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Calculating intravenous flow rates
When a provider orders an intravenous infusion, it is your responsibility to make sure that the
fluid will infuse at the prescribed rate. IV fluids may be infused by gravity using manual control
or infused using an infusion pump. Regardless of the method, you will be responsible for
calculating the correct IV flow rate.
Example: The provider has ordered 1,000 mL 0.9% sodium chloride to infuse over 8 hr. You
have a macrodrip tubing with a drop factor of 15 gtt/mL available. Calculate how many gtt/min
to set as the IV flow rate.
Step 1: Choose the formula.
Step 2: Use the formula.
Example: The provider has ordered ranitidine (Zantac) 50 mg in 100 mL 0.9% sodium chloride
intravenous piggyback to be infused over 20 min. You have a macrodrip tubing with a drop factor
of 10 gtt/mL. Calculate how many gtt/min to set as the IV flow rate.
Step 1: Choose the formula.
Step 2: Use the formula.
Example: The provider has ordered 600 mL of 5% dextrose in water to infuse over 8 hr.
Determine how many mL/hr to set the IV pump to deliver.
Step 1: Choose the formula.
Step 2: Use the formula.
Example: The provider has ordered amiodarone (Cordarone) 300 mg in 100 mL to be infused
over 30 min. Determine how many mL/hr to set the IV pump to deliver.
Step 1: Choose the formula.
Step 2: Use the formula.
When calculating the flow rate, first determine whether the intravenous tubing you are using is
microdrip or macrodrip, so that you can use the appropriate drop factor in your calculations. The
drop factor, also called the drip factor, is the calibration or number of drops per mL of solution
delivered for a particular drip chamber. Always check the tubing package to be sure.
Microdrip tubing universally delivers 60 gtt/mL. It is used for infusing small or very precise
amounts of fluids. Macrodrip tubing varies with the manufacturer but usually delivers between 10
gtt/mL and 15 gtt/mL. It is used to infuse large volumes or to infuse fluids quickly.
After you’ve completed your calculations and before you start the infusion, it is important to
mark the bag of fluids with adhesive tape or a commercial time tape next to the volume
markings on the bag. Time taping the IV bag helps you check at a glance that the fluids are
infusing over the correct period of time.
Click image to play
Once an intravenous infusion is initiated, monitor the infusion closely to ensure that it is infusing
at the correct rate. Check the IV site for signs of infiltration and inflammation. How often you
must check varies with the facility, so be sure to become familiar with your facility’s policies and
follow them consistently each time you are caring for a patient who is receiving an IV infusion.
References
Assessing and managing an intravenous site
Patients receiving intravenous (IV) therapy require frequent assessment of the IV site. Each time
you inspect the site, check the solution, tubing, and flow rate as well.
How often you assess an IV site often depends on what is being infused, your patient’s age, and
your agency’s policy. In addition to inspecting the site as required, it is also a good practice to
assess and document the condition of the IV site, solution, tubing, and flow rate at the beginning
of your shift, to establish a baseline at that point in time. You can then compare your ongoing
assessments throughout your shift and at the end of your shift to what you assessed at that
initial point.
When you begin your assessment of an IV site, start by inspecting it for any redness or swelling.
Next, palpate the area around the site and along the vein for any pain, firmness, or swelling.
While palpating, be sure to note the skin temperature near the site and along the vein, especially
if you note any redness.
A peripherally inserted venous catheter is usually replaced every 72 to 96 hours or per your
agency’s policy. If the IV was initiated outside of the hospital setting or in an emergency
situation and there is any question about sterility during the initiation, it is best to remove the
catheter and start a new IV line.
All patients with IV access are at risk for developing IV-related complications, such as phlebitis
and infiltration. Those receiving hypertonic, acidic, or irritating fluids or medications; patients
with fragile veins; and pediatric patients, however, are at higher risk and require especially
frequent assessment.
Phlebitis is characterized by pain, increased skin temperature, and redness along the vein. It is
commonly treated by discontinuing the IV line and applying a moist, warm compress over the
area.
The degree of phlebitis is often documented using a scale that ranges from 0 for no symptoms to
4, the most severe. When determining the degree of phlebitis, use the most severe symptom.
Infiltration results when the IV catheter is dislodged and fluid infuses into the tissue. It is
characterized by edema, pallor, decreased skin temperature around the site, and pain.
Consult your agency’s policy for treatment, which usually involves discontinuing the IV line and
elevating the extremity. It may also recommend applying a warm compress at the site to help
absorb the fluid.
Again, the degree of infiltration is often documentedusing a scale that ranges from 0 for no
symptoms to 4, the most severe. Use the most severe presenting symptom to determine the
degree of infiltration.
Another complication of IV therapy is extravasation. This term is sometimes used
interchangeably with infiltration but more accurately describes a situation when an IV catheter
becomes dislodged and medication infuses into the tissues.
Extravasation is characterized by pain, stinging or burning at the site, swelling, and redness.
Follow your agency’s policy for treatment, which will likely include discontinuing the IV line and
applying a cool compress to the area. If the medication has an antidote, it should be prescribed
and administered immediately.
This complication can be quite serious since some medications, if infused into the tissue rather
than the vein, can cause severe tissue damage. The degree of extravasation is usually
documented using the same scale that is used for determining the degree of infiltration.
Urine specimens
Urine specimens are collected by either a clean-catch method or from a catheter to obtain
diagnostic information and to assess patients’ status. Urine can be screened routinely with a
clean voided specimen collectedduring normal voiding for some
point-of-care tests, with a routine urinalysis performed in a laboratory as indicated. If a urine
specimen is going to be sent for laboratory testing, it must be stored in appropriate conditions
and transported properly to ensure the quality of the sample. For all urine sampling, be sure to
document the method of collection, the patient’s tolerance, and any pertinent physical findings
(including a description of the urine specimen).
Clean-catch urine samples
The clean-catch method is suitable for patients who are able to
understand instructions for depositing a urine sample into a sterile
cup or receptacle. Patient education, including written instructions,
helps ensure that patients use the proper technique. They must
wash their hands prior to providing a sample. Then, with a sterile
cup and clear instructions, they produce the sample. You do not
need to observe them unless they request assistance.
Label urine specimens according to
your facility’s policy prior to sending
them to the laboratory. Refrigerate
them or put on ice until they are
transported (usually in a cooler to
preserve the samples).
When your patient is male
Male anatomy provides a distinct advantage in
providing adequate urine samples with the clean-
catch method. Instruct male patients to direct the
initial stream of urine into the toilet, pause, and
then proceed to urinate into the collection cup. With
the lid in place on the cup, label the sample and
send it to the laboratory for analysis.
When your patient is female
Female patients sometimes encounter difficulty because of the potential to contaminate the
sample with skin or bacteria from the external genitalia surrounding the urethra. Instruct female
patients to wash their hands, hold the collection cup in one hand, and use the other hand to part
their external genitalia to help reduce contamination. Tell them to allow the initial stream of
urine to go into the toilet, pause, and then urinate into the collection cup. With the lid in place on
the cup, label the sample and send it to the laboratory for analysis.
