Daily CHG baths are required if a pt has had an OR debridement, central line, or a chest tube
IV Poles, Avasure, etc. is found in storage room
Whiteboard shows my pt's / who I will be getting report from. Orange dot = Difficult pt
Black telephone at nursing station = To comm. with Tele. You would call them here to let them know your patient is being sent to radiology or somewhere and will be taken off tele monitoring.
Grey telephone at nurses station = To comm. with the remote sitter, but can also call them via vocera(??). E.g. You would ask them for privacy if the pt requests privacy for a procedure.
At the end of shift: Fill out charge report sheet/ w updated or pertinent info regarding your pt's. --> Left computer at nursing station --> Open microsoft teams --> Open charge sheet document and fill out, highlight yellow when finished.
Dakin's solution: a topical antiseptic used to cleanse and disinfect wounds. This should be put in thr wound care order by the MD.
To message Dr.: Click Team (color): Type in name of Team color under "Providers" --> Click chat bubble --> Add pt to the chat. After messaging Dr. for request for an order to be put in, also fill out "provider notification" form as good practice to show proof of communication.
2 30 minute breaks: around 1800 and 2100
When getting something for a pt you will be using, such as a pill cutter: Always make sure to put their pt label on it after using it and storing it.
Pyxis A: Big Supply room in the middle, Pyxis B: Near room 25, Pyxis C: On opposite end
TOC Pharmacy: Sometimes pt's will have meds from pharmacy. You can try finding them in the grey bath bins in the big med room. If not found there, look in pt's room, or may have to call pharmacy to either have them sent up, or have to go down to pharmacy to pick them up.
Stuff I Did
Bomb enema: involves administering a solution of sodium bicarbonate and citric acid into the rectum to stimulate bowel movements. Need: bottle of citric acid, sodium bicarb, enema bag w/tube, IV pole, lubricant, med cups for measuring, wipes and chucks.
ICP / Straight cath: Know to msg MD if there is no order for ICP (e.g. We need to know if it needs to dont q 4-6 hours). You cna ICP as needed (prn) like I did. Review procedure (male) Review procedure (female)
ICP supplies: Located in big supply room: Kit from urinary cabinet, Sterile gloves, Catheter in corner bottom cabinet.
Req. Docs: Finished sepsis screening, head-to-toe, etc. within 2 hours of shift. Finish care plan doc. and education by 2200.
Report: Draft report sheet on WOWs: print on copy room computer.
Stuff I wanna do:
Discharge planning and teaching, printing out required consent forms and signatures. Know how to do wound dressing change teaching.
Admission: What to do, admission documentation. How to set up a room for a new patient.
Brush up on disease processes like cardiac/tele, dysrhythmias, notice what pts are coming in with
Rectal tube insertion. Want to learn how to do this.
Wound dressing changes. Different types (general)
Learn how to take labs: Urine culture, blood culture, etc. and send them to lab and get results
Know when I would need to change IV tubing, replace drips, whether to bring in supplies for dressing changes.
Questions
How often do you have STEMI patients and is there a protocol like MONA and heparin?
Day 2 - 3/23/2024 (Week 1)
To Do:
Figure out code of grey machines next to each room, and figure out the purpose of it (?).
Learn how to properly "waste" medication, narcotic vs. non-narcotic.
Learn tele-monitoring if tele pt. Do we need to print out tele strips? What sort of assessments and documentation are involved in tele monitoring?
Day 3 - 3/24/2024 (Week 1)
Took on two patients
Gave a lot of PRN IV Injections using filter needle + empty syringe.
Gave report on 2 patients
Did CHG bath, CHG wipes found in warmer in narcotics room
Administered Heparin SubQ (Grey needle)
Did wet to moist gauze wound dressing w/Dakin's solution
Day 4 - 4/212024 (Week 1)
Did not write anything down :(
Day 5 - 4/2/2024 (Week 1)
Did a discharge (kinda)
Did a blue draw via line (Blue Vacutrainer
Collected stool sample and sent to lab
Administered Mag Bag and K+
Attempted vein blood draw
Admitted a transfer pt: Checked for at home meds --> Place in medication folder, had pt sign paper and let them keep one, put one in binder, and one for pharmacy
For admission: Use flow sheets "admission" THEN navigators
Check "demographics" if family calls and wants health information
Day 6 - 4/3/2024 (Week 1)
Performed transfer discharge for SNF placement: print belongings sheet, schedule appointments if ordered (order history), take out belongings sheet from binder and have signed, confirm belongings, print AVS, make copy of AVS to place in binder, have pt fill out stroke survery and place into deisgnated folder, order transport (EMS? Wheelchair? Visitor?)
Don't remember... did not write enough down.
Day 7 - 4/5/2024 (Week 1)
Took on 4 pts
Did transfer admission: Get room ready with supplies, perform admission req docs, ask about medications and belongings
Performed ICP: Remember to bladder scan before and after, make sure to check PVR order before straight cathing. If PT not urinating, make sure they are hydrated and inform MD of bladder scan result if high result.
