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Old 02-20-2008, 08:52 AM
spencer.jj
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Default Nifty tidbits

Does anyone have nifty tidbits they've picked up over the years (or months or weeks) of nursing? Suggested topics could be things that make life easier (for patients and nurses), common mistakes, or anything else you can think up. Please provide rationales behind the procedures/techniques/etc.

For example, I just learned in clinical yesterday that you're not supposed to blow the bubble out of Lovenox syringes. I've had instructors tell me to blow it out, as well as various nurses who I've worked with during clinicals or jobs. The bubble is nitrogen, and it is supposed to be pushed through after all the Lovenox has been given to clean out the Lovenox from the syringe path so it doesn't bleed/bruise (since Lovenox prevents the formation of clots). It was also recommended to wipe off the little drop at the end of syringe before you inject, because if you don't you can introduce Lovenox to the syringe path, again causing bleeding/bruising.

So, to prevent nasty bruising or excess bleeding, don't blow the bubble out, do clean off the drip, and remind the patient not to rub or scratch the injection site.

Any other helpful tips?
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Old 02-20-2008, 10:24 AM
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I assume that this is what we call Clexane. The bubble is used to form an air-lock so that the injection is not tracked back through the tissues.

Z track all IMI injections, that way you will always give the ones that MUST be Z tracked with the right procedure.

Another is not to give Diazepam via IMI, it is known to hurt so either inform the complaint patient or try give to give it oraly or IV where possible.

Thats it for now seeing its 0125 in the morning.
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Old 02-20-2008, 12:05 PM
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Quote:
Originally Posted by P/J View Post
I assume that this is what we call Clexane.
Righto - I suppose we should all just use generic instead of trade names...less confusion that way.

Enoxaparin it is!
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Old 02-20-2008, 05:58 PM
Marachne
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Here's one I actually learned from a patient:

If you have a pt. with a PICC line who wants to take a shower, take an exam glove, cut off all the fingers but NOT the thumb. Pull the glove up the arm, tuck the "pigtail" of the PICC into the thumb, tape at top and bottom and voila! you have a protected PICC site.
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Old 02-20-2008, 08:29 PM
NurseSean
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If your new admission is having trouble with oxygenation...make sure you check that you hooked the tubing to 02 and not medical air!

It will save you from the look a code team gave me after doing this very thing! And evil glare as they switched the nasal prongs to oxygen....Sa02 went up from 70s to 90s instantly.

But!!! You learn from your mistakes. I responded to a new nurse who's patient's Sats just wouldn't go up. I gave her a much friendlier look (perhaps even a giggle) as I hooked up the oxygen tubing to the right outlet.

Bigger picture...double, triple, and quadruple check your tubes, IV lines, monitors, drains at the beginning of your shift. I like to do another equipment check halfway through my shift as well.
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Old 02-20-2008, 08:34 PM
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I just wanted to concur regarding the Lovenox. It is a VERY common misconception that you are supposed to expel the air bubble out of the pre-filled syringe. But you are absolutely supposed to inject the air bubble.

I remember when I told that to a preceptor. She thought I was wrong and looked it up. I got to feel smart that day!

She also didn't believe me when I told her that NSTEMI stood for Non ST elevated Miocardial infarction--and had to look it up.

OK...another common mistake...just because someone is a nursing student doesn't automatically make them wrong! LOL!
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Old 02-21-2008, 03:46 AM
Marachne
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Here's a kind of odd one, but really important I think. You will, eventually make a med error. Hopefully, it will either be caught quick enough or not be that serious. You will feel awful. But the best thing you can do is report it and figure out what, if anything you need to do to rectify the immediate issue and what might be wrong w/the system that allowed it to happen. What ever you do, do not cover it up and just go on like nothing has happened, even if you just know that the consequences are minimal. A good system is not retaliatory but learns from these kinds of mistakes.
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Old 02-21-2008, 12:14 PM
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Not a ground-breaking tip, but when flushing an NG tube I always like to leave some air in the syringe to push through after all the liquid has gone in.

