NG tube
When inserting an NG tube, where do we want the tip on the XRAY?
In the stomach
Patient admitted for SOB and suspected pneumonia, on 2L nasal cannula, develops chest pain. What do you do?
Call a rapid
You obtain an EKG and there are suspicious changes in the T waves.
Patient now on 10L oxy mask with o2 sat 86%
Are you supposed to do bedside shift report? If so, why?
It is the standard of the hospital, and it includes the patient when applicable, we often catch mistakes and patient decompensations at shift change.
Name the rhythm if every QRS has a normal P wave beforehand and the rate is 70.
Normal sinus rhythm
If there is an unconditional DC home, can you proceed with the discharge?
YES!
What is the blue port on the side of the NG tube?
The oxy mask isn't helping. O2 say 82% on 10L. What is the next step for oxygen supplimentation?
ALWAYS _______ liters
After getting bedside shift report, what is next on your routine?
Look up the patient!
Today's labs, XRAY/CT, and at least ONE provider note to ensure you are following the plan of care.
Absent P waves before the QRS
Afib
If a patient is being discharged home with a foley, do you provide them with DC instructions for that? If so, HOW and WHERE do you do that?
Discharge instructions, education and it will print in the DC packet
Can we put medications through the BLUE PORT on the NG tube?
NO! This is a one-way valve for air to escape the stomach; we should never push medications through it!
The provider at the bedside calls the on-call STEMI MD and they rule out STEMI but can see that something is wrong. You have on IV (#20 left AC)
They order -CTA chest and Heparin drip with bolus along with transfer to ICU (there isn't an open bed)
What is your next move?
Start a secondary IV
Heparin drip with bolus
Next CTA chest
Finally transfer to ICU
If you have 1000 meds, what is the earliest and latest time you can administer them before they are considered late?
0900/1100
"Saw tooth pattern" for the P waves
A flutter
If a patient is being transferred to another hospital, do you call report?
Yes
How do you check residuals on an NG tube?
Stop the tube feed, attach the large syringe, and pull back on the syringe. When there is resistance, you have reached the end of the stomach contents and that is the residual volume in the stomach.
Bolus 7000 units Heparin drip at 18 units/kg/hr
IV drip titration
Prioritization:
*Unconditional DC home
*BP 182/90 P 140
*Drink of water
*Unhappy family member
BP 182/90 P 140
BP 170/73
P 59
Meds to give this morning: Metoprolol, Digoxin, Eliquis, Clonidine, Lasix, Cavedilol
Which meds would you consider holding?
Metoprolol
Carvedilol
Beta blockers affect HR (59)
Digoxin- a cardiac glycoside that decreases HR
If a patient wants to leave AMA, do you have to notify the MD?
Yes
Does the patient have to sign the paper? Ideally, yes, but there is a section where you can write that they refused to sign.
How often does the tubing need to be changed out for tube feedings?
Every 24 hours
CTA chest shows bilateral diffuse ALMOST completely occlusive PE's with right heart strain. The patient barely tolerated lying flat for the CT. Now you are on the way back to 4W from CT. What would be a proactive phone call to make before you go to 4W with this patient?
Call ICU and check on the status of the bed availability and notify RT.
Essentially attempt to move the patient straight to the ICU from CT due to instability.
Patient went to ICU then to IR for a mechanical thrombectomy.
Delegation to PCT:
*Administer medications
*Apply purewick and suction canister
*Speak to unhappy family member
*Turn off beeping IV pump
PCT's can apply Purewick and suction canister for patients.
PCT should NOT be touching IV pumps! One PCT this week turned off an Amiodarone drip!
If a patient is noted to be in VFIB/VTACH and unresponsive, what do we do?
Start CPR
Shock ASAP
What is the form needed to DC a patient to a facility?
3008 and it needs to be complete and accurate