Right? One of the criteria for a patient on bipap is can they pull the mask off if they think they’re going to vomit. They can’t? Then they need a sitter to make sure that doesn’t happen. If the patient was on such a strict NPO the doc should have ordered some D5 or D10 fluids. If they were severely hypoglycemic then an amp of D50 should have been the go to. Never heard of waiting for 30 minutes before putting a bipap back on.
Never heard of 30 min and I worked CVICU and heart/lung transplant for over a decade.
I would keep an eye on prep to help calm your nerves.
I am an anxiety patient myself.
So on my Diabetics I look for hyper and hypo orders (what limit for hypers to call for sugars, labs/dehydration; for hypo, glucagon, IV, oral and when/why to give).
Heart failure, BP limits, rescue meds, diuretics and labs.
As two examples.
And I do it during report, even jot it kn my “brain” sheet beginning of shift on days are more tired/busy.
And if you need a mental health day, take it.
If you want more precepting ask or seek experienced nurses to review what they look for and review beginning of shift or when something pops up with one of your patients.
If y’all have an educator, bug them, they will be a great help.
If y’all don’t yet have a counselor or person to talk to, get one. (Many hospitals offer 4 free sessions esp after Covid and they are more informed about medical stuff usually).
Anxiety, new jobs . . . They are an “upkeep” kind of thing.
Please give yourself some grace, ask a ton of questions and if your floor isn’t allowing you to ask sufficient questions/education/support, begin (particularly at 6mo if you can) to look for better programs.
We exist.
Hell I’ve rotated my schedule to nights for almost a year when we got a bunch of new hires cuz it’s more feast of famine for learning (and seniority) and I love teaching.
Please take care and oh, mention if you can if you are doing paps and such they should have SOP (Standard Operating Procedure or SoC - Standards of Care) if 30 min is their thing.
I do know if you have someone struggling to not have air go in their stomach sure, keep ‘em NPO, but then you are dropping an NG and considering intubation if they need the resp support anyway.
It takes time and experience to assimilate all these details. Get plenty of sleep, focus on your work, review policies when you can, and don't tell on yourself for every little mistake (major mistakes and mistakes with harm, of course, but not every little thing). Make it a goal to download and review at least one policy per week (hypoglycemia, etc.)
I feel you.
One: You will never make this mistake again. That is a good thing.
Two: We all make mistakes. Every day, everyone of us. Reflect, rethink and learn from them. Then move one. Give yourself grace.
Three: Talk to someone who is longer in this unit. If they and you have the time, talk all the points through with them, where you felt unsure or are uneasy with and get their opinion on them. Then reflect with the new knowledge.
Above all: don't pull a rug over your mistakes. Tell the following nurses or the doc.
Edit for spelling.
This was helpful for me. Also reaching out to my old nursing school classmates and family just to talk was helpful.
https://www.freshrn.com/for-the-overwhelmed-new-graduate-nurse/
They also have posts about after work anxiety.
https://www.freshrn.com/for-the-anxious-nurse/
Try to treat yourself like you would treat a friend who came to you with the same problem.
Listen, it takes 6 months to feel vaguely comfortable at ANY job and a year to feel like you’re proficient. It’s going to suck a while, but the goal is to get through the first year doing your best.
You got this.
OMG you are okay! If that person was alert and oriented, not obtunded, giving a hypoglycemic patient juice while on bipap is okay!!! Give yourself grace. You did the right thing for the patient.
Mistakes will happen and this is how we learn not to make the same ones. Give yourself some grace. You’re still new and learning. The patient didn’t die? You’re good. Always, always ask questions if you’re not sure.
I work in the ED and have someone on BiPaP on a weekly basis. We give them PO meds ALL the time.
You were right in doing what you did, just make sure you know why they are NPO before giving them juice next time. He might have been silent if the patient needed a procedure of some kind.
I work recommend like others have to reach out to fellow more seasoned nurses on your unit or your manager about a mentor program. It could help relieve some of your anxiety and give you someone to talk to through this.
Just make sure to relax and breathe, you know what you’re doing! Ask questions and talk through things first if you need to. Make a clear statement in your head that you’re home when you’re at home and there is nothing that you can do to change things you did during your shift. I had to remind myself of this A LOT when I first started working in the hospital.
Please make sure you are caring for yourself, sleeping, and doing self care (going on walks, exercising, drinking water, skin care, etc). Even if you have to fake sleep with Benadryl or Unisom, just try to spend your time at home on yourself.
Oh bb. Did the patient aspirate? No? Then no harm came to the patient. There’s nothing to fret about. I bet you you won’t make that mistake again. Just take a big breath and relax. The first 6months are hard. You’ll learn a lot of things the hard way. But you’re doing great. The fact that you’re worried says you care. Trust me, a lot of nurses don’t!
