Medication Orders
"Dilaudid IR 1-2mg PO PRN". What are the 3 errors?
it's a naked PRN with no indication when the medication can be given
brand name vs generic hydromorphone
no frequency specified
How many units should the insulin pen be primed with and when?
2 units after application of new needle and prior to the second nurse check
how do we determine that a patient is at risk for skin breakdown + give 3 examples of prevention strategies
Braden scale on admission and every Wednesday (wound Wednesday!)
turning routing, offload heels, good incontinence care, encourage mobility, ensure adequate nutrition, heel boots
What is the starting rate for a transfusion of PRBC for the first 15 minutes and why?
50ml/hr
give two examples of medications that require a two nurse check and how would you document for high risk medications?
two initials on the record (MAR, Blood Glucose sheet for insulin)
remember that students do not count towards a two nurse check
"d/c lasix 20mg IV OD". What are the 3errors?
banned abbreviation d/c - discontinue, OD - daily, lasix - generic name furosemide;
On which part of the insulin pen should the label with patient's information be applied ?
the body of the pen, not the lid, because once the lid is removed, the pen becomes unlabeled
what do we do for VTE prophylaxis?
considered for every admission (FM first orders): Physician decides to continue treatment, change or do not initiate (must give reason why not).
prophylactic doses of dalteparin or heparin for those who are not already on blood thinners, SCDs if pharmacological anticoagulation is not appropriate
What is the maximum time that can elapse between picking up blood and starting the transfusion? what should you do if you cannot start the transfusion within allotted time?
1hr
How do you know that a MAR has been reconciled and can be used?
it is signed and dated at the bottom
all MARs must be reconciled (verified) prior to use
"hold atenolol". What is the error?
no parameters, timeframe or reason. Could read: hold atenolol if systolic BP less than 100; or hold today, reassess tomorrow
Do you need to prime the semaglutide (Ozempic) pen with every use?
no, only prime with the very first use of a brand new pen
how do we determine if patient is at risk for falls? give 3 preventative interventions
falls assessment on admission , score recalculated if patient falls in hospital
bed at lowest position, bed/chair check, move patient closer to nursing station, ask the ABCDE questions (analgesic, bathroom, call bel, drink of water, equipment)
who can obtain consent?
only a Physician or their designate (resident, PA), NP or RN with an extended license can obtain consent
where would you document a continuous heparin infusion?
anticoagulation record
"insulin glargine 7u sc in AM". What are the 2 errors?
banned abbreviations u-units, sc-subcutaneously
You treated blood glucose of 3.5 with dextrose tablets as per Hypoglycemia policy. When do you check the blood glucose next?
in 15 minutes, and treat again as indicated
what are the 4 safety rights of a worker?
1. right to know
2. right to participate
3. right to refuse
4. right to protection from reprisal
What is the absolute maximum duration of a blood transfusion? and what do you do if that amount of time has elapsed but there is blood left over?
4hrs
discard remaining blood and notify physician
What 4 things get documented on the diabetic blood glucose record? why?
all oral diabetic medication, insulin administration, blood glucose, hypoglycemia treatment
patient's blood glucose is 3.3 and they have insulin due. What do you do?
speak to Physician to obtain a hold order or make a clinical judgment decision to hold medication remembering that a physician must be notified asap and proper documentation completed
when administering insulin, you inject subcutaneous tissue at how many degrees (what angle) and hold the pen pressed to the patient's skin for how many seconds?
90 degrees, and hold for 10 seconds
how do you respond to code red on your unit? list 4 things
Race (rescue, activate alarm, confine, evacuate)
return to your unit, get fire extinguisher, rescue people from immediate danger, patients in rooms, close doors, clear corridors
Give at least 4 properties of a proper transfusion consent
informed, voluntary, witnessed, dated, specific blood product and specific physician
there are a total of 3 continuous medication infusions we can carry out on FM (one of them is heparin). What are the other two and where do you document them?
pantoprazole, potassium in IV (e.g. NS with 40KCL). continuous infusion medication flow sheet