Floor Medicine
Nursing Pages
Always physically see the patient before you talk to your senior about them.
| Pager Chief Complaint | What to ask nurse on phone before seeing pt. | What to ask patient. | What to examine. | Management BEFORE call chief* |
| Neuro exam change | turn off sedation and paralysis now and please have a train of four and pupillometer ready. | 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. | Condition and ICU transfer | ||
| "I think they just aspirated" | Ok I will order a stat CXR | CXR
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| Intractable vomiting | When was the last time? How many times? was it after eating? Did they aspirate the vomitus or clear it? | Add more anti-emetics (see HY pharm chart) Make sure not aspirating | ||
| HYPO-tension | Did you repeat check on other arm? Is BP cuff size appropriate? What meds on? | Symptomatic? HA, drowsy, etc. |
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| 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? | Restart home anti-HTN + / - medicine consult Condition and ICU if legit HTN urgency / emergency End-organ damage orders CT scan if ischemic / hemorrhage stroke concern EKG / Echo for MI / HF CXR for pulm edema Renal consult if hematuria U/S or CTAP if have known aortic aneurysm Optho consult for DFE if vision changes | |
Febrile (see chart for post-op fever timeline below) | can you recheck a core temp (rectal) What is the actual temperature? A true fever is 38.5 / 101.3 | basic fever workup: ESR, CRP, CXR, UA, BCx if you want them and LEDs | ||
| Hyperglycemia | Endo consult for insulin mgmt Remember ADA guidelines for hospitalized patients are 140-180. | |||
| Hypoglycemia | Endo consult for insulin mgmt Make sure all home PO meds are held | |||
| Chest pain | Are they anxious? Are they having pain? | Crushing? | Is it reproducible? | EKG, trop, lytes CXR |
| Diarrhea | Is it truly watery? How many times in past 24 hours. Does it smell like C diff? | C diff test if 3 liquid BM in < 24 hrs | ||
| Leg pain / swelling | Ask about all vitals (tachycardia, tachypnea) uncomfortable breathing? | swelling erythema sweaing | painful? SOB? Chest pain?
| CTPE if c/f PE LED
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| Arm swelling | Was there an IV there? Is it infiltrated? Is it painful? | swelling erythema | Monitor + / - UED | |
| Abdominal pain | distended? Hard? rebound tenderness? | Abdominal Xray if ALIF patient, very low threshold for ACS consult or STAT page to general surgery team that operated with us. | ||
| Uncontrolled pain in spine |
| oxy5 for mild pain oxy10 for moderate pain dilaudid for breakthrough pain norco or oral hydromorphone is alternative to oxy (shortage) AIPSS consult | ||
| Uncontrolled pain in cranial | ||||
| Urinary Retention | Straight cath if PVR > 400 cc UA | |||
| Family wants to talk to a doctor | If you are extraordinarily busy (not just being lazy) and it is just a gomey question not related to patient being sick, you can kindly ask nurse to put the family on phone. | |||
CSF Studies
Do this anytime CSF is obtained from LP/EVD/Shunt tap
P1 procedure (OP = , RBC/WBC/glucose/protein/gram stain / Cx)
Urinalysis
TBA
Trach cuff status
TBA
How to transfer patient to Medicine