GUIDELINES FOR New Nurses
This is merely a guide designed to cause you to think about things before they happen. It is expected that things you do not know , recall or have questions about you look those topics up. Remember when you are in patient situations, always anticipate what may happen. Anticipate what your patient needs, their families needs, the doctors needs, your needs and not necessarily in that order.
In Medical practice treating problems changes virtually everyday, so it becomes necessary to build on what you have previously learned and adapt quickly to new changes.
Whether you are new to nursing in medical or the emergency department (ER), getting started in a seemingly chaotic, fast paced environment can be challenging and down right scary.
FEAR is such an environment is a normal emotion. The purpose of this content is to allow you to admit your fears, face your fears and ultimately control the fear rather than it controlling you. This is a fundamental key to success in working in the ER. There are so many things that are needed in an emergent scenario but here we are only going to focus on the 1st through 4 things you can do in just about any emergency.
Working in the ER of any hospital is a window to that hospital. The care provided in the ER is how that hospital provides care overall and in most other departments. The ER nurse is often the first point of contact which means the first actions by nurses are going to determine the outcome of the patient’s experience. A good example would be a patient comes to your ER with hypertension and the worse headache of their life. Placing the patient in a supine position while awaiting MD evaluation is absolutely contraindicated if the patient is having a hemorrhagic stroke. These are the kinds of issues these pages will help you avoid.
STEMI-ST Segment MI
One of the most common presenting symptoms in the emergency room is chest pain. Pain can be subtle or obvious. Thus the most primary, early action is obtain an echocardiogram and putting that EKG in an emergency room physician’s hand.
Getting an EKG during or even before triage is entirely appropriate. If you’re the primary nurse obtain a good set of vital signs , undress the patient and place the patient on a heart monitor. Obtain an oxygen saturation and place the patient on 2L nasal cannula. Obtain a health history along with medication taken at home. Enlist some assistance if possible and establish 2 IV’s and send blood work to lab.
Anticipate orders for a portable chest x-ray. If Heparin is ordered, verify that doctor has read the chest x-ray prior to starting of heparin. Also anticipate coagulation studies and CBC & chemistry as well as facilities cardiac enzymes studies.