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An illustrated guide to tough, at-work questions

What do you do when you’re handed a tough task at work? Well, you handle it. As a nurse, juggling difficult, complex tasks that require your full attention (ironically) is pretty much the name of the game from the beginning of your shift to the last minute of the work day.

All nurses, regardless of how seasoned they are, has that one task that gives them butterflies in the stomach. Here are answers to six at-work questions that nurses — the new as well as the seasoned — frequently ask.

1. How do I properly pronounce ‘Guaifenesin’?

Can I get a vowel?!

Guaifenesin??

Gwuah?…Did you just sneeze or something?

The next time someone asks you how to pronounce this common expectorant, think of another ‘G’ word that we commonly see when we suspect gastrointestinal bleeding. Remember the test we order called Guaiac stool?

(Why does everything lead back to poo? Really?)

Guaiac = ‘gwi-ak’

Guiltiness = ‘gwi-Fen-ah-sin’

You just correlated coughing with pooping in the same sentence. Isn’t nursing fun?!

2. How do I memorize common lab values?

Memorizing common lab values used to be a toughie, but thanks to the modern Electronic Health Record (EHR) and full computer access, nurses don’t need to memorize most lab values.

The other caveat to lab values is that each institution has its own set of normal value ranges. One “norm” may not be the same as another neighboring institution or facility. The difference is usually ± 1-3 percent.

As a nurse, it’s normally your job to notice and address extreme values that do not coincide with your patient assessment, but always keep them in the context of the patient.

And to make matters even more complicated, some values will be read and displayed using different methods of measurement. Instead of mmHg, they could use cm of H2O. Just something to pay attention to.

Outside of memorizing the values outright, here are a couple helpful tips to keep in mind:

Example: Hemoglobin and Hematocrit (H and H)

  • General rule of thumb is a 1:3 ratio
  • Hematocrit should be approximately 3X the Hemoglobin
  • Norm ~ Hgb 10 / Hct 30 (minimum values)
  • Also Hgb 13 / Hct 40 accepted

Example: BUN and Creatinine (Cr)

  • General rule of thumb is a 1:20 ratio
  • BUN should be approximately 20x the Creatinine
  • Norm ~ BUN 20 / Cr 1.0

Get more examples here.

Whatever you do, don’t treat ANY lab value as if it lived in a vacuum. Apply what you see in the context of the patient. Above all, always verify.

3. How do I avoid medication errors?

There are a bazillion suggestions that can help you administer your medications quickly, efficiently, effectively and safely. In my opinion, they all have their place, but the single most important thing you need to worry about is safety.

Safety first, safety last.

There are many studies out there indicating that most medication errors (for any health care professional delivering medications – not just nurses) happen during the preparation phase of administration. This is when you are separating, verifying and confirming that what you plan on delivering is what is in front of you. This is when you put that safety checklist into action.

Of course we ALL know about the five rights (some schools of thought use seven – and I’ve read up to 10) of safe medication administration. Back in my day it was five. I can only assume these rights have been burned into your brain:

  • The right patient
  • The right drug
  • The right dose
  • The right route
  • The right time
  • (The right reason)
  • (The right documentation)
  • (The right to refuse)
  • (The right patient education)
  • (The right evaluation)

All are extremely important, but none of it matters if you are distracted during the preparation stage. Do not allow a fellow coworker, staff member, physician, family member, patient or any other individual interrupt you during the preparation phase. Eliminate all distractions. This includes answering phone calls, as well as texting on your personal cell phone!

Here is my most important tip: ELIMINATE DISTRACTIONS DURING MEDICATION PREPARATION.

If you get distracted, sooner or later you’ll make a mistake.

4. 5 tips for assessing patients

Most nurses take assessing patients for granted. We think that if we just follow the PQRST, we will be good. Well, for the most part this may be correct but here are some tips to help you always perform your best, top notch assessments.

1. Begin with the basics and when trouble starts, always start with the ABC’s again. Airway, breathing, circulation.

2. If your patient is altered, check the oxygen and the glucose.

3. Always use a system when assessing your patients. Always. The day you deviate from your routine is the day you miss something really, really important.

