prioritization marky mark edition

Question 1

importance of age and gender

Answer 1

NOT IMPORTANT, age is important in peds

MODIFYING PHRASE = most important

Question 2

four rules for prioritization

Answer 2

1. acute beats chronic
2. fresh post op (12 hr) beats medical or other surgical
3. unstable beats stable
   $$$$ four things that always make you unstable even if expected
   - hemorrhage
   - high fevers over 105 can lead to seizures
   - hypoglycemia can lead to brain damage
   - pulseless or breathless ex: v-fib, asystole BUT unwitnessed pulseless/breathless are LOW PRIORITY bc likely dead
4. tie breaker rule
   - the more vital the organ, the higher the priority
5. brain 2. lungs 3. heart 4. liver 5. kidney 6. pancreas

Question 3

3 things that result in black tag

Answer 3

pulseless
breathless
fixed and dilated pupils EVEN IF STILL BREATHING

tag them black and ship them last

Question 4

pts w expected s/s

stable or unstable

Answer 4

STABLE!

Question 5

do not delegate to LPN

Answer 5

1. Cannot start an IV
2. Cannot hang or mix IV meds
3. Cannot push IV Push meds
   * *can only maintain IV and document flow**
4. Cannot administer blood or deal with Central lines … Including flush, change dressings
5. Cannot make the care plan … They can however implement the care plan
6. Cannot perform or develop teaching … They can reinforce teaching
7. Cannot take care of unstable pts
8. Cannot perform the “first” of anything … The first of anything is either making the care plan or assessment
9. Is not allowed to assess: admission, d/c, transfer, or first assessment after a change.

Question 6

do not delegate to UAP

Answer 6

1. Charting—UAP can chart what they did but they cannot chart about the pt. For
   example,
   • They can chart, “side rail is up, bed is lowered, etc.”
   • They cannot chart, “patient less anxious, tolerated ambulating well”
   2.Medication administration—They cannot administer medications unless medication is
   • Topical medications, over the counter (OTC) medications, and barrier creams
   • Cannot give Nitroglycerin or Neosporin ointments because nitroglycerin and Neosporin
   are not OTC
   • Can they give hydrocortisone cream? No
   • Can they give A&D ointment? Yes
2. Assessments—Except vitals or Accu-Chek for diabetes
   4.Treatments—Except for enemas

should never do an ADL FIRST

Question 7

What to do if staff member is foing something illegal

Answer 7

tell the supervisor

Question 8

what to do if staff is doing something wrong but not illegal

Answer 8

ask self is anyone in immediate physical or psychological harm?
yes? CONFRONT IMMEDIATELY + TAKE OVER

no? if behavior is simply inappropriate… talk to staff member at a later time about the incident

Question 9

suspect RN diverting narcotics

Answer 9

tell supervisor

Question 10

aide is giving perineal care to pt, not wearing gloves

Answer 10

confront and take over

Question 11

RN is going home w bulging pockets

Answer 11

tell supervisor

Question 12

you notice surgeon contaminates gloves?

Answer 12

confront

Question 13

RN always gives report saying exasperation instead of exacerbation

Answer 13

talk to them later

Question 14

if illegal act could be harmful to pt…

Answer 14

takeover task then report incident to supervisor

Question 15

stumble upon pt masterbating

Answer 15

shut the door and give privacy

Question 16

psych guessing strategies

Answer 16

i will examine my feelings

establish a trusting relationship

Question 17

nutrition guessing strategies

Answer 17

go with baked, not friend
if no chicken, pick fish… not shellfish
never pick casseroles for kids (stew…slow cooked food)
don’t mixx meds in kids food, ask permission
toddlers –> pick finger food (hot dogs, tofu, ff)… eating on the run
prek “leave them alone,” one meal a day is okay… growth curve during this time plateaus

Question 18

pharm guessing strategies

Answer 18

• If you know what a drug does but don’t know the S/E, how do you proceed? … Pick the “S/E in the same body system the drug is working”
o For instance, if you have a GI drug, and drowsiness, tachycardia, and diarrhea are part of the answer choices. What S/E will you pick? Pick “diarrhea”
o From the same above list … For cardiac drug, pick “tachycardia”
o For CNS drug, pick “drowsiness”
o If you have no idea what the drug is … and the drug is PO, pick a GI side-effect

Question 19

OB guessing strategies

Answer 19

fetal HR

Question 20

med surg guessing strategies

Answer 20

• What is the first thing to assess? “Check for LOC (level of consciousness)”—not airway
o Think about a code or you find a pt on the floor … LOC is always checked first
o “Sir, Sir, Sir! Are you ok? Can you hear me?” If there is no response, A-B-C is then done next.
• What is the first thing to do? “Establish an airway”

Question 21

peds guessing strategies

Answer 21

GIVE THE CHILD MORE TIME
Rule #1: When in doubt, “call it normal” … Example: Some six year olds can read. Some can and some can’t. Pick the answer that says, “Give the child more time” … There is no doubt that a 13-year-old who not potty-trained is normal

o Rule #2: When in doubt, pick the “older age” in the 2 that it could be … In what age can the child walk? Both 12 months and 14 months are right … Pick 14 months. In that case, you give the child more time

o Rule #3: When in doubt, pick the “easier task” … At 6 months, a baby can roll over or sit with support … Pick “roll over” as your answer because it is the easier task

Question 22

General guessing skills

Answer 22

• no absolutes, except K+
• avoid answers that say the same thing
• if two answers are the opposite one is prob correct
• umbrella strategy… more than one correct answer? find the global answer

Question 23

sesame street rule

Answer 23

if one answer looks completelty diff than the others, pick that one