When your patient is a child
Children can obtain clean-catch urine samples, but they might find
it easier with a sterile receptacle placed within the toilet for
specimen collection. Pour the sample from the receptacle into a
sterile collection cup. Then, with the lid in place on the cup, label
the sample and send it to the laboratory for analysis. Do not
squeeze samples from a wet diaper or pad, as the results are likely
to be inaccurate. Some studies have demonstrated accuracy of
some urine tests when urine is collectedin a syringe from a
disposable diaper. However, the preferred and more reliable
collection method for all urine tests is a collection cup or bag.
Sampling urine through a catheter
Perform a straight catheterization if prescribed to obtain a sample
from a patient who is unable to urinate. Use surgical asepsis when
inserting the catheter, and allow a small amount of urine to pass
prior to filling a sterile cup for sampling.
Use the appropriate port for collecting
a urine specimen from a patient who
has an indwelling urinary catheter in
place. Many catheters have a
needleless systemthat involves
cleansing the port and using a syringe
to withdraw a sample from the tubing.
If too little urine is in the tubing,
clamp the catheter below the port to
allow some urine to collect in the
tubing rather than going into the
collection bag. Never take a urine
sample from the collection bag as this
type of sample is often concentrated or contaminated and can alter
the test results. Place the urine sample in a sterile collection cup,
label it, and send it to the laboratory for analysis.
Perform suprapubic catheter sampling similarly to indwelling catheter sampling. Store the sample
on ice or in a refrigerator and transport it as directed by the laboratory.
Urine for point-of-care testing
Urine pregnancy testing requires a first-voided morning sample to
check for levels of human chorionic gonadotropin. This hormone is
produced when the body is preparing for pregnancy. Test kits are
available over the counter; results are not necessarily more
accurate when completed at the site of care.
Most urine pregnancy testing is done
by applying a urine sample to a
chemically treated systemthat shows
positive results by changes in the
color of the paper based on detection
of the hormone. These tests can yield
both false positive and false negative
results. The timing of urine pregnancy
tests determines the validity of the
test, thus an additional blood test is
often recommended. It is important to
document the date of the patient’s
last menstrual period when performing a urine pregnancy test.
Urine drug screening is performed in a similar manner and requires
analysis to confirm positive findings.
Urine for reagent strip testing
The most commonly performed point-of-care urine test is a urine
reagent strip or “dipstick” test. It involves placing a chemically
treated strip into a random urine sample collected in a clean cup
and observing color changes on the strip.
Most reagent strips provide information about pH, specific gravity,
leukocytes or leukocyte esterase, blood, ketones, bilirubin or
urobilinogen, and glucose (depending on the type of reagent strip
used). The pH, an indicator of acid-base balance, can range
between 4.6 and 8.0 and should be about 6.0 for a urine specimen.
This is pertinent when examining bacterial growth because bacteria
grow more easily in an alkaline environment than in an acidic
environment. (Samples left unrefrigerated for extended periods will
become more alkaline, resulting in higher and inaccurate bacteria
counts.) Specific gravity is an indicator of the concentration of the
urine. The expected range for urine specific gravity is 1.0053 to
1.030. A specific gravity below 1.010 indicates dilute urine. A
specific gravity above 1.010 indicates concentrated urine. Highly
concentrated urine can be an indicator of dehydration.
All other components of the urine reagent test strip should be
negative in a normal urine sample. Leukocytes and leukocyte
esterase indicate the presence of infection. Blood in the urine can
indicate infection, cancer, and other pathology. Ketones are products of fat metabolism; their
presence in urine may indicate diabetes mellitus. Bilirubin and urobilinogen in the urine can
indicate liver disease or red blood cell destruction. Nitrites in the urine can indicate infection.
Glucose in the urine can indicate diabetes mellitus. Urine reagent test strips are used as a
screening tool and are not considered diagnostic. Therefore, any unusual findings on a urine
reagent test must be confirmed by laboratory analysis.
Laboratory analysis of urine specimens
Laboratory analysis of urine specimens can be done to confirm
findings from point-of-care tests or to conduct various other
diagnostic tests. The most commonly ordered laboratory test is
urinalysis with culture and sensitivity (C & S), used to diagnose
urinary tract infection (UTI). If an elevated white blood cell count
(above the expected reference range of 0 to 4,000/mm3
) is found in
the urine reagent test sample, the culture is set up and then
sensitivity testing (to identify the appropriate antibiotic treatment)
is completed. Sensitivity testing is also helpful in identifying drug-
resistant bacteria. Many providers now wait for C & S results to
return before treating a patient for a UTI. Laboratory analysis of
urine specimens allows for a more accurate analysis and
confirmation of findings.
Timed urine specimens are usually collected for 24 hours (although
2- and 12-hour collections are sometimes ordered). They are most
often done to determine creatinine clearance or to measure protein
or hormone levels. The timing begins right after the patient
urinates (with that urine discarded). The patient then urinates into a container each time during
the prescribed time period, and the collection of urine is kept on ice. If the patient urinates and
discards the urine, timing the specimen must begin again with the next urination.
Neutropenia, precautions – white blood cell count drops below 1,000/mm3 – private room - no fresh
flowers,freshfruitsorveggiesandnomilk. Keep designated equipment in the client’s room (blood pressure,
therm.) Hand hygiene, transport for procedures with mask. Administer colony-stimulating factors filgrastim
(Neupogen, Neulasta) as prescribed to promote white blood cell production.
ulcerative colitis –may nottolerate foodwithiron
chronic renal failure diet - Limiting fluids, Eating a low-protein
diet, Limiting salt, potassium, phosphorous, and other electrolytes, Getting enough calories
if you are losing weight
ATI PredictorA
rename
za105's versionfrom12-18-2013
edit
Section 1
Question Answer
What isa kosherdiet?
No shellfishbutyesfishwithfinsandscales;
no pork;no mixingmeatwithmilk,ever;
Woman ispostpelvicsurgeryandaskswhy she hasa foley
catheterinserted,whatisyourresponse?
It avoidsstressonthe incisionsite/bladder
Crutcheson whatside whenrising?Whenwalking?
Unaffectedside whenrising,affectedside
while walking.
Armsat whatdegreeswhenhandsoncrutchrailswhile
standing?
30 degrees
What walkinggate forstairs? 3 point
Normal stomafindings
Moist shinyandpink;mildsoapandwager,
thendry gentlyandcompletely,applypaste
if used,applybarrierpastestocreases
Cholecystitisdiet
No cheese!!Low fat,low cholesterol (<200),
if AST and lipase,anytype of bilirubin,WBC,
amylase,LDH,are elevated,bad.
Expectwhatduringthe latentphase of labor.
