KNOWLEDGE PART 1
Hgb
• Males 14-18
• Females 12-16
Hct
• Males 42-52
• Females 37-47
RBCs
• Males 4.7-6.1 million
• Females 4.2-5.4 million
WBCs
• 4.5-11k
Platelets
• 150-400k
PT (Coumadin/Warfarin)
• 11-12.5 sec (INR and PT TR = 1.5-2 times normal)
APTT (Heparin)
• 60-70 sec (APTT and PTT TR = 1.5-2.5 times normal)
BUN 10-20
Creatinine 0.5-1.2
Glucose 70-110
Cholesterol < 200
Bilirubin Newborn 1-12
Phenylalanine Newborn < 2, Adult < 6
Na+ 136-145
Ca++ 9-10.5
• Hypocalcemia …muscle spasms, convulsions, cramps/tetany, + Trousseau’s, + Chvostek’s,
prolonged ST interval, prolonged QT segment
o Mg+ 1.5-2.5
o Cl- 96-106
o Phos 3-4.5
o Albumin 3.5-5
o Spec Gravity 1.005-1.030
1
,o Glycosylated Hemoglobin (Hgb A1c): 4-6% ideal, < 7.5% = OK (120 days)
o Dilantin TR = 10-20
o Lithium TR = 0.5-1.5
RN’s DO NOT delegate what you can EAT! E – evaluate A – assess T- teach
Delegation
RN Only
• Blood Products (2 RNs must check)
•Clotting Factors
• Sterile dressing changes and procedures
• Assessments that require clinical judgment
• Ultimately responsible for all delegated duties
Unlicensed Assistive Personnel
• Non-sterile procedures
• Precautions & Room Assignments
Addisons = down, down down up down (↓↓↓↑↓) >< Cushings = up up up down up
(↑↑↑↓↑)
Addisons = hyponatremia, hypotension, Cushings = hyponatremia, hypertension,
decreased blood vol, increased blood vol, hypokalemia,
hyperkalemia, hypoglycemia hyperglycemia
No Pee = No K (do not give potassium without adequate urine output)
K+ = 3.5 - 5
• HypoK+ . . . Prominent U waves, Depressed ST segment, Flat T waves
• HyperK+ . . . Tall T-Waves, Prolonged PR interval, wide QRS
Perfusion: EleVate = Veins, dAngle = Arteries for better
APGAR = 1-5 min After Birth SCORE 1 to 10 HIGHER THE SCORE THE BETTER THE
BABY
A= appearance, skin color (color all pink, pink and blue, blue [pale] ) 0 - 2
P= pulse, heart rate (>1O0, <100, absent) 0 - 2
G= grimace (cough, grimace, no response) 0 - 2
A= activity, muscle tone (flexed, flaccid, limp) 0 - 2
R= respirations, breathing effort (strong cry, weak cry, absent} 0 - 2
TRANSMISSION-BASED PRECAUTIONS: -
AIRBORNE = My Chicken hez(has) TB OR MTV
My – Measles M =Measles
2
,Chicken – Chicken Pox/Varicella T= TB
Hez – Herpez Zoster/Shingles V= Varicella, chicken Pox/Herpes
TB Zoster-Shingles
Maslow’s Hierarchy of Needs
1. Physiologic
2. Safety
3. Love and Belonging
4. Esteem
5. Self-actualization
Universal (Standard) Precautions … HIV initiated
• Wash hands
• Wear Gloves
• Gowns for splashes
• Masks and Eye Protection for splashes and droplets
• Don’t recap needles
• Mouthpiece or Ambu-bag for resuscitation
• Refrain from giving care if you have skin lesion
DROPLET
Think of SPIDERMAN!
Private Room or cohort:
WEAR Mask
S- sepsis
S- sczarlet fever
S- streptococcal! Pharyngitis
P- parvovirus B19
P- pneumonia
P- pertussis
I- influenza
D- diphtheria (pharyngeal)
E- epiglottitis
R- rubella
M- mumps
M- meningitis
M- mycoplasma ormenirsgeat pneumonia
An-Adenovirus
3
, Contact Precautions = Universal + Goggles, Mask and Gown
MRS WEE
M – multidrug resistant organism
R – respiratory infection
S – skin infection
W – wound infxn
E – enteric infxn – clostridium difficile
E – eye infxn - conjunctivitis
o No infection patients with immunosuppressed patients
• RSV (needs contact precautions)
• TB … Respiratory Isolation
Arterial Blood Gases … Used for Acidosis vs. Alkalosis
• PH 7.35 - 7.45
• CO2 35 - 45 (Respiratory driver) … High = Acidosis OUT THE ASS
• HCO3 21-26 (Metabolic driver) … High = Alkalosis OUT THE MOUTH
• O2 80-100
• O2 Sat 95-100%
Antidotes
o Digoxin … Digiband
o Coumadin … Vitamin K (Keep PT and INR @ 1-1.5 X normal)
o Benzodiazapines … Flumzaemil (Tomazicon)
o Magnesium Sulfate … Calcium Gluconate?
o Heparin … Protamine Sulfate (Keep APTT and PTT @ 1.5-2.5 X normal)
o Tylenol … Mucomist (17 doses + loading dose)
o Opiates (narcotic analgesics, heroin, morphine) … Narcan (Naloxone)
o Cholinergic Meds (Myesthenic Bradycardia) … Atropine
o Methotrexate … Leucovorin
**********************************************************************************
***********
KNOWLEDGE PART 2
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic,
Sense of impending doom) turn pt to left side and lower the head of the bed.