Makes it so the liquid isn't sitting in the port of the stopcock and keeps the linens nice and clean :-)
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Old 02-21-2008, 05:46 PM
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Yep, Lovenox - inject the bubble. I only know that because I had to inject myself everyday with these during my pregnancy.
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Old 02-21-2008, 07:59 PM
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I used to have difficulty with inserting NG tubes. But I learned that when you are inserting the tube and you get to the apex of the nasal passage twist the tube. It will slide right in. I wish I could show you--but I think you know what I am saying--I hope.

Also--if you ever need a restraint free alarm for a bed or chair go to the Radio shack and get a 10$ personal alarm. They work just as good and at that price you can get two--one for the bed and one for the chair.

This may be obvious and kinda silly but as a student I had a horrible time with smells--guts, blood, massive wounds stuff like that never bothered me--but diarrhea or emesis and I am putty.
I'll tell you a little story about it:
THE HARD STUFF

I had one very personal problem that was difficult for me to overcome. Smells-bad smells were hard for me. Guts, blood and wounds I had no problem with but you let me smell vomit or feces and I was in trouble.

I did not want to be that way but I could not help it. I just had a hard time with these bad smells. The problem is that in nursing some things smell really, really bad. Like a milk and molasses enema we had to give one time. The doctor ordered it to be given, “HHH”. Which we found out that HHH meant, “high hot and a hell of a lot”. I learned that milk and molasses enemas really do work and work well. To this day the smell of molasses makes me gag.

To be able to administer something like that then clean it up and do so while respecting the dignity of the patient is very difficult. But, as a caring compassionate nurse you must be able to develop this skill. You must somehow be able to do those nasty jobs without making a face or gagging. This may sound trivial but it is important.

You may not always have a student to do this for you. What are you going to do, leave your patient in that shape? Of course not. You roll up your sleeves double glove and go for it. In realizing this I knew I had a problem, an obstacle that I must overcome!!

My lesson in learning this came early on.

I was assigned to a patient that had a hip replacement. She was 2 days post op and it was my job to provide all the care she required. Total care nursing and she was my patient. I had been told in report that she was a V.I.P. She was a city councilwoman and had been in city politics for years. I will tell you about the smell and then I will tell you about how I feel about V.I.P. treatment.

The morning care went pretty well and she seemed to appreciate my caring attitude and attentiveness. I helped her with her bath and to change her gown and I fluffed her pillow and tidied her room. I even brought coffee to her visitor. My name tag should have said, ‘Nancy Nurse’. 

I served her breakfast and gave her medication. I thought things were going pretty well and I was following my well thought out care plan to the letter. I could quote every med, action, dosage and side effect and had assessed my patient for every possible scenario.

I was apprehensive and I wanted to do well with the care I provided that day—just like every other day. I wanted to be the best nurse she had ever had. I wanted to make a good grade, and I was eager to learn. Not because she was a so called VIP but because she was my patient and I took that very seriously.

When lunch break came I met Carol in the cafeteria and we discussed the care we had provided that day. I had a salad. I remember that I had a salad because I did not get to keep the salad. When it was time to go back to the floor my patient had finished her lunch and someone had assisted her to a bed pan. My first job after lunch was to go get her off the bedpan. Seemed easy enough.

I walked in that room and honestly the smell almost knocked me down. I have no idea what she had been eating that came out smelling so rancid. I hurriedly got her safely off the fracture pan but I knew I was going to gag, I could feel it coming on and there was nothing I could do to stop it.

I managed to get the bedpan out from under her and into the bathroom. I was dumping it in the toilet and loosing my salad in the sink. I tried so hard to hide it from the patient and I never said a word about it to her. I quickly washed out the bedpan. I washed my hands and face and excused myself as gracefully as I could.

I was crying by the time I saw my instructor. Concerned, she took me into the report room to find out what I had done that made me so upset. By the way I was crying she probably thought I had killed someone.

Crying and embarrassed, I told her that I did not think I was going to be able to be a nurse. I had decided after that incident I wasn’t worthy to be a nurse if I could not do any better than that. After I explained what happened she smiled and put her arm around me and said, very calmly and reassuringly, “Angela, hold your breath.”

I got really good at holding my breath and turning away to catch another breath then holding it again--you get the picture!!!
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