(0-3, 5-30, 30-45) 0-3cm, contractionsmild
and moderate,5-30min.apart/30-45
seconds.
Contractions3 minutesapart= whatphase of labor? Active
Variable decelerations=what?Intervention?
Cord compression!Prepforemergency c-
sectionorinducinglabor.Alsocanchange
position,d/coxytocin,O28-10L/minper
mask,perform/assistwithvaginal exam,
assistwithamnioinfusionif ordered
Whichof the followingisthe initial nursingactionthe
nurse shouldtake whenlate decelerationsappearonthe
fetal monitor?A.Repositionthe clientintoleft-lateral
positionB.Applyafetal scalpelectrode C.Increase the IV
fluidrate D. Performavaginal examtoassessdilation
Repositionclientleft-lateral position
Bestpainmanagementfor8-10 postopen
cholecystectomy:Demerol,hydromorphone,fentanyl,
morphine
Demerol,NOTmorphine orothers.
Morphine can cause biliaryspasms.
Fontanelsclose when?
Posterior2-3 months,anterior12-18
months
Do youreport chlamydia,doyouneed consent,etc.
MandatedreportingtoCDC, withoutverbal
or writtenconsent
EmptyJP drainwhen?Cleanhow?
Before half full,orevery8-12 hours,NOT24
hours.Cleanwithsoapand water,NOT
antimicrobialsorDakin'setc.
If JP drainage hasdoubledinlasttwohours,possible
cause?
Hemorrhage.Soassess,statCBC, notify
physician.
What do bananas,avocadoand spinachhave incommon?
If patienton whatmed,these are goodfoods?
^ K+, sogood forhypokalemicpatients.If
patientsonthiazide diuretics (Diuril,
Enduron),maybe HYPOkalemic,sogive
these
MAOI's/Nardil,avoidwhat? cheese!
Cheese isnotgoodwithwhat?Cheese isgoodforwhat
and why?
Nardil/MAOI's!Goodforhyponatremia
because highinsodium, highinprotein
Is drainage at pinsites okwithbuckstraction?
Drainage ok,note the type,odor,color and
amount.Leave crust as a barrier,pincare
3x/day
Phenytoin,SMZ-TMP,commandhallucinations=what? Phenytointoxicity!
If patienthas commandhallucinations,withholdmed? Yes!
memorize
edit
Section 2
Question Answer
Methergine risk?Whatdoesitdo?
Treats postpartumhemorrhage by
inducinguterine contractions,
reducinghemorrhage.HYPERTENSION
isa risk,soCHECK BP prior to
administration,watchforn/v,
headache,
Highpressure alarm,dowhat?
Assessforkinks,clientbiting,excess
secretions(suction),pulmonary
edema,etc.Notifyprovider
Low pressure alarm,dowhat?
Assessforleaks,displacement.If can't
findanythingwrong,MANUALLY
VENTILATEANDCALL RESPIRATORY
STAT, doNOT LEAVE ALONE
2 yearsof age, presentationof armslongerthantorso,or
roundand softabdomen?
Roundand softabdomen,NOTarms
longerthantorso
3 yearsof age normals;immunizations?
2-3kg/yr,2.5-3in./yr.,pickyeater,
initiativevs.guilt,imaginaryfriends,
ride tricycle,jumpoff bottomstep,
standon one footfor few seconds.
DTaP, IPV,MMR, varicella,influenza
Firstthingto do witha newborn:Take temperature,weigh,
dry...
Dry
Terminallyill patientonlywantsfamily,notfriendswiththem.
Type of grief?
Anticipatory,notdysfunctional,
normal,or disenfranchised.
A clientinvolvedinamotorvehicle crashpresentstothe
emergencydepartmentwithsevere internal bleeding.The
clientisseverelyhypotensiveandunresponsive.The nurse
anticipatesthatwhichIV solutionwill mostlikelybe prescribed
to increase intravascularvolume,replace immediate bloodloss
volume,andincrease BP?1.5% dextrose inlactatedRinger's2.
0.33% sodiumchloride (1/3normal saline) 3.0.225% sodium
chloride (1/4normal saline) 4.0.45% sodiumchloride (1/2
normal saline)
5% dextrose inLR
Give whatfor hypovolemicshock 5% dextrose inLR
Client'sfamilyasksyoutopraywiththem.Response? Refertospiritual services
Aftera bloodinfusion,willyoulookathub,hct, BP,or HR for
changes?
Hgb! 1-2 pointincrease perunitof
blood.
Can yougive an antibioticinaTPN infusionline?Whatcanyou
add to a TPN infusionline?
NO!Nothing!
Change a TPN infusionline every24hours,or how often? Yes!Every24 hours
Can client'sfamilychange dressingdaily?Tie tubingtoneck?
No,every8 hours!Yes, square knot
with1-2 fingerwidths,
TPN,slowdowninfusionbefore ending,d/cuntil new bag
ready?
No,don't d/c or change rate,don't
change flow rate!
Hip arthroplasty,whattowatch outfor?
Peripheral pulses!Socool and weak,
1+ peripheral pulses,signtocall
provider.
Mom engorged,don'tdowhat?
Don't self expressmilk!Ice packs,
supportbra all ok.
Rifampin,isoniazid,phenytoin,what'sup?
INH/Isoniazidincreasesphenytoin
toxicity,meaningataxiaand
hallucinationsmaypresent.Decrease
phenytoindosage.Hepatotoxicity
possible withrifampin.
Palpate fontanelsby2-3 years?
No!Bulgingfontanelscouldmean^
ICP,meningitis.
FirstpriorityforDKA patients
ESTABLISH VENOUSACCESS,before
ANYTHING.
memorize
edit
Section 3
Question Answer
DKA patientdropsglucose from450 to 250, do
what?Measure glucose,temp,what,andhow
often?
Measure glucose & potassiumhourly,provide IV
glucose at 250 to preventhypoglycemia.
PatienthasL1-L2 paralysis,liveswithspouse,
bathroomand bedroomon2nd floor.NeedsPT,
respite,speechtherapy,what?
Needsoccupational andphysical therapy,butsocial
servicesisnumberone forhelpwithhome
adaptation!
Highestriskto patientisbedtrayleftinroom,
tray table at endof bed,restraintstiedtobed
rails?
Restraintstobedrails!Thisis inappropriate.
Infanthas scalyspots,erythemicpapillae,and
somethingonlips.Reportwhichtophysician?
Lips!
A womancomesinto you andsays she ison
contraceptionandwantsto getpregnant.What
isshe at riskfor?
If IUD, then ectopicpregnancy!
Infanthas substernal heaves,expectwhat? O2, suction,Survantaforsurfactant,vent.support
aPTT normal 25-35
Plateletsnormal 150-400
aPTT 30 and platelets200,what's wrong? Nothing
Can youdelegate anLPN to checkNG tube
placement?Cantheyprovide firstfeedingafter
CVA?
