A roundtable for New Nurses, Student Nurses, Veteran Nurses, and everyone in between.
(A sister site to The All Nighter)
Bring on the rapid responses and codes, I’m ready for it!
A few tips:
-Regardless of the situation, the first priorities in ACLS are O2 supplementation, IV/IO access, and cardiac monitoring. As a team leader, make sure all 3 are established as you assign individual roles.
-Once a patient is found without a pulse, DO NOT do regular pulse checks until an organized rhythm appears on the monitor. This wastes valuable time. The basic pattern goes: 2 minutes CPR (or begin with defibrillation ASAP if needed), stop CPR for rhythm check, defib if needed, immediately resume chest compressions (NO PULSE/RHYTHM CHECK!), administer medications if needed.
-High quality CPR is necessary after med administration!! Without chest compressions and limb elevation, that medication is staying exactly where you put it, and it ain’t moving. As much as possible, have the team member in charge of medications prepare doses ahead of time, and administer in the beginning of the 2 minute CPR cycle.
-First line medications in PEA and Bradycardia depend on the first vowel:
PEA (Epinephrine), Bradycardia (Atropine)….. This trick also used to include Asystole (Atropine), but Atropine is no longer recommended for Asystole. Dammit.
-Epinephrine first for any rhythm without a pulse. You may give an unlimited number of 1mg doses, but they must be 3-5 minutes apart. This means if you alternate with something else after 2 minutes of CPR (i.e. Amiodarone), after another 2 minute cycle you’ll be ready for another epi.
Variable deceleration—Cord compression
Early deceleration—Head compression
Late deceleration—Poor placental perfusion
This is one I haven’t heard before! I heart mnemonics, I wouldn’t have graduated from nursing school without them. My favorite has to be the one to remember which cranial nerves do what:
“Some Say Marry Money, But My Brother Says Big Boobs Matter More.”
I. Sensory (Olfactory)
II. Sensory (Optic)
III. Motor (Oculomotor)
IV. Motor (Trochlear)
V. Both (Trigeminal)
VI. Motor (Abducens)
VII. Both (Facial)
VIII. Sensory (Auditory/Vestibulocochlear)
IX. Both (Glossopharyngeal)
X. Both (Vagus)
XI. Motor (Spinal Accessory)
XII. Motor (Hypoglossal)
What’s your favorite? Send your reply via submission, and I’ll post them to be shared!
SO true! Oh, my struggling RNs to be… don’t give up hope! Every sleepless night is another night closer to your blissful reunion with the old fluffy pillow— ahh, sleep never felt so yummy.
Check out more nursing school problems and submit your own at Christian’s Tumblr! A must-follow for all you nursing students looking for a little something to put a smile on your sleep deprived faces.
I feel like this is what Nursing is all about.
Many times, our patients and their families are in situations that bring out the worst in them. Our job is to see through what a patient does and says to recognize who he is: a human being, one who deserves to be comfortable and well cared for.
(Or: “How To Make your Shift Less Shitty”)
Ahh, the smell of fresh clostridium difficile in the morning. Contact precautions with no hand gel allowed, needing a new chux every five minutes, and being elbow deep in poop… I think the only thing worse than having a patient with c.diff is probably being a patient with c.diff. Before Fecal Management Systems (FMS) like the Flexi-Seal rectal tube, having c.diff or any other form of incontinent liquid stool more than likely meant that you’d be sitting in it for most of the day. As a nursing student, I didn’t really find that an FMS could make much of a difference. In fact, the other day was the first time I actually saw a FMS that was not constantly leaking all over the place. After taking report on a patient whose diarrhea had been unmanageable throughout the previous shift despite his Flexi-Seal and the nurse’s best efforts, I was speaking to one of my mentors on the staff and expressed my opinion of FMS’s as a big waste of time, money, and hope. She brought me to the patient’s bedside, taught me the following, and changed my views on Flexi-Seals forever. Using her advice, I was able to keep the patient and his bed clean and dry for the entirety of my shift! Though these are anything but secrets, and are in fact the manufacturer’s recommendations, not many nurses know about or do them. Maybe next time you hear a fellow nurse complaining about FMS’s as I did, you can teach them a thing or two and do The Night Nurse proud.
The patient requiring a FMS is the same patient at extremely high risk for skin breakdown. Good old fashioned turning and positioning from left to right should be done constantly throughout your shift—the key and the challenge to incorporating a FMS into this regimen is that in order for the device to work, it must be unobstructed from where it exits the body to where it enters the collection bag. The easiest way to do this is to place support pillows at the patient’s side and between his legs to provide a clear path for the tube, and hang the collection bag on the side of the bed that the patient is facing.
Milk the rectal tube frequently to prevent backup—at minimum, this should be done every time the patient is repositioned. If the tube is obstructed by dried or thick stool, it can be irrigated as per the manufacturer’s instructions.
If these steps have been taken with no success, there is a good chance that the balloon is improperly inflated. The Flexi-Seal balloon is intended for inflation with 45cc of WATER. If it is filled with air, it may deflate over time. If it is underinflated, liquid stool may leak around it. Filling the balloon to its maximum may not be appropriate for patients of all sizes. Think about it—too large an object in the rectum would send anyone’s bowels into hypermotile-mode. To find out if an improperly inflated balloon is the source of your FMS woes, take a large syringe and aspirate its contents. If it is filled with air, fill it with water. If it is filled with less than 45cc, try filling it to capacity. If it filled with 45cc, try removing 5cc and reevaluating for leaks.