Hi. Welcome to our video series
on neurological disorders.
Now, we're going to continue
following Mr. Johnson.
We're looking at the nursing care of a
stroke patient, but now we're going to
be in the Med-Surg unit. So, in this series,
you've had the opportunity to be an
ER nurse, an ICU nurse,
and now you'll see the role
of a Medical-Surgical nurse.
We're going to transfer Mr. Johnson
to the next level of care.
We're going to make it a
Now, I want you to practice using the SBAR
method for organizing your information to
give report about Mr. Johnson.
If you've already been the ICU
nurse, you should have that
ready to go. If not,
we'll give you the opportunity to practice
SBAR later on in the video series.
Remember, SBAR is situation,
and recommendation. Now, I also want you
to practice receiving an abbreviated report
from the ICU nurse, writing down the
information that you feel is most important.
I'll help guide you to identify
that after you're done.
So, write your notes about report
in your downloadable notes
as you listen to report on Mr. Johnson.
Okay. Let's look at the health
care provider's initial orders.
Usually, you'll receive these often before
you receive the patient or they may come
with the patient. Most hospitals
are using electronic orders.
Now, orders are written in a little bit
different language. They're not always
complete sentences, but they'll
have specific information
to help you know what the
physician wants done,
or the healthcare provider wants done
for this patient. Well, first of all, you're
going to see an admission order, so it will
say something like you see on the screen:
"Admit patient to telemetry Med-Surg
unit for telemetry monitoring."
So we know that's why Mr. Johnson
is coming here because it's
the monitoring that's important.
"Oxygen at 2 liters
per nasal cannula." So we know that he'll
have a nasal cannula on. That's the
tubing that you see with a little prongs
that go in the patient's nose,
go around their ears, and we'll
have it at a rate of 2 liters.
Now, the patient will come with transportable
oxygen, they'll come with it on a tank,
and then when we get them in the room,
we'll need to take it off the portable tank,
turn off the tank, and connect it to the
oxygen that's likely located in the wall.
Now we're going to keep monitoring
his oxygen saturation. Remember, it's
only been a couple days since Mr. Johnson
had a stroke. We want to make sure that we
keep him > 94%. The healthcare provider took
the time to let us know, "Hey, monitor
that sat and this is the mark,
this is the target that I want you
to maintain that sat at.
" If he's dropping below 94% very often,
we're going to need to really
look at the next step and
letting the healthcare provider know.
Now, this is where Mr. Johnson
is going to get lots of therapy.
We're going to meet with all kinds of
team members and this is where it gets
really interesting because you get to
work with other professional colleagues
in specialties. So he's got orders for
physical therapy, speech therapy,
occupational therapy, and a
registered dietician consult.
ow, these inter-department professionals
will come to the unit,
to your floor, they'll meet Mr. Johnson,
and they will assess him.
And then they'll make some recommendations
to the physician. They'll work together.
The physician will read the recommendations
and then he'll decide
or how long or how often they want
each one of these therapies.
So, how often Mr. Johnson
will get physical therapy,
what they want from speech therapy, how
often occupational therapy will come.
So, speech therapy may do an eval and
decide if they need to continue seeing the
patient or not. Occupational therapy
is the one that's going to help
Mr. Johnson learn how to do the activities
of daily living. They really help
the quality of life. Physical therapy
is going to keep him safe
as in walking and as he -- can he transfer
from the bed to the chair, and can he
stand up and can he walk. So, the
physician might write
some very specific orders right
from the beginning,
or he might just ask for a consult,
and then he'll work from there.
Now, we've got specific orders on when the
blood pressure is going to be monitored.
So here it says, "Monitor blood pressure
every 4 hours for the first 24 hours,
then every 8 hours." The physician lets
you know when she wants to be connected.
Look, "Notify health care practitioner
if blood pressure is above 180/105 mm Hg.
" So, you know, this is what the goal is
because they're new and just going
through the transfer to another unit. At
first, the physician wants the blood
pressure every 4 hours, just for the first 24.
Then once we hit that 24-hour mark,
e can just take it once every 8 hours.
Now it's really important
for a stroke patient recovering
and for all patients,
try not to interrupt their sleep.
So try to get that blood
pressure right when you get on shift, so
you have a good feel of what's going on
for the patient and you don't disrupt
their sleep if you're a night shift nurse.
Okay. So, we know those parameters.
Now it says, "Normal
saline at 75 mL/hour until
patient is cleared by speech therapy
to take oral fluids.
" This is because we don't want Mr.
Johnson to get dehydrated, right?
If he is dehydrated, he's going
to have less volume
in his intravascular space, and we
really don't want his blood
pressure to get too low. We want
him to maintain a healthy blood
pressure that's going to keep
perfusing his brain well.
Now, "Discontinue the saline if patient
able to drink fluids." So, this is
an example of one of those orders where
you're not going to have to keep contacting
the healthcare provider. What they've told
you is, "Hey, once speech therapy comes
and he can drink fluids, stop this IV,"
because we don't want to keep giving
him extra fluids if he's able to take IV.
And in the nursing world, and
the NCLEX world,
the goal is to keep the patient as
independent as possible. So,
do we want an IV or a
patient drinking liquids?
We would much prefer the patient be
able to drink liquids, like normal.
Okay. So, that's a few of the orders.
We've got those initial orders
and what we're going to be doing
with the patient. They also would
probably write specific
medication orders and etc.
So we didn't include those. We just want to
give you some good general orders to get a
feel for what it might look like
when someone comes from an intensive
care unit to a telemetry unit.