mark klimek Questions & Answers Already Graded A+

four rules of prioritization - Answer-1. acute beats chronic 2. fresh postop (<12hrs) beats medical or other surgical 3. unstable beats stable 4. the more vital the organ, the higher the priority (only use as tiebreaker) things that make a pt stable - Answer--Use of the word STABLE -A CHRONIC illness -Post-op MORE than 12 hours old -Local or regional anesthesia -Unchanged assessment -Lab abnormalities of an A or B -ready for/to be discharge, or admitted longer than 24 hrs ago. -experiencing EXPECTED s/sx of the disease they're diagnosed things that make a pt unstable - Answer--Use of the word UNSTABLE -ACUTE illness -Post-op LESS than 12 hours old -General anesthesia (for the 1st 12 hours) -A changed or changing assessment -Use of the phrase "newly or just admitted" or "newly diagnosed" -Lab values of a C or D -UNEXPECTED s/sx things that are unstable regardless of whether theyre expected or not - Answer-1. hemorrhaging 2. fever >105 3. hypoglycemia4. pulselessness or breathlessness order of organ vitality - Answer-1. brain 2. lungs 3. heart 4. liver 5. kidneys 6. pancreas things that result in a black tag in an unwitnessed accident - Answer-pulselessness, breathlessness, fixed & dilated pupils do not delegate the following to a LPN - Answer--starting IVs (can maintain & document) -hanging or mixing IV meds -IV push meds -blood administration or central line care -planning care (RN makes plan, LPN can implement) -planning or performing teaching (can reinforce) -care for unstable pts -do the 1st of anything -the following assessments: admission, transfer, discharge, or first one after a change *this list is different in LTC bc pts are stable do not delegate the following to a UAP - Answer--charting (can chart what they did ex- bath given, ROM performed. but not about pt ex- pt is stable) -give meds (except topical OTC barrier creams) -assessments (other than vitals & accucheck) -cath (sometimes can, be cautious about this)When intervening with inappropriate staff behavior first ask yourself - Answer-is what they're doing illegal? if it is illegal - Answer-tell the supervisor if it is not illegal - Answer-ask yourself, is anyone in immediate danger of physical or psychological harm? if they are in danger - Answer-confront the person immediately & take over the task if no one is in danger - Answer-pull them aside later & talk to them if what is happening is both illegal & harmful - Answer-confront the person immediately & take over, then tell the supervisor calcium channel blockers are - Answer-like valium for your heart (calms it down/treats tachycardia) Ca channel blockers have 3 effects - Answer--Antihypertensive -AntiAnginal -Anti Atrial Arrhythmia (A flutter, afib, SVT) Ca channel blocker side effects - Answer-H&H -headache (due to brain vasodilation) and hypotension names of Ca blockers - Answer-end in -dipine (amlodipine, nifedipine) -2 others are verapamil and diltiazem diltiazem can be given - Answer-through a continuous IV drip -make sure to assess BP before admin-hold if systolic is <100, continuously assess and titrate v fib - Answer-looks like a chaotic squiggly line & has no pattern -*lethal arrhythmia* -must defib the vfib vtach - Answer-looks like a 70's wallpaper pattern, sharp peaks & jags -treat with amiodarone p wave - Answer-atrial depolarization (contraction) QRS wave - Answer-ventricular contraction a flutter - Answer-sawtooth patter "i saw a tooth and my heart fluttered" PVCs - Answer-are generally low priority -priority increases to moderate when: -more than 6 in a row -more than 6 in a minute -PVC falls on T wave of previous beat PVCs are good when - Answer-they occur after a MI, indicates that the heart is reperfusing ventricular problems (vtach, pvcs) are treated with - Answer-amiodarone atrial problems (SVT, a fib, a flutter) are treated with - Answer-ABCDs A- adenosine (must push <8sec/fast; will stop heart for up to 30 sec) B-beta blockers (end in -lol, can cause HA)C- ca channel blockers D-digitalis if you break the water seal of a chest tube - Answer-clamp the tube, cut it away from device, stick the tube in sterile water, then unclamp If chest tube gets pulled out? - Answer-cover with vaseline gauze