Did you know...

There are several kinds of IV's that are avaiable to use on a patient in the hospital.

Before meeting a patient for the first time, check to see what IV is flowing and what the rate is BEFORE going into their room.

After introducing yourself check the IV bag to make sure the correct fluid is running and that it is flowing at the correct rate.

I was at Clincial on friday and went into my patients room introduced myself, and then I checked the IV. The IV that was listed to run was Lactated Ringers. I came to find that the solution that was actually running was D5 1/4 NS. (5% Dextrose 1/4 Normal Saline) I finished up my assessment and went and told my nurse of the discovery that I had made.

We check the eMAR (medication list) and then we check the MD orders. Both said the IV was suppossed to be Lactated Ringers. Now this wouldn't be such a problem for any other patient, however this was bad for mine. He was a diabetic.

So what does this mean?

You never give a Dextrose IV to a diabetic becasue it's SUGAR!!!

So an incident report was filled out.

And I saved the day!!!

P.S.

I passed Scenario.

Scenario...

I have never been so nervous in my entire life. I was scared stiff I wasn't going to pass.

Passing scenario is a requirement to stay in the nursing program. No pressure!

There were three parts to this scenario.

Part 1: Head to Toe assessment.
My patient was a 84 year old Caucasian female with pneumonia and dyspnea if she layed flat in bed. I took her vital signs and found out that her O2 saturation was at 82%. In case you don't know that is bad! A person should have their sats 90% or higher, but not to high because you can over oxygenate a person. Because I found out her O2 sats were 82% I administered O2 to her at a rate of 4 L/min. I then went on to do a focus assessment on her respiratory system. Upon completion I continued on with the Head to Toe assessment. I finally finished barely within the allotted time.

Part 2: Documentation
Now documenting seems easy right? WRONG! It is very hard to get the hang of. Everything needs to be documented. Everything! If the nurse doesn't document everything he or she does she could end up in a court of law or get fired or get a talking to from the higher ups. Back to documentation... Everything has to be in a nice neat order. Starting with Neurological, Respiratory, Gastrointestinal, Genitourinary, and finally Musculoskeletal. Now if everything is not charted correctly in scenario you get dinged!

Part 3: Nursing diagnosis and Care Plan
First, who knew that a nurse had to figure out a diagnosis for a patient. I always thought the nurse just took care of the patient. WRONG! Nurses figure out another diagnosis that realtes to the medical diagnosis.

My patient had pneumonia. With in typical pneumonia patients crackles can be heard in the lower lobes of their lungs. Som my nursing diagnosis was Impaired Gas Exchange r/t imparied alveoli gas exchange secondary to pneumonia AMB: crackles in lower lobes of lungs, dyspnea, and increased respiration rate of 24 (normal is 12-20).

Then the care plan consists of: first, a short term goal and a long term goal the patient will accomplish. Second, Assess, Do, Teach (three things to asses with this patient, three things to do to the patient, and three things to teach the patient). Third, Rationale for doing everything, however we haven't learned that part yet. And fourth, evaluation of the goals that were set. Met or not met.

Whew! that was a lot to accomplish.

You may wonder how long did I have for all of this?

Well you are just going to have to suffer because I am not going to tell you! Ha!

Assesments...

Who knew that a nurse did a assessment every single time they came on shift for every single patient they were assigned to? Not me!

First Step: Meet the Patient

Knock , perform hand hygiene, introduce self, check the name band on the patient, ask how he or she would be like to be addressed, see if they are alert, oriented x3 (person, place, time), ask about the pain level and when last pain medications were given, check IV site and tubing along with the solution, rate at which it is flowing (usually in mL), check the oxygen, check any other tubes or drains, perform vital signs (blood pressure, pulse, respiration, O2 sats, pain, and temp), safety check(bed in lowest position, breaks on, side rails x2, call light in reach).

Whew! and that was just the first step.

Next check the system that involves the patient's medical diagnosis.

Then comes the Head to Toe. which means that you check every single part of the body and I mean every single part. Leave nothing out! From the head to the toe literally. You also ask the uncomfortable questions. No one ever wants to ask those questions.

After all that the assessing is done.

failure...

I officially just failed my first test.