195 Flashcards by Alayna Johnson

What are the 5 rights to delegation?

1. Right task (w/in scope)
2. Right circumstance (stable vs nonstable)
3. Right person (who can perform task w/in scope)
4. Right supervision (report back/ trust but verify)
5. Right direct & communication (be specific)

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How should a LPN assign & delegate a task?

Collect data - Get report from previous shift, pt assessment

Plan - Establish goals for the shift, set priorities

Implement - monitor, assist, being avalible, intervene

Evaluate - Give feedback

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What must you make sure of when delegating to an UAP & What can you delegat to a UAP?

Is the task w/in the UAPs scope & does the UAP have the knowledge, skills, & ability to perform the task

Can delegate:
* OTC topical meds to intact skin
* OTC eye/ear drops
* Suppository meds
* Foot soak tx
* Enemas

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What can you NOT delegate to a UAP?

Assessments & judgement calls

Prescription meds

Unstable Pts
* Ex -Postop pt (surgery/ procedure return), Multiple seizures

Pt education
* Ex - Discharge instructions

TIP: You cannot delegat what you EAT
E - educate
A- Assess
T - Teach

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Promote specific improvement in Pt safety
* Important to delivery of safe, high quality of life

Goals: Address identification problematic areas across health care

National Patient Safety Goals (NPSGs)

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What are some ways to ensure the National Patient Safety Goals (NPSGs) are met?

Identify Pt correctly
* Use double identifier

Improve staff communication
* Give important test results to right staff on time

Use medications safely
* Label meds, take extra care of Pts on blood thinners, pass/record medications, compare meds to new meds, tell Pt to bring in up-to-date med list to Dr visits

Prevent infection
* Use standard precaution or sterile tech

Use alarms safely
* Make improvements to ensure alarms on medical equipment are heard & responded to on time

Identify Pt safety risk
* Reduce risk for suicide

Prevent mistakes in surgery
* Make sure correct surgery is done to the correct body part on the correct Pt & pause before surgery to make sure no mistakes have been made

Improve health care equality
* Health care disparities in the patient population are identified and
a written plan describes ways to improve health care equity.

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What are the Maslows Heirarchy levels from bottom to top?

Physiological
* Breathing, food, water, sex, sleep, homeostasis,excretion

Safety
* security of body, of employment, of resources, or morality, of the family, of health, of propery

Love/belonging
* Friendship, family, sexual intimacy

Esteem
* Self esteem, confidence, achievement, respect of others, respect by others

Self actualization
* Morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts

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How do nurses set priorities?

Priority 1 - ABCs, Vitals, Labs:
* Airway problem
* Breathing problem
* Cardiac/circulation problem
* Vital signs concerns
* Lab values that are life threatening

Priority 2:
* Change in mental status
* Untreated medical problems (Ex- Diabetic who hasnt had insulin)
* Pain
* Urinary elimination problems

Priority 3:
* Health problems that dont fit into first 2 categories (Activity/rest, family coping, lack of knowledge)

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Make all decisions & are generally more concerned w/ tasks to be accomplished

Maintain distant from followers, motivating them through threat of punishment & offering reward incentives

Often used when decisions need to be made quickly
(Emergencies)

Autocratic Leaders

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Involved in followers decision making process by using a participatory leadership

Useful when followers are experienced workers
* Professional education/socialization

Effective when followers are committed to goal

Help followers develop technical/emotional maturity

Democratic Leaders

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Do not interfere w/ employees and their work - Stand distant

Provide minimal info to followers
& have little communication w/ them about work

Works best when followers are highly experienced in their work, but often result in emplyee apathy, ineffectivity, & chaos

Authentic Leaders

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“Brain attack” - medical emergency
- S/s appear suddenly
- occurs more in men

S/s:
-“worst headache ever” (Hemorrhagic)
- stiff neck (Hemorrhagic)
- loss of consciousness (Hemorrhagic)
- seizure (Hemorrhagic)
- depends on area affected (Ischemic)
- one sided weakness (unilateral; Ischemic)
- vision changes (Ischemic)
- confusion (Ischemic)
- headache (Ischemic)
- dysphagia (Ischemic)

2 types:
- Hemorrhagic: hemorrhage into brain; shows on CT
- Ischemic: formation on embolus/ thromboses that occluded an artery; does NOT show on CT

Stroke (CVA - Cerebrovascular Accident)

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What does BEFAST stand for?

B - Balance: sudden loss of balance?

E - Eye: vision changes?

F - Face: droop? have smile

A - Arms: weakness?

S - Speech: strange/slurred

T - Time: LKW, TPA given
w/in 3 hr

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What are modifiable/non-modifiable risk factors for a stroke?

Modifiable:
- DM, HTN, high cholesterol, heart disease
- smoker, alc.
- obesity, sedentary lifestyle

Non-modifiable:
- age (50-75), gender (men)
- race, hereditary (latino, AA d/t HTN)
- previous hx

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What neurological deficits could occur after a stroke?

