The Complete Nursing School Bundle (PDF)

THE COMPLETE g n i s r Nu l oo Sch BUNDLE BROUGHT TO YOU BY © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Nurse in the making 1 Nurse in the making WWW.ETSY.COM/SHOP/NURSEINTHEMAKING @KRISTINE_NURSEINTHEMAKING @NURSESINTHEMAKING...

THE COMPLETE g n i s r Nu l oo Sch BUNDLE BROUGHT TO YOU BY © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Nurse in the making 1 Nurse in the making WWW.ETSY.COM/SHOP/NURSEINTHEMAKING @KRISTINE_NURSEINTHEMAKING @NURSESINTHEMAKING [email protected] @NURSEINTHEMAKINGKRISTINE By purchasing this material, you agree to the following terms and conditions: you agree that this ebook and all other media produced by NurseInTheMaking LLC are simply guides and should not be used over and above your course material and teacher instruction in nursing school. When details contained within these guides and other media differ, you will defer to your nursing school’s faculty/staff instruction. Hospitals and universities may differ on lab values; you will defer to your hospital or nursing school’s faculty/staff instruction. These guides and other media created by NurseInTheMaking LLC are not intended to be used as medical advice or clinical practice; they are for educational use only. You also agree to not distribute or share these materials under any circumstances; they are for personal use only. © 2021 NurseInTheMaking LLC. All content is property of NurseInTheMaking LLC and www.anurseinthemaking.com. Replication and distribution of this material is prohibited by law. All digital products (PDF files, ebooks, resources, and all online content) are subject to copyright protection. Each product sold is licensed to an individual user and customers are not allowed to distribute, copy, share, or transfer the products to any other individual or entity, they are for personal use only. Fines of up to $10,000 may apply and individuals will be reported to the BRN and their school of nursing. © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 2 TABLE OF CONTENTS Head To Toe Assessment...................................................................4 Dosage Calculation.........................................................................6 Lab Value Cheat Sheet...................................................................18 Lab Value Memory Tricks................................................................19 Blood Types................................................................................20 Electrolyte Imbalances...................................................................21 Fundamentals............................................................................. 25 Pharmacology: Suffixes, Prefixes, & Antidotes......................................40 Mental Health Disorders............................................................... 48 Mental Health Pharmacology.......................................................... 58 Mother Baby.............................................................................. 64 Pediatric Development Milestones.....................................................81 Pediatrics.................................................................................. 86 Med-Surg Renal / Urinary System.........................................................104 Cardiac System....................................................................113 Endocrine System.................................................................137 Respiratory Disorders........................................................... 147 Hematology Disorders........................................................... 153 Gastrointestinal Disorders..................................................... 156 Neurological Disorders.......................................................... 161 Burns............................................................................... 166 ABG’s...............................................................................170 Templates & Planners.................................................................. 174 Note from Kristine..................................................................... 193 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 3 HEAD-TO-TOE ASSESSMENT Introduction INSPECT • Knock PALPATE • Introduce yourself PERCUSS • Wash hands • Provide privacy AUSCULTATE Orientation "Normal" Vital Signs • What is your name? PULSE: 60-100 bpm • Do you know where you are? • Do you know what month it is? • Verify patient ID and DOB • Explain what you are doing (using non-medical language) • Who is the current U.S. president? BLOOD PRESSURE:120/80 mmHg O2 SATURATION: 95-100% • What are you doing here? TEMPERATURE: 97.8-99.1° F • A&O X4 = Oriented to Person, Place, Time, and Situation RESPIRATIONS: 12-20 breaths per min Head & Face HEAD Neck, Chest (Lungs) & Heart NECK • Inspect head/scalp/hair • Inspect and palpate • Palpate head/scalp/hair • Palpate carotid pulse FACE • Inspect • Check for symmetry • To assess Cranial Nerve 7, check the following: – Raise eyebrows – Smile – Frown – Show teeth – Puff out cheeks – Tightly close eyes EYES • Check skin turgor (under clavicle) POSTERIOR CHEST • Inspect • Auscultate lung sounds in posterior and lateral chest – Note any crackles or diminished breath sounds ANTERIOR CHEST • Inspect: – Use of accessory muscles – AP to transverse diameter – 6WHUQXPFRQILJXUDWLRQ • Inspects external eye structures • Palpate: symmetric expansion • Inspect color of conjunctiva and sclera • Auscultate lung sounds – anterior
and lateral • PERRLA – Pupils Equal, Round, Reactive to Light, & Accommodation – Note any crackles or diminished breath sounds HEART • Auscultate heart sounds (A, P, E, T, M) with diaphragm and bell – Note any murmurs, whooshing, bruits, RUPXIŶHGKHDUWVRXQGV © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 4 Peripherals Spine PERIPHERALS ELBOWS • Have the patient stand up (if able) Upper extremities • Inspect, palpate, and assess • Inspect the skin on the back • Inspect and palpate. HANDS AND FINGERS • Inspect: spinal curvature (cervical/thoracic/lumbar) • Note any texture, lesions, temperature, moisture, tenderness, & swelling • Palpate radial pulses bilaterally (+1, +2, +3, +4) SHOULDER • Inspect, palpate, and assess Ř ,QVSHFWKDQGVŵQJHUVQDLOV • Palpate spine Ř 3DOSDWHKDQGVDQGŵQJHUMRLQWV • Check muscle strength of hands bilaterally – Does each hand grip evenly? +1 = Diminished +2 =”Normal” +3 =Full +4 =Bounding, strong Lower Extremities (hips, knees, ankles) LOWER EXTREMITIES • Inspect: – Overall skin coloration – Lesions – Hair distribution – Varicosities – Edema • Palpate: Check for edema (pitting or non-pitting) Ř &KHFNFDSLOODU\UHŵOOELODWHUDOO\ • Note any lesions, lumps, or abnormalities Abdomen • Inspect: – Skin color – Contour – Scars – Aortic pulsations • Auscultate bowel sounds: all 4 quadrants (start