Heart Rates: Babies - Infants = 120-160 bpm Toddlers = 90-140 bpm Preschoolers & School Aged = 75-110 bpm

Adults & Teens = 60-100 bpm On the ECG or EKG: P wave = atrial depolarization P-R interval = represents atrial,AV node, & Purkinje depolarization Q wave = septal depolarization R wave = apical depolarization S wave = depolarization of lateral walls QRS complex = spread of excitation through the muscle of the venticles T wave = ventricular repolarization Starling's Law = the greater the strength of the myocardium as the ventricles fill with blood, the stronger the contraction. Cardiac output = the amount of blood that is pumped out of the LV each minute. The mitral valve is the most common site for vegetations. ACE-I exert their effect by reducing preload. Digitalis and related cardiac glycosides act by directly inhibiting the Na/K pump in the cell membranes. After cardiac cath, monitor the person for bleeding &/or hematoma formation. Pulses are palpated distal to the site every 15 minutes for at least 1 hour, patient is on bedrest with lower extremities extended for at least 8 hours. Acute blood loss (hemorrhage) is likely to cause sinus tachycardia. When the heart rate increases with inspiration and decreases with expiration it is called sinus arrhythmia. When someone’s heart "skips a beat" this is most times called premature atrial complex. PVCs can lead into V-Fib Verapamil reduces afterload and with concurrent use of nitroglycerine can cause ( increase ) hypotension. Amlodipine ( Norvasc )- CCB used for systemic vasodilation and decreased blood pressure. Coronary vasodilation and decreased frequency and severity of angina. CONTRAINDICATION BP <90mmHg. Fosinopril ( Monopril )- tx of hypertension and CHF; dosage is 5-40 mg once daily max dose in a day is 80mg

Pts having a MI ( heart attack ) remember MONA = morphine, oxygen, nitroglycerine, and aspirin. The pathophysiology of HTN includes damage & inflammation of the vessel walls that stimulates the vessels to thicken, harden, and become narrow. Narrowing causes vasoconstriction and increases the permeability of the vessel walls leading to the influx of sodium, calcium, water, plasma proteins, and other substances. Calcium further increases smooth muscle contraction. Clinical manifestations of HTN result from damage of organs and tissues outside the vascular system. These include heart disease, renal disease, central nervous system problems, and muscular dysfunction. Adenosine is for supraventricular tachycardia. Epinephrine is given during code to vasoconstrict the periphery & shunt the blood to the central circulating system. ( hope I explained it right ) Atropine is used in asystole & symptomatic bradycardia. Lidocaine is the drug of choice for ventricular irritability. It suppresses ventricular ectopy. Hypokalemia can cause increase in cardiac electrical instability, ventricular dysrhythmias, & increases risk of digoxin toxicity. CK-MB if up means myocardial damage, the elevation happens aprox. 4-6 hrs after an acute ischemic attack. Normal for CK-MB is 0-7 U/L. Lactic dehydrogenase ( LDH ) increases within 48 hrs of myocardial infarction. Normal is 70-200 U/L. Mitral Valve Prolapse, valve leaflets protrude into left atrium during systole. Cardiac: ACE Inhibitors: Benazipril ( Lotensin ) Captopril ( Capoten ) Lisinopril ( Zestril ) Enalapril ( Vasotec ) Ramipril ( Altrace ) Quinapril ( Accupril ) Calcium Channel Blockers: Amlodipine ( Norvasc ) Diltiazem ( Cardizem ) Nicardipine ( Cardene ) Verapamil ( Calan , Isoptin ) Atrial Septal Defect : abnormal opening between atria which causes increased flow of oxygenated blood to go into right side of heart. Right atrial & right ventrical enlarge. May be closed using cardiac catheterization or surgically with cardiopulmonary bypass which is done before school age. Ventricular Septal Defect: characteristic murmur, CHF is common, many times will close by itself if small-moderate defect. Patent Ductus Arteriosus ( PDA ): characteristic machine like murmur , can be asymptomatic or s/s of CHF, wide pulse pressure & bounding pulses.

Coartication of the aorta: narrowing near insertion of ductus arteriosus. S/S of CHF in infants, HTN & bounding pulses in arms but weak or absent femoral pulses, low extremities may be cool. Tetrology of Fallot Tetra means four so it consists of four defects: pulmonary artery stenosis hypertrophy of right ventricle venticular septal defect overriding of aorta Dx of Tetrology of Fallot is done by chest x-ray that shows a typical boot shaped heart. An echocardiogram, 3 dimentional echocardiography, & cardiac cath help to confirm diagnosis. s/s of TOF include: " blue spells or tet spells " relieved by having child squat. Murmur may be present. Poor growth, clubbing of fingers. Beta Blockers: Used for angina, dysrhythmia, HTN, migraine, prevent MI, & glaucoma. Contraindicated in asthma, bradycardia, CHF, severe renal/hepatic disease, CVA, & hyperthyroid. May mask hypoglycemia so monitor diabetics closely. Side Effects : hypotension, bradycardia, bronchospasm, dizziness, hyperglycemia to name a few. Atenolol ( Sectral ) Labetolol ( Normodyne, Vescal ) Metoprolol ( Lopressor, Toprol ) Propranolol ( Inderal ) Nadolol ( Corgard ) Hold if BP or pulse not within prescribed parameters. Call MD for orders. Follow hospital/facility policy. In diastole, that is where the ventricles relax & fill with the blood. There are 4 valves in the heart. The apical pulse sometimes can be seen in children with thin chest walls. Cardiac tamponade is caused by pericardial fluid that accumulates & compresses the heart. Virchow's Triad is slowed circulation, altered blood coagulation and trauma to a vein that can lead to thrombus formation. The SA node is the natural pacemaker of the heart. The pulmonary veins return the oxygenated blood from the lungs. Starling's law = The greater stretch of the myocardium results in a stronger ventricular contraction. Cardiac output is the amount of blood that is pumped out of the left ventricle every minute.

3) The duration of action is how long the drug maintains its effect. Alcohol withdraw= Librium.. usually are in this class -caine .. antianxiety -pril .. opioid analgesic -ide. antibiotic -dine . proton-pump inhibitor -sone . diuretic gr 1 = 60 mg gr 5 = 300 mg gr 15 = 1000 mg = 1 gram 1 oz = 30 ml = 30 cc 1 dr = 4 ml 1 Tbsp = 15 ml = 3 tsp anticholinergic meds: can't see can't pee can't spit can't shit Gout Meds: Probenecid (Benemid). Colchicine. diuretic -mycin . Know your onset. . Iron= deferoxamine Digitoxin. Allopurinol (Zyloprim) Theophylline: tx of asthma or COPD. beta blocker -oxacin .. Therapeutic drug level: 10-20 To Reverse Toxicity: heparin= protamine sulfate coumadin= vitamin k ammonia= lactulose acetaminophen= n-Acetylcysteine. and duration of action for your meds. cholesterol -vir. antibiotic -nium. peak.. 1) The onset is the time it takes to reach the minimum effective action after a drug is given. steroids -statin . antibiotic -pam . local anesthetics -cillin. anti-ulcer ( H2 blocker ) -done. oral hypoglycemics -lam. digoxin= digibind. antianxiety -mide . ACE inhibitor -prazole.. neuromuscular blocking -olol. antiviral -zide. 2) The Peak happens when the drug reaches its highest blood or plasma concentration..Drugs with these endings.

(children over 3 yrs are same as adult ) 4) Give drops as ordered by MD 5) Be sure to not contaminate the dropper. lungs.4-6 hours Peak .4-6 hours Peak .2 hours Peak . bile. 7) Wash Hands INSULINS: Rapid: ( Lispro ) Onset-15 minutes Peak-1 hour Duration.16-24 hours Long Acting: ( Ultralente ) Onset .12-16 hours Duration .4-6 hours Intermediate: ( NPH or Lente ) Onset .> 24 hours Very Long: ( Lantus ) Onset . feces.24 hours continuous 7 Rights of Medication Administration • Right Drug • Right Amount • Right Route • Right time • Right patient • Right approach • Right documentation Medication Administration • 2 ml= maximum volume of injection per site for IM meds .1/2 hour Peak . liver. Other routes of excretion are: breast milk. Steps for administering ear drops: 1) Wash your hands 2) Have medication at room temperature 3) Have the person sit up with head tilted slightly to the unaffected side. saliva. 6) Have the person maintain the position for a good 2-3 minutes.6-12 hours Duration . Straighten the ear canal by pulling up and back on the auricle (adult ) or (child) pull down and back on the auricle.None Duration .3 hours Short: ( Regular ) Onset.2-3 hours Duration . sweat.The Main Route of Drug Excretion is through the kidneys.

Alkylating Agent: [ Cisplatin ( Platinol ) ] . female infertility. Remember. ensure adequate hydration and give diuretics prior to therapy. carbidopa prevents metabolism of levodopa and allows more levodopa for transport to brain. Do not give longer than 5 days.tx for Parkinson's. Whereas. inhibits Ca++ transport in heart and vasculary muscle cells therefore inhibiting excitation and subsequent contraction. Ibuprofen = kidney toxic . Phenazopyridine (Pyridium)--Urine will appear orange. Carbidopa/Levodopa ( Sinemet ). galactorrhea.used for lymphoma. suppression of postpartum lactation.kidney disease Anticholinergic agents cause Dry mouth.esophageal. Cisplatin caauses nephrotoxicity and ototoxicity. osteosarcoma. when it comes to iron administration: • Iron supplements IM or IV----iron dextran (IV route is preferred) • IM causes pain.cardiac disease .ovarian. skin staining. urinary retention and constipation. higher incidence of anaphylaxis • Take oral supplements with meals if experience GI upset • Then resume between meals for max absorption • Use straw if liquids are used Diltiazin (Cardizem) a calcium-channel blocker. Have client void every hour or insert foley before therapy. Ace Inhibitors can cause hyperkalemia and chronic cough. Bromocriptine ( Parlodel ) . .pt's should not use salt substitutes because they are mostly made from K+ which will further increase the K+.gastrointestinal disease . Assess for hearing loss/deficits.Ketorolac ( toradol ) for short term pain management. cervical. myeloma. 60gtts = 1 tsp 3 tsp = 1 Tbsp 6 tsp = 1 ounce 2 Tbsp = 1 ounce 6 oz = 1 teacup 8 oz = 1 glass 8 oz = 1 cup Diseases that can affect a drugs response are: . Dexamethasone used to decrease cerebral edema and pressure.lung.liver disease .tx of Parkinson's.testicular.and prostate cancers. Tylenol = Liver toxic (no more than 4 g/day) Give Mucomyst for overdose. amenorrhea. Levodopa ( Larodopa ) should be d/c'd 8 hours before statring Sinemet. acromegaly. melanoma.

.tx of idiopathic Parkinson's disease. dry mouth. CONTRAINDICATION BP <90mmHg. dosage is 4-8 mg as a single daily dose or in 2 divided doses ( use cautiously if edema or CHF ) When using a bronchodilator inhaler in conjunction with a glucocorticoid inhaler.. Used in a-fib and a-flutter. Coronary vasodilation and decreased frequency and severity of angina. Aldosterone conserves sodium and promotes potassium excretion which helps to control sodium and water balance. dosage is 5-40 mg once daily max dose in a day is 80mg Rosiglitazone ( Avandia )-tx type 2 diabetes.tx of hypertension and CHF.give with food. robs the bones.leads to increased Ca resortion from bones and WEAK BONES).antianxiety agent. confusion. reduced libido. Alprazolam ( Xanax ). monitor liver and kidney function. Thiazide diuretics increase blood sugar. usual dose is 0.Ropinirole ( Requip ) . Fosinopril ( Monopril ). dizziness. encourage patient to report dizziness or faintness immediately. Theophylline increases the risk of digoxin toxicity and decreases the effects of lithium and Dilantin. Long term use of amphogel (binds to phosphates. increases Ca. lethargy.25-0. weight loss. Prozac (a SSRI) side effects are diarrhea.CCB used for systemic vasodilation and decreased blood pressure. administer the bronchodilator first. monitor electrolytes. Quinidine . Amlodipine ( Norvasc ).5 mg two to three times daily. Types of Bronchodilators: Beta Adrenergic Agonists Albuterol ( Proventil. Ventolin ) Metaproterinol ( Alupent ) Terbutaline Bitolerol Levalbuterol ( Xopenax ) Pirbuterol Salbutamol ( Serevent ) Anticholinergic Ipratropium bromide ( Atrovent ) Oxitropium bromide ( Oxivent ) Methylxanthines Aminophylline Theophylline ( Slo-Bid or Theo Dur ) . Side effects: drowsiness.

Remove any exudate from inner canthus outwards. Monitor levels closely. Dantrolene [ Dantrium ] Skeletal Muscle Relaxant Used for: Emergency treatment of malignant hyperthermia Contraindicated : pregnancy Cardizem [ Diltiazem ] Calcium Channel Blocker Used for: A-fib.penicillin tx with chloramphenicol. sulphatrimethoprim *Antihistamines can aggravate urinary incontinence. could be sign of suicidal ideation. Sucralfate ( Carafate )used for peptic ulcers side effects: constipation. skeltal and bone pain is a common side effect. 6.) Give the drops per MD orders. *Withdrawal from depression medication can cause new symptoms and/or bring back old ones. *Demerol is contraindicated in clients with sickle cell disease. Dilantin. Theophylline. Clean eyes with a separate cloth for each eye. Because the therapeutic levels are so small.) Have the person either lie down or sit down and look upwards.2 weeks after starting pt on antidepressants. cardiogenic shock. pulmonary edema About 1. no systemic effects antacids interfere with carafates absorbtion Letrozole is used to treat advanced breast cancer. leading to a resultant increase in optic pressure. 7. depression medications often cause dependency. Teach pt accordingly.Giving Eye Drops 1. 4. Wolf-Parkinson -White syndrome. Chicken Pox: Diptheria: Lyme Disease: Typhoid Fever: tx with Acylovir tx with diptheria antitoxin. . icrease fluids and fiber. ampicillin.) Using clean technique. 3.) Gently pull skin down below the affected eye(s) to expose the conjunctival sac.) Gently press on the lacrimal duct with sterile gauze or tissue for 1-2 minutes to prevent systemic absorption via the lacrimal canal. Be careful not to let the dropper tip touch eyelashes or eyelids. It may cause seizures. wide complex tachycardia of unknown type. maintaining good blood levels can be a problem when given through a tube. 5. A-flutter. penicillin. ) Wash hands 2. *Atropine is contraindicated for a client with angle-closure glaucoma b/c it can cause pupillary dilation with an increase in aqueous humor. erythromycin tx with tetracycline.) Have the person keep eyes closed for 1-2 minutes afterwards to promote better absorption. PSVT refractory to adenosine Contraindicated: drug or poison induced tachycardia. assess for increased energy. This drug may be poorly absorbed with continuous tube feedings. *Due to their mood lifting effects. Discontinue feedings 1-2 hours before and after giving dilantin to enhance absorption.

pallor. fever.assessment findings: cough ( yellow mucoid sputum ) . and heredity. A tracheostomy cuff may be deflated and inflated periodically to prevent tissue necrosis. Monitor prothrombin times closely and adjust as indicated. chronic laryngitis. double check calculations. fatigue. hemoptysis. Tuberculosis. rales or crackles. Vital capacity is the maximum amount of air exhaled after a maximum inhalation. WBC & ESR will be elevated. malaise. indutrial pollution. A collection of fluid between the viseral and parietal pleura is a pleural effusion. Tube-feeding solutions contain vitamin K & coumadin & vitamin K anatagonize each other. Diagnostic Tests used in TB . Thoracentesis is where a needle goes into the pleural space and removes fluids. * Never.loss. night sweats. Call MD if there is any doubt about the medication. Culture will be positive. Risk factors for laryngeal cancer may include: indoor/outdoor air pollution. Skin test (PPD) positive. Fact Files Volume 2 ( Respiratory ) Tidal volume is the volume of air breathed in and out ( inhaled/exhaled ) within a normal breath. tobacco use. antibiotics/aminophyline.Chest x-ray indicates presence and extent od disease but cannot show if active or inactive. Here's a mneumonic my instructor used for an acute asthma attack & tx: NOAH nebulizers. Double check dosages. * Never leave a meds out of your site. and mild or moderate difficulty with breathing. hydrocortisone Pleurisy is a inflammation of the viseral and parietal pleura. habitual overuse of the voice.area of induration 10mm or more in diameter after 48 hrs. Take no chances. . pain. Symptoms of an infectious or inflammatory issue going on within the upper airway may include: headache. Go back and double check again. * Don't give any meds that another nurse dispensed. * Never give a med if the patient says it does not look like what they usually take. * Never guess when giving medications. Sputum positive for bacillus ( 3 samples is diagnostic for TB ). dyspnea. Triple check with the MAR. wt. never leave any meds for any reason at a patient's bedside.Warfarin. Better safe than sorry. ask when in doubt. * Always wash your hands before preparing someone's medications. afternoon low grade temp. ( needle aspiration of fluid from the pleural space ) Perfusion lung scan .. anorexia. oxygen.is a lung scan that shows patterns of blood flow. pain. Initial treatment of a nose bleed includes having applying pressure by holding the soft parts of the nose firmly between thumb and finger to pinch nostils together.

