Adult Health 1 Study Guide Part 2

Normal Saline Administration

  • Components: Use normal saline with proper tubing and filters for blood transfusions.

  • Monitoring for Reactions:

    • Look for symptoms like fever, chills, back pain, shortness of breath (SOB), or hives.

  • If Reaction is Suspected (ATI Sequence):

    1. Stop Transfusion: Immediately halt the blood transfusion.

    2. Keep IV Patent: Maintain intravenous access by keeping the IV open using normal saline.

    3. Notify Authorities: Inform the healthcare provider and the blood bank about the suspected reaction.

    4. Monitor Vital Signs (VS): Continuously monitor the patient's vital signs.

    5. Send Tubing/Blood Samples: Follow policy to send the used tubing and blood samples for further analysis.

Medication Calculations (Med Math)

  • Practice Questions with Solutions:

Question 1

  • Order: 500 mL Normal Saline over 4 hours.

  • Calculation:

    • Rate in mL/hr = Total Volume ÷ Time

    • Solution: rac500extmL4exthours=125extmL/hrrac{500 ext{ mL}}{4 ext{ hours}} = 125 ext{ mL/hr}

Question 2

  • Order: Morphine 4 mg IV; Supply: 10 mg/1 mL.

  • Calculation:

    • extVolume=rac4extmg10extmgimes1extmL=0.4extmLext{Volume} = rac{4 ext{ mg}}{10 ext{ mg}} imes 1 ext{ mL} = 0.4 ext{ mL}

Question 3

  • Order: 1,000 mL over 8 hours.

  • Calculation:

    • Rate in mL/hr = Total Volume ÷ Time

    • Solution: rac1000extmL8exthours=125extmL/hrrac{1000 ext{ mL}}{8 ext{ hours}} = 125 ext{ mL/hr}

Question 4

  • Order: Amoxicillin 250 mg; Supply: 125 mg/5 mL.

  • Calculation: Need a double dose.

    • Solution: 10 mL.

Question 5

  • Order: Heparin infusion at 18 units/kg/hr; Patient weight: 70 kg.

  • Calculation:

    • extUnits/hour=18extunits/kg/hrimes70extkg=1260extunits/hrext{Units/hour} = 18 ext{ units/kg/hr} imes 70 ext{ kg} = 1260 ext{ units/hr}

NGN Question Types (Strategies for Success)

  • Types of Questions:

    • Drop-down Cloze (Fill in the Blanks):

    • Tip: Read the entire sentence first, then select the answer that ensures safety and accuracy.

    • Drop-down Table:

    • Tip: Analyze one row at a time, asking yourself what is normal, what does it cause, and what actions to take.

    • Bowtie (Cause → Signs → Actions):

    • Tip: Prioritize selection of the most dangerous signs such as airway issues, breathing difficulties, bleeding, or seizures. Actions should focus on first responses.

    • SATA (Select All That Apply):

    • Tip: Treat each option as if it is true or false; don’t seek a specific number of correct answers.

High-Yield DO / DON'T List

  • Chemotherapy:

    • DO: Report fever immediately.

    • DON'T: Take rectal temperatures in cases of neutropenia.

  • Low Platelets:

    • DO: Use a soft toothbrush and electric razor.

    • DON'T: Administer IM injections or use NSAIDs/aspirin.

  • Potassium Administration:

    • DON'T: Ever push potassium IV.

  • Hyponatremia Management:

    • DO: Implement seizure precautions and conduct neuro checks.

    • DON'T: Correct sodium levels too rapidly.

PCA (Patient-Controlled Analgesia)

  • Administration Guidelines:

    • DO: Allow only the patient to press the button for medication delivery.

    • DON'T: Permit family members to press the button on behalf of the patient.

Retinal Detachment Emergency Care

  • DO: Seek emergency treatment for symptoms such as flashes, floaters, or curtain vision.

Blood Transfusion Reaction Protocol

  • DO: Stop the blood transfusion, keep normal saline (NS) running, and notify appropriate personnel.

IV Solutions and Their Uses

  • Adult Health IV Solutions:

    • Isotonic Solution: Dextrose 5% in water (DSW)

    • Uses: Treat fluid loss and dehydration. Use cautiously in renal and cardiac patients to avoid fluid overload.

    • Isotonic Solution: 0.9% Sodium Chloride (Normal Saline)

    • Uses: Management of Hypernatremia, shock, fluid resuscitation, fluid challenges, diabetic ketoacidosis (DKA).

    • Cautions: Can lead to overload; use carefully in patients with heart failure or edema.

    • Isotonic Solution: Lactated Ringer's (LR)

    • Uses: Hydrate in dehydration, burns, lower GI fluid losses, acute blood loss, and hypovolemia related to third spacing.

    • Hypotonic Solution: 0.45% Sodium Chloride (½ Normal Saline)

    • Uses: For water replacement and as needed in DKA or gastric fluid loss from NG or vomiting.

    • Hypertonic Solutions:

    • Dextrose 5% in ½ Normal Saline

    • Dextrose 5% in Normal Saline

    • Uses: Administer later in DKA treatment; can provide temporary treatment for shock if plasma expanders aren't available.

    • Hypertonic Dextrose 10% in Water:

    • Uses: Water replacement and conditions requiring nutrition with glucose.

  • Cautions:

    • Monitor blood sugar levels diligently; use cautiously in renal failure patients due to potassium content.

    • Avoid in liver disease as they cannot metabolize lactate; may cause cardiovascular collapse or increased intracranial pressure.