PRADAXA VS. COUMADIN: JUST THE FACTS MA’AM!

The media sometimes snookers even nurses when it comes to new drugs. The fancy ads, testimonials by “doctors” on commercials and even patients can influence our opinions. However, be warned…as a new nurse, it’s so important that you first do a bit of fact finding before you buy into the latest new miracle drug.

Dabigatran (Pradaxa) seems like a wonder drug, right? It has the same effect as Warfarin (Coumadin) but without the need for weekly blood work. However, don’t throw Warfarin out the window yet! 

There are important differences between these two anti-coagulants that nurses need to understand to help patients make good decisions.

CLINICAL PRACTICE TIP FOR NEW NURSES: BIG BELLY RISK

Anytime I care for a patient with cirrhosis of the liver who is in crisis, my internal alarms go off. These patients often arrive with high ammonia levels causing confusion, extreme malnutrition, coagulation issues, and huge abdomens from ascites. Although we check their ammonia, coags and mental status, they are not the most important aspects of our assessment.

When caring for a patient with the above issues, what is the most important aspect of your nursing assessment?

SUCCESS TIP FOR NEW GRADS: LAYER YOUR LEARNING

When new nurses start their first jobs, they quickly realize that they only learned a fraction of what they really need to know to effectively care for patients. You see…nursing school teaches you the basics of patient care. The NCLEX is designed to make sure nurses are “safe” to practice – that’s it. Just because you graduated from nursing school and passed NCLEX doesn’t mean you know everything there is to know about taking care of patients.

NEW NURSE SUCCESS TIP: THE POWER OF FOCUSED ASSESSMENTS

The quintessential gift nurses bring to the delivery of healthcare is our assessments. Our assessments provide clues; telling us if patients are getting better or worse. In addition, assessments help us and others make decisions regarding care.

In the ideal world, nurses would have ample time to do a comprehensive assessment on every patient as often as needed. In the real world, nurses are lucky if they get 5 minutes to do a “drive-by” making sure their patients are breathing!

If assessments are our gift, how do we continue to “give” with the added demands placed on us?

We do this by mastering the skill of focused assessments.

MEDICATION ADMINISTRATION: DO NO HARM?

It’s been said that hospitals are one of the most dangerous places for patients. Although we provide great care, we can also do great harm – especially when administering medications. We all know the 5 rights, but even if we comply, mistakes are made.  Potassium is given to a patient with a level of 5.5mEq or Dilantin is given to a patient with an existing level of 30mcg/ml (normal is 10-20). By not doing our due diligence prior to administration, we put our patients at risk.

Making sure you give the right drug to the right patient isn’t enough. We have to truly understand how every drug we give will affect the individual patient. Mastering that is quintessential way we can provide “great care” to patients.

TIPS FOR NEW NURSES: BE THE MASTER OF DELEGATION

Many new nurses struggle to delegate patient care activities to nursing assistants. Sometimes it’s because they were working as a nursing assistant before they graduated and have trouble with role transition. Other times it’s because they may be working with older NAs who have been there for a long period of time. These more seasoned nursing assistants may be intimidating causing new nurses to avoid delegating anything to them.

However, independent of the reason, the only way you will succeed as a clinical nurse in today’s complex healthcare environment is to master the skill of delegation.

NEW NURSES UNDERSTANDING FLUID BALANCE. WHO’S AT RISK?

When the temperature heats up or during flu season, some patients are more at risk for dehydration.  Who’s at risk?  To answer this correctly, you need to understand how the body maintains fluid balance.

Question

Who has more water in their body – men or women; the elderly or babies?

To answer this question, you have to understand this…