This packet was developed to assist you in strengthening ... 1 This packet was developed to assist you in strengthening your medical-surgical nursing knowledge by allowing you to practice

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This packet was developed to assist you in strengthening your medical-surgical nursing knowledge by

allowing you to practice some key concepts.

Remember it’s all about perfusion! -Dr. Casey Scudmore

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Tool Box (From Tim Bristol/Victoria Kyarsgaard)

Lab Values every Nurse should know:

Fluids/Electrolytes:

What are the electrolytes? Na+, K+, Ca++, Mg++

Abnormal K+ causes heart problems

Abnormal Na+ causes CNS problems

Water likes to follow Na+

Oncotic pressure: plasma proteins pulling water in their direction

Where are the electrolytes?

We want Na+ in ECF (135-145)

We want K+ in the ICF (3.5-5.0 )

We don’t want Ca++ in the ICF (8.6-10)

o We want Ca++ hiding ECF if released it will activate a lot of enzymatic activity and cause the

cell to stop functioning and dissolve

We want an optimal level of Mg++ in the ICF (1.3-2.1)

o Too low can cause cardiac dysrythmias

Anticoagulant/bleeding times:

PTT, PT/INR-if these go up you bleed easier

Platelets- if these go down you bleed easier

D-Dimer-any clots, non specific

Norms: PT 11-15, PTT 60, INR 1, Plt 150-450

Hematology

Indicators of oxygen carrying capacity

Hgb: Male 13.5-17.5, Female 12-16

Hct: Male 39-49%, Female 35-45%

RBC: Male 4.3-5.7, Female 3.8-5.1

Indicators of infection

WBC normal (varies with age) 4500-11000

o Leukocytosis: WBC >11000 (infection or leukemia depending on how high it goes)

o Neutropenia: WBC<1 (BIG infection risk)

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Liver Function

AST/ALT-elevated means liver is in trouble

Hepatotoxicity manifests as lethargy and jaundice

Renal Function

BUN/Creat-if elevated means kidneys are sick

BUN high/creat normal=dehydration

Creat high=kidney damage

Cardiac Enzymes

Troponin-elevation means heart cells have died

Diabetes

HgbA1c (glycosolated hemoglobin)-average glucose control over 2-4 months

TargetA1c <7

Glucose normal: Fasting 70-110, (Diabetic >130)

Nutrition

Low serum albumin-poor nutritional status, if too low get edema because decrease oncotic pressure

Normal >3.5

CRITICAL REMINDERS

Anti-coagulation therapy:

Thrombosis-pt admitted for a clot they are started on heparin or Coumadin

Normal INR for someone without a clot or no history of clot is 1

Coumadin/Warfarin- anticoagulant

Monitor the PT/INR

Therapeutic (good/desirable) INR for someone with a clot or history of clot is 2-3

Coumadin takes a few days to get the INR therapeutic

Antidote is vitamin K

Safety precautions: electric razor, limit green leafy veggies high in Vitamin K, No contact sports, watch

injuries for prolonged/excessive bleeding, soft toothbrush

Takes longer to clear than heparin

Heparin/Enoxaparin-Anticoagulant-DO Not Give with a platelet <100

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Monitor the PTT

Advantage over coumadin, starts to work quickly, metabolized quickly-stops working soon after

discontinue

Antidote is protamine sulfate

Safety precautions: same as coumadin

Aspirin (ASA)-Anticoagulant

Suspect a heart attack-give Aspirin

Caution with GI ulcers

GI bleed-do not give ASA or NSAIDS

Stop 1 week prior if having surgery

COMMON DIAGNOSIS AND DRUG REMINDERS

CHF-How do we deal with fluid overload? (Nancy McMahon)

Pump it-digoxin is a positive inotrope that helps push fluid along (slow HR, pump more effective)

Park it- nitroglycerin will cause massive vasodilation so decreases the amount of fluid the heart has to

pump with each beat

Pee it-diuretics to get rid of fluid

Dopamine is a potent vasopressor and makes arteries constrict

BNP-(brain type natriuretic peptide)-if elevated than your patient has CHF

ACE inhibitors-can increase your K+

End in –pril

Inhibits renin angiotensin system (a major stimulator of aldosterone)

Aldosterone causes us to hold on to Na+ and lose K+

Lack of aldosterone leads to low K+

Diuretics-

Loop-lasix (what is the K+)

K+ sparing-Sprionolactone-aldosterone antagonist, the opposite of lasix

Watch BP and lytes with any diuretic

Increases fall risk

Digoxin- what are the pulse and potassium?

