Hello, I am starting my nursing clinicals and I will be on a tele floor. I am nervous because I don’t have the strongest clinical skills due to lack of experience. I know patients on this floor are monitored carefully and even have cameras in every room to monitor all care. I was hoping someone would be able to tell me specific things to watch out for or some procedures I should review before starting. Any information would be greatly appreciated, thanks.
Ohhhh, so many things, so little time.
One of my tele clinical’s came to mind reading your question. A patient was on the floor for observation. They could not find anything wrong with him and were going to discharge him at 3PM. On entering the room during my rotation, I noticed he had sleep apnea. Back then this was not a big thing to watch for. On reporting to the floor nurse who reported to the doctor, he was kept for a few more days and this indeed was the cause of his heart problems.
His chief complaint, “There is something wrong with my ticker but they can’t figure it out.” Leave it to a student nurse to do just that. This was actually one of several times I picked up on something.
So, if your patients are sleeping, you will chart on them that they are resting with their eyes closed (you do not know if they are sleeping or not), mouth breathing or not, respiratory rate and rhythm.
Next… you will want to look for pedal edema. Read up on how to measure / chart it. +1 to +4. pitting edema or just edema.
People in bed will have less than those who are sitting, standing and or walking. This is the sign of left sided failure.
Now, here is another bit of info BUT you need to be careful with it. A MSG reaction in some causes pedal edema. Chances are they will not be on the tele floor unless they have heart related problems. However, since those who work there tend to have tunnel vision, if someone has edema and there is no cardio related sign and symptoms, pull this out of your hat. Otherwise, keep it to yourself or you will look like a moron.
Start learning your meds. Start learning the rhythms. There are mnemonics to help you remember them.
For instance…Wenckebach- pronounced WINKY-BOK goes…longer, longer, longer, block, know you know your winkey bok.
Don’t worry about the regular irregular rhythms right now. Learn the life threatening ones first. They are few and easy to remember.
Oh yea, learn about Sick Sinus Syndrome. In the ICU, a patient with a resting heart rate of 48 next to mine had an alarm go off. Failed to look at the chart (not my patient) before telling the doc (he was right there at the nurses station after all). Any way, had I known that this was the patients normal, I would have kept quiet.
Finally, if you want to do a paper on anything and really want to blow your instructor away, there are a couple of things that may not have hit their radars and you will be a hit, that is, unless they read Yahoo Answers.
One is Bloodless Medicine. Having had over 600 patients refusing blood and not one died, the lowest count Hgb 2.9 (record was 1.2 until they started bone marrow transplants with out blood in PA Hospital). My patients got out of the hospital 2-3 days faster than those who got blood, with lower risk, morbidity or mortality.
Second is Glutathione. Do a pub med search on any disease and glutathione and or the precursors like dietary cysteine.
I am currently (just started Saturday, Jan 18) working with a doc in Nigeria on a pedes patient with Myelodysplastic Syndrome. This used to be called pre-leukemia. The family want to stop the blood transfusions. I am putting them together with the MD who is one of the leading experts in on Glutathone. This is not an approved therapy and is off label. However, since nothing else is working, this may save her life and the doctors are open to considering it.
They are looking into treating her with a bonded whey protein made from bovine milk. One version of this is actually in the PDR and the RedBook. However, it is probably not available in Nigeria. There are a couple of European countries who are manufacturing the stuff.
Hey, this might be interesting for your class to follow. If you want to and get the approvals, I could ask for permission from Nigeria and your class could read the play by play transcript of how this hopefully works out to save an 11 year old girls life.
While your at it, even meet the girl through e-mail and send her a card or such. If everybody approves, this would probably lift her spirits and that of her family. Kind of an adopt a patient and help nurse her to health from around the world.
If you go with this, I will expect you to run with the idea as thought it is your own.
Once all the permissions are in place, part of the info will be posted on NoBlood.com and or on UltriorHealth.com
Who knows, the little lady may be a future nurse as a result of all the care she receives from nurses who are on the other side of the world and do not even know her.
If you like, talk to your powers to be and if they give the go ahead, I will run it by my contacts. If all is OK, we can get started and introduce each other. It is a teaching hospital and it should not be a problem from the standpoint of the facility.
Finally, do a search on glutathione and any heart related disease or complication. Also do a search on cysteine. The drug form of cysteine is NAC or N-ac