Behind the glass
Your patient with a new diagnosis of B-ALL recently got chemo and had a big drop in ANC and has an ANC of 150 for the first time. What would you teach the family about this new finding?
This is called Neutropenia.
The immune system is essentially non-existent
Avoid having large groups of people and small kids around.
Wear a mask.
No flowers
No fresh fruit.
Wash hands before touching patient.
Watch for fever
No invasive procedures.
Your pt is in bilateral soft wrist restraints. How often do you chart on them?
Q 2
What is an NAT?
Non- accidental trauma it is a complete work up to be sure no child abuse is evident
Quick! Your patient is seizing and there's no suction at the bedside what do you do?
Turn on their side
Yell for help- get sz meds if available
start a mental timer or on watch
Get code cart suction
vitals
make sure they don't hit their head
get oxygen available
Your pt's port was accessed Sunday 11/10 when they came in when should it be due to be reaccessed? What's the rule? And what can I reinforce it with if I need to until then?
Every Sunday 11/17, every 5-7 days unless soiled, steri strips only!!
Your sickle cell patient is starting Hydroxyurea, what can you teach them about this medicine?
It can suppress your immune system.
It will make your RBCs bigger/rounder and less likely to sickle.
It is a chemotherapy drug.
You can feel tired, have loss of appetite, or be constipated
You're getting a 1013 pt. What do you need to do to prep?
Take out call light, IV pole if not needed, shower curtains, phone
Make sure pt has paper scrubs on
Make sure visitors do not bring anything in the room ESPCIALLY bags with stuff in them
Print some sitter forms
Assure 1013 and sitter is ordered
Your patient with a chest tube has to go to CT what do you do?
If to suction unplug it, if not just get them in chair or wheel chair to go. DO NOT CLAMP!!
You have an infant admitted for SVT their HR goes to 200, she is not symptomatic, what do you do? What if she becomes symptomatic?
Get a bag of ice and slam it on her face if that doesn't work, adenosine. (put on defib)
Cardioversion
Your patient's IV tubing was hung per the label 11/3 on night shift, they are saline locked during the day. When should it be replaced?
11/4 on night shift
Your patient's WBC is 1.2, Bands are 6, Segs are 2. What is their ANC?
What is 96?
What qualifies a pt to be a CAT pt?
Your pt that you admitted earlier in the shift from the ER for n/v/d and poor appetite has been NPO for surgery. You sent her CMP off and her glucose comes back as 45. What do you do?
See if she is responsive
Call Dr to get d5W IV ASAP
get fluids started on her
How long is a type and screen good for?
72 hrs if > 2months old
if >2 months old- the whole stay
You are about to hang etopiside. What are some nursing considerations for this drug and what do you need to chart for this?
High reaction rate
Pt must be on monitor
Have they reacted before, if so make drs aware to maybe add additional premeds
BP q 15 mins
Hang with NS or D51/2NS
Make parents aware of reaction risk
Your patient from STICU has a chest tube to water seal what does that mean?
No suction is hooked to the chamber
You have a femur fx and IV valium is ordered how will you administer this and what do you need to do?
pull a sterile water from the omnicell and use that to flush and dilute. DO NOT MIX WITH NS IT WILL CRYSTALZIE
TRUE OR FALSE
A year 2 resident can clear my patient's c-collar
FALSE
Only senior trauma/surgery or neurosurgery residents and trauma/surgery, neurosurgery attending can clear a c-collar
You admitted a 6 y/o sickle cell patient for crisis earlier in the night. The pt has been in severe pain despite getting several doses of morphine, ibuprofen, and tylenol. He is crying, HR is 135, the palms of his hands are pale, and he is grabbing at his abdomen saying it hurts really bad. What do you maybe suspect is wrong, what should we assess, and what can we ask the provider to order?
Splenic Sequestration, assess abdomen gently for spleen enlargement, ask for CBC, CT, US
You have a pt with a TBI s/p hemi craniotomy. She is on sz precautions. She is mostly unresponsive besides grinding her teeth and bending her arms and moving her head. What tasks can you expect for this patient and monitoring will you be doing?
Neuro checks
Turn q2
monitor for high HR, high BP (neurostorming)
Monitor for seizure like activity
try to cluster care
Monitor for signs of pain
Monitor BM make sure she doesn't get constipated
Make sure suction and ambu are at bedside
Make sure she has PRN sz meds and neurostorm meds
Assure there's clear parameters for scheduled neurostorm meds
You started PRBCs on a pt and the mom calls your name while you are standing at the door in the first 15 mins, the pt is having CP, HR is high, and having a hard time breathing. What do you do?
STOP THE INFUSION
Call dr
Get more benadryl
Monitor VS q15 x2 then q30 x4
Call blood bank
They may investigate and do a- urine, plain red top,
Return the whole transfusion set tubing, blood bag, everything
TRUE OR FALSE
Anyone can give PO chemo
TRUE
you just need a witness