Source of infection is from the respiratory tract of infected person. smoke. long term or in between!!! As the nurse:1) assess pt.a) increased secretions in the airway b) wheezing or bronchospasm c) displaced ET tube d) obstructed ET tube( check 4 kinks ) e) pt coughing. then put on sterile gloves to apply clean ties. *Persistant fine crackles scattered across the chest happen with pneumonia. and amount of secretions 6) check pulse ox 7) check alarms on vent 8) empty vent tubings when moisture collects 9) turn pt. bites tube f) pt. Give pertussis-immune globulin as ordered.be sure to remove old ties with non-sterile gloves. such as dust. gaging. Give antimicrobial therapy as ordered. will use a breathing pattern that does not lead to tiring and to plan activities so that he/she does not become overtired. rate and breathing pattern 3) monitor color of lips & nail beds 4) monitor chest for symetry 5) assess need for suctioning & observe type. or atelectasis. indirect contact from freshly contaminated articles. Mechanical Ventilators: Can be short term. fighting vent (bucking) Low Pressure Alarm. respiratory precautions are no longer needed. Remember. first then the vent 2) assess vitals. the cough is severe. and sudden temperature changes. start respiratory precautions. every 2 hours and prn 10) have resuscitation equipment by bedside Causes of Alarms: High Pressure Alarm. Use a humidifier or tent to increase humidity. When you go to change the trach ties. *Unequal chest expansion happens with flail chest. During the convalescent phase. Care should be spaced.Trach care should be provided once every 8 hours and prn. *In emphysema there is destruction of the alveolar walls and patient will often present with a barrel chest. Pertussis [ Whooping cough ] What it is: Comes from Bordetella pertussis has an incubation period of 5-21 days with an average of 10 days. Ethambutol. pneumonia. color. isonazid. * The trachea lies just in front of ( anterior ) to the esophagus and is 10 to 11cm long in adults.a) disconnection or leak b) pt. and preventing fatigue. Reduce environmental factors that promote coughing. allowing frequent rest periods. bronchiolitis. A major goal for the pt with COPD is that the pt. It is transmitted by direct contact or droplet spread from infected person. part of the lung is either obstructed or collapsed or with guarding to avoid post-op insision pain or pleurisy.stops spontaneous breathing Some Signs/Symptoms of Hypoxia * fatigue . What to do? Isolation during the catarrhal stage. resp.

Dyspnea is labored breathing aka.where there is a thickening of the bronchial mucosa obstruction of the airway.as in emphysema Eupnea is normal breathing .* dyspnea * cyanosis * anxiety/apprehension * decreased concentration * altered level of consciousness * vertigo * increased pulse rate * faster and deeper respirations ( advanced hypoxia respirations get slower and more shallow * increased blood pressure * pallor * dysrhythmias * clubbing of nails if prolonged/chronic Normal ABG's pH = 7. or mucus loss of lung elasticity. shortness of breath. Your lungs consist of 5 lobes.45 Paco2 = 35 to 45 mm Hg Pao2 = 80 to 100 mm Hg HCO3 = 21 to 28 mEq/L O2 saturation = over 95% In older adults with pneumonia.rate is usually 12 . hydration is very important as it helps to thin secretions and promotes expectoration. warms.as in a tumor.rate is over 24 bpm and usually rapid & shallow A cough that changes in character should cause suspicion of possible lung cancer. and moistens the incoming air. an object swallowed that gets stuck.18 breaths per minute Bradypnea is slower than normal breathing . The right lung has 3 lobes and the left lung has 2 lobes. Pulmonary ventilation *movement of air into the lungs which is inspiration *movement of air out of the lungs which is exhalation External Respiration *the movement of oxygen from the lungs to the blood *the movement of carbon dioxide from the blood to the lungs Three Regions of the Pharynx ( also known as your throat ) *nasopharynx *oropharynx *laryngopharynx Your Trachea ( windpipe ) Functions as an air passageway and it cleans.rate is less than 10 bpm with normal depth and rhythm is regular Tachypnea is faster than normal breathing .35 to 7. . Things that increase airway resistance ( make it difficult to get enough air ): asthma-where the bronchial smooth muscle contracts chronic bronchitis.

decrease urinary output PVC or A-Fib on heart monitor Give fluids and blood.decreases surface tension which 1) lowers the effort needed to expand the lungs 2) lessens the risk for the alveoli to collapse.tx with abx *inadequate chest expansion *dullness of percussion Treat post-op atelectasis: * Enc to cough & deep breath ( huff ) * respiratory activity as prescribed * reposition Post -Op Hemorrhage hemothorax .hypovolemia . 40 mm Hg is the typical partial pressure of oxygen in the cells of the body.decrease BP/ increase pulse rate restless . may need to return to surgery Pulmonary Edema * lungs do not expand fast enough & circulatory overload early S&Sx *cough *dyspnea *restless *anxiety *low pitch wheezes .air that can be inhaled during forced breathing in addition to the resting tidal volume * Expiratory Reserve Volume .pallor decrease CVP .amount of air inhaled or exhaled with each breath when resting * Inspiratory Reserve Volume .values are set using a spirometer * Tidal Volume .Four Measurements ( respiratory volumes ) .shock S&S .amount of air that remains in the lungs after a forced exhalation Surfactant . Atelectasis (post-op): Collapsed alveoli *Usually caused by bronch secretions *not coughing & deep breathing *may be all or part of the lung S&S *restless *tachycardia *decrease PaO2 *decrease cap refill *tachypnea *fever/infection .is the amount of air that can be exhaled during forced breathing in addition to tidal volume * Residual Volume .

Master gland is the pituitary gland.oxygen G . gonads. hinders growth & development. FSH. inhibits secretion to target glands Insulin . thymus gland.diuretic O .digoxin D . development. Exocrine glands = duct glands Endocrine glands = rely on blood/lymph to carry stuff to tissues Non-steroidal hormones are amino-based molecules. LH.gases Influenza has an incubation period of 1-3 days with a sudden onset. fever/chills. headache.morphine A .regulates the movement of glucose across the cell membrane decreasing blood glucose levels. adrenal gland. Usually last about 7-10 days. Your endocrine glands are: pituitary gland. hypothalamus gland. TSH. and health of the body. sex. parathyroid gland. thyroid gland.aminophylline D . Anterior pituitary gland secretes ACTH. & muscle aches. pineal gland.Late S&Sx *acute dyspnea *blood tinge sputum *increase pulse *decrease BP *anxiety *skin cool & clammy Tx for pulmonary edema MAD DOG M . pancreas. Incentive Spirometer * have patient sit upright unless contraidicated * mark the goal for inhalation * have pt exhale * have pt place the mouthpiece in their mouth * inhale slowly till the predetermined mark is reached * hold at the mark for 3-6 seconds * repeat this 10 times or as ordered every hour while awake or as ordered * do not rush during procedure and slow down if dizziness occurs Fact Files 4 ( endocrine ) The endocrine system affects 5 things: assists the nervous system. Lactogenic Hormone Posterior Pituitary gland secretes ADH and Oxytocin Disorders of the pituitary gland include: Hyperpituitarism = BIG. growth. giantism. . acromegaly Hypopituitarism = SMALL. GH.

Immunosuprresion.Cortisol is replaced with an oral synthetic glucocorticoid. Common Signs/symptoms *weakness *fatigue *abdominal pain *nausea *weight loss *low blood pressure *darkened skin (in the case of Addison’s disease) *salt craving (in the case of Addison’s disease) *dizziness upon standing *depression Treatment of Addison’s disease involves replacing the cortisol and/or aldosterone that your body is not able to produce—or that it secretes in an insufficient quantity. and dexamethasone. Hypothyroidism is when your thyroid doesn’t produce enough hormones. Cushings Disease/Syndrome Results from excessive glucocorticoids. Addison’s disease. in most cases. prednisone. The thyroid hormones T3 and T4 help regulate your body’s metabolism and how you use energy. Does the president just automatically know what is going wrong in the states? No they talk to the vice president who tells it to the president who in turn reacts. TB reactivation TX: When Cushing's syndrome is caused by glucocorticoids that are taken for another medical condition. The drug is taken one or two times each day. develops when the adrenal glands do not produce enough of the hormone cortisol.centripetal truncal and livid purple striae Hypertension and headache Moon face and Facial plethora and acne Osteopenia and back pain and proximal myopathy Thin fragile skin and bruising Avascular necrosis of femoral head Diabetes and IGT Psychosis and neuropsychatric disorders Menstrual disorders and impotence Dorsocervical fat pad "Buffalo hump" Impaired growth in children Septicaemia. Here is what a man who is an AMAZING teacher told me: The Pituitary gland is like the president. the adrenal glands also don’t produce enough of the aldosterone hormone.Glucagon . But. stopping the glucocorticoids often resolves symptoms. the body has . Sometimes. S&S: Obesity . Generic drug names for glucocorticoids include hydrocortisone. He also told me that all hormones with an S are from the pituitary and that the S stands for stimulate. a rare disorder. the hypothalamus is the vice-president. All the other glands are all the heads of states.stimulates your liver to release glucose to increase the blood glucose levels.

nausea/emesis. one of which is chronic thyroiditis (Hashimoto's Thyroiditis). anorexia. Train cars carrying oxygen was just some little thing my prof used for my first nursing class to get us to understand the relationship between H&H and oxygen/perfusion. In SIADH. basically the same symptoms you'd expect with hyponaturemia ( low sodium ) is what you'll see. T4 blood levels are higher than those of T3. Thyroid storm is an exacerbation of all of the signs and symptoms of hyperthyroidism and is a true medical emergency.adapted to the presence of the glucocorticoids..edema. high levels of ADH interfere with renal function which leads to hyponaturemia and hypoosmolarity. treatment may include surgery. or medication to lower cortisol levels. I wanna share more NCLEX Questions for practice. Dont worry it's all free. Most of the disorders of thyroid function are related to hypersecretion (hyperthyroidism) and hyposecretion (hypothyroidism) of thyroid hormones.net: . but T3 is four times more potent. dyspnea on exertion. Insulin should be stored in a refrigerator and must be taken out 15. Normally the body converts T4 to T3 as needed.20 minutes before being given to the patient. It is associated with some forms/kinds of cancer and transient SIADH may follow pituitary surgery as the stored ADH may then be released unregulated. thirst. SIADH is associated with some kinds of cancers because of ectopic secretion oF ADH by the tumor cells. Main Features are water retention. impaired taste. The pathophysiology of all types of diabetes is related to the hormone insulin. In an average cardiac arrest you have a mixed acidosis-low cardiac output and tissue hypoperfusion causes lactic acidosis. The nurse should take care that the injection locations don't repeat daily. fatigue. and they must be tapered off gradually to allow the pituitary and adrenal glands to resume normal function. A record of the different sites where the injections are given to the patient should be maintained. go with the lactic acidosis answer.. which is secreted by the beta cells of the pancreas. and toxic adenoma. As different sites will have varied absorption ability. If they are talking about a hospitalized pt who would be getting O2 and bagged. Long-standing hypothyroidism may result in myxedema SIADH is characterized by high levels of ADH when the normal process for it's stimulation is not working. radiation. which leads to respiratory acidosis. When Cushing's syndrome results from an ACTH-producing tumor of the pituitary gland (Cushing's disease). ventilation is also depressed in cardiac arrest. thyroxine-T4 (with four iodines) and triiodothyronine T3 (with three iodines). There are three common causes of hyperthyroidism in adults: Grave's disease. urine sodium losses. but. There are various causes. Hypothyroidism is a condition characterized by inadequate or low levels of thyroid hormones. From nursetoday. it is preferable to change the sites occasionally. The thyroid gland makes two hormones. just a stupid thing from class More NCLEX Questions Hi guys. toxic multi-nodular goiter. sodium loss. improvement in hyponaturemia with water restriction.

when spontaneous circulation returns.net/nclex-question.30 compressions in 18 seconds. CPR devices. it is recommended that lay rescuers should just assume that an adult who suddenly collapses.ion-nutrition/ http://nursetoday.. compressions should resume immediately. Several devices have been studied in recent years. gasping) has had a cardiac arrest. . It is believed that a significant obstacle to bystanders performing CPR is their fear of doing mouth-to-mouth breathing. The traditional recommendation of "look.net/nclex-question. and feel" has been removed from the basic life support algorithm because the steps tended to be time-consuming and were not consistently useful. and begin compressions.http://nursetoday. which previous guidelines had recommended at the start of resuscitation.. listen. • • • Most survivors of adult cardiac arrest have an initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). There are several reasons for this change. If no pulse is found within 10 seconds.ral-therapies/ http://nursetoday. ETCO2 levels are expected to abruptly increase to at least 35-40 mm Hg. whether mouth-to-mouth breathing.. interruptions in compressions for pulse checks become unnecessary. Pulse checks by lay rescuers should not be attempted because of the frequency of falsepositive findings. The 30 compressions are now recommended to precede the 2 ventilations. Other recommendations: • • • • Hands-only CPR (compressions only -.. If pulse checks are performed. By monitoring these levels. activate the emergency response system. is unresponsive and not breathing normally (eg.net/more-nclex-questions-rationales/ http://nursetoday. often results in a delay of initiation of good chest compressions. No improvements in survival to hospital discharge or neurologic outcomes have been proven with any of these devices when compared with standard. including the impedance threshold device and load-distributing band CPR. and these patients are best treated initially with chest compressions and early defibrillation rather than airway management. Pulse checks by healthcare providers have been de-emphasized in importance. However. Airway management.no ventilations) is recommended for the untrained lay rescuers to obviate their fears of mouth-to-mouth ventilations and to prevent delays/interruptions in compressions. it is thought that more patients will receive important bystander intervention. These pulse checks are often inaccurate and produce prolonged interruptions in compressions. Instead. or endotracheal intubation. the ETCO2 is generally ≤ 10 mm Hg. bagging." A major change in basic life support is a step away from the traditional approach of airway-breathing-chest compressions (taught with the mnemonic "A-B-C") to first establishing good chest compressions ("C-A-B"). healthcare providers should take no longer than 10 seconds to determine if pulses are present. When patients have no spontaneous circulation. Only a minority of cardiac arrest victims receive bystander CPR..net/nclex-question. Basic life support. even if it is limited to chest compressions. Airway management is no longer recommended until after the first cycle of chest compressions -. By changing the initial focus of resuscitation to chest compressions rather than airway maneuvers..ial-reduction/ Study Summary Change from "A-B-C" to "C-A-B. The use of end-tidal CO2 (ETCO2) monitoring is a valuable adjunct for healthcare professionals.

withholding any . Chest compressions for 1. but it fosters even further delays in airway intervention -. Good basic life support. intravenous infusion of chronotropic agents (eg. In reviewing these guidelines. Transcutaneous pacing of patients who are in asystole has not been found to be effective and is no longer recommended. CCR also promotes the "C-A-B" approach to resuscitation. Viewpoint The AHA 2010 guidelines represent significant progress in the care of victims of cardiac arrest. I must admit. dopamine. The recommendations for airway management have undergone 2 major changes: (1) the use of quantitative waveform capnography for confirmation and monitoring of endotracheal tube placement is now a class I recommendation in adults. and (2) the routine use of cricoid pressure during airway management is no longer recommended. There is also increasing support for patients without ST-segment elevation on ECG who are suspected of having acute coronary syndrome to receive urgent cardiac catheterization. is again emphasized as the foundation of successful advanced cardiac life support. As noted above. including high-quality chest compressions and rapid defibrillation of shockable rhythms. Advanced cardiac life support. Defibrillation should then be performed immediately. is generally recommended for adult survivors of cardiac arrest who remain unconscious. Electrical therapies • • • Patients with VF or pulseless VT should receive chest compressions until a defibrillator is ready. As they did in 2005.. Post-cardiac arrest care has received a great deal of focus in the current guidelines and is probably the most important new area of emphasis. There are several key highlights of post-arrest care: • • • Induced hypothermia. that I was disappointed that AHA hesitated to adopt the concepts of "cardiocerebral resuscitation" (CCR). Induced hypothermia is underscored. Post-cardiac arrest care. avoidance of hyperventilation. regardless of presenting rhythm. Most important is the stronger emphasis on post-cardiac arrest care. however. Urgent cardiac catheterization and percutaneous coronary intervention are recommended for cardiac arrest survivors who demonstrate ECG evidence of ST-segment elevation acute myocardial infarction regardless of neurologic status. epinephrine) is now recommended as an equally effective alternative therapy to transcutaneous pacing when atropine fails. The wealth of data thus far indicate that post-arrest percutaneous coronary intervention may be the most significant advance toward improving survival and neurologic function since defibrillation was first introduced decades ago. but recent data have not demonstrated improvements in outcome. Hemodynamic optimization to maintain vital organ perfusion. the AHA acknowledges once again that as of 2010. and maintenance of euglycemia are also critical elements in post-arrest care. Hypothermia should be initiated as soon as possible after return of spontaneous circulation with a target temperature of 32°C-34°C." Several important changes in recommendations for dysrhythmia management have occurred: • • • For symptomatic or unstable bradydysrhythmias.conventional CPR. data are "still insufficient . although best studied in survivors of VF/pulseless VT arrest.. transcutaneous pacing for asystole is no longer recommended.5-3 minutes before defibrillation in patients with cardiac arrest longer than 4-5 minutes have been recommended in the past. and Atropine is no longer recommended for routine use in patients with pulseless electrical activity or asystole. and perhaps the most important advance is the recommendation for urgent percutaneous coronary intervention in survivors of cardiac arrest.to demonstrate that any drugs improve long-term outcome after cardiac arrest.