Yes,accordingto book; notclear,but assume no,
because highriskscenario
Ventriculartachycardia/Vtach=what ECG? WIDENED QRS
What can a 3-montholdeat,carrots, grapes,
graham crackers,or popcorn?
Graham crackers
Dehydration=what v/s
Low BP,highHR, metabolicacidosis(low pH,high
bicarb).postural hypotension,H&H,BUN and other
elevated
Glucose reaches250 on insulin,givewhat?
Isotonic,hypotonic,hypertonic,dextrose?
Dextrose toprevent hypoglycemia.
Bendat waistto pickup, or tuck pelvisandflex
abs?
Flex andtuck,NEVER bendat waist
Give patientcoolingblanketwhenfebrile,whatis
signof adverse reaction?
Shivering
Can digoxintoxicityoccurwith3.2 potassium? Yes
130/86 BP, severe headache,whatwouldyou
reportin pretermlabortoprovider?
Severe headache!!HYPERTENSIVECRISIS
S/Sof magnesiumsulfatetoxicity?2main
interventions
urine output< 30, RR < 12, no deeppatellartendon
reflexes,decreasedLOC,cardiacdysrhythmias.
IMMEDIATELY D/C, give CALCIUMGLUCONATE
Tuna goodfor what,bad for what? Highin proteinANDpotassium, sowatchout.
If anemic,increase ordecrease milk,andgive
ironor no?
Decrease milkasitinterfereswithironabsorption,
and theyneed iron;give iron!
memorize
edit
Section 4
Question Answer
Reportwhat aftera
craniotomy?
Aphasia,because thismeansincreasedICPr/tincreasedbleedingwhich
isthe highestrisk.KeepHOBat30
Prednison10months,ok?
Watch for what?
Long termnot recommend,neverchange dosage,watchfor
osteoporosis,AVOIDLARGECROWDSdue to ^ riskfor infection
, ATI Predictor B
rename
za105's versionfrom12-19-2013
edit
Section 1
Question Answer
Nurse iseducatingonlosingone poundaweek;how manycalories? 500 caloriesaday
Bad signwitha motherwithnewborn? Disapproval
Dietfor glomerulonephritis? Low sodium, waterrestriction
Pediatricpatientdehydrated,afterinitial oral rehydration,givewater,
juice,orgingerale?
None!
Postoperativecare fora clientfollowingacolonresectionfor
colorectal cancerincludeswhichof the following?(Selectall that
apply.) Reporttothe providerthatthe stoma isred incolor andhas
serosanguineousdischarge.Monitorandtreatpain,andevaluate pain-
relief measures.Startafull liquiddietuponreturntomedical unit.
Provide woundcare usingsurgical aseptictechnique.Advise the client
to use stool softenerstopreventstraining.
2, 4, 5
Naegele'srule? -3+7
Boggyuterus,do what? Massage the fundus!
Vertebrae relatedtoparalysis?
Below orabove L1-L2 =
paralysis
Priorityinfectionforamniotomy? FEVER/INFECTION!
Patienthasstairs,has hada stroke,andhas trouble communicating—
prioritytherapy?
Speechr/tABC
Bestto orientwhat?What not?
Follow nurse,NOTskills
checklist
What can grant informedconsent?
Parentof minor,spouse or
closestrelative grantedpower
of attorney,court-orderedrep.,
legal guardian
Impairednurse,dowhat? Reportto CHARGE NURSE
Med error iswhattrait, like fidelity,veracity,beneficence? Veracity
Patientupand walking,pain8,needwhattype of painmanagement? PCA pump,prn morphine
Singulair
Preventexercise-induced
bronchospasm, andforlong-
termuse.Take ONCEDAILY AT
BED TIME
Take peakgentamicin(aminoglycoside) when?Trough?
30 minutesaftergivingIM,or
30 minutesafterIV has
finished;troughimmediately
before givingnextdose
Lithiumlevels? 0.4-1.0
S/Sof earlylithiumtoxicity?
Slurredspeech,NVD,thirst,
polyuria,muscle weakness
What's up withcentral linesandpushingmedswithresistance?
Don't do it!May be dislodginga
thrombosis!
If you run outof TPN,do what? Hang dextrose
memorize
edit
Section 2
Question Answer
Have clientdo what withanthrax? Stripdown!
Asthmaand beta-blockers(lols) Don't give lols/betablockerstoasthmapatients!
ACE-inhibitors? Dry cough
How doesdopamine work,by
vasodilatingorincreasingcardiac
output?
Increasingcardiacoutput
Thorazine HOLD IF SHUFFLING
Fentanyl patchchangingtime 72 hours,48 of intolerant
Long termeffectof corticosteroids Losinghairon legs
ChronicemphysemaABG? RESP.ACID. (low pH,low CO2 35-45)
IncreasedPAWPmeanswhat?
Reference
4-12, ^ meansL-sidedfailure
A patientisexperiencingumbilical
cord prolapse—intervention?
Put handup vaginaandholdit there
GERD s/s Atypical chestpainandSOB
Reglan
extrapyramidal sideeffectse.g.twitching,facial spasms.Give
antihistaminetohelp.
Iron deficiencyanemialabresults Hgb <12, Hct < 33
Arteriovenousfistulafact Don't measure BPon thisside!
Withoxygentoxicity,will yousee
hypoor hyperventilation?
HYPOVENTILATION
Explainirrigatingwithsolution Hold1 inchabove
Woundhas dehisced,dowhat? Put saline soakedsterilegauze over
What ishistrionicpersonality
disorder?
FLIRTY AND SEDUCTIVE
Expectedfindingsof schizophrenia?
Memorydeficit,difficultyconcentrating,disorderedthinking,
poor problemsolvinganddecision-making
What testfor breastcancer vs.
ovariancancer?
HER2 (her2 boobs) gene =breastAFTER biopsy,butBRCA1 isfor
detectingbreastcancerwithoutbiopsy(BReastCancer),CA-125
(clitarea) = ovarian
memorize
edit
Section 3
Question Answer
Appropriate post-opcare fordiabetes? VitaminC!
Flusha central line withhowmanymL? 10! 3 if peripheral
What doesabnormal PAPsmearindicate? Cervical cancer
What to tell womantryingtoget
pregnant?
Afterstops,maytake a while
Treatmentforchlamydia,bothmomand
baby?Timingforbaby?
Zithromax,amoxicillin,anderythromycinforbothmomand
babyIMMEDIATELY FOLLOWINGDELIVERY
Decontaminationforradiation Soap andwaterand disposable towels
Insuline,rotate site orno? DO NOT ROTATE SITE
Valproicacid liverfailure,jaundice
Firstthingfor implementingstaff
changes?
INVESTIGATESTAFFINGISSUESwithTASKFORCE
No consentfromED to surgery,dowhat? Get official interpreter!
