Pure Food and Drug Act of 1906

-placed strict controls on narcotic drugs

-began requirement of drug reconcilation to thwart diversion and drug abuse

-Doctor and nurse must be licensed

-the nurse must know the purpose, action and side effects of drugs.

-the medication order must be valid.

-patients name

-date and time the order was written

-name of drug to be administered

-route of administration

-frequency of administration

-signature

**** Types of medication orders*****

indicates that a medication should be given on a routine basis.

-may or may not indicate a time limit.

**** Types of medication orders*****

-order for medication given as needed

-lists the minimum amount of time to elapse between doses

-may specify symptoms its used to treat

**** Types of medication orders*****

-medication order carried out one time

**** Types of medication orders*****

-to be implemented immediately

6 Rights to Medication Administration

*** hint***

Patient Might Die Right NOW! so write it down

Right Patient

Right Medication

Right Dosage

Right Route

Right Time

Right Documentation

1. Assess the client

2. Notify Dr.

3. Document--- but don't say "error" or claim fault in the patient chart..... 

-Communication

-Quality Assurance

-Legal Accountability

-Reimbursement

-Research

***** TYPES OF ENTRIES*****

-written on new client who has just entered facility

-narrative entry noting complete assessment and describing client's status

***** TYPES OF ENTRIES*****

-client assessment made on rounds 

-things for the next shift to know

***** TYPES OF ENTRIES*****

Interdisciplinary notes entered at varous times during the shift reflecting change in condition or anything affecting the client.

***** TYPES OF ENTRIES*****

-Reflects the movement of a client

-includes reason for transfer, person giving report, client condition

***** TYPES OF ENTRIES*****

Instruction/eduction given to client

***** TYPES OF ENTRIES*****

-Objective descriptions of observations, avoiding use of vague terms

-document complaints, observations of drains, tubing, dressings, medications and treatments, psychosocial status, ADLs, valuables, spiritual care, safety concerns

***** Charting Formats *****

- provides information in the form of statements that describe events surrounding patient care
-disadvantages: time consuming and difficult to track information 

Addresses client problems or needs and includes a column that summarizes the focus of the entry

Data, Action, Response

 Data, Action, Evaluation

FOCUS:   DAR/DAE

-

-Charting begins with the admission assessment, and the initiation of a problem list

-Documentation is focused on interventions, and evaluations related to problems listed

-each problem should be evaluated at least once per shift

-

-Used to record progress notes with problem focused charting

-includes narrative notes, flowsheets, and used by all members of the healthcare team

-Narrative notes specifically related to a problem list and are numbered and titles accordingly

SOAP

S-Subjective data

O- Objective data

A-    Assessment

P-              Plan

- Read labels and check 3 times (6 rights and 3 checks)

- Avoid interruptions

-look up all unfamiliar medications

-Check the Dr.'s order to ensure proper transcription

Oral 

sublingual

buccal

Intradermal

Subcutaneous

Intramuscular

Intravenous

Topical

Inhalation

and more lol

Mechanism of action - how it works

- alter body fluids

-alter cell membrane

-interaction with receptor sites

***** Needles ******

27G 3/8     27G 1/2

26G 1/2     25G 5/8

Given at a 10-15 degree angle.

The above needle sizes would be used to give a _____

injection in the inner aspect of forearm, back of scapulae, or the upper aspects of the chest?

***** Needles ******

***** Needles ******

The method for injecting medications that cause irritation, bruising, or staining of superficial tissue when they escape from injection site...

*** HINT ***

Seals the medication in the injection site!

Giving Ear Drops- for a CHILD-

How do you position the ear?

*** TYPES OF FEEDBACK ***

Self-perception

*** TYPES OF FEEDBACK ***

Information from another about how effectively the message was transmitted

*** TYPES OF FEEDBACK ***

Reinforcing successful communication

*** TYPES OF FEEDBACK ***

Response that denotes poor transmission of message

Define:

Culture

Define:

Race

Define:

Family

**** STAGES OF PSYCHOSOCIAL DEVELOPMENT ****

Erikson

"self" is good and the world is good

-characterized by HOPE

Sensorimotor 

Birth- age 2

Preoperational 

Age 2-7

Concrete Operations

age 7-11

Formal Operations

age 11 to adulthood

**** STAGES OF PSYCHOSOCIAL DEVELOPMENT ****

Freud

Major focus of sexual interest is anus

control of body function is major feature

**** STAGES OF PSYCHOSOCIAL DEVELOPMENT ****

Freud

genitals become focus of sexual curiosity

superego develops

feelings of guilt emerge

**** STAGES OF PSYCHOSOCIAL DEVELOPMENT ****

Freud

Sexual feelings are firmly repressed by superego

period of relative calm

**** STAGES OF PSYCHOSOCIAL DEVELOPMENT ****

Freud

Stimulated by increasing hormone levels

sexual energy wells up in full force, resulting in fersonal and family turmoil

**** STAGES OF MORAL DEVELOPMENT ****

Kohlberg

Naivete and egocentrism 

no moral sensitivity

decisions are made upon what pleases the child

no awareness of the effects of their actions on others

stage 4 (age 10-12 years old)

Respiratory

The sound of the lungs is??

