The delegator delegates tasks but no what? - Responsibility. Still legally responsible for the outcomes.
What do we need to know about delegating? - TELL= Taught (does the person know the skill), Evaluate (return demonstration), License (is one needed for the skill), and Lists (agency policy).
What things should an RN never delegate? - TIA= Teaching, Interventions, and Assessments
What is the ideal situation that is present on the NCLEX? - 1 nurse, 1 patient, and all the time in the world. Assume all orders are written.
What types of activities should a nurse delegate to NAs? - Standard unchanging procedures and Stable patients only. Always ask which patient will die 1st.
What are the rules to remember when delegating to NAs? - Chronic stable patient only. Assigned tasks defined in procedures Can take VS on stable patients and 1/2 hour after blood is started.
NO delegation of tasks where medical knowledge is necessary or required WATCH KEY WORDS AND STAY AWAY FROM: (show, explain, monitor, teach, check, assess, and demonstrate=NO), Can walk stable patients, reorient/co-conduct.
Sterile procedures Assessments including VS on new admits Feeding choking risk patients Drugs (even OTC topicals), teaching, chest tubes, art lines, trachs, endo tubes, contagious diseases, or vents.
What are the ?HOSPITAL: An works under direct supervision of an RN. NURSING HOME: they might be charge nurses and handle all aspects of care. EX: plan, assess, evaluate, intervention and notify Dr.
BUT IN HOSPITAL: Assign: Stable chronic conditions with predictable outcomes. ( : discharge planning, admission assessments (including VS).
IVs and NO teaching.
: give narcotics.
Can HAVE a patient
after (after
1 week),
and may reinforce teaching.
What is the mnemonic for remembering who to see first (prioritizing patients)?
What are the rules for prioritizing patients? - Acute problems more serious than chronic.
- More serious than medical conditions from older surgeries.
Unstable patient are more serious (ACUTE patients
than
STABLE), when in doubt select the more vital organ (heart or lungs over toes, fingers and legs).
What patients are prioritizing----, ,
(pregnancy or seizure patients), ,
, (pain not relieved by drugs/cast or crushing injury c swelling), (cardiac tamponade), (may be another MI), ,
), DVT/PE,
,
,
,
Burns c smoke inhalation, ,
, ,
What patients is NOT a priority? – RUQ (gallbladder) pain, Pain in the (CVA) costovertebral angle= ( Head trauma, , Pain butt to ankle (sciatica),
Meniere’s disease (these people always dizzy),
),
Chronic conditions, COPD, Cystic fibrosis, Laparoscopy c chest or shoulder pain,
Paperwork (document wait end of shift), Calling doctor, Teaching, Bleeding, High or low BS, Poop, FXs, Obtaining lab studies, And Pain.
?– Head trauma with INCREASED ICP, Bleeding FROM MAJOR ARTERY,
Increased (blood sugar) BS IN COMA, Decreased BS C S&S OF SHOCK, Paperwork FOR PREOP CHECKLIST, Poop FROM AN SCI ABOVE T6 OR APPENDICITIS (STRAIN AND RUPTURE), Lab studies- ABGs, Chronic Conditions C ACUTE LIFE THREATENING PROBLEM. Angina c decreased LOC, Decreased cardiac output = decreased urine output, arrhythmia, dizziness/faint PAIN- BACK PAIN: abdominal aortic aneurysm, RLQ: Appendicitis, (RLQ with ) Ectopic pregnancy, Or back pain with blood transfusions.
In what order should patients be removed in the event of a disaster? = mbulatory (walking), ed Ridden, and ritical Care Patients.
What is the mnemonic to help you ?xtinguish.
= emove, ctivate, ontain, and
emove the client, ctivate the fire alarm, xtinguish the fire).
onfine the fire and
What is the mnemonic to remember how to use the Fire Extinguisher? = ull Pin, im, queeze, and weep
What is – RISK:
to remember with
?
HOWEVER, if there is a an infection, this would not the child
but the child has be an appropriate roommate for .
With which conditions are
?–
With which conditions are Droplet Precautions Important? –
WHAT IS THE MEMONIC TO REMEMBER THE PROPER TRIAGE PRIORITIES? ( !) – TRIAGE:
NOT IMPORTANT: meaning not priority!!!!!!! GI (bleed, pain, and distention-not important!), Elimination- (pyelonephritis or trouble voiding) these client should be triaged.
What should be done if someone is brought in with fixed and dilated pupils, not breathing and no heart rate present? - Nothing they are dead so go to the next person.
What should you be concerned about first with someone who experienced burns? -
because if they were close enough
to get burned they were close enough to inhale smoke.
