July 11, 2011

Critical Care Dosage Calculations

What Is A Complete Medication Order?

A completed medication order has to have SIX THINGS!

1. DRUG NAME | Tylenol
2. DOSE | 650 mg
3. ROUTE | PO 
5. QUALIFIER (if PRN orders) | For pain or temp > 101

FULL TEXT: Tylenol 650mg PO, q6h PRN for pain or temp greater than 101
Dr. John Smith, Critical Care, Physician # 123456

SBAR Reporting Tips

1. Assess the patient! When you're calling the physician, will need the most recent vitals and labs. Presenting the blood pressure or labs you received four hours ago isn't the patient's current state. Remember MOST RECENT/UPDATE information when calling. 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 issue you're calling about.

2. Call the RIGHT physician! Is it nephrology or critical care? If you don't know, ask your charge nurse. Nothing is more annoying than wasting time paging a doctor and then you’re told, they aren't the person hanging that particular issue. 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, so you call the critical care physician. WRONG, when it comes to anything hemodialysis related, it's nephrology always (or at my hospital anyway). It can get confusing sometimes.

3. Know the admitting diagnosis! The physician you're calling as tons of patients, just because the patient has MRSA now, doesn't mean that was the reason for the admission. Check the chart, come prepared!
4. Review the progress notes! Yes, you're the patient's nurse for that day. But to get the big picture, get the progress or surgical notes. This will help you to develop a plan of care or the recommendation needed in SBAR. Plus, this will help you to be proactive in finding any problems you patient might soon face. For example, your patient had hip surgery 2 days ago. You would make sure the patient is using the incentive spirometer and get an order for the patient to get out of bed.

5. Have available: computer (electronic chart), hard-copy chart (physical chart) and notes... in case the physician has any additional questions or if other physicians have written orders that haven't been added to the electronic chart. Have all aspects of information available at the time of the call.

How To Organize Your Day & Round Effectively

Being a new nurse is mind blowing but my employer has provided me with some really great tips for success. These tips can also be used when you're in clinicals. This will help you to be organized and decreased the # of tasks you forget to do during your shift.

When you hit the floor, VISIT THE PATIENT! Go see the patient. Introduce yourself and explain you're going to get report. But you CAN NOT ask questions, if you DO NOT know the discrepancies. Now, let's get the history, progress notes, surgical notes, consultations and physical information on your patient. Find out what type of lines/drains your patient has (central and peripheral lines or jackson-pratt and blake drains), body system issues (no bowel movements, thready pulses, weak muscle strength) and medications (PO/IV). This will give you a full picture of what your patient looks like. Once you have that full page, does it match what you saw initially? If not, ask the previous shift nurse for any additional details. This is why seeing before writing is important. You won't know what is an issue, if you don't put your eyes on your patient first.

After you have your visual and have your report, it's time to find out which patients are MOST CRITICAL. Which patient do you want to do your assessment on first? The one that will require the most time and needs the most care. Your first few hours are going to centered around doing your assessments and finding out when your patient's medications are due. What's the point of giving medications first... such as Colace, if your patient doesn't need it. Always make sure you assess BEFORE you implement! Or you'll be running back and forth from the Pyxis.

Once you have your assessments and the medications in orders, start to plan your day. Make SHORT TERM GOALS in two hours sections. 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 any goals, you'll be behind the entire day. 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 sections. This will keep your organized and prepared for your day. We all know nursing isn't this simple but with a plan of action, hopefully your day will be easier.

In the end, it comes down to being organized and taking the time to remember the little things. The devil is in the details and these things have helped me to be more organized and hopefully will help you!

July 10, 2011

Know Your State Practice Act & Expectations

Every state has it's 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 already learned that in nursing school, right? Wrong! I just read, you could get fined and your license suspended if you misrepresent yourself. Sounds vague right? Well 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, will get you into a pickle. To be a specialized nurse of diabetes, you have to be certified and there is a protocol. 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.

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!