Med Surg medications

CIWA Precautions

Alcohol Withdrawal Scale

The higher the score, the more severe the withdrawal and the more likely the patient needs medication (if ordered by protocol).

Med room #

53923

What time is 1800?

6;00 pm

What time is 1730?

5:30

Blue tube top

PTT

Pink tube top

Type and screen

Braden Scale

Lower score = Higher risk for pressure injuries.

Large bruising or bleeding under the skin is called?

ecchymosis

Patients may require blood transfusions for hemoglobin of?

7.0

Explain Type and Screen

• Done before a blood transfusion.

• Type = Finds the patient's blood type (A, B, AB, O and Rh +/-).

• Screen = Checks for antibodies that could react with donor blood.

Supplies needed for blood draw

• Gloves

• Tourniquet

• Alcohol pad

• Butterfly needle

• Vacutainer holder

• Blood tubes

• Gauze

• Biohazard Bag

• Bandage

• Printed labels

Medication room #

53923

Lock blue medication bin

0400

Supply and Staff room #

3923

Latanoprost (Xalatan)

• Used for: Glaucoma (lowers eye pressure).

• Route: Eye drops.

• Remember: Give 1 drop as ordered. Do not touch the tip of the bottle to the eye

Magnesium Sulfate 2g IV

• Used for: Low magnesium (hypomagnesemia).

• Route: IV.

• Remember: Watch OUT FOR: Slow breathing, low blood pressure, and flushing (feeling warm).

Sucralfate (Carafate)

Back:

• Used for: Treats stomach ulcers and protects the stomach lining.

• Route: PO.

• Remember: Give on an empty stomach (before meals to COAT the ulcer)

Carboxymethylcellulose (Artificial Tears

• Used for: Dry eyes.

• Route: Eye drops.

• Remember: Lubricates and moisturizes the eyes.

Piperacillin/Tazobactam (Zosyn) PIE – per – uh – SILL – in

• Used for: Treats bacterial infections.

• Route: IV.

• Remember: Check for penicillin allergy before giving.

Quetiapine (Seroquel) Kwe-TYE-uh-peen

• Schizophrenia, bipolar disorder, and agitation.

• Route: PO.

• Remember: Can cause drowsiness → use fall precautions.

Enoxaparin (Lovenox)

• Type: Low molecular weight heparin

• Used for: Prevents/treats blood clots.

• Route: Subcutaneous injection.

• Watch for: Bleeding.

Type and Screen tube color top?

Pink top (anticoagulant on bottom to prevent blood clotting)

Iohexol (Omnipaque)

• Used for: Contrast dye for CT scans and imaging.

• Route: IV (commonly).

• Remember: Check for contrast/iodine allergy and monitor for reaction.

UGIB

upper gi bleed

AMS

altered mental status

Helps make red blood cells;

folic acid

What labs to check for a patient with red blood cell deficiency

cbc (hgb, hct)

high MCV lab meaning

red blood cells are larger than normal, needs folic acid

Hematocrit

Male: ~41–50%

Female: ~36–44%

• What it tells you: The percentage of blood made up of red blood cells (RBCs).

• Low Hct: Can mean anemia or blood loss.

• High Hct: Can mean too many RBCs or dehydration

High Hct

too many RBCs or dehydration

Reasons for High hematocrit

Low oxygen = body says "make more RBCs( smoking, high altitudes

Cauda Equina Syndrome

Back:

• What it is: Compression of the nerves at the bottom of the spinal cord

• Watch for:

  • Loss of bowel or bladder control

  • Numbness in the saddle area (inner thighs/groin)

  • Leg weakness or numbness

Pain medications → for severe back/leg pain.

Alprazolam (Xanax) Al-PRAY-zoh-lam

• Used for: Anxiety and panic disorders.

• Class: Benzodiazepine.

• Remember: Can cause drowsiness/sedation → fall risk.

Duloxetine (Cymbalta)

• Used for: Depression, anxiety, and nerve pain.

• Class: SNRI antidepressant.

• Remember: Monitor for mood changes and possible dizziness.

Pantoprazole (Protonix)

Back:

• Used for: Reduces stomach acid (GERD, ulcers, GI protection).

• Class: Proton pump inhibitor (PPI).

• Remember: Usually given before meals.