[2-4] I think that CCR should be incorporated into basic life support protocols for victims of primary cardiac arrest as quickly as possible to further improve outcomes. and Catheterization. in favor of persistent chest compressions.[1] CCR has been studied more recently as well and demonstrated marked improvements in rates of resuscitation and neurologic survival. Medscape: Medscape Access TOP 100 MEDS : Brand Name & Generic (NEED TO KNOW ALL) Lortab Synthroid Prinivil. Zestril Zocor Amoxil Zithromax. Cooling. Optimal management of cardiac arrest in the current decade can be summarized simply by "the 4 Cs": Cardiovert/defibrillate. Ambien CR Hydrocodone Bitartrate with Acetaminophen Levothyroxine Sodium Lisinopril Simvastatin Amoxicillin Trihydrate Azithromycin Dihydrate Atorvastatin Calcium Metformin Hydrochloride Hydrochlorothiazide Alprazolam Albuterol Sulfate (salbutamol) Metoprolol Succinate Atenolol Furosemide Amlodipine Besylate Zolpidem Tartrate . for as long as 5-10 minutes after the cardiac arrest. First described in 2002. Ventolin HFA Toprol-XL Tenormin Lasix Norvasc Ambien. Zmax Lipitor Glucophage Hydrochlorothiazide Xanax Proventil HFA. The current guidelines recommend withholding positive pressure ventilation for a mere 18 seconds. CCR. Proair HFA.form of positive pressure ventilations.

Potassium Chloride Lopressor Percocet Zoloft Prilosec Nexium Prednisone Lexapro Coumadin Singulair Cipro (XR) Motrin Plavix Prozac Ultram Keflex Ativan Klonopin Celexa Wellbutrin (SR. XL) Neurontin Darvocet Potassium Chloride Metoprolol Tartrate Oxycodone Hydrochloride with Acetaminophen Sertraline Hydrochloride Omeprazole Esomeprazole Magnesium Prednisone Escitalopram Oxalate Warfarin Sodium (Crystalline) Montelukast Sodium Ciprofloxacin Hydrochloride Ibuprofen Clopidogrel Bisulfate Fluoxetine Hydrochloride Tramadol Hydrochloride Cephalexin Lorazepam Clonazepam Citalopram Hydrobromide Bupropion Hydrochloride Gabapentin Propoxyphene Napsylate with Acetaminophen .

Prinzide Dyazide Augmentin (XR) Flexeril Bactrim Effexor (XR) Prevacid Advair Desyrel Paxil (CR) Allegra Flonase Lisinopril with Hydrochlorothiazide Triamterene with Hydrochlorothiazide Amoxicillin Trihydrate with Clavulanate Potassium Cyclobenzaprine Hydrochloride Sulfamethoxazole with Trimethoprim Venlafaxine Hydrochloride Lansoprazole Fluticasone Propionate with Salmeterol Xinafoate Trazodone Hydrochloride Paroxetine Hydrochloride Fexofenadine HCl Fluticasone Propionate (nasal) GO TO THIS SITE: http://nursetoday. truthfulness and straight dealing with every person. 5. 4. .net/nclex-questions-basic-care-comfort/ The 12 Absolutely Unbreakable Laws of Leadership 1. 6.The Law of Power: Power gravitates to the person who can use it most effectively to get the desired results. under all circumstances.Zestoretic.The Law of Realism: Leaders deal with the world as it is.The Law of Optimism: The true leader radiates the confidence that all difficulties can be overcome and all goals can be attained. 3.The Law of Integrity: Great business leadership is characterized by honesty. they have a clear vision of a better future. not as they wish it would be.The Law of Ambition: Leaders have an intense desire to lead. 2. which they are determined to realize.The Law of Courage: The ability to make decisions and act boldly in the face of setbacks and adversity is the key to greatness in leadership.

difficulties and adversity. 12. the witness is to answer questions. note the differences from the actual case before responding to the question. Have a clear understanding of the facts of the case. If you don't know the answer. Do what your attorney advises. Sarcasm and wisecracks should not be a part of the testimony. If you are tired and need a short break. Giving testimony can be a terrifying experience. 9. adapted from Myers and Fergusson. This technique should not be used when giving testimony. Do not blurt out an answer. If you are asked a question about a document. cool and controlled in the face of problems. feelings and motivations of their people. . Dress appropriately. look like one.The Law of Emotional Maturity: Leaders are calm. If you are asked a hypothetical question. directly. 8. If you are concerned about a line of questioning. It is better to admit to a gap in knowledge than to give the wrong answer.The Law of Empathy: Leaders are sensitive to and aware of the needs. and honestly with short. what they believe in and they think for themselves.The Law of Excellence: Leaders are committed to excellent performance of the business task and to continuous improvement. If you want to be recognized as a professional. 11. a nurse might be called upon to testify in a trial on his/her own behalf as a defendant or as an expert witness on behalf of a plaintiff or other defendant. Do's and don'ts of testimony. This is an accepted practice for witnesses. in-depth preparation can help alleviate those fears. disappointments and temporary failures experienced in the attainment of any worthwhile goal. 10. don't hesitate to ask to see the document before responding to the question. often use rephrasing techniques in practice to elicit information from patients. Think about what to say before saying it. are as follows: The dos: • • • • • • • Get a good sleep the night before the testimony.7. Nurses. say so. Keep in mind.The Law of Foresight: Leaders have the ability to predict and anticipate the future. unemotional answers. However. not to ask them. Speak clearly. The don'ts: • Don't guess.The Law of Resilience: Leaders bounce back from the inevitable setbacks. explain your concerns to your attorney during a break. Stay alert. For example: 1. What to do if I get sued or have to testify? Testifying During the course of a career. 2.The Law of Independence: Leaders know who they are. Answer the question asked of you. ask for one.

Another myth is that a nurse who purchases liability insurance is no longer covered by an employer's policy. It is illegal for an employer's policy to drop an employee because he/she has liability insurance. Student Nurses Can Be Sued Student nurses can be held liable for their actions and can be sued.• • • • • • • • • • Don't waste energy trying to anticipate what the plaintiff s attorney is leading up to. A professional liability insurance policy is another risk management tool. Don't be defensive. Tell the truth in an open. Don't answer off-the-record questions. Don't volunteer new information. Don't use medical jargon. If you don't remember what happened. the instructor might have been found liable on the basis of inadequate supervision had the instructor given the task to the student knowing the student was not capable or competent to perform the task. concern for the nurse will be secondary. Don't take any documents to a deposition or other session that you were not asked by counsel to bring. an attorney might switch from a hostile manner to a soft spoken one or from a friendly attitude to an unfriendly one in an effort to manipulate the witness. There are also a number of myths about liability insurance in the nursing profession. Current knowledge about professional standards. O'Sullivan (1996) also advises that nurses can no longer assume the hospital will provide the best defense in lawsuits as a hospital attorney's primary concern will be the hospital. Attorneys use different approaches. . say "I don't recall. A student nurse is held to the same standard of care as a registered nurse when performing RN duties. If a student nurse cannot safely function in the performance of these duties while unsupervised. Liability insurance protects against the financial consequences of suits. The student was found to be negligent because she should have known the proper procedure and taken special precautions with the patient who was very thin. lawyers normally do not know if the nurse named in lawsuits has extra insurance or not" (O'Sullivan. codes of conduct. straightforward way. treatment modalities. Kelly and Joel (1995) report the case of a first year student who administered an intramuscular injection into a patient's sciatic nerve causing severe damage. 1996). Familiarity with the reasons nurses are sued is also relevant to managing risk. Speak in laymen's terms. Insurance is basically a contract between an insured and an insurance company that upon the payment of a premium the company will provide the insured certain financial payments when the insured is accused of causing injury to another. In another set of circumstances. nurses believe that an employer's liability insurance is all the coverage needed." Don't be caught off guard. Often. Keeping up to date on new technologies. medications. and employer policies and procedures is a must. the attorney should have briefed you fully prior to the testimony. Don't try to convince the lawyers. (If you are a witness for the plaintiff.) Don't apologize. Protection Against Suits Nurses must continuously monitor their practice to manage away from risk. For example. try to convince the jury or judge. and accreditation criteria are also important. One myth is that a nurse runs a greater risk of being sued if the nurse has liability insurance. Stick to what has been agreed to with counsel. Don't be evasive. O'Sullivan (1996) points out that some hospital policies have not kept up with the changing role of the nurse and that an employer's policy may not cover nurses off-duty or volunteering in a community role. "In reality. the student should not be carrying out the duties.

. the illegal drug. dependence can lead to opiate overdose and even death. Opiates are the most abused of all drugs. Opiate drugs are narcotic sedatives that depress the activity of the central nervous system. Some of the most commonly prescribed opiates include: • • • • • • • Fentanyl Morphine Vicodin (hydrocodone) Oxycontin Oxycodone Codeine Methadone In addition to the prescribed opiates mentioned. depending on the clinical situation. Important Warning! If Suboxone is chewed or crush and injected. they have a high incidence of physical and emotional dependence. the naloxone contained in the drug will produce severe opiate withdrawal symptoms." naloxone blocks the effect of opiates. meaning the amount taken must increase to acheive the same effect.This drug is an opiate antagonist. there is a risk of misuse by people addicted to opiates. Because Suboxone is an opiate agonist (a molecule that can trigger a receptor). Opiates are a family of drugs derived either naturally or synthetically from the seed of a plant known as the poppy. dependence can occur. meaning it can both activate and block opiate receptors. It is actually two drugs in one pill. As the amount of opiates increase to compensate for tolerance.This is the active ingredient in Suboxone. Buprenophine is a partial opioid agonist. the physical and emotional attraction to opiates makes it almost impossible for most. If Suboxone is crushed and injected in hopes of getting an opiate "high. they attach to receptors in the brain. naloxone is not absorbed in sufficient amounts to have a clinical effect. reducing pain and inducing sleep. How Does Suboxone Help Beat Opiate Addiction • When opiates are taken into the body. How Does Suboxone Help? Suboxone (buprenorphine + naloxone) has been approved for the treatment of opiate dependence. To prevent this. producing severe withdrawal symptoms. • • Buprenorphine . Heroin is also an opiate. causing dopamine release and euphoria. naloxone was combined with buprenorphine. While many wish to quit. Longterm use of opiates can result in tolerance of the drug. While opiates are an effective treatment for many types of moderate to severe pain. But now there is hope for those people with opiate addiction who want to quit. Naloxone .ANA Continuing Education | ANA: ANA Nursing Risk Management Series: I: An Overview of Risk Management Suboxone for Opiate Addiction Opiate addiction is a very common problem in our culture today. meaning it blocks the effects of opiates. When Suboxone is taken under the tongue as prescribed. The drug Suboxone is offering people with opiate addiction new hope in their attempts at kicking the habit. But the use of Suboxone for opiate addiction is making a difference in people living with opiate addiction. Using Suboxone for opiate addiction does work. Often. In fact some consider Suboxone a miracle drug.

An 83 year old woman with a history of leukemia. At the end of the shift. ask her why she has not completed her med charting. filling them and blocking other opioids from occupying those receptors. Suboxone therapy can begin. so the effects do not wear off quickly as is the case with opiates. Teaching proper nutrition 3. A woman with unstable diabetes who is scheduled for a pancreatic cat scan. notify her nurse manager and make sure to include it on her evaluation. d. Because there are no withdrawals. You are the charge nurse and have a new nurse on the floor. the new nurse lets you now that she has not completed charting her medications for the shift. At this point. What do you tell her? a. a. Because the receptors are no longer empty. Which of the following would be an appropriate job to give the CNA? a. Buprenorphine has a much longer duration of action than do other opioids. nothing 2. b. Which of the following would be an appropriate job to give an LPN/LVN? a. help her document so you can both go home c. Patients have better long term success when the medication is combined with an outpatient therapy program. opiates leave the receptors causing the feelings of euphoria to fade and the symptoms of withdrawal to begin. A man with a history of chest pain who was admitted with shortness of breath. Buprenorphine attaches firmly to the receptors. NCLEX Questions ~ Nursing Delegation 1. 5. A patient with sudden unexplained bleeding b. helping the patient to bathe c. IV medications d. A patient scheduled to have a chest x-ray done d. with temp and shortness of breath. As more of the receptors become empty. From the following list of patients which one can be assigned to a nursing assistant/CNA? a. the withdrawal symptoms worsen. Daily weight b. teaching the patient about a low salt diet b. grant her overtime so she can get it done d. A young black woman with sickle cell anemia who has multiple IV medications ordered. b. A patient with unresolved pain over the past 8 hour shift c. e. You are caring for a patient with an acute MI. You are caring for a patient with extreme malnutrition and suspect anorexia nervosa. A patient who has multiple allergies to medications? 4. When Suboxone is taken. c.• • • • • Eventually. assessing their pain d. Which of the following patients would you assign to the new nurse? There is more than one answer. . the buprenorphine attaches to the receptors in the brain once occupied by opiates. A woman who is one day post-op for a lap choly. You want to assign a certified nursing assistant to the patient. Oral hygiene c. withdrawal symptoms diminish. the person can stop taking opiates and start working on kicking his opiate habit.

proficient nurse 8. restocking supplies b. The answer is: Oral hygiene 3. giving out assignments to her team with includes 2 LPN/LVN's and 2 nursing assistants. The answer is: A patient scheduled to have a chest x-ray done 4. Openly ask her about it and tell her that she is wrong and report her. Discuss it at the next staff meeting c. advanced beginner c. competent nurse d. You know that one of the tasks she is assigning to the CNA should only be done by a licensed nurse. What should you do? a. transporting patients c. clerical activities d. d. Tell the charge nurse who is in a meeting. Which of the following is a direct patient care task? a. Which nurse still needs help in setting priorities and relies on rules and protocols? a. b. an RN. ANSWERS: 1. You are listening as one of your co-workers. novice nurse b. The answer is: Helping the patient to bathe 2. Discuss with her why the task is not appropriate for the CNA.6. The answer is: The only patient you wouldn't give the new nurse is the patient in . performing an EKG 7.

