Nursing Pages

Generally speaking, always physically see the patient before you talk to your senior about them.

Dangerous red flag clinical signs that should prompt consideration for condition / ICU transfer / expedient notification of your senior/chief or direct calling of a condition - you will have to use your judgement, err on the side of calling for help.

not swallowing their own secretions
Not protecting airway (obtunded or hematemesis / hemoptysis of any degree)
Seizures
Hypotension (systolic < 80 unresponsive to fluid bolus or if systolic < 80/90 and displaying e/o perfusion e.g. drowsy, CP, etc.)
Symptomatic hyponatremia
clear stroke symptoms

Page	Ask / Tell Nurse	Ask Patient	Examine	Management
Neuro exam change	turn off sedation and paralysis now and please have a train of four and pupillometer ready.	ㅤ	everything	NOTE: this is exception to rule of ordering things before talking to senior. Talk to a senior before ordering a CTH unless it is a profoundly obvious exam change.
Not protecting airway	Call respiratory ASAP for suctioning and go see immediately.	ㅤ	ㅤ	Very low threshold for condition and ICU transfer. If this is actually an issue, nurses will be on top of it before you even get there.
"I think they just aspirated"	Ok I will order a stat CXR	ㅤ	ㅤ	CXR
Intractable vomiting	When was the last time? How many times? was it after eating? Did they aspirate the vomitus or clear it?	ㅤ	ㅤ	Add more anti-emetics (see HY pharm chart) Make sure not aspirating
HYPO-tension	What is the MAP? If > 65, that is ok, do not need to traet Did you repeat check on other arm? Is BP cuff size appropriate? What meds on?	Symptomatic? HA, drowsy, etc.	ㅤ	try giving 500 BOLUS (careful if CKD or CHF) ask what Na+ is, if high give plasmalyte if low give NS Get orthostatics + / - medicine consult if orthostatic
HYPER-tension	Do they take any home anti-HTN? Were they in pain when you measured? Did you give labetalol / hydralazine	Is your pain well-controlled? Red flag signs for hypertensive emergency - AMS - Headache - Blurry vision - Vision loss - Chest pain - Palpitations - Sweating - SOB - Nausea / vomiting - Back pain?	ㅤ	Restart home anti-HTN meds Give PRNs for CAP 180 (unless this is a stroke, in which case ICU should be managing this) Consider medicine consult
Febrile	- What is the actual temperature? A true fever is 38.5 / 101.3 - Where was this measured from? - can you recheck a core temp (rectal)	ㅤ	it patient toxic appearing?	basic fever workup: ESR, CRP, CXR, UA, BCx, LED
Chest pain	Are they anxious? Are they in pain?	Is it crushing?	Is it reproducible?	EKG, Trop, BMP w/ Mg/Phos
Diarrhea	Is it truly watery? How many times in past 24h? Does it smell like C Diff?	ㅤ	ㅤ	C diff test if 3 liquid BM in < 24 hrs
Arm swelling	Was there an IV there? Is it infiltrated? Is it painful?	swelling/erythema	evaluate for distal pulses	Monitor, order dopplers
Abdominal pain	Are they eating? Vomiting?	ㅤ	Abdomen distended? Abdomen firm? Rebound tenderness?	Abdominal Xray if ALIF patient, very low threshold for ACS consult or STAT page to general surgery team that operated with us.
Spine drains dumping a lot	- any motor exam changes - is it clear (check op note if CSF leak) —> take seriously if so	positional HA verify motor exam	check color of blood coming out	Check H&H —> if not dropping significantly and no motor exam changes, ok to watch
Cranial drains dumping a lot	- any neuro exam change at all? - it it on suction?	ㅤ	ㅤ	ㅤ