Cannula security in the profusely diaphoretic patient

Most of us have had to deal with it. A profusely diaphoretic patient.

These patients are usually unwell, exactly the time you least want to lose their IV access. Yet due to the moistness of the patient’s skin their cannula dressing just lifts away, and scrumples up into a mess, and floats free, and you just can’t seem to do anything to get it to stick.

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This is it! Don’t get scared now.

The following is a guest post by Vanessa Katsoolis.


 

If I ever come across a nursing student in their final year of their Degree that is willing to be honest about how they feel the first thing they will say is that they feel they don’t know enough, that they are scared that they are going to graduate, get their scrubs, put them on and walk into their first day on the floor and not actually know what to do next.

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Care goes in. Crap goes out. 

Susan Silk is a clinical psychologist who is also a breast cancer survivor. In a story for the Los Angeles Times, her friend Barry Goldman recounts the day a friend wanted (needed) to visit her immediately following surgery:

Susan didn’t feel like having visitors, and she said so. Her colleague’s response? “This isn’t just about you.”
“It’s not?” Susan wondered. “My breast cancer is not about me? It’s about you?”

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Emergency Department Rules!

A list of essential rules for the ED nurse. Slightly modified from the original Red’s Rules by Ed Hunt.

Bringing a crash cart into the room can ward off evil spirits.

Don’t panic. If the airway is patent, and there is output, get help and then get a set of vitals. It’s useful information and buys you time to figure out your next move. Moreover, it makes you look like you know what you are doing.

Know basic life support like you know your wardrobe. That way the very worst thing that can happen to your patient is comfortable and familiar territory. Moreover you DO know what your are doing.

We will treat all our patients, not just the nice ones.

The patient is not the enemy.

There are many reason for people to be assholes – demanding, agitated, argumentitive. Sometimes it is an underlying disorder of the personality that you have no control over. Sometimes it is because they are dying. Often they don’t know what to expect and aren’t used to being powerless. At the very least, it may be because you just met them on the worst day of their life. This is a good possibility given that they are in an emergency department.

Your job is to try and be the best part of the worst day of their life.

The Emergency Department is an easy place for a nurse to kill people. If you don’t walk into work a little scared of doing so, you probably aren’t paying attention.

Err on the side of the patient. Over time, it is always easier if you do the right thing in the first place. That said, it is never too late to do the right thing.

Support your colleagues at every opportunity. Seek support PRN. This is the vital sign of a strong unit.

You are never the most important person in the patient’s room.

Attend to patients in the waiting room. Review them and inform them.
Let them wait… but don’t let them simmer.

The one time you don’t do what you always do, you will get burned.

Check blood sugar on anyone with altered LOC.

Don’t forget to check for cannulas in dressed patients about to discharge.

Don’t argue with drunks.

Mental health (Psych) is just a label. Nurse the person.

The correct response is ALWAYS “how can I help you?”  They are ALL your patients.

Nurses don’t work for doctors, they work for patients.

Quick adult respiratory assessment. 

The following guideline is by no means a complete or thorough respiratory assessment (For example, I have not covered palpation or percussion).

It is instead, one example of a structured approach to performing a quick respiratory assessment on a new patient, or a patient who requires rapid re-assessment (leave out the history taking part).

Key descriptors are in bold to help you improve your documentation vocabulary.

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