Heavylochia,boggyfunds,dowhat? GIVE OXYTOCIN
AutismATI Lack of responsiveness
FrequentVARIABLEDECELERATIONS Turn on LEFT SIDE first
PostEGD, whatto watch for? COOL CLAMMY SKIN,signof perforation
Cytoxanforneuroblastomasintoddlers HYDRATE LIBERALLY
Riskfor diabetesinsipidus? Monitorfor POLYURIA
Postpartum,immediate action? Boggyuterus
Cushing'sdisease,2things Moon face,^ cortisol
Memoryloss= ^ ICP

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  • 1. Calculating intravenous flow rates When a provider orders an intravenous infusion, it is your responsibility to make sure that the fluid will infuse at the prescribed rate. IV fluids may be infused by gravity using manual control or infused using an infusion pump. Regardless of the method, you will be responsible for calculating the correct IV flow rate. Example: The provider has ordered 1,000 mL 0.9% sodium chloride to infuse over 8 hr. You have a macrodrip tubing with a drop factor of 15 gtt/mL available. Calculate how many gtt/min to set as the IV flow rate. Step 1: Choose the formula. Step 2: Use the formula. Example: The provider has ordered ranitidine (Zantac) 50 mg in 100 mL 0.9% sodium chloride intravenous piggyback to be infused over 20 min. You have a macrodrip tubing with a drop factor of 10 gtt/mL. Calculate how many gtt/min to set as the IV flow rate. Step 1: Choose the formula.
  • 2. Step 2: Use the formula. Example: The provider has ordered 600 mL of 5% dextrose in water to infuse over 8 hr. Determine how many mL/hr to set the IV pump to deliver. Step 1: Choose the formula. Step 2: Use the formula. Example: The provider has ordered amiodarone (Cordarone) 300 mg in 100 mL to be infused over 30 min. Determine how many mL/hr to set the IV pump to deliver. Step 1: Choose the formula. Step 2: Use the formula. When calculating the flow rate, first determine whether the intravenous tubing you are using is microdrip or macrodrip, so that you can use the appropriate drop factor in your calculations. The
  • 3. drop factor, also called the drip factor, is the calibration or number of drops per mL of solution delivered for a particular drip chamber. Always check the tubing package to be sure. Microdrip tubing universally delivers 60 gtt/mL. It is used for infusing small or very precise amounts of fluids. Macrodrip tubing varies with the manufacturer but usually delivers between 10 gtt/mL and 15 gtt/mL. It is used to infuse large volumes or to infuse fluids quickly. After you’ve completed your calculations and before you start the infusion, it is important to mark the bag of fluids with adhesive tape or a commercial time tape next to the volume markings on the bag. Time taping the IV bag helps you check at a glance that the fluids are infusing over the correct period of time. Click image to play Once an intravenous infusion is initiated, monitor the infusion closely to ensure that it is infusing at the correct rate. Check the IV site for signs of infiltration and inflammation. How often you must check varies with the facility, so be sure to become familiar with your facility’s policies and follow them consistently each time you are caring for a patient who is receiving an IV infusion. References Assessing and managing an intravenous site
  • 4. Patients receiving intravenous (IV) therapy require frequent assessment of the IV site. Each time you inspect the site, check the solution, tubing, and flow rate as well. How often you assess an IV site often depends on what is being infused, your patient’s age, and your agency’s policy. In addition to inspecting the site as required, it is also a good practice to assess and document the condition of the IV site, solution, tubing, and flow rate at the beginning of your shift, to establish a baseline at that point in time. You can then compare your ongoing assessments throughout your shift and at the end of your shift to what you assessed at that initial point. When you begin your assessment of an IV site, start by inspecting it for any redness or swelling. Next, palpate the area around the site and along the vein for any pain, firmness, or swelling. While palpating, be sure to note the skin temperature near the site and along the vein, especially if you note any redness.
  • 5. A peripherally inserted venous catheter is usually replaced every 72 to 96 hours or per your agency’s policy. If the IV was initiated outside of the hospital setting or in an emergency situation and there is any question about sterility during the initiation, it is best to remove the catheter and start a new IV line. All patients with IV access are at risk for developing IV-related complications, such as phlebitis and infiltration. Those receiving hypertonic, acidic, or irritating fluids or medications; patients with fragile veins; and pediatric patients, however, are at higher risk and require especially frequent assessment. Phlebitis is characterized by pain, increased skin temperature, and redness along the vein. It is commonly treated by discontinuing the IV line and applying a moist, warm compress over the area.
  • 6. The degree of phlebitis is often documented using a scale that ranges from 0 for no symptoms to 4, the most severe. When determining the degree of phlebitis, use the most severe symptom. Infiltration results when the IV catheter is dislodged and fluid infuses into the tissue. It is characterized by edema, pallor, decreased skin temperature around the site, and pain.
  • 7. Consult your agency’s policy for treatment, which usually involves discontinuing the IV line and elevating the extremity. It may also recommend applying a warm compress at the site to help absorb the fluid. Again, the degree of infiltration is often documentedusing a scale that ranges from 0 for no symptoms to 4, the most severe. Use the most severe presenting symptom to determine the degree of infiltration. Another complication of IV therapy is extravasation. This term is sometimes used interchangeably with infiltration but more accurately describes a situation when an IV catheter becomes dislodged and medication infuses into the tissues. Extravasation is characterized by pain, stinging or burning at the site, swelling, and redness. Follow your agency’s policy for treatment, which will likely include discontinuing the IV line and applying a cool compress to the area. If the medication has an antidote, it should be prescribed and administered immediately. This complication can be quite serious since some medications, if infused into the tissue rather than the vein, can cause severe tissue damage. The degree of extravasation is usually documented using the same scale that is used for determining the degree of infiltration.
