Class notes
graces review
- Course
- NUR 283 Comprehensive
- Institution
- Galen College Of Nursing
the Grace's review for nur 283 comps
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Graces ReviewsRattle #1 October 13th:
Post op—Nurse should do first vitals & get patient up first
o Make sure they can bear weight!
Blood transfusion
o Fluids-NS
o How long to hang blood?
4 hours, have 30 minutes to hang it from when you get it
o Reaction what next?
Stop it!
o Stopped it, now what?
Disconnect, pull back blood, hang new NS with new tubing
o What you need before you get blood?
Vitals, type & cross, consent, verified orders, 18-20 gauge needle*
Flu- what isolation?
o Droplet (mask, goggles & gloves)
NG tube
o Listening to BS, what you do before that?
Turn off suction
Afib on the monitor, physician will order what?
o Anticoagulants, Diltiazam, Amiodarone, SCDS, Compression socks
Vfib= Defib; if no defibrillator= CPR
Who can remove a chest tube?
o MD only
o If bubbling, what do you look for?
Leaks or kinks
*gauge is too high!
Car seat safety
o Strap= armpit
o Rearfacing in the middle seat and anchored
Burns
o Rule of nines:
1 arm= 9%
1 leg= 18%
Torso= 18%
Back=18%
Head= 9%
Genitals= 1%
First sign of rejection from a stem cell transplant or organ transplant?
o 1 degree increase in temperature
Atherosclerosis- what would you avoid eating?
o High cholesterol foods
, Egg yolks
o Cholesterol levels: <200 total cholesterol
HDLs: >55 for females, > 45 in males
LDs: <130
Writing something bad= libel
Talking badly about someone= slander
Alternative to restraints = music
What can an RN delegate to an LPN?
o They can pass certain meds, tube feeds, accu checks, wound dressing changes, medical
hx
o RN can not delegate what they EAT (evaluation, assessment, and teaching)
o LPN can reinforce, and reassess
Pt comes from OR, what would you do?
o #1= verify the patient, look at arm band!
o #2= Assess the patient
Pt comes up from endoscopy/surgery, on clear liquids and they start coughing, what are we
concerned about?
o Aspiration, not ready to drink! Watch them!
When should an infant be able to smile?
o 3-4 months
When should a child be able to hold a sippy cup?
o 9-12 months
When should a child be able to pull themselves up on an arm of chair/couch?
o By 9 months
If the child is not meeting these milestones what are they?
o Delayed
What is the primary cause of Anaphylactic shock?
o Allergy/ allergic response/ reaction
What is the primary cause of hemorrhagic/ hypovolemic shock?
o Blood loss
What is the primary cause of neurogenic shock?
o CNS damage
What is the primary cause of cardiogenic shock?
o Pump failure/ Decreased cardiac output
What is the primary cause of septic shock?
o Sepsis/ infection
What is shock?
o It is a decrease in perfusion to vital organs
What is the first organ to fail?
o Kidneys
What are you primarily looking for with a patient with AKI?
o Decreased urinary output
What lab in shock will come up in septic shock?
, o Lactic acid
What are interventions for shock?
o Pharm: Fluids, vasopressors, then tx underlying cause
Anaphylaxis, what body system response causes the primary problem?
o Vascular, dilate (vasodilation)-- give vasopressors to constrict
Cardiogenic shock body system problem?
o MI- sternal chest pain
o Left side big, stretched out= Left sided heart failure/ cardiomyopathy
Blood loss with hypovolemic shock= hypovolemia
o Causes are DI, burns etc
o Stop bleeding and fluids
Anaphylaxis- what drugs?
o Epinephrine, Antihistamine and diphenhydramine (benadryl)
What is the treatment of cardiogenic shock?
o Decrease in cardiac output
o Could be MI, HF or cardiomyopathy
o Drugs? Dopamine, Dobutamine, and Epinephrine
Hypovolemic and Burns?
o Fluid resuscitation
Laceration of a major artery, what is priority?
o Stop the bleeding!
Neurogenic shock- loss of vessel tone, won't constrict properly= vasodilation
o Add fluids
Septic shock caused by sepsis what happens to vessels? Vasodilation
o ARDS can happen (ARDS- refractory hypoxemia, tx: PEEP)
o Antibiotics, fluids and vasopressors
Septic shock can move into respiratory distress syndrome if they stay in a compromised state.
o What drug would be used to tx underlying cause of sepsis?
Antibiotics
Heparin drip going, you make a change per order, what safety measure is needed?
o 2 nurse verification!
o What labs do you watch for Heparin?
APTT, PTT and platelets
Patient asks if TPN can be disconnected what is the response? NO b/c they could go
hypoglycemic
o If it is disconnected, what do you hang?
D10
Witnessing medication;
o 2 mg morphine, but only need 1 mg?
Waist before you administer!
MI s/s: chest pain, jaw pain, increase HR, N/V, indegestion, DIAPHORESIS
o Tx MI with MONA:
M= morphine
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