What Would You Do?
Your patient will be going to endoscopy and the consent reads:
"PEG Tube Placement by Southwest Gastroenterology Group"
What is wrong with this and what would you do?
Need to write out Percutaneous endoscopic gastrostomy tube placement on the consent.
Need to find out what MD will be completing the procedure & write out their name on the consent, NOT the group name.
You will need to re-write this consent.
What would you do if you walk into 6201 & find the patient exhibiting stroke-like symptoms?
Call a CODE ABC.
The ICU charge or House Supervisor will activate the CODE STROKE.
Once you receive blood from the blood bank, how long do you have to get it started?
15 minutes
Does every patient who is considered suicidal need to have a PSA sit with them?
Yes until cleared by the Psych MD
A patient is admitted with abdominal pain and diarrhea. What type of isolation should be ordered and instituted?
Contact Enteric Precautions
Your patient becomes extremely agitated & hostile towards you after the doctor changed his pain medications from IV to PO Dilaudid.
After explaining the reason for the switch and the timing of the medications, he is now even more agitated.
What would you do?
Offer them choices.
ARCC up his concern to your Clinical Supervisor or manager.
Call Code BERT if needed for support.
What other condition mimics stroke-like symptoms?
Hypoglycemia
You suspect your patient is experiencing a possible blood transfusion reaction.
What do you do?
Close the transfusion line immediately.
Remove the blood components & administration set from the patient. Keep the vein open by hanging 0.9 NS with new tubing.
Contact MD & the Blood Bank Immediately.
Assess the patient & give supportive care.
Take the blood bag & tubing to Transfusion Services.
Follow directions from the MD & Transfusion Services.
You come on shift and notice the belongings are not locked up for your suicidal patient. What do you do?
Call Security and have them lock up the patient’s belongings
You received a new patient and are unsure of their history. In order to determine if they have had a Multi-Drug Resistant Organism (MDRO) at Silver Cross in the past, the easiest place to look is?
On the Banner Bar in Cerner
Sara Stedy
A patient exhibiting stroke-like symptoms can travel to CT with transport only.
True or False?
False
When a patient is placed in violent restraints, when does a face-to-face need to occur?
How do you order a Safety Tray in Cerner?
Enter “Suicide Precautions” under the orders section. This then flags dietary to bring the correct dinnerware.
Who can apply the external female urinary management device?
Only nurses. CNAs are NOT allowed to apply this device.
Your patient & their spouse are arguing prior to you entering the room to complete your vital signs & give the patient his medications. While you are completing these tasks, the spouse turns her anger towards you.
What would you do?
Stop in the face of uncertainty.
ARCC up your concerns about them arguing.
Pause before going into the room and DO NOT proceed with any nursing tasks while patient or visitors are upset.
Which physician group(s) needs to be notified if a Code Stroke is activated?
The stroke Neurologists & Neuro Interventionist
How long can patients be restrained with opposite limbs?
They CANNOT be in opposites.
Your suicidal patient has 4 visitors arrive to the unit. One of the visitors is holding a drink tray from Starbucks with 5 drinks in it. What would you do?
Inform them that the patient is only allowed to have 2 visitors at a time and for safety reasons they are not allowed to bring in any outside food or drinks.
Your patient was admitted yesterday for nausea. In ER they had a CT with contrast to rule out any GI issues. They have been afebrile, normal labs, with some mild cramping. Today they told the physician that they had 2 episodes of “mushy” diarrhea. Physician wants to order a stool for c.diff. What red flags do you notice that he should NOT order this test?
Mushy stool is not considered Type 7 on the Bristol Stool Chart
The patient received CT with contrast within the last 24 hours.
No fever or elevated WBC
Patient only had 2 of these “mushy” stools and they need to have 3 liquid (Type 7) stools in a 24 hour period
Your patient states they are a DNR and hands you only a DPOA for healthcare.
What would you do & what is their code status?
Code status is FULL CODE until you either receive a DNR order from the physician or have a completed POLST form.
Once a Code Stroke is called, what is the goal time for the patient to be in CT to be scanned?
15 minutes
Having all four side rails up on the bed is always a restraint?
True or False
False - If your patient is ALERT and ORIENTATED and requests to have all side rails up then you can complete this request BUT make sure you document it.
What does the nurse need to review and explain to the PSA each time they switch?
The nurse needs to give the PSA report and explain the PSA Responsibilities for Non-Restraint Patients Requiring Observation.
Your patient is admitted through the ER. They state that they are unable to void. You notice that they last voided over 8 hours ago. What do you do?
Follow the Intermittent Straight Cath Procotol