prioritization marky mark edition Flashcards
importance of age and gender
NOT IMPORTANT, age is important in peds
MODIFYING PHRASE = most important
four rules for prioritization
- acute beats chronic
- fresh post op (12 hr) beats medical or other surgical
- 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 - tie breaker rule
- the more vital the organ, the higher the priority - brain 2. lungs 3. heart 4. liver 5. kidney 6. pancreas
3 things that result in black tag
pulseless
breathless
fixed and dilated pupils EVEN IF STILL BREATHING
tag them black and ship them last
pts w expected s/s
stable or unstable
STABLE!
do not delegate to LPN
- Cannot start an IV
- Cannot hang or mix IV meds
- Cannot push IV Push meds
* *can only maintain IV and document flow** - Cannot administer blood or deal with Central lines … Including flush, change dressings
- Cannot make the care plan … They can however implement the care plan
- Cannot perform or develop teaching … They can reinforce teaching
- Cannot take care of unstable pts
- Cannot perform the “first” of anything … The first of anything is either making the care plan or assessment
- Is not allowed to assess: admission, d/c, transfer, or first assessment after a change.
do not delegate to UAP
- 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 - Assessments—Except vitals or Accu-Chek for diabetes
4.Treatments—Except for enemas
should never do an ADL FIRST
What to do if staff member is foing something illegal
tell the supervisor
what to do if staff is doing something wrong but not illegal
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
suspect RN diverting narcotics
tell supervisor
aide is giving perineal care to pt, not wearing gloves
confront and take over
RN is going home w bulging pockets
tell supervisor
you notice surgeon contaminates gloves?
confront
RN always gives report saying exasperation instead of exacerbation
talk to them later
if illegal act could be harmful to pt…
takeover task then report incident to supervisor
stumble upon pt masterbating
shut the door and give privacy
psych guessing strategies
i will examine my feelings
establish a trusting relationship
nutrition guessing strategies
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
pharm guessing strategies
• 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
OB guessing strategies
fetal HR
med surg guessing strategies
• 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”
peds guessing strategies
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
General guessing skills
- 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
sesame street rule
if one answer looks completelty diff than the others, pick that one