The answer is: Ask her why she hasn't completed her med charting. a pharmaceutical market intelligence firm.sickle cell crisis with multiple IV medications. a water pill used to lower blood pressure -.1 million prescriptions Lisinopril (brand names include Prinivil and Zestril). The 10 Most Prescribed Drugs April 20. 5. a cholesterol-lowering statin drug -. In order of number of prescriptions written in 2010. The answer is: Discuss with her why the task is not appropriate for the CNA. Nursing Lab Values Cheat Sheet Lab Values: Cheat Sheet Red Blood Cells (RBC): .S. synthetic thyroid hormone -.6. are: • • • • • • • • • • Hydrocodone (combined with acetaminophen) -.2.5 million prescriptions Generic Norvasc (amlodipine besylate).70.3 million prescriptions Hydrochlorothiazide (various brand names). the 10 most-prescribed drugs in the U. a blood pressure drug -.131. Continuing a major trend.53. an antacid drug -.48. 6. IMS finds that 78% of the nearly 4 billion U.6 million prescriptions Amoxicillin (various brand names). a diabetes drug -.57.6. aren't the drugs on which we spend the most. an antibiotic -.2 female = 4.Normal: male = 4.47. an antibiotic -.52. The institute is the public face of IMS.52.S. according to a report from the IMS Institute for Healthcare Informatics. The answer is: Performing an EKG 7. an angina/blood pressure drug -.3 million prescriptions Generic Glucophage (metformin). 2011 — The 10 most prescribed drugs in the U. prescriptions written in 2010 were for generic drugs (both unbranded and those still sold under a brand name).4 million prescriptions Generic Synthroid (levothyroxine sodium).2 . The answer is: Advanced beginner 8.2 million prescriptions Generic Prilosec (omeprazole).4 million prescriptions (does not include over-the-counter sales) Azithromycin (brand names include Z-Pak and Zithromax).2 million prescriptions Generic Zocor (simvastatin). prescription drug use.Actual count of red corpuscles .5.S.94.S.8 million prescriptions.87. Its latest report provides a wealth of data on U.

lethargy.5% of RBC .000 * Low: worry patient will bleed * High: not clinically significant White Blood Cell (WBC): . restlessness. inability to replace insensible losses.Normal: 27.= the percentage of blood that is composed of erythrocytes Mean Cell Volume (MCV): .Indicates variation in red cell volume * Increase: indicates iron deficiency anemia or mixed anemia .5-2.Note: increase in RDW occurs earlier than decrease in MCV therefore RDW is used for early detection of iron deficiency anemia Platelet Count: .Hemoglobin: .Normal: male = 80.4 – 10 * Increase: occur during infections and physiologic stress * Decreases: marrow suppression and chemotherapy Sodium (Na): . muscle twitching.An indirect measure of RBC production Red Blood Cell Distribution Width (RDW): .Normal: 136.145 .440.45% .98 Mean Cell Hemoglobin (MCH): .Normal: males = 39.Normal: 3. coma and death. seizures.000 .49% female = 35.33 .Major contributor to cell osmolality and in control of water balance * Hypernatremia: greater than 145  Causes: sodium overload or volume depletion  Seen in: impaired thirst.Normal: 0. hyper flexia.35 Reticulocyte Count: . irritability.Normal: 11-16% .A direct measure of oxygen carrying capacity of the blood Hematocrit : .96 female = 82. * Hyponatremia: 136 or less  Causes: true depletion or dilutional . renal or GI loss  S/sx: thirst.Normal: 140.= % volume of hemoglobin per RBC * Increase: indicates folate deficiency * Decrease: indicates iron deficiency Mean Cell Hemoglobin Concentration): .Normal: male = 14-18 g/dl female = 12-16 g/dl .Normal: 31.

5.9. hunger.0 (panic > 6) NOTE: False K elevations are seen in hemolysis of samples! Chloride (Cl): .Normal: 96.SCr is constant in patients with normal kidney function. thiazides  Symptoms: agitation.5. insulin administration BUN: Blood Urea Nitrogen .Total protein: normal = 5.5 * Hyperkalemia: greater than 5.7 for children . periorbital edema and pulmonary edema..0. anorexia.1.Panic = > 100 mg/dl Serum Creatinine (SCr): . May progress to coma  causes: include diabetes * Hypoglycemia:  s/sx: sweating.20 .Albumin: normal = 3.30 . * Increase:  Indicates worsening renal function Total Protein and Albumin: . lethargy. anxiety. muscle cramps and nausea Potassium (K): . sweating.Normal: 3.5. Serum Calcium (Ca): . diarrhea.5 for adults and 0.110 * Hyperglycemia:  s/sx: increase thirst.8 . headache or altered mental status  causes: fasting.Normal = 8.Normal: 0. increase urination and increased hunger (3Ps).The test represents bicarbonate (the base form of the carbonic acid-bicarbonate buffer system) * Decreased: acidosis * Increased: alkalosis GLUCOSE: Normal: 70.0 . weakness.106 * Reduced: by metabolic alkalosis * Increased: by metabolic or respiratory acidosis Bicarbonate (HCO3): .7.5 * Related to liver status * Low: Cause: liver dysfunction S/sx: peripheral edema. trembling.5. disorientation.10.0 . apathy.2.Regulated by renal function * Hypokalemia: less than 3.Normal: 8.Normal: 24. Occur in: CHF. blurred vision. ascites.

2 . decreased intake. Alcoholism may lead to low levels  S/sx: weakness. . * Hypermagnesemia: more than 2.5  Causes: excessive losses from GI tract (diarrhea or vomiting) or kidneys (diuretics). increased reflexes. cerebellar ataxia and possibly coma or death  Increased risk of digoxin toxicity Phosphate (PO4): . hallucinations and possible seizures or tetany  Lead to: MI.Normal ALT: 3.30 Direct Bilirubin (Conjugated): . flushing. excessive vit D or thyroid hormone.  Acute (>14. EKG changes over 15 = respiratory distress and asystole. N/V.5  Causes: low serum proteins (most common). psychosis. * Hypercalcemia: more than 10.5 Magnesium (Mg): .1-0. steroids. progesterone. sweating. small intestine. muscle fasciculation with tremor. * Increase: associated with increases in other liver enzymes and reflect liver disease . hyperthyroidism.* Hypocalcemia: less than 8. Increase: occurs after MI.3 mg/d.2  Caueses: incrased intake in the presence of renal dysfunction (common). renal failure. placenta and leukocytes (most activity from bones and liver) * Increased: occurs in liver dysfunction Aminotransferases (ALT and AST): . kidneys. vitamin D deficiency (common). tingling. androgens.6. dyspepsia and anorexia  Severe s/sx: lethargy. tamoxifen.5.Normal: ranges vary widely .5) s/sx: nausea.Normal: 2. loop diuretics.Normal: 0. psychosis. memory loss. chronic immobilization. vomiting.2.8  Cause: malignancy or hyperparathyroidism (most common).4.Primarily eliminated by the kidney * Hypomagnesemia: less than 1. . low Mg. pancreatitis  S/sx: fatigue. hypoparathyroidism (common). cardiac arrhytmias and hypotension  Early signs: finger numbness. sarcoidosis. bones. convulsions. high PO4. low Ca at 10-15 mEq/L = flaccid paralysis. supplements. burning of extremities and paresthias. Sensitive to hepatic inflammation and necrosis.Normal: 1. estrogen. tetany. personality changes. hepatitis and Addisons disease  S/sx: at 2-5 mEq/L = bradycardia. come and cardiac arrhythmia. Alkaline Phosphatase: .ALT and AST are measure indicators of liver disease. muscle diseases and hemolysis.Group of enzymes found in the liver. calcitonin. excessive IV Ca salts. lithium. Pagets disease. depression.

multiple myeloma.0) .provides calories and free water. Clorets abuse * Brown-Black: Cascara. provides some sodium and chloride o 0. senna. chloroquine.Significant bacteriuria is defined by an initial positive dipstick for leukocyte esterase or nitrites.0) . o 5% Dextrose and Water (Osmolarity of 253. metabolic alkalosis where there has been sodium depletion and fluid loss. phenothiazines.Urine should be sterile (no normal flora) . contaminated specimen is likely.8) .provides electrolytes.primarily used to replace sodium and chloride. renal tubular damage.Urine: .Side note: some medications will change color of urine * Red-Orange: Pyridium. exercise. When used continuously and exclusively.0 to 6.7) . pH of 6.3) provides calories and free water.Few.8 Protein content [in urine]: . fever.45% Sodium Chloride (Osmolarity of 280. pH of 4. cells should be found . iron salts. lupus nephritis and others. Also contains sodium lactate which is used in treating mild to moderate metabolic acidosis.replaces sodium. pH of about 4. The reason for it's used with blood transfusion is because it will not hemolyze erythrocytes. high BP. Learn the Difference in IV Fluids • • Hypotonic solutions o 0.5) provides calories and free water o 5% Dextrose and 0.provides electrolytes o Plasmalyte R [Baxter] (Osmolarity of 312.6) .5 to 5. the patient needs to be monitored for hyponatremia and calorie depletion (there are no calories in this solution). Elavil. o Normosol R [Abbott] (Osmolarity of 295. pH of about 4. Isotonic solutions o 2.4) .Normal: 4.5% Dextrose and 0. Used most often to hydrate patients and to treat hyperosmolar diabetes.Normal: 0 . Microscopic analysis of Urine: .5 to 5.+1 or less than 150 mg/day * Protein in urine: indication of hemolysis. and provides free water. Flagyl. replaces chloride. nephrosis. It's components include . CHF.6) . If more than 1 or 2 species seen.9% Sodium Chloride (Osmolarity of 308. pH of about 4.5.5) . pH of 6. Contains 77mEq of sodium and 77mEq of Chloride.it's content is very similar to plasma. treats hyperosmolar diabetes. o Isolyte E [McGaw] (Osmolarity of 315. senna.45% Sodium Chloride (Osmolarity of 155. rifampin. * Blue-Green: Azo dyes. phosphates (alkaline) or presence of RBC or WBC * Foam: from protein or bile acids in urine . preeclampsia of pregnancy.0 to 4. pH of 5.provides electrolytes o Ringer's (Osmolarity of 310. but should not be used continuously since it contains no calories and could result in an excessive amount of one or more of the electrolytes it contains. UTI. pH of 5. sulfonoamides and nitrofurantoin pH: . pH of 5.provides electrolytes o Plasmalyte A [Baxter] (Osmolarity of 294.0 to 5. diabetic nephropathy. metabolic alkalosis where there has been sodium depletion and fluid loss.Normal: should be clear yellow * Cloudy: results from urates (acid). Often given as rapid bolus for fluid replacement during resuscitation. if any.11% Sodium Chloride (Osmolarity of 290. methylene blue. pH of 7.

It is also used for the prophylactic prevention of venous thrombosis and pulmonary embolism during surgery. often where there has been extracellular fluid loss. Adding Dextrose increases the osmolarity of the solution and lowers it's pH making it a hypertonic solution.9% Sodium Chloride (Osmolarity of 308. Complications include circulatory overload that results in various kinds of congestion and increased bleeding time. pH of 4. provides electrolytes.5) . replaces sodium and chloride o 5% Dextrose and 0. trauma. pH of 4. • Hypertonic Solutions o 5% Dextrose and 0.10% Dextran is a low molecular weight dextran. Lactated Ringer's [also known as Hartmann's solution] (Osmolarity of 275. metabolic alkalosis where there has been sodium depletion and fluid loss. It should NOT be used as a blood substitute except in emergencies when blood is not available. It is used in treating shock related to vascular system fluid losses such as in burns. Because dextran pulls fluid into the vascular system it will result in altered blood tests.o o o o sodium.5% Dextrose in half strength Lactated Ringer's (Osmolarity of 263.0 to 4. replaces sodium and chloride. This is given for fluid replacement. but should not be used continuously since it could result in an excessive amount of one or more of the electrolytes it contains. Since lactate is metabolized in the liver it shouldn't be used in patients with hepatic diseases. Also contains sodium lactate which is used in treating mild to moderate metabolic acidosis. As with the 6% Dextran solutions. It draws fluid into the vascular system. chloride. GI problems of nausea and vomiting. It is used to replace electrolytes and to hydrate.0 to 4. Using it in a patient with lactic acidosis will overload the person's buffering system. subsequent laboratory blood tests will be altered due to it entering the vascular system.45% Sodium Chloride (Osmolarity of 405. o 5% Dextrose and 0. calcium and sodium lactate which is used to replace electrolytes and to hydrate. This is given for fluid replacement. It is used in treating mild to moderate metabolic acidosis and hypovolemia. Complications with the use of this solution include anaphylactic reaction. 6% Dextran and 0. pH of 4. pH of 4. pH of 6.4) . 2. This is given for fluid replacement.4) . . It's components include sodium. pH of 4. wheezing. pH of 5. The NaCl replaces sodium and chloride. replaces sodium and chloride.0 to 4.0 to 4. potassium. the type and cross match needs to be done before this solution is started. Also see the information above with Lactated Ringers.6% Dextran is a high molecular weight solution. This Dextran is excreted through the renal system within 24 hours. often used where there has been extracellular fluid loss. burns or hemorrhage.4) provides calories and water. o 5% Dextrose and 0. tightness in the chest.0 to 4. Dextran is a plasma expander that is given for shock or anticipated shock related to trauma.5) . potassium and calcium. Treats hyperosmolar diabetes. circulatory overload and tissue dehydration. Adding Dextrose also increases the osmolarity of the solution and lowers it's pH making it a hypertonic solution.6) .5 to 6. If blood transfusion is intended. 10% Dextran and 0.4) .provides calories and water.0) provides calories and free water. it's content is very similar to plasma. It's volume expansion effect lasts for approximately 24 hours during which the dextran is slowly broken down to glucose and metabolized into carbon dioxide and water. and for the prophylactic prevention of venous thrombosis and pulmonary embolism during surgery.provides calories and water.3% Sodium Chloride (Osmolarity of 365. Often given as rapid bolus for fluid replacement during resuscitation.0 to 4. surgery. replaces sodium and chloride.provides calories and water.as with Ringer's. hemorrhage and surgery.2% Sodium Chloride (Osmolarity of 320. pH of 4. chloride.9% Sodium Chloride (Osmolarity of 252.9% Sodium Chloride (Osmolarity of 560.

7) . It maintains osmotic pressure and acid-base balance. It is primarily used for intracranial pressure and cerebral edema where it acts within 15 minutes of being infused.provides calories and water.Is an alkalizing solution that is used to treat metabolic acidosis associated with renal disease and cardiac arrest. hypokalemia. Other conditions it might be used for are excessive sweating.0) . The major complications associated with it's use are related to electrolytes and include metabolic alkalosis.provides calories and free water. The patient's blood tests should be monitored when the patient is receiving mannitol. 15% Mannitol Injection (Osmolarity of 823. replaces sodium and chloride 10% Dextrose and 0.0 to 5.provides calories and water 5% Dextrose in Ringer's (Osmolarity of 562. It will also be used during the oliguric phase of acute renal failure to promote the excretion of toxic substances from the body. pH of 4. It acts rapidly and is excreted within 3 hours through the kidneys.3) .45% Sodium Chloride (Osmolarity of 660. ulceration and sloughing of the skin. It promotes diuresis by drawing fluid from the cells into the plasma. In high intraocular pressure. replaces sodium and chloride 10% Dextrose and 0.used to replace severe sodium and chloride losses.9% Sodium Chloride (Osmolarity of 815. renal impairment and excessive water intake where hyponatremia has occurred. cell dehydration. pH of 4. 5% Sodium Chloride (Osmolarity of 1710. provides electrolytes.used to replace severe sodium and chloride losses. replaces sodium and chloride 3% Sodium Chloride (Osmolarity of 1030. precipitate formation in the IV line and altered laboratory blood tests. fluid overload. hypocalcemia. pH of 4. It will also be used during the oliguric phase of acute renal failure to promote the excretion of toxic substances from the body. pH of 4. It is also used in severe hyperkalemia.0 to 4. other electrolyte imbalances and IV site extravasation that causes chemical cellulitis. 10% Dextrose and Water (Osmolarity of 505.3) .5) . Also contains sodium lactate which is used in treating mild to moderate metabolic acidosis. pH of 4. pH of 4. pH of 5.0) . skin extravasation and necrosis with infiltration of the IV site. Also see the information above with Lactated Ringers. pH of 8.5) . pH of 5.provides calories and water 50% Dextrose and Water (Osmolarity of 2526. provides electrolytes.o o o o o o o o o o o o o o 10% Dextrose and 0. pH of 5.provides calories and water.7) .3) .Contains sodium lactate which is used in treating mild to moderate metabolic acidosis.Mannitol is a sugar alcohol colloid and a plasma expander.9) . Also see the information above with Ringer's 5% Dextrose in Lactated Ringer's (Osmolarity of 527. vomiting. Other conditions it might be used for are excessive sweating. it pulls fluid from the anterior chamber of the eye within 30 to 60 minutes of infusion. water and sodium retention that cause hypernatremia. pH of 4. 10% Mannitol Injection (Osmolarity of 549. 5% Dextrose and 5% Alcohol (Osmolarity of 1114. In high intraocular . renal impairment and excessive water intake where hyponatremia has occurred. The sodium in the solution is an antagonist to the cardiac effects of potassium.provides calories and free water. pH of 5. 1/6 M(olar) Sodium Lactate (Osmolarity of 335.3 to 4. necrosis. It acts rapidly and is excreted within 3 hours through the kidneys.8) . It promotes diuresis by drawing fluid from the cells into the plasma.3) provides calories and water.2) . It is primarily used for intracranial pressure and cerebral edema where it acts within 15 minutes of being infused. Complications include frequent and severe fluid and electrolyte imbalances.5) . vomiting.Mannitol is a sugar alcohol colloid and a plasma expander.Provides calories and free water 5% Sodium Bicarbonate Injection (Osmolarity of 1190. pH of 6.2% Sodium Chloride (Osmolarity of 575.0 to 4. pH of 4.

