Gold Standard for NCLEX

Prioritization Techniques

Prioritize ​systemic​ vs. ​local​ (life before limb)
● Prioritize ​acute​ before ​chronic
● Prioritize ​actual​ before ​potential​ future problems
● Prioritize according to Maslow's- ​physiological​ needs before ​psychosocial
(acute safety can take priority- ATI)
● Recognize and respond to trends vs. transient findings (recognizing a
gradual deterioration)
● Recognize signs of emergencies and complications vs. "expected client
findings"
● Apply clinical knowledge to procedural standards to determine the priority
action- recognizing that the timing of administration of antidiabetic and antimicrobial medications is more important than administration of some other medications

CONTACT

MRS. WEE
M- multidrug resistant organism (MRSA)
R- respiratory infection
S- skin infections (localized herpes zoster)
W- wound infections
E- enteric infection ​→​ clostridium difficile
E- eye infection ​→​ conjunctivitis(Also, Hep A)

DROPLET

SPIDERMAN
S- sepsis
S- scarlet fever
S- streptococcal pharyngitis
P- parvovirus B19
P- pneumonia (pneumonic plague)
P- pertussis-
I- influenza
D- diphtheria (pharyngeal)
E- epiglottitis
R- rubella
R- respiratory syncytial virus (RSV)
M- mumps
M- meningococcal (infectious meningitis)
M- mycoplasma or meningeal pneumonia An- adenovirus

Skin Infections

VCHIPS

V- varicella zoster

C- cutaneous diphtheria

H- herpes simplex

I- impetigo

P- pediculosis

S- scabies

Impetigo​- caused by Staph and Strep, untreated can cause acute glomerulonephritis (periorbital edema—indicates poststreptococcal glomerulonephritis)

Order of PPE Application

● Gown

● Mask

● Goggles/face shield

● Gloves

Order of PPE Removal

● Gloves

● Goggles/face shield

● Gown

● Mask

No pee, no K (do not give potassium without adequate urine output)

El​V​ate ​V​eins, d​A​ngle ​A​rteries for better perfusion

CONVERSIONS

1 oz = 30 mL
1 cup = 8 oz
1 Kg = 2.2 lbs
1 lb = 16 oz

Asthma - positioning

● Orthopneic position where patient is sitting up and bent forward with arms support on a table or chair arms

Air Embolism - positioning

(S/S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of impending doom)

● Turn patient to ​LEFT​ side and ​LOWER ​head of bed

Pulmonary Embolism - positioning

(S/S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of impending doom)
● Elevate HOB

Women in Labor with non-reassuring FHR

(S/S: late decels, decreased variability, fetal bradycardia, etc.)

● Turn mother on ​LEFT ​side (and give O2, stop Pitocin, increase IV fluids) 7

Tube Feeding w/ Decreased LOC

Head of bead ​ELEVATED​ (to prevent aspiration) and position patient on

RIGHT ​side (promotes gastric emptying)

Postural Drainage

Lung segment to be drained should be in the uppermost position to allow gravity to work

During Epidural/Lumbar Puncture

● Side-lying ​(“C” curved spine)- lateral recumbent/fetal position

Post​ Lumbar Puncture (LP) –​ (and also oil-based myelogram)

● Patient lies in ​flat supine​ (to prevent CSF leak and headache) for 2-3

hours

● Sterile dressing applied

● Frequent neuro checks

Thoracentesis

● Position patient with arms on pillow over bed table or lying on side

● NO MORE THAN 1000cc at one time

● Post- check blood pressure, auscultate bilateral breath sounds, check for

leakage, sterile dressing

Patient with Heat Stroke

● Lie ​flat ​with ​legs elevated

Hemorrhagic Stroke

● HOB elevated 30 degrees to reduce ICP and facilitate venous drainage

Post​ Myringotomy​

Surgical incision in eardrum to relieve pressure and drain fluid (tubes)

