406 Midterm Flashcards
Break up the presentation/question into parts (cues) to determine meaning (i.e. normal vs. abnormal). Identify cues.
Analyzing
Cluster cues to determine meaning
Analyzing
Generates hypotheses
Analyzing
Use research based standards/rules to rule in or rule out hypothesis
Applying standards
NDX defining characteristics, related factors and risk states; patho
Applying standards
Making a judgment as to “fit”
Applying standards
Look for differences and similarities
Discriminating
Does this help confirm or disconfirm hypothesis
Discriminating
Do you need Lab data? Further physical assessment?
Information seeking
Draw conclusions
Logical reasoning
If this then probably that
Logical reasoning
Confirm or disconfirm DX
Logical reasoning
Predict potential patient problems and envision a plan & desired outcomes .
Predicting
How will this prob/plan affect patient safety? If I do this then….
Predicting
How will you recognize this same concept/problem in other situations?
Transforming knowledge
Are you confident in your reasoning abilities?
Confidence
Have you considered the entire context of this problem? Age, co-morbidities, medication, etc
Contextual perspective
Were you creative when you generated or restructured ideas? Did you think of alternatives?
Creativity
Did you consider multiple possibilities? Did you get stuck on one train of thought?
Flexibility
Were you eager to correctly interpret the situation/problem and did you use observation and thoughtful questioning to explore possibilities?
Inquisitiveness
Did you use research-based process and research-based criteria to interpret the situation/problem?
Intellectual integrity
Guessing without a basis for deriving meaning does not count
Intellectual integrity
Did you recognize anything that seemed familiar from past experiences?
Intuition-pattern recognition
Were you open to other possible interpretations of the situation/data?
Open-mindedness
Did you constantly reflect on your thinking, assumptions, and decisions to assure accurate interpretation of data
Reflection
QSEN: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care
Patient-centered Care
QSEN: Honor learning opportunities with patients who represent all aspects of human diversity
Patient-centered Care (attitude)
QSEN: Seek to understand one’s personally held attitudes about working with patients from different ethnic, cultural and social backgrounds
Patient-centered Care (attitude)
QSEN: Value cultural humility
Patient-centered Care (attitude)
QSEN: Respect the boundaries of therapeutic relationships
Patient-centered Care (skill)
QSEN: Integrate principles of effective communication with knowledge of quality and safety competencies
Patient-centered Care (knowledge)
QSEN: Value consensus
Patient-centered Care (attitude)
QSEN: the process of reflective practice
Patient-centered Care
QI definition: use
data to monitor the outcomes
QSEN: Assure ethical oversight
QI
QSEN: Explain common causes of variation in outcomes of care in the practice specialty
QI
QSEN: Appreciate how unwanted variation affects outcomes of care processes
QI
QSEN: differences between micro-system and macro-system change
QI
Informatics
Use information and technology to communicate, manage knowledge, mitigate error, and support decision making
What’s wrong with this order: 10 mg morphine, IM, Q4h, prn for pain
the dose is too high
Acute cholecystitis: clear liquid diet; progress to low fat as tolerated
Wrong. Patient should be NPO until bowel sounds return
What’s wrong with the order: O2 per protocol to maintain POX at 95%
not specific; need to know the rate and dose
Cholecystectomy for acute cholecystitis: before the dangle at the side of the bed
give pain medication
2 days post op, consideration for temperature
Normal for it to be elevated slightly at this point
What is the GI complication of morphine
constipation
what is the serious complication that a d-dimer test can rule out
PE
MI case: Yes or No: Basal metabolic panel
Yes
MI case: Yes or No: PT and PTT
Yes
MI case: Yes or No: bilirubin
No
MI case: Yes or No: Urinalysis
Yes (to assess kidney function)
MI case: Yes or No: Type and crossmatch for 2 units of packed RBCs
No
MI case: Yes or No: chest x ray on admission and in morning
Yes
MI case: besides pain management, why give morphine?
