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Drugs, for instance.  Techs can't give drugs.  Nurses learn a lot about pharmacology and the whole area of how drugs interact and how they act on and in patients.

A person in hospital is likely to be on more drugs than they are used to being on at home.  Also, hospitals always buy generic drugs.  So, if you're in hospital, you need to make sure that what you are taking is what you need and what your doctor ordered.  If your pills don't look familiar, ASK.  When I give a person a cup full of pills, I point out each one and tell the person what it is and what it's for.  After several days giving the same meds to a patient, I don't necessarily give the whole runthrough, but I'll say "Here's your muscle relaxer, your steroid, and the stool softener."

So that's why a nurse has to give you the medicine.  If a tech brought you a cup of pills, and you didn't know what the funny-shaped pink one was, a tech wouldn't be able to tell you.  Your nurse not only knows what she's giving you and what it's supposed to do to/for you, she also has a good idea of how the drugs will interact with each other.  Notice I say "a good idea?"  That's because if you're taking more than five drugs, you're beyond medical science.  If you're taking one drug to reduce or eliminate the effects of another drug, there again...  ahead of the curve.

Nurses assess their patients, and document their findings.  I'll bet that you didn't know that nurses diagnose as well.  Nurses make nursing diagnoses, not medical diagnoses.  Nursing diagnoses include such things as: fluid overload, potential for. Or: Alteracton in mental status. Nursing diagnoses suggest an area that a nurse needs to keep in mind whilst caring for THIS patient. Nursing diagnoses are formed in the nurses' mind or written down, and then a plan is made to deal with the diagnosis. We then assess how well our intervention has worked, and we either decide to keep on course, or make some changes.

A nursing diagnosis that I use often is: Coping, deficiency. This might describe a person who's had a stroke and is having a hard time coming to terms with that fact. He won't work with the therapists, or won't cooperate with the nurse.

I had an otherwise very healthy patient who'd had a "light" stroke that caused him to be very impulsive and to have difficulty speaking.  He didn't observe his impulsiveness (jumping out of bed without thinking about it, walking very quickly when he was less than 100% steady on his feet) and was very frustrated that I wanted him to let me walk with him.  He wanted to go home because this slow speech didn't bother him enough for him to feel that the hassles of being in hospital were worth it to him.

He told me (with almost a second-long delay between each word) "There is nothing physically wrong with me."  (try it out loud, with the delay - it's pretty impressive, but didn't register with him). I replied "And yet, you've had a stroke."    He said "A very MILD one."  I had to agree with him that it was mild, but I didn't recommend that he go home and wait for the big one.

I do a quick physical exam on every patient every shift.

Click Here if you want to know what I look for and at, and why.

Treatments - Most patients work with the various rehabilitation departments.  Physical Therapy, Occupational therapy, Speech therapy.  But aside from these things, in general, if it happens to a patient on a regular hospital floor, the nurse does it to him or her!  We do things now that were done only by doctors a few years ago.  I take out surgical drains, except the ones in the head.  I take out stitches and staples.

I put in things that the techs can remove but can't put in. Catheters into bladders, and IV's are two things that techs can remove but can't put in.

Nursing is a team job. We have quick conferences in the hall many times a day. There are some medications that require a team approach by law or by hospital policy. When we give insulin, another nurse always looks at the glucose level we've gotten, checks the dose of insulin and compares it against what's ordered.

Some meds require computation. We almost always check each other's figures for anything that we have to figure dose, rate or time.

We have to work together in Patient Controlled Analgesia (PCA). This involves an IV solution of narcotic in a special pump that administers the pain medication either continually, or when the patient pushes the button to administer the med. The pump doesn't let the patient have more medication than it is programmed to give. So two nurses sign for the narcotic when it comes from the pharmacy, two nurses validate that an order exists for this PCA and they check the way the pump is set up. Two nurses sign the administration record when the new bag is hung, and if an old bag is being taken down, any narcotic wasted is signed for by two nurses.

Blood administration is always begun by two nurses, checking and rechecking that the blood that's being administered is the blood that was ordered.

If there's an unfamiliar drug, or a drug that's being given in an unfamiliar way, we always have a conference and discuss options until the nurse who has to give the medication feels comfortable and confident with it.

I'm sure there are some floors where some nurses would be unhappy about being asked to help like this. I'm very lucky - my floor is a very strong team of very good nurses. We work together very well.

I'm sure there are other things that don't come under these headings. If I think of something, I'll add it later.

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