● Position on side of ​affected ear​ after surgery (allows drainage of secretions)

Post​ Cataract Surgery

● Patient will sleep on ​unaffected side​ with night shield for 1-4 weeks

(adequate vision may not return for 24 hours)

● Pain that is not relieved by prescription pain medication may signal hemorrhage, infection or increased ocular pressure

Infant with Spina Bifida

● Position ​prone ​(on abdomen) to prevent sac from rupturing

Buck’s Traction ​(skin traction)

● Elevate ​foot of bed for counter-traction

Post​ Total Hip Replacement

● DON’T ​sleep on ​affected/operative ​side

● DON’T ​flex hip more than ​45-60 degrees

● DON’T ​elevate HOB more than 45 degrees

● Maintain ​hip ​abduction ​by separating thighs with a pillow

● NO adduction ​or​ internal rotation

Prolapsed Cord

● Knee-chest ​or ​Trendelenburg ​(goal is to prevent pressure on cord)

Vena Cava Syndrome (pregnant women)

● Position woman on her left side (relieves pressure off vena cava from fetus)—knees flexed (blood return)
o Mother may present with hypotension

Pancreatitis

● Patients should lie in fetal position
● Maintain NPO status (to rest the gut)—patient may also have PICC line
inserted for TPN/lipids

To Prevent Dumping Syndrome

● Eat in ​reclining ​position

● Lie down after meals for 20-30min

● Restrict fluids during meals, low carbohydrate, low fiber, high fat and

protein

● *GOAL: decrease gastric motility

Above Knee Amputation

● Elevate for first 24 hours on pillow

● Position ​prone ​daily to provide for hip extension

● Do not keep leg elevated beyond 24 hours—causes hip flexion which can

lead to contractures

● Rewrap 3x day (elastic bandages)

Below Knee Amputation

● Foot of bed elevated for first 24 hours

● Position ​prone ​daily to provide for hip extension

● Do not keep leg elevated beyond 24 hours—causes hip flexion which can

lead to contractures

*​Activity helps reduce the frequency and degree of phantom pain

Detached Retina

● Area of detachment should be in the ​dependent ​position (head in

downward direction, lying on unaffected side)

After Supratentorial Surgery ​(suture behind hairline)

● Elevate HOB 30-45 degrees

After Intratentorial Surgery​ (incision at nape of neck)

● Position patient ​flat​ and ​lateral​ on either side

During Internal Radiation

● On ​bed rest​ while implant is in place

Autonomic Dysreflexia/Hyperreflexia ​

(S/S: pounding H/A, profuse sweating, nasal congestion, goose flesh, bradycardia, HTN)

● Place patient in ​sitting position- HIGH FOWLER’S (elevate HOB- FIRST ACTION)—​decreases venous return

● Check for kinks in foley catheter tubing

Spinal Cord Injury

● Immobilize on spine board
● Head in neutral position
● Immobilize with padded C-collar
● Maintain traction and alignment of head manually
● Log roll client and do not allow to twist or bend

Shock

● Bed rest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified Trendelenburg)

Peritoneal Dialysis when Outflow is Inadequate

● Turn patient from side to side ​BEFORE​ checking for kinks in tubing

(according to Kaplan)

Cardiac Catheterization

● Keep site extended (usually involves femoral artery)

Post-thyroidectomy

● Semi-Fowler's position, prevent neck flexion/hyperextension (support head, neck and shoulders)
● Trach at bedside
● Monitor respiratory status every hour

Post-Bronchoscopy

● Semi Fowler's
● Check V/S q15 min until stable
● Assess for respiratory difficulty (stridor, dyspnea resulting from laryngeal
edema or laryngospasm)

Epistaxis

Upright and lean forward (prevent blood from entering the stomach and to avoid aspiration)

Post​-Liver Biopsy

● Place patient on right side over a pillow to prevent bleeding (liver is very

vascular)

● No heavy lifting for 1 week’