What should be done if someone is present with dilated pupils and
decreased LOC? - They probably have
so
What should you use to help determine appropriate delegation tasks for a ? - Their
and
of the task.
Who should Ambulate a newly admitted post-op/acutely ill patient? An
Who should Ambulate a one day or 24hr P/O patient? -
Who should Ambulate a stable medical & surgical patient? Who should Ambulate an acutely ill, chronic condition patient? -
Who should Evaluate an initial post op patient's pain? -
Who should Evaluate a patient’s pain after a narcotic? -
Who should establish a patient's initial plan of care? Who should update a patient's plan of care? -
Who should manage a patient's on a vent for the first week (acute)? -
Who should manage a patient on a vent after a week (chronic/stable)? Who should manage IVs for (LPN or NA should never manage IVs)
?
Who should take care of an Spinal Cord Injury patient during their first week (acute)? Who should take care of an SCI patient after a week (chronic/stable)?
Who should transcribe orders? - An RN Who should complete sterile procedures? - An RN or LPN Who should teach self-injections, dressing changes, or diets (except DM and CRF)? - An RN
Who should change sheets, get water for, enemas, stool spec/I&O for stable patients? - An NA Who should transport a patient to an area within the hospital? - An NA
Who should feed a person with CHRONIC PARKINSON'S? - An NA Who should feed a patient with an acute CVA? - An RN Who should feed a patient with a chronic CVA? - An NA Who should feed a new trach patient? - An RN Who should feed a stable trach patient on a vent? - An LPN
Who should do an assessment on a new admit and new Post-Op patient? - An RN
*Who should do an assessment on a stable acute patient? - An LPN *Who should do an assessment on a stable chronic patient? - An LPN
Who should
with airborne, droplet, or
contact precautions? - An LPN
Who should administer medications? - An RN or LPN but (no IVs)
Who should do the (assess, plan, interventions, outcomes)? - The RN
RNs should delegate to what level of a person's confidence? Based on? - Highest level of confidence and based on experience, training, and licensure. What does it mean if the glucometer isn't giving a reading? - There isn't enough blood to get a reading. What does it mean if a PCA pump isn't delivering medication to the patient? - The may be asking too often or not enough medication to control the pain. What does it mean if the vent is beeping with a - The patient is causing problems (fighting the vent- holding breath, etc.). What does it mean if the vent is beeping with a - There is a problem with the machine so get a new one and send the broken one to biomed engineering to have it fixed. What does it mean if an O2 mask with a rebreather bag during inspiration? - The bag should NEVER
deflate so get new equipment. What does it mean if there is no pulse ox reading? - It's on too fat of a finger or no light is seen through the finger. Put it on another location.
What does it mean if the pulse ox is not alarming when O2 is at 92%? - Check the alarm level settings. May be too low and need readjusted. What does it mean if the ? - Patient may have been exposed to carbon monoxide. What should be done if an IV pump (IVAC) set to run 1 liter of fluid at 150 ml/hr after 6 hours there is 200 ml left in the bag? - Send to biomed engineering and obtain another pump. What does it mean if the doppler isn't reading? - Patient may not have pulses!! What does it mean if the bladder scanner doesn't produce a reading? What does it mean if there is
in the
H20 seal chamber of a chest tube? - There is an air
leak so a new
Plurovac should be used!! What should be done if there is
from an
? - Reposition patient or tube What does it mean if the - NG may be occluded so irrigate. What should be done if a (CAPD) shows 2000 ml in and 1500 ml cloudy output? - Reposition patient and call MD.
What should be done if the ? – IT’s filled Q24 hours so call the pharmacy for the med. What should be done if a is on a patient with a temp of 38 C (100.4 F), then after three hours their temp is 102F? Send to biomed engineering and obtain a new cooling blanket. What should be done if a has NO
suction? - Check to see if the tape is loose.
