Diabetes
This type of insulin has an onset of 15 minutes and should be given right before meals.
What is rapid-acting insulin (e.g., lispro, aspart)?
Think: Should we give both long acting and short acting insulin at the same time?
Your diabetic patient is confused, diaphoretic, and shaky with a blood glucose of 52 mg/dL. Your post-op patient has oxygen saturation of 78% on room air. Which patient requires your immediate attention?
Who is the post-op patient with low oxygen saturation (Airway-Breathing-Circulation priority using ABCs)?
You have two patients. One is experiencing delirium and is repeatedly trying to get out of bed but he is unstable on his feet.
The other patient has Alzheimer's and is is repeatedly trying to get out of bed but he is unstable on his feet.
This is the patient with the acute condition.
What is the patient with delirium?
Think: What are the similarities and and differences between delirium, Alzheimer's, and dementia.
This subjective assessment finding is considered the most reliable indicator of pain, and it is commonly mischaracterized as an objective finding.
What is the patient's self-report?
Think: What is the difference between acute pain and chronic pain?
The physician writes an order for:
'Morphine 1.0 mg IV push'.
You should do this before administering the medication.
What is clarify the order?
Think: What specifically would you need to clarify?
These are the three classic signs of hyperglycemia, often called the '3 Ps'.
What are polyuria (excessive urination), polydipsia (excessive thirst), and polyphagia (excessive hunger)?
You have four patients: one with a severe headache, one with a blood glucose of 450 mg/dL, one with chest pain radiating to the jaw, and one requesting a sleeping pill.
You should see this patient first.
Who is the patient with chest pain radiating to the jaw (possible myocardial infarction)?
When two are used they promote safety and ease independent movement, but when four are used they can increase the risk of falls.
What are bed rails?
Think: Why are 4 siderails considered a restraint and why is the fall risk increased?
Do you need a provider order for restraints?
This type of pain lasts longer than 3-6 months, may not have an identifiable cause, and is often accompanied by depression and fatigue, unlike the other type which has a sudden onset, identifiable cause, and resolves with healing.
What is chronic pain (versus acute pain)?
Think: What other symptoms do might a person experience if they have chronic pain?
These two numbers are the number of milliliters in one fluid ounce, and the number of teaspoons used to measure this amount, which is important for measuring liquid medications.
What are 30 mL and 6 teaspoons?
This is a test for blood sugar that can be taken at any time of the day and is used to diagnose diabetes, and to evaluate glycemic control, but in not used to determine the amount of insulin to be given before a meal.
What is HgA1c?
Why is it that there is no need to fast before this blood test is drawn?
A patient with frequent watery diarrhea caused by C. difficile infection, which often develops after antibiotic use, may experience fatigue due to this.
What is dehydration?
Remember: There is a modification to contact contact precautions for a patient with C. Diff and you must use soap and water handwashing, not hand sanitizer, because alcohol doesn't kill C. diff spores.
The most common healthcare-associated infection and can be prevented by avoiding unnecessary use of this device.
What is a foley catheter?
What is an indwelling urinary catheter?
Think: Why does a foley increase the risk of infection?
When you assess you patient and notice retractions and dyspnea, this is the best position to ease their distress.
What is a high fowlers position?
or What is an upright position (90 degrees)?
A patient receives a 250 ml IV bolus, MIVF NS 125 ml/h x 2 hrs, then sucks 200 ml of ice chips, drinks 8 oz of grape juice, eats a banana, and is given 1 tbsp of oral ibuprofen. This is the total to chart for intake.
What is 855mls?
250+125+125+100+240+15=855
A patient receiving NPH insulin at 0800 is most at risk for hypoglycemia during this time period.
What is mid-afternoon (4-6 hours after administration, during peak action)?
A patient post-appendectomy has a temperature of 101°F. Another patient with COPD is using accessory muscles to breathe and has a respiratory rate of 32. You should assess this patient first.
Who is the COPD patient with respiratory distress (life-threatening breathing problem)?
An elderly post-operative patient is confused, trying to get out of bed, and pulling at their IV line. Before considering restraints for this patient experiencing delirium, the nurse should try these interventions first.
What are non-pharmacological interventions such as reorienting the patient, ensuring adequate lighting, having a family member stay with them, addressing pain/discomfort, checking for full bladder or other needs, and removing unnecessary tubes/lines?
Restraints (which require an order) should not be used as they can worsen delirium and increase agitation.
Unlike rhonchi and wheezing which occur in the lower airways, this high-pitched, harsh sound indicates upper airway obstruction and is heard during inspiration, often signaling a life-threatening emergency.
What is Stridor?
Think: Why is this a higher risk for a life threatening emergency than other adventitious breath sounds?
This route of med administration allows the med to be absorbed directly through the highly vascularized mucosa into the systemic circulation. This reduces the risk of drug degradation from gastric acid or digestive enzymes.
What is SL (sublingual) medication administration?
Think: When would the SL route be advantageous?
How does this differ from buccal medication administration?
The physician orders 8 units of regular insulin. The vial contains 100 units/cc. How many cc will you administer?
What is 0.08 mL?
Remember: A cc (cubic centimeter) is the same as a mL (milliliter). These terms are interchangeable.
You will only ever use a specific insulin syringe to administer insulin - It will be measured in units, not milliliters.
The first is a learning domain that evaluates the understanding of a process, but the second term is a much better means of evaluating learning.
What are Cognitive, and Psychomotor learning domains.
Think: Which domain is teachback?
What is the Affective domain, and how does that differ from cognitive?
This is the first action that a nurse should take when they suspect a specific condition that is characterized by hemoptysis, night sweats and weight loss.
What condition are we talking about here?
How do airborne precautions differ from droplet precautions?
A patient receiving an opioid analgesic for post-op pain has a respiratory rate of 6 and receives Narcan with good effect. The nurse knows that the patient should be watched for at least 6 hours because of the possibility of this.
What is re-sedation? (or respiratory depression returning)
Patients should be continuously monitored for 6 to 12 hours since some opioids like methadone, fentanyl, and buprenorphine have a much longer half-life than naloxone (30-90 mins)
If you inadvertently gave your patient double the ordered dose of a medication, this would be your first priority action.
What is assess your patient?
Think: What is this medication designed to do?
Is your patient clinically stable or showing signs related to this medication.
What other critical steps would you complete?