Electrolyte Protocol
Patient, Penny, came in dehydrated and nurse started IV fluids per order. Labs ordered and her results read: Potassium 3.0, Phosphorus 2.2. Dr. Smith orders "Initiate Electrolyte Protocol: Potassium, Phosphorus". What will you correct?
Replace 40mEq KCl PO or IV
What is the only fluid that can be run with blood?
Normal Saline
How does Bryan Health ask patient's pain score?
Mild, moderate, or severe
Where is your Black RCRA bin located?
Soiled Utility Room
Patient refuses Flagyl PO dose this morning at 0900. What do you do?
Educate patient and notify provider of refusal.
1 hour after replacement
Why does blood have special filter tubing?
Remove clots, small clumps of platelets and WBC that form during collection and storage.
You administered 500mg Tylenol and 800mg Ibuprofen to your patient who had shoulder surgery 2 days ago. He is complaining of his pain mild and would like something stronger. What is your next intervention?
Offer ice, heat, distraction, position change. Call PT/OT for therapy. Call Provider.
Where do you dispose hazardous drugs?
Yellow Plastic Bags in patient room
Red bin with YELLOW plastic bag in soiled utility
Patient's armband is taped to the bedrail. Is it okay to scan?
No. Reprint and replace on arm or leg of patient.
Dr. Smith orders additional labs today due to Penny's low urine output after 2 fluid boluses. Her creatinine is 2.1 mg/dL. Her current fluids running are: NS @ 150ml/hr and Potassium IV. What is your intervention?
Pause Potassium and Notify Provider
240 ml/hr
Patient, Ruth, admitted for pancreatitis, Provider ordered Morphine PCA. Patient is complaining of moderate discomfort and requesting more pain medications. When looking at MAR, patient has Morphine 2-4mg IV ordered. What is your next step?
Question the Morphine IV and consult with care partner.
Where do you dispose of Blood products?
Red lined red bin in soiled utility
You administer Zofran ODT. What questions do you ask the patient to prior to scanning?
Name and DOB, always good to clarify allergies!
Provider modifies and re-enters the protocol: "Initiate Electrolyte Protocol: Potassium, Magnesium, and Calcium". Your lab results show Potassium 4.0 mEq/L, Magnesium 1.9, and last Calcium result was > 24 hours ago. What is your intervention to correct the electrolytes?
1) Magnesium Oxide 400mg PO BID x2 doses
2) Order Calcium from Protocol to get baseline
Patient, Sally, reports lower back discomfort and warm. What is your intervention?
1) Stop the blood! Keep IV line open with NS
2) Release the standing order "Transfusion Reaction Eval"
Patient's RR decreases to 8-9 per minute and patient is drowsy. What is your next step?
Call BRRT
Give Narcan over 15 seconds per order set
Where do you dispose of OPENED narcotic pills?
Flush down toilet with SECOND nurse present
When administering a medication to a patient, what are the 5 rights you verify?
RIGHT:
Medication, Patient, Dose, Route, Time
When can you discontinue the Electrolyte Protocol?
After TWO normal values
Reminder: IF only discontinuing ONE electrolyte, modify order to keep other electrolyte orders in place.
What is your first step in transfusing PRBC?
CONSENT by patient!
You pull (2) 5mg Percocet from Pyxis. You get to the room and your patient only wants (1) tab for now. What do you do with the second tab?
Return (1) unopened tab ASAP into pyxis narcotic roll draw with second nurse witness present
Patient brings in home medications that are controlled substances. What do you do with them?
Take them to pharmacy to be verified.
If provider wants to continue during hospital stay, will need double locked with green sheet. *Counted q 12 hours.
On average, Nurses walk how many miles on a 12-hour shift?
4.5 miles