Increases force of contraction of heart, positive inotrop

Do not give with pulse less than 60 unless MD orders

Do not give with potassium less than 3 unless MD orders

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Beta Blockers-

End in –lol

What is the pulse? Do not give with pulse less than 60 unless MD order

Watch use of beta blockers in diabetics, they can hide signs of hypoglycemia

Caution with asthma, can inhibit bronchodilation

Pain-think fall precautions, prevent constipation

Infection- antibiotics kill normal gut flora, fungus moves in

Thyroid-

Common lab to check is TSH

TSH is high, we need more T3/T4

TSH is low, we need less T3/T4

DM- Even non-diabetics may have higher BG when traumatized and need insulin

Only NPH and Regular can be mixed, clear to cloudy

Med/Surg Nursing Packet Dr. Casey Scudmore 2014

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Know the following about your patient:

Allergies

Code status

Weight

Diagnosis & plan of care

I/O

VS

Labs: K+, Bun/Cr, WBC, H/H

Meds-antibiotics, anticoagulants

Nurses own:

Infection control

Skin

Mobility

Safety

Teaching

Nursing Sensitive Indicators:

(every patient, every shift, every day)

Restraints

HAPU: Hospital acquired pressure ulcer

CAUTI: catheter associated UTI

Falls

CLBSI: central line blood stream infection

HAI: hospital acquired infection

MDRO: multi drug resistant organisms

VAP (VAE now): ventilator associated

event

Accurate height and weight

Medication reconciliation

Core measures

HCAHPS (hospital consumer assessment of

healthcare providers and systems)

SBAR

Medication administration

Patient education with diversity

Skilled communication

Core Measures:

Heart failure

VTE

SCIP

Pneumonia

Immunization

AMI

Stroke

NPSG (national patient safety goals):

Patient identification

Communication

Medication labeling

Infection prevention

Universal protocol


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Report Guidelines

Name, Age, Diagnosis

Allergies, code status

Relevant history (past medical problems that impact current hospital stay, ie DM, HTN, COPD)

Current problem (why are they here and are they on the appropriate unit)

Assessment:

Neuro (LOC, confusion)

CV (fluid issues, EKG, BP, HR)

Resp (lung sounds, oxygen amount, RR, CXR)

GI (last BM, any abnormalities, NG)

GU (voiding, BSC, foley, dialysis)

Skin (wounds, ulcers, incisions, drains)

Lines (IV, central line, PAC, fistula/shunt)

Drips/Fluids

Pain med last dose/next dose

Mobility (type of assistance needed, OOB, turn q2, fall risk)

Diet

Accuchecks (last BG, covered?)

Abnormal labs (esp K, BUN/Cr, H/H, WBC, cultures)

VTE (thromboguards, anticoagulant)

Doctors

To do’s (follow up items including labs, procedures, meds)

Plan of care

Review last 12 hours of orders


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Core Measures 2014

Hospital Inpatient

Acute Myocardial Infarction (AMI)

Aspirin (ASA) within 24 hours before or after arrival

ASA prescribed at discharge

Angiotensin Converting Enzyme Inhibitor (ACEI)/Angiotensin II Receptor Blocker

(ARB) at discharge for LV systolic dysfunction (LVSD)

Fibrinolytic within 30 minutes of arrival

Percutaneous Coronary Intervention (PCI) within 90 minutes of arrival

Beta Blocker prescribed at discharge

Statin prescribed at discharge

Heart Failure (HF)

Discharge Instructions documented

Diet, activity, weight management, what to do if symptoms worsen, medications,

physician follow up appointment

Evaluation of Left Ventricular Systolic (LVS) Function

ACEI or ARB for Left Ventricular Systolic Dysfunction (LVSD)

Pneumonia (PNA)

Blood culture in ED prior to antibiotic

Blood cultures < 24 hours prior to or 24 hours after arrival for patients transferred or

admitted to ICU

Antibiotics selection ICU/non-ICU

Surgical Care Improvement Project (SCIP)

Antibiotic within 1 hour of surgical incision

Prophylactic antibiotic selection

Antibiotic discontinued within 24 hours of anesthesia end time

Appropriate hair removal

Urinary catheter removed by Postoperative Day #1 or #2

Perioperative temperature management


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Venous thrombo-embolism (VTE) prophylaxis ordered & administered within 24 hours

of anesthesia end time

Beta Blocker given in the perioperative period if on Beta blocker prior to arrival