Adding Dextrose to them makes the resulting solution hypertonic. In high intraocular pressure.0 g/dL (male). The higher percentage Dextrose solutions are used to supply the patient with calories and often need to be given via a central IV line.o pressure. Sodium deficits occur in head injuries.Normal: 3.Normal: 0. pH of 5.0 mEq/liter  chloride .0-16.Normal: 97-110 mEq/liter .0 g/dL o serum osmolality . Complications include frequent and severe fluid and electrolyte imbalances. It is primarily used for intracranial pressure and cerebral edema where it acts within 15 minutes of being infused.7) .Normal: 280-295 mOsm/kg o serum electrolytes  sodium . cell dehydration.5-18. Complications include frequent and severe fluid and electrolyte imbalances. It promotes diuresis by drawing fluid from the cells into the plasma. Basically • • • • • • • • • the Dextrose solutions also serve as diluents for the administration of many IV medications. the electrolyte solutions are isotonic. particularly o the BUN (blood urea nitrogen) . The patient's blood tests should be monitored when the patient is receiving mannitol. fluid overload. In general. precipitate formation in the IV line and altered laboratory blood tests. It acts rapidly and is excreted within 3 hours through the kidneys. fluid overload. 39-47% (female) o hemoglobin . cell dehydration.7-1.The dextrose in IV solutions is metabolized very rapidly since it is a simple sugar which leaves behind plain old water.45%) o calorie depletion o hypernatremia (with continuous infusion of the higher percentage NaCl solutions) o peripheral edema o an exhaustion of other body electrolytes o hyperchloremia 5% Dextrose in one liter of water contains 5 grams of dextrose per every 100mL which gives 170 calories per liter of fluid (this was a question on my state board exam in 1975).5-5. Free water . Hypovolemia occurs in acute pancreatitis. The patient's blood tests should be monitored when the patient is receiving mannitol. it pulls fluid from the anterior chamber of the eye within 30 to 60 minutes of infusion. • Always review your patient's laboratory tests to determine if the IV solution is appropriate. it pulls fluid from the anterior chamber of the eye within 30 to 60 minutes of infusion. This water is able to cross all cell and tissue membranes to go into the various fluid compartments where is it needed.Normal: 13. precipitate formation in the IV line and altered laboratory blood tests. SIADH (Syndrome of Inappropriate Antidiuretic Hormone) and cirrhosis I boldfaced the solutions with the lowest and highest osmolarity Problems with using IV solutions of strictly Sodium Chloride include o hyponatremia (with continuous infusions of 0. 12. 20% Mannitol Injection (Osmolarity of 1098.5 mg/dl o hematocrit .Normal: 135-145 mEq/liter  potassium .Normal: 44-52% (male). It will also be used during the oliguric phase of acute renal failure to promote the excretion of toxic substances from the body. skin extravasation and necrosis with infiltration of the IV site.Mannitol is a sugar alcohol colloid and a plasma expander. skin extravasation and necrosis with infiltration of the IV site.Normal: 10-20 mg/dl o serum creatinine .

Normal: 38-42 mm Hg  bicarbonate . Bertie’s Coumadin dose was reduced. or 4.3-4. 4. cuts). a skin infection? 2.8-3. hit her forearm on a chair. so good.6-5.5-4. Set priorities Did the nurses get so busy that checking Bertie’s arm was no longer a high priority? There are so many pressing tasks that must be done and so little time to do them.Normal: 1. would you know to check for increased warmth? Would you call the NP. Follow the care plan until the problem is resolved A few weeks ago. The PT/INR results proved we were right.5 mg/dL.0 mg/dL. pain. suctioning and fistulas fluid lost through the skin as the body attempts to regulate it's temperature or trauma of the skin (burns.Normal: 2.Normal: 80-100 mm Hg  PaCO2 .0-7. renal disorders. large open wounds. on Coumadin for chronic atrial fibrillation. would you mention Bertie’s allergies and that she was on Coumadin so if an antibiotic was prescribed. We suspected the bleeding was from her Coumadin dose being high. We wrote a nursing care plan stating the nurses needed to watch Bertie’s forearm for edema. Because the edema and ecchymosis were improving.3-2.the shift of fluid from the circulation to a space where it is trapped and cannot be exchanged with fluid in the extracellular space.1 mEq/liter. Bertie. PA or physician to describe your findings? When you talked to the health care professional.8-2.35-7. administration of concentrated IV solutions and tube feedings hemorrhage which causes loss from the intracellular compartment third spacing . very young age or very old age and not recognizing the sense of thirst 3 Ways to Prevent Missing Critical Changes in Your Patient’s Condition Nurses-3 Ways to Prevent Missing Critical Changes in Your Patient’s Condition Here’s 3 ways you can prevent missing critical changes in your patients. coma.Normal: 22-26 mEq/liter  base excess . There is no actual physical fluid loss but the involved fluid is basically "out of commission". ecchymosis. loss of fluid through the renal system (these losses are usually excessive) by polyuria due to hyperglycemia.9-10. diarrhea.o calcium .1 mEq/liter magnesium .Normal: 8.Normal: -2 to +2    Dehydration may also be called fluid volume deficit or hypovolemia and is due to: • • • • • • • excessive fluid and electrolyte losses from the extracellular compartment loss of GI fluids due to vomiting.45  PaO2 .3 mg/dL. 1. or 1. The interruptions seem endless at times. did the nurses stop looking at Bertie’s arm daily? Were we so focused on the current problem that we overlooked the new problem.) Or would you just continue to “monitor” the site and . Within hours her entire arm was edematous and ecchymotic. This occurs in intestinal ileus decreased fluid intake due to confusion. or 2.0 mg/dL phosphate . But do nurses always focus on what’s most important? Do we delegate some things to other members of the nursing team so that we have time to perform important assessments of our patients? 3. So far.1 mEq/liter (children) arterial blood gasses for the  pH . numbness or tingling or infection.Normal: 7. the PT/INR could be checked more frequently? (Many antibiotics affect the blood levels of Coumadin.6 mEq/liter (adults). Fine tune your assessment skills If you saw Bertie’s forearm with a 10 cm by 6 cm area of erythema and edema. administration of osmotic diuretics. or 1.

read articles written about the hospital. If you see an abnormality. Nursing Interview Tips from a Recruiter Nursing Interview Tips from a Recruiter Making a lasting impression. When Steffel interviews nurses.. direct eye contact. Dress professionally. They discern this through the nurse’s non-verbal cues. Research the organization. or gum smacking. you would think it would be a no-brainer to do so before a job interview. Read and follow your nursing care plans. look the part: Keep it conservative. and that they are fond of the organization for a specific reason (i. “Because it’s the closest to where I live. hold great recommendations—but if you come in as Sally or Sal Slop.e.” 5. In a world in which we are constantly reminded to turn off our cell phones and pagers. don’t just pass on the information. While you may not have years of experience to buttress your credibility. wrinkled slacks. Turn off your phone. overpowering fragrances. Steffel has had nurses arrive at interviews wearing shorts and flip-flops. “Interviewers are fully present for the interview. . a pleasant smile. Engaging the interviewer in conversation about the organization. You may have a stellar resume—aced nursing school. 2. In short. Here’s her best advice from years of interviewing nurses: 1.interviewers appraise your non-verbal communication as much as your verbal communication.pass this information on to the next shift? By following these three steps. your credibility will plunge. you can lessen the chance that you will miss changes in your patients’ conditions. neat. Watch your non-verbal cues. uncrossed arms. received high marks on your NCLEX. Don’t forget interviewing fundamentals.” says Steffel. 4. and clean. Steffel recommends staying away from anything that will distract the interviewer from what you’ll bring to the organization—hiked-up hemlines. also demonstrates your eagerness and ability to interact with people (which nursing is all about). According to Steffel. Still. Steffel knows people are nervous and might occasionally flounder for words—that’s expected. Delegate tasks that other members of the nursing team can do. like a firm handshake. that they have something unique to offer. disheveled hair. Be prepared to answer the questions: “Why are you interested in our organization? What brings you here? Why do you want to work at this hospital?” And don’t say. flashy jewelry. she also looks for a passion for the profession and the organization for which the nurse is applying. interviewers are looking for a nurse to be well composed and professional. 3. street attire. Aside from displaying enthusiasm and sharpness. And your poise points to how you will handle the countless unfamiliar and frightening scenarios a nurse faces during his/her career. It will be invaluable information during your interview.” Take time to review the hospital’s mission statement. these gestures also reveal how you will interact with future customers (patients). First impressions are lasting. their mission statement or they’re a magnet hospital). or review the job posting—find any information you can about the hospital and study it. and an energetic tone of voice. Since you’re applying for a professional position. Guess whether they got the job. take action. Exude enthusiasm. Don’t let yourself get so busy that the highest priorities get missed. “The candidate needs to abide by those same principles. your excitement and interest in the organization will do so. Diligently prepare and take your interview seriously. nurses should demonstrate excitement about their careers.

use information like this to demonstrate your interest in the organization. including peripherally inserted central catheters (PICCs) and hemodialysis catheters. Read more Managing Your Career articles www. In pediatric patients.com Goals of New Recommendations "The goal of an effective prevention program should be the elimination of CRBSI from all patient-care areas. Ask the right questions. antibiotic lock prophylaxis. etc. peripheral arterial catheters and pressure-monitoring devices for adult and pediatric patients. “I want to be hired because I want to be at a magnet hospital. This attention to detail shows the interviewer how serious you are about the position you are vying for. “You’re interviewing the organization just as much as we’re interviewing you. central venous catheters (CVCs). programs have demonstrated success. you’d find it’s a magnet hospital and about their brand promise to deliver care “for people who don’t like hospitals.For instance. The goal of the measures discussed in this document is to reduce the rate to as low as feasible given the specific patient population being served. Steffel recommends. where Steffel is a recruiter. patient cleansing. Now is the time to find out what won’t work for your personality—rather than later.” Take it a step further. the universal presence of microorganisms in the human environment. peripheral catheters and midline catheters. . skin preparation. antimicrobial catheter flush and catheter lock prophylaxis. the transition training program. selection of catheters and sites. catheter site dressing regimens. outpatient.” Maybe there was something that the interviewer said during the interview that you’d like to be clarified. Questions nurses should ask include the following: • What is your orientation program like? Do you have a preceptor program? What is its duration? • Do you allow time off for and/or pay for continuing ed? • Do you have nurse educators.” During the interview. the internship. the upper or lower extremities or the scalp (in neonates or young infants) can be used. antimicrobial/antiseptic impregnated catheters and cuffs. from the National Institutes of Health in Bethesda. replacement of administration sets. hand hygiene and aseptic technique. the preceptor program. umbilical catheters. Multidisciplinary strategies and topics addressed in the updated guidelines include education. “so you need to have questions prepared. and how frequently? • Will I have to work weekends and holidays? Will I be on call? • What is your retirement plan like? Will you contribute? Preparation at every level will set you apart from your competition—and may help you even enjoy the process. O'Grady. but sustained elimination requires continued effort. and performance improvement. and colleagues from HICPAC. Recommendations Some of the specific recommendations include the following: • For peripheral and midline catheters. But don’t simply say. once you’ve signed the dotted line. systemic antibiotic prophylaxis. and home healthcare settings. training. and explain why you want to be at a magnet hospital: because of the nurse support. 6. replacement of peripheral and midline catheters. "Although this is challenging. if you researched Edward Hospital. Don’t hesitate to ask. catheter securement devices. needleless intravascular catheter systems. an upper-extremity site is preferred in adults. and the limitations of current strategies and technologies. MD.” says Steffel. anticoagulants. antibiotic/antiseptic ointments.seasonedrn. Maryland. replacement of CVCs. and staffing." The new recommendations are addressed to healthcare personnel responsible for intravascular catheter insertion as well as those involved in surveillance and containment of infections in hospital." write Naomi P. and how often are they available? • How are performance evaluations done. maximal sterile barrier precautions.

When adherence to aseptic technique cannot be ensured. Calculating Drug Dosages and Self-Test http://www." is another biggie in documentation classes. such as for catheters inserted during a medical emergency. The catheter insertion site should be evaluated daily. Not to worry.htm http://www. patient care reports are not created for the singular purpose of feeding the voracious appetites of greedy lawyers. Risks and benefits of a central venous device to reduce infectious complications should be weighed against the risk for mechanical complications. Ultrasound guidance by those fully trained in its technique should be used to place CVCs. and why. Systemic antimicrobial prophylaxis before insertion or during use of an intravascular catheter is not routinely recommended to prevent catheter colonization or CRBSI. use of the femoral vein for central venous access should be avoided. lousy documentation — and your career — make for a nice meal and there are plenty of sharks eager to take a big bite out of your assets. which is what is required to pass dose calc at my school. Know your audience Like every call. For patients with chronic renal failure. unfortunately many providers are painting the wrong picture and telling the wrong story because they are not thinking about their audience.• • • • • • • • • • • Steel needles should be avoided when administering fluids and medications that might cause tissue necrosis if extravasation occurs. the reader will gather some insight about your appreciation of the circumstances that brought you to the scene. How to document disasters "If you didn't write it. "paint a picture & tell a story. I can fix it. and clearly describes your reaction to it.testandcalc.com/ is a phenomenal site. There is a specific series of events (or non-events) that must somehow be recorded in a way that both shows and tells the reader what happened. A CVC should have the minimal number of ports or lumens essential for patient treatment. and your application of technique. your assessment of everything. a midline catheter or PICC is preferred to a short peripheral catheter. and peripheral venous catheters should be removed if signs of phlebitis develop. Likewise. Any intravascular catheter that is no longer essential should be promptly removed. for better or worse. They are not considering who will be reading their report and why. For example. the catheter should be replaced as soon as possible (within 48 hours). It helped me pass my tests with 100%. For nontunneled CVC placement. a subclavian site is preferred to a jugular or a femoral site. When the duration of intravascular therapy is likely to be more than 6 days.dosagehelp. That is a boatload of information for one narrative and how you communicate it will depend on who will be reading it. at feeding time. However. the narrative for a fatal gunshot wound to the head that is left on scene for the medical examiner will look entirely different than that of a gunshot to the head that is transported and later . a fistula or graft instead of a CVC for permanent access for dialysis should be used. I happen to agree with that one. To avoid subclavian vein stenosis. the subclavian site should be avoided in hemodialysis patients and patients with advanced kidney disease. Contrary to popular belief." That may be the oldest and most tired cliché in all of EMS and it is not exactly true. At the same time. every report is unique. In adult patients. you didn't do it.com/quiz/testiv. your understanding of associated protocols.

but true) 2) Organize as if you expect to see the report projected onto a giant screen in a courtroom — because it will be 3) Assume that the person reading your report (and the jury) knows nothing about anything that happened while you were on the scene 4) Make the reader understand WHY you didn't treat or transport 5) Presume nothing and leave nothing [relevant] to the imagination As you can see. why that poor unfortunate is no longer an active participant in the game of life and whether you could have or should have done something about it. but the fact remains that the audience for your documentation is most likely to be a lawyer who wants something from you because something bad happened after you left. perhaps more so if knowing the audience leads to greater diligence . the calls in which there is a patient who refuses treatment and transport are the most dangerous calls of all. While the outcome is the same. The BIG Five 1) Write for medical examiners. When called upon to document death in the field. the audience is different and thus the documentation is different. patient care reports are generated so future caregivers can know what happened before the patient came to them. Patient transports First and foremost. The BIG Five 1) Write for the Attorney who is suing you over this call (sad. The information is used to diagnose or rule out medical conditions. homicide detectives. Nurses. to identify medications taken and known drug allergies so as to prevent lethal combinations or anaphylactic nightmares. knowing the audience for your documentation is as important as everything else an emergency provider has to do. and Allied Professionals 2) Organize as if the patient will become unconscious and unable to provide any information 3) Assume that the person reading your report knows nothing about anything that happened before the patient arrived in the ED 4) Make sure the reader knows WHEN you did what you did 5) Presume nothing and leave nothing [relevant] to the imagination Death in the field Then there is the issue of death in the field. the easily avoidable can become an irreversible tragedy in the blink of an eye. for patients who are transported. you are writing for medical examiners. and criminal justice attorneys 2) Organize as if you expect to see the report projected onto a giant screen in a courtroom 3) Assume that the person reading your report knows nothing about anything that happened while you were on the scene 4) Make sure the reader knows WHY you didn't treat or transport 5) Presume nothing and leave nothing [relevant] to the imagination Patients not transported As I have said and continue to say. homicide investigators. If your prehospital documentation is inaccurate or incomplete. to guide advanced clinical assessments and treatment modalities. Most systems have protocols that allow providers to withhold treatment and transport for the obviously dead. and the list goes on. you are not writing for the sake of future care. The BIG Five 1) Write for Doctors. There are times when a patient refusal is acceptable.dies. your death-in-the-field documentation will speak volumes about what did or didn't happen. and possibly even criminal prosecutors (and criminal defense attorneys). While dead men tell no tales.