Paracentesis

● Semi-Fowler's or upright on edge of bed
● Void prior- prevent puncture of bladder
● Post-​ V/S (BP), report elevated temp, observe for signs of hypovolemia

Pneumonia

● Lay on affected side to splint and reduce pain
● Trying to reduce congestion: the sick lung goes up

Post-Radical Mastectomy

● Position in Semi-Fowler’s with arm (affected side) elevated – if left mastectomy, elevate left arm, if right mastectomy, elevate right arm!

o This facilitates removal of fluid through gravity and enhances circulation

Liver biopsy

Prior to ​liver biopsy​ it is important to check lab results for PT time (vascular organ)

(prior) administer Vitamin K, NPO at midnight, teach patient that he will be asked to hold breath for 5-10 sec, supine position with upper arms elevated

Type I (insulin dependent)

Immune disorder, body attacks insulin producing beta cells with resulting ​Ketosis​ (result of ketones in blood due to gluconeogenesis from fat)

o Excessive thirst and weight loss are characteristic of T1DM

● Type II​ ​(insulin resistant)

Beta cells do not produce enough insulin or
body becomes resistant

DM - Type 2

o Assessment

▪ 3 P’s● Polyuria (excessive urination), polydipsia (extreme

thirst), polyphagia (excessive hunger)

▪ Elevated blood sugar

▪ Blurred vision

▪ Elevated HbA1C

▪ Poor wound healing

▪ Neuropathy

▪ Inadequate circulation

▪ End organ damage is a major concern due to damage to

vessels

● Coronary artery disease

o HTN, cerebrovascular disease

DM - complications

● Lipoatrophy
o Loss of subq fat at injection site (alternate injection sites)
● Lipohypertrophyo Fatty mass at injection site
● Dawn phenomenono Reduced insulin sensitivity between 5-8AM o Evening administration may helpo Adjust evening diet, bedtime snack, insulin
dose, and exercise to prevent early morning hyperglycemia - adjust do not eliminate (usually intermediate acting insulin is used)
● Somogyi phenomenono Night time hypoglycemia results in rebound
hyperglycemia in the morning hours

Rapid-acting insulin should only be given if food is available and patient is ready to eat

Repaglinide is a meglitinide analog drug—short-acting agents used to prevent postmeal blood glucose elevation—should be given within 1 to 30 minutes before meals and cause hypoglycemia shortly after dosing when a meal is denied or omitted

Drawing up regular insulin and NPH together

Cloudy (air into NPH) Clear (air into regular)

Clear (draw up regular)

Cloudy (draw up NPH)

Or

RN- regular before NPH

Diabetic Ketoacidosis (DKA)​

-​ body is breaking down fat instead of sugar for energy—fats leave ketones (acids) that cause ​pH​ to ​decrease*DKA is rare in DM Type 2 because there is enough insulin to prevent breakdown of fats

● Serum acetone and serum ketones increase in DKA

● As you treat the acidosis and dehydration expect the potassium to drop

rapidly ​→​ be ready with potassium replacement

● Fluids are the most important intervention for DKA and HHNS

o NS or LR

● Second voided urine is the most accurate when testing for ​ketones​ and

glucose

● Bringing the glucose down too much too quickly can result in increased ICP due to water being pulled into the CSF

● Urine ketone testing should be done whenever the patient’s blood glucose is greater than 240

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

● Potassium is low due to diuresis
● Fluids are the most important intervention
● No acidosis and no ketosis
● Weight loss is a symptom
● Often occurs in older adults with T2 Diabetes
● Risk Factors
o Diuretics
o Inadequate fluid intake (dehydration)

Myasthenia Gravis​

​Decrease in receptor sites for acetylcholine- because the smallest concentration of ACTH receptors are cranial nerves, expect ​fatigue​ and weakness ​in ​eye, mastication/chewing, ​and ​pharyngeal muscles

