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Nursing Pearls of Wisdom-20 Things That Every New Nurse & Student Needs to Know (Part 1)



SOME PEARLS OF WISDOM: 20 THINGS EVERY NEW NURSE & NURSING STUDENT SHOULD KNOW


      1. Insulin generally lowers potassium. Albuterol treatments, steroids, and calcium gluconate also lower potassium.
      2. Alcoholics often have low magnesium and low platelets
      3. Anuric is general < 100 cc a day & Oliguric <500 cc day (some sources will say <400 cc day).
      4. If a patient develops shortness of air, lower extremity swelling, and is on IV fluids– stop IV fluids and call on call provider. This could be a sign that they are in fluid over load
      5. COPD patients tend to have chronically higher levels of C02. Normally, sleepiness and altered mental status develops as the C02 level increases.
      6. Chronic kidney disease patients are often (almost always) anemic because of the lack of production of erythropoietin (hormone that stimulates RBC production) from the kidneys.
      7. If you are taking vitals and you notice on the monitor that the heart rate is jumping from high rates and then back downan EKG is needed. This may likely be atrial fibrillation.
      8. Renal patients MUST take calcium carbonate (tums) near meals, if they are using this as a phosphorus binder. This is because the calcium carbonate helps to decrease the excess phosphorus in the body by attaching to phosphorus in foods. Only a small amount of phosphorus actually dialyzes off, so if a phosphorus binder is not used- phosphorus can actually build up in the body and cause calcifications, lining major arteries. I have seen many patients who will let the calcium carbonate sit near their meals and won’t take them. They will say things like “I will take them later”. But it is important to explain to them why they must take this medication near meals- as this is how it works best. The other important thing is to make sure that as a nurse, you are watching your patient take their meds.
      9. If a renal patient has a fistula or AV graft always assess the bruit (auscultation) & thrill (feel) to make sure it is working. This is their life line to remove toxins from their body!
      10. Steroids (solumedrol, prednisone, methylprednisolone) can cause insomnia, agitation, weight gain, lower extremity swelling, increased hunger.
      11. Have to be very cautious using norvasc (CCB) and steroids in patients with CHF, as these can potentially cause a patient with this diagnosis, to go into an exacerbation. Both of these meds can increase fluid retention.
      12. Accurate I/O (intake and output), means literally just that- Accuracy is the goal. This does not mean to estimate the intake & output. This means to add up every container. And always make sure that there is a “hat” in the toilet/commode or a urinal at bedside, for exact measurement. Surprisingly, many new nurses and students tend to estimate I/O. Accurate I/O’s mean to measure and add up everything that goes in and comes out. Most hospital pitchers have 800-1000 cc..but always check with your hospital for exact amounts. Don’t forget about other drinks as well!
      13. If giving Vancomycin & patient suddenly gets flushed & red – stop infusion and call on call provider. It is likely that Redman syndrome is happening and that the infusion just needs to be slowed
      14. Head of bed should always be 30 degrees (sometimes up to 45) if patient has peg tube feeding
      15. If patient has diarrhea and is on antibiotics or has had recent use- they should be tested for C-diff
      16. No sticks, IV insertion, draws, blood pressures on arm of dialysis access (AV graft, fistula)
      17. Don’t go outside of a contact precautions room with the protective gear on. You must take it off before going out of the room
      18. If patient nose dries out from nasal cannula do not put Vaseline (can potentially cause a flame) in their nose- instead get a bubbler to humidify the air
      19. Consents: The provider needs to be the one to explain the procedure
      20. Do not wipe finger with alcohol pad right before taking a glucose (at least allow it to dry) as this may falsely elevate glucose. Wiping finger with water & drying immediately after is best

     

  1.          SEE PART TWO FOR MORE PEARLS OF WISDOM..…....


    NOTE: The above information is not intended to be medical advice. This is for educational purposes only. This is intended for medical professionals & students. All patients should ALWAYS check with their primary care provider with any questions that they may have about their health. This is not intended to guide in medical decisions or treatment in any way. It does not serve to replace clinical judgement. As always, medical professionals should always call the on call provider if any clarifications are needed. State and hospital protocols should always be followed accordingly. Med Made Ez (MME) disclaims any liability for the decisions you make based on this information.

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