What should be done if an Oto thermometer isn't registering? Check charge or send to biomed engineering and obtain new. What does it mean if a patient’s pacemaker is set at 75 and the patients rate is 80? - It OK and working fine. The patient’s heart can do better than the pacemaker just no worse! What does it mean if the patients pacemaker is set at 75 and the patient's rate is 60? - It is defective and the MD should see the patient. What should be done if staff turns off alarms on equipment? MORE EDUCATION What should be done if staff uses extension cords for equipment? MORE EDUCATION What should be done if staff applies restraints to a patient to keep them from falling or wandering? - MORE EDUCATION What should be done if staff doesn't recognize false imprisonment such as Geri chair c tray, not allowing patient to leave w/o MD
orders, or anything preventing freedom to move about? - MORE EDUCATION What should be done if staff breaches confidentiality (taking in public areas, giving D/C instructions with others in room, teaching with family in room, calling support groups w/o pt permission? MORE EDUCATION. NURSE MANAGER OFFICE IS NOT OPEN TO THE GENERAL PUBLIC (=safe place to discuss). Who does an interdisciplinary team consist of? - MD, RN, PT, Social worker, etc. For whom does the interdisciplinary team meet? - For those with chronic non-compliance issues (Ex: sickle cell admitted 3x for crisis, DM admitted for hyperglycemia, celiac not gaining weight, asthma admitted for bronchospasms several times a year). What types of conditions doesn't the interdisciplinary team not meet for? - Chronic stable conditions that are compliant and/or resolved by surgery or medical management (Ex: Pyloric stenosis, cleft lip, nephritis, glomerulonephritis, multiple fx after MVA, and acute leukemia on chemo). What should be taught regarding home safety? - Bikes & skateboards should not be ridden in the street, guns should not be in homes with children even if they are locked up, less than 1 year old=sit in back seat facing backward, more than 1 yr & less than 12 yrs= sit in back seat facing forward, home oxygen should be kept away from flames (stove, fireplace, no wool blankets, and no smoking- the smoke itself won't cause an explosion).
Who is at risk for falling, blind/deaf patients or those with canes/walkers/or small animals? - Those with canes/walkers/small animals (geriatrics) are at risk for falling. What should be done if someone is pulling out their IVs? - Put a mitten on them (least restrictive). Who should an NA never position/move? - Total Hip replacement, total knee replacement, Increased ICP, acute CVA, or above knee/below knee amputations. What should be your response to Non-patient/non-medical issues that arise? (Ex: staff eating off of patient's trays). What should be your response when a patient lack of intervention?
d/t
- Intervene immediately and do procedure correctly. ( What should be your response if a staff member’s action is incorrect but the patient? - Wait until they are finished then teach the correct procedure to them.
If there is a should you call the doctor?
IMMEDIATE ATTENTION when
. If it is serious enough to call the Dr. (Then you need something to keep them alive until Dr. Gets there.)
What should be included in change of shift report? – 1. Changes in condition, 2. New medications, 3. Complications the patient was having
4. Diagnostic procedures that where done 5. Treatments that was given (Lasix for crackles, etc.)
Which of these is within the RN scope of practice? 1. Starting IVs,
2. Isolation placement, 3. Problem w/NGs tubes, 4. Room Assignments. - All are within the RN scope of practice!!!!!!
What three things
be called for? –
1. Acute epiglottitis, 2. Back pain (Abdominal Aortic Aneurysm (triple A)), 3. And Eye Pain (glaucoma or cataract surgery).
What is important to remember about prioritizing in the ER? - It won't be the obvious answer and don't be swayed by adjectives. Ex. Gentle, educated, strong
What should pregnant nurses avoid? – 1. 5th disease (slap face/Parvovirus), 2. Measles, 3. Varicella,
4. Internal radiation, 5. Isotopes, 6. And chemo drug handing.
What information do you need to know prior to starting your
shift?
What is important to know about evaluating a treatment? - All drugs/tx are used to bring a pt back to normal. A successful tx will always reverse the presenting signs and symptoms (ask why treatment
initiated). How are patients on the psych ward prioritized? – 1st: Physiological, ex: food, water, comfort 2nd: Change in psych behavior, 3rd: Safety
Who should float
nurses be assigned to? –
To patients with a condition similar to what they would see on their OWN floor, and , NEVER
or (They will
eat them up because they are so
manipulative). What kinds of patients could be assigned to an OB Closed abdominal surgeries, HTN,
float nurse? –
DM, Epidurals, And IV drips. If cardiac, maybe telemetry things because it’s similar.
What kinds of patients could be assigned to a MEDICAL SURGICAL FLOAT NURSE? – 1. DM, 2. DVT, 3. HTN, 4. SURGERIES, 5. CHRONIC CONDITIONS (only because that’s not there floor) so always chronic NEVER NEW PATIENTs (stable) 6. AND SEIZURES.
What types of patients should never be transferred from the OB floor to the med surg floor? - MOMS C BABIES, IN LABOR, OR C COMPLICATIONS
What patients are IMMUNOCOMPROMISED? –
What KILLS THE IMMUNOCOMPROMISED PATIENTS? – 1. Infection, 2. Live viruses (oral polio or varicella), 3. Pneumocystis Carnii Pneumonia (PCP) (danger to immcprd pts only).