Emergency Department (ED) Throughput Measure-Admitted Patients

Median Time from ED Arrival to ED Departure for Admitted ED Patients

Admit Decision Time to ED Departure for Admitted Patients

Global Immunization

Pneumococcal Immunization

Patients age 65 and older

Patients age 6-64 years with high risk conditions

Influenza Immunization

Patients 6 months and older

Hospital Out-patient (HOP)

Emergency Department (ED) Throughput Measures -Discharged Patients

Median Time from ED Arrival to ED Departure

Door to Diagnostic Evaluation by MD/NP/PA

Left Without Being Seen

Median Time to Pain Management for Long Bone Fracture (patients >= 2 years of age)

Head CT scan results for Stroke (acute ischemic or hemorrhagic) interpreted within 45

minutes of Arrival

Surgery

Timing of Antibiotic Prophylaxis

Antibiotic Selection

AMI/Chest Pain

Median Time to Fibrinolysis-patients with ST elevation MI (STEMI) or left bundle

branch block (LBBB)

Fibrinolytic Therapy Received Within 30 Minutes

Median Time to Transfer to Another Facility for Acute Coronary Intervention

Aspirin at Arrival

Median Time to ECG


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National Patient Safety Goals 2014

Identify patients correctly

2 identifiers

Blood transfusion-2 nurses verify

Improve staff communication

Get important test results to the right staff person on time

Use medications safely

Label medications

Prep medications where medicine and supplies are setup

Extra care for blood thinners

Medication reconciliation

Use alarms safely

Ensure alarms are appropriate, heard, responded to on time

Prevent infection

Hand hygiene

Appropriate isolation

Central line infection prevention

Surgical infection prevention

Urinary tract infection from catheters

Identify patient safety risks

Suicide risk assessment and precautions

Prevent mistakes in surgery

Procedural pause

Mark surgical site


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Type of Insulin & Brand Names

Onset Peak Duration Role in Blood Sugar Management

Rapid-Acting

Humalog or lispro 15-30 min.

30-90 min 3-5 hours Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection. This type of insulin is used with longer-acting insulin. Novolog or aspart

10-20 min.

40-50 min. 3-5 hours

Apidra or glulisine 20-30 min.

30-90 min. 1-2½ hours

Short-Acting

Regular (R) humulin or novolin

30 min. -1 hour

2-5 hours 5-8 hours Short-acting insulin covers insulin needs for meals eaten within 30-60 minutes

Velosulin (for use in the insulin pump)

30 min.-1 hour

2-3 hours 2-3 hours

Intermediate-Acting

NPH (N) 1-2 hours

4-12 hours 18-24 hours

Intermediate-acting insulin covers insulin needs for about half the day or overnight. This type of insulin is often combined with rapid- or short-acting insulin. Lente (L)

1-2½ hours


Long-Acting

Ultralente (U) 30 min.-3 hours


Long-acting insulin covers insulin needs for about one full day. This type of insulin is often combined, when needed, with rapid- or short-acting insulin.

Lantus 1-1½ hour

No peak time; insulin is delivered at a steady level

20-24 hours

Levemir or detemir(FDA approved June 2005)

1-2 hours

6-8 hours Up to 24 hours

Pre-Mixed*

Humulin 70/30 30 min. 2-4 hours 14-24 hours

These products are generally taken twice a day before mealtime.

Novolin 70/30 30 min. 2-12 hours Up to 24 hours

Novolog 70/30 10-20 min.

1-4 hours Up to 24 hours

Humulin 50/50 30 min. 2-5 hours 18-24 hours

Humalog mix 75/25 15 min. 30 min.-2½ hours 16-20 hours


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TEST TAKING

http://passnclex.drexel.edu/study_resources.aspx

STUDY RESOURCES

Would you like to be a better test-taker? Do you have difficulty with multiple

choice exams? If so, the following Test Taking Tips will help you. These are valuable strategies taken from

Drexel University's NCLEX® EXCEL! Prep Course. Please feel free to copy our Test Taking Tips and refer to

them when taking ANY test.