in RLQ and go clockwise) • Light palpation: all 4 quadrants ABSENT: Must listen for at least 5 minutes to chart absent bowel sounds HIPS • Inspect and palpate HYPOACTIVE: One bowel sound every 3-5 minutes NORMOACTIVE: Gurgles 5-30 time per minute KNEES • Inspect and palpate HYPERACTIVE: Can sometimes be heard without a stethoscope constant bowFl sounds, > 30 sounds per minute ANKLES • Inspect and palpate • Post tibial pulse (+1, +2, +3, +4) • Dorsal pedis pulse bilaterally (+1, +2, +3, +4) – Check strength bilaterally – 'RUVLŶH[LRQŶH[LRQDJDLQVWUHVLVWDQFH OVERALL • Positions and drapes patient appropriately during exam (gave patient privacy) • Gave patient feedback/instructions • Exhibits professional manner during exam, treated patient with respect and dignity • Organized: exam followed a logical sequence (order of exam “made sense”) © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 5 v DOSAGE CALCULATION BROUGHT TO YOU BY © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Nurse in the making 6 ABBREVIATIONS LE EXAMP TIMES OF MEDICATIONS ac before meals pc after meals daily every day bid two times a day tid three times a day qid four times a day qh every hour ad lib A patient is receiving 1 mg tid. How many mg will they receive in one day? Remember: tid = 3X a day Answer: if they are receiving 1 mg for 3X a day, that’s 1 mg x 3 = 3 mg per day ROUTES OF ADMINISTRATION PO by mouth IM intramuscularly PR per rectum as desired SubQ subcutaneously stat immediately SL sublingual q2h every 2 hours ID intradermal q4h every 4 hours GT gastrostomy tube q6h every 6 hours IV intravenous IVP intravenous push prn as needed IVPB intravenous piggyback hs at bedtime NG nasogastric tube DRUG PREPARATION tab, tabs tablet cap, caps capsule gtt drop EC APOTHECARY AND HOUSEHOLD METRIC gtt drop min, m, mx minim tsp teaspoon pt pint kilogram gal gallon L liter dr dram mL milliliter oz ounce mEq milliequivalent T, tbs, tbsp tablespoon qt quart g (gm, Gm) gram mg milligram enteric coated mcg microgram CR controlled release kg (Kg) susp suspension el, elix elixir sup, supp suppository SR sustained release © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 7 CONVERSIONS BASED ON VOLUME THE METRIC SYSTEM 1 mg = 1,000 mcg Large unit to small unit Small unit to large unit 1 g = 1,000 mg 1 oz = 30 mL 8 oz = 1 cup 1 tsp = 5 mL 1 dram = 5 mL 1 tbsp = 15 mL 1 tbsp = 3 tsp 1 L = 1,000 mL 1 mL = 15 gtts (drops) TIP move decimal to the right move decimal to the left Moving to a larger unit? Move the decimal place to the Left (Ex: mcg → mg) (Larger unit think Left) EXAMPLE 1500 mcg = mg A “mg” is larger (Larger unit think Left) than a “mcg” Therefore you move decimal 3 places to the Left 1500. mcg = 1.500 mg (1.5 mg) BASED ON WEIGHT 1 kg = 2.2 lbs 1 lb = 16 oz lb kg DIVIDE by 2.2 kg lb MULTIPLY by 2.2 Example: 120 lbs = _____kg Example: 45.6 kg = ______lb 120 lbs / 2.2 = 54.545 kg 45.6 kg x 2.2 = 100.32 lb © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 8 DOSAGE CALC RULES KEY Medication errors kill, PREVENTION is crucial! 1 Show ALL your work. 2 Leading zeros must be placed before any decimal point. The decimal point may be missed without the zero EXAMPLE .2 mg should be 0.2 mg WHY? .2 could appear to be 2 (0.2 mg of morphine is VERY different than 2 mg of morphine!) 3 No trailing zeros. 4 DO NOT round until you have the final anwser! 0.7 mL NOT 0.70 mL 1 mg NOT 1.0 mg WHY? 1.0 could appear to be 10! HOW TO ROUND YOUR FINAL ANSWER If the number in the thousands place is 5 or greater → The # in the hundredth place is rounded up EXAMPLES: 1.995 mg is rounded to 2 mg 1.985 mg is rounded to 1.99 mg If the number in the thousands place is 4 or less 5 → DECIMAL REFERENCE GUIDE 34.732 tens ones The # is dropped thousandths hundredths tenths EXAMPLE: 0.992 mg is rounded to 0.99 mg Most nursing schools, if not all, do not give partial credit. (THIS MEANS EVERY STEP MUST BE DONE CORRECTLY!) © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 9 FORMULA METHOD (FOR VOLUME-RELATED DOSAGE ORDERS) D x V = A H D = DESIRED NOTE: Some medications like Heparin and Insulin are prescribed in units/hour Example: “The physician orders 120 mg...” H = DOSAGE OF MEDICATION AVAILABLE Example: “The medication is supplied as 100 mg/5 mL” V = VOLUME THE MEDICATION IS AVAILABLE IN Example: “The medication is supplied as 100 mg/5 mL” A = AMOUNT OF MEDICATION REQUIRED FOR ADMINISTRATION KEY Your answer EXAMPLE 1 Ordered: Drug C 150 mg Available: Drug C 300 mg/tab How many tablets should be given? D x V = A H What’s our desired? Drug C 150mg PO What do we have? Drug C 300mg/tab What’s our quantity/volume? tablets 150 mg 150 300 mg x 1 tab = 0.5 tabs 300 = 0.5 x 1 = 0.5 tabs FINAL ANSWER: 0.5 tabs © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. You should assume that all questions are asked “per dose” unless the question gives a timeframe (example: “how many tablets will you give in 24 hours?”) EXAMPLE 2 Ordered: Drug C 10,000 units SubQ Available: Drug C 5,000 units/mL How many mL should be given? D x V = A H What’s our desired? Drug C 10,000 SubQ What do we have? Drug C 5,000 units What’s our quantity/volume? 1 mL 10,000 units 10,000 5,000 units x 1 mL = 2 mL 5,000 = 2 x 1 = 2 mL FINAL ANSWER: 2 mL 10 IV FLOW RATES mL / hour mL of solution total hours = mL/hr What if the question is given in minutes? If the question is asking for flow rate and you’re given units of mL, you need to write the answers in mL/hr! mL/hr is always rounded to the nearest whole number! mL of solution min 333.333 mL/hr 50 mL mL of solution total minutes gtt / min Remember our abbreviations: gtt means “drop”! 60 min 30 min ANSWER: 333 mL/hr What if the question is given in hours? NOTE: If a drop factor is included, the question is asking for flow rate in gtt/min. You need to write the answers in gtt/minute! Convert hours to minutes! For example: 1 hours = 60 minutes 2.5 hours = 150 minutes EXAMPLE #2 Ordered: 1000 mL of Lactated Ringer’s to infuse at 50 mL/hour. Drop factor for tubing is a 5 gtt/mL. (Convert: 1 hour = 60 min) 5 gtt/mL 4 gtt/min 50 ÷ 60 = 0.833 x 5 = 4.166 Round to the nearest whole number → 4 Ordered: 100 mL of Metronidazole to infuse over 45 minutes. The tubing you are using has a drop factor of 10 gtt/mL. 100 mL 45 min 10 gtt/mL 4 gtt/min Remember Rule #4 Don’t round till the end! © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 22 gtt/min 100 ÷ 45 = 2.222 x 10 = 22.222 Round to the nearest whole number → 22 NOTE: NOTE: FINAL ANSWER: 100 mL/hr ANSWER: 100 mL/hr drop factor = gtt/min EXAMPLE #1 60 min = mL/hr Ordered: Infuse 3 grams of Penicillin in 50 mL normal saline over 30 minutes. (rounded to the nearest whole number) 50 mL 60 (minutes) EXAMPLE #2 Ordered: 1000 mL D5W to infuse over 3 hours. What will the flow rate be? 3 hr NOTE: Since there are 60 minutes in one hour, use this formula: EXAMPLE #1 1000 mL NOTE: FINAL ANSWER: 22 gtt/min Remember Rule #4 Don’t round till the end! 11 PRACTICE QUESIONS Do all 10 questions without looking at the correct answers on the following pages. Don’t forget to show all your work. After you are done, walk through each question…even the questions you got correct! 