final 2.0 Flashcards
Where do we do a capillary glucose measurement?
In the side of the finger
Why do we wipe away first drop of blood?
Potential for extra fluid to alter readings?
Verbalize how you would take a capillary blood glucose measurement.
A capillary blood glucose measurement is taken thusly
Take all supplies to bed-side (including the scanner, strip lancette and swab)
Pick a finger that has no callouses on it or ask them to pick one
Squeeze finger, prick it with a lancette
Squeeze to make blood drop come out
Wipe away first one
Squeeze again, catch drop of blood on the reader of the strip
Read strip
What is DKA and how might it present in a patient?
Diabetic ketoacidosis wherein there is an overuse of ketones resulting in fruity breath and sweet-smelling urine. Excessive thirst too.
Draw up 4 Units of Insulin R and 12 Units of Insulin NPH in the same syringe. What order will you draw it up in?
Intermediate (N) swab and inject air into insulin N vial
Short (R) swab and inject air into insulin R vial
Short (R) Draw up R insulin
Intermediate (N) Draw up the N insulin
What kind of insulin are they and how fast will they work?
Intermediate (Normal) works in 2 hours
Short (Rapid) works in 30 minutes
Administer the injection. Verbalize what sites can be used for insulin and the angle of injection.
Stomach, back of the arm, upper back at a 45 degree angle
What is heparin?
Heparin is an anticoagulant
What are contraindications to Heparin administration?
Active bleeding, pregnancy, heparin-induced thrombocytopenia.
What is the correct size of subcutaneous syringe?
5/8ths of an inch syringe 1-1.6 cm
What is the maximum amount of volume in the subcutaneous site
Maximum 2 mls though that is debated
Why do we do a TB skin test
A TB skin test is done to test for tuberculosis via a mantoux test that will cause the skin to raise
TB injection test location
The location for the TB injection test is located in the middle of the forearm on the palm-side of the arm
Angle of TB test insertion
The needle should be nearly flush with the arm when injecting 5-15 degree angle
How do we read a tb skin test?
Must be read 48-72 hours after injection
Reading means looking for induration - a raised thickened area where injection was done
Immunocompromised people may show a positive result with a 5 mm area of induration, whereas a 15 mm area of induration is indicative of a positive result for healthy individuals
What other things might be given intradermal?
Allergy testing
Difference between filter needle and blunt fill
Filter needle has a rubber webbing to filter glass
Blunt fill is literally just a big needle that prevents needle stick injuries
Which do you use for a vial? An ampule?
Filter is for ampule, blunt-fill for a vial
What are some differences between vial and ampule?
Ampule’s are single use and need to be broken open
Vials are multi-used and should be swabbed beforehand if previously opened
if you have a single use vial and multi use vial, which would you draw up from first when mixing two medicaitons?
Draw from multi-use vial first as it cannot contaminate the single use vial
Single use to multi-use contaminates though
Name the different parts of a syringe
Plunger, barrel and tip
what are 3 parts of needles
hub, shaft, bevel
Would you draw up from a vial or ampule first if you were mixing two medications?
Draw up from vial first as ampoules are single-use and cannot be cross contaminated
How many liters would you put the oxygen to for: Nasal prongs
1-6 liters per minute
How many liters would you put the oxygen to for: Simple face mask
5-8 liters per minute
How many liters would you put the oxygen to for: Non-rebreather
10-15 liters per minute
What is a normal oxygen level?
95%+
What is normal oxygen for someone with COPD?
88-92
Signs of hypoxia include
restlessness , confusion , pallor , tachycardia and tachypnea, cyanosis of lips
What is the difference between High and Low flow oxygen delivery devices?
Low oxygen delivery devices suplement oxygen combine with room air while high delivery devices replace oxygen
Name two breathing exercises that require no equipment and how you would explain them to your patient.
Pursed lip breathing
Tripod position breathing
Verbalize the administration of nebulized medication
Insert mouth-piece into mouth and inhale the misted medication in slow, deep breaths for up to 10-15 minutes.
Atrovent and Ventolin, which would you give first and why?
This is a loaded question lmao
Atrovent is a scheduled maintenance med meant to prevent attakcs
Ventolin is a prn that provides immediate relief.
If you have to give both, you should PROBABLY go with the Ventolin first because it’s the EMERGENCY inhaler and trying to prevent an attack when its already happened is a bad move
What time of day is the best for sputum sample?
Early in the morning because built up mucous
What three elements do you assess in order to pronounce someone’s death?
One minute no apical pulse
One minute no breathing
No pupillary reflex
Under what circumstances can an RPN pronounce?
If the death was entirely expected based off of trends and condition and its ordered by doctor. It’s when it is sudden and out of nowhere that it’s time for a coroner
Rigor mortis
the stiffening of the body after death
Algor mortis
The cooling of the body after death
Livor mortis
The pooling of the blood in tissues after death resulting in a reddish color to the skin
What is the advantage of a subcutaneous butterfly
Ease of injections / less intrusive
Where can we put subcu butterflies
arms, stomach, legs
How would you prepare a subcutaneous medication for the first use of butterfly?
