Environment of
Care
Care
Where can you find Safety Data Sheets (SDS)?
On https://diablo.ca.kp.org under workplace resources
Safety ->SDS –> Safety
What does BEFAST stand for?
What is the door to EKG time for chest pain?
10 minutes
What is pre-eclampsia?
Preeclampsia is a serious blood pressure condition that develops during pregnancy. People with preeclampsia often have high blood pressure (hypertension) and high levels of protein in their urine (proteinuria).
What is SIRS criteria? How many do you need to meet SIRS?
When is it considered Sepsis?
Fever
Elevated Heart rate
Elevated respirations
Low BP
Elevated WBC > 12000 Low WBC <4000
Bands 10% on WBC w/ diff
All of the above + source of infection
Where is the Decon shower located? What is the process post decontamination?
Located outside at the ambulance bay.
What is the timeframe for thrombolytics?
What is the dose of Tenectaplase?
What is the max dose?
What are shockable rhythms?
V.Fib and pulseless V.Tach
What does HELLP syndrome stand for?
Hemolysis
Elevated liver enzymes
Low platelets
Protein in urine
If suspected sepsis, what do you anticipate will be ordered?
Obtain weight
Labs – CBC, WBC w/ diff, Blood cultures, Lactic acid, VBG, Chem 7, UA, coagulation studies, wound cultures if present
Imaging (order dependent on c/c)
IVF
Antibiotics
Where are the emergency shut off valves located and who is responsible to shut off?
A – POD: hallway outside of cast room
B – POD: hallway outside of B1/B2
Designated RN or engineering
What are the two types of adverse reactions to thrombolytics?
What are signs and symptoms of each and of neurologic deterioriation post thrombolytic therapy?
Angioedema: rapid swelling of dermis, subcutaneous tissue, mucosa, and submucosal tissues.
ICH: hemorrhage or bleeding w/in skull.
Sudden HA, N/V, decreased LOC or worsening neurological deficits.
For Kaiser Antioch, where do STEMI patients go and within what timeframe? What type of transport?
Transfer to Sutter Delta within 30 minutes
911 transport
What are signs and symptoms of Pre-Eclampsia?
How many weeks PP can it present?
Dizziness, HA, RUQ pain, generalized edema, elevated BP.
Symptoms can persist up to 12 weeks PP.
What is normal lactic acid level?
After draw, how should it be stored?
How often?
Normal level : < 2
Draw and place immediately on ice
0 hour and repeat at 3-hour mark
Where are your eye wash station and how long should you rinse for?
Eye wash station in soiled utility room and rinse for 15 minutes.
What are the blood pressure parameters for a thrombolytic candidate?
<185/110
What nursing interventions for suspected STEMI patient?
What timeframes for troponin lab draw?
EKG, VS monitor, weight, oxygen, place 2 large bore PIVs, lab collection, confirm allergies, last dose of ASA, Nitro and ED medication.
0hr-2hr
When should Magnesium be considered for treatment?
What is the initial dose? Continuous dose? Antidote? What should be monitored and how often should nursing documentation be documented?
What tubing is preferred to be used?
Considered after OB consult and when symptomatic: neurologic signs and symptoms: refractory HA, visual changes, or hyperreflexia
Initial dose: 4-6 G
Continuous: 1-2g/hr
Antidote: 1g Calcium Gluconate
Document every 15 minutes: VS, LOC, DTR. Ice packs/adjust temp in room.
Portless tubing or red caps placed on port sites
Patient suspected of sepsis, weight 230lbs.
Per sepsis protocol you are to give 30ml/kg or ideal body weight, rounding to the nearest 250 increment.
What is the exact total fluid amount? What is the rounded amount?
Kg: 104.54
3136.36 ml exact total fluid volume
3250 ml rounded total volume
You come on shift and find your rooms are
T-T-T-T-TRASHED. What can you do to ensure room readiness to receive a patient?
Floor is clutter free, Bed is made in locked/low position, suction in place, oxygen/air connecters on wall and delivery device, BVM (adult/pedi), IV pumps with charger, WOW with functioning barcode scanner, zero out bed scale, monitor with cords,
A 58-year-old female brought by family at 1500, presents with jumbled speech and new onset left arm weakness. Family reports noticing she has had trouble with speech since 1000 at brunch, and recently started Coumadin for new onset A.Fib. The physician activates stroke alert, what are your initial nursing interventions?
Is she within thrombolytic window?
Place patient on VS monitor
Obtain POCT glucose to r/o hypoglycemia
Place 2 PIVs and obtain blood work
Prepare for transport to CT
Document all interventions
Yes within window, but contraindicated
Male patient, age unknown, walks into ED grasping chest, diaphoretic, and complaining of severe chest pain, states “it feels like its tearing”. EKG completed and showed ST elevation in leads I and II. Heart alert is activated and the physician orders MONA.
What does MONA stand for? And what must be ruled out prior to administering Nitro?
M – Morphine
O – Oxygen
N – Nitroglycerin
A – Aspirin
Rule out Right Inferior Infarct – preload sensitive!
33 year old female, 32 weeks gestation presents in ED with 7/10 headache and photosensitivity. Has PMHx of hypertension, migraines, and anxiety. Initial BP 202/108, HR 100. At 15 minute recheck BP 190/116 HR 103. What is her ESI level, what medications do we anticipate will be ordered or and what immediate actions should take place?
ESI level 1
Direct room and overhead page
“Perinatal Alert” MD ____ to room ___”
Notify ED MD, ANM, and primary/Float RN
Meds orders
Nifedipine PO 1st 10 mg, 2nd 20 mg, 3rd 20 mg
Every 20 minutes at max dose 50mg
Labetalol IVP 1st 20 mg, 2nd 40 mg, 3rd 80 mg slow IVP every 10 minutes max dose 300mg/24hrs
Hydralazine IVP 1st 5 mg, 2nd 10 mg every 20 minutes
Magnesium if indicated post OB consult
A 6-year-old presents with fever. Mom reports he is normally active, but for the last 2 days has been very lethargic and “cuddly”. Weight obtained – 50 lb.
Physician suspects sepsis and orders fluid replacement.
Per protocol how many ml/kg should be given and what is the total fluid volume to be administered?
Kg: 22.72
20ml/kg
454.54 ml total fluid volume