  • 8. Urine specimens Urine specimens are collected by either a clean-catch method or from a catheter to obtain diagnostic information and to assess patients’ status. Urine can be screened routinely with a clean voided specimen collectedduring normal voiding for some point-of-care tests, with a routine urinalysis performed in a laboratory as indicated. If a urine specimen is going to be sent for laboratory testing, it must be stored in appropriate conditions and transported properly to ensure the quality of the sample. For all urine sampling, be sure to document the method of collection, the patient’s tolerance, and any pertinent physical findings (including a description of the urine specimen). Clean-catch urine samples The clean-catch method is suitable for patients who are able to understand instructions for depositing a urine sample into a sterile cup or receptacle. Patient education, including written instructions, helps ensure that patients use the proper technique. They must wash their hands prior to providing a sample. Then, with a sterile cup and clear instructions, they produce the sample. You do not need to observe them unless they request assistance. Label urine specimens according to your facility’s policy prior to sending them to the laboratory. Refrigerate them or put on ice until they are transported (usually in a cooler to preserve the samples). When your patient is male
  • 9. Male anatomy provides a distinct advantage in providing adequate urine samples with the clean- catch method. Instruct male patients to direct the initial stream of urine into the toilet, pause, and then proceed to urinate into the collection cup. With the lid in place on the cup, label the sample and send it to the laboratory for analysis. When your patient is female Female patients sometimes encounter difficulty because of the potential to contaminate the sample with skin or bacteria from the external genitalia surrounding the urethra. Instruct female patients to wash their hands, hold the collection cup in one hand, and use the other hand to part their external genitalia to help reduce contamination. Tell them to allow the initial stream of urine to go into the toilet, pause, and then urinate into the collection cup. With the lid in place on the cup, label the sample and send it to the laboratory for analysis. When your patient is a child Children can obtain clean-catch urine samples, but they might find it easier with a sterile receptacle placed within the toilet for specimen collection. Pour the sample from the receptacle into a sterile collection cup. Then, with the lid in place on the cup, label the sample and send it to the laboratory for analysis. Do not squeeze samples from a wet diaper or pad, as the results are likely to be inaccurate. Some studies have demonstrated accuracy of some urine tests when urine is collectedin a syringe from a disposable diaper. However, the preferred and more reliable collection method for all urine tests is a collection cup or bag. Sampling urine through a catheter
  • 10. Perform a straight catheterization if prescribed to obtain a sample from a patient who is unable to urinate. Use surgical asepsis when inserting the catheter, and allow a small amount of urine to pass prior to filling a sterile cup for sampling. Use the appropriate port for collecting a urine specimen from a patient who has an indwelling urinary catheter in place. Many catheters have a needleless systemthat involves cleansing the port and using a syringe to withdraw a sample from the tubing. If too little urine is in the tubing, clamp the catheter below the port to allow some urine to collect in the tubing rather than going into the collection bag. Never take a urine sample from the collection bag as this type of sample is often concentrated or contaminated and can alter the test results. Place the urine sample in a sterile collection cup, label it, and send it to the laboratory for analysis.
  • 11. Perform suprapubic catheter sampling similarly to indwelling catheter sampling. Store the sample on ice or in a refrigerator and transport it as directed by the laboratory. Urine for point-of-care testing Urine pregnancy testing requires a first-voided morning sample to check for levels of human chorionic gonadotropin. This hormone is produced when the body is preparing for pregnancy. Test kits are available over the counter; results are not necessarily more accurate when completed at the site of care. Most urine pregnancy testing is done by applying a urine sample to a chemically treated systemthat shows positive results by changes in the color of the paper based on detection of the hormone. These tests can yield both false positive and false negative results. The timing of urine pregnancy tests determines the validity of the test, thus an additional blood test is often recommended. It is important to document the date of the patient’s last menstrual period when performing a urine pregnancy test. Urine drug screening is performed in a similar manner and requires analysis to confirm positive findings. Urine for reagent strip testing The most commonly performed point-of-care urine test is a urine reagent strip or “dipstick” test. It involves placing a chemically treated strip into a random urine sample collected in a clean cup and observing color changes on the strip.
  • 12. Most reagent strips provide information about pH, specific gravity, leukocytes or leukocyte esterase, blood, ketones, bilirubin or urobilinogen, and glucose (depending on the type of reagent strip used). The pH, an indicator of acid-base balance, can range between 4.6 and 8.0 and should be about 6.0 for a urine specimen. This is pertinent when examining bacterial growth because bacteria grow more easily in an alkaline environment than in an acidic environment. (Samples left unrefrigerated for extended periods will become more alkaline, resulting in higher and inaccurate bacteria counts.) Specific gravity is an indicator of the concentration of the urine. The expected range for urine specific gravity is 1.0053 to 1.030. A specific gravity below 1.010 indicates dilute urine. A specific gravity above 1.010 indicates concentrated urine. Highly concentrated urine can be an indicator of dehydration. All other components of the urine reagent test strip should be negative in a normal urine sample. Leukocytes and leukocyte esterase indicate the presence of infection. Blood in the urine can indicate infection, cancer, and other pathology. Ketones are products of fat metabolism; their presence in urine may indicate diabetes mellitus. Bilirubin and urobilinogen in the urine can indicate liver disease or red blood cell destruction. Nitrites in the urine can indicate infection. Glucose in the urine can indicate diabetes mellitus. Urine reagent test strips are used as a screening tool and are not considered diagnostic. Therefore, any unusual findings on a urine reagent test must be confirmed by laboratory analysis. Laboratory analysis of urine specimens Laboratory analysis of urine specimens can be done to confirm findings from point-of-care tests or to conduct various other diagnostic tests. The most commonly ordered laboratory test is urinalysis with culture and sensitivity (C & S), used to diagnose urinary tract infection (UTI). If an elevated white blood cell count (above the expected reference range of 0 to 4,000/mm3 ) is found in the urine reagent test sample, the culture is set up and then sensitivity testing (to identify the appropriate antibiotic treatment) is completed. Sensitivity testing is also helpful in identifying drug- resistant bacteria. Many providers now wait for C & S results to return before treating a patient for a UTI. Laboratory analysis of urine specimens allows for a more accurate analysis and confirmation of findings. Timed urine specimens are usually collected for 24 hours (although 2- and 12-hour collections are sometimes ordered). They are most often done to determine creatinine clearance or to measure protein or hormone levels. The timing begins right after the patient urinates (with that urine discarded). The patient then urinates into a container each time during the prescribed time period, and the collection of urine is kept on ice. If the patient urinates and discards the urine, timing the specimen must begin again with the next urination.
  • 13. Neutropenia, precautions – white blood cell count drops below 1,000/mm3 – private room - no fresh flowers,freshfruitsorveggiesandnomilk. Keep designated equipment in the client’s room (blood pressure, therm.) Hand hygiene, transport for procedures with mask. Administer colony-stimulating factors filgrastim (Neupogen, Neulasta) as prescribed to promote white blood cell production. ulcerative colitis –may nottolerate foodwithiron chronic renal failure diet - Limiting fluids, Eating a low-protein diet, Limiting salt, potassium, phosphorous, and other electrolytes, Getting enough calories if you are losing weight ATI PredictorA rename za105's versionfrom12-18-2013 edit Section 1 Question Answer What isa kosherdiet? No shellfishbutyesfishwithfinsandscales; no pork;no mixingmeatwithmilk,ever; Woman ispostpelvicsurgeryandaskswhy she hasa foley catheterinserted,whatisyourresponse? It avoidsstressonthe incisionsite/bladder Crutcheson whatside whenrising?Whenwalking? Unaffectedside whenrising,affectedside while walking. Armsat whatdegreeswhenhandsoncrutchrailswhile standing? 30 degrees What walkinggate forstairs? 3 point Normal stomafindings Moist shinyandpink;mildsoapandwager, thendry gentlyandcompletely,applypaste if used,applybarrierpastestocreases Cholecystitisdiet No cheese!!Low fat,low cholesterol (<200), if AST and lipase,anytype of bilirubin,WBC, amylase,LDH,are elevated,bad.
