN exam. From antibiotics to antipsychotics medications, this book has it all. You get medication information, side effects, important labs, nursing inventions along with cute pictures (so you can remember them). I spent about three hours reading and tagging the pharmacology book.  Vancomycin causes red neck syndrome. I just typed that from the top of my head. How do I retain it you ask? There was a picture of a "redneck" reindeer. I laughed and now... I will NEVER forget it. I love this book. The nursing book is awesome too. It provides the same technique to studying. It also providing pictures and important information you will probaly see on the NCLEX-RN exam. Good luck everyone!