Patient Safety
Patients who are a high fall risk
confused, agitated, unsteady, dizzy, low BP
shortness of breath, edema, weight gain
heart rate
less than 60 or more than 100
LVAD
patients may or may not have a blood pressure, discuss with the nurse
NEVER help a patient make connections
I don't need to perform hand hygiene before putting gloves on
FALSE
Before leaving a patient's room
Bed/Chair alarm on
Call bell in reach
Interventions when a patient complains of chest pain
tell the nurse
get an EKG
less than 90/60 or more than 150/60
PA line
Do not help patient OOB unless with RN
Do not unplug cords from the monitor
It is ok to leave a patient on the commode
FALSE, even if they say they are fine.
CHG bath and peri care
every patient that has a central IV needs a CHG bath daily
every patient with a foley catheter needs peri care wiping AWAY from the patient
2 important interventions for a patient with HF for PCTs
STRICT Intake and Output
Daily weights
oxygen
less than 90
Heart Transplant
always wear a mask
no flowers
Purewicks do not need to be changed, they can be used throughout a hospital stay
FALSE. they need to be changed at least daily and whenever they are soiled
The patient tells you to not put that obnoxious thing on (bed alarm) again
Tell the nurse and document
The heart has how many chambers?
4
blood sugar
less than 70 or more than 400
pericardial drain
bag should be secured to the patient's gown
do not get this patient OOB unless with RN
If a patient is on suicide precautions, I need to be within arm's reach at all times
TRUE. You should also always be able to see their hands.
I ask the nurse before ambulating a patient with...
A low blood pressure, a high blood pressure, a PA catheter, pericardial drain, chest tube
Medication to get extra fluid off patients
diuretics
urine output
less than 250 in an 8 hr shift
I should respond to telemetry alarms
TRUE! You can replace leads if they come off and change batteries.
You should also alert the nurse if the patient is unresponsive or unwell.