Instead. http://www. This needs to happen more frequently. After all. preceptors aren’t villains. . No one should be doing something they feel they can’t do or have never done before. RN. So it’s shocking to me that new grads start making demands when this is what they’ve signed up for.. “I already know how to do that. then cattiness takes over. . And if you listen and watch closely. “I can’t. a preceptor for many years.” The know-it-all attitude—and cutting off your preceptor in the midst of instruction—will keep you from learning all you can. Kim Rapper.s/david-givot/ It's Grad Time ~ 6 things your preceptor never wants to hear Contrary to nursing legend. really. It’s in those instances that a good preceptor will be able to push you—so. Saying “I can’t” suggests you don’t care to learn. saying things that demonstrate they don’t want help. Sometimes. you’re agreeing to work any shift. and many preceptors take on that responsibility by inviting new nurses out to lunch and introducing them to the physicians. seek support and advice from your preceptor on how to make nights work for the short-term. ultimately. You don’t know it all.. and coaching. But don’t say. it’s okay for there to be differences. has insights from which you can benefit.com/Columnists/david. “I don’t feel comfortable with so-and-so nurse. “If you don’t put me on the day shift. I need your help. It’s okay for a nurse to say to a preceptor. They want you to succeed. . “Did you hear what so-and-so said?” Cattiness and gossip are never appropriate. it’s an unrealistic one. When you sign a contract. she’s been there. And. say. and be open to new ways of doing things. Don’t get me wrong. If preceptors don’t socialize new nurses into their peer group in a professional manner. tells you what not to say to your preceptor so that your relationship stays healthy and beneficial to you: 1. New nurses are low on the totem pole. your preceptor needs to be in the room watching. as you know. you will be able to fly on your own. it’s not always the preceptor’s fault . 3. However. when your priority shifts from quality patient care to the “Who’s Who” network. 4. there is a problem. And it is completely appropriate. if given the chance. because you will be doing it by the end of the orientation. Every preceptor. “Did you hear what so-and-so did?” chips away at your professional demeanor. “I don’t know how to do this yet. you can benefit from the reiteration. even if his/her personality drives you crazy.” This demonstrates a willingness to learn. seniority is rewarded. not even the most seasoned nurse does. Also remember that if you want to pick and choose your shifts. However. 2. day shifts come with seniority. you may pick up some simple strategy to master the skills you already possess. don’t shut your preceptor out. Even if you’ve seen a procedure done 102 times. most of them have volunteered for the job or have been identified by their manager as the type of person who would be able to help you best.” But to come out and say things like. so expect to work the hard shifts. could be your best advocate. “I can’t do this!” Most preceptors appreciate when a new nurse admits they don’t know how to do something. or don’t want to work at all. and. New nurses need to be socialized appropriately. helping. if you are struggling with the night shift. you have to stick with your hospital. don’t need help. Most new grads start on the night shift. new nurses shut out their preceptor.and better care.ems1. So.” It’s not the right word. At many hospitals. When preceptor-new nurse relationships get to the point of intervention. I’m going to quit!” We had a new graduate make this demand.

or monthly for routine maintenance 1.. I dabble in graphic arts. you’ve got to discuss that with your preceptor. Accessing and Deaccessing Accessing the Implanted Port -To be done weekly if accessed. which rejuvenates me.heart. “I’d rather be doing…” Once I heard a new grad frequently and freely talk about changing her career—because nursing was “beneath” her aspirations. I’ve learned you need to be able to do this job for the right reasons: to give the best possible patient care and make a difference in people’s lives.. no longer Look.com/browse/more.es/precepting/ [NEW] 2010 Guidelines CPR & ECC http://www. If nursing isn’t what you expected. Attach 10cc NSS syringe to extension tube. Push Hard [at least 2"] & Push Fast [at least 100 x's/min]. When I go back to work. Nursing demands passion and a stick-with-it attitude. more often than not. Or maybe you need to pursue activities that recharge you. . I do my nursing job much better because I want to. Peel open one corner of the Huber needle package only. Care. That may mean dumping some of your expectations of yourself..ucm_317350.realityrn.it's now C A B with emphasis on compressions FIRST. Feel prior to compressions. For instance.” These types are called appliance nurses. Wash hands with soap and water 3. That may not be something that everyone can do. e. Port-a-Caths ~ Use. 5. Listen. I made a commitment to myself when I was in nursing school that I would never keep doing this if it became just a job. if you know you’re not going to stick with it.org/idc/groups/hear. Extend end of extension tubing only out the opening 4. But if you find you are seeing your job just as a paycheck.pdf No longer A irway B reathing C irculation . 6.. or your preceptor’s time.That’s why I’ve stayed with the hospital I started with. i. then maybe you need to take a step back.. Assemble Supplies • Betadine swabsticks • Alcohol swabsticks • Masks • Sterile gloves • Huber needle • Prefilled 10” NSS syringe • Prefilled 5” Heparin syringe • 2 x 2 gauze 2. “I’m doing it just for the money. not because I’m locked in. I get the shifts I request. now.. http://www. But don’t waste your time. So.

5. 18. Fold wings of Huber needle back and hold securely. 14. Do NOT aspirate an arterial port 17. close clamp. Do NOT attempt to aspirate blood with the Heparin syringe . swelling or discomfort. if present. 12. Do NOT touch Huber needle until sterile gloves are on 7. if still present. repeat using all three swabsticks 10. Pick up Huber needle with NSS syringe attached. the patient has the option of putting on a mask or turning their head away from the port area 8. If this is a routine maintenance flush. this confirms proper placement. Caregiver applies mask. Allow alcohol to air dry and then repeat procedure with three Betadine swabsticks 11. Flush the port with 2-5cc NSS and then attempt to aspirate a blood return. remove the Huber and re-access or call the physician. remove clear protective sheath from the needle. remove empty NSS syringe and attach Heparin filled syringe. Locate and stabilize the port site with your thumb and index finger. creating a “V” shape. Once accessed. the needle must not be twisted. PORT ACCESSING AND FLUSHING PROCEDURE 13. excessive twisting will cut the septum and create a drug leakage path 16. observe for resistance. assess needle placement. Access the port by inserting the Huber needle at a 90° angle into the reservoir 15. Place Huber needle package on a secure flat surface and peel back package open. Put on sterile gloves 9. touch only the Huber needle as this is sterile and the syringe is not. prep site from center of port and work outward in a circular motion to include a 2”-3” area. Prime tubing and needle with NSS 6. Open alcohol swabsticks. Slowly inject the remaining 10cc NSS.

Remove old dressing and deaccess port 6. This procedure should be done every 4 weeks if port is not used Dressing the Port Site 1.19. Access port using the procedure described in A.pdf Different Types of Hubers: The new GRIPPER PLUS™ Safety Needle is used to deliver medications intravenously through a patient's implanted port. If port is being used for continuous infusion. Secure the port with your thumb and forefinger and pull the Huber needle straight out 21. An audible click provides clinicians with confirmation that the de-accessed needle is in its locked safety position. tape over Huber wings in a “X” format 10.horizonhealthcareservices. Secure the extra tubing with tape to prevent catching on clothes http://www. if port is being used for intermittent infusion. Its unique feature is a safety arm that is lifted to lock the needle into a protected position when de-accessing it from an implanted port. connect IV tubing after step 17 of the accessing procedure. Assemble Supplies CVC dressing kit • Flat clean work surface 4. stops.. Hold slight pressure with a 2 x 2 until bleeding. apply clave clamp after step 19 of the accessing procedure 2. 7. there should never be excessive bleeding 22. Port should be redressed once a week with needle change 3. It also allows institutions to comply with NIOSH / CDC criteria for sharps safety. The GRIPPER PLUS™ Safety Needle is based on the input of many clinicians and the design of the . The GRIPPER PLUS™ Safety Needle is safe for clinicians. Tear a piece of Durapore tape approximately 3 ” long. split tape lengthwise. this provides an occlusive dressing and allows the patient to bathe or shower without disturbing the dressing 11. Open the package of 2 x 2’s if extra padding is needed 8. Wash hands with soap and water 5. Place one 2 x 2 under the wings to provide padding on the skin if Huber is not flush with chest 9.. comfortable for patients.ort_access. and easy to use. Flush with 5cc Heparin and close the clamp 20. if any. Cover site with Tegaderm.

which are recognized as the gold standard in Huber needles. ready to be disposed of in a sharps container. Deltec has sold over 10 million GRIPPER® needles worldwide. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ LifeGuard's needle trap fully encapsulates the needle upon de-access. • • • • • • Safeguard against Needlestick injuries Enhanced for Patient Comfort Designed for Maximum Control Easy to Use Minimum change to technique Large Grip Handle for Secure control . 1: From behind the GRIPPER PLUS Safety Needle place fingers on each side of the base to stabilize it. place a finger on the tip of the safety arm.familiar GRIPPER® Huber needles. Lifeguard is designed for maximum control and safety with minor changes to technique. In the last five years. Compared to traditional needles and sharps. With the other hand. It is now safely out of the way. 3: Continue lifting the safety arm until the needle "clicks" into the lock position. 2: Begin to lift the safety arm straight back. Notice that the needle comes out perfectly straight.

or parenteral nutrition.no user activation needed Enables you to inject medication or withdraw blood from the Y-site with a simple luer connection when using available ULTRASITE® Needle-free valve DEHP-free for compatibility with chemo drugs and lipids . That's safety and compliance virtually assured. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Whether you're delivering chemotherapy. preventing unnecessary needlesticks to clinicians and custodial staff. SURECAN® Safety Huber Needle Features: • • • Passive design .LifeGuard features: • • • • • • Visual and audible confirmation of safety Colored safety handle for needle gauge confirmation Low profile design Height adjustable wings Needleless compatibility Easy to secure LifeGuard™ Safety Needle will easily insert into all implanted ports and when de-accessing from the port it encapsulates the sharp point fully. the Surecan Safety Huber Needle's patented safety clip will automatically engage as you withdraw the needle from the base plate. antibiotic therapy.

Its needle forward design facilitates dual lumen port access. and your patients! ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MiniLoc® Safety Infusion Set is Specialized Health Products’ premier safety Huber needle. easy safety mechanism engagement. MiniLoc’s specially lubricated needle reduces penetration and access forces during port access. and 22 gauge) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Simple to use Robust safety mechanism Easy visibility of access site Small footprint Non-absorbent patient comfort pad Non-coring needle Latex free Best overall value SafeStep® Huber Needle Set combines excellent safety Huber needle technologan affordable.• • Latex-free to avoid the risk of allergic reaction Conveniently color-coded by size (19. one of the smallest available today! Its patient comfort pad is soft and supple for patient comfort during infusion. SafeStep features ay in robust safety mechanism with a clear base for easy site visibility. simple to use product. your nurses.php . small footprint and enhanced angled tubing to facilitate dressing and help maintain dressing integrity. MiniLoc is latex free and features DEHP free tubing.org/Safety_Huber_Needle. integral wing design allows controlled. 20.isips. MiniLoc is designed with an ultra-low profile. It boasts a small footprint. An audible “click” as well as tactile feel and a visual indicator confirm safety mechanism engagement http://www. MiniLoc’s ergonomic. SafeStep is the best overall value for you.

aciDotic. If the bicarb is normal (22-26). Respiratory acidosis or alkalosis is caused by various malfunctions of the lungs. ( "D" for down. Both acidosis and alkalosis can be of two different types: respiratory and metabolic. your alkalotic. So the first part: Metabolic or Respiratory. its a respiratory problem. it is a metabolic problem. alKalotic ( "K" for Clouds. you get your answer :) The end! You got the Ph.45 The pH is the best overall indicator in determining the acid-base status of the patient. we combine the two to get the answer.hey its close!) Bicarb is kidneys. Which one is out of range? Now the second part: ** We look at the PH: Is the Ph high. you're acidotic.45. If the Pc02 is above or below normal. So we look at the bicarb and the PCo2. If its high.35 to 7. metabolic. if the bicarb is above or below normal. respiratory. or greater then -. Now we need to figure out if its respiratory. up.45 Look at pH and determine if it is acidotic or alkalotic > 7. Metabolic acidosis or alkalosis is caused by various metabolic disorders which result in an excessive build up or loss of acids or bases. then it cannot be a respiratory problem. ( 22-26) PCo2 is lungs. ** We look at the bicarb and the PCo2. or metabolic. If the Pc02 is normal ( 35-45). or low? That gives you the answer to that. Then. same as the ph) Put them together. right?? If its low. If Ph < 7.Let's Learn ABG's ~ Part I Normal pH of the blood is 7. then it cannot be a metabolic problem.35. Ok heres my basic first step interpretation: Ph interpretation. (35-45. . or less then). If Ph > 7.

A respiratory rate of 20 breaths per minute (or more than 25 breaths per minute for someone in a nursing home) indicates tachypnea. the patient has air trapping and cannot empty the lungs. Audible Breath Sounds Pay attention to the breath sounds. In such cases. COPD. In such cases. Chest Movement During Respiration The next part of the chest inspection is to observe the patient's chest movement during respiration. Percussion Make sure your hands are warm before you begin percussion. Tachypnea. a sitting patient may lean forward with hands propped on the knees. If it is labored. For example. One trick is to practice over a . Respiratory Patterns Check for respiratory patterns and signs that indicate specific conditions.Resp or Meta Acid or Alka ______________________________________________________________ Basic Geriatric Respiratory Assessment The objective of the pulmonary assessment of a geriatric patient is to check for the following: • • • Quality of respiratory efficiency. Bradypnea Bradypnea is a form of hypoventilation. Respiratory Rate Normal respiratory rates for older patients are 12 to 18 breaths per minute for those living independently and 16 to 25 breaths per minute for those in long term-care. Stridor implies partial airway obstruction. labored breathing prevents airway closure. consider the characteristic of the structure you are percussing. it is important to note respiratory effort. Congestive heart failure Pulmonary embolus Metabolic acidosis. and Presence of disease. It is key to keep the wrist loose and the hand floppy. Respiratory Effort Normal breathing is quiet and unlabored. Use of Accessory Muscles Using accessory muscles implies that the forced expiratory volume is decreased to 30% of normal. Wheezing is an important clue to reactive airways or local obstruction. inspiration interrupted by cough suggests pleuritic pain or inflammation. As you percuss. Start at the back and check each side to compare the quality of the sensation. In patients with pneumonia or acute abdomen. in which the patient has a respiratory rate of less than 10 breaths per minute. Coughing indicates lower airway irritation. Gas exchange. look for the following: • • • • • Infection (especially pneumonia). Patients who have air hunger will often breathe with an open mouth.

producing dullness in the mid lung fields of both the dependent and upward lungs. Starting at the bases allows you to appreciate any basilar crackles secondary to atelectasis or early congestive heart failure. Auscultation Make sure that the listening area is quiet. Indirect percussion Place your non-dominant hand on the skin and with your dominant middle finger tap the middle finger of your nondominant hand at the sistal interphalangeal joint. Warm your stethoscope either by carrying it in your pants pocket or by vigorously rubbing it. Direct percussion. They can occur on both inspiration and expiration. or pleural scarring. Notice how the percussion note feels firm when over the leg of the table. Light pat. such crackles might disappear by the time you get to the bases. One strategy is to place a rubber membrane on the bell and have the patient breath deeply with the mouth open. Sometimes an elderly patient is too ill to sit up and percussion must be accomplished with the patient in the lateral decubitus position. breathe on the tubing beforehand to appreciate the low-pitched rustling sound your breath produces. but they usually occur . body hair can produce a crackling sound that resembles dry cellophane crackles. Crackles (Rales) Inspiratory crackles are common in elderly people. Note the location of expiratory crackles. Make sure that your stethoscope bell is securely placed flat on the chest and that you are not breathing on your tubing. 3. and importantly. Fixed crackles suggest fibrosis or pneumonia. do not listen through the patient's clothing. Of note. For example. Pleural Friction Rubs Pleural friction rubs are leathery. If you hear additional noises make sure they are coming from the patient's chest and not from the skin. creaky sounds similar to the sound of slowly rubbing your palms together. Begin at the bases and work up the back.table percussing from the center toward the legs. pleural fluid. In fact. Be sure that your earpieces are securely in your ears to exclude environmental noise. Basic Percussion Techniques 1. especially in a noisy setting such as a crowded emergency room. Place your dominant hand on the skin and raise your forefinger and tap on the skin directly. All breath sounds should increase in pitch with inspiration and decrease with expiration. Wheezes Wheezes are musical sounds that indicate airway obstruction. Wheezing that occurs on inspiration suggests obstruction in the trachea (outside the chest). or other extraneous source. where subtleties of sound are more difficult to appreciate. They do not have a musical quality. Close your eyes and practice until you can reliably stop over the leg. like a wheeze does. muscles. the feel of the resonance may be more sensitive than the sound of the percussion note. Hearing both inspiratory and expiratory wheezes is more concerning than hearing either alone. which when it occurs during expiration. but suggest 2 inflamed pleural surfaces rubbing together. 2. Dullness and Its Indications Dullness to percussion implies consolidation. This position can add some artifacts of lung compression. suggests a source within the chest. Rhonchi Rhonchi are coarse flapping sounds that suggest fluid or mucus in an airway. If you start at the apices and work down. Gently pat the back on each side starting at the apices and moving down to the diaphragm. Listen to at least 2 respiratory cycles at each location.

is both an ethical obligation and a legal requirement spelled out in statutes and case law in all 50 states. Patients in respiratory distress will often sit leaning forward using their accessory muscles. i. The risks and benefits of a proposed treatment or procedure. your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure. or drowsy. Patients who sit leaning forward with their legs dependent (Fowler's position) may have severe heart failure. It is important that the communications process itself be documented. A well-designed. Hearing a pleural friction rub implies neoplasm. Informed Consent Informed consent is more than simply getting a patient to sign a written consent form. . The nature and purpose of a proposed treatment or procedure. The risks and benefits of the alternative treatment or procedure. Good documentation can serve as evidence in a court of the law that the process indeed took place. Demeanor and Posture Patients in respiratory distress may appear restless.e. signed informed consent form may also be useful. but the legal concept of informed consent itself is recent. under which liability is imposed for unpermitted touching. The patient's eyes may be prominent. Signs of Pleural Inflammation Pain offers a clue to possible pleuritic inflammation. or a variation thereof. agitated. pneumonia or tuberculosis. In the communications process the physician providing or performing the treatment and/or procedure (not a delegated representative). Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance). pulmonary infarction. if known. Forms that serve mainly to satisfy all legal requirements (stating for example that "all material risks have been explained to me") may not preclude a patient from asserting that the actual disclosure did not include risks that the patient unfortunately discovered after treatment. should disclose and discuss with your patient: • • • • • • The patient's diagnosis. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention. whether the patient was given sufficient information to make a decision regarding his or her body and health care. and The risks and benefits of not receiving or undergoing a treatment or procedure. Pain from pleural irritation may also be referred to the shoulder. In turn.with inspiration and tend to be localized. Though battery claims occasionally occur when treatment is provided without consent. This communications process. Providing the patient relevant information has long been a physician's ethical obligation. so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention. The first case defining informed consent appeared in the late 1950's. but an overly broad or highly detailed form actually can work against you.. A timely and thorough documentation in the patient's chart by the physician providing the treatment and/or performing the procedure can be a strong piece of evidence that the physician engaged the patient in an appropriate discussion. Earlier consent cases were based in the tort of battery. most consent cases generally center around whether the consent was "informed".

At the other extreme, listing all of the risks may not be wise either. A comprehensive listing will be difficult for the patient to understand and any omission from the list will likely be presumed undisclosed. Medicare participating physicians must also be cognizant of CMS's requirements for informed consent. ________________________________________ When you find a pill lying about, or in an unmarked container, try this site for pill ID: www.pharmer.org Righthand side, best resources in the NAVIGATION brown box. You land on other sites, but the drug.com pill wizard is fantastic. www.epocrates.com has my fav free drug guide and compatability stuff online or PDA/Blackberry, but not all options are free. And for my 'Como se dice esto en Espanol' issues, I like www.freetranslation.com

Encyclopedia of Nursing and Allied Health This is probably more of a resource for students, but is jam packed with useful information for all. http://www.enotes.com/nursing-encyclopedia/

Insulin Chart ~ Types, Onset, Peaks, and Durations Types of Insulin Each type of insulin has an onset, a peak, and a duration time. The onset is how soon the insulin starts to lower your blood glucose after you take it. The peak is the time the insulin is working the hardest to lower your blood glucose. The duration is how long the insulin lasts—the length of time it keeps lowering your blood glucose. http://diabetes.niddk.nih.gov/dm/pub...z/insert_C.htm Eat Right - Printable Patient Handouts The American dietetic association.The ADA Nutrition Care Manual is a valuable resource providing disease-specific information and evaluation, printable patient handouts, calculators that compute BMI/weight range, customization tools and much more. http://www.eatright.org/cps/rde/xchg...xsl/index.html

The Land of ABG * A. The Last Name 1. First, look at her pH. (Normal = 7.35-7.45) 2. If her pH is < (less than) 7.35; her last name is ACIDOSIS. 3. If her pH is > (greater than) 7.45; her last name is ALKALOSIS. (Note: To be an absolutely perfect last name--her pH needs to be 7.40. So, keep in mind, that if her pH is 7.35-7.39--she’s thinking about marrying into the ACIDOSIS family. If her pH is 7.41-7.45--she’s thinking about marrying into the ALKALOSIS family.) B. The First Name Now that you know your patient’s last name, you would like to also learn her first name. 1. Look at her pH again. 2. If it is 7.35-7.45 (normal) then her first name is COMPENSATED. 3. If the pH is <7.35 or >7.45--then her first name is UNCOMPENSATED. C. The Middle Name Now that you know your patient’s first and last name, you would like to know her middle name. (Name Alert: These people are all related and you have many patients with the same first and last name. A middle name will give you more information to go on.) 1. First you need to look at the CO2 and HCO3. (Remember: Normal CO2 = 35-45. Normal HCO3 = 22-26) 2. The middle name will either be Respiratory or Metabolic. 3. If the CO2 is <35 or >45--her middle name is RESPIRATORY. 4. If the HCO3 is <22 or >26--her middle name is METABOLIC. D. The Family Feud 1. pH and HCO3 are "kissin’ cousins"--they like to go in the same direction. 2. But CO2 is the "black sheep"--pH runs the opposite direction when it sees him coming. Therefore: 3. Decreased pH with Decreased HCO3 = ACIDOSIS.

4. Increased pH with Increased HCO3 = ALKALOSIS. 5. Decreased pH with Increased CO2 = ACIDOSIS. 6. Increased pH with Decreased CO2 = ALKALOSIS. http://realnurseed.com/abg.htm Peds Quiz ~ 25 questions/Instant Scoring Click this link to take the test live: http://www.peppsite.com/course_pretesting_als.cfm 1.A 2-year-old girl who is having difficulty breathing and a barky cough has had a fever and runny nose for the past 3 days. She is alert and sitting on her mother s lap. Assessment reveals that she has warm, flushed skin, is using her abdominal muscles to breathe, and has increased work of breathing. She has a blood pressure of 88/66 mm Hg, a pulse of 128 beats/min, and respirations of 48 breaths/min.

You should immediately determine whether the patient has: A.stridor. B.delayed capillary refill time. C.weak pulses. D.the ability to tolerate oral feedings. 2.A 2-year-old girl who is having difficulty breathing and a barky cough has had a fever and runny nose for the past 3 days. She is alert and sitting on her mother s lap. Assessment reveals that she has warm, flushed skin, is using her abdominal muscles to breathe, and has increased work of breathing. She has a blood pressure of 88/66 mm Hg, a pulse of 128 beats/min, and respirations of 48 breaths/min. Abdominal breathing in this patient should be viewed as a: A.normal finding for a toddler. B.sign of impending respiratory failure. C.sign of decreased perfusion to the respiratory center. D.compensatory mechanism to increase the volume of air inhaled and respiratory rate. 3.A 2-year-old girl who is having difficulty breathing and a barky cough has had a fever and runny nose for the past 3 days. She is alert and sitting on her mother s lap. Assessment reveals that she has warm, flushed skin, is using her abdominal muscles to breathe, and has increased work of breathing. She has a blood pressure of 88/66 mm Hg, a pulse of 128 beats/min, and respirations of 48 breaths/min. The first step in treatment is to: A.administer a nebulizer treatment with a beta-agonist medication. B.administer humidified oxygen via blow-by method. C.suction the oropharynx for secretion. D.deliver bag-valve-mask ventilations.

administer 100% oxygen by mask. D. a pulse of 190 beats/min. He has a blood pressure of 74/60 mm Hg. and diarrhea for the past 3 days. without increased work of breathing. What do these findings tell you about the patient s condition? A. cool skin.A 3-month-old infant who is extremely lethargic has had a cough. vomiting.swelling of the brain. D. Assessment reveals that he responds to pain. He has a blood pressure of 74/62 mm Hg.Crackles in the lungs C. Assessment reveals that he responds to pain.anxiety.He is unresponsive and his skin is cool because of a low body temperature from being outside B.Activated charcoal is contraindicated in a patient who has ingested a toxic substance if: A. C. respirations without increased work of breathing at 60 breaths/min.hypovolemia. and respirations of 44 breaths/min.there is a history of abdominal surgery. and rapid. a pulse of 152 beats/min.His heart rate is fast because of pain in his shoulder and leg C.administer dopamine intravenously.Which of the following findings in a 2-year-old child assists in identifying the cause of a grand mal seizure? A.the substance was corrosive. 6. and diarrhea for the past 3 days.A 6-year-old boy who was struck by a car while he was riding his bicycle is unresponsive and has pale. The appropriate initial treatment is to: A. C. The tachycardia in this infant is most likely due to: A.Cardiac dysrhythmia 8.Abdominal tenderness D. B.the substance was ingested approximately one hour ago.there is a history of diarrhea or vomiting. .administer epinephrine via an intraosseous needle. a pulse of 190 beats/min. and a capillary refill time of 4 seconds. respirations without increased work of breathing at 60 breaths/min. 7. Assessment reveals abrasions to his left shoulder and back and a swollen. He has a blood pressure of 74/60 mm Hg. C.Fever B.His respirations are fast because the impact affected the respiratory center in his brain D. has mottled skin color. vomiting. deformed left thigh.4.perform endotracheal intubation. D. has mottled skin color.A 3-month-old infant who is extremely lethargic has had a cough. B.His blood pressure is low because compensatory mechanisms for blood loss are failing 5. and a capillary refill time of 4 seconds. B. and rapid.pneumothorax.

Asking him if it is okay to listen to his lungs and touch his chest and stomach D. C. Assessment reveals that he has pale.Exposing only those areas currently being assessed and then covering them C. multiple abrasions on his right shoulder and hip. B. a pulse of 128 beats/min.Telling him he must lie still or he may become paralyzed B.History of recent cold symptoms .9. warm skin.initiate hyperventilation to reduce the accumulation of acids in the body.An 8-year-old boy fell 7 feet out of a tree.Position of the patient when found C.An 8-year-old boy fell 7 feet out of a tree. and a deformed right forearm. landing on his right arm and falling to his right side. Assessment reveals that he has pale. 12.Secondary brain injury B. and a deformed right forearm. landing on his right arm and falling to his right side. multiple abrasions on his right shoulder and hip. and respirations of 32 breaths/min. What is the best approach to conducting the assessment of this patient? A.open her mouth and insert an oropharyngeal airway to maintain a patent airway. He is crying and appears agitated.Hypothermia 13.Hypoxia C. a pulse of 128 beats/min.cover him with blankets to prevent heat loss.stabilize her cervical spine to reduce the risk of further spinal injury. He is crying and appears agitated. D. He is crying and appears agitated. multiple abrasions on his right shoulder and hip.What information is important to obtain about a child with smoke inhalation? A. Bystanders report that she was shaking all over as they pulled her out of the water.Presence of windows or ventilation in the room B.elevate her head to reduce the risk of aspiration. What is the most likely cause for the abnormal appearance of this patient? A.Asking him what hurts the most and begin by assessing that area of the body 11. 10. and respirations of 32 breaths/min. warm skin. C. He has a blood pressure of 92/74 mm Hg.manually stabilize the cervical spine to reduce the risk of spinal injury. a pulse of 128 beats/min. and a deformed right forearm. and respirations of 32 breaths/min. He has a blood pressure of 92/74 mm Hg. B.turn her on her side to allow any water to drain from her mouth. landing on his right arm and falling to his right side. the first step in caring for this patient is to: A. warm skin. After completing your initial assessment.Pain D.An 8-year-old boy fell 7 feet out of a tree.A 10-year-old girl is unresponsive when she surfaces after diving into a quarry. The first step in caring for this patient is to: A. Assessment reveals that he has pale. D. He has a blood pressure of 92/74 mm Hg.place him in a position of comfort to decrease anxiety.

Please help her.Confront them by telling them you know that this injury could not have occurred from a fall.decide if an on-scene delivery is needed.Ask them why they waited so long to call for help. All of a sudden she got really quiet. therefore.Assessment of a newborn five minutes after delivery reveals cyanosis of the hands.administer oxygen by nasal cannula at 4 L/min.assemble the correct size of equipment to care for the baby. pink skin and respirations without increased work of breathing.copiously suction the mouth and nose.determine if meconium aspiration may have occurred.An 18-month-old boy who reportedly fell down the stairs earlier in the day just isn t acting right. the delay has made the child very sick. I can't take her crying any more. and I couldn't wake her up. C. What is the best way to interact with the caregivers? A. B.Explain that you are very concerned about the child s condition and that he needs to be examined at the hospital for a possible a broken leg. "I couldn t get her to stop crying. you will need to administer oxygen and establish an IV. you are obligated to take him to the hospital. D.Contact the local law enforcement agency to request that the caregiver be arrested while you transport the child. feet. 17. The most important treatment of the newborn is to: A. The babysitter states. 16.respiratory failure. B.Location in the room where the patient was found 14. C. therefore. The babysitter appears anxious and frustrated and explains that the infant had been crying for hours and would not stop.A 6-month-old infant who is being cared for by a babysitter is unresponsive and has warm.seizures. trunk. and face. according to his caregivers.shaken baby syndrome.toxic exposure.decide whether the baby will be delivered at the scene or if there is time to transport the mother to the hospital.vigorously dry and warm the baby. 15. C. Vital signs are pulse 160 beats/min and respirations 44 breaths/min. I tried everything. B." The babysitter states that she does not think that the infant has been sick recently.. Treatment of this newborn includes: . C. Assessment reveals multiple bruises on his thighs and back and a deformity of his right thigh. particularly if the infant is premature.Ascertaining the due date of a newborn during an impending delivery helps you to: A. as the labor is often shorter for these infants. D. D.A woman who is about to deliver a baby at home reports that the fluid was thick green when her bag of waters broke. The infant s altered level of consciousness is most likely due to: A. D. B.D.calculate the APGAR score. 18. He is alert and crying.

Palpate for chest rise and fall over the anterior chest and abdomen B. what is the correct way to manage the respiratory status of a boy who is on a ventilator but also breathes on his own? A.Switch the patient to oxygen by blow-by method because the ventilator will not work in the ambulance D.A.What is the danger of using a mask that is too large on a child who requires ventilatory assistance? A.Decrease the flow rate as the oxygen in the ambulance is more potent and requires a lower flow rate 22. and has copious secretions in the tracheostomy tube.During transport. Which of the following signs suggests significant obstruction of the tracheostomy tube? A.Acting fussier than normal D.initiating bag-valve-mask ventilations.If the mask extends across the eyes.Unequal chest rise and wheezing 21. which may cause dislocation of the mandible D. has cool.Temperature of 37 degrees (98.What is the correct method to confirm proper placement of an endotracheal tube? A.A slow heart rate and poor air exchange B.Auscultate the anterior chest and mid-abdominal area for the presence of bubbling or gurgling sounds D.Refuses a pacifier 20. mottled skin.reassessing the skin color in five minutes and then initiating oxygen therapy if needed. He is on continuous oxygen.Use of abdominal muscles to breathe B. it may exert pressure and stimulate the vagus nerve 23.It will be more difficult to obtain a seal for ventilation C.6 F) C.Immediately deliver bag-valve-mask ventilations because you may not be familiar with the ventilator C.Eye injuries may occur from the mask touching the globe B. Assessment reveals that he is lethargic. His mother states that his breathing is getting much worse. D. B.Allow the patient to remain on the ventilator if he is not in respiratory distress B. C.Irregular respirations and wheezing C.More pressure will need to be applied to obtain a mask seal.performing intubation and positive pressure ventilation.A 3-year-old boy who has a tracheostomy has had difficulty breathing and coughing for 2 days because of increased secretions.An infant should be immediately evaluated by a physician if which of the following signs or symptoms are present? A. 19.Auscultate for bubbling or gurgling sounds over the epigastrium and breath sounds at the .Crackles and decreased breath sounds D.Observe for gastric distention which indicates leakage of air around the tube in the trachea C.applying free flow oxygen by mask at 5 L/min.

htm ECG ~ 6 Second Strips Challenge yourself to identify rhythm strips http://www. but before the lateral stabilization devices to ensure that the tape is applied tightly C.All medications except sodium bicarbonate and dextrose C.Which of the following substances can be infused via an intraosseous needle? A. and healthcare-related infections (on Division of Healthcare Quality Promotion site) Occupational exposure and health (on Division of Healthcare Quality Promotion site) Opportunistic infections Parasitic infections Sexually transmitted diseases Surveillance Travel and immigration Note: for SARS-related guidelines.cdc.com/tut-15.htm ECG Encyclopedia .gov/ncidod/guidelines. please see the Severe Acute Respiratory Syndrome site Vaccination Viral infections http://www.After the body straps and lateral stabilization devices have been applied B.ines_topic.When should the child s head be secured to the spine board during the immobilization procedure? A.Only medications and fluids that have a neutral pH __________________________________ CDC .After the body straps have been applied.midaxillary regions 24.Before any straps or lateral stabilization devices have been applied D..Infectious Disease Guidelines Topic Sections Antibiotic and antimicrobial resistance Bacterial infections Diarrheal diseases Infection control..All medications and intravenous fluids B. healthcare quality.medi-smart.If the child is quiet the head does not need to be secured once lateral stabilization devices are applied 25.Fluids or medications that are not acidic D.

html The Virtual Pediatric Patient Available Cases • • • • • • • • Case 1 .com/tut-40.especially the prevention of secondary injury.. emergency department management of the head injured patient. What interesting phenomena occurs? .shtml The Virtual Autopsy Ever had the urge to be a Medical Examiner? This site gives you 12 cases. What is the rhythm? An elderly man with stroke. oxygenated state as in the picture below! http://www. http://www. What is the diagnosis? A 58 year old female with chest pains..ca/heart/egcyhome.medi-smart.A child with an abdominal mass Case 3 .htm Traumatic Brain Injury Simulator The Neurotrauma Moulage is a traumatic brain injury simulator. You will not be presented with the next scenario until you've managed to get the brain back to it's calm.A newborn with vomiting http://www. Once on the intensive care unit you are faced with various scenarios and you have to act to minimise brain ischaemia.medi-smart.mmi. It is designed to simulate a range of conditions affecting the management of the injured brain. What is the rhythm? A patient with chest pain and dyspnea.A child with chronic constipation and pica Case 5 .A cranky child Case 2 .dsVPHome.mcgill.An adolescent with leg pain Case 4 .htm ECG Workshop ECG ROUNDS:Choose a case below CaseDescription A 75 year old man with dyspnea.. What is the diagnosis? A 75 year old woman with new onset of palpitations.EKG Encyclopedia: http://sprojects. their medical history & exam results ~ You try to pinpoint the cause of death. The initial stages of the moulage take you through the acute.com/tut-38.A child with vomiting and diarrhea (Note this case is only available to users at the University of Iowa) Case 6 .A child with a sore throat Case 7 .virtualpediatrichospital. blue. What is the diagnosis? A 43 year old man with atypical chest pains. and to encourage a greater understanding of the main tenets of traumatic brain injury management .A child with a fever Case 8 .

male c/o weakness and dyspnea. What's the diagnosis? Is it ventricular or atrial? Interesting Rhythm and complexes.o. Lidocaine may be hazardous to your health. 74 y. They liked it so much they encouraged us to put it online for others to use. Arterial Lines Sedation and Paralysis Central Lines .asp Orientation to ICU/CCU We wrote this book to help new nurses and those orienting to ICU. 52 yo male c/o chest pain. What's the rhythm? A 29 year old female with palpitations. The EKG makes the diagnosis.com Starting Out ... A 36 year old female with dyspnea after cocaine. Enjoy.mdchoice.com/EKG/ekg. Thanks! http://www.icufaqs. http://www.. What's the diagnosis? Anorexia and dehydration. but please give us attribution. What's the rhythm? A 27 year old male with chest pain.Chest pain while visiting in the hospital... A case of abnormal complexes..New in the ICU Labs Pressors and Vasoactives Pacemakers Med Tips Arryhthmia Review Chest Tubes Blind Suctioning for Beginners Reading X-rays Perhipheral IV's for Beginners Intubations NG Tubes for Beginners Vents and ABGs Foleys for Beginners Pulmonary Embolisms ICP Monitoring Transfusions and Blood Two Interesting Situations PA-Lines Defibrillation Bedside Emergencies Heart Blocks Reading EKGs II What Nurses Really Do.feel free to use these materials.org/ markhammerschmidt@yahoo. feel free to copy them for any useful purpose.

com/intro/ NCLEX Sample Questions NCLEX Sample Questions 1." Which of the following muscles cannot be considered as possibly being torn? . Know Your Labels. Practice Questions. Chapter 1: Review of Arithmetic for Medical Dosage Calculations Chapter 2: Safe and Accurate Drug Administration Chapter 3: Dimensional Analysis Chapter 4: Systems of Measurement for Dosage Calculations Chapter 5: Converting from One System of Measurement to Another Chapter 6: Calculating Oral Medications Doses Chapter 7: Syringes Chapter 8: Preparation of Solutions Chapter 9: Parenteral Medications Chapter 10: Calculating Flow Rates and Durations of Enternal and Intravenous Infusions Chapter 11: Calculating Flow Rates for Intravenous Medications Chapter 12: Calculating Pediatric Dosages Comprehensive Self-Test http://wps.org/ Help Calculating Medication Dosages . Case Studies." • Click on "Practice ECGs" to hone your skills. a Link to the New York Times.prenhall. "I tore 3 of my 4 Rotator cuff muscles in the past. which will help you apply the concepts presented in this new exciting text. http://www. Matching Questions. At the completion of each quiz section you may submit your answers to receive an instant score of your results.icufaqs. Student Success.12leadecg. • Look up vocabulary at "Online Glossary.com/chet_olsen_medicaldosage_9/ ECG: The Art of Interpretation This site gives you many valuable tools to enhance learning: • Test yourself with "ECG Quizzes. and WebLinks. • Choose "Flashcards" to quiz yourself on key terms." • Use "Web Links" as a resource for further online ECG information.Includes test with instant scoring Calculating Medication Dosages This interactive study guide features Learning Outcomes. A nurse is working in an outpatient orthopedic clinic.Reading 12-lead EKGs IABP Review Nutrition http://www. During the patient’s history the patient reports.

D: Recommend the patient attempt to walk pushing the w/c for safety." 5. 8. "I think I sprained my ankle about 2 weeks ago. D: Patient may be experiencing anxiety after surgery." B: "Has this been going on for a while?" C: "How do you know this?" D: "Teenagers often exhibit signs of sexual interest in females. All of these may indicate which of the following medical conditions? A: Patient may have a DVT." B: A patient that received an upper extremity cast yesterday reports. B: Recommend family members bring pictures to the patient’s room. Which of the following calls should have the highest priority for medical intervention? A: A home health patient reports. The mother of the child states. "I think my son is sexually interested in girls. when I put weight on my crutches." D: The patient reports. A nurse is caring for a patient who has recently been diagnosed with ." C: A young female reports. "My left leg has really been itching. C: Observe the hairline and scalp for possible signs of lice. D: Contact the student’s physician." 7. The patient has exhibited signs of increased confusion and limited stability with gait. "I am starting to have breakdown of my heels. B: Contact the female’s parents about your observations." 3. A 93 year-old female with a history of Alzheimer’s Disease gets admitted to an Alzheimer’s unit. calf pain. A nurse working a surgical unit. Moreover. "The arthritis in my wrists is flaring up. "I can’t feel my fingers in my right hand today. Which of the following is the most appropriate course of action for the nurse? A: Recommend the patient remain in her room at all times. A high school nurse observes a 14 year-old female rubbing her scalp excessively in the gym. A nurse at outpatient clinic is returning phone calls that have been made to the clinic. "I have been having pain in my left calf. C: Recommend a speech therapy consult to the doctor. C: Patient may be in the late phases of CHF. notices a patient is experiencing SOB. The most appropriate course of action for the nurse to do is: A: Request a private evaluation of the female’s scalp from her parents. Which of the following statements should the nurse be most concerned about? A: The patient reports." C: The patient reports." The most appropriate course of action of the nurse is to respond by stating: A: "I will talk to the doctor about it. 6." B: The patient reports. and warmth over the posterior calf. "My knee is still hurting from the TKR.A: Teres minor B: Teres major C: Supraspinatus D: Infraspinatus 2. the patient is refusing to use a w/c." D: A middle-aged patient reports. B: Patient may be exhibiting signs of dermatitis. 4. "I didn’t keep my extremity elevated like the doctor asked me to. A nurse is performing a screening on a patient that has been casted recently on the left lower extremity. A nurse is covering a pediatric unit and is responsible for a 15 year-old male patient on the floor.

baby boy 3 days ago via c-section. Which of the following medications may be necessary? A: Nystatin B: Atropine C: Amoxil . then left upper extremity gait sequence. A patient that has delivered a 8. mask. and goggles B: Surgical cap. mask. A nurse has been instructed to place an IV line in a patient that has active TB and HIV. D: Place the cane in the patient’s right upper extremity. encourage cane. gloves. C: The patient’s plans for the future have been clarified. then left upper extremity gait sequence. 13. encourage cane. then right upper extremity gait sequence. The physician orders restraints to be placed on the patient. A nurse has just started on the 7PM surgical unit shift. The nurse should where which of the following safety equipment? A: Sterile gloves. gloves. mask. A 22 year-old patient in a mental health lock-down unit under suicide watch appears happy about being discharged. following a MVA and has phantom pain. then left lower extremity. Which of the following is probably happening? A: The patient is excited about being around family again. via transfusion the previous day. B: The patient’s suicide plan has probably progressed. C: Taking the patient’s breath sounds D: Educating the patient on monitoring fatigue 9. Which of the following is the most appropriate gait sequence? A: Place the cane in the patient’s left upper extremity. gown. then right upper extremity gait sequence. B: Place the cane in the patient’s left upper extremity. encourage cane. B: Ambulating the patient for the first time. C: Communicate with the patient and family the need for restraints. C: Place the cane in the patient’s right upper extremity. B: Notify the physician that restraints have been placed properly. D: Position the head of the bed at a 45 degree angle. and gown 10. then right lower extremity.2 lb. D: The patient’s mood is improving. then right lower extremity. A 64 year-old Alzheimer’s patient has exhibited excessive cognitive decline resulting in harmful behaviors. B: A 34 year-old male who is complaining of low back pain following back surgery and has an onset of urinary incontinence in the last hour. 14. Which of the following tasks should the nurse delegate to a nursing assistant? A: Transferring the patient to the shower. reports white patches on her breast that aren’t going away.5 units of RBC’s.fibromyalgia and COPD. and proper shoewear C: Double gloves. D: A 27 year-old female who has received 1. then left lower extremity. 12. encourage cane. A nurse is instructing a person who had a left CVA and right lower extremity hemiparesis to use a quad cane. C: A 21 year-old male who had a lower extremity BKA yesterday. Which of the following patients should the nurse check on first? A: A 75 year-old female who is scheduled for an EGD in 10 hours. 11. and mask D: Goggles. Which of the following is the appropriate procedure? A: Secure the restraints to the bed rails on all extremities.

D: Request the physician on-call assess the patient. C: Encourage the patient to ambulate to reduce lower extremity edema. Exposure to TB can be identified best with which of the following procedures? Which of the following tests is the most definitive of TB? A: Chest x-ray B: Mantoux test C: Breath sounds examination D: Sputum culture for gram-negative bacteria . D: Non-productive cough for 72 hours. B: Encourage repetitive heavy lifting exercises that will increase strength. B: Check the intake and output on the patient’s flow sheet. over the last few days. A patient asks a nurse the following question. and CHF exhibits an increase in total body weight of 10 lbs. 20. A 13 year old girl is admitted to the ER with lower right abdominal discomfort. A patient that has TB can be taken off restrictions after which of the following parameters have been met? A: Negative culture results. D: Take breaks every 10-20 minutes with exercises. C: Limit exercises based on respiratory acidosis. 17. C: Normal body temperature for 48 hours. D: Provide pain reduction techniques without administering medication. D: Check the patient’s vitals every 2 hours. 19. A 64 year-old male who has been diagnosed with COPD. B: After 30 days of isolation. The admitting nursing should take which the following measures first? A: Administer Loritab to the patient for pain relief. The nurse should: A: Contact the patient’s physician immediately. IV.D: Loritab 15. The nurse should do which of the following first? A: Check the patient’s chest x-ray results. B: Place the patient in right sidelying position for pressure relief. 18. B: Retake vitals including blood pressure. C: Perform a neurological screen on the patient. A 32 year-old male with a complaint of dizziness has an order for Morphine via. C: Start a Central Line. 16. A nurse teaching a patient with COPD pulmonary exercises should do which of the following? A: Teach purse-lip breathing techniques.

10. Moreover. and Subscapularis make up the Rotator Cuff. (B) The new onset of urinary incontinence may require additional medical assessment. 2. 15. (A) The cane should be placed in the patient’s strong upper extremity. (B) Check the intake and output prior to making any decisions about patient care. Pain following a TKR is normal. and breakdown over the heels is a gradual process. 16. (A) Thrush may be occurring and the patient may need Nystatin. (B) Pain may be indicating neurovascular complication. 5. 3. Supraspinatus. (B) The patient experiencing neurovascular changes should have the highest priority. 12. (A) All of these factors indicate a DVT. a subacute ankle sprain is almost never a medical emergency. 11. (B) The suicide plan may have been decided. (B) Stimulation in the form of pictures may decrease signs of confusion. and the physician needs to be notified. for normal gait. (C) Observation of the student’s hair is the next step. 13. 17. it is not required to double glove. 7. (B) Dizziness can be a sign of hypotension. (C) Both the family and the patient should have the need for restraints explained to them. (D) Do not administer pain medication or start a central line without MD orders. Infraspinatus. (D) All protective measures must be worn. 8. 4. (A) Nursing assistants should be competent on all transfers. . 14.Answer Key 1. (D) Adolescents exhibiting signs of sexual development and interest are normal. that may a contraindication with Morphine. (B) Teres Minor. 6. and left arm/right foot go together. 9.

20.testtrade. http://www. http://solutions. 19. (A) Purse lip breathing will help decrease the volume of air expelled by increased bronchial airways.com/wps/portal/3... (B) The Mantoux is the most accurate test to determine the presence of TB.3m.t-lung-sounds/ .18.com/nclex1. (A) Negative culture results would indicate absence of infection.pdf The Auscultation Assistant ~ Heart Sounds & Breath Sounds to improve your skills Provides heart and lung sounds to help students improve their assessment skills.

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