Lab Values & Medication Calculations
What is the primary lab value used to indicate renal insufficiency?
creatinine
How long can primary IV tubing be hung for?
96 hours
According to AHS policy
What are the 3 common types of surgery?
Elective
Urgent
Emergent
What do you do if TPN must be discontinued abruptly?
Infuse D5W - D10W to prevent hypoglycemia
What blood type is the universal receiver?
AB+
What lab value is used to adjust a heparin infusion?
PTT
Give 2 examples of Isotonic Solutions
1. Normal Saline
2. Lactated Ringers
3. Dextrose 5% in Water
What are 3 common post op complications?
1. Hemmorrhage
2. Hypotension
3. Infection
4. DVT
5. Atelectasis
6. Pneumonia
What 4 components are included in TPN formulations?
Amino acids
Carbohydrates
Lipids
Trace elements
Name 3 nursing considerations before administering blood.
1. type and screen is completed
2. blood work is completed
3. consent is signed
4. minimum 20g IV is placed and patent
It is 0800 and your patient's CBG is 8.1. Why type(s) of insulin and how many units will you administer?
Sliding scale:
CBG Regular Insulin
<4 0 units
4.1-6 4 units
6.1-8 6 units
8.1-12 8 units
12.1-14 10 units
14.1-16 12 units
16.1-18 14 units
>18 Call physician
Insulin NPH 14 units in am and 16 units at hs
Name all types of Central Venous Catheters.
1. peripherally inserted central catheter (PICC)
2. tunneled - long term
3. implanted (port-a-cath) - long term
4. percutaneous - short term
What are 3 important things to document when describing a wound?
1. Color
2. Temperature
3. Wound bed
4. Edges
5. Peri Wound
6. Drainage
What is an important consideration/intervention prior to, during, and following tracheostomy suctioning?
Hyperoxygenation of the patient before & after suctioning. Monitoring SpO2 throughout whole procedure (before, during and after).
Name 5 priorities in order when you find a client pulseless.
1. call for help
2. What is the Goal of Care?
3. start compressions
4. place the backboard
5. assist with airway as needed and bag the patient with 100%/Max O2
What is the formula for gtt/min?
ml x gtt/ml
________
minutes
1. ensure the CVC is secured (sutured if applicable)
2. ensure post-insertion x-ray was completed to confirm placement
3. initial dressing placed
Name one factor you must assess on an incision before removing staples?
What are the 3 indications for chest tube placement?
Pneumothorax, pleural effusion, hemothorax
100-120/min
5 cycles of 30
What is the maximum total dose of PCA hydromorphone that the patient can receive in 4 hours?
Hydromorphone 2 mg/hour continuous infusion
Hydromorphone 1 mg bolus, lockout time 15 minutes.
A: 24 mg/4 hr
2mg/hr continuous x 4 = 8mg/4 hr
4mg/hr bolus x 4 = 16 mg/4 hr
8 mg + 16 mg = 24 mg/ 4 hours
Name 4 potential complications during CVC insertion.
(bleeding is assumed)
1. dysrhythmias
2. arterial puncture
3. pneumothorax
4. air embolism
What are the clinical outcomes related to wound irrigation?
1. loosen, soften, and remove devitalized tissue
2. Separate eschar from granulating/fibrotic tissue
What do you do in an emergency situation for
a. chest tube displacement
b. tracheostomy displacement
a. cover with an occlusive dressing (hemothorax or pleural effusion) or a dressing taped on 3 sides (pneumothorax)
b. bag ventilation, prepare for intubation or tracheotomy
Name 5 signs of a blood transfusion reaction.
1. Chills
2. fever
3. headache
4. flushing
5. tachycardia
6. anxiety
7. hives
8. severe SOB
9. bronchospasm
10. flank pain
11. Hypotension