The Parts of a Question

The question contains several parts:

the case (sometimes called scenario) - the description of the client and what is happening to him/her

the stem - the part of the question that asks the question

the correct response

distracters - incorrect but feasible choices

Key Words

The most important skill for the test taker is the ability to read the question carefully and determine the key

elements in each question. Each question has key words. Key words relate to the client; to the problem; and to

specific aspects of the problem.

Client

Factors such as age, sex, and marital status may be relevant. When a child's age is given it often is very relevant

to the answer. Vital signs vary with age. Preoperative teaching methods vary with age. Appropriate toys and

diversional activities vary with age. Always pay special attention to the age of a client when it is given. Also

consider who is the client for this question. That is, who is the focus of the question. The client may be the

identified sick person, or it might be a relative of the identified sick person, or even a staff member.

Problem/Behavior

The problem may be a disease, a symptom or a behavior.

Details of the Problem

Is the question asking for nursing actions or client symptoms or family responses?

Does the question ask about a specific aspect of nursing care assessment, planning, implementation,

evaluation?

Does the question ask details relevant to a specific symptom or behavior the client exhibits?

Is there additional information about the client or the problem that is important?

Priority Setting

"What action takes priority?"

"What should the nurse do first?"

"What should the nurse do initially?"

"What is essential for the nurse to do?"

Physiologic needs are first, followed by safety needs, then love and belonging, self-esteem and self-

actualization.

http://passnclex.drexel.edu/study_resources.aspx


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The first step of the nursing process is assessment! When the stem of a question asks for the initial nursing

action always look to see if there is a relevant assessment answer. The nurse will take an action only when there

is enough data to act. Call the physician only when there is not a nursing action that should be taken first. The

stem of the question may ask for a nursing action and the correct answer may be to assess.

When the stem of the question asks what is essential for the nurse to do, think safety. Remember many of the

test questions are safety questions.

What is the Time Frame? Whenever a specific time frame is indicated in a question it is very important. Pay attention to it. Time related

words may be like early or late in relation in symptoms, pre operative or post operative, care on the day of

surgery or later postoperative care.

Repeated Words Words from the question are repeated in the answer. Frequently the same word or a synonym will be in both the

question and the answer.

Opposites When two answers are opposite such as high blood pressure and low blood pressure or increase the drip rate and

stop the IV, or turn on the right side and turn on the left side, the answer is usually one of the two.

Same Answer If two or three answers say the same thing in different words none can be correct. If the answers are too alike,

then neither one is correct.

Odd Answer Wins

The answer that is different from the others is apt to be the correct answer. It may be the longest or the shortest

or simply very different in content or style.

Umbrella Answer

One answer includes the others. There may be more than one correct answer. One answer is better than all the

others because it includes them.

Test Item Check List Use this handy list to check yourself every time you answer a test question.

Say to yourself, DID I CAREFULLY...

Read the stem?

Read all of the options?

Read the stem again?

Look for key words?

Eliminate obviously incorrect options?

Absolutes

Answers containing universal or absolute words are very apt to be incorrect. Very little in life or nursing is

always correct or incorrect. Answers stated in absolute terms should be looked at with great caution.


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Terms to pay attention to during test taking:

Deadly

all

every

total

nothing

always

each

only

any

nobody

never

none

Dangerous

main

chief

avoid

primarily

major

shall

inevitable

eliminate

rarely

impossible

too

Safe

usually

almost

frequently

probably

potentially

may

sometimes

partial

some

might

should

few

essentially

generally

occasionally

nearly

maybe

could

commonly

average

seldom

often

normally


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QSEN Competencies (QSEN.org)

OVERVIEW

The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of

preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve

the quality and safety of the healthcare systems within which they work.

PATIENT-CENTERED CARE

Definition: Recognize the patient or designee as the source of control and full partner in providing compassionate and

coordinated care based on respect for patient’s preferences, values, and needs.

Knowledge Skills Attitudes

Integrate understanding of multiple dimensions

of patient centered care:

patient/family/community preferences, values

coordination and integration of care

information, communication, and education

physical comfort and emotional support

involvement of family and friends

transition and continuity

Describe how diverse cultural, ethnic and

social backgrounds function as sources of

patient, family, and community values

Elicit patient values, preferences

and expressed needs as part of

clinical interview, implementation of

care plan and evaluation of care

Communicate patient values,

preferences and expressed needs

to other members of health care

team

Provide patient-centered care with

sensitivity and respect for the

diversity of human experience

Value seeing health care

situations “through patients’ eyes”

Respect and encourage

individual expression of patient

values, preferences and

expressed needs

Value the patient’s expertise

with own health and symptoms

Seek learning opportunities with

patients who represent all

aspects of human diversity

Recognize personally held

attitudes about working with

patients from different ethnic,

cultural and social backgrounds

Willingly support patient-

centered care for individuals and

groups whose values differ from

own

Demonstrate comprehensive understanding of

the concepts of pain and suffering, including

physiologic models of pain and comfort.

