graces review

Graces Reviews

Rattle #1 October 13th:

 Post op—Nurse should do first vitals & get patient up first
o Make sure they can bear weight!
 Blood transfusion
o Fluids-NS
o How long to hang blood?
 4 hours, have 30 minutes to hang it from when you get it
o Reaction what next?
 Stop it!
o Stopped it, now what?
 Disconnect, pull back blood, hang new NS with new tubing
o What you need before you get blood?
 Vitals, type & cross, consent, verified orders, 18-20 gauge needle*
 Flu- what isolation?
o Droplet (mask, goggles & gloves)
 NG tube
o Listening to BS, what you do before that?
 Turn off suction
 Afib on the monitor, physician will order what?
o Anticoagulants, Diltiazam, Amiodarone, SCDS, Compression socks
 Vfib= Defib; if no defibrillator= CPR
 Who can remove a chest tube?
o MD only
o If bubbling, what do you look for?
 Leaks or kinks
 *gauge is too high!
 Car seat safety
o Strap= armpit
o Rearfacing in the middle seat and anchored
 Burns
o Rule of nines:
 1 arm= 9%
 1 leg= 18%
 Torso= 18%
 Back=18%
 Head= 9%
 Genitals= 1%
 First sign of rejection from a stem cell transplant or organ transplant?
o 1 degree increase in temperature
 Atherosclerosis- what would you avoid eating?
o High cholesterol foods

,  Egg yolks
o Cholesterol levels: <200 total cholesterol
 HDLs: >55 for females, > 45 in males
 LDs: <130
 Writing something bad= libel
 Talking badly about someone= slander
 Alternative to restraints = music
 What can an RN delegate to an LPN?
o They can pass certain meds, tube feeds, accu checks, wound dressing changes, medical
hx
o RN can not delegate what they EAT (evaluation, assessment, and teaching)
o LPN can reinforce, and reassess
 Pt comes from OR, what would you do?
o #1= verify the patient, look at arm band!
o #2= Assess the patient
 Pt comes up from endoscopy/surgery, on clear liquids and they start coughing, what are we
concerned about?
o Aspiration, not ready to drink! Watch them!
 When should an infant be able to smile?
o 3-4 months
 When should a child be able to hold a sippy cup?
o 9-12 months
 When should a child be able to pull themselves up on an arm of chair/couch?
o By 9 months
 If the child is not meeting these milestones what are they?
o Delayed
 What is the primary cause of Anaphylactic shock?
o Allergy/ allergic response/ reaction
 What is the primary cause of hemorrhagic/ hypovolemic shock?
o Blood loss
 What is the primary cause of neurogenic shock?
o CNS damage
 What is the primary cause of cardiogenic shock?
o Pump failure/ Decreased cardiac output
 What is the primary cause of septic shock?
o Sepsis/ infection
 What is shock?
o It is a decrease in perfusion to vital organs
 What is the first organ to fail?
o Kidneys
 What are you primarily looking for with a patient with AKI?
o Decreased urinary output
 What lab in shock will come up in septic shock?

, o Lactic acid
 What are interventions for shock?
o Pharm: Fluids, vasopressors, then tx underlying cause
 Anaphylaxis, what body system response causes the primary problem?
o Vascular, dilate (vasodilation)-- give vasopressors to constrict
 Cardiogenic shock body system problem?
o MI- sternal chest pain
o Left side big, stretched out= Left sided heart failure/ cardiomyopathy
 Blood loss with hypovolemic shock= hypovolemia
o Causes are DI, burns etc
o Stop bleeding and fluids
 Anaphylaxis- what drugs?
o Epinephrine, Antihistamine and diphenhydramine (benadryl)
 What is the treatment of cardiogenic shock?
o Decrease in cardiac output
o Could be MI, HF or cardiomyopathy
o Drugs? Dopamine, Dobutamine, and Epinephrine
 Hypovolemic and Burns?
o Fluid resuscitation
 Laceration of a major artery, what is priority?
o Stop the bleeding!
 Neurogenic shock- loss of vessel tone, won't constrict properly= vasodilation
o Add fluids
 Septic shock caused by sepsis what happens to vessels? Vasodilation
o ARDS can happen (ARDS- refractory hypoxemia, tx: PEEP)
o Antibiotics, fluids and vasopressors
 Septic shock can move into respiratory distress syndrome if they stay in a compromised state.
o What drug would be used to tx underlying cause of sepsis?
 Antibiotics
 Heparin drip going, you make a change per order, what safety measure is needed?
o 2 nurse verification!
o What labs do you watch for Heparin?
 APTT, PTT and platelets
 Patient asks if TPN can be disconnected what is the response? NO b/c they could go
hypoglycemic
o If it is disconnected, what do you hang?
 D10
 Witnessing medication;
o 2 mg morphine, but only need 1 mg?
 Waist before you administer!
 MI s/s: chest pain, jaw pain, increase HR, N/V, indegestion, DIAPHORESIS
o Tx MI with MONA:
 M= morphine