Titrations
True or False: Titration orders should provide directions for increasing or decreasing the dose, either in response to a patient's condition or according to a planned schedule and are detailed in the administration instructions.
TRUE (HW 830)
True or False: when titrating a sedative medication with a RASS goal, a RASS needs to be documented with each titration.
TRUE
True or False: A Patient may not request to take a different (lesser) potent medication or a lower dose of the same medication than that which is ordered per their pain score, as long as the medication has been ordered as part of the prn orders
FALSE (HW 603.4)
What concentration of Norepinephrine must be infused via a central line?
16mg/250mL
True or False: Specimen collection details for patients on a Heparin drip- for a Venous draw: the preferred method is to draw from the opposite arm, if drawing from the opposite arm you do not pause the heparin infusion. If drawing from the same arm, pause the drip for 10 minutes and attempt to draw below the infusion site.
TRUE (Heparin Standard Work Sheet)
If the patient requires frequent or emergent dose titration, the patient will have continuous or cycled monitoring of vital signs. Vital signs will then be documented at least every 15 minutes until stable. A single note reflecting multiple titrated doses over no more than 4 hours may be entered in the medical record. This is defined as:
Block Charting (HW 830)
Patient has Precedex ordered with a RASS goal of 0, and Propofol ordered with a RASS goal of -1. What is the most appropriate step the nurse should take.
Contact the provider to update the ordered RASS to reflect the same goal (both -1 or both 0)
TRUE or FALSE: Anticipatory Pain Management: involves anticipating and addressing potential sources of pain before they occur. Pre-procedure medication: For Procedures that are known to be painful (i.e., wound dressing changes, chest tube removal, venipunctures, endotracheal suctioning, etc.), assess the patient's pain level and administer appropriate analgesia prior to the anticipated painful procedure. Document the reason for giving preemptive analgesia
TRUE (HW 603.4)
This type of medication can cause blistering and tissue necrosis if it leaks into the tissue __________
vesicant
When collecting a PTT/AntiXa from a patient with an arterial line you DO or DO NOT pause the heparin drip prior to obtaining your specimen from the arterial line?
DO NOT (Heparin Standard Work Sheet)
Infusions at a rate of zero for more than ______ shall only be reinitiated with a newly signed order by the prescriber
24 hours (HW 830)
True or False: ALL sedation drips must be discontinued prior to extubation?
False: Precedex (dexmedetomidine) is an exception and may be continued post extubation (ACCU 205)
If Fentanyl (ordered for a CPOT less than 2) was titrated at 0805, 0815 and 0830. What times would you document your CPOT in EPIC?
0805, 0815, 0830 AND within 15 minutes of 0830 as a reassessment.
You are suspecting extravasation with Norepinephrine. List at least 4 actions that you MUST take.
Stop the infusion
Notify the provider
Notify the pharmacist for an antidote
DO NOT flush the line
Aspirate the line if possible
Assess the extremity distal to the insertion site
Remove the catheter after the antidote is given
Mark and photograph the site
create a wound LDA in EPIC to ensure assessment
You are managing a patient on a heparin drip. You drew your PTT at 1400. At 1437 the PTT resulted and a dose increase is required for your heparin drip. You make the change and document it in the MAR at 1444. When is your next PTT due?
2044 (6 hours after the rate change)
Pausing Titrated Medications: If the medication needs to be restarted based on assessment of the patient and physiological parameter the medication shall be restarted at what rate? the rate required immediately before pausing the infusion.
The rate required immediately before pausing the infusion (HW 830)
Describe the difference between a RASS of -1 and a RASS of -2
RASS -1:Drowsy= not fully alert, but has sustained awakening to voice (eye opening and contact for greater than 10 seconds)
RASS -2: Light Sedation= briefly awakens to voice (eye opening and contact for less than 10 seconds)
Symptoms of toxicity from overdose of local anesthetics that affect the cardiovascular system, central nervous system, or both. This occurs due to excessive vascular uptake of local anesthetic. Onset of symptoms typically occurs between 1 and 5 minutes after local anesthetic injection but may be delayed more than 15 minutes. Symptoms include: hemodynamic instability, cardiovascular collapse, seizures, and cardiac arrest. This is rare but is life-threatening without the use of specific, rapidly administered treatment and requires alterations from standard advanced cardiovascular life support.
This is defined as:
Local Anesthetic Systemic Toxicity (LAST) (HW 603.6)
The antidote used for extravasation of Norepinephrine is:
Phentolamine (HW 870)
The max dose for a patient received low dose fix rate Heparin infusion is:
500 units/hr.
Required Elements for Medication Titration Orders must include which 6 items?
1. Medication Name
2. Medication Route
3. Initial or Starting rate of infusion
4. Incremental units the rate can be increased or decreased and frequency for incremental doses.
5. Maximum Rate of infusion
6. Objective clinical end point (RASS, CPOT, BP/MAP, RDOS, ect.)HW 830
Sedation optimization: The goal RASS for all intubated patients is _____ to ______.
-1 to +1 (ACCU 205)
Minimum frequency to administer oral or IV medication: Oral pain medication shall not be given sooner than every __ hours, unless otherwise ordered by the LP. Injectable pain medications shall not be given sooner than every __ hours, unless otherwise ordered by the LP.
4, 2 (HW 603.4)
The patient is on Norepinephrine as 1st line and Epinephrine as second line. Which medication would you max out first? Which medication would you titrate down first?
First to reach max dose should be Norepinephrine (1st line)
First to titrate down should be Epinephrine (2nd line)
A heparin drip was ordered for your patient. The patient does not have a baseline PTT, what is your next step?
Draw a baseline PTT prior to starting the Heparin drip. You can start the heparin drip while the results are pending.