  • 14. Expectwhatduringthe latentphase of labor. (0-3, 5-30, 30-45) 0-3cm, contractionsmild and moderate,5-30min.apart/30-45 seconds. Contractions3 minutesapart= whatphase of labor? Active Variable decelerations=what?Intervention? Cord compression!Prepforemergency c- sectionorinducinglabor.Alsocanchange position,d/coxytocin,O28-10L/minper mask,perform/assistwithvaginal exam, assistwithamnioinfusionif ordered Whichof the followingisthe initial nursingactionthe nurse shouldtake whenlate decelerationsappearonthe fetal monitor?A.Repositionthe clientintoleft-lateral positionB.Applyafetal scalpelectrode C.Increase the IV fluidrate D. Performavaginal examtoassessdilation Repositionclientleft-lateral position Bestpainmanagementfor8-10 postopen cholecystectomy:Demerol,hydromorphone,fentanyl, morphine Demerol,NOTmorphine orothers. Morphine can cause biliaryspasms. Fontanelsclose when? Posterior2-3 months,anterior12-18 months Do youreport chlamydia,doyouneed consent,etc. MandatedreportingtoCDC, withoutverbal or writtenconsent EmptyJP drainwhen?Cleanhow? Before half full,orevery8-12 hours,NOT24 hours.Cleanwithsoapand water,NOT antimicrobialsorDakin'setc. If JP drainage hasdoubledinlasttwohours,possible cause? Hemorrhage.Soassess,statCBC, notify physician. What do bananas,avocadoand spinachhave incommon? If patienton whatmed,these are goodfoods? ^ K+, sogood forhypokalemicpatients.If patientsonthiazide diuretics (Diuril, Enduron),maybe HYPOkalemic,sogive these MAOI's/Nardil,avoidwhat? cheese! Cheese isnotgoodwithwhat?Cheese isgoodforwhat and why? Nardil/MAOI's!Goodforhyponatremia because highinsodium, highinprotein
  • 15. Is drainage at pinsites okwithbuckstraction? Drainage ok,note the type,odor,color and amount.Leave crust as a barrier,pincare 3x/day Phenytoin,SMZ-TMP,commandhallucinations=what? Phenytointoxicity! If patienthas commandhallucinations,withholdmed? Yes! memorize edit Section 2 Question Answer Methergine risk?Whatdoesitdo? Treats postpartumhemorrhage by inducinguterine contractions, reducinghemorrhage.HYPERTENSION isa risk,soCHECK BP prior to administration,watchforn/v, headache, Highpressure alarm,dowhat? Assessforkinks,clientbiting,excess secretions(suction),pulmonary edema,etc.Notifyprovider Low pressure alarm,dowhat? Assessforleaks,displacement.If can't findanythingwrong,MANUALLY VENTILATEANDCALL RESPIRATORY STAT, doNOT LEAVE ALONE 2 yearsof age, presentationof armslongerthantorso,or roundand softabdomen? Roundand softabdomen,NOTarms longerthantorso 3 yearsof age normals;immunizations? 2-3kg/yr,2.5-3in./yr.,pickyeater, initiativevs.guilt,imaginaryfriends, ride tricycle,jumpoff bottomstep, standon one footfor few seconds. DTaP, IPV,MMR, varicella,influenza Firstthingto do witha newborn:Take temperature,weigh, dry... Dry Terminallyill patientonlywantsfamily,notfriendswiththem. Type of grief? Anticipatory,notdysfunctional, normal,or disenfranchised.
  • 16. A clientinvolvedinamotorvehicle crashpresentstothe emergencydepartmentwithsevere internal bleeding.The clientisseverelyhypotensiveandunresponsive.The nurse anticipatesthatwhichIV solutionwill mostlikelybe prescribed to increase intravascularvolume,replace immediate bloodloss volume,andincrease BP?1.5% dextrose inlactatedRinger's2. 0.33% sodiumchloride (1/3normal saline) 3.0.225% sodium chloride (1/4normal saline) 4.0.45% sodiumchloride (1/2 normal saline) 5% dextrose inLR Give whatfor hypovolemicshock 5% dextrose inLR Client'sfamilyasksyoutopraywiththem.Response? Refertospiritual services Aftera bloodinfusion,willyoulookathub,hct, BP,or HR for changes? Hgb! 1-2 pointincrease perunitof blood. Can yougive an antibioticinaTPN infusionline?Whatcanyou add to a TPN infusionline? NO!Nothing! Change a TPN infusionline every24hours,or how often? Yes!Every24 hours Can client'sfamilychange dressingdaily?Tie tubingtoneck? No,every8 hours!Yes, square knot with1-2 fingerwidths, TPN,slowdowninfusionbefore ending,d/cuntil new bag ready? No,don't d/c or change rate,don't change flow rate! Hip arthroplasty,whattowatch outfor? Peripheral pulses!Socool and weak, 1+ peripheral pulses,signtocall provider. Mom engorged,don'tdowhat? Don't self expressmilk!Ice packs, supportbra all ok. Rifampin,isoniazid,phenytoin,what'sup? INH/Isoniazidincreasesphenytoin toxicity,meaningataxiaand hallucinationsmaypresent.Decrease phenytoindosage.Hepatotoxicity possible withrifampin. Palpate fontanelsby2-3 years? No!Bulgingfontanelscouldmean^ ICP,meningitis. FirstpriorityforDKA patients ESTABLISH VENOUSACCESS,before ANYTHING.
