Friday, January 13, 2006

Clinical Judgements/Decision Making

I have been contemplating the process of making decisions as a novice RN. I think although this is largely experience based and would be difficult to prepare for if some of you could share some advice about making judgement based decisions as new grads (or new grads you have assisted, or witnessed) I am sure that will help me feel more prepared. For instance you may remember a situation where there were several different things to consider eg: you have a patient who is due for an IM anti-nausea medication, but has vomited on themselves, and needs to be cleaned up for a procedure, what do you do and why????

If anyone has any experiences like this and would be willing to share I would be most grateful.


"Courage is being scared to death, but saddling up for the ride anyway"

8 comments:

Jo said...

First, Medicate ASAP. Why? Because cleaning him up and moving him around to undress, etc. might make hime vomit again. Then he'll really be late for the procedure. It will take less then 5 minutes to draw up the med and he'll thank you for it.

ICU 101 said...

i agree... geth the anti-emetic on board first, then worry about cleaning him up before the procedure... because without the anti-emetic, anything you do to the poor patient will be nauseated torture...

Unimum209 said...

Thanks for your imput and ofcourse I agree. That scenario is pretty simple, I am trying to push myself and look for some more scenarios with more difficult decisions.....Hope you can help!

Jo said...
This comment has been removed by a blog administrator.
Jo said...

(Sorry, I deleted that last one to fix it)
How about this one:
You have two patients and you just got report from the nurse leaving shift:
One a post op appendectomy with perforation who last rated his pain was a 7 on the pain scale, last medicated for pain 4 hors ago, and is on the call light saying he needs help up to urinate.
The second patient in for asthma exacerbation and pneumonia, fever of 101 degrees F, and her O2 sats just dropped from 99 to 94. She's due for IVPB antibiotics now.

Which patient do you assess first?

(Our school's been ramming a ton of these down our throats lately, this is one I remembered)

Unimum209 said...

Thanks for this one I will be sure to note it down and share it with my friends. Ok I guess I would ensure adequate oxygenation for the 2nd patient (ie sit up and administer o2) and check for antipyretic order. Meanwhile is apendectomy pt mobile or will he use a bottle? If a bottle this is a quick one, give him a bottle whilst checking next pain med due (Q4H?), then off to the treatment room to get antipyretic & ivab for patient 2 and pain med for patient 1. I don't know if that is right? I guess my first priority is always the airway, after that it is multitasking based on information available......

Jo said...

We are taught Airway first as well. (ABCs, airway, breathing, circulation)
However there was contraversy when our instructor brought this one up as one could reason that an asthma/pnemonia sufferer with an O2 sat of 94% was still pretty normal and above normal limits. However, a one day post op appy with a pain rating of a 7 was kind of high. A lot of factors involved, but yes, I would have gone with the second too, a sudden drop in sats and a fever would make her first priority to me.

Gypsybobocowgirl said...

Medicate first. You may never get ahead of the vomit without it.