Aphasia, dysarthria (communication issue)

Dysphagia (aspiration, malnutrition, check gag reflex, swallow study - swallowing trouble)

hemiplegia

unilateral neglect (patient doesn’t believe or “forgets” that side doesn’t work)

sensory impairment

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What are some diagnostic tests for a stroke?

CT (fastest, determines stroke type - 1st)
-w/o contrast

MRI (2nd), ECG/EKG

EEG (later)

Cerebral & carotid angiography

Blood studies (lipid, PT/INR)

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Deficient blood flow to the brain from a partial or complete occlusion of an artery (clot)

Causes:
- Thrombotic (atherosclerosis; coagulation disorder/ chronic hypoxia)

Embolic (thrombus is endocardial layer of heart; rheumatic heart disease)

treatment:
- Thrombolytics such as tissue plasminogen activator (tPA, alteplase; acute ischemic stroke)

digests fibrin and fibrinogen and thus lyses the clot
platelet inhibitors and anticoagulants given if stroke is caused by thrombus or embolus (ischemic stroke) to prevent more clots (must be given after 24hrs if treated with TPA)

Ischemic stroke

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Results from bleeding into the brain tissue or subarachnoid space
- the bleed causes damage by destroying and replacing brain tissue

an aneurysm is often the cause of hemorrhage

treatment:
- craniotomy: clipping the aneurysm/ removing the clot to prevent re-bleed

hemorrhagic stroke

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What are some ways to prevent a CVA (stroke)?

Quit smoking

Weight loss

BP control (avoid HTN)

Reduce saturated fats

Pt education

DM dx test

Measures average blood glucose reading and estimates glucose control for the prior 3 months

A reading of 6.5% is indicative of diabetes

An A1c of 70% has been associated w/ reduced risk for complications of diabetes
* recommended goal for glucose control

Glycosylated hemoglobin (HgbA1c)

Waste product of skeletal muscle breakdown
* Renal function test

Not influenced by diet, hydration, nutritional status, or liver function

Lab value: 0.6-1.2

absence of endogenous insulin
- NO oral glucose

Autoimmune process possibly triggered by viral infection, destroys beta cells (insulin)
- if sick, check BS q2-3hr, give insulin as scheduled & check urine (BS >200 breaks down ketones)

Affected people need exogenous insulin for life

Goal: Have controlled Bs
- BS 120-140 depending on person

Type 1 DM

How do you manage Type 1 DM?

Med therapy:
- IV insulin drip (regular/short)

Nutrition therapy:
- Monitor calories & weight

Check BS before exercise

Manage stress/ acute illness
- increased BS d/t cortisone (counter reg. hormone)

Snack in middle of day and before bed to prevent BS from decreasing at night

What are s/s of type 1 DM?

Polyuria (dehydration/ hypovolemic shock)

Polyphagia (no glucose for cell energy)

polydipsia (d/t diuretics)

weight loss (10lb/week)

weakness/fatigue

Hyperglycemia/DKA

which insulin used for sliding scale?

Rapid-acting insulin (Humolog (lispro), Novolog (aspart))

Regular/short acting insulin (Humulin , Novalin)

Can be controlled by sedentary lifestyle and increase of activities
- NOT insulin dependent
- insulin sensitivity may decrease

Older adults
- 80% overweight
- Gradual, may be Asymptomatic
- Hx high BP

S/s like type 1

treatment: diet, exercise, & oral meds

Type 2 DM

What does type 2 DM result from?

High cholesterol

High BP/ HTN

Obesity

Insulin resistance

oral hypoglycemic that reduces hepatic glucose production and lowers fasting blood glucose levels
- initial treatment for T2DM

Increases use of glucose in muscle cells

Does not cause hypoglycemia when used alone but increased risk when used with sulfonylurea d/t increase in insulin

Adverse reaction: Lactic acids

BLACK BOX WARNING - Do not give w/ radiologic contrast (can lead to kidney failure & Lactic acids)
- HOLD MED 48hrs after contrast

monitor for hypoglycemic reactions, renal studies, & CBC

Metformin (Glucophage)

oral hypoglycemic that stimulates the pancreas to secrete insulin lowering blood sugar by causing the release of your body’s natural insulin
- Piggy backed w/ metformin (increases risk of hypoglycemia)

used with a proper diet and exercise program to control hyperglycemia in T2DM

Decreases glucose production & metabolism by liver

Adverse reaction:
- Hepatotoxicity
- Jaundice
- Hypoglycemia

Assess for hyper/hypoglycemic reactions & monitor vitals

Can increase liver function and kidney function labs

Glipizide (Glucotrol XL)

What is the normal RBC range?

4.0-6.0 million (x10^6/mL)

NCLEX QUESTION

The nurse receives a call from a client with type 2 diabetes. The client reports mid-morning blood sugars in the 60s for the last three days. Which oral antidiabetic medication is most likely causing this reaction?

