Dosage Calculations!!!!! Questions will be similiar 1. 5mcg/ kg/min; 120kg; 300mg/500mL= find mL/hr as whole number 2. 100mg/250mL over 1 hour; 20gtt/mL; find gtt/min 3. 823cc infuse 76mL/hr; find hr/min 4. 500mL/4hours= ml/hr 5. 7mg/kg; 200lbs; 150mg/10mL find mL/dose Lecture 6 10/24/2023 COMPS will be in different Order ...base on review given by professor Comprehensive Practice Exam Review 1.Asthma exacerbation med not working see first 2.Spinal cord C7 - raise head of bed 3. Liver cirrhosis and expected esophageal varices , jaundice, ascites (albumin), fruity breath, expected change in LOC, = REPORT: bloody tarry stools 4. MI patient taking heparin look at labs ptt 5. Disaster triage= black no pulse, *red= low BP, hypertensive 6. Need mental health intervention= MS depression and not eating 7. MVA flank bruise= Assess VS first (could be internal bleeding) 8. Ethical dilemma = RBCs transfusion with Jehovah witness 9. Full term healthy baby= umbilical cord will fall off in 2 -3 weeks; must sleep on baby back (prevent SIDS) , NO bumper pads in crib; circ umcision clean with water and Cover with petroleum and gauze 10. Stroke - put wheelchair on unaffected side , will assess b link reflex 11. Restraints - 2 soft every 2 hours ; assess every 15mins 12. Disaster triage= cystic fibro sis – postural drainage can be discharge d (patient is stable ) 13. Incident report - report the fall of patient 14. See first= flowers and fruit bowls someone who is neutropenic 15. Cervical cancer with internal radiation= should NOT ambulate 16. Bladder cancer - smoking is major risk factor 17. Needs follow up= never had kids but bleeding and is over 60 years old 18. Newborn teaching= diapers 6 -8 per day is expected 19. Osteoporosis exercise 30mins 5 times a week teaching 20. What would a ffect discharge and treatment planning= being homeless and is transient 21. pt crying about husband dx therapeutic response =”Il sit here and wait with you. ” 22. Depression= “Do you have a plan to hurt yourself” most important questions to ask SAFETY 23. If pt is having Hallucinations - investigate what voices are saying 24. Borderline personality _ b cluster; impulsive, wild, attention seeking= cutting self 25. Hearing aid teaching – clean with soap and water, Do not turn it high est on dial (muffled noises) ; turn to where you can h ear NOT necessarily highest volume. 26. Walker - use chair to help you reach walker, do not look down when using walker , should not be 12 inches in front while in use. 27. Post mortem care - do NOT sit up deceased patient 60 degrees 28. Ileal conduit - 2 inches around stoma should be assessed ( mucus in urine expected ) 29. Uric acid in kidney stones= lessen purine in diet 30. Osteoporosis = calcium biphosphate= sit up after taking 31. Ed nurse –IV glucose to person in acute adrenal crisis see first can push to other size 32. See first - heparin see ptt labs first 33. Epidermal – light headed and nervousness alert complication 34. Pre op report to dr. Tell dr pt is taking ginko balboa 35. K sparing – do not take with ace inhibitor causes high K 36. Insulin - DO not massage over subQ, 37. Cast – tell D r= compartment syndrome pain meds not working 38. New onset slurred speak - question during lumbar puncture 39. Mitral valve - 5th intercoastal space mid clavicular 40. Trach care - do not remove old before putting new 41. Rheumatoid Arthritits – present with Morning stiffness 42. PACU – femoral bypass - check distal pules 43. Malignant hypothermia = tell surgeon if pat has fam member with hx of MH 44. Superior vena cava syndrome – facial swelling 45. IV – put in 20 gauge 1 -1.5 inches Lecture 10/28/2023 Review for comp 1 1. Priority= ABC’s; safety ; who will die first!!!! a. Triage 1st client w/ multiple compound fractures and reporting chest pain b. Report to HCP pt who has drainage that has was serosanguineous and has not become sanguineous c. See patient first who polycystic fibrosis is bleeding with gross hematuria