What time is 1500?

3:00 pm

What time is 1300

1:00 pm

What time 1600?

4:00 pm

What time is 1400?

2:00 pm

What time is 1900

7:00 pm

What is Tamsulosin (Flomax)

Used for patients with enlarged prostate to relax the prostate

An enlarged prostate squeezes the urethra, making it hard for urine to get out.

Diazapam (Valium)

• Used for: Anxiety, alcohol withdrawal, muscle spasms, and seizures.

• Class: Benzodiazepine.

• Remember: Can cause drowsiness and respiratory depression → monitor breathing and use fall precautions.

Vancomycin

• Used for: Serious bacterial infections (especially MRSA).

• Route: Usually IV.

• Remember: Monitor vancomycin levels and kidney function. Infuse slowly to help prevent Red Man Syndrome (flushing/redness).

• Used for: C. difficile (C. diff) infection in the intestines.

• Route: PO.

• Remember: It stays in the gut to kill the bacteria there. It is not absorbed well into the bloodstream, so it's not used by mouth to treat infections elsewhere in the body.

Oral Vancomycin

Ceftriaxone (Rocephin) sef-try-AK-sone

• Used for: Treats bacterial infections.

• Route: IV or IM.

• Remember: Check for cephalosporin/penicillin allergy before giving.

Thiamine (Vitamin B1)

• Used for: Prevents/treats thiamine deficiency, especially in patients with alcohol use disorder.

• Route: PO or IV.

• Remember: Commonly given to patients with alcohol withdrawal to help prevent Wernicke's encephalopathy.

Wernicke's Encephalopathy

alcohol related Confusion, trouble walking (unsteady gait), and eye movement problems.

• An IV catheter left in the vein without continuous IV fluids.

• Flushed with normal saline to keep it open.

• Used when the patient only needs intermittent IV medications or blood draws.

Medlock (Saline Lock)

What it is: Low platelet count called (blood not clotting)

Thrombocytopenia

Pancytopenia

Everything is low. (RBC, WBC, PLATELETS)

• 🩸 Anemia

• 🦠 Infection risk

• 🩹 Bleeding risk

• Anemia/ Cancers

Vitamin K (Phytonadione)

Clotting vitamin

• Helps make clotting factors to stop bleeding

How to print REPORT?

My patient

Print

Hand off

HS

At bedtime

HS = Hit the Sheets 🛏

Before meals

AC

Patient is on medication and you see that the patients vitals are declining

Recognize → Stop the infusion → Get help quickly-RRT or CODE

Code blue/RRT #

35110

Braden Scale Range

• Highest score: 23

• Lowest score: 6

Chlordiazepoxide (Librium)

• Used for: Alcohol withdrawal TREMORS and anxiety.

• Class: Benzodiazepine.

• Remember: Can cause drowsiness and respiratory depression → monitor breathing and use fall precautions.

What time is 2000

8:00 pm

A patient has a primary IV of 0.9% NS at 75 mL/hr and a secondary IVPB of ceftriaxone. Which infusion will the pump administer first?

The secondary IVPB (ceftriaxone) runs first. When it finishes, the pump automatically resumes the primary NS infusion.

What time is 1930

7:30 pm

Before you are going to collect your patients medications what should you do?

Bring up your patients in epic on the side so you esily find them in the med room

With an IV pump before prijmin what is the first you should do?

CLAMP THE TUBES!!

How do you stop and infusion in the IV pump?

Press the stop button

Press C to clear the infusion and C to clear the secondary line

How many mm must the pupils b to be considered normal?

• Pupils 3 mm, equal, round, reactive to light

A quick memory aid:

• 2–4 mm = bright light

• 4–8 mm = dark

pupils <2mm abnormally constricted (pinpoint pupils) mean?

• Opioid overdose (e.g., morphine, heroin, fentanyl)

• Some medications (opioids)

pupils >8 mm = abnormally dilated

• Head injury/increased intracranial pressure

• Certain drugs (e.g., cocaine, amphetamines)

• Eye medications used to dilate the pupils

• Severe hypoxia in some situations

Pediatric pt normal HR

80-110

Pediatric RR

18-30 breaths

Pediatric Blood pressure

• Systolic: 95–110

• Diastolic: 60–75

How to do RN Handoff Report

Go to each patient chart

Click SUMMARY

Scroll all the way down

Click RN Handoff

How to Select your patients to give medications

Anywhere RN

Click on the HEAD

Select your patients

When hanging a ivpb line what is the first thing you should do?

