Mark Klimek Nuclex Review

Mark Klimek Nuclex Review 5/9 Prioritization & Delegation • Completely get rid of age and gender, they do not matter. A two year old is not more valuable that a 90 year old, men are not more valuable than women • Modifying phrase is always more important 1. An acutely ill person is higher priority than chronic 2. Fresh post op beats medical or other surgical 3. Unstable beats stable 4. The more vital the higher the priority. Is it the organ of the modifying phrase? • What makes an answer stable? Use of the world stable. What makes an answer unstable? Use of the world Unstable • Stable- Chronis Illness, post op greater than 12 hrs, local or regional anesthesia, lab abnormalities of an A or B level, ready for discharge, to be discharged, or admitted longer than 24 hours ago, unchanged assessments, experiencing the typical expected signs and symptoms of the disease with which they diagnosed. Unstable- Acute, post op less than 12 hrs, general anesthesia, Lab values of an C or a D, not ready for discharge, newly admitted, newly diagnosed, or admitted less than 24 hours ago, changed assessments, experiencing unexpected signs and symptoms. Hemorrhage, always bad even if its expected. High fever of over 105. Hypoglycemia. Pulselessness, breathlessness. Witness the event. • When you get a symptom on a question do not look how bad it is, look if it is expected in the disease. Delegation • Do not delegate the following to an LPN: o Starting IV’s o Hanging or mixing IV meds o Pushing IV meds o Administer blood or anything having to do with a central line o Plan of care o Perform or develop teaching o Not allowed to take care of unstable patients o Can not do the first of anything o Admission assessments o Discharge or transfers o • Do delegate the following to an LPN: o Maintain and document the flow of IV meds o Implement care plan o Reinforce teaching • Do not delegate the following to an UAP o Cant chart on patients care o Not allowed to give meds o Not allowed to do assessments o No treatments except enemas • Do delegate the following to an UAP o Topical over the counter barrier cream o ADL’s o Bed baths • Do not delegate the safety of a patient to a non hospital person, for example the family of a patient. Staff Management • You never ignore inappropriate staff behavior • Is what they are doing illegal? Tell supervisor. • Is anyone in immediate danger of physical or psychological harm? Confront immediately and take over. • Is the behavior not illegal, not harmful but inappropriate, approach them later on and talk to them Point and Click • Aortic - second intercoastal space at the right sternal border • Pulmonic- second intercoastal space left sternal border • Tricuspid- 4th intercoastal space left sternal boarder • Mitral valve- 5th intercoastal space mid clavicular line *apical point* How to guess • Establishing a trusting relationship in psych Nutrition • In a tie, pick chicken! Not fried chicken • Pick fish, not shellfish. • Never pick casserole for children. • Never mix meds in children’s food • If you do mix meds in adult food, you need permission • For toddlers, finger foods Pharmacology • If you know the drugs you don’t know the side effects? Pick a side effect of the same system the drug is asking about • If its PO pick a GI side effect OB • Assess fetal heart rate Medsurg • Airway Growth and development Always give the child more time 1. When in doubt call it normal 2. When in doubt pick the older age *the older age in the one it could be* 3. Always pick the easiest task General Guessing 1. Rule out absolutes 2. If two answer say the same thing, neither of them are right 3. If two answers are opposite, one of them are probably right 4. Umbrella term- an answer so broad that when you do it, it covers all the others 5. If the question gives you four right answers, worst possible outcome game. What would happen if I didn’t do this? 6. When youre stuck between two answers, reread the question 7. Sesame street rule- right answer tends to be different than the other. All the wrong answers share something in common- they are wrong 8. If you don’t know what something is, take it out of the question and see what you DO know. 9. Always go with your gut answer, only change if you can prove that the other answer is superior, not good Obstetrics Fetal monitoring patterns- 7 you should know • Low fetal hear rate: under 110 , bad, you do LION Left side, IV, O2, Notify. If Pitocin is running, you stop it • High fetal heart rate: over 160, no big deal, document, take moms temp • Low baseline variability: stays the same, does not change, that’s bad, you do LION Left side, IV, O2, Notify • High baseline variability: babys heart rate is always changing, that’s good, document it • Late decelerations: late means near the end of a contraction, and decelerations mean slow down. Fetal Heart rate slows down near the end or after a contraction, this is bad, you do LION • Early decelerations: heart rate slows down before or at the beginning, normal, document • Variable decelerations: prolapse cord, VERY BAD, push position If it starts with an L, bad needs LION, if it doesn’t, its ok. If its variable, its very bad so push position V- Variable decelerations C- Cord compression E- Early decelerations H- Head Compression A-Acceleration O-Ok L-Late decelerations P- Placental Insufficiency Second stage: Delivery of the baby 1. Head first 2. Suction of the mouth first, then nose