d. Pt w/ asthma suddenly stops wheezing e. Pancreatitis with pain upon inspiration f. Chest burn low 02 is priority g. Report 6 year old with HR 130 2. Delegation= LPN vs UAP within scope a. UAP - change linens, VS NOT NEW ADMIN , REMIND, administer tap water enema (NOT FLEET) . Document drainage, Output i. UAP turns patient every 2 hours ; or can recheck VS 2 hours after kidney biopsy b. LPN- Reinforce teaching, eternal feeding , PPN, Meds, PO SQ, IM, IV (isotonic) monitor, 24 hr post op, wound care , i. LPN can collect medical hx, get blood sugar 3. Unit assignment= related to nurses skill set if from MedSurg , ortho ect , a. OB nurse gets appendicitis patient 4. Management – use translator ... speak with eye contact patient NOT translator 5. Nurse suspect child abuse. Nurse should first a. Assess/ Obtain detail bruising on body map 6. Signs of labor = a. True labor S/S= bloody show, water breaks, contractions increase freq, duration, intensity, Cervix dil ated 10cm , effacement 0 -
100% (cervix thinner shorter) i. Regular contractions= increase in freq , duration, intensity, DOES NOT decrease with rest b. False Labor – Braxton hicks= disappear with walking or position changes i. Irregular contractions alleviated with rest or position change, no changes to 7. Stage 1 of labor = Active, laten post labor expected ; Normal FHR 110 -140 a. Late decelerations tell Dr as priority b. Pt is 2nd stage of labor FHR decrease = turn patient to the left 1st ( least invasive) c. Stage 1 =contractions=cervix dilation i. 1. Early/latent phase (early education 0 -3cm, dilation, monitor FHR ) ii. 2. active phase (breathing technique, pain management, cervix 4 -7cm, continue , OXTYTOCIN, EPIDURAL , IV narcotics slowly over peak of contractions ), iii. 3. transition phase (8-10cm, 100% effacement, ANXIETY & VOMITY, urge for BM , Push @ 10cm, BLOODY SHOW assess amniotic fluid , emotional support, breathing techniques ONLY PUSH @ 10cm ) d. Stage 2 delivery of baby (cervix 100% effaced 10cm dilated, urge to bear down, Fergueson reflex) position= high fo wlers, lithotomy, side -lying (assess - FHR, freq, duration, ) e. Stage 3 delivery of placenta = high risk for infection, uterine inversion (NEVER pull cord), give PITOCIN f. Stage 4 postpartum recovery (check bleeding peri pads (report fully saturated in 1 hr, infection over 100.4 report ) 2-4 hours after birth= breast feeding and skin to skin i. Interventions= check fundus 1st 3 times every 5mins then every 15mins , void (every 2 -3hrs) or use cath, Pitocin IV or IM, breast feeding , ii. Treatment for boggy fundus -fundal massage, void, oxytocin , methergine (increases BP) iii. Lochia= Rubra/ dark red 3 -4 days; Serosa/ pink brown= 4 -10 days; Alba/ white/yellow= 10 -28 days iv. Peri-care - Squeeze peri -bottle with warm water, front to back wipe, blot area, v. Report bloody fluid should be clear vi. If FHR is 180 turn mom to left side = priority vii. Report late deceleration viii. 2nd stage of labor= FHR 132= priority see first ix. Client in 2nd stage of labor . Nurse should see first= 8. Injections time frames a. Intra dermal = can be delegated to LPN, forearm, return to office 48-72hrs after injection; if date missed must receive again after 7 days; 25 -27 guage.25 -.5 length, 5 -15 needle angle ; 0.1mL i. Positive TB induration 10mm Begin Airborne precautions ii. PPD - not 22guage should be 27 guage b. SubQ - 26-30 gauge 1.5mL or less , pinch skin 45 degree angle ; insulin or heparin ; obese 90 degrees ; i. Insulin best absorbed thru abdomen c. IM- 22-25 length 0.5 -1inches ; 90 degrees , 1-2mL (in deltoid) = ventral gluteal , Dorso gluteal , deltoid; infants 0 -12months vastus laterals ; Z track d. IV- immediate absorption 9. Ostomy care = bag and wafer ; pat skin dry, apply barrier cream only 2cm from stoma; wafer should 1/8 cm larger than stoma ; empty pouch 1/3 full ; DO NOT empty 30 mins after eating a. NORMAL Red beefy = fresh new ostomy; OR pink moist normal ; REPORT : pale, gray, blue, dry stoma= no blood flow b. Teach – ileostomy watery stools; 10. NOT ready for discharge a. New med , unstable, acute S/S ect , 11. S/S MI = heart attack = unstable angina, chest pain, left substernal pain, sudden, crushing chest pain, left arm, jaw, heartburn, SOB, N/V abd pa in, diaphoresis, dusky skin a. Risk factors -SODDA= stress, obesity (BMI over 25), Bad diet, Diabetes & HTN, African American males over 50 i. Is receiving treatment heparin ; non -stemi = sent to cath lab
