Ethics
You think one of your nurse friends is diverting narcotics.- What next
Ask to speak privately with manager. Report facts
Upon assessment your patient is lethargic,
Saturations are 85% on RA
Pt has hx of COPD and Sleep Apnea, what is wrong with your patient?
Retaining CO2
Not breathing adequately to exchange O2 and CO2.
What order should you give these meds to your septic patient?
Morphine 2mg IVP Q4hr prn mod pain (pain 8/10)
Zosyn 3.375 IVPB Q8hr 1st dose now
Protonix 40 mg IVP daily
zosyn
morphone
protonix
Need x-ray confirmation
HOB >30 degrees
check residual and patency
Actions before giving NG/OG meds
What kind PMH would you expect for a patient with a Creatinine of 7.2?
ESRD on dialysis
You find an antibiotic hanging with a full bag that was supposed to be given at 0600 - What next?
tell nurse, call pharmacy to retime, med error report
Upon assessment your patient has new onset garbled speech and right sided weakness. What are your next 3 actions
Vitals signs
Call RRT
Check a blood sugar
Keep pt NPO
Note time of onset of symptoms
Prioritize nursing diagnosis:
1.Impaired Electrolyte Imbalance AEB diarrhea and low K+
2.Decreased Cardiac output AEB low blood pressure
3. Ineffective Health Management AEB pt not check blood sugars
2
1
3
3 Activities to do before administering Furosemide IVP
Check labs, electrolytes and renal status
Check blood pressure
Check IVP rate
Check compatibility
I and O
What medication might my patient be on if their INR is 3.2?
Warfarin/Coumadin
Your Doctor comes into your room and begins a procedure on your patient without you. What do you do.
online report, tell charge nurse, send email to manager of incident.
Upon assessment your patient complain of 10/10 chest pain. What are you next 3 actions
Oxygen
Vitals
EKG
Call MD
Prioritize tasks upon receiving this new patient.
stat labs
head to toe assessment
check vital signs
vitals
stat labs
head to toe
Name 3 medications that use an inline filter
TPN
Amiodarone
Mannitol
What labs are ordered if a MD wants a Pan culture of a paitent?
UA with culture
Blood culture x2 15 min apart (peripheral)
Sputum culture
Your patient confides in you that they want to hurt themselves. Who do you contact?
Charge nurse, MD, place on suicide watch 24/hr sitter, chaplain, social work. Stay in room with patient.
Your patient has distended abdomen, Shortness of breath and fluid overload. What test will the Provider likely order?
Paracentesis
Assess the scene safety
shake and shout
begin CPR
Apply defibrillator
What is BLS
This antibiotic is used for Methicillan Resistant Staphylococcus Aureus
Vancomycin
What does an increased procalcitonin level indicate?
Bacterial infection, bacterial source of sepsis
policy and procedures
Your patient's ABG is
pH 7.28, CO2 60, P02- 60%, HCO3- 24.
What two ways can you reduce the CO2 to balance the pH
Increase RR
Increase volume of breaths
Prioritize:
1. vented patient 100% fi02/prone/ periodically desats to 83%
2. B/P is 75/42 pt awake and alert but dizzy HR is SVT 175.
3. Confused pt with left sided weakness is trying to get OOB
See pt 2 first, needs nursing intervention
delegate 1 to respiratory
delegate 2 to patient care tech or fellow RN
Epinephrine
Norepinephrine
Vasopressin
Neosynephrine
How many points do you typically see hemoglobin rise with each pint of blood transfused?
1