  • 17. memorize edit Section 3 Question Answer DKA patientdropsglucose from450 to 250, do what?Measure glucose,temp,what,andhow often? Measure glucose & potassiumhourly,provide IV glucose at 250 to preventhypoglycemia. PatienthasL1-L2 paralysis,liveswithspouse, bathroomand bedroomon2nd floor.NeedsPT, respite,speechtherapy,what? Needsoccupational andphysical therapy,butsocial servicesisnumberone forhelpwithhome adaptation! Highestriskto patientisbedtrayleftinroom, tray table at endof bed,restraintstiedtobed rails? Restraintstobedrails!Thisis inappropriate. Infanthas scalyspots,erythemicpapillae,and somethingonlips.Reportwhichtophysician? Lips! A womancomesinto you andsays she ison contraceptionandwantsto getpregnant.What isshe at riskfor? If IUD, then ectopicpregnancy! Infanthas substernal heaves,expectwhat? O2, suction,Survantaforsurfactant,vent.support aPTT normal 25-35 Plateletsnormal 150-400 aPTT 30 and platelets200,what's wrong? Nothing Can youdelegate anLPN to checkNG tube placement?Cantheyprovide firstfeedingafter CVA? Yes,accordingto book; notclear,but assume no, because highriskscenario Ventriculartachycardia/Vtach=what ECG? WIDENED QRS What can a 3-montholdeat,carrots, grapes, graham crackers,or popcorn? Graham crackers Dehydration=what v/s Low BP,highHR, metabolicacidosis(low pH,high bicarb).postural hypotension,H&H,BUN and other elevated
  • 18. Glucose reaches250 on insulin,givewhat? Isotonic,hypotonic,hypertonic,dextrose? Dextrose toprevent hypoglycemia. Bendat waistto pickup, or tuck pelvisandflex abs? Flex andtuck,NEVER bendat waist Give patientcoolingblanketwhenfebrile,whatis signof adverse reaction? Shivering Can digoxintoxicityoccurwith3.2 potassium? Yes 130/86 BP, severe headache,whatwouldyou reportin pretermlabortoprovider? Severe headache!!HYPERTENSIVECRISIS S/Sof magnesiumsulfatetoxicity?2main interventions urine output< 30, RR < 12, no deeppatellartendon reflexes,decreasedLOC,cardiacdysrhythmias. IMMEDIATELY D/C, give CALCIUMGLUCONATE Tuna goodfor what,bad for what? Highin proteinANDpotassium, sowatchout. If anemic,increase ordecrease milk,andgive ironor no? Decrease milkasitinterfereswithironabsorption, and theyneed iron;give iron! memorize edit Section 4 Question Answer Reportwhat aftera craniotomy? Aphasia,because thismeansincreasedICPr/tincreasedbleedingwhich isthe highestrisk.KeepHOBat30 Prednison10months,ok? Watch for what? Long termnot recommend,neverchange dosage,watchfor osteoporosis,AVOIDLARGECROWDSdue to ^ riskfor infection
  • 19. , ATI Predictor B rename za105's versionfrom12-19-2013 edit Section 1 Question Answer Nurse iseducatingonlosingone poundaweek;how manycalories? 500 caloriesaday Bad signwitha motherwithnewborn? Disapproval Dietfor glomerulonephritis? Low sodium, waterrestriction Pediatricpatientdehydrated,afterinitial oral rehydration,givewater, juice,orgingerale? None! Postoperativecare fora clientfollowingacolonresectionfor colorectal cancerincludeswhichof the following?(Selectall that apply.) Reporttothe providerthatthe stoma isred incolor andhas serosanguineousdischarge.Monitorandtreatpain,andevaluate pain- relief measures.Startafull liquiddietuponreturntomedical unit. Provide woundcare usingsurgical aseptictechnique.Advise the client to use stool softenerstopreventstraining. 2, 4, 5 Naegele'srule? -3+7 Boggyuterus,do what? Massage the fundus! Vertebrae relatedtoparalysis? Below orabove L1-L2 = paralysis Priorityinfectionforamniotomy? FEVER/INFECTION! Patienthasstairs,has hada stroke,andhas trouble communicating— prioritytherapy? Speechr/tABC Bestto orientwhat?What not? Follow nurse,NOTskills checklist What can grant informedconsent? Parentof minor,spouse or closestrelative grantedpower of attorney,court-orderedrep., legal guardian
  • 20. Impairednurse,dowhat? Reportto CHARGE NURSE Med error iswhattrait, like fidelity,veracity,beneficence? Veracity Patientupand walking,pain8,needwhattype of painmanagement? PCA pump,prn morphine Singulair Preventexercise-induced bronchospasm, andforlong- termuse.Take ONCEDAILY AT BED TIME Take peakgentamicin(aminoglycoside) when?Trough? 30 minutesaftergivingIM,or 30 minutesafterIV has finished;troughimmediately before givingnextdose Lithiumlevels? 0.4-1.0 S/Sof earlylithiumtoxicity? Slurredspeech,NVD,thirst, polyuria,muscle weakness What's up withcentral linesandpushingmedswithresistance? Don't do it!May be dislodginga thrombosis! If you run outof TPN,do what? Hang dextrose memorize edit Section 2 Question Answer Have clientdo what withanthrax? Stripdown! Asthmaand beta-blockers(lols) Don't give lols/betablockerstoasthmapatients! ACE-inhibitors? Dry cough How doesdopamine work,by vasodilatingorincreasingcardiac output? Increasingcardiacoutput Thorazine HOLD IF SHUFFLING Fentanyl patchchangingtime 72 hours,48 of intolerant Long termeffectof corticosteroids Losinghairon legs
  • 21. ChronicemphysemaABG? RESP.ACID. (low pH,low CO2 35-45) IncreasedPAWPmeanswhat? Reference 4-12, ^ meansL-sidedfailure A patientisexperiencingumbilical cord prolapse—intervention? Put handup vaginaandholdit there GERD s/s Atypical chestpainandSOB Reglan extrapyramidal sideeffectse.g.twitching,facial spasms.Give antihistaminetohelp. Iron deficiencyanemialabresults Hgb <12, Hct < 33 Arteriovenousfistulafact Don't measure BPon thisside! Withoxygentoxicity,will yousee hypoor hyperventilation? HYPOVENTILATION Explainirrigatingwithsolution Hold1 inchabove Woundhas dehisced,dowhat? Put saline soakedsterilegauze over What ishistrionicpersonality disorder? FLIRTY AND SEDUCTIVE Expectedfindingsof schizophrenia? Memorydeficit,difficultyconcentrating,disorderedthinking, poor problemsolvinganddecision-making What testfor breastcancer vs. ovariancancer? HER2 (her2 boobs) gene =breastAFTER biopsy,butBRCA1 isfor detectingbreastcancerwithoutbiopsy(BReastCancer),CA-125 (clitarea) = ovarian memorize edit Section 3 Question Answer Appropriate post-opcare fordiabetes? VitaminC! Flusha central line withhowmanymL? 10! 3 if peripheral What doesabnormal PAPsmearindicate? Cervical cancer
  • 22. What to tell womantryingtoget pregnant? Afterstops,maytake a while Treatmentforchlamydia,bothmomand baby?Timingforbaby? Zithromax,amoxicillin,anderythromycinforbothmomand babyIMMEDIATELY FOLLOWINGDELIVERY Decontaminationforradiation Soap andwaterand disposable towels Insuline,rotate site orno? DO NOT ROTATE SITE Valproicacid liverfailure,jaundice Firstthingfor implementingstaff changes? INVESTIGATESTAFFINGISSUESwithTASKFORCE No consentfromED to surgery,dowhat? Get official interpreter! Heavylochia,boggyfunds,dowhat? GIVE OXYTOCIN AutismATI Lack of responsiveness FrequentVARIABLEDECELERATIONS Turn on LEFT SIDE first PostEGD, whatto watch for? COOL CLAMMY SKIN,signof perforation Cytoxanforneuroblastomasintoddlers HYDRATE LIBERALLY Riskfor diabetesinsipidus? Monitorfor POLYURIA Postpartum,immediate action? Boggyuterus Cushing'sdisease,2things Moon face,^ cortisol Memoryloss= ^ ICP