Assess presence and extent of pain

and suffering

Assess levels of physical and

emotional comfort

Elicit expectations of patient &

family for relief of pain, discomfort,

or suffering

Recognize personally held values

and beliefs about the

management of pain or suffering

Appreciate the role of the nurse

in relief of all types and sources

of pain or suffering

Recognize that patient


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Initiate effective treatments to

relieve pain and suffering in light

of patient values, preferences and

expressed needs

expectations influence outcomes

in management of pain or

suffering

Examine how the safety, quality and cost

effectiveness of health care can be improved

through the active involvement of patients and

families

Examine common barriers to active

involvement of patients in their own health

care processes

Describe strategies to empower patients or

families in all aspects of the health care

process

Remove barriers to presence of

families and other designated

surrogates based on patient

preferences

Assess level of patient’s

decisional conflict and provide

access to resources

Engage patients or designated

surrogates in active partnerships

that promote health, safety and

well-being, and self-care

management

Value active partnership with

patients or designated surrogates

in planning, implementation, and

evaluation of care

Respect patient preferences for

degree of active engagement in

care process

Respect patient’s right to access

to personal health records

Explore ethical and legal implications of

patient-centered care

Describe the limits and boundaries of

therapeutic patient-centered care

Recognize the boundaries of

therapeutic relationships

Facilitate informed patient consent

for care

Acknowledge the tension that may

exist between patient rights and

the organizational responsibility

for professional, ethical care

Appreciate shared decision-

making with empowered patients

and families, even when

conflicts occur

Discuss principles of effective communication

Describe basic principles of consensus

building and conflict resolution

Examine nursing roles in assuring

coordination, integration, and continuity of

care

Assess own level of communication

skill in encounters with patients and

families

Participate in building consensus

or resolving conflict in the context

of patient care

Communicate care provided and

needed at each transition in care

Value continuous improvement of

own communication and conflict

resolution skills

TEAMWORK AND COLLABORATION

Definition: Function effectively within nursing and inter-professional teams, fostering open communication, mutual

respect, and shared decision-making to achieve quality patient care.


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Describe own strengths, limitations,

and values in functioning as a

member of a team

Demonstrate awareness of own

strengths and limitations as a team

member

Initiate plan for self-development as a

team member

Act with integrity, consistency and

respect for differing views

Acknowledge own potential to

contribute to effective team functioning

Appreciate importance of intra- and

inter-professional collaboration

Describe scopes of practice and roles

of health care team members

Describe strategies for identifying

and managing overlaps in team

member roles and accountabilities

Recognize contributions of other

individuals and groups in helping

patient/family achieve health goals

Function competently within own scope

of practice as a member of the health

care team

Assume role of team member or

leader based on the situation

Initiate requests for help when

appropriate to situation

Clarify roles and accountabilities under

conditions of potential overlap in team

member functioning

Integrate the contributions of others

who play a role in helping

patient/family achieve health goals

Value the perspectives and expertise

of all health team members

Respect the centrality of the

patient/family as core members of

any health care team

Respect the unique attributes that

members bring to a team, including

variations in professional orientations

and accountabilities

Analyze differences in communication

style preferences among patients and

families, nurses and other members of

the health team

Describe impact of own

communication style on others

Discuss effective strategies for

communicating and resolving

conflict

Communicate with team members,

adapting own style of communicating to

needs of the team and situation

Demonstrate commitment to team

goals

Solicit input from other team members

to improve individual, as well as team,

performance

Initiate actions to resolve conflict

Value teamwork and the relationships

upon which it is based

Value different styles of

communication used by patients,

families and health care providers

Contribute to resolution of conflict

and disagreement

Describe examples of the impact of

team functioning on safety and quality

of care

Explain how authority gradients

influence teamwork and patient

Follow communication practices that

minimize risks associated with handoffs

among providers and across transitions

in care

Assert own position/perspective in

Appreciate the risks associated with

handoffs among providers and across

transitions in care


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safety discussions about patient care

Choose communication styles that

diminish the risks associated with

authority gradients among team

members

Identify system barriers and facilitators

of effective team functioning

Examine strategies for improving

systems to support team functioning

Participate in designing systems that

support effective teamwork

Value the influence of system solutions

in achieving effective team functioning

EVIDENCE-BASED PRACTICE (EBP)

Definition: Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of

optimal health care.


