- Insulin generally lowers potassium and so does albuterol treatment
- Accurate I/O means literally just that
- Anuric is general < 100 cc a day & Oliguria <500 cc day
- Measurement: 30 ml (cc) = 1 oz.
- A typical hospital patient pitcher is usually 800-1000 cc
- If patient gets SOA and is on IV fluids- stop IV fluids and call on call provider
- COPD tend to have higher C02 levels
- Chronic kidney disease patient are often (almost always) anemic because of the lack of production of erythropoietin (hormone that stimulates RBC production) from kidney.
- Sodium bicarbonate helps to neutralize the body when it has become acidotic
- Renal patients taking calcium carbonate (tums) near meals- this is actually to help decrease the phosphorus as it attaches to phosphorus containing food. Phosphorus does not dialyze off
- If a renal patient has a fistula or AV graft– always assess the bruit (auscultation) & thrill (feel) to make sure working. This is their lifeline to remove toxins from their body!
- Steroids (solumedrol, prednisone, methyprednisolone) can cause insomnia, agitation, weight gain, lower extremity swelling, increased hunger
- Alcoholics often have low magnesium and low platelets
- If giving Vancomycin & patient suddenly gets flushed – stop infusion call on call provider. It is likely that Redman syndrome is happening and that the infusion needs to be slowed
- Head of bed should always be at least 30 degrees if patient has peg tube feeding
- If patient has diarrhea or suddenly has diarrhea- they really should be tested for C-diff
- No sticks, IV insertion, draws, blood pressures on arm of dialysis access (AV graft, fistula)
- 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
- 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
- Consents: The provider needs to be the one to explain the procedure
- Do not wipe finger with alcohol pad right before taking a glucose (at least allow it to dry) as this may falsely elevate glucose due to the ETOH. Wiping finger with water is best
- Best place for absorption of insulin is in abdomen
- Make sure to rotate sites with injections
- Normal ejection fraction 55-60%
- It is ideal that a patient is NPO for an abdomen ultrasound
- Metformin needs to be held if contrast is given (for 48 hrs after)
- Fluoroquinolones (levofloxacin, ciprofloxacin,) are antibiotics often given in hospital. It is important to watch for muscle pain ache as this may be a sign of the black box warning of tendon rupture. This adverse reaction is more common in patients >55 years old
- Do not be afraid to clarify an order
- Stress tests: patient should not smoke the day of the test. The patient should not have any caffeine 24 hrs before the test. Patients should also not take beta blockers, nitroglycerin, and some other heart medications on day of the test (nurse should always clarify with cardiology if any questions on this)
- If you did not witness a fall you should not technically chart that the patient fell. You must chart what you actually witnessed and notify on call provider immediately
- Blood should be transfused within 4 hours (no longer). In general PRBC transfused is transfused under 2 hours. Exception include CHF & ESRD
- Sickle cell crisis pain is REAL and can be SEVERE!
- If a patient begins to have confusion, in addition to a neurological exam a glucose should also be checked
- Often the better report you receive, the better shift you will have (not always but more likely). So the point is, ask questions, get details, clarify
- LPN’s generally do not do: IV pushes, administer blood products, admission assessment, IV insertion (allow I have heard of certification to do this). These are general and may possibly change so if anyone has any update on this info is always welcome!
- Chest pain: If an MI is suspected general orders include EKG, cardiac enzymes, EKG, CBC, BMP, Morphine, oxygen administration, nitroglycerin, aspirin
- Blood cultures should ideally be drawn before antibiotic administration
- If a patient suddenly develops severe headache or abdomen pain let on call provider know this!! Don’t just give pain medication available. Imaging may be needed. If it is truly severe, we need to know what is causing these severe symptoms
- Many hospitals require a second nurse to verify insulin dosage before being administered
- CHF and Renal patients need to have accurate intake and output along with daily weights
- Consider asking for a catheter if risk for skin breakdown likely, need accurate I/O but unable to obtain, and/or comfort measures
- If suspect urine retention- bladder scan before calling on call provider
NOTE: The above is not intended as medical advice for patients. This is simply for educational purposes for medical professionals only. All patient should ALWAYS check with their primary care provider with any questions that they may have. This informational sheet does not serve as medical advice. 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-
Updated 4/21/16