1 ORDERED: Rosuvastatin 3000 mcg PO ac AVAILABLE: Rosuvastatin 2 mg tablet (scored) How many tabs will you administer in 24 hours? 2 ORDERED: Tylenol supp 2 g PR q6h AVAILABLE: Tylenol supp 700 mg How many supp will you administer? Round to nearest tenth. 3 4 ORDERED: Potassium cholride 0.525 mEq/lb PO dissolved in 6 oz of juice at 0930 AVAILABLE: Potassium cholride 12 mEq/mL How many mL of potassium chloride will you add to the juice for a 66.75 kg patient? Round to nearest tenth. 6 250 mL normal saline over 5 hours. Tubing drop factor of 10 gtt/mL. 7 Humulin R 200 units in 100 mL of normal saline to infuse at 4 units/hr. 8 Dopamine 600 mg in 200 mL of normal saline to infuse at 10mcg/kg/min. Pt weight = 190 lbs. 9 2.5 L normal saline to infuse over 48 hours. 1000 mL D5W to infuse over 4 hours. 10 5 ORDERED: Morphine 100 mg IM q12h prn pain AVAILABLE: Morphine 150 mg/2.6 mL How many mL will you administer? Round to nearest hundredth. 150 mL Cipro 250 mcg to infuse over 45 minutes. © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 12 COMPREHENSIVE REVIEW 1 ORDERED: Rosuvastatin 3000 mcg PO ac AVAILABLE: Rosuvastatin 2 mg tablet (scored) 2 ORDERED: Tylenol supp 2 g PR q6h AVAILABLE: Tylenol supp 700 mg How many tabs will you administer in 24 hours? How many supp will you administer? Round to nearest tenth. STEP 1: CONVERT DATA STEP 1: CONVERT DATA mcg → mg g → mg 3000 mcg = 3 mg 2g = 2000 mg Remember: small to big, move the decimal point 3 to the left (unit is getting Larger think Left) Remember: big to small, move the decimal point 3 to the right STEP 2: READY TO USE DATA STEP 2: READY TO USE DATA Ordered: 3 mg Available: 2 mg Volume: 1 tab Administered ac: before each meal Question is asking: dosage in 24 hours Ordered: 2000 mg Available: 700 mg Volume: 1 supp STEP 3: IRRELEVANT DATA STEP 3: IRRELEVANT DATA N/A N/A STEP 4: FORMULA USED STEP 4: FORMULA USED SHOW YOUR WORK SHOW YOUR WORK D x V = A H 3 mg 2 mg D x V = A H NOTE: = 1.5 1.5 x 1 tab = 1.5 1.5 x 3 = 4.5 tabs per day Don’t forget to check times of medication! The medication is ordered to be given AC, which means before each meal. Since there are 3 meals in a day (24 hours), the answer must be multiplied by 3. ROUND: No rounding necessary FINAL ANSWER: 4.5 tabs © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 2000 mg 700 mg NOTE: = 2.857 Remember Rule #4 Don’t round till the end! 2.857 x 1 supp = 2.857 supp ROUND: Nearest tenth 2.857 supp → 2.9 supp FINAL ANSWER: 2.9 supp 13 COMPREHENSIVE REVIEW 3 ORDERED: Potassium chloride 0.525 mEq/lb PO dissolved in 6 oz of juice at 0930 AVAILABLE: Potassium chloride 12 mEq/mL 4 1000 mL D5W to infuse over 4 hours. How many mL of potassium chloride will you add to the juice for a 66.75 kg patient? Round to nearest tenth. STEP 1: CONVERT DATA STEP 1: CONVERT DATA kg → lb N/A 66.75 kg x 2.2 (lb/kg) = 146.85 lb NOTE: In this case, ordered amount depends on patient weight mEq/lb → mEq ( 0.525 mEq/lb x 146.85 lb = 77.096 mEq ) STEP 2: READY TO USE DATA STEP 2: READY TO USE DATA Ordered: 77.096 mEq Available: 12 mEq Volume: 1 mL 1000 mL 4 hr STEP 3: IRRELEVANT DATA Dissolved in 12 oz of juice at 0930 STEP 3: IRRELEVANT DATA KEY Question asked for “per dose” because no timeframe was given STEP 4: FORMULA USED STEP 4: FORMULA USED D x V = A H mL of solution = mL/hr total hours SHOW YOUR WORK 77.096 mEq 12 mEq = 6.424 6.424 X 1 mL = 6.424 mL SHOW YOUR WORK NOTE: 1000 mL Remember rule #4 Don’t round till the end! 4 hr ROUND: Nearest tenth 6.424 mL → 6.4 mL FINAL ANSWER: N/A = 250 mL/hr NOTE: mL/hr is always rounded to nearest whole number! ROUND: No rounding necessary 6.4 mL © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. FINAL ANSWER: 250 mL/hr 14 COMPREHENSIVE REVIEW 5 6 150 mL Cipro 250 mcg to infuse over 45 minutes. Remember: If the question is asking for flow rate (“to infuse”) and you’re given mL of solution, you need to write the answer in mL/hours! STEP 1: CONVERT DATA 250 mL normal saline over 5 hours. Tubing drop factor of 10 gtt/mL. STEP 1: CONVERT DATA hr → min N/A 1 hour = 60 minutes 5 hr x STEP 2: READY TO USE DATA mL of solution: 150 mL total hours: 45 min 60 min = 300 min 1 hr STEP 2: READY TO USE DATA mL of solution: 250 mL total minutes: 300 min Drop factor: 10 gtt/mL STEP 3: IRRELEVANT DATA Cipro 250 mcg Important: don’t let this information lead you to use the wrong formula. In this example, we’re asked for a flow rate which requires mL of solution and total time. STEP 4: FORMULA USED mL of solution total minutes 45 min mL of IV solution x drop factor = gtt/min time in minutes x 60 = mL/hr NOTE: Remember rule #4 Don’t round till the end! = 3.333 x 60 = 200 mL/hr NOTE: mL/hr is always rounded to nearest whole number! ROUND: No rounding necessary FINAL ANSWER: N/A STEP 4: FORMULA USED SHOW YOUR WORK 150 mL STEP 3: IRRELEVANT DATA 200mL/hr © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. SHOW YOUR WORK 250 mL 300 min NOTE: = 0.8333 mL/min Don’t round till the end! 0.8333 mL/min x 10 gtt/mL = 8.3333 gtt/min ROUND: gtt/mL is always rounded to the nearest whole number! 8.3333 gtt/min → 8 gtt/min FINAL ANSWER: 8 gtt/min NOTE: The question may not specify to round the final answer to a whole number; you are expected to know this with gtt/min units. 15 COMPREHENSIVE REVIEW 7 Humulin R 200 units in 100 mL of normal saline to infuse at 4 units/hr. 8 Dopamine 600 mg in 200 mL of normal saline to infuse at 10 mcg/kg/min. Pt weight = 190 lbs. Remember: If the question is asking for flow rate (“to infuse”) and you’re given mL of solution, you need to write the answer in mL/hr! STEP 1: CONVERT DATA STEP 1: CONVERT DATA mcg → mg N/A Remember: Small to big: move the decimal point 3 to the left (unit is getting Larger think Left) 10 mcg = 0.010 mg lb → kg 190 lb / 2.2 = 86.363 kg STEP 2: READY TO USE DATA KEY mg/kg mg → min min Desired: 4 units/hr Available: 200 units Volume: 100 mL In this case, ordered amount depends on patient weight 0.010 mg/kg/min x 86.363 kg = 0.863 mg/min STEP 2: READY TO USE DATA STEP 3: IRRELEVANT DATA Desired: 0.863 mg/min Available: 600 mg Volume: 200 mL N/A STEP 3: IRRELEVANT DATA N/A STEP 4: FORMULA USED STEP 4: FORMULA USED SHOW YOUR WORK SHOW YOUR WORK D x V = A H 4 units/hr 200 units D x V = A H 0.863 mg/min = 0.02 /hr 0.02 /hr x 100 mL = 2 mL/hr ROUND: No rounding necessary FINAL ANSWER: = 0.00143 /min 600 mg 0.00143 /min x 200 mL = 0.2878 mL/min NOTE: mL/hr is always rounded to nearest whole number! 2 mL/hr © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 0.2878 mL/min x 60 min = 17.2727 mL/hr WAIT! This is mL/min... we need units of mL/hr! ROUND: mL/hr is always rounded to nearest whole number! 