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BAD NEWS BY TELEPHONE
It’s usually best to relate bad news in person to a patient’s family. In reality, however, this may not always be possible. Sometimes you may have the unpleasant task of telephoning a patient’s family with news of a patient’s deteriorating condition or death. Check the patient’s chart for the designated contact person. Don’t leave the bad news on the answering machine. Do leave your name and number so that the family member can reach you. Know whether your facility’s policy specifies whether a nurse may relate bad news by telephone.
BLADDER IRRIGATION, CONTINUOUS
Continuous bladder irrigation can help prevent urinary tract obstruction by flushing out small blood clots that form after prostate or bladder surgery. It may also be used to treat an irritated, inflamed, or infected bladder lining.
This procedure requires placement of a triple-lumen catheter. One lumen controls balloon inflation, one allows irrigant inflow, and one allows irrigant outflow. The continuous flow of irrigating solution through the bladder also creates a mild tamponade that may help prevent venous hemorrhage. Although typically the catheter is inserted while the patient is in the operating room after prostate or bladder surgery, if he isn’t a surgical patient he may have it inserted at the bedside.
ESSENTIAL DOCUMENTATION
Each time a container of solution is completed, record the date, time, and type and amount of fluid given on the intake and output record. Include any medications added to the solution. Also, record the time and amount of fluid each time you empty the drainage bag. Note the appearance of the drainage and any complaints by the patient. Document any changes in the patient’s condition (such as a distended bladder, clots, or bright red outflow), the name of the doctor notified and time of notification, and actions taken. (See Documenting bladder irrigation, page 40.)
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DOCUMENTING BLADDER IRRIGATION
BLANK SPACES IN CHART OR FLOW SHEET
Blank spaces shouldn’t be left in a patient’s chart or flow sheet. Follow your facility’s policy regarding blank spaces on forms. A blank space may imply that you failed to give complete care or assess the patient fully. Because flow sheets have increased in size, nurses may be required to fill in only those fields or prompts that apply to their patient. It’s now common for health care facilities to have a written policy on how to complete such forms correctly. Leaving blank spaces in the nurse’s note also allows others to add information to your note. If you’re charting electronically, the computer may not allow you to exit from a particular field unless all spaces are documented.
ESSENTIAL DOCUMENTATION
If information requested on a form doesn’t apply to a particular patient, your facility’s policy may require you to write “N/A” (not applicable) or draw a line through empty spaces.
When writing your nurse’s notes, draw a line through any blank space after your entry, and sign your name on the far right side of the column. If you don’t have enough room to sign your name after the last word in the entry, draw a line from the last word to the end of the line. Then drop down to the next line, draw a line from the left margin almost to the right margin, and sign your name on the far right side.
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BLOOD TRANSFUSION
A blood transfusion provides whole blood or a blood component, such as packed cells, plasma, platelets, or cryoprecipitates, to replace losses from surgery, trauma, or disease. No matter which blood product you administer, you must use proper identification and crossmatching procedures to ensure that the correct patient receives the correct blood product for transfusion. Be sure to follow facility policy for administering blood products.
ESSENTIAL DOCUMENTATION
Before administering the blood transfusion, clearly document that you matched the label on the blood bag to the:
patient’s name
patient’s identification number
patient’s blood group or type
patient’s and donor’s Rh factor
crossmatch data
blood bank identification number
expiration date of the product.
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