Myasthenic ​Crisis​:​

Often follows some type of infection—client is at risk for inadequate respiratory function
● S/S: elevated temperature, tachycardia, HTN, incontinent of urine and stool

Cholinergic Crisis

​ Caused by excessive medication, stop med​→​ Tensilon will make it worse

Endocrine System

Hormone

Growth Hormone (GH) ADHT3, T4PTH

Glucocorticoids: cortisol Insulin

Gland

Anterior Pituitary Posterior Pituitary Thyroid Parathyroid Adrenal gland Pancreas

Myxedema/Hypothyroidism​

Hyposecretion of thyroid hormone (TH) resulting in decreased metabolic rate (slowed physical and mental function)

Myxedema coma

Life threatening state of decreased thyroid production—coma result of acute illness, rapid cessation of medication, hypothermia

Myxedema coma assessment:

▪ Think ​HYPO​metabolic state

▪ Cardiovascular​- bradycardia, anemia, hypotension

▪ Gastrointestinal​- constipation (GI motility slows)

▪ Neurological​-​ ​lethargy, fatigue (due to decreased

metabolic rate—“body is slow and sleepy”), weakness, muscle

aches, paresthesias

▪ Integumentary​- ​goiter, dry skin, dry hair, loss of

body hair

Hypothyroidism​- hypo metabolism

Therapeutic Management

▪ Cardiac monitoring

▪ Maintain open airway

▪ Monitor medication therapy (overdose with thyroid

medications possible)

▪ Medication therapy- ​levothyroxine (Synthroid)

● Take in morning before breakfast to prevent insomnia (on empty stomach)

▪ Assess thyroid hormone levels

▪ IV fluids

▪ Monitor and administer glucose as needed

*Myxedema is COLD (hypothermia)

Hyperthyroidism - hypermetabolism

Excess secretion of thyroid hormone (TH) from thyroid gland resulting in ​increased ​metabolic rate (​accelerated​ physical and mental function)

Graves disease

(autoimmune reaction)o Excess secretion of TSH, tumor, medication reaction

● Thyroid Storm (Thyroid Crisis)o Extreme hyperthyroidism (life threatening) due to infection, stress,

trauma▪ Febrile state, tachycardia, HTN, tremors, seizures

Hypermetabolism

▪ Elevated T3, T4, free T4, decreased TSH, positive radioactive uptake scan

▪ Goiter

▪ Bulging eyes

▪ Cardiac- tachycardia, HTN (increased systolic, decreased

diastolic), palpitations

▪ Neurological- hyperactive reflexes, emotional instability,

agitation, hand tremor

▪ Sensory- ​exophthalmos ​(Graves disease), blurred vision,

heat intolerance

▪ Integumentary- fine, thin hair

▪ Reproductive- amenorrhea, decreased libido

▪ Metabolic- increased metabolic rate, weight loss

Hypermetabolism therapeutic managment

▪ Provide rest in a cool quiet environment

▪ Anti-thyroid medications (PTU, propylthiouracil)

▪ Cardiac monitoring

▪ Maintain patent airway

▪ Avoid drinks that are stimulants (increases metabolic rate) ● Caffeine- coffee, tea, soda

▪ Provide eye protection

● Regular eye exams

● Moisturize eyes

▪ Radioactive Iodine 131

● Taken up by thyroid gland and destroys some thyroid cells over 6-8 weeks

o Avoid with pregnancy

o Monitor lab values for hypothyroidism

Thyroid surgical removal

● Monitor airway

● Maintain in semi-Fowlers position

● Assess surgical site for bleeding

● Monitor for ​hypocalcemia

o Have calcium gluconate available

● Minimal talking during immediate post-op period

● (Partial-thyroidectomy) Monitor temperature

post-op​→​ elevated temp by even 1 degree may indicate impending thyroid crisis​→​ report to MD immediately

Hypo-parathyroid

​Decreased calcium (implement high calcium, low phosphorous diet; provide Vitamin D which aids in calcium absorption) *Trousseau's and Chvostek's signsCATS (S/S):
C- convulsions
A- arrhythmias
T- tetany
S- spasms
S- stridor