100% (cervix thinner shorter) i. Regular contractions= increase in freq , duration, intensity, DOES NOT decrease with rest b. False Labor – Braxton hicks= disappear with walking or position changes i. Irregular contractions alleviated with rest or position change, no changes to 7. Stage 1 of labor = Active, laten post labor expected ; Normal FHR 110 -140 a. Late decelerations tell Dr as priority b. Pt is 2nd stage of labor FHR decrease = turn patient to the left 1st ( least invasive) c. Stage 1 =contractions=cervix dilation i. 1. Early/latent phase (early education 0 -3cm, dilation, monitor FHR ) ii. 2. active phase (breathing technique, pain management, cervix 4 -7cm, continue , OXTYTOCIN, EPIDURAL , IV narcotics slowly over peak of contractions ), iii. 3. transition phase (8-10cm, 100% effacement, ANXIETY & VOMITY, urge for BM , Push @ 10cm, BLOODY SHOW assess amniotic fluid , emotional support, breathing techniques ONLY PUSH @ 10cm ) d. Stage 2 delivery of baby (cervix 100% effaced 10cm dilated, urge to bear down, Fergueson reflex) position= high fo wlers, lithotomy, side -lying (assess - FHR, freq, duration, ) e. Stage 3 delivery of placenta = high risk for infection, uterine inversion (NEVER pull cord), give PITOCIN f. Stage 4 postpartum recovery (check bleeding peri pads (report fully saturated in 1 hr, infection over 100.4 report ) 2-4 hours after birth= breast feeding and skin to skin i. Interventions= check fundus 1st 3 times every 5mins then every 15mins , void (every 2 -3hrs) or use cath, Pitocin IV or IM, breast feeding , ii. Treatment for boggy fundus -fundal massage, void, oxytocin , methergine (increases BP) iii. Lochia= Rubra/ dark red 3 -4 days; Serosa/ pink brown= 4 -10 days; Alba/ white/yellow= 10 -28 days iv. Peri-care - Squeeze peri -bottle with warm water, front to back wipe, blot area, v. Report bloody fluid should be clear vi. If FHR is 180 turn mom to left side = priority vii. Report late deceleration viii. 2nd stage of labor= FHR 132= priority see first ix. Client in 2nd stage of labor . Nurse should see first= 8. Injections time frames a. Intra dermal = can be delegated to LPN, forearm, return to office 48-72hrs after injection; if date missed must receive again after 7 days; 25 -27 guage.25 -.5 length, 5 -15 needle angle ; 0.1mL i. Positive TB induration 10mm Begin Airborne precautions ii. PPD - not 22guage should be 27 guage b. SubQ - 26-30 gauge 1.5mL or less , pinch skin 45 degree angle ; insulin or heparin ; obese 90 degrees ; i. Insulin best absorbed thru abdomen c. IM- 22-25 length 0.5 -1inches ; 90 degrees , 1-2mL (in deltoid) = ventral gluteal , Dorso gluteal , deltoid; infants 0 -12months vastus laterals ; Z track d. IV- immediate absorption 9. Ostomy care = bag and wafer ; pat skin dry, apply barrier cream only 2cm from stoma; wafer should 1/8 cm larger than stoma ; empty pouch 1/3 full ; DO NOT empty 30 mins after eating a. NORMAL Red beefy = fresh new ostomy; OR pink moist normal ; REPORT : pale, gray, blue, dry stoma= no blood flow b. Teach – ileostomy watery stools; 10. NOT ready for discharge a. New med , unstable, acute S/S ect , 11. S/S MI = heart attack = unstable angina, chest pain, left substernal pain, sudden, crushing chest pain, left arm, jaw, heartburn, SOB, N/V abd pa in, diaphoresis, dusky skin a. Risk factors -SODDA= stress, obesity (BMI over 25), Bad diet, Diabetes & HTN, African American males over 50 i. Is receiving treatment heparin ; non -stemi = sent to cath lab
