Mark K Nursing Lecture #12 Flashcards

do we prioritize chronically or acutely pts more?

acutely ill patients!

among the following pts: a pt with COPD, CHF, or appendicitis, which one has the highest priority?

appendicitis

do we prioritize fresh post-op patients or medical/surgical patients?

fresh post op (less than 12 hours)

among the following pts: a pt with COPD, a pt 2-hours post cholecystectomy, or a pt with acute appendicitis, which pt has highest priority?

pt 2 hours post cholecystectomy

which of the following pts is highest priority?

a. a 16 y.o. female with meningococcal meningitis who has had a temp of 103.8 degrees F since she was admitted 3 days ago

b. 67 y.o. male with IBS who spiked a temp of 103.4 this afternoon

B

what are four things that make a pt unstable (high priority)?

1. hemorrhage

2. high fever over 105

3. hypoglycemia

4. pulseless or breathless

in a mess casualty incident, what 3 things result in a black tag?

1. pulseless

2. breathless

3. fixed and dilated pupils

what are the most prioritized organs in order (1-6)?

1. brain

2. lung

3. heart

4. liver

5. kidney

6. pancreas

which pt is the highest priority?

a. 23 y.o. male with CHF with K+ of 6.6 and no EKG changes

b. chronic renal failure with a creatinine of 24.7 (low) and pink, frothy sputum

c. acute hepatitis with jaundice, increased ammonia levels, who you cannot arouse

C

is angina pectoris stable or unstable?

stable

is angina pectoris with crushing sternal pain stable or unstable?

stable - expected

is angina pectoris not relieved by rest stable or unstable?

unstable

what can a LPN not do?

-cannot start a IV

-cannot hang or mix IV meds

-cannot push IV push meds

(they can only maintain an IV and document flow)

-cannot admin blood or deal with central lines (no flushing or changing dressings)

-cannot make care plan

-cannot perform or develop teaching

-cannot take care of unstable pts

-cannot perform the first of anything

-cannot assess: admission, d/c, transfer, or first assessment after a change

i think i heard new crackles on that guy in room 52. who should go assess this pt? RN or LPN?

RN

who should the RN check and who should the LPN check?

1. angina with crushing substernal chest pain, 3 days ago, on nitro

2. subtotal thyroidectomy done 2 days ago and now states "why are they watching elephants"

1 - LPN

2 - RN

what should we not delegate to the UAP?

1. charting

2. medication admin (unless they are topical, OTC, or barrier creams)

3. assessments (except vitals or accu-check)

4. treatments (except for enemas)

do we ever delegate safety responsibilities to the patients friends and family?

no

if staff is doing something illegal, what do we do?

tell supervisor

if it is harmful to anyone, confront and take over first

if staff is doing something inappropriate, but not illegal, what do we do?

first, ask ourself if anyone is in risk of physical or psychological harm

if yes, confront immediately and take over

if no one is in harms way, talk to that staff member at a later time about the incident

example: you suspect the RN is diverting narcotics

tell supervisor

example: the aide is giving perineal care to a patient, but is not wearing gloves?

confront and take over the task

example: the RN is going home with bulging pockets?

tell supervisor

example: you notice surgeon contaminates her gloves

confront

example: the RN always gives report and says exasperation instead of exacerbation

talk to them later

locations of heart valves

A P

T

M (apical pulse is here)

where is erb point?

3rd ICS left sternal border

posterior tibial pulse

Pulse felt on inside of either ankle

dorsalis pedis pulse

pulse located on top of the foot

brachial pulse

the pulse felt in the upper arm

radial pulse

the pulse felt at the wrist

ulnar pulse

pinky side of wrist

femoral pulse

pulse of the femoral artery felt in the groin

popliteal pulse

behind the knee

for nutrition questions, if we have to guess, what do we choose for adult foods?

baked options (not fried)

if no chicken, pick fish

do kids like casseroles?

no

do we mix meds in kids food?

no not without permission

what type of food do we pick for toddlers if we have to guess?

finger foods

is one meal a day okay for preschoolers?

yes

if the drug is PO, what type of side effect do you pick?

GI side effect

what is the first thing to assess for a pt?

check for LOC

what is the first thing to do for a pt?

establish an airway