Hyper-parathyroid:​

Hyper-parathyroid:​ increased calcium (implement low calcium, high phosphorous diet)S/S: Fatigue, polyuria, muscle weakness, ​renal calculi ​(55% have urinary tract calculi), back and joint pain, ​monitor for bone deformities

Pre-parathyroidectomy- low calcium, high phosphorous diet

20

*For patients who are not candidates for para-thyroidectomy, diuretics (furosemide) and hydration (IV NS) in combo help reduce serum calcium ​→ furosemide increases kidney excretion of calcium when combined with IV saline in large volumes

Hypovolemia

(dehydration) increased temperature, rapid/weak pulse (tachycardia), increased respirations, hypotension, anxiety, urine SG > 1.030 (dark urine), confusion (early sign)
● Increased sodium with dehydration
● Increased BUN with dehydration
● Increased hematocrit with dehydration

Hypovolemic Shock

● Isotonic fluids - increase intravascular volume (NS or LR)
● Albumin can be given too (expander)

Hypervolemia​:​

(fluid volume excess/overload) bounding pulse, SOB, dyspnea, crackles, peripheral edema, HTN, urine SG <1.010 (dilute urine); Semi-Fowler’s

*D5W-body rapidly metabolizes the dextrose and the solution becomes hypotonic

Low phosphorous—patient will exhibit generalized muscle weakness​→​ may lead to acute muscle breakdown (rhabdomyolysis)

● Phosphate is necessary for energy production in the form of ATP—when not produced, leads to generalized weakness

Diabetes Insipidus (DI):​

hyposecretion​ or failure to respond to ​ADH​ from posterior pituitary—leading to excess water loss

▪ NCLEX Pointso Assessment (S/S)

▪ Excessive urine output● Dilute urine (USG <1.006)

▪ Hypotension leading to cardiovascular collapse

▪ Tachycardia

▪ Polydipsia (extreme thirst)

▪ Hypernatremia

▪ Neurological changes

DI Therapeutic management

▪ Water replacement● D5W if IV replacement is required

▪ Hormone replacement ● Desmopressin

● Vasopressin

▪ Monitor urine output hourly and urine SG ● Report urine output > 200mL/hour

▪ Daily weight monitoring

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)​:​

excessive secretion​ of ​ADH​ (from posterior pituitary) leading to ​hyponatremia​ and water intoxication ​(excessive water retention)

● Caused by trauma, tumors, infection, medications

● NCLEX Points

o Assessment (S/S)

▪ Fluid volume excess (HTN, crackles, JVD)

▪ Altered LOC

▪ Seizures

▪ Coma

▪ Urine specific gravity > 1.032

▪ Decreased BUN, hematocrit, Na (hyponatremia)

SIADH therapeutic management

▪ Cardiac monitoring

▪ Frequent neuro exams

▪ Monitor I&O

▪ Fluid restriction

▪ Sodium supplement

▪ Daily weight (loss of 2.2 lbs or 1 kg = 1 L)

▪ Medication

● Hypertonic saline (D5 w/ NS)

● Diuretics (furosemide)

● Electrolyte replacement

*Water intoxication – drowsiness and altered mental status

Specific Gravity

● 1.010-1.030
● High- (concentrated/dark urine)
o Dehydration o SIADHo Heart failure
● Low- (dilute/water-like urine) o CKD
o Diabetes Insipiduso Fluid volume overload

Hypomagnesemia​ ​

​ ​(low Mg): tremors, tetany, seizures, dysrhythmias (life threatening ventricular arrhythmias), depression, confusion, dysphagia *Low Mg may lead to digoxin toxicity

Hypermagnesemia

​(high Mg): depresses the CNS, hypotension, facial flushing, muscle weakness, absent deep tendon reflexes, shallow respirations *Emergency