4. As soon as you take report on a patient, check the ID band, the fluids, the IV, etc. When your name goes on the patient, now everything is your responsibility. When possible, give report at the bedside so you can avoid these things.

5. When at a loss for words, ask the patient, “Tell me more about that.” Open-ended questions are SO helpful in getting the most out of your patient.

5. What’s the best method of using a pre-filled syringe?

Be sure to remove the cap and then retract the plunger on the syringe (as if you are aspirating) BEFORE you depress the plunger. There’s compressed air hidden in the needle-less leur-lock. If you depress the syringe first after the initial removal of the cap you will squirt saline like a laser in whatever direction you are pointing (there are numerous ceiling tiles at every hospital that can corroborate this story)!

6. How do I get pen marks off of scrubs?

Alcohol pads can remove pen mark stains and streaks in scrubs. You may need to use a little elbow grease but they’ll do the job if you’re at work and need a quick fix! If you’re prone to using the back of your hand as a portable notepad during the day, these handy pads can also remove ink and most markers from your skin, too.

A bonus tip: For some strange reason an alcohol pad placed on the bridge of the nose seems to slow down or even stave off nausea. This only works sometimes, but when it does, it’s pretty darn cool and useful as a temporary solution until you can retrieve an anti-emetic.

7. 5 surefire tips for cannulation success

Nurses and intravenous catheters (IVs) seem to go hand in hand. Yes, yes, I know nurses are not the only health care professionals that place and start IVs, but we do the majority of it. My sincere apologies to all the out-of-hospital EMS personnel.

Oh, and as a side note to all the TV fanatics out there: Physicians RARELY start peripheral IVs. In fact, in my short tenure doing this job, I’ve seen ONE physician start one.

Anyway…

Even though my IV skills had a pretty rough start, I thought I’d share some tried and true tips to help increase your chances of success.

Know your anatomy

  • This is a simple yet vitally important rule. Don’t go rooting around for that “magic” vein. Know where to look and what you are looking for. Most cephalic forearm veins are overlooked, while the median anticubital vein is usually abused. Remember, the ventral side of the forearm is sometimes a gold mine!

Trust your gut

  • After your initial survey, if you know in your gut that you’re going into it blindly, stop what you are doing and ask for help. Ask for assistance or simply hand the task off to someone who is more experienced. There is no shame in knowing your limits, but don’t be afraid to fail, either.

Stick to your own routine

  • For some reason, every nurse thinks his or her way of prepping the vein, applying the tourniquet and exposing the vein is the best way. Ehhhh. Wrong answer! Once you develop your skill, be sure to follow your own routine. Your routine will ensure you do it the right way, each time, every time.

Hone your skills of palpation and touch

  • This seems to be a dying art these days. Just because you can’t see the vein doesn’t mean it’s not there. Be sure to practice your palpation skills. Practice and sharpen this skill by closing your eyes and palpating a known large exposed vein on a well-hydrated patient. When you see “that” patient with the good veins, be sure to palpate the veins with your eyes closed. Do it over and over again until you can recognize what the vein should feel like. Don’t ever rely on just your sight.

Don’t forget there’s a patient attached to that vein!

  • Once again, we nurses get so focused on the task that we forget there is a human being on the other side of that vein. Just because the dorsal hand veins are prominent does not mean you ignore the forearm! You are inevitably causing pain to your patient–be sure to empathize and make every attempt to increase their comfort level. I haven’t met a patient yet who actually likes being stuck with a needle!

Starting an IV is a skill like all others–practice makes perfect. It also follow our mantra, “If you don’t use it, you lose it.” Don’t handicap your practice as a nurse by letting your IV skills lapse. It’s better to try and fail than to never try at all!

Do you have a genius, at-work solution? Tell us!

Or perhaps you have a burning at-work question that you’d like to ask Nurse Sean Dent? Ask away in the comments!

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One Response to An illustrated guide to tough, at-work questions

  1. Realistic yet funny! Love this….keep them coming!

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