Demonstrate knowledge of basic scientific

methods and processes

Describe EBP to include the

components of research evidence,

clinical expertise and patient/family

values.

Participate effectively in

appropriate data collection and

other research activities

Adhere to Institutional Review

Board (IRB) guidelines

Base individualized care plan on

patient values, clinical expertise

and evidence

Appreciate strengths and weaknesses

of scientific bases for practice

Value the need for ethical conduct of

research and quality improvement

Value the concept of EBP as integral

to determining best clinical practice

Differentiate clinical opinion from research

and evidence summaries

Describe reliable sources for locating

evidence reports and clinical practice

guidelines

Read original research and

evidence reports related to area of

practice

Locate evidence reports related

to clinical practice topics and

guidelines

Appreciate the importance of regularly

reading relevant professional journals

Explain the role of evidence in determining

best clinical practice

Describe how the strength and

relevance of available evidence

influences the choice of interventions in

provision of patient-centered care

Participate in structuring the work

environment to facilitate integration

of new evidence into standards of

practice

Question rationale for routine

approaches to care that result in

Value the need for continuous

improvement in clinical practice based

on new knowledge


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less-than-desired outcomes or

adverse events

Discriminate between valid and invalid

reasons for modifying evidence-based

clinical practice based on clinical expertise

or patient/family preferences

Consult with clinical experts before

deciding to deviate from evidence-

based protocols

Acknowledge own limitations in

knowledge and clinical expertise before

determining when to deviate from

evidence-based best practices

QUALITY IMPROVEMENT (QI)

Definition: Use data to monitor the outcomes of care processes and use improvement methods to design and test

changes to continuously improve the quality and safety of health care systems.


Describe strategies for learning about the

outcomes of care in the setting in which one

is engaged in clinical practice

Seek information about outcomes of

care for populations served in care

setting

Seek information about quality

improvement projects in the care

setting

Appreciate that continuous quality

improvement is an essential part of

the daily work of all health

professionals

Recognize that nursing and other health

professions students are parts of systems of

care and care processes that affect outcomes

for patients and families

Give examples of the tension between

professional autonomy and system

functioning

Use tools (such as flow charts,

cause-effect diagrams) to make

processes of care explicit

Participate in a root cause

analysis of a sentinel event

Value own and others’ contributions

to outcomes of care in local care

settings

Explain the importance of variation and

measurement in assessing quality of care

Use quality measures to understand

performance

Use tools (such as control charts

and run charts) that are helpful for

understanding variation

Identify gaps between local and

best practice

Appreciate how unwanted variation

affects care

Value measurement and its role in

good patient care

Describe approaches for changing processes

of care

Design a small test of change in

daily work (using an experiential

learning method such as Plan-Do-

Value local change (in individual

practice or team practice on a unit)

and its role in creating joy in work


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Study-Act)

Practice aligning the aims,

measures and changes involved in

improving care

Use measures to evaluate the

effect of change

Appreciate the value of what

individuals and teams can to do to

improve care

SAFETY

Definition: Minimizes risk of harm to patients and providers through both system effectiveness and individual

performance.


Examine human factors and other basic

safety design principles as well as

commonly used unsafe practices (such as,

work-arounds and dangerous

abbreviations)

Describe the benefits and limitations of

selected safety-enhancing technologies

(such as, barcodes, Computer Provider

Order Entry, medication pumps, and

automatic alerts/alarms)

Discuss effective strategies to reduce

reliance on memory

Demonstrate effective use of

technology and standardized

practices that support safety

and quality

Demonstrate effective use of

strategies to reduce risk of

harm to self or others

Use appropriate strategies to

reduce reliance on memory

(such as, forcing functions,

checklists)

Value the contributions of

standardization/reliability to safety

Appreciate the cognitive and physical

limits of human performance

Delineate general categories of errors and

hazards in care

Describe factors that create a culture of

safety (such as, open communication

strategies and organizational error

reporting systems)