Addison’s Disease

hyposecretion of adrenal cortex hormones; decreased levels of glucocorticoids and mineralcorticoids leads to hyponatreamia, hyperkalemia, hypoglycemia, decreased vascular volume—fatal if not treated

● NCLEX Points

o Assessment

▪ Hyponatremia (down)

▪ Hyperkalemia (up)

▪ Hypoglycemia (down)

▪ Decreased blood volume (down)- anemia

▪ Hypotension (down) – most important assessment

parameter

▪ Weight loss

▪Hyperpigmentation (tanned skin)

▪ Decreased resistance to stress

Addison's disease therapeutic management

o Therapeutic Management –​ with Addison’s you must ​add hormone (teaching about steroid replacement is important)

▪ Monitor vital signs

▪ Monitor electrolytes

▪ Monitor glucose

● Treat low blood sugar

▪ Administer replacement adrenal hormones as needed

▪ Lifelong medication therapy needed

▪ Managing stress in a patient with adrenal insufficiency is

important—if the adrenal glands are stressed further it can

result in Addisonian Crisis

Addisonian Crisis

▪ Caused by acute exacerbation of Addison’s Disease

▪ Causes severe electrolyte disturbances

▪ Monitor electrolytes and cardiovascular status closely

▪ Administer adrenal hormones as needed

▪ S/S: N/V, confusion, abdominal pain, extreme weakness,

hypoglycemia, dehydration, decreased blood pressure

▪ During times of stress- increase sodium intake​ ​→​ a

decrease in aldosterone leads to increase in excretion of sodium)

Cushing’s​ ​Disease​-

- hypersecretion of glucocorticoids leading to elevated cortisol levels; greater incidence in women; life threatening if untreated

● NCLEX Pointso Assessment

▪ Hypernatremia (up)

▪ Hypokalemia (down)

▪ Hyperglycemia (up)

▪ Increased blood volume (up)

▪ Hypertension (up)

▪ Prone to infection

▪ Moon face

▪ Buffalo hump

▪ Muscle wasting

▪ Edema (signs of CHF)

▪ Risk to bruising

Cushing's disease therapeutic management

● Therapeutic Management –​ you have excess “cushion” of hormones o Monitor electrolytes and cardiovascular status

▪ Prevent fluid overload – respirations are the first priority

▪ Cardiovascular feature- capillary fragility​→​ results in

bruising and petechiae

o Provide skin care and meticulous wound care (paper thin skin that

is easily injured)o Provide for client safetyo Adrenalectomy (surgical removal of adrenal gland) o Protect client from infectiono Often caused by tumor on adrenal or pituitary gland

Pheochromocytoma

vascular tumor of adrenal medulla (adrenal glands) leading to a hypersecretion of epinephrine/norepinephrine
● S/S: persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding headache
● Management: avoid stress and frequent bathing, and take rest breaks (limit activity), avoid stimulating foods, avoid foods high in tyramine
● Avoid palpating the abdomen as it can cause a sudden release of catelcholamines and severe HTN
● Tx: surgery to remove tumor

Neuroleptic Malignant Syndrome (NMS)

-You get hot (increased temp/hyperpyrexia) -Stiff (increased muscle tone)-Sweaty (diaphoresis)-BP, pulse, and respirations go up-You start to drool*Flu like symptoms

Pulmonary Embolism

● First sign- sudden chest pain,​ followed by dyspnea and tachypnea

● O2 deprived—first intervention is usually oxygen (check ABGs)

o Patient may be hyperventilating as a compensatory mechanism Risk Factors

● Obesity

● Immobility

● Pooling of blood in extremities

● Trauma (MVA)

Tetralogy of Fallot

*​Think ​DROP ​(child drops to floor or squats)

D- defect, septal

R- right ventricular hypertrophy

O- overriding aorta

P- pulmonary stenosis

For neonates with Tetralogy of Fallot- prostaglandin E1 infusion *Give O2 and morphine, IVF for volume expansion