Increases cardiac perfusion (by decreasing O2 demand)
primary MI NDX
Alteration in cardiac tissue perfusion r/t myocardial ischemia secondary to coronary artery occlusion
MI NDX: Fear
Fear and anxiety related to impending doom secondary to MI
MI NDX: Activity
Activity intolerance related to decreased cardiac reserve
MI NDX: knowledge
Deficient knowledge related to lack of information
PT range
11 to 14
PTT range
25 to 35
INR range
0.8 to 1.2
hemoglobin range
about 12 to about 17
hematocrit range
about 35 to about 50
Lantus
long acting insulin
What time of day should Lantus (long acting insulin) be taken
bedtime
Onset of lantus (long acting insulin)
5 hours
Duration of lantus (long acting insulin)
24 hours
Hypoglycemic patient with DM: NDX:
Alteration in tissue perfusion r/t inadequate supply of glucose in the brain
Cold weather can be a precipitating factor in
angina
MI case: Yes or No: CBC
Yes
MI case: Yes or No: electroencephalogram
No
Patient has cigarettes at hospital
ask family to take them home
MI: decreasing chest pain also decreases ___
anxiety
MI: patient is instructed not to ___ ___
bear down
MI: patient is not allowed to g___________ by themselves
go to the bathroom
MONA
morphine, oxygen, nitroglycerine, aspirin
nitro has a _____ effect
vasodilation
action of aspirin in MI:
antiplatelet
MI: morphine reduces __load
preload
MI: don’t give morphine if rr is below
10
MI: check pt ___ min after giving morphine
30
MI: give morphine over ____ min
4 to 5
MI: no ____, bed pan with assistance
commode
MI: put them on __ __
bed rest
MI: give __ __ for HTN
ace inhibitor
eject fraction
normal is 50 to 70. It’s the amount shot from left vent.
CVA case: first order to be carried out
administer O2
CVA case: Contraindicated for fibrinolytic therapy? taking warfarin and has INR of 2.4
Contra
CVA case: Contraindicated for fibrinolytic therapy? Major surgery in last 14 days
Contra
CVA case: Contraindicated for fibrinolytic therapy? Systolic BP 150
Not contra
CVA case: Contraindicated for fibrinolytic therapy? Platelet less than 100,000
Contra
CVA case: Contraindicated for fibrinolytic therapy? Blood sugar less than 50
Contra
CVA case: Contraindicated for fibrinolytic therapy? H/o MI 1 year ago
Contra
CVA case: The patient had a thrombolytic infusion. How long should you wait before giving anticoagulant or antiplatelet meds?
24 hours
How does a statin benefit a CVA patient
- Prevents narrowing of vessels
- Prevents platelet aggregation
CVA case: modified barium swallow study is to r/o
aspiration
CVA case: Non contrast CT should be done within __ __ and read within 45 minutes
25 min
CVA case: you must give the thrombolytic within
3 hours
How long does it typically take for bowel sounds to return
24 to 48 hours
Hypoglycemia/DM case: the main dx could be
acute confusion
Hypoglycemia/DM case: Give 4 ounces of juice of
soda (not diet soda)
Hypoglycemia/DM case: Give 8 ounces of
milk
Hypoglycemia/DM case: give 7
life savers
Hypoglycemia/DM case: 1 tablespoon of
sugar
Hypoglycemia/DM case: 3
glucose tablets
Hypoglycemia/DM case: 2 tablespoons of
raisins
Hypoglycemia/DM case: A safety precaution
seizure precautions
Hypoglycemia/DM case: offer sugar followed by
carb and protein
DVT activity level instructions
bed rest, but permitted to move about the bed
DVT patient should be on bed rest, position legs
elevated but don’t put pillows under the knees
Where in the hospital is an MI patient given thrombolytics
the ED (don’t wait until they get transferred)
Can nurses give morphine by IVP
only if they certified
Pt has an anaphylactic reaction, treat with
epinephrine and benedryl
Morphine’s half life is approx
2 hours
Morphine’s onset
5 min (IV), 15 min (IM), 20 min (PO)
Need to be careful giving morphine to an asthma patient because
they already have resp issues
Patient has h/o seizures; morphine will
worsen it
morphine dose for older adults
should be smaller
Morphine can prolong
labor
Morphine can show up in
breast milk
Breathing pattern of morphine OD
cheynne stokes
DM patient: nervousness and tachycardia are signs of
hypOglycemia
dose of an IM glucagon
1 to 2 mg
Glucagon revives the patient rapidly, but they will be
confused
regular insulin peaks around
2 to 3 hours
Lantus doesn’t have a very distinct
peak (even though the other card says 5 hours)
What about cookies and ice cream for a hypo glycemic?
not the best because high fat foods slow down absorption
CT skill that includes following hospital policies
Applying Standards
A1C is not used for
children
A healthy BMI is below
30
In which part of SPAR do you put the Vitals
Assessment
What is the criteria for removing an NG tube
when nothing else is coming out in the suction
Pt has been NPO and needs oral care: one option is
glycerin swabs
Hallmark sign of atelectasis
diminished breath sounds
Warfarin: therapeutic INR is
2.5
A fib can lead to thrombus formation because
the blood is stagnant
