Now it's time. The ICU nurse has
arrived with Mr. Johnson.
So, let's talk about our immediate nursing
priorities. He's rolling into the
door. So the first thing we're going
to do is get Mr. Johnson
from the ICU gurney and the monitors,
and get him on the Med-Surg telemetry
monitors and back up to his
oxygen, because ABC is still a top
priority and we want to get his vitals. So,
it can sometimes feel chaotic when a
patient first comes in the room.
But remember, you'll usually have other
people there to help you get Mr.
Johnson settled. So, you want to get
him transferred from the ICU bed
into the Med-Surg/telemetry bed,
get the monitors transferred over,
and make sure you're making
contact with Mr. Johnson
the whole time during the transfer.
So you don't want to talk
in third person around him. Be very
intentional about greeting him,
and explaining to him what you're going
to do. Don't just pick a patient up
and slam them over to the bed. You always
want him to be very aware, because
all hospital patients feel out of control.
And the more that you
start your relationships like that with
patients, you're going to have a much
more therapeutic relationship throughout
their stay. So, you've got
continuity of care, right? You're
going to get report
with the ICU nurse right there, verify his
neuro assessment, like what you received
in report, and what he's doing now.
Check his rate of oxygen, his IV rates, and
any orders that the ICU nurse may
have completed before he
came to your unit. Then you're
going to do your own
head to toe assessment, look at his NIHSS,
review the healthcare provider orders.
That's your next step.
Then you're going to figure out what has
to be done this shift? What are your
top priorities to do? And when you're
looking through the orders
thinking about what we had, obviously,
you're going to get him on the oxygen
and get him on the monitors. Those
are number 1 priorities, right?
Then you're going to work through his other
orders. You're going to make sure that
those consult orders get into that
interdisciplinary part, so we can
have those professionals see him
as quickly as possible.
So that's how we're going to
practice with Mr. Johnson,
thinking through him system by system.
You've done your assessment.
Now as the Med-Surg/telemetry nurse, what
you want to do is think about what really
are the priorities, specifically,
for Mr. Johnson?
Well, when you think through neurological
system, okay, we know that he's had a stroke.
We know that he has right-sided
weakness. It was a left-sided stroke.
We know he's having a little bit of
problems with speech, and so, that is
going to be one of our main priorities that
we watch. You're going to look and see
if there's any exams, any diagnostic testing,
any lab work that applies to that,
and work your way through each system.
We know cardiovascular,
his blood pressure's up a little bit, but we're
okay with that because he was a stroke.
We know respiratory-wise, he's on oxygen.
We also know the sat that we want to maintain.
But you're going to make a mental note.
Anything that a patient's on that's
not natural, like oxygen
or IV, I say, like, anything they didn't
come out of the womb with,
always think about, why do we have it on,
are we going up, are we going down,
or can we take this off? Because
if Mr. Johnson,
we see that he doesn't need that oxygen,
then we should look at weaning it off,
titrating it off, so we can get that off of
him and he can live a more normal life.
We're going to look at his musculoskeletal
mobility. So, how does he do getting up
from the bed? Can he dangle his
legs on the side of the bed?
Is he safe to stand up? Can he move to
the chair? So, we're going to look at
those issues with him and set his
priorities. You'll work your way
through the rest of the system.
Don't overlook skin.
Skin is really important because if he's
starting to have some breakdown
somewhere from being in bed so long,
that's going to be a huge issue.
When we talk about GI, it isn't
the most glamorous
part of nursing, but it's vitally important
that you know when his last
bowel movement was, because if he gets
constipated, this could be a really big
issue. Plus, it's just going to
mess everything up. So,
you want to know how bowel
and bladder are also doing.
Now, this system right here is a great
way to think about all of your patients.
If you want to be prepared when a physician,
he or she runs onto your unit
and has to see a patient, if you've taken the
time to think through your patient,
take him system by system by system. Think
about any assessment information
you have in each one of these systems.
Think about any lab work
that applies to these systems. Think about
any meds the patient is taking
that applies to that system. You can set
a priority list of problems to talk
to the physician. So when they come in, you
just pull your paper out of your pocket
say, "Yes, I want to talk to -- about Mr. Johnson's --"
Boom, boom, boom, boom, boom.
That way, you can stay organized and you're
ready before the healthcare provider
comes for report.