CLAMP THE LINE!!

What must the nurse do if a patient refuses to take a scheduled Narcotic?

Return it to the omnicell

Return to side of the omnicell

Requires another nurse as witness

What must you do at the beginning of your shift?

Check the side board for your room assignement

Go into your rooms put your name on the board

Go assess and talk to your patients

Go and stock up on supplies

If you need to pause or stop the IV infusion?

Press the circle button for 3 seconds

IV Protonix (pantoprazole) 40mg comes as a powder and must be reconstituted HOW before it can be given?

With 10 mL of 0.9% Normal Saline (NS) Flush

What is Jardiance used for

To help patients with Type 2 diabetes to help the kidneys flush out extra glucose (sugar) from kidneys and also used for heart failure and kidney disease in certain patients

Why is magnesium often given with potassium chloride?

Your magnesium and potassium electrolytes levels are low

our body needs for your muscles, nerves, and heart to work properly. We’re replacing them through your IV because your levels need correction.”

What if a patient as why am i getting Folic acid

Vitamin that helps your body

Make healthy red blood cells and supports cell growth and repair.”

• Helps prevent anemia (low red blood cells

• Supports normal nerve and brain function

Patient ask why they are getting Vitamin K

prevent any abnormal bleeding (Given IM)

MAP (Mean Arterial Pressure)

The average pressure pushing blood to your body and organs

• MAP ≥ 65 mmHg is usually the goal for many critically ill adults.

• Low MAP = organs may not be getting enough oxygenated blood.

• High MAP = blood pressure may be too high.

• A high MAP (Mean arterial pressure) means

The organs are being exposed to higher pressure than needed and can be associated with hypertension and increased cardiac workload.

Tenofovir = antiviral

think HIV or Hepatitis B.

Explain Hepatitis B

Caused by the Hepatitis B virus (HBV)

Spread through:

• Blood exposure

• Sexual contact

• Sharing needles

Hepatitis B affects?

• Liver inflammation

• Chronic hepatitis

• Cirrhosis

• Liver cancer (long-term risk)

Explain Biktarvy

A antiviral medication that helps control certain viruses. It’s used for HIV treatment.” helps keep the virus at a low level and protects your immune system.”

Zofran

Nausea and vomiting

Explain Midline double lumens

Red lumen (usually): Blood draws, blood products, high-flow infusions.

White lumen (usually): Routine IV medications and fluids.

How to draw blood from a picc or central line?

Use the lumen with Red**

Sanitized for 30 seconds

Flush with 10ml of saline

Sanitized for 30 seconds

Flush with 10ml of saline

Use same flush to draw out 10ml blood

Attach vacutainer to tubes to draw blood

The Flush one more time.

Cozaar (Losartan)

• Use: High blood pressure, protects kidneys in diabetes

• Main side effects: ↓BP, dizziness, ↑K⁺

• Monitor: BP, potassium, creatinine

What is the #1 thing you must do before giving heart of Blood pressure medications?

Check the Vitals (BLOOD PRESSURE AND HEART RATE!!!!)C

Carvedilol (Coreg)

Carvedilol (Coreg)

• Uses: HTN, heart failure, post-MI

• Before giving: Check BP & HR

• Main side effect: Hypotension (also bradycardia/dizziness)

What do you say if a patient ask why am i getting Seroquel (quetiapine)

It helps to keep you relaxed, calm, and comfortable

Olanzapine (Zyprexa)

• Uses: Agitation, schizophrenia, bipolar disorder

• Simple patient explanation: "This medication helps keep you calm and helps with your mood and thinking."

• Main side effect: Drowsiness (can also cause dizziness)

What is a patient ask why am i getting Olanzapine (Zyprexa)?

Simple patient explanation: "This medication helps keep you calm and helps with your mood and thinking."

Rifaximin (Xifaxan)

Uses: Prevents hepatic encephalopathy (reduces confusion caused by liver disease); also used for certain intestinal infections

When should Lorazapam (Ativan) be given?

Give before they have eaten something