.

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'ifest-TaKing Strategies
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Prioritizing - Means ranking the client's problems in order of importance depending on: * Iss.u~ of the ~uestion <- ~n\! c\:ients rrobie.m * Clinical settmg \ 7cUn icoJ se..-t--ri () 9 . * Client's condition [acu\e \~-\ -\hen chm"lc) > ell et,\1-s co \'1cll h''' n ' * Needs/problems that require immediate attention ~ trob\-evY) o~i'ng oa-l aci-u, A. Priority Classification System. ".ll..r.t 'f un'J~~ ~\\i r~t)t+ in 1. High Priority .? H"ft t\1ttO-\e.nH9 ct?roIltlf>{)~,....... I d~\rlt require u.. I~ non ~~erx;..<j J 2. Intermediate Priority >f\OO It'1'~ T' 1\'lXt-rc-n r~ .. 3. Low Priority
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B. Guides for Prioritizing 1. Keywords or key phrases 7. Maslow's Hierarchy of Needs Theory a. Physiological needs are the first priority :(!)A- A\~)' ~f'AI)J C - 0I~\Cd'10 ""' b. Pain c. Safety 3. Steps of the Nursing Process a. Assessment vs. Implementation b. Expected outcome ~ cY' '("0""" c. C. Other PrioritieV. 6# . /6

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1. Most acute fleast stable chent 2. Complication of the disease condition .. otan expected outcome' n II. Delegation 'andAssignment-making A. Principles and Guidelines 1. Ensure client safety. 2. Focus on what the question is asking for. 3. Determine which activity can be delegated safely and legally. 4. Match the activity on the basis of the nurse practice Act. 5. Provide adequate supervision. B. Who can do what? 1. Unlicensed personnel - Noninvasive tas, the following: a Ambulation b.Bathing. c. Client transport d. Grooming e. Hygiene measures

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oasic client care activities that include f. Positioning g. Range-of-motion exercises h. Skin care 1. Some specimen collection, such as urine or stool
EXCELL Nursing Review

>1iO\.l-1 N\JASVC ,Ask <J~L't

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2. Licensed Practical or Vocational Nurse - Certain invasive tasks and client care >1'16 \v'PR\,)0S '> fIIO vc; f"'. activities that include the following: a. Administering oral d. Irrigating wounds medications e. Monitoring an intravenous b. Administering intramuscular flow rate and subcutaneous injections f. Suctioning c. Changing dressings g. Urinary catheterization 3. Registered Nurse - Some of the tasks and client care activities that only the registