0615 Arrive at the Hospital. Go straight to the break room and put the lunchbag in the fridge, backpack in the locker, get flash light pen, pen, eraser pen, and stethoscope littmann out in the pocket or in the fannybag.
0621 Find the assignment with 4 to 5 patients assigned, go to the computer, quickly read the main reason for Pt. being in the hospital, procedures done, medication times, and antibiotics next dose, next pain medication dose, allergies, past medical history,
0639 Clock in, get report from the night nurse, ask to spell out the abbreviations, ask again if he or she speaks too fast, write down really quickly everything. X4 X5 Shift change meet and greet Pt. update the board with the date, nurse, PCT, patient care technician, charge nurse names, phone numbers (work phones) plan of care, pain control, goals of the day, etc
0720 to 0930 Pass medications of the 7, 8, and 9 hour medication, Synthroid first is given 2 hours before breakfast. Insulin short-acting following the sliding scale, first need to know from PCT how much was the last glucose results, Insulin Glargine Lantus is long-acting and it is usually given by prescription certain units.
Beta-blockers (Metoprolol, Carvidelol) Always check blood pressure and apical pulse before administering, if lower than 50 hold, some recommend to hold if pulse is lower than 60 and Systolic pressure lower than 100, Digoxin hold if Pulse is lower than 60. Hold heparine and betablockers if there is surgery or call the anesthesiologist to ask first. Some medications are held before hemodilalysis, usually hypertension medication.
Narcotics Oxycodone step one and step 2, Dilaudid, morphine, Tramadol after pulling from the BD Pyxis (an automated medication dispensing system) YOU HAVE 30 MINUTES TO ADMINISTER the narcotics, if waste get a nurse witness to witness, if Pt. refuses pain medication return medication back to Pyxis BEFORE THE 30 MINUTES. Pain scale must be moderate to severe and POSS score must be completed 1 for awake and alert, 2 for slightly drowsy.
Antibiotics double check if it's the initial loading dose which is usually given in 6 minutes, maintenance dose is given over 2 or more hours. For Vancomicin runs for 4 hours, when trough level is due, collect blood for lab from a fresh vein, 30 minutes before the next dose. Laboratory says it's normal 10 to 20mcg/mL that number can vary depending on each hospital
Heparine or Lovenox is given SC usually on the lower abdomen.
Tip: wake up Pt, do a quick assessment head to toe, ask about pain, if constipation, numbness and tingling check arms and leg strength, pulses, eyes, level of consciousness pulses, heart, lungs, sensibility on operated leg toes, arms fingers, color temperature. Ask pt. his/her name and date of birth, scan medication, give medication unwrapped in the medicine cup, explain each and what it is, its side effects, open the chart begin charting the assessment, Cerner or Meditech select only a few items of charting, just to set the time and register important information, charting completely after passing all medication is better so they dont't get too late.Check orders constalty, refresh your screen every 15 minutes. Get help from your PCT with perineal care comfort care, check the skin while wiping with warm sponges no rinse sponges dry with towel, turning Pt with two-person assistance, mornings go by very quickly.
1110 finish charting on Cerner or Meditech
1200 Pass noon medication rounding every room again, collect blood for lab studies, check lab results, eletrolytes results, administer Potassium if level is low, following the sliding scale the Potassium PO dose must be given with meals.
1230 bathroom break drink water.
1100 or 1300 meeting with the interdisciplinary team.
8000 to 1230 answer calls and texts from work phone, if there is a surgery get informed consent signed by the Pt for surgery, explain risks, and consent for blood transfusions if needed and risks sign as witness, if Pt, needs further instructions doctoe can explain procedure again. All procedures are written without abbreviations, put it in the binder, delegate CHG bath.
13:30 take your lunch break, yes, finally another bathroom break warm up in the microwave, relax enjoy your lunch.
1400 pass medication, finish charting, discharge or admission.
1500, 1600, 1700 1800 rounding educating teaching Pt & passing medication fluids. collecting blood if necessary.
1800 Ins and outs. fluids, charting of food and beverage, urine output, and last bowel movement are usually done by the PCT, nurses can do it too, beverage and urine output empty measure cup, , chest tube drainage, mark with sharpie pen last measurement on the device, JP drainage, on drains section.
1800 pass medication if any
1900 give Pt. report to the night nurse. see here an example of a bedside report.!930 to 1945 clock out, go home, and get some sleep. You made it woohoo!
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