The Dog Ate My Care Plan…

Just a mom/wife/nursing student extraordinaire trying to make it in the big bad city…

Posts Tagged ‘medication’

No Crystal Stair

Posted by isntshelovlei on April 28, 2010

We had an exam last night in Maternity/OB (final next Tuesday!). Usually there are not a lot of meds to remember for maternity since technically the patients aren’t “sick.” Other than epidurals and such during labor most of what you’ll see is postpartum—percocet and motrin for pain, maybe a stool softener if mom had a episiotomy. But when something goes amiss—antepartum, intrapartum, or postpartum—that’s when you get hit over the head with all kinds of stuff—pitocin to start or augment labor, tocolytics to stop labor, hydralazine  for hypertension, magnesium sulfate to prevent seizures (in eclampsia), methergine for hemorrhage, and injection-only insulin for diabetics since oral agents are teratogens. It’s enough to make your head spin and this is only scratching the surface of all the meds I need to know!

So needless to say I can already tell that pharm is going to be a beast. Everyone makes it sound like such a “bird course,” and that “it’s just straight memorization”…OK, if you say so. You not only have to learn the names (trade and generic) of about a gillion drugs, but also the actions, interactions, indications, contraindications, side effects, rationale for why you are or aren’t giving it…the list goes on. You have to know all of these things to be able to challenge that brand new resident’s order for your pregnant patient to receive coumadin (which crosses the placenta), or to be able to question why he wrote an order for methergine when your patient’s blood pressure is already 160/100. You have to know all of these things because in the end YOU are giving the patient their medications—YOU are their last line of defense before a potential medication error occurs. Yes, Mr. Resident that wrote the order should have some accountability as well, but everyone will be looking at YOU because YOU should have caught it. 

So although the wonderful world of maternity is coming to a close, I now have to prepare myself for a whole new kind of headache. One of my favorite poems, “Mother to Son” by Langston Hughes, sounds just like the plight of a student nurse. Nursing school for me ain’t been no crystal stair…

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A Gag Order? Shame on You Temple

Posted by isntshelovlei on March 30, 2010

If you live or work in the tri-state area then you’ve probably heard about the drama brewing around Temple University Hospital and their intention to essentially gag their nursing and allied health staff.

Just this past year, two Texas nurses were prosecuted for voicing their concerns via a so-called anonymous complaint about one docs’ practices. The charges were dropped against one of the nurses; the other nurse was later found not guilty.

And now, Temple President Ann Weaver Hart wants to include a provision in their nursing contracts that basically says that if you do your job, you lose your job. Has the familiar saying “snitches get stitches” now crept into the healthcare system?!? Needless to say—the staff aren’t having it (thankfully and rightfully so).

This is not a joke—and it’s really not about money or nurses and other health care professionals on a power-trip either. This is also bigger than freedom of speech—this is about PATIENT SAFETY. Peoples’ lives are hanging in the balance here. Now I may be a wet-behind-the-ears student nurse but what I do know is that one of the very tenets of nursing practice is patient advocacy. And for some patients, their nurses are their only voices. Nurses are at the front line caring for their patients day in and day out, monitoring them closely. Nurses are more likely than other health care professionals to catch a medication error, notice an unsafe practice, or know when something is just not quite right. If there is something amiss, it is their duty to speak up.  

Hart’s proposition is truly ridiculous. Next thing you know they’ll have patients signing statements upon admission that they can only be treated if the patient promises not to sue…

With that said, Temple nurses plan to strike tomorrow, Wednesday, March 31, 2010 at 7am. For updates on this situation, check out Temple Watch.

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Med Math

Posted by isntshelovlei on March 24, 2010

So we had a dimensional analysis quiz last night. Ah yes, the dreaded med math—what some nursing students have nightmares about. Every semester we have quizzes on drug calculations. In my program we have to get a 90% or higher on them—at some schools it’s 100%—or you will fail the clinical portion of the course (which means you’ll just fail the course—you can’t fail clinical and pass lecture). Hence why many students get their panties (or boxers/briefs) all up in a bunch. I’m not sure what the old-school method was, but dimensional analysis is really quite simple. The biggest challenge is remembering all of the conversion factors. Some are well-known such as 1000 mg = 1 g, whereas some like 1 gr = 60 mg (what the heck is a grain anyway?) are a little less so. But once you have the conversions factors under your belt, it’s pretty much all downhill from there.

Let’s look at an example. Let’s say the physician has ordered a patient to receive Erythromycin 150 mg PO TID. The pharmacy sends the medication in a bottle labeled 0.75 g per fluid ounce. How many ml should be given at each dose?

I always like to start with the amount ordered (150 mg). Next I look at the dose on hand (as if the pharmacy could ever send it to you the way you actually need it), which is 0.75 g per fluid ounce. The monkeywrench is that I need to administer the medication in milliliters. So I’ll need two conversion factors to make this work—1 gram = 1000 mg and 30 ml = 1 ounce. If you set up the problem correctly the unnecessary measurements will cancel out and you’ll be left with what you need—milliliters. Keep in mind that the conversion factors can always be flipped so that the unwanted measurements cancel out properly—notice how I wrote 1 oz / 0.75 g instead of 0.75 g / 1 oz. Once you have it all lined up, multiply across the top, multiply across the bottom, simplify, and voilà! Piece of cake.

There are a few miscellaneous rules to remember with med math. For instance, always use leading zeros and never use trailing zeros. This helps to reduce possible medication errors. People’s handwriting often sucks and so if a nurse transcribes an order into the MAR for 1.0 grams of a medication but the next nurse doesn’t see the barely-there decimal sign and misinterprets it as 10 grams—she just gave your patient ten times the medication they were supposed to get. Same thing with leading zeros—.1 g can be misinterpreted as 1g. Watch those zeros! Rounding answers can also be tricky. In general, you’ll want to round to a whole number when your measurement is a capsule, gelcap, unscored tablet, etc. Nothing like trying to administer 0.92 of a tablet to a patient…

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