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Nursing School week #7
Oct. 2nd, 2011 01:02 pmWe're now about halfway through the first semester....1/8 of the way through the whole program (okay, in terms of "weeks class actually meets," not "weeks on the calendar.") One of the instructors has been calling us "almost-RNs" from day 1 and reminding us how fast it will go. I think she's onto something.
Our theory work this week was on Stress and Coping (on the patient/family's side) and Pharmacokinetics (in a pretty elementary way, but basically it's "how drugs work inside your body, and what elements of your body affect their effectiveness"). In Lab we learned how to give oral medication and eyedrops, which is less about technique (except for the eyedrops) and more about checking, doublechecking, and triplechecking. We use a system called 6 Rights (sometimes 8) and 3 Checks.
The Rights are: Right patient, right drug, right dose, right route (oral, transdermal, etc...), right time, right documentation (following dose), right reason (why are they getting this drug?), and right assessments.
Right reason: All drugs are prescribed by doctors or Nurse Practitioners, but since the nurse actually gives the medication, s/he is also responsible for checking the appropriateness of the drug. Now that drug orders must be on a computer/print-out, there are fewer errors due to illegible handwriting, but it's still possible that a patient could have an order for a drug that doesn't seem to make sense--and better to check in advance than find out later!
Right assessments: Some drugs require a particular assessment to be done before or after receiving the drug (ex: Check the patient's blood pressure before giving their dose of BP medicine...if it falls below a certain threshold, don't give the medicine). Also, you should always check with the patient after meds to see how they're doing in a general way...any nausea? Did their pain level reduce?
The Checks are: Check the label and the order (following the 6/8 Rights) and the expiration date of the drug you're holding 1: When you get it from the drawer, 2: When you prepare it (pour it into a cup, or whatever), 3: At the bedside before giving it to the patient. The Checks are a little blurry for us right now, because half of us are working in a hospital that has computerized medication verification (you get the meds out of a fancy computer with a lot of individual drawers, and scan each one as you remove it, then scan the patient's wristband, your own ID tag, and the med package at the bedside) and the remaining half are in a hospital that doesn't have this on every floor yet. So, the theory is sound, but the application varies...
Last week we learned the basics of dosage calculations. The Dr's order will only say how much TOTAL of a medicine is ordered (ex: 1g of Tylenol, or 15mg of something that's in a solution); the nurse on the floor may need to figure out how to create this total dose out of what's available. (Obviously when you go to a pharmacy, the pharmacist figures this out. But in the hospital that I'm at, ALL the meds for all the patients (for a day) are in the magical computer drawers--not individually dispensed by the pharmacist). At its simplest, dosage calculation is really easy: "I need 1g of Tylenol and I have 500mg (0.5g) tablets? Great, I'll give 2 tablets!" However, we still need to write out the calculation using dimensional analysis (explained below) to demonstrate that 1g = 1000mg = 2(500mg). It gets slightly trickier when we get to liquid suspensions--if the Dr. ordered 15mg, and the suspension contains 10mg/5mL, then you need to be able to figure out that you're giving the patient 7.5 mL..... and this is all leading up to future semesters, where we'll start to calculate IV doses, including how many drips per minute the IV must deliver.
[I'm not sure I can explain dimensional analysis without graphics, but I'll try briefly. DA involves multiplying the number of units you HAVE by a series of equivalencies to get the number of units you NEED. So, if I HAVE 24 inches, and I want to know how many feet that is, I multiply 24 inches by a fraction that is written as "1 foot / 12 inches" which allows the unit of "inches" to cancel from top to bottom. Simple multiplication across the fraction gives me (24*1foot)/12, which simplifies to 2 feet. 1 foot = 12 inches is an equivalency that can be written "upside down" or "rightside up"--since the whole thing's equal to 1, it doesn't matter. You line up all the equivalencies so that the units you don't need can be canceled out, and then multiply. You're left with a number and the units you need. You can use as many equivalencies as necessary, and they can apply to the numerator and denominator--so you could set up an equation to calculate km/second from miles/hour, for example.]
Preparing my patient this week was easier than last week, but soon we're going to start having 2 patients! This coming week, however, we don't have any patients at all--it's a bit of a midterm break, and we get evaluated by our clinical instructors (and do a self-evaluation). It's a bit of a relief, since it takes me a long time to prep my patient's info...