What are examples of progressive
neurological diseases? ?–
1. Multiple Sclerosis, 2. Amynotrophic lateral Sclerosis (ALS), 3. Parkinsons, 4. Huntingtons Chorea,
5. Gullian Barre Syndrome, 6. Myasthenia Gravis, 7. And Scleroderma (hardening).
What are interventions for a patient with a progressive neurological disease who may have respiratory problems as a result? –
What should be done for effective infection control? –
Who should be ISOLATED? –
What type of patient should be discharged during an emergency? –
STABLE CHRONIC CONDITION.
DO NOT!
ACUTE SURGICAL PATIENTS
Pressure ulcers are considered chronic
What should be done 1ST AND 2ND if the event of a MED ERROR, PT INJURY, OR ATTEMPTED SUICIDE? –
1st provide care, ALWAYS!!!!! 2nd Then notify MD.
What meds/herbs should you make sure to ask patients if they are taking (so you can implement bleeding precautions)? –
What patients are on BLEEDING PRECAUTIONS? –
On Coumadin/heparin, Hemophilia, Problems with bone marrow, Chemo, Liver disease, HIV, DIC, ASA/NSAIDS, And Cancer.
Patients on/with what should ANTICOAGULATED PATIENTS: With low platelets, High PT or PTT, Or On Coumadin/heparin.
What should be given to a patient on Coumadin before they have surgery? When should it be given? - Aqua Mephyton (Vitamin K) is needed b4 surgery for someone on Coumadin so they don't bleed out (it helps coagulation). If it is D/C 24 hours before they may still bleed because it's not long enough prior to surgery so Vitamin K will help.
What needs to be done prior to transferring patient to another unit?
What ADULTS should be transferred to the Pediatric ward if necessary? – Adult with condition/tx similar to that which is seen in the pediatric population. (COPD is like cystic fibrosis, pneumonia is pneumonia).
How should Pediatric Patients be transferred to the Med Surg floor? –
What conditions require seizure precautions? – Cirrhosis encephalopathy, PIH (HTN), DTs, ICP, CVA, Meningitis, Brain surgery, and Head trauma.
What interventions are needed to prevent aspiration? - HOB elevated to eat, bed in low position, place on right side after eating, call bell in reach, suction available, and side rails elevated. What are the 2 general rules for vaccines? - No vaccine given if pt temp > 101 or on an antibiotic.
What is given to anyone with acute exposure to any infection or enlarged lymph nodes? –
What should be done for pain and discomfort? - Avoid
drugs, use nursing interventions (positioning, heat,
etc.), and when in doubt flush the patient out.
What is ? - MMR
with an
and flu shot
What is
with an ? - Diagnostic test with
/
for foleys/surgery.
What is CONTRAINDICATED with an Allergy to yeast? -
Hepatitis B vaccine
What is contraindicated with an Allergy to bananas, kiwi,
chestnuts, and avocado? - Latex/rubber What should you NEVER Massage? – Veins, Z-track, Pressure ulcers, SQ heparin, Wilms tumor, And Intradermal (PPD TB test).
For what things should you use massage? –
What procedures are done STERILE in the home? IVs Dressings Peritoneal Dialysis.
What procedures are done NON-STERILE in the home? – Foley catheter, Trach suctioning Insulin, Injections, Intermittent, And suprapubic catheters.
– Anytime a foreign object inserted into the body the complication may be rupture of the organ. Cold/ Dehydrated baby is the DEAD BABY.
Drunks and druggies commit SUICIDE Never discharge a WHEEZER Watch for MUSCLE and WEAKNESS.
A PATIENT WITH GLAUCOMA IS TREATED WITH - DIAMOX is used for GLAUCOMA patient to decrease aqueous humor. But here mannitol used for PAIN in the (eye).
SUICIDE: highest in patient that drink and /or take drugs.
ALWAYS bring the patient back to reality
--- Avoid selecting answers that advise----giving meds or using restrains When choosing NURSING INTERVENTION for patient problems-----STAY AWAY FROM CRY BABIES.
STRESS RELATED CONDITION PATIENT –
FLOATERS (NRSES WHO FLOAT FROM THE OTHER UNITS) - Assign the float nurse a condition they would see in their own ward. Give them the most stable patients.
RULE: ASSIGN OB FLOAT NURSE ( ex: They review data from special equipment like checking vitals, monitor HR, temp etc.
RULE: MED SURGE ASSIGN MED SURGE FLOAT NURSE –
WHAT IS THE MEANING OF PHYSIOLOGICAL SIGN IN PSYCH PATIENT - .Anxiety (also called or worry) is a psychological and physiological sign and also including vital signs of the patient...
