Day in the Life of a Med-surg Nurse

NCLEX RN

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Outline

Overview

Day on med-surg
1. Beginning of shift
2. Patient assessments
3. Medication administration
4. Care management
5. End of shift

Nursing Points

General

Beginning of shift
1. Gather supplies
2. Write down patient group
3. Log into computer system
4. Receive bedside report
5. Get started!
Patient assessments
Medication administration
Care management
1. Procedures/ wound care
  1. Check orders
  2. Complete consent form
  3. Gather supplies
  4. Prepare patient
2. Discharges
  1. Review orders
  2. Prepare paperwork
  3. Provide discharge education
    1. Follow-up appointments
    2. Medication changes and additions
  4. Remove lines
3. Admissions
  1. Receive report
  2. View patient chart
  3. Prepare room
  4. Patient arrives
    1. Admission questions
    2. Medication reconcilliation
    3. Assessment
    4. Apply orders
End of shift
1. Check the chart
  1. Patient charting complete
  2. Medications given
2. Round on patients
3. Give bedside report

Assessment

Assess patient
1. Head-to-toe
2. Objective and subjective
Assess patient room
1. Safety checks
2. Supplies needed

Therapeutic Management

Patient population
1. Respiratory/cardiac
  1. CHF
  2. COPD
  3. Pneumonia
2. Mental illness/substance abuse
  1. Suicide attempts
  2. ETOH
3. GI
  1. Bleed
  2. Obstruction
  3. Failure to thrive
4. Vascular/skin/Endocrine
  1. PVD
  2. Cellulitis
  3. Diabetes
    1. DKA
    2. Hypoglycemia
  4. Amputations
5. Neurologic
  1. Falls
  2. Encephalopathy
6. Urinary system
  1. UTI/kidney infection (sepsis)
  2. Kidney failure
  3. Dehydration

Nursing Concepts

Patient-centered care
1. Assess patient needs
2. Adjust care accordingly
Clinical judgement
1. Assess situation
2. Make decisions based on knowledge and judgement
Prioritization
1. Prioritize care based on clinical judgement

Patient Education

ALWAYS tell your patient what you are doing
Educate on disease process
Educate on lifestyle modifications
Teach new medications
Inform of procedures or changes to orders

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Transcript

Hey guys! Welcome to the lesson where we will explore what a day in the life as a med-surg nurse is like, starting with the patient population.

On med-surg, we care for the largest variety of patients. I’m going to mention the most common that come to mind for me. We care for respiratory and cardiac illnesses such as CHF, COPD, and pneumonia quite often. This includes chest tubes and trachs. We care for patients with GI disease like bleeds, obstruction, and failure to thrive. We also see a lot of vascular/skin/endocrine illness such as PVD, cellulitis, diabetes, and amputations. Common neurologic illness on med-surg include encephalopathy and falls. Urinary diseases include kidney failure, dehydration, or UTI including sepsis. It should be mentioned that we commonly care for patients with mental illnesses that attempt suicide as well as patients with substance abuse issues that detox on the unit. Now let’s move on to talk about what a shift on med-surg is like.

So I’ve worked on a med-surg floor for seven years now, and I am going to give you a peak of what it’s like! So the first thing we do when we get to the unit is gather our supplies. This includes our stethoscope, pens, report sheets, and scissors. Then we write down our assignments that show which patients we will be caring for during the shift. I always log into the computer system before getting report so it is easily available in case I need to give something or look something up right away. I then receive bedside report from the previous nurse where I introduce myself to each of my patients. Then I get started with my shift!

After reviewing the chart, I like to assess my patients. I try to see the sickest patient first. I perform a head-to-toe assessment on them while gathering objective data that I see, and subjective data by asking the patient questions. I observe the patient’s room while I’m in there to check for safety. Check out the lesson on safety checks for more info. I also look to see what supplies I might need such as new IV bags or water for them to take pills with.

An important thing that I have to plan my shift around is medication administration. I view the times that they’re due, write them on each patient, and make a plan for who to give meds to first and so on. On med-surg as on many floors, change happens often. It’s important to have that plan, but be flexible for when new orders come through or something else happens that takes up time. Now let’s move on to different care management topics, starting with procedures.

We often have different procedures that we perform or prepare the patient for on med-surg. I always check the orders and complete any consents necessary. I then gather the supplies that I need and prepare the patient. An example is a wound dressing change. I check the wound nurse’s orders and gather the supplies that I need to clean and dress the wound.

We have discharges every day on med-surg. Some patients discharge home, others to skilled care or nursing homes. When I see discharge orders, I review them closely and prepare the paperwork based on where they’re going. I then spend time educating the patient on any changes in medications and provide information on their disease process and orders that the doctor gives such as follow-up appointments. All lines are removed on discharge unless the doctor orders not to. I call report if they are going to a facility or if they will have visiting nurses, and then take the patient out.

So, we also receive many new admissions every day on med-surg. I count on getting one every day. The charge nurse assigns the admits in the order that they see appropriate. The ED calls report and I like to look at the patient chart while I get report. I then prepare the room based on any information that the nurse gave me and orders that the doctor has put in. For example, if I see an order for telemetry or IV fluids, I’ll bring the supplies into the room so my hands aren’t full later. When my patient arrives, I get them settled in and start the admission questions. I complete the med rec that shows which medications they take and when they had them last. I then perform a complete assessment on them and apply any new orders that the doctor puts in. And of course, I chart EVERYTHING!

When the shift is coming to an end, I check my charts to make sure I didn’t leave out any charting or miss any new orders. I round on my patients to make sure they don’t need anything else, and then give bedside report to the next nurse.

Okay, let’s review the key points about med-surg. On med-surg, we care for a wide variety of patients from pulmonary disease to the results of mental illness. We start our shift off with report and planning our day while meeting our patients. We assess our patients objectively and subjectively while checking the rooms for safety. We administer medications throughout our shift based on the scheduled times and events that occur. We manage our care based on different procedures that are ordered or need to be done like wound care or placing IVs. Admissions and discharges are a regular occurrence for us. We finish our shift up by tying loose ends and checking over our work followed by report to the next shift!

Alright guys, now that you’ve gotten a glimpse of what it’s like to work on a med-surg floor, go out and be your best self today, and as always, happy nursing!