MAOIs

MAOIs

*Pirates say “arrrr”—when pirates are depressed they take MAOIs-MAOIs used for depression have an “ar” sound in the middle (parnate, marplan, nardil)..or..PANAMA

PArnate-​ tranylcypromine

NArdil-​ phenelzine

MArplan-​ isocarboxazid

*Avoid tyramine when taking MAOIs—aged cheese, chicken liver, avocados, bananas, meat tenderizer, salami, bologna, wine, beer—may cause HTN crisis

Systemic Lupus Erythematous

​ progressive systemic inflammatory disease resulting in major organ system failure; immune system “hyperactive” attacks healthy tissue; no known cure

● NCLEX Pointso Assessment

▪ Assess for precipitating factors ● UV light

● Infection ● Stress

▪ Arthritis

▪ Weakness

▪ Photosensitivity

▪ Butterfly rash

▪ Elevated ESR and C Reactive Protein

Albumin

levels are the best indicator of long-term nutritional status (normal 3.5-5.0)

● (Same range as potassium)

One of the goals for a client with ​anorexia​ is to achieve a sense of self-worth and self-acceptance that is ​not​ based on appearance ​→​ encourage activities that will promote socialization and increase self-esteem

Autonomic Dysreflexia​

Potentially life threatening emergency (seen with patients with spinal cord injuries)

● Elevate HOB to 90 degrees - FIRST

● Usually T6 or above spinal cord injury

● Vasoconstriction below

● Vasodilation above

● Sudden, acute onset of HTN

● Loosen constrictive clothing

● Assess for bladder distention and bowel impaction (can trigger AD)-

SECOND

● Administer anti-HTN medications (may cause stroke, MI, seizure

● Metallic bitter taste

Thrombolytic therapy​

Avoid injury​→​ avoid activities that could cause bleeding (NO IM injections)

*The Institute for Safe Medication Practices guidelines indicate that the ​use of a trailing zero​ is ​not appropriate ​when writing medication orders—because it is easily mistaken for a larger dose!

First action after medication administration error is to assess the client for adverse outcomes

Drug Schedules

● Schedule I- no currently accepted medical use, research only (heroin, LSD, MDMA)
● Schedule II- drugs with high potential for abuse and requires written prescription (Ritalin, hydromorphone/Dilaudid, meperidine/Demerol, and fentanyl)
● Schedule III- requires new prescription after 6 months or five refills (codeine, testosterone, ketamine)
● Schedule IV- requires new prescription after 6 months (benzodiazepines)
● Schedule V- dispensed as any other prescription or without prescription
(cough preparations, laxatives)

Digoxin​

Assess pulse for a full minute, hold if HR less than 60, check digoxin levels and potassium and magnesium levels (low K and Mg can lead to digoxin toxicity)S/S of toxicity- yellow halo, N/V
Digoxin is given with loading doses (normally 2- 0.5mg or higher)—maintenance dose is typically 0.25mg*Increases ventricular irritability—can convert a rhythm to V-Fib following cardioversion

Aluminum Hydroxide (Amphojel)​

​(antacid) treatment of GERD and kidney stones- watch for constipation*Take after meals

Amiodarone

Treats life-threatening heart rhythm problems; watch out for diaphoresis, dyspnea, lethargy—take missed dose any time in the day or skip it entirely—DO NOT take double dose

Warfarin (Coumadin)

Anticoagulant therapy; watch for signs of bleeding, diarrhea, fever or rash; stress the importance of complying with prescribed dosage and follow-up appointments
● Patients taking warfarin should not make sudden dietary changes, because changing the oral intake of foods high in Vitamin K (green leafy vegetables, some fruits) will impact the effectiveness of the medication

Methylphenidate (Ritalin)

Treatment of ADHD; assess for heart related side-effects and report immediately; child may need drug holiday because the drug stunts growth; poor appetite- parents should watch for weight loss