Prime it with 0.4 mL of the medication beforehand. I’m not going into detail because I suck lmao
What is the otic route?
ear
opthalmic
eye
What instructions do we give patients when taking Sublingual medications
Let medications entirely dissolve beneath tongue
Do not drink anything or swallow intentionally for 15+ minutes
What position do we put the patient in for rectal medication, such as suppositories and enemas?
left sims position
Transdermal patches deliver medication how?
through skin
What is the difference between buccal and SL?
Buccal is in the cheek, SL is under the tongue
What size needle size and gage do we use for IM?
Kinda depends on where we’re giving it
1-1.5 inches 22-25 gauge.
1 inch in the deltoid
1.5 in a THICC muscle
Name the 4 sites for IM and land mark, naming the appropriate anatomy
Vastus Lateralis (Divide lower leg in 3, inject at angle into middle muscle)
Deltoid (Three finger down from acromian process)
Ventrogluteal (Divide buttock into four twice, picking top left or top right quadrant both times)
Dorsogluteal (Opposite palm on greater trochanter, put fingers on anterior illiac spine, open up while sliding fingers on illiac crest)
What is the max volume for each site?
It’s like 3 mL’s for every muscle except deltoid (2mL)
What is the preferred site for adults? For children?
Ventrogluteal (according to the textbook anyways) for adults
Vastus lateralis for children (best developed muscle)
Why are women more prone to UTIS?
Shorter urethra than males and higher chance to be exposed to microorganisms in external environment
What are signs of UTI?
-fever, urinary frequency, urgency, difficult or painful urination, discomfort, burning, foul-smelling, infrequent or insufficient urination.
Polyuria
excessive urination
dysuria
painful urinaiton
oliguria
small urination
anuria
absence of urine
urinary frequency
voiding lots of times
retention
inability to empty baldder
neurogenic bladder
a urinary problem caused by interference with the normal nerve pathways associated with urination
Purpose of a bladder scanner
Scans the bladder to see if you need a catheter / presence of kidney stones probably
What is fecal occult blood test for?
This test is used to test for hidden blood within the stool that may be indicative of cancer
Advantage of condom catheter over urinary catheter?
Easier to remove, easier to clean, a touch more protective of groin
C+S urinary test
Testing for bacteria in urine
What is surgical asepsis
sterile technique. This is where we obliterate all microorganisms
What is a nosocomial infection
infection
hospital acquired infection
Standard Precautions
used with every patient-hand hygiene &ppe (blood &body fluid)
Cytotoxic precautions
-when patient is on cytotoxic medications, body fluids are contaminated for 48 hrs after last admin of cytotoxic med-double glove, long sleeve moisture resistant gown, eye/face protection
contact precautions
-infections caused by direct or indirect contact-gown and gloves for any contact with patient or environment
contact plus precautions
same as contact but need to use soap and water for hand hygiene Typically in use for C. Difficile
Droplet precautions
-microbes transmitted by droplets produced by coughing, sneezing or talking-private room or cohort patients-mask & eye protection within 2m of patient-gown and gloves while caring for the patient(influenza)
Airborne precautions
-microbes transmitted by airborne droplets-private room, door closed, negative pressure airflow-N95, gown gloves & goggles if risk of contact with splash or sprays (tb & measles)
What is the chain of infection?
infectious agent
reservoir
portal of exit
mode of transmission
portal of entry
susceptible host
infectious agent
reservoir
portal of exit
mode of transmission
portal of entry
susceptible host
Donning: Hand hygiene –> Gown —> Mask —> Goggles —> Gloves
Doffing —> Gloves —> Hand hygiene —> Gown —> Eye protection —> hand hygiene —> Mask —> Hand Hygiene
When are the 3 checks performed for medication preparation?
-Check the label against the medication form three times:
(1) before removing the container from the drawer or shelf
(2) when the amount of medication ordered is removed from the container
(3) before returning the container to storage.
Which tablets can be broken?
Anything but capsules and enteric-coated drugs
What does the count of controlled substances at the end of a shift include?
- Count narcotics frequently. Count and record inventories on a continuous basis, especially when narcotic drawers are opened and when nursing shifts change.
- Report discrepancies in narcotic counts immediately.
- Students are never going to be asked to conduct the count
What are the 3 most common types of syringes?
Luer-Lok Syringe (marked in 0.1, or tenths of milliliters)
Tuberculin syringe (marked in 0.01 or hundredths of milliliters)
Insulin syringe
How much medication can be injected via the subcutaneous route?
2 milliliter
How do you decide whether to inject at a 45-degree or a 90-degree angle for subcutaneous injections?
Depends on patient weight. 45 degrees usually, Obesity makes 90 degrees more pertinent
3 Characteristics of NPH insulin (insulin N)
*Intermediate acting (onset ~2 hrs)
*Medication has a cloudy appearance
*Given once or twice a day - works to keep pt’s blood glucose stable throughout the day
(BONUS: Roll the cloudy insulin in hands to re-suspend before drawing)
3 Characteristics of regular insulin (Insulin R)
*Short acting (onset ~30 minutes)
*Medication is a clear liquid
*Often used to correct a patient’s blood sugar prior to meals, using a sliding scale dose
what size needle and gauge is used for subq
25 gauge, 1.6cm needle at 45 degree angle for normal sized patient
Why does the nurse wipe/clean the clients's eye from the inner canthus to the outer canthus?
As to prevent bacteria, dirt, or other things from getting into patients eye