17.2727 mL/hr → 17 mL/hr FINAL ANSWER: 17 mL/hr 16 COMPREHENSIVE REVIEW 9 2.5 L normal saline to infuse over 48 hours. Remember: If the question is asking for flow rate (“to infuse”) and you’re given mL of solution, you need to write the answer in mL/hours! STEP 1: CONVERT DATA L → mL 10 ORDERED: Morphine 100 mg IM q12h prn pain AVAILABLE: Morphine 150 mg/2.6 mL How many mL will you administer? Round to nearest hundredth. STEP 1: CONVERT DATA N/A Remember: big to small, move the decimal point 3 to the right 2.5 L = 2500 mL STEP 2: READY TO USE DATA STEP 2: READY TO USE DATA mL of solution: 2500 mL total hours: 48 hr Ordered: 100 mg Available: 150 mg Volume: 2.6 mL STEP 3: IRRELEVANT DATA N/A STEP 3: IRRELEVANT DATA IM q12h prn pain STEP 4: FORMULA USED mL of solution = mL/hr total hours SHOW YOUR WORK 2500 mL 48 hours ROUND: mL/hr is always rounded to nearest whole number! 52.0833 mL/hr FINAL ANSWER: → 52 mL/hr 52 mL/hr © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Question asked for “per dose” because no timeframe was given STEP 4: FORMULA USED D x V = A H SHOW YOUR WORK 100 mg = 52.0833 mL/hr KEY = 0.6666 150 mg 0.6666 x 2.6 mL = 1.7333 mL ROUND: nearest hundredth 1.7333 mL → 1.73 mL FINAL ANSWER: 1.73 mL 17 LAB VALUE CHEAT SHEET VITAL SIGNS BASAL METABOLIC PANEL (BMP) • Blood pressure RENAL • Sodium: 135 – 145 mEq/L • Systolic: 120 mmHg • Potassium: 3.5 – 5.0 mEq/L • Diastolic: 80 mmHG • Chloride: 95 - 105 mEq/L • Heart Rate: 60 - 100 BPM • Calcium: 9 - 11 mg/dL • Respirations: 12 - 20 Breaths per min • BUN: 7 - 20 mg/dL • Oxygen: 95% - 100% • Creatinine: 0.6 – 1.2 mg/dL • Temperature: 97.8 °F - 99 °F • Albumin: 3.4 - 5.4 g/dL • Calcium: 9 - 11 mg/dL • Magnesium: 1.5 - 2.5 mg/dL • Phosphorus: 2.5 - 4.5 mg/dL • Specific gravity: 1.010 - 1.030 • GFR: 90 - 120 mL/min/1.73 m2 • BUN: 7 - 20 mg/dL • Creatinine: 0.6 – 1.2 mg/dL • Total protein: 6.2 - 8.2 g/dL LIVER FUNCTION TEST (LFT) LIPID PANEL ABG’S • ALT: 7 - 56 U/L • Total cholesterol: <200 mg/dL • AST: 5 - 40 U/L • Triglyceride: <150 mg/dL • ALP: 40 - 120 U/L • LDL: <100 mg/dL → Bad cholesterol • Bilirubin: 0.1 - 1.2 mg/dL • HDL: >60/dL → Happy cholesterol • PH: 7.35 - 7.45 • PaCO2: 35 - 45 mmHg • PaO2: 80 - 100 mmHg • HCO3: 22 - 26 mEq/L HbA1c REMEMBER • Non-diabetic: 4 - 5.6% PANCREAS ROME • Pre-diabetic: 5.7 - 6.4% Opposite Metabolic Equal • Diabetic: > 6.5% (GOAL for diabetic: < 6.5%) • Amylase: 30 - 110 U/L Respiratory • Lipase: 0 - 150 U/L COMPLETE BLOOD COUNT ( CBC ) COAGs • WBC: 4,500 - 11,000 • RBC’s: 4.5 - 5.5 • PT: 10 - 13 sec • PLT: 150,000 - 450,000 • PTT: 25 - 35 sec • Hemoglobin (Hgb) Female: 12 - 16 g/dL Male: 13 - 18 g/dL • Hematocrit (HCT) Female: 36% - 48% Male: 39% - 54% • aPTT: 30 - 40 sec (heparin) • INR - NOT ON Warfarin < 1 sec - ON Warfarin 2 - 3 sec OTHER Measured with Therapeutic Range Antidote HEPARIN aPTT 1.5 - 2.0 x normal “control” value Protamine Sulfate WARFARIN PT/INR 1.5 - 2.0 x normal “control” value Vitamin K *The higher these numbers = higher chance of bleeding © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. • MAP: 70 - 100 mmHg • ICP (intracranial pressure): 5 - 15 mmHg • BMI: 18.5 - 24.9 • Glascow coma scale: Best = 15 Mild: 13-15 Moderate: 9-12 Severe: 3-8 18 ELECTROLYTES LAB VALUE MEMORY TRICKS SODIUM: 135 - 145 POTASSIUM: 3.5 - 5 *Commit to memory! BANANAS: There are about 3-5 in every bunch & you want them half ripe (½) PHOR: 4 US: 2 (me + you = 2) *don’t forget the .5 So, think 3.5 - 5.0 CALCIUM: 9 - 11 CALL 911 COMPLETE BLOOD COUNT (CBC) PHOSPHORUS: 2.5 - 4.5 MAGNESIUM: 1.5 - 2.5 MAGnifying glass you see 1.5 - 2.5 bigger than normal CHLORIDE: 95 -105 Think of a chlorinated pool that you want to go in when it’s SUPER HOT: 95 - 105 °F • Hemoglobin (Hgb) Female: 12 - 16 g/dL Male: 13 - 18 g/dL • Hematocrit (HCT) To remember HCT, multiply Hgb by 3 Female: 36% - 48% Male: 39% - 54% 12 X 3 = 36 16 X 3 = 48 13 X 3 = 39 BASAL METABOLIC PANEL (BMP) 18 X 3 = 54 BUN: 7 - 20 mg/dL Think hamburger BUNs... Hamburgers can cost anywhere from $7 - $20 dollars (Female) (Male) CREATININE: 0.6 – 1.2 mg/dL This is the same value as LITHIUM’s therapeutic range (0.6 - 1.2 mmol/L) Lithium is excreted almost solely by the kidneys... And creatinine is a value that tests how well your kidneys filter © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 19 BLOOD TYPES ANTIGENS: Proteins that elicit immune response → → → Plasma WBC’s RBC’s A Identifies the cell PLASMA ANTIBODIES Protects body from “invaders” (think ANTI) Opposite of the type of antigen that is found on the RBC B rsal Unive ENT RECIPI AB rsal Unive R DONO Antigen: A Antigen: B Antigen: Antibodies: B Antibodies: A Antibodies: NONE Recipient: Donor: A, O A, AB Recipient: Donor: B, O B, AB A&B Recipient: Donor: ALL AB O Antigen: NONE Antibodies: A&B Recipient: Donor: O ALL Rh FACTOR Has Rh on surface Can receive Does not have Rh on surface Can receive © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 20 POTASSIUM IMBALANCE 3.5 - 5 mEq/L Potassium imbalance plays a vital role in cell METABOLISM, and TRANSITION of nerve impulses, the functioning of cardiac, lung, muscle tissues, & acid-base balance. HYPERKALEMIA SIGNS & SYMPTOMS ✹ > 5 mEq/L TIGHT & CONTRACTED ✹ Orthostatic hypotension uscle cramps & weakness D E R ecreased cardiac contractility (↓HR, ↓BP) ✹ Shallow respirations rine abnormalities ✹ Anxiety, lethargy, confusion, coma ✹ Paresthesias espiratory distress eflexes (↑ DTR ) • Tall peaked T waves • Flat P waves • Widened QRS complexes • Prolonged PR intervals RISK FACTORS ✹ Medication ➥ Potassium-sparing diuretics (Spironolactone) ➥ Ace inhibitors ➥ NSAIDs ✹ Excessive potassium intake (Example: rapid infusion of potassium-containing IV solutions) ✹ Kidney disease or those on Dialysis ➥ Decreased potassium excretion ✹ Adrenal insufficiency (Addison’s disease) ✹ Tissue damage ✹ Acidosis ✹ Hyperuricemia ✹ Hypercatabolism MANAGEMENT < 3.5 mEq/L ✹ Thready, weak, irregular pulse M U R CG changes HYPOKALEMIA ✹ Hyporeflexia ✹ Hypoactive bowel sounds (constipation) ✹ Nausea, vomiting, abdominal distention ✹ ECG changes • ST depression • Shallow or inverted T wave • Prominent U wave ✹ Actual total body potassium loss ✹ Inadequate potassium intake ➥ Fasting, NPO ✹ Movement of potassium from the extracellular fluid to the intracellular fluid ➥ Alkalosis ➥ Hyperinsulinism ✹ Dilution of serum potassium ➥ Water intoxication ➥ IV therapy with potassium-deficient solutions Potassium imbalance can cause cardiac dysrhythmias that can be life-threatening! ✹ Monitor EKG ✹ Oral potassium supplements ✹ Initiate a potassium-restricted diet ✹ Potassium-retaining diuretic ✹ Discontinue IV & PO potassium ✹ Potassium-excreting diuretics ✹ Prepare the client for dialysis ✹ Prepare for administration: ➥ IV calcium gluconate & IV sodium bicarb ✹ Liquid potassium chloride ✹ Potassium is NEVER administered by IV push, IM, or subcut