Meanwhile, we have our next psych exam tomorrow, so off to study for that!
[edited for lack of subject line]
Our theory work this week was on Stress and Coping (on the patient/family's side) and Pharmacokinetics (in a pretty elementary way, but basically it's "how drugs work inside your body, and what elements of your body affect their effectiveness"). In Lab we learned how to give oral medication and eyedrops, which is less about technique (except for the eyedrops) and more about checking, doublechecking, and triplechecking. We use a system called 6 Rights (sometimes 8) and 3 Checks.
The Rights are: Right patient, right drug, right dose, right route (oral, transdermal, etc...), right time, right documentation (following dose), right reason (why are they getting this drug?), and right assessments.
Right reason: All drugs are prescribed by doctors or Nurse Practitioners, but since the nurse actually gives the medication, s/he is also responsible for checking the appropriateness of the drug. Now that drug orders must be on a computer/print-out, there are fewer errors due to illegible handwriting, but it's still possible that a patient could have an order for a drug that doesn't seem to make sense--and better to check in advance than find out later!
Right assessments: Some drugs require a particular assessment to be done before or after receiving the drug (ex: Check the patient's blood pressure before giving their dose of BP medicine...if it falls below a certain threshold, don't give the medicine). Also, you should always check with the patient after meds to see how they're doing in a general way...any nausea? Did their pain level reduce?
The Checks are: Check the label and the order (following the 6/8 Rights) and the expiration date of the drug you're holding 1: When you get it from the drawer, 2: When you prepare it (pour it into a cup, or whatever), 3: At the bedside before giving it to the patient. The Checks are a little blurry for us right now, because half of us are working in a hospital that has computerized medication verification (you get the meds out of a fancy computer with a lot of individual drawers, and scan each one as you remove it, then scan the patient's wristband, your own ID tag, and the med package at the bedside) and the remaining half are in a hospital that doesn't have this on every floor yet. So, the theory is sound, but the application varies...
Last week we learned the basics of dosage calculations. The Dr's order will only say how much TOTAL of a medicine is ordered (ex: 1g of Tylenol, or 15mg of something that's in a solution); the nurse on the floor may need to figure out how to create this total dose out of what's available. (Obviously when you go to a pharmacy, the pharmacist figures this out. But in the hospital that I'm at, ALL the meds for all the patients (for a day) are in the magical computer drawers--not individually dispensed by the pharmacist). At its simplest, dosage calculation is really easy: "I need 1g of Tylenol and I have 500mg (0.5g) tablets? Great, I'll give 2 tablets!" However, we still need to write out the calculation using dimensional analysis (explained below) to demonstrate that 1g = 1000mg = 2(500mg). It gets slightly trickier when we get to liquid suspensions--if the Dr. ordered 15mg, and the suspension contains 10mg/5mL, then you need to be able to figure out that you're giving the patient 7.5 mL..... and this is all leading up to future semesters, where we'll start to calculate IV doses, including how many drips per minute the IV must deliver.
[I'm not sure I can explain dimensional analysis without graphics, but I'll try briefly. DA involves multiplying the number of units you HAVE by a series of equivalencies to get the number of units you NEED. So, if I HAVE 24 inches, and I want to know how many feet that is, I multiply 24 inches by a fraction that is written as "1 foot / 12 inches" which allows the unit of "inches" to cancel from top to bottom. Simple multiplication across the fraction gives me (24*1foot)/12, which simplifies to 2 feet. 1 foot = 12 inches is an equivalency that can be written "upside down" or "rightside up"--since the whole thing's equal to 1, it doesn't matter. You line up all the equivalencies so that the units you don't need can be canceled out, and then multiply. You're left with a number and the units you need. You can use as many equivalencies as necessary, and they can apply to the numerator and denominator--so you could set up an equation to calculate km/second from miles/hour, for example.]
Preparing my patient this week was easier than last week, but soon we're going to start having 2 patients! This coming week, however, we don't have any patients at all--it's a bit of a midterm break, and we get evaluated by our clinical instructors (and do a self-evaluation). It's a bit of a relief, since it takes me a long time to prep my patient's info...
Meanwhile, we have our next psych exam tomorrow, so off to study for that!
[edited for lack of subject line]