Communicate observations or

concerns related to hazards

and errors to patients, families

and the health care team

Use organizational error

reporting systems for near

miss and error reporting

Value own role in preventing errors

Describe processes used in understanding

causes of error and allocation of

responsibility and accountability (such as,

root cause analysis and failure mode

effects analysis)

Participate appropriately in

analyzing errors and designing

system improvements

Engage in root cause

analysis rather than blaming

Value vigilance and monitoring (even of

own performance of care activities) by

patients, families, and other members of

the health care team


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when errors or near misses

occur

Discuss potential and actual impact of

national patient safety resources, initiatives

and regulations

Use national patient safety

resources for own professional

development and to focus

attention on safety in care

settings

Value relationship between national safety

campaigns and implementation in local

practices and practice settings

INFORMATICS

Definition: Use information and technology to communicate, manage knowledge, mitigate error, and support decision

making.


Explain why information and technology skills

are essential for safe patient care

Seek education about how

information is managed in care

settings before providing care

Apply technology and

information management tools

to support safe processes of

care

Appreciate the necessity for all health

professionals to seek lifelong,

continuous learning of information

technology skills

Identify essential information that must be

available in a common database to support

patient care

Contrast benefits and limitations of different

communication technologies and their

impact on safety and quality

Navigate the electronic health

record

Document and plan patient

care in an electronic health

record

Employ communication

technologies to coordinate

care for patients

Value technologies that support clinical

decision-making, error prevention, and

care coordination

Protect confidentiality of protected

health information in electronic health

records

Describe examples of how technology and

information management are related to the

quality and safety of patient care

Recognize the time, effort, and skill

required for computers, databases and

other technologies to become reliable and

effective tools for patient care

Respond appropriately to

clinical decision-making

supports and alerts

Use information management

tools to monitor outcomes of

care processes

Value nurses’ involvement in design,

selection, implementation, and

evaluation of information technologies to

support patient care


Page 22

PLACE PT ID STICKER HERE

Essentials: Allergies: Code status: Wt: Dx: 24 hr I/O: Recent VS: BP HR RR T EKG Abx: Anticoag: VTE: Hep/Lov/SCD Fall Risk Accucheck: Freq___________ Last_____________ Insulin covered?___________

Hx (details on back): Labs: (cardiac) Na___ K+____ Mg___ Trop____ (Renal) BUN/CR______ WBC____ Bands____ (other) H/H_____ PT/INR_____ (Micro) Cx

Neuro: Cardio: TLC IVs: _________________ _________________ Resp: O2 GI: Diet___________last BM______________ GU: Foley/void Skin: Braden POC: Procedures to do: Shopping list:

ICU: VS q1, Turn/oral/I&O q2, EKG/assess q4 0630: Look in chart/computer/SBAR for essentials Peak in on patients-breathing/in bed/pain? 07: Get Report/Assessments 08 Accucheck? Insulin/BKFST trays 09 Meds 10 11 12 Accucheck? Lunch trays 13 14 Meds 15 16 17 Accucheck? Dinner trays 18


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Assessment Guide

VS:

Pain:

Time:

S/S:

Location:

Scale Used:

Action:

Was intervention adequate?

What intervention (s) may have been more effective

for pain relief?

IF pain unrelieved was RN informed?

Neurological:

Mood/Affect:

A&O________________ Pupils_______________

Reflexes WNL?_______________

Is speech clear?_______________

Able to swallow without difficulty?____________

Able to MAE?________________

List any

deficits:__________________________________

_________________________________________

Treatment/Diagnostic procedure:

Did patient tolerate?

Lab results: if abnormal, what is significance?

Specific concerns:

Integumentary:

Color ______________________

Condition___________________

Turgor______________________

Warm/Cool__________________

Lesions/Wounds_____________________________

S/S infection________________________________

IV site (s) __________________________________

Respiratory:

Rate_______________________

Breath Sounds_______________

SOB_______________________

O2________________________

Suctioned___________________

Respiratory Tx_______________

Chest tube___________________

Other_______________________

Genitourinary:

Continent_______________

Foley___________________

Bed Pan________________

Retention_______________

Frequency________________

Urine Color_______________

Odor____________________

Sediment_________________

Other____________________

Cardiovascular:

Apical pulse_______________

Rhythm__________________

Heart sounds______________

Murmur__________________

Edema___________________

Capillary refill______________

Pulses____________________

Homan’s___________________

Activity intolerance____________

Echocardiogram_______________

Gastrointestinal:

