NCLEX

Five Rights of Delegation

1. Right Person
2. Right Task
3. Right Circumstance
4. Right Direction and Communication
5. Right Supervision and Evaluation

Maslow's Hierarchy of Needs

Five Rights of Medication Administration

1. Right Client
2. Right Drug
3. Right Dose
4. Right Route
5. Right Time

Acetaminophen (Tylenol)

Antidote/Reversal: acetylcysteine (Muscomyst)

Toxic Level: >250mcg/mL

Benzodiazapine

Antidote/Reversal: flumazenil (Romazicon)

Curare

Antidote/Reversal: edrophonium (Tensilon)

Cyanide Poisoning

Antidote/Reversal: methylene blue

Digitalis/Digoxin

Antidote/Reversal: digoxin immune FAB (Digibind)

Ethylene Poisoning

Antidote/Reversal: fomepizole (Antizol)

Heparin and enoxaparin (Lovenox)

Antidote/Reversal: protamine sulfate

Iron

Antidote/Reversal: deferoxamine (Desferal)

Lead

Antidote/Reversal: succimer (Chemet)

Magnesium Sulfate

Antidote/Reversal: calcium gluconate 10% (Kalcinate)

Narcotics

Antidote/Reversal: naloxone (Narcan)

Warfarin

Antidote/Reversal: phytonadione (Vit. K)

Aminophylline

bronchodilator (IV)
Therapeutic Level: 10-20 mcg/mL
Toxic Level: >20 mcg/mL

Carbamazepine

anticonvulsant
Therapeutic Level: 5-12 mcg/mL

Amitriptyline

antidepressant and nerve pain med
Toxic Level: >500 ng/ML

Digoxin

antiarrhythmic, blood pressure
Therapeutic Level: 0.8-2.0 ng/mL
Toxic Level: >2.4 ng/mL

Gentamicin

antibiotic (renal/oto toxic)
Therapeutic Level: 0.5-0.8 mcg/mL
Toxic Level: >12mcg/mL

Lithium

bipolar disorder
Therapeutic Level: 0.4-1.4 mEq/L
Toxic Level: >2 mEq/L

Magnesium Sulfate

anticonvulsant
Therapeutic Level: 4-8 mg/dL
Toxic Level: >9mg/dL

Phenobarbital

barbiturate/anticonvulsant
Therapeutic Level: 10-30 mcg/mL
Toxic Level: >40 mcg/mL

Methotrexate

Chemotherapy/Immunosuppressant
Toxic Level: >10 mcmol over 24 hours

Phenytoin

anticonvulsant
Therapeutic Level: 10-20 mcg/mL
Toxic Level: >30 mcg/mL

Quinidine

antiarrhythmic/anti-parasite
Therapeutic Level: 2-5 mcg/mL
Toxic Level: >10 mcg/mL

Salicylate

NSAID
Therapeutic Level: 100-250 mcg/mL
Toxic Level: >300 mcg/mL

Theophylline

bronchodilator
Therapeutic Level: 10-20 mcg/mL
Toxic Level: >20 mcg/mL

Tobramycin

Therapeutic Level: 5-10 mcg/mL
Toxic Level: >12 mcg/mL

-dipine

Ca+ Channel Blocker

-afil

Erectile Dysfunction

-caine

Anesthetics

-pril

ACE inhibitor

-pam, -lam

Benzodiazapine

-statin

Antilipidemic

-asone, -solone

Corticosteroid

-olol

Beta Blocker

-cillin

Penicillin derivative (antibiotic)

-ide

Oral Hypoglycemic

-prazole

Proton Pump Inhibitor

-vir

Antiviral

-ase

Thombolytic

-azine

antiemetic

-phylline

bronchodilator

-arin

anticoagulant

-tidine

antiulcer

-zine

antihistamine

-cycline

antibiotic

-mycin

aminoglycoside

-floxacin

antibiotic

-tyline

Tricyclic antidepressants

-pram, -ine

SSRI's

Serum Sodium (Na+)