2. Woman in labor w/Un-reassuring FHR (late decels, decreased variability/ fetal
Bradycardia(HR<60), etc) turn on left side (and give 02, stop Pitocin, increase IV fluids)
4
Hgb
• Males 14-18
• Females 12-16
Hct
• Males 42-52
• Females 37-47
RBCs
• Males 4.7-6.1 million
• Females 4.2-5.4 million
WBCs
• 4.5-11k
Platelets
• 150-400k
PT (Coumadin/Warfarin)
• 11-12.5 sec (INR and PT TR = 1.5-2 times normal)
APTT (Heparin)
• 60-70 sec (APTT and PTT TR = 1.5-2.5 times normal)
BUN 10-20
Creatinine 0.5-1.2
Glucose 70-110
Cholesterol < 200
Bilirubin Newborn 1-12
Phenylalanine Newborn < 2, Adult < 6
Na+ 136-145
Ca++ 9-10.5
• Hypocalcemia …muscle spasms, convulsions, cramps/tetany, + Trousseau’s, + Chvostek’s,
prolonged ST interval, prolonged QT segment
o Mg+ 1.5-2.5
o Cl- 96-106
o Phos 3-4.5
o Albumin 3.5-5
o Spec Gravity 1.005-1.030
1
,o Glycosylated Hemoglobin (Hgb A1c): 4-6% ideal, < 7.5% = OK (120 days)
o Dilantin TR = 10-20
o Lithium TR = 0.5-1.5
RN’s DO NOT delegate what you can EAT! E – evaluate A – assess T- teach
Delegation
RN Only
• Blood Products (2 RNs must check)
•Clotting Factors
• Sterile dressing changes and procedures
• Assessments that require clinical judgment
• Ultimately responsible for all delegated duties
Unlicensed Assistive Personnel
• Non-sterile procedures
• Precautions & Room Assignments
Addisons = down, down down up down (↓↓↓↑↓) >< Cushings = up up up down up
(↑↑↑↓↑)
Addisons = hyponatremia, hypotension, Cushings = hyponatremia, hypertension,
decreased blood vol, increased blood vol, hypokalemia,
hyperkalemia, hypoglycemia hyperglycemia
No Pee = No K (do not give potassium without adequate urine output)
K+ = 3.5 - 5
• HypoK+ . . . Prominent U waves, Depressed ST segment, Flat T waves
• HyperK+ . . . Tall T-Waves, Prolonged PR interval, wide QRS
Perfusion: EleVate = Veins, dAngle = Arteries for better
APGAR = 1-5 min After Birth SCORE 1 to 10 HIGHER THE SCORE THE BETTER THE
BABY
A= appearance, skin color (color all pink, pink and blue, blue [pale] ) 0 - 2
P= pulse, heart rate (>1O0, <100, absent) 0 - 2
G= grimace (cough, grimace, no response) 0 - 2
A= activity, muscle tone (flexed, flaccid, limp) 0 - 2
R= respirations, breathing effort (strong cry, weak cry, absent} 0 - 2
TRANSMISSION-BASED PRECAUTIONS: -
AIRBORNE = My Chicken hez(has) TB OR MTV
My – Measles M =Measles
2
,Chicken – Chicken Pox/Varicella T= TB
Hez – Herpez Zoster/Shingles V= Varicella, chicken Pox/Herpes
TB Zoster-Shingles
Maslow’s Hierarchy of Needs
1. Physiologic
2. Safety
3. Love and Belonging
4. Esteem
5. Self-actualization
Universal (Standard) Precautions … HIV initiated
• Wash hands
• Wear Gloves
• Gowns for splashes
• Masks and Eye Protection for splashes and droplets
• Don’t recap needles
• Mouthpiece or Ambu-bag for resuscitation
• Refrain from giving care if you have skin lesion
DROPLET
Think of SPIDERMAN!
Private Room or cohort:
WEAR Mask
S- sepsis
S- sczarlet fever
S- streptococcal! Pharyngitis
P- parvovirus B19
P- pneumonia
P- pertussis
I- influenza
D- diphtheria (pharyngeal)
E- epiglottitis
R- rubella
M- mumps
M- meningitis
M- mycoplasma ormenirsgeat pneumonia
An-Adenovirus
3
, Contact Precautions = Universal + Goggles, Mask and Gown
MRS WEE
M – multidrug resistant organism
R – respiratory infection
S – skin infection
W – wound infxn
E – enteric infxn – clostridium difficile
E – eye infxn - conjunctivitis
o No infection patients with immunosuppressed patients
• RSV (needs contact precautions)
• TB … Respiratory Isolation
Arterial Blood Gases … Used for Acidosis vs. Alkalosis
• PH 7.35 - 7.45
• CO2 35 - 45 (Respiratory driver) … High = Acidosis OUT THE ASS
• HCO3 21-26 (Metabolic driver) … High = Alkalosis OUT THE MOUTH
• O2 80-100
• O2 Sat 95-100%
Antidotes
o Digoxin … Digiband
o Coumadin … Vitamin K (Keep PT and INR @ 1-1.5 X normal)
o Benzodiazapines … Flumzaemil (Tomazicon)
o Magnesium Sulfate … Calcium Gluconate?
o Heparin … Protamine Sulfate (Keep APTT and PTT @ 1.5-2.5 X normal)
o Tylenol … Mucomist (17 doses + loading dose)
o Opiates (narcotic analgesics, heroin, morphine) … Narcan (Naloxone)
o Cholinergic Meds (Myesthenic Bradycardia) … Atropine
o Methotrexate … Leucovorin
**********************************************************************************
***********
KNOWLEDGE PART 2
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic,
Sense of impending doom) turn pt to left side and lower the head of the bed.
2. Woman in labor w/Un-reassuring FHR (late decels, decreased variability/ fetal
Bradycardia(HR<60), etc) turn on left side (and give 02, stop Pitocin, increase IV fluids)
4
