Med-Math
Your patient has a 1-liter bag of NS running. You see that there is 800mL remaining in the bag. How many mL would you document that the patient has received?
200mL
1000mL - 800mL = 200mL
Name 1 intervention (action) that you can do to avoid using a restraint.
Goal: Reduce agitation and aggression:
Distraction
Deep Breathing
Call Family
****Remember restraints are a last resort*****
The nurse on your unit asks for your help because their patient is showing signs of "phlebitis" around their IV site. What would you expect to see when you enter the room?
What is: Redness, warmth, swelling.
In contrast to that, infiltration would be coldness, pain, swelling, pale in color (pallor)
We know that the average intake and output over 24 hours is about 2,500 mL per day for an adult. What are 2 things that you could measure that would be considered "intake"
YES! IV fluids, water, apple juice, popsicles.
Exactly!
Output would be things like urine, blood, stomach contents etc.
How would you demonstrate respect and professionalism when you identify a patient?
Hint: How would you identify the patient (by disorder, room number, name, nickname)
Correct! By name.
Why?
It is not respectful or professional. You may also not call the patient "the accident victim" "the flu in 103" or any pet names like sweetie pie.
The physician has ordered 1000 mL of D5W to run at 75mL per hour. How many hours would this fluid take to infuse? Round to the nearest whole number
1000 divided by 75 = 13.333333
Rounded - 13 hours
What is the FIRST thing that you do if you need to put a patient in a restraint.
What is: You get an order :)
Great job!!!
How often do you need to have that order renewed?
You are giving report to the nurse taking your patient. You will need to tell them that the IV catheter dislodged and has gone through the vessel wall while normal saline was infusing causing their skin to become cool and pale. What is the term you will use to describe this IV complication?
What is: Infiltration
The escape of fluid into the subcutaneous tissue due to a dislodged catheter or needle puncture that is outside of the vein.
Normal saline should not cause extravasation because it is not a vesicant as seen in extravasation
Your patient ate sushi from their neighborhood gas station and has had diarrhea and vomiting for 3 days! What would this patient be at risk for?
(Hint)
Fluid volume ________
RIGHT!
Deficit (Hypovolemia)
Excess would be hypervolemia (too much fluid) as seen in kidney disease or heart failure
You have just educated your patient on how to check their blood pressure at home. What is the best question to ask to gage their understanding?
1) Do you feel like you can do this at home?
2) Explain to me how you would check your blood pressure at home?
It is #2 - Correct!
(1) Closed questions are usually yes or no and are focused on getting a specific answer. These are okay if you need answers right away but considered a barrier to effective communication.
(2) Open-ended questions allow you to hear detailed answers/thoughts from your patient. It allows for a range of possible responses so.
You have an order for 500mL of medication to run at 125mL/hour. What would you set the infusion rate on the IV pump to?
125mL/hour
Don't second guess yourself. You know this!
What is one measure that you can take to ensure that a patient is safely restrained?
(Hint) When you assess the patient being restrained, what are you looking for to make sure they are safe.
Two fingers can be inserted between the restraint and the extremity
They are in a normal anatomic position
The restraint is tied out of reach and to the bed frame, not the side rail or something movable
A quick-release knot is used
When you notice a patient's IV site becoming swollen, cool, and painful, this is the priority nursing intervention you should take before anything else.
What is: discontinue the IV!
You guys are amazing!
In Arterial Blood Gas studies, what is the normal parameter for the partial pressure of carbon dioxide (PaCO2)
What is: 35-45 mm Hg (PaCO2)
pH is 7.35-7.45 and
bicarb (HCO3) is 22-26
**You will need to know normal levels to answer 2 ABG questions on your exam.
In communication, this disruptive, intimidating behavior includes a failure to act when action is warranted.
An example would be you having a patient that is calling another team member inappropriate names, and you do not say anything.
(Page 200)
Incivility
Please also know the barriers to communication on 198-199.
The clinician ordered you to give 500mL of NS over 4 hours. What would the correct IV flow rate be in milliliters per hour?
What is 125mL per hour
Total Volume (500mL) divided by the number of hours (4 hours)
500 divided by 4 = 125mL per hour
Name two recommendations that you can give your patient about gun safety
Educate them on telling children not to play with them and to leave a friends house if they see one.
Keep guns and ammunition locked up in two seperate places - then place the key in an inaccessible location
Install a trigger lock
This complication is more likely when aseptic technique is not followed, allowing pathogens to enter the bloodstream through the IV site
What is: infection!! Great job
Other complications (Page 1705, box 41-9) include speed shock - body reaction to rapid administration, thrombus - blood clot that is stationary, air embolus - air in the circulatory system, and pulmonary embolus - clot that travels to the lungs
Interpret this arterial blood gas (ABG).
pH - 7.52
PaCO2 - 39
HCO3 - 31
PaO2 - 99
What is: Metabolic Alkalosis
1) pH will tell you if it is acidosis or alkalosis
2) Find the abnormal lab value and that is what tells you if it is metabolic or respiratory
On your exam, you will see the partial pressure of oxygen (PaO2) listed. The normal rates are 75-100.
SBAR: In the SBAR, which part is used to provide the clinician with the reason or purpose for your call?
What is the "recommendation" and you are letting them know what you are calling for.
"I am calling to request to have an order for additional pain medication". The S-B- and A includes my supporting information on why they should agree with me and give me what I need.
The clinician ordered 3/4 strength feeding formula with a total volume of 250mL. How many mL of water would you need to mix with the formula?
What is 62.5mL
Step One (Formula Amount)
Strength Desired (3/4 or 0.75) x mL (250) = 187.5
Step Two (Water Needed)
Total Desired (250mL) - Formula (187.5) = 62.5
Name 3 health hazards that a person may experience in the workplace.
What are: excessive noise, pollution, toxic chemicals, infectious agents, dangerous equipment, sleep deprivation, back injuries, needle sticks, radiation exposure, moral distress, workplace violence
(For more see page 852).
You have a chemotherapy drug running and know that this is known to cause extravasation. You hear your IV pump beeping and notice that there is fluid leaking into the patient's tissue. What is one complication with extravasation that different from infiltration?
What is: cause severe damage to tissues.
What do you do?
Stop the pump/Discontinue that IV!
Interpret this arterial blood gas (ABG).
pH - 7.31
PaCO2 - 49
HCO3 - 24
PaO2 - 95
What is: Respiratory Acidosis
pH is lower than 7.35 (acidosis)
PaCO2 normal is 35-45 (results are ABNORMAL)
HCO3 22-26 (Normal)
On your exam, you will see the partial pressure of oxygen (PaO2) listed. The normal rates are 75-100.
SBAR: Using the scenario below, what is the "S" (situation) piece of the SBAR.
"Hi, this is Adriane at Waterman in Observation. I have Ms. Nash in room 103, admitted after a motor vehicle accident. Vital signs are within normal limits. She is alert and oriented x 3. I have assessed her pain level which is at a 9/10. We currently have Tylenol 650mg ordered for pain, but it is only reducing it to 8/10. My assessment is that the pain medication is not sufficient for the level of pain she has. I am calling to request to have an order for additional pain medication.
"Hi, this is Adriane at Waterman in Observation. I have Ms. Nash in room 103, admitted after a motor vehicle accident. Vital signs are within normal limits"
Background - Mental Status (oriented x 3), Assessment - What we think the problem is (her pain medication is not helping her pain) Recommendation - What we want (pain meds)
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