Nursewillexamineownfeelingaboutsomething-sodonotcountertransfer

1 MarkKlimeknotes Howtoguess 1.Useknowledge 2.Commonsense 3.Guessingstrategy Psych Nursewillexamineownfeelingaboutsomething-sodonotcountertransfer Establishtrustrelationship Nutrition Pickchickennotfriedchicken Fishbutnotshellfish Neverpickcasserolesforkids Nevermixmedsinfood Toddlers-fingerfoods Preschool-onemealadayisOK.Leavethemalone 3expectationstohave Donotexpect75questions-think265 Donotexpecttoknoweverything Donotexpecteverythingwillgoright Pharm Mosttestedareaissideeffects Donotworryaboutrouteordose Ifknowwhatdrugdoesbutdonotknowsideeffect-pickasideeffectinsamebodysystemthedrugis working Noideawhatthedrugis-looktoseeifitisPO-pickGIsideeffect Nevertellkidsthatmediscandy OB-checkfetalHR MedSurg 1 st thingassess-LOC 1 st thingdo-establishairway Peds Allbasedonprinciple-givechildmoretimetogrowanddevelop Whenindoubt-callitnormal Whenindoubt-picktheolderage Whenindoubt-picktheeasiertask-moretimetodotheharderone

2 General Ruleoutabsolutes If2answerssaysamething-neitheriscorrect If2answersareopposite-oneisprobablyright Umbrellastrategy Ifquestionshas4rightanswersandaskforpriorityofneedsofapatient-worseconsequencesgame-worst outcome Whenstuckbetweentwoanswers-readthequestion Sesamestreetrule-useonlyaslastoption Rightanswertendstobedifferentthantherest Wronganswersareusuallyallsimilar Rightanswerismostuniqueordifferent Answerbasedonwhatyouknow,notwhatyoudon’tknow Ifyoudontknowsomethinginaquestion-pullitoutoftheequation-usecommonsense Nclexalsotestingoncommonsense-donotoveranalyze-donotthinklikeanurse Gowithgutanswer-onlyifotheranswerissuperior

3 Prioritization Decidewhoissickestorhealthiest--->basedonquestion ABCdoesnoworkwithprioritizationquestions Answerswillhave4parts Age Gender Diagnosis Modifyingphrase 2areirrelevant---->ageandgender InPedspayattentiontoagebutinprioritizationageisnotimportant Modifyingphrasemostimportant

Ex:pthasanginapectorisvsMI---->MIishighpriority

PthasanginapectorisandunstableBPvsMIwithstableVS---->anginawithunstableBPisnowthe priority 4rulestoprioritization 1.Acutebeats(higherprioritythan)chronic

Example:COPDversusappendicitis--->appendicitisisthepriority

2.Freshpostop(<12hrs)beatsmedicalorothersurgical

Example:2hrpostopversusappendicitis--->2hrpostopisthepriority

3.Unstablebeatsstable StablewordsUnstablewords Stable Chronicillness Postop>12hrs Localorregionalanesthesia LababnormalitiesAorBlevel Unchangedassessments Tobedischarged Readyfordischarge Admittedlongerthan24hrsago ExperiencingthetypicalexpectedS/Sof diseasewithwhichtheywerediagnoses Unstable Acuteillness Postop<12hrs Generalanesthesia(1 st 12hrs) LababnormalitiesCorClevel Changed/changingassessment Notreadyfordischarge Newlydiagnosed Newlyadmitted ExperiencingunexpectedS/S

Example:

16yow/meningococcalmeningitiswhohashadtempof103.8Fsinceadmission3daysago.61yomalew/IBSwhospikedtempof103Fthisafternoon.Whoishigherpriorityandwhy?--->2ndoptionispriority-->havemorehighprioritiesthan1 st Alwaysunstablenomatterwhat-evenifexpected

4 Hemorrhaging(notbleeding) Highfeverover105F--->patientcanhaveseizure Hypoglycemia Pulselessness(vfiborasystole)orbreathlessness

Note:atsceneofaccident(unwitnessed)-theyaredeath-lowpriority

3thingsthatcausesblacktag @sceneofaccident Pulselessness Breathlessness Fixedanddilatedpupils(evenifstillbreathing) 4.Tiebreaker--->themorevitaltheorgan,thehigherthepriority.Organinwhichthemodifyingphraseisreferringto Mostvitalorgans 1.Brain 2.Lungs 3.Heart 4.Liver 5.Kidneys 6.Pancreas