routes. ➥ IV potassium is always diluted & administered using an infusion device! ✹ Avoid the use of salt substitutes or other potassium-containing substances Potassium & sodium = opposites © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Example: ↑ Na = ↓ K+ 21 CALCIUM IMBALANCE Calcium is found in the body’s cells, bones, and teeth. Needed for proper 9 - 11 mg/dL functioning of the CARDIOVASCULAR, NEUROMUSCULAR, ENDOCRINE systems, blood clotting & teeth formation SIGNS & SYMPTOMS HYPERCALCEMIA B A HYPOCALCEMIA > 11 mg/dL one pain rrhythmias C ardiac arrest (bounding pulses) K idney stones M uscle weakness ↓ (DTR) E xcessive urination C A onvulsions T S etany < 9 mg/dL rrhythmias (dimished pulses) pasms & stridor GO NUMB ness in the fingers, face, & limbs POSITIVE TROUSSEAU’S: Carpal spasm caused by inflating a blood pressure cuff CHVOSTEK’S SIGNS: Contraction of facial muscles w/ light tap over the facial nerve. Think “C” for Cheesy smile MANAGEMENT RISK FACTORS ✹ Increased calcium absorption ✹ Decreased calcium excretion ✹ Kidney disease ✹ Thiazide diuretics ✹ Increased bone resorption of calcium ➥ Hyperparathyroidism / Hyperthyroidism ➥ Malignancy (bone destruction from metastatic tumors) ✹ Hemoconcentration ✹ D/C IV or PO calcium ✹ D/C Thiazide diuretics ✹ Administer phosphorus, calcitonin, bisphosphonates, & prostaglandin synthesis inhibitors (NSAIDs) ✹ Avoid foods high in calcium ✹ Inhibition of calcium absorption from the GI tract ✹ Increased calcium excretion ➥ Kidney disease, diuretic phase ➥ Diarrhea & steatorrhea ➥ Wound drainage ✹ Conditions that decrease the ionized fraction of calcium ✹ Adm. calcium PO or IV ➥ For IV, warm before & adm. slowly ✹ Adm. aluminum hydroxide & Vit D ✹ Initiate seizure precautions ✹ 10% calcium (acute calcium deficit) ✹ Consume foods high in calcium A client with a calcium imbalance is at risk for a pathological fracture. Move the client carefully and slowly Calcium & phosphate = Inverse © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Example: ↑ Ca+ = ↓ Po4 22 MAGNESIUM IMBALANCE Most of the magnesium found in the body is found in the bones. Regulates BP, blood sugar, muscle contraction & nerve function. HYPERMAGNESEMIA > 2.5 mg/dL MEMORY TRICK: SIGNS & SYMPTOMS ✹ LOW 1.5 - 2.5 mg/dL HYPOMAGNESEMIA < 1.5 mg/dL MAGNESIUM IS A SEDATIVE! EVERYTHING AKA SEDATED ✹ HIGH EVERYTHING AKA NOT SEDATED ✹ Low energy (drowsiness / coma) ✹ High HR (tachycardia) ✹ Low BP (hypotension) ✹ Increased deep tendon reflex (hyperreflexia) ✹ Low HR (bradycardia) ✹ Low RR (bradypnea) ✹ ↓ Respirations (shallow) ✹ ↓ Bowel sounds ✹ ↓ DTR’s (deep tendon reflex) ✹ High BP (hypertension) REMEMB ER: Als ✹ Shallow respirations ✹ Twitches, paresthesias ✹ Tetany & seizures ✹ Irritability & confusion hypoca o seen lcemia Mg rise POSITIVE TROUSSEAU’S: in . Ca & and fall togeth er! Carpal spasm caused by inflating a blood pressure cuff CHVOSTEK’S SIGNS: RISK FACTORS Contraction of facial muscles w/ light tap over the facial nerve ✹ Increased magnesium intake ➥ Magnesium-containing antacids (TUMS) & laxatives ➥ Excessive adm. of magnesium IV ✹ Renal insufficiency ➥ ↓ renal excretion of Mg = ↑ Mg in the blood ✹ DKA (Diabetic Ketoacidosis) ✹ Insufficient magnesium intake ➥ Malnutrition/vomiting/diarrhea ➥ Malabsorption syndrome ➥ Celiac & Chron’s disease ✹ Increased magnesium excretion ➥ Diuretics or chronic alcoholism ✹ Intracellular movement of magnesium ➥ Hyperglycemia & Insulin adm. MANAGEMENT ➥ Sepsis ✹ Diuretics ✹ IV adm. calcium chloride or calcium gluconate ✹ Magnesium sulfate IV or PO ✹ Avoid the use of laxatives & antacids containing magnesium ✹ Instruct the client to increase magnesium-containing foods ✹ Restrict dietary intake of Mg containing foods ✹ Hemodialysis Magnesium & Calcium = SAME © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. ✹ Seizure precautions Example: ↑ Mg = ↑ Ca+ 23 SODIUM IMBALANCE Sodium is a major ELECTROLYTE found in ECF. Essential for acid-base, fluid balance, active & passive transport mechanism, irritability & CONDUCTION of nerve-muscle tissue HYPERNATREMIA RISK FACTORS SIGNS & SYMPTOMS ✹ > 145 mEq/L F R I lushed skin E D dema (pitting) S kin flushed & dry A L T gitation ↓ of fluid & sodium estless, anxious, confused, irritable ncreased BP & fluid retention ecreased urine output < 135 mEq/L HYPERVOLEMIC HYPONATREMIA: ↑ body water that is greater than Na+ S A tupor/coma L imp muscles (muscle weakness) norexia (nausea/vomitting) rthostatic hypotension L ethargy (weakness/fatigue) T achycardia (thready pulse) 0 S S eizures/headache tomach cramping (hyperactive bowels) ✹ Increased sodium excretion ➥ Diaphoresis (ex: high fever) ➥ Diuretics ➥ Diarrhea & vomiting ➥ Drains (NGT suction) ➥ Diuretics (Thiazides & loop diuretics) ow-grade fever hirst (dry mucous membranes) 5 d’s ✹ SIADH ✹ Increased sodium intake ➥ Excess oral sodium ingestion ➥ Excess administration of IV fluids w/ sodium ➥ Hypertonic IV fluids ✹ LOSS OF FLUIDS! ➥ Fever ➥ Watery diarrhea ➥ Diabetes insipidus ➥ Excessive diaphoresis ➥ Infection HYPONATREMIA HYPOVOLEMIC HYPONATREMIA: BIG & BLOATED 135 - 145 mEq/L ✹ Adrenal insufficient (adrenal crisis) ✹ Inadequate sodium intake ➥ Fasting, NPO, Low-salt diet ✹ Kidney disease ✹ Heart failure hemoconcentration = Increased sodium! ✹ Decreased sodium excretion ➥ Kidney problems ADMINISTER IV sodium chloride infusions (Only if due to hypovolemia) DIURETICS (If due to hypervolemia) Hyponatremia → high fluids & low salt = hemodilution Daily Weights MANAGEMENT ✹ If due to fluid loss: ➥ Administer IV infusions ✹ If the cause is inadequate renal excretion of sodium: ➥ Give diuretics that promote sodium loss ✹ Restrict sodium & fluid intake as prescribed © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Where sodium goes, water FLOWS Safety (orthostatic hypotension AKA risk for falls) Airway protection (NPO) Don’t give food to a lethargic, confused client (INCREASED RISK FOR ASPIRATION) Hypervolemic hyponatremia (high fluid & low salt) Limit water intake Teach to avoid a diet high in salt (Canned food, packaged/processed meats, etc.) 24 FUNDAMENTALS OF NURSING Nurse in the making © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 25 ABBREVIATIONS Abd.................... Abdomen A.B.G.................. Arterial blood gas ADL.................... Activity of daily living a.c....................... Before meals A&O................... Alert & oriented BP....................... Blood pressure d/c...................... Discontinue H&H................... Hemoglobin & hematocrit DNR.................... Do not resuscitate DX...................... Diagnosis ECG.................... Electrocardiogram Fx....................... Fracture h.s....................... At bedtime HOB................... Head of bed HOH................... Hard of hearing H&P.................... History & physical HR...................... Heart rate ICU..................... Intensive care unit I&O..................... Intake & output IM....................... Intramuscular IV........................ Intravenous NGT.................... Nasogastric tube NPO................... Nothing by mouth CPR.................... Cardiopulmonary resuscitation PPE..................... Personal protective equipment PO...................... By mouth p.r.n.................... As needed ROM................... Range of motion S&S..................... Signs & symptoms Stat..................... Immediately U/A..................... Urinalysis V/S..................... Vital signs PERRLA.............. Pupils equal, round, & reactive to light & accommodation DO NOT USE POTENTIAL PROBLEM INSTEAD, WRITE: U Mistaken for “0” (zero) or “cc” unit IU Mistaken for IV (intravenous) or the number 10 (ten) "international unit" Mistaken for each other "daily" or "every other day" Decimal point is missed "X mg" "0.X mg" MS, MSO4, MgSO4 Can mean morphine sulfate or magnesium sulfate "morphine sulfate" "magnesium sulfate" @ Mistaken for the number “2” (two) “at” cc Mistaken for U (units) when poorly written “mL” or “milliliters” Q.D., QD, q.d., qd, Q.O.D.,QOD, q.o.d, qod Trailing zero (X.0 mg) Lack of leading zero (.X mg) THE NURSING PROCESS ASSESS "A Delicious PIE" SUBJECTIVE DATA Gather information Verify the information collected is clear & accurate EVALUATE DIAGNOSE OBJECTIVE DATA Determine the outcome of goals Interpret the information collected Data the nurse obtains through their assessment & observation Evaluate client's compliance Document clients response to pain Identify & prioritize the problem through a nursing diagnosis (be sure it's NANDA approved) What the client tells the nurse SET SMART GOALS Specific Measurable Achievable Relevant Time frame Modify & assess for needed changes IMPLEMENT PLAN Reaching those goals through performing the nursing actions Set goals to solve the problem. "Implementing" the goals set above in the planning stage © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Prioritize the outcomes of care 26 PRIORITY QUESTIONS A B C ABC'S #1 • ASK #3 BREATHING CIRCULATION PATENT AIRWAY • Patent #2 AIRWAY ! means "open"; their airway is clear! YOU KNOW YOU ARE BEING ASKED A PRIORITY QUESTION WHEN THE QUESTION ASKS: • What is the most important? • What is the initial response? • Which action should the nurse take first? When you see these questions, you should immediately think of Maslow’s Hierarchy of Needs as well as ABC’s! YOURSELF: Can they successfully breathe oxygen in and breathe CO2 out? BREATHING • Gas exchange taking place inside the lungs • ASK YOURSELF: Can gas exchange successfully happen in their lungs? CIRCULATION • Can they circulate blood through their body and are their organs being perfused? • ASK YOURSELF: Is there a reason that the blood isn't pumping/circulating in the body? (Example: The heart is working to pump the blood to the vital organs) MASLOW'S HIERARCHY OF BASIC NEEDS Self-fulfillment needs NCLEX TIP Psychological needs SELFACTUALIZATION SELF-ESTEEM SELFESTEEM LOVE & BELONGING Pain is considered “psychological” meaning it does not take priority. *Pain rarely kills people basic needs SAFETY & SECURITY PHYSIOLOGICAL NEEDS © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. • Hope • Spiritual well-being • Enhanced growth This shows the 5 levels of human needs Physiological needs being the most important (Oxygen, fluids, nutrition, shelter). ABC’s fall into Maslow's Physiological need! • Control • Competence • Positive regard • Acceptance/worthiness • Maintain support systems • Protect from isolation • Protection from injury • Promote feeling of security • Trust in nurse-client relationship • Airway • Respiratory effort • Heart rate, rhythm, and strength of contraction • Nutrition • Elimination 27 NURSING ETHICS & LAW ETHICAL PRINCIPLES PATIENT RIGHTS The right to... AUTONOMY → Privacy Respect for an individual’s right to make their own decisions → Considerate & respectful care NONMALEFICENCE → Be informed Obligation to do & cause no harm to others → Know the names & roles of the persons who are involved in care BENEFICENCE → Consent or refuse treatment Duty to do good to others → Have an advance directive JUSTICE → Obtain their own medical records & results Distribution of benefits & services fairly VERACITY CONSENT Obligation to tell the truth FIDELITY TYPES OF CONSENT: • Admission agreement • Immunization consent • Blood transfusion consent • Surgical consent • Research consent • Special consents Following through with a promise HIPAA The Health Insurance Portability & Accountability Act → Treatment can not be done without a client's consent → Clients records are private & they have the right to ensure the medical information is not shared without permission → All health care professionals must inform the client how their health information is used → The client has the right to obtain a copy of their personal health information © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. → In the case of an emergency when a client cannot give consent, then consent is implied through emergency laws → Minors (under 18), consent must be obtained from a parent or legal guardian ! Before signing the consent, the client must be informed of the following: risks & benefits of surgery, treatments, procedures, & plan of care in layman's terms so the client understands clearly what is being done. 28 PPE INFECTION CONTROL PERSONAL PROTECTIVE EQUIPMENT DONNING DOFFING PUTTING ON PPE • Put on PPE before entering the client's room • Do not touch your face while wearing PPE • Avoid touching areas in the client's room REMOVING PPE • Remove PPE at the client's door way or outside the room • If hands become soiled while removing PPE, stop & perform hang hygiene. Then, continue with PPE removal. 1 HAND HYGIENE 1 GLOVES 2 GOWN 2 GOGGLES / FACE SHIELD 3 MASK / RESPIRATOR 3 GOWN 4 GOGGLES / FACE SHIELD 4 MASK / RESPIRATOR 5 GLOVES 5 HAND HYGIENE HOSPITAL-ASSOCIATED INFECTIONS HAI............. Hospital-associated infection CAUTI......... Catheter-associated urinary tract infection SSI.............. Surgical site infection CLABSI....... Central line-associated blood infection VAP............ Ventilator-associated pneumonia © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. Meticulous hand hygiene practices and use of chlorhexidine washes helps in preventing HAI's 29 INFECTION CONTROL STAGES OF INFECTION Causative Agent • Bacteria • Virus • Fungus • Prion • Parasite Susceptible Host Leaves the host more susceptible to infections Chain Of Infection Portal Of Entry • How it gets to the host Mode Of Transmission • Same as portal of exit Reservoir • Human • Animal • Surfaces • Food • Soil • Insects Portal Of Exit • Skin (wound) • Mouth (Vomit, Saliva) • Blood (Cuts on the skin) • Respiratory tract • Contact • Droplet • Airborne • Vector borne Incubation Interval between the pathogen entering the body & the presentation of the first symptom Prodromal Stage Onset of general symptoms to more distant symptoms; the pathogen is multiplying Illness Stage Symptoms specific to the infection appear Convalescence Acute symptoms disappear and total recovery could take days to months TRANSMISSION BASED PRECAUTIONS Airborne • Single room under negative pressure • Door remains closed • Health care workers wear a respiratory mask (N95 or higher level) Think Measles "Mtv" T uberculosis V aricella (Chickenpox) & Disseminated herpes-zoster (Shingles) *Airborne precaution is no longer needed when all lesions have crusted over. droplet • Private room or a client whose body cultures contain the same organism • Wear a surgical mask • Place a mask on the client whenever they leave the room • Adenovirus • Diphtheria (pharyngeal) • Epiglottitis • Influenza (flu) • Meningitis • Mumps • Parvovirus B19 • Pertussis • Pneumonia • Rubella • Scarlet fever • Sepsis • Streptococcal pharyngitis © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. contact • Private room or cohort client • Use gloves & a gown whenever entering the client's room • Colonization or infection with a multidrug-resistant organism • Enteric infections (Clostridium difficile) • Respiratory infections (RSV, Influenza) • Wound & skin infections (cutaneous diphtheria, herpes simplex, impetigo, pediculosis, scabies, staphylococci, & varicella-zoster) • Eye infections (conjunctivitis) 30 IV THERAPY: TYPES OF IV SOLUTIONS Fluid in our body is found in 2 places: if Intracellular & Extracellular Intracellular (ICF) is Fluid INSIDE the cell Extracellular (eCF) is Fluid OUTSIDE the cell if icf icf (Millions of these cells in our body) iv Interstitial (IF) Intravascular (IV) is fluid that surrounds the cell AKA fluid in the tissues is plasma in the blood vessels if icf icf if HYPERTONIC "Enter the vessel from the cells" 5% dextrose in 0.9% saline (D5NS) USES 5% dextrose in 0.45% saline 5% dextrose in LR • Cerebral Edema • Low levels of sodium (hyponatremia) • Metabolic alkalosis • Maintenance fluid • Hypovolemia More concentrated & ↑ osmoladity ISOTONIC "Stays where I put it" 0.9% saline (NS) Lactated Ringers Ringer’s lactate (LR) Same osmolality as body fluids (ISO means Equal) (Equal water & particle ratio) Used with BLOOD PRODUCTS 5% dextrose (D5W) USES • EXPANDS intravascular fluids volume & replaces the fluid loss associated with... • Burns • Hemorrhage • Surgery • Dehydration ➥ Vomiting & diarrhea • Also used for fluid maintenance HYPOTONIC "Go Out of the vessel" & into the cell" Fluids goes Out of the vessel & into the cell making the cell SWELL! More diluted & ↓ osmolality (less salt, more water) "Water flows where sodium (particles) goes" © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 0.45% NS 2.5% Dextrose 0.33% NS Uses In DKA, there is so much glucose in the cells they need water! • Intracellular dehydration such as DKA • Never give to clients with burns or liver disease • Helps kidneys excrete excess fluids 31 IV THERAPY: COMPLICATIONS symptoms • Tachycardia • Chest pain • Hypotension • ↓ LOC • Cyanosis symptoms • At the site... ➥ Pain ➥ Swelling ➥ Coolness ➥ Numbness • No blood return symptoms • Tachycardia • Redness • Swelling • Chills & Fever • Malaise • Nausea & vomiting symptoms • ↑ blood pressure • Distended neck veins • Dyspnea • Wet cough & crackles symptoms • At the site ➥ Heat ➥ Redness ➥ Tenderness • ↓ Flow of IV symptoms • Ecchymosis • At the site ➥ Blood ➥ Hard & painful lump AIR EMBOLISM Air enters the vein through the IV tubing INFILTRATION IV fluid leaks into surrounding tissue INFECTION Entry of microorganism into the body via IV CIRCULATORY OVERLOAD Administration of fluids too rapidly (Fluid Volume Overload) PHLEBITIS treatment • Clamp the tubing • Turn client on the left side & place in Trendelenburg position • Notify the HCP treatment • Remove the IV • Elevate the extremity • Apply a warm or cool compress • Do not rub the area treatment • Remove the IV • Obtain cultures • Possible antibiotics administration treatment • ↓ flow rate (keep-vein-open rate) • Elevate the head of the bed • Keep the client warm • Notify the HCP treatment Inflammation of the vein Can lead to a clot (thrombophlebitis) • Remove the IV • Notify the HCP • Restart the IV on the opposite side HEMATOMA treatment Collection of blood in the tissues © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. • ELEVATE the extremity • Apply Pressure & Ice 32 BLOOD TRANSFUSIONS ADMINISTRATION OF THE TRANSFUSION FACTS ABOUT BLOOD TRANSFUSION 1 Insert an IV line using an 18- or 19-gauge IV needle 2 Run it with normal saline (keep-vein-open-rate) 3 Use the largest catheter port available  Only Normal Saline (NS) can be used in conjunction with blood 4 Begin the transfusion slowly  Type & screen and a cross match are good for 72 hours A 5  Administered by the RN  30 minutes - from the time you received it from the blood bank to the time you infuse The first 15 min *MOST CRITICAL* monitor the client for S/S of any transfusion reaction B Vital signs are monitored every 30 minutes - 1 hour C After 15 minutes the flow can be increased (unless a transfusion reaction has occurred)  4 hours - All blood must be transfused  STOP the transfusion if you suspect a transfusion reaction Document the client’s tolerance to the administration of the blood product TRANSFUSION REACTION A transfusion reaction is an adverse reaction that happens as a result of receiving blood transfusions SIGNS OF TRANSFUSION REACTIONS Immediate transfusion reaction  Fast heart Rate Chills, diaphoresis, aches, chest pain, rash, hives, itching, swelling, rapid, thready pulse, dyspnea, cough, or wheezing  Itching/urticaria/skin rash  Wheezing/dyspnea/tachypnea Circulatory overload  Anxiety  Flushing / fever Infusion of blood too rapid for the pt to tolerate  Back pain Cough, dyspnea, chest pain, headache, hypertension, tachycardia, bounding pulse, distended neck vein, wheezing Septicemia Blood that is contaminated with microorganisms Rapid onset of chills, high fever, vomiting, diarrhea, hypotension & shock Iron overload Complication that occurs in client's who receive multiple blood transfusions Vomiting, diarrhea, hypotension, altered hematological values © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. NURSING ACTIONS TO A TRANSFUSION REACTION 1 STOP the transfusion 2 Change the IV tubing down to the IV site 3 Keep the IV open w/ normal saline 4 Notify the HCP & blood bank 5 Do not leave the client alone (monitor the client's vital signs & continue to assess the client) 33 PHARMACOKINETICS A "ADME" Absorption Medication going from the location of administration to the bloodstream d Subcut & IM IV Takes the longest to absorb Depends on the site of blood perfusion. More blood perfusion = rapid absorption Quickest absorption time Distribution