Question: How can nursing education impact critical thinking skills for new nurses on a cardiac floor? What would be one of the most significant aspects of cardiovascular pathophysiology or medications the new nurse should learn?
Answer: Larry Bird of the National Basketball Association Hall of Fame gave aspiring hopefuls this advice, First master the fundamentals. At the risk of sounding too simplistic, I think one of the most significant aspects of any medications any nurse should learn is to ask, Does the patient need this? The second is to anticipate any side effects.
Our Pyxis will prompt questions when medications are removed. One example is “Is potassium level in range? when potassium is removed. I am always amazed how many times I administer medications without considering such basic questions.
Another example was when a patient admitted with life threatening hyperkalmeia. I noticed the T wave was not peaked as one would anticipate prior to administering the next dose in a series of Kayexolate. Serum potassium confirmed the potassium was not significantly elevated and the physician discontinued the order when I called him.
It also applies to administering blood pressure medications. Too often we discover hypotensive patients transferred to the unit were administered their routine antihypertensives even thought their blood pressure was low prior to administration. A disconnect may occur when techs take the B/P and a nurse administers medications. Rather than hunt the tech when I work the floor, I check the B/P myself prior to administering such medications and document it on the MAR.
Checking and Verifying Findings
Nurses should verify abnormal findings prior to treating or calling the physician. One such example occurred when I worked the floor and the tech reported an abnormally high B/P. The tech had used a cuff too small for the obese patient. The B/P was normal with an appropriate size cuff.
I will also mention the importance of having another nurse verify high risk meds or calculations independently. This is done without walking the other nurse through the process so as not to mislead the verifying nurse.
Another skill is to use resources available for patient safety when administering high risk medications such as IV pumps with preset drips and dosages. Additionally, the amount to be infused can be used much like a buretrol and set to deliver only 4 hours at a time to prevent inadvertent overdosage.
Always verify the patency of the IV when administering high risk medications, especially those administered at relatively low drip rates such as heparin, insulin, or nitroglycerin. The low drip rate may not cause significant signs or symptoms of infiltration. Doses may be increased because the effect is not therapeutic when the IV is infiltrated.
When administering high risk medications know if there are reversal agents. It may be appropriate to have reversal agents at the bedside. We have a patient who is treated with extremely high doses of narcotics and benzodiazepams. I leave Narcan and Romazicon in the PCA kit at her bedside.
Further education for nurses should provide preparation for critical situations. The other day I had a patient with sick sinus syndrome who had 2-6 second pauses. I placed pacer pads on the patient and left atropine at the bedside as we prepared for transfer.