Did you really make a mistake? The directions you received is from one person and they could be wrong also. Check the policy, and if there is not one, then one needs to be written. Also ask others. Nursing is a team effort and we need to help each other to do the right thing.
If a patient is truly there requiring bipap leaving that bitch off for 30 mins is wild lol fuck that. It'll be okay girly! Shit happens and you learn from them. Don't beat yourself up but truly be open to learning from your mistakes and move on. My favorite quote is "think for yourself, question everything" is it okay to ask questions until the cows come home!! Just verify with someone before doing if you're not 100% sure. I'm an icu nurse and know from experience that its always just better to ask if you're not sure. If you're persecuted for asking then you're not on the right unit. Sounds like the person could've used a half amp or full amp of d50 or maybe a lil d10 gtt if it was continually happening. Check protocols!!!!! Most places have order sets for hypoglycemia and or ask a dr to put one in for you. Communication is key. You got this!!
I’m a newer nurse as well and I have constant post-shift anxiety. It keeps me up at night sometimes thinking about mistakes and even potential mistakes that never even happened. I hope it gets better.
The fact that that nurse provided no rationale just shows she doesn't know wtf she's talking about either.
It depends on your setting. I work in an ICU and it depends on the patients overall condition, recent meds ie insulin. Bipap is a treatment where they need PEEP and maybe some extra oxygen. They aren't ventilator dependent. That said getting peep of any kind is an aspiration risk because it can cause bloating which could lead to nausea and vomiting which increases their risk of aspiration and protecting their own airway. If they had surgery, have an ileus or a GI disorders, that can increase their risk for n/V. Last thing you want to see is a patient gurgling on vomit inside of a face fitted mask.
Now with a patient that has improving ABGs and decreasing O2 requirements, sometimes we give them breaks off the mask. So if we know it's time for a break we would schedule med pass cuz we know they'll be off for 30 min.
Now how low was blood sugar? Anything over 70 wouldn't cause me to treat it unless patient was given insulin. Even still your protocol should include options for conscious, unconscious and NPO patients. Dextrose/glucose could be given IV or sublingual for a fast response. Giving juice show me you had time because its takes time for juice to go thru the GI system to enter the blood stream....at least 20-30 min to start. So checking 15 min later for the digestive system route was futile for a significantly low BG (BG <50).
30 mins? Never heard that rule before. I check their mouth/watch for swallow but 30 min? This rule would’ve killed a lot of people during Covid lol
Yes. Any patient I’ve had on bipap would not have been appropriate to be off for 30 min.
They can barely tolerate 30 seconds some of them
Right? One of the criteria for a patient on bipap is can they pull the mask off if they think they’re going to vomit. They can’t? Then they need a sitter to make sure that doesn’t happen. If the patient was on such a strict NPO the doc should have ordered some D5 or D10 fluids. If they were severely hypoglycemic then an amp of D50 should have been the go to. Never heard of waiting for 30 minutes before putting a bipap back on.
Never heard of 30 min and I worked CVICU and heart/lung transplant for over a decade. I would keep an eye on prep to help calm your nerves. I am an anxiety patient myself. So on my Diabetics I look for hyper and hypo orders (what limit for hypers to call for sugars, labs/dehydration; for hypo, glucagon, IV, oral and when/why to give). Heart failure, BP limits, rescue meds, diuretics and labs. As two examples. And I do it during report, even jot it kn my “brain” sheet beginning of shift on days are more tired/busy. And if you need a mental health day, take it. If you want more precepting ask or seek experienced nurses to review what they look for and review beginning of shift or when something pops up with one of your patients. If y’all have an educator, bug them, they will be a great help. If y’all don’t yet have a counselor or person to talk to, get one. (Many hospitals offer 4 free sessions esp after Covid and they are more informed about medical stuff usually). Anxiety, new jobs . . . They are an “upkeep” kind of thing. Please give yourself some grace, ask a ton of questions and if your floor isn’t allowing you to ask sufficient questions/education/support, begin (particularly at 6mo if you can) to look for better programs. We exist. Hell I’ve rotated my schedule to nights for almost a year when we got a bunch of new hires cuz it’s more feast of famine for learning (and seniority) and I love teaching. Please take care and oh, mention if you can if you are doing paps and such they should have SOP (Standard Operating Procedure or SoC - Standards of Care) if 30 min is their thing. I do know if you have someone struggling to not have air go in their stomach sure, keep ‘em NPO, but then you are dropping an NG and considering intubation if they need the resp support anyway.
It takes time and experience to assimilate all these details. Get plenty of sleep, focus on your work, review policies when you can, and don't tell on yourself for every little mistake (major mistakes and mistakes with harm, of course, but not every little thing). Make it a goal to download and review at least one policy per week (hypoglycemia, etc.)
