February 3, 2018 - • Four parts usually in the answer o Age o Ge...

Mark Klimek Lecture #12 February 3, 2018

Prioritizing • You are deciding which patient is the sickest patient.• Four parts usually in the answer

• Age
• Gender
• Diagnosis
• Modifying phrase

• Gender or age are irrelevant when it comes to prioritizing • Modifying phrase is the most important

• If the patient had angina pectoris vs. MI = MI is priority
• If the patient had angina pectoris with unstable vital signs Vs. MI with stable

vital signs – angina pectoris is priority Four rules of prioritization

• Acute beats chronic
• Fresh post-op (within 12 hours) beats medical or other surgical
• Unstable beats stable

Stable Unstable If it says they’re stable in the question Use of the word unstable Chronic illness Acute illness Post-op greater than 12 hours Post-op less than 12 hours Local or regional anesthesia General anesthesia Lab abnormalities of A or B level Lab abnormalities of C or D level “Ready for discharge”, “to be discharged”, admitted longer than 24 hours ago “Newly admitted”, “newly diagnosed”, admitted less than 24 hours ago Unchanged assessments Changed assessments, something new and different Experiencing the typical expected signs and symptoms of the disease with which they were diagnosed Experiencing unexpected signs and symptoms

• The more vital the organ the higher the priority
• Organ vitality
• Brain

ii. Lung iii. Heart iv. Liver

• Kidney

vi. Pancreas Four things that make you unstable

• Hemorrhage
• High fevers over 105
• Hypoglycemia
• Pulseless or breathlessness

Delegation • Do you not delegate the following to an LPN

• Starting an IV
• Hanging or mixing IV meds
• IV push meds

• They’re allowed to maintain and document the flow
• They can not administer blood or mess with central lines
• They’re not allowed to plan care
• They can preform or develop teaching, but they may reinforce teaching
• They cant take care of unstable patients
• They aren’t allowed to do anything for the first time, the RN should always assess first
• They cant do admissions, discharge, or transfers, or first assessment after there’s been a change

• Do you not delegate the following to an UAP

• Charting, except what they did
• Not allowed to give meds except topical OTC barrier creams
• They cant do assessments except for vitals and accu check
• Do not delegate to the family safety responsibilities

Staff Management • How do you intervene with inappropriate behavior with staff?

• Ask yourself, “is what they are doing illegal?”

▪ If the answer is yes, choose “tell supervisor”

• Is the staff member or patient in harms way?

▪ If the answer is yes, choose confront immediately and take over

• Is this behavior legal? Not harmful? But simply inappropriate?

▪ If the answer is yes, approach them and counsel them later on

Aortic – 2 nd right intercostal space at the right sternal border Pulmonic – 2 nd left intercostal space at the left sternal border Tricuspid – 4 th intercostal space at the left sternal boarder Mitral (apical) - 5 th

intercostal space in the midclavicular line

How do you guess?• Psych questions – best psych answer if you’re clueless is the nurse examines their own feelings about something, because of countertransference. Also another good answer is establishing a trust relationship.• Nutrition – pick chicken, except fried. Or fish. NEVER pick casserole for children because they wont eat it.Never mix medications in children’s food. With toddlers its finger food. Preschoolars leave them alone, one meal a day is okay Pharmacology • If you know what a drug does but you don’t know the side effects how should you preceed?

• Pick a side effect in the same body system where the drug is working

• If you have no idea what a drug even is?

• If its PO pick a GI side effect

• Never tell a child that a medicine is candy OB • Check fetal heart rate Med surg • Always assess LOC first, then you do ABC’s • Establish an airway Pediatric

• Three rules for growth and development questions

• Always give the child more time to grow and develop
• When in doubt pick the older age
• When in doubt pick the easier task

Guessing • Rule out absolute answers unless 100% certain