135-145 mEq/L

Serum Potassium (K+)

3.5-5 mEq/L

Serum Calcium (Ca++)

8.5-10.5 mg/dL

Magnesium (Mg++)

1.3-2.1 mEq/L

Phosphorus (PO4)

3.0-4.5 mg/dL

Chloride (Cl)

98-106 mEq/L

pH

7.35-7.45

PaCO2

35-45 mmHg

PaO2

80-100 mmHg

SaO2

90-100 mmHg

HCO3 (bicarbonate)

21-28 mEq/L

RBC

Male: 4.5-6.1 million/uL

Female: 4.0-5.5 million/uL

Hgb

Male: 14-18 g/dL

Female: 12-16 g/dL

Hct

Male: 42%-52%

Female: 37%-47%

WBC

5,000-10,000 mm3

Erythrocyte Sedimentation Rate (ESR)

<20mm/hr

Total Serum Cholesterol

<200 mg/dL (desirable)

>150 mg/dL (risk for stroke/cardiac events)

Low-Density Lipids (LDL)

<130 mg/dL (desirable)

High-Density Lipids (HDL)

Male: 35-65 mg/dL

Female: 35-80 mg/dL

Triglycerides

<150 mg/dL
Male: 40-160 mg/dL
Female: 35-135 mg/dL

INR

0.7-1.8 (normal)
2.0-3.0 (therapeutic-on anticoagulant therapy)

PT

11-12.5 (normal)
Therapeutic Level: 1.5-2 times normal value

Partial Thromboplastin Time (aPTT)

30-40 seconds
Therapeutic Level: 1.5-2 times normal value

Platelets

150,000-400,000 mm3

Albumin

3.5-5 g/dL

Ammonia

15-45 mcg/dL

Total Bilirubin

0.1-1.0 mg/dL

Total Protein

6-8 g/dL

Urine Specific Gravity

1.003-1.030

Protein (urine)

0.8 mg/dL

Glucose (urine)

<0.5 g/day

Ketones

NONE

pH (urine)

4.6-8

WBC (urine)

Male: 0-3 per high power field

Female: 0-5 per high power field

Serum Creatinine

Male: 0.6-1.2 mg/dL

Female: 0.5-1.1 mg/dL

BUN

10-20 mg/dL

Creatinine Clearance
*best indicator of overal renal function

Male: 90-139 mL/min

Female: 80-125 mL/min

Blood Glucose (fasting)

70-110 mg/dL

Glycosylated Hemoglobin (HbA1C)

4%-6% (expected range)
>8% indicates poor diabetes mellitus control

TPN
Total Parenteral Nutrition

Hypertonic Solution
Given via PICC line, tunneled catheter
Prepared daily by pharmacy
Use Sterile Asepsis for dressing change
Check blood glucose every 4-6 hours
Change bag every 24

Standard Precautions

When handling blood, bodily fluid, bodily tissue, mucous membranes, open skin

PPE: depends on type of exposure (minimal is nothing)

Contact Precautions

Used when germs are spread by touching
ex) C. Difficile, Norovirus

Minimal PPE: Gloves and Gown

Droplet Precautions

Used to prevent contact with mucus and other secretions from nose, sinuses, throat, airway, and lungs. Use when contact will be within 3 ft or less
ex) infulenza, mumps, pertussis

Minimal PPE: Mask

Airborne Precautions

Needed to prevent transmission from particles so small the can float in the air and travel long distances.
ex) chickenpox, measles, Tuberculosis, SARS

Minimal PPE: Well fitting mask
*Use respirator mask for TB and SARS
**Negative Pressure room

Trust vs. Mistrust

0-1 yr
Teach parents to meet infant's physical and social needs

Autonomy vs. Shame and Doubt

1-3 yrs
Provide child with acceptable options. Let them CHOOSE

Initiative vs. Guilt

3-6 yrs
Assist parents to identify age/disease appropriate activities

Idustry vs. Inferiority

6-12 yrs
Encourage child's participation in their care