Fluid and Electrolytes

The main electrolyte in extracellular fluid is ???

Fluid and Electrolytes

The main electrolyte in intracellular fluid is ???

Fluid and Electrolytes

Most body water is in ???

Electrolyte normal plasma value:

Sodium

Electrolyte normal plasma value:

Potassium

*** Potassium causes contractility of heart muscle

Electrolyte normal plasma value:

Calcium

Electrolyte normal plasma value:

Magnesium

Electrolyte normal plasma value:

Chloride

Electrolyte normal plasma value:

Phosphorus

Normal range of pH

Normal  7.35-7.45

Low is Acid  (1-7.34)

High is Alkaline  (7.46-14)

Normal range of PaCO2

**** Respiratory ****

Normal   35-45

Low is Alkaline (0-34)

High is Acid  (46 up)

Normal range of HC03

**** Metabolic ****

Normal 22-26

High is Alkaline  (27 up)

Low is Acid (0-21)

Hyperventilation is associated with which of the following?

Metabolic Alkalosis

Metabolic Acidosis

Respiratory Alkalosis

Respiratory Acidosis

Respiratory Alkalosis

Define Hyponatremia

and tell what can cause it....

...is an electrolyte disturbance in which the sodium concentration in the serum is lower than normal..

Causes... diarrhea or vomiting or excess water accumulate faster than it can be excreated as in congestive heart failure.

...is an electrolyte disturbance in which the sodium concentration in the serum is higher than normal..

Causes... dehydration or excessive sodium intake

****Cardiovascular****

The pacemake of the heart is???

****Cardiovascular****

****Cardiovascular****

Epicardium -- outside

Myocardium -- middle layer

Endocardium - inner layer

****Cardiovascular****

****Cardiovascular****

****Cardiovascular****

****Cardiovascular****

****Cardiovascular****

****Cardiovascular****

Define:

Automaticity

Is this stable or unstable angina????

There are no other symptoms associated with it and it is predictable....

**** PAIN ****

What is pain... how do you know it exist?

**** PAIN ****

well localized pain usually from injury to cutaneous or deep tissue

**** PAIN ****

poorly localized  - described as squeezaing, pressure, cramping, distention, deep stretching

**** PAIN ****

Pain experienced at a site distant from the injured tissue

**** PAIN ****

The steps of pain.... what are they and define.

Think**** touching hot pan....  :)

Tranduction - stimulus change into an electrical stimulus by activating nociceptors.

Transmission- electrical implse travels from site of injury

Perception- action potential reaches cortical areas

Modulation- intermal or external restraining of the nociceptive process that inhibits transmission of pain signal at any place along the transmission pathway

Most common Urinary disorder....

*** most frequently in women

*** Cardiac ***

Force ventricles must over come to eject blood is known as?

*** Cardiac ***

what term stands for the amount of blood in the left ventricle immediately before contraction.  The main force that stretches cardiac much fibers? 

If a client is constipated the nurse should suggest they eat?

Hemorrhaging

Drinking alcohol--- ie on the last test...

drinking a small glass of wine 30 min prior to going to sleep...

TRUE OR FALSE??????

A female is more likely than a male to develope a UTI. 

An older female not on hormone replacement is more likely to develope a UTI than a younger woman...

TRUE OR FALSE??????

TRUE OR FALSE??????

A condom Cath for a confused 70 year old man with incontinence issues would be acceptable means of controlling this issue?

when giving medication to a younger child which would be the best way to approach the child?

1.... Yell at child to TAKE THE MEDICATION

2.... ask child... after you take your medication do you want apple juice or water to drink?

which is slower?

SubQ or IM route

TRUE OR FALSE??????

Accidents are the leading death in children

Accidental death

Homicide

Suicide

****DOCUMENTATION****

TRUE OR FALSE???

You can go back and add to electronic documents even after documenting a later event?

****DOCUMENTATION****

TRUE OR FALSE???

At the end of shift the nurse makes the report and then  draws an X on the rest of the paper.

TRUE OR FALSE>>>>
As a nursing student I can .......

Chart what I do 

AND 

Use different types of charts.

Chronic Hypoxia is seen in people...

with ....

that.....

and a sign of chronic hypoxia is....

with Emphysema

that smoke

clubbing of the finger nails

TRUE OR FALSE???

Shifting of water is called Osmosis

what is hypoxy drive?

and what happens when a person depending on hypoxy drive is given too much oxygen?

When a person depends on the level of CO2 in their body to tell them to breath.

If given too much oxygen the client will stop breathing.

TRUE OR FALSE???

Cheese is a good source of calcium?

what type of drug dries up secretions?

TRUE OR FALSE???

With an obesse patient the healing time is increased and so is the chance of infection.

maintain hydration and ambulate the client...

also encourage turning and coughing every 2 hours

TRUE OR FALSE???

You should tell the post op client to turn from side to side every hour to open each of the lungs to full expansion one at a time.

TRUE OR FALSE???

Poor circulation reduces distal pulses?

Lungs fill with fluid

Hear crackles

Distended Jugular Vein.... JDV

Organs are filled