A.) Sitagliptin phosphate, 100 mg, once per day

B.) Metformin, 1,000 mg, twice per day with meals

C.) Glipizide, 10 mg, daily 30 minutes before breakfast

C.) Glipizide, 10 mg, daily 30 minutes before breakfast

Explanation: Glipizide is a sulfonylurea oral antidiabetic medication that works by stimulating insulin release from the pancreas, reducing glucose produced by the liver, and increasing insulin sensitivity

NCLEX QUESTION

Which medication is most likely to cause hypoglycemia when taken alone

A.) Sitagliptin
B.) Glipizide
C.) Metformin

B.) Glipizide

Explanation: Glipizide is a sulfonylurea medication used to increase the release of insulin from the pancreas

What is the therapeutic rang for INR for a Pt taking warfarin?

Therapeutic - 2-3

Normal - 0.8-1.2

What are the normal Renal panel levels?

Ca 8.5-10

Mg 1.5-2.5

Phos 3-4.5

What is the normal calcium (Ca) level?

8.5 - 10 mEq/L

What is the normal sodium (Na) level?

135-145 mEq/L

What is the normal Potassium (K) level?

3.5-5.0 mEq/L

What is the normal lab value range for platelets (PLT)?

150,000 - 400,000 Cells/mcL

ACE Inhibitor

Use: HTN, HF

Route: PO

Contradictions: Hx angioedema (black folks at greater risk of developing), Pregnancy

Caution with:
* Renal dysfunction
* Ischemic heart disease

Adverse reactions:
* angioedema
* Acute renal function

Assess/monitor:
* Renal/Liver function
* Serum electrolytes
* Signs of angioedema in face, lips, throat, or intestines
* Obtain BP before admin - Notify HCP if SBP < 90

Lisinopril

Antihyperlipidemics

Use: hyperlipidema

Adverse reaction:
* Rhabdomyolysis
* Hepatotoxicity

Caution w/:
* Elderly
* Renal failure
* Liver failure

Assess/monitor:
* Lipid panel
* Liver function
* serum Cr kinase
* Presence of muscles

Pt education:
* Avoid alc.
* Report unexplained muscle pain, tenderness, or weakness
* Consult provider before starting new medications d/t numerous drug interactions

Simvastatin (Zocor)

Loop Diuretic

Use: Edema associated w/ HF, renal failure, & cirrhosis of the liver

Adverse reaction:
* Hypotension
* Severe electrolyte imbalance resulting in cardiac arrest

Assess/monitor:
* Obtain BP before admin - notify HCP if BP < 90
* S/s of hypokalemia (weakness/fatigue, palpitations, numbness/tingling)
* Serum K, Na, & Ma levels

Pt education:
* Change positions slowly to prevent orthostatic changes, especially w/ elderly
* Increases urion O/P

Furosemide (lasix)

Thiazides

Use: Edema, HTN

Adverse reaction:
* Electrolyte imbalance
* Hepatotoxicity
* Renal failure
* Pulmonary edema

Assess/monitor:
* Obtain BP before admin - notify HCP if SBP < 90
* Presence/ resoultion of edema
* Serum electrolytes
* I/O, daily weights

Pt education:
* Notify provider before beginning any new drug/ supplememnt
* Increases urine O/P

Hydrochlorothazide (HCTZ, Microzide)

Anticoagulant/ antiplatelet - IV, SubQ

Use:
* Afib, DIC
* Venous thromboembolism prophylaxis or Tx
* Venous cath. occlusion
* Warfarin bridging

Contradictions:
* Severe thrombocytopenia
* Uncontrolled active bleeding

Caution w/ severe HTN, Hx thrombocytopenia, Hepatic Disease, Major surgery

Adverse affects:
* Heparin- induced thrombocytopenia (HIT)
* Anemia
* Thrombocytopenia
* Bleeding

Assess/monitor:
* Signs of bleeding before administrating medication
* Heparin aPTT/ AntiXa labs for dose titration for Pts on GTTs
* Platelets, INR (If on warfarin)
* Hgb, Hct, Liver function

Pt education:
* Rotate injection site
* Report signs of thrombocytopenia / Bleeding

Enoxaparin (lovenox)

Anticoagulant/ antiplatelet
* can be taken w/ or w/o food

Use:
* Acute MI
* CVA, PAD
* Prevention of thrombosis after PCI

Contradictions: Active bleeding

Adverse reaction:
* Agranulocytosis
* GI bleed
* Intracranial hemorrhage

Asses/ monitor:
* Signs of bleeding before admin. medication

Pt education:
* Report S/s of bleeding
* Inform provider about use of drugs prior to procedures that may cause bleeding
* Do not discontinue abruptly
* Do not take w/ NSAIDs d/t increased risk for bleeding

Aspirin (Bayer)

How would you label a math problem involving fluids on a pump/ infusion?

mL/h

How many lb equal 1kg?

2.2lb

National standards for electronic health care transactions and code sets, unique health identifiers, and security

Rule set national standards for the protection of individually identifiable health information by three types of covered entities: health plans, health care clearinghouses, and health care providers who conduct the standard health care transactions electronically
* Compliance with the Privacy Rule was required

Health Insurance Portability and Accountability Act (HIPAA)

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195 Flashcards

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