Dental caries _______________

Oral lesions________________

Bowel sounds_______________

Abdomen soft/firm/distended/tender

N/V

NGT/OGT/PEG/NPO/Tube Feeding

Diet:

Musculoskeletal:

Tone strength_________________

Range of motion_______________

Gait_________________________

Assistance device_______________

Fall precaution_________________

Intervention ___________________


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Cardiovascular

Drug/Dose/

Freq/Route

Pharm

Class

Dose

Range Action

Required

Assess Side/Adverse Effects

Carvedilol

Metoprolol

Amiodorone

Morphine

Heparin

Plavix

Warfarin

Nitroglycerin

Diltiazem


Page 25

EKG

Resource websites:

http://co.grand.co.us/DocumentCenter/Home/View/636

http://www.slideshare.net/mohammedshakir2/ecg-easy-way?related=1

Analysis:

1.) Rate and rhythm

2.) Measurements (PR, QRS, QT Intervals)

4.) Morphology

5.) STE-mimics

6.) Ischemia, Injury, Infarct

Let’s break them down one at a time.

1.) Rate and rhythm

Are you dealing with a bradycardia or a tachycardia? If the exact rhythm is unknown, are we certain we’re

dealing with a supraventricular rhythm?

This is critical because if the rhythm has wide QRS complexes (fast or slow) it’s ventricular until proven

otherwise!

Failure to observe this simple rule can cause a lot of problems.

2.) QRS duration (and other intervals like the PR interval and QT interval)

Now is the designated time to make sure you’re dealing with a narrow QRS rhythm (or a supraventricular

rhythm with wide QRS complexes).

http://co.grand.co.us/DocumentCenter/Home/View/636




Page 26

This is also the designated time that you look at the QT/QTc and verify that the QTc is < 500 ms (and hopefully

< 460 ms).

4.) Morphology

If the QRS complex is “wide” (the QRS duration is = or > 120 ms), what is the QRS morphology in lead V1?

5.) STE-mimics (QRS confounders, Imposters of AMI)

By now we’ve already determined whether or not a bundle branch block or paced rhythm is present, and there’s

an excellent chance you’ve already picked up on several other abnormalities that could mimic or mask acute

myocardial infarction.

However, this is where I explicitly rule out the STE-mimics (paced rhythm, left bundle branch block, left

ventricular hypertrophy, benign early repolarization, pericarditis, Wolff-Parkinson-White pattern, ventricular

aneurysm, hyperkalemia).

6.) Ischemia, Injury, Infarct.

Finally, I look for the obvious signs of acute STEMI (ST-elevation or hyperacute T-waves). I also look for ST-

depression, T-wave inversion, abnormal Q-waves, and so on.

- See more at: http://www.ems12lead.com/2010/01/25/the-six-step-method-for-12-lead-ecg-

interpretation/#sthash.SoK3QKTz.dpuf

http://www.ems12lead.com/2010/01/25/the-six-step-method-for-12-lead-ecg-interpretation/#sthash.SoK3QKTz.dpuf

http://www.ems12lead.com/2010/01/25/the-six-step-method-for-12-lead-ecg-interpretation/#sthash.SoK3QKTz.dpuf


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Cardiac Physiology

Resource website:

https://www.youtube.com/watch?v=6veA0PawZlc

https://www.youtube.com/watch?v=6veA0PawZlc


Page 38

Respiratory

Resource Websites:

http://www.rnceus.com/course_frame.asp?exam_id=18&directory=abgs

http://www.slideshare.net/drmsaqib/abg-interpretation

Analysis Steps:

1. Is the pH normal, acidic, or alkalotic?

2. Is the CO2 normal, acidic, or alkalotic?

3. Is the HCO3 normal, acidic, or alkalotic?

4. Match the acids and the alkalotics

5. Metabolic is HCO3 matches the pH

6. Respiratory is CO2 matches the pH

7. If the pH is normal, we have compensated!

http://www.rnceus.com/course_frame.asp?exam_id=18&directory=abgs

http://www.slideshare.net/drmsaqib/abg-interpretation


Page 39

Oxygen Delivery:

http://medicalslides-ppt.blogspot.com/2010/10/oxygen-delivery-devices.html

http://medicalslides-ppt.blogspot.com/2010/10/oxygen-delivery-devices.html


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This packet was developed to assist you in strengthening ... 1 This packet was developed to assist you in strengthening your medical-surgical nursing knowledge by allowing you to practice