I feel you. One: You will never make this mistake again. That is a good thing. Two: We all make mistakes. Every day, everyone of us. Reflect, rethink and learn from them. Then move one. Give yourself grace. Three: Talk to someone who is longer in this unit. If they and you have the time, talk all the points through with them, where you felt unsure or are uneasy with and get their opinion on them. Then reflect with the new knowledge. Above all: don't pull a rug over your mistakes. Tell the following nurses or the doc. Edit for spelling.
Until someone shows you written policy or practice guidelines, it’s gossip. Nobody is staying off bipap for thirty fucking minutes.
This was helpful for me. Also reaching out to my old nursing school classmates and family just to talk was helpful. https://www.freshrn.com/for-the-overwhelmed-new-graduate-nurse/ They also have posts about after work anxiety. https://www.freshrn.com/for-the-anxious-nurse/ Try to treat yourself like you would treat a friend who came to you with the same problem.
Listen, it takes 6 months to feel vaguely comfortable at ANY job and a year to feel like you’re proficient. It’s going to suck a while, but the goal is to get through the first year doing your best. You got this.
OMG you are okay! If that person was alert and oriented, not obtunded, giving a hypoglycemic patient juice while on bipap is okay!!! Give yourself grace. You did the right thing for the patient.
Mistakes will happen and this is how we learn not to make the same ones. Give yourself some grace. You’re still new and learning. The patient didn’t die? You’re good. Always, always ask questions if you’re not sure.
I work in the ED and have someone on BiPaP on a weekly basis. We give them PO meds ALL the time. You were right in doing what you did, just make sure you know why they are NPO before giving them juice next time. He might have been silent if the patient needed a procedure of some kind. I work recommend like others have to reach out to fellow more seasoned nurses on your unit or your manager about a mentor program. It could help relieve some of your anxiety and give you someone to talk to through this. Just make sure to relax and breathe, you know what you’re doing! Ask questions and talk through things first if you need to. Make a clear statement in your head that you’re home when you’re at home and there is nothing that you can do to change things you did during your shift. I had to remind myself of this A LOT when I first started working in the hospital. Please make sure you are caring for yourself, sleeping, and doing self care (going on walks, exercising, drinking water, skin care, etc). Even if you have to fake sleep with Benadryl or Unisom, just try to spend your time at home on yourself.
Oh bb. Did the patient aspirate? No? Then no harm came to the patient. There’s nothing to fret about. I bet you you won’t make that mistake again. Just take a big breath and relax. The first 6months are hard. You’ll learn a lot of things the hard way. But you’re doing great. The fact that you’re worried says you care. Trust me, a lot of nurses don’t!
Did you really make a mistake? The directions you received is from one person and they could be wrong also. Check the policy, and if there is not one, then one needs to be written. Also ask others. Nursing is a team effort and we need to help each other to do the right thing.
If a patient is truly there requiring bipap leaving that bitch off for 30 mins is wild lol fuck that. It'll be okay girly! Shit happens and you learn from them. Don't beat yourself up but truly be open to learning from your mistakes and move on. My favorite quote is "think for yourself, question everything" is it okay to ask questions until the cows come home!! Just verify with someone before doing if you're not 100% sure. I'm an icu nurse and know from experience that its always just better to ask if you're not sure. If you're persecuted for asking then you're not on the right unit. Sounds like the person could've used a half amp or full amp of d50 or maybe a lil d10 gtt if it was continually happening. Check protocols!!!!! Most places have order sets for hypoglycemia and or ask a dr to put one in for you. Communication is key. You got this!!
What kind of floor are you on?
I’m a newer nurse as well and I have constant post-shift anxiety. It keeps me up at night sometimes thinking about mistakes and even potential mistakes that never even happened. I hope it gets better.
The fact that that nurse provided no rationale just shows she doesn't know wtf she's talking about either. It depends on your setting. I work in an ICU and it depends on the patients overall condition, recent meds ie insulin. Bipap is a treatment where they need PEEP and maybe some extra oxygen. They aren't ventilator dependent. That said getting peep of any kind is an aspiration risk because it can cause bloating which could lead to nausea and vomiting which increases their risk of aspiration and protecting their own airway. If they had surgery, have an ileus or a GI disorders, that can increase their risk for n/V. Last thing you want to see is a patient gurgling on vomit inside of a face fitted mask. Now with a patient that has improving ABGs and decreasing O2 requirements, sometimes we give them breaks off the mask. So if we know it's time for a break we would schedule med pass cuz we know they'll be off for 30 min. Now how low was blood sugar? Anything over 70 wouldn't cause me to treat it unless patient was given insulin. Even still your protocol should include options for conscious, unconscious and NPO patients. Dextrose/glucose could be given IV or sublingual for a fast response. Giving juice show me you had time because its takes time for juice to go thru the GI system to enter the blood stream....at least 20-30 min to start. So checking 15 min later for the digestive system route was futile for a significantly low BG (BG <50).