Transportation by bodily fluids of the medication to where it needs to go m Metabolism How is the medication going to be broken down? Most common site: LIVER e ORAL Influencing factors: • Circulation • Permeability of the cell membrane • Plasma protein binding Influencing factors: • Age (Infants & elderly have a limited med-metabolizing capacity) • Medication type • First-pass effect Liver may inactivate some medication (may need non enteral route) • Nutritional status Excretion How is the medication going to be eliminated from the body? Most commonly done by KIDNEYS Influencing factors: • Kidney dysfunction Leads to an increase in the duration and intensity of a medication response © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 34 MEDICATION ADMINISTRATION 6 RIGHTS OF MED ADMIN RIGHT PATIENT RIGHT MED RIGHT TIME RIGHT ROUTE RIGHT DOSE RIGHT DOCUMENTATION COMMON MEDICATION ERRORS TYPES OF ORDERS ROUTINE Given on a regular schedule with or without a termination date SINGLE "ONE-TIME" Given on a regular schedule with or without a termination date STAT Only for administration once and given immediately PRN "As needed" must have an indication for use such as pain, nausea & vomiting. © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. ! Medication error kills, prevention is crucial! • Wrong medication • Incorrect dose • Wrong... ➥ Client ➥ Route ➥ Time • Administer a medication the client is allergic to • Incorrect D/C of Medication • Inaccurate prescribing 35 PARENTERAL ADMINISTRATION Any route of administration that does not involve drug absorption through the GI tract 10-15° Angle INTRADERMAL (ID) USES: • TB testing • Allergy sensitivities needle size: 25 - 27 gauge Needle length: Usual site: Normal to overweight clients 90° Angle Thin clients 1.4 - 5/8 in (0.6 - 1.6 cm) "BLEB" Inner forearm SUBCUTANEOUS (SUBLET) 45° Angle USES: non-irritating, water-soluble medication (insulin & heparin) Needle size: 25 - 27 gauge Needle length: Usual site: 90° Angle Should form a 3/8 - 5/8 in (1.0 - 1.6 cm) Abdomen, posterior upper arm, thigh INTRAMUSCULAR (IM) USES: Irritating, solutions in oils, and aqueous suspensions Needle size: 18 - 25 gauge Usual site: Deltoid, vastus lateralis, ventrogluteal Do not inject more than 3 mL (2 mL for the deltoid) • Divide larger volumes into two syringes & use two different sites Use the Z-track method 25° Angle INTRAVENOUS (IV) USES: Administering medications, fluids, & blood products Needle size: Usual site: The smaller the gauge, the larger the IV bore. EXAMPLE: 16 gauge is the largest needle size 16-gauge: client's who have trauma 18-gauge: surgery & blood administration 22 - 24-gauge: children, older adults, & clients who have medical issues or are stable post-op Hand, wrist, cubital fossa, foot, scalp © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. 36 NONPARENTERAL ADMINISTRATION Absorbed into the system through the digestive tract ORAL OR ENTERAL → Have client sit at 90 angle to help with swallowing → Lateral or sims' position rectal → CONTRADICTIONS: vomiting, aspiration precautions/absence of a gag reflex, decreased LOC, difficulty swallowing SUPPOSITORIES vaginal TRANSDERMAL gauze and wipe from inner to outer canthus to prevent bacterial from entering the eye eyes → Have the client tilt their head back slightly → Rinse mouth after the use of steroids → Close eye lid & apply gentle pressure on the nasolacrimal duct for 30 - 60 seconds → Use a spacer if possible to prevent thrush © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. the conjunctival sac sac & drop medication directly into the sac → 2 - 5 minutes between different medications ears → Have client tilt their head → Warm the solution before adm. to prevent vertigo & dizziness → Adults: pull ear upward & outward → < 3 years of age: pull ear down & back nose → DO NOT eat or drink until the tablet has completely dissolved → Pull lower eye lid down gently to expose → Hold the dropper 1 - 2 cm above the conjunctiva → 20 - 30 seconds between puffs → Keep the tablet in place until it has completely absorbed (DROPS, OINTMENTS, SPRAYS) → If there is dried section use a moisten sterile → Always take off the old patch before placing a new one on Sublingual: Under the tongue Buccal: Between the cheek & the gum → Insert the suppository along the posterior wall of the vagina (3 - 4 inches deep) INSTALLATION → Rotate the sites of the patch to prevent skin irritation SUBLINGUAL & BUCCAL → Supine with knees bent & feet flat on the bed, close to hips → Stay supine for at least 5 minutes → Place the patch on a dry and clean area of skin (free of hair) INHALATION → Insert beyond the internal sphincter → Leave it in for 5 minutes → NEVER crush enteric-coated or time-release medications → Break or cut scored tablets only! → Use lubrication → Have client lie supine → Do not blow nose for 5 min after drop instillation 37 PRESSURE INJURIES (ULCERS) "DECUBITUS ULCER" "BED SORES" The break down of skin integrity due to unrelieved pressure Type 1 • Skin is intact (unbroken) • Nonblanchable redness • Swollen tissue • Darker skin → may appear blue / purple Type 2 • Partial thickness • Epidermis & the dermis ➥ No fatty tissue is visible • Superficial ulcer • Abrasion or ulcer Type 3 • Full thickness SKIN loss ➥ Damage to or necrosis of subcut tissue ➥ No exposed muslce or bone • Ulcer extend down to the underlying fascia, but not through it • Deep crater with or without tunneling Type 4 • Full thickness TISSUE loss ➥ Destruction of tissue ➥ Damage to muscle & bone • Deep pockets of infection & tunneling Unstageable When the stage cannot be determined due to ESCHAR or SLOUGH covering the visibility of the wound making the depth unknown. → Sensory Perception → Moisture → Activity → Mobility → Nutrition → Friction & shear Asses your client's skin EVERY shift for pressure injuries using the Braden Scale! Interpretation Looks at 6 categories BRADEN SCALE → Low risk: 22 - 23 → Less risk: 19 - 21 → High risk: <18 © 2021 NurseInTheMaking LLC. Sharing and distributing this copyrighted material without permission is illegal. RISK FACTORS " AVOIDS PRESS " WHAT IS A PRESSURE ULCER? A GING SKIN VASCULAR DISORDERS O BESITY I MMOBILITY & INCONTINENCE D IABETES S KIN FRICTION POOR NUTRITION R EDUCED RBC'S (ANEMIA) E DEMA S ENSORY DEFICITS S EDATION PREVENTION relieve pressure → Apply pressure relieving devices (overlays, speciality beds, air cushions, foam-padded seat cushions, etc.) → Do not use donut-type devices or synthetic sheepskins! proper nutrion → ↑ protein intake → Adequte hydration → Possible enteral nutrition skin hygiene → Clean skin with mild soap → Clean incontinent clients → Do not scrub or rub bony prominences → Barrier for incontinence → Moisturizer for hydration repositioning → Turn/reposition your client every 2 hours while in the bed → Lift, do not PULL • Pulling could cause shearing & friction from force