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Welcome,future rn!
Delegation & Prioritization
How do you decide which patient toassess 1st when prioritizing multiplepatients that have urgent needs?What question do you ask yourself?
Acute vs. ChronicABCsCurrent problem vs. hxWhich one of the options can kill mypatient quickest?
Can you give some examples of astable patient vs an unstable patient?
Stable: chronic illness, >12 hr postop, experiencing expectedsymptoms. Unstable: acute illness, fresh postop, assessment is changing
Which 5 types of patients are alwaysconsidered unstable and are alwaystop priority?
a hemorrhaging patient a patient with a high fever over105a patient with hypoglycemiaa lack of pulsea lack of breathing
What do RNs NOT delegate?
What they E.A.T
What interventions can an LPN NOT complete?
Admission/Discharge assessmentIV push medicationsBlood administration Care planInitial teaching
Fluids & Electrolytes
What changes in vital signs wouldyou expect to see if a patient is influid volume deficit?
BP & CVP decreasedNarrow pulse pressurePulse increasedRespirations increased
What changes in vital signs wouldyou expect to see if a patient is influid volume excess?
BP & CVP increasedPulse increasedRespirations increased
What are the most common IV fluidsto treat fluid volume deficit?
Isotonic solutions: Normal Saline (NS) &Lactate Ringers (LR)
Your patient with fluid volume excess isprescribed furosemide. What labswould you monitor and why?
Potassium
Your patient has been orderedpotassium chloride (KCL) replacement.What routes are appropriate?
By mouth or IV, never IV push.
Your patient is has a sodium levelof 119 mEq/L. What symptomswould you monitor for?
Confusion and seizures.
Which food should we recommend toa patient on a restricted sodium diet?
Recommended: fresh fruit,veggies & meat Advised against: canned food,cured meats, bread, cheese
Peri Operative
What is the nurses responsibilityregarding the surgical consentform?
Witness the consent form
What is an Advanced Directive?
It specifies the patients wishes inregard to healthcare decisions
Which home medications shouldnot be taken prior to surgery?
Diabetic medications:Insulin or Glipizide
What are the OR nursesresponsibilities?
Safety! Monitoring all activities Performing “time-out” Documenting Equipment counts
What are a few postop complicationsyou would monitor for?
BleedingHypovolemic shockInfectionRespiratory problems
What interventions would you put inplace to prevent postopcomplications?
Monitor VS Assess the LOC, gag reflex, lungsounds, bowel sounds and UO Assess the surgical site
Neurological
What are your nursing considerationsfor a patient with a cognitiveimpairment, like Alzheimer’s?
Consistent caregiversGive two choices, not moreProvide memoriesProtect against wanderingDecrease overstimulationMedications: donepezil & memantine
What could happen when a patientwith a T6 or higher SCI has adistended bladder?
Autonomic Dysreflexia orhyperreflexia
What interventions could be used for apatient with aphasia after a stroke?
Be patientGive time to speakUse simple questions Communication boardSpeech therapy
What is most commonly the firstsymptom of myasthenia gravis?
Eye problems!
What are the symptoms of increasedintracranial pressure (ICP)?
Decreased LOC, restlessness,confusion or lethargy. Also, Cushing’s triad - this is a medical emergency.
If you assess your patient and noteracoon eyes or battle’s signs, whatcondition may this indicate?
A basilar skull fracture!
What are your priority actions if yourpatient has a seizure?
Start with patency of the airway. Then, focus on Safety!
Respiratory
Who is at the highest risk forpneumonia and what are someimportant diagnostic tests?
The very young, the very old, theimmobile, immunocompromised orcigarette smokers.
Albuterol is a common bronchodilatoryou’ll give to asthmatic patients. Whendo you give this medication and whatdoes it do?
Albuterol inhaler dilates the airway. You'll give when your patient is havingsymptoms or exacerbations.
What type of precautions would beimportant for your patient withpneumonia?
Droplet Precautions
Your patient on a ventilator is receivingpositive end-expiratory pressure (PEEP)therapy, what complication do you wantto assess for?
Tension Pneumothorax
You’re caring for a patient diagnosedwith acute respiratory distress syndrome(ARDS). Which symptom is mostcommonly seen with ARDS?
Consistently decreased Sa02 levels
Your patient is in extreme respiratorydistress, what should you do first?
Position the head of the bed up and then give oxygen.
You’re caring for a patient having a COPDexacerbation, what safety considerationsdo you want to be thinking aboutregarding oxygen administration?
Minimal oxygen for a patient with COPD
10 minute break!
Blood in the stool with UC
Your patient with end stage liver cirrhosishas a sengstaken-blakemore tube. Whatare you nursing considerations?
If the patient has difficulty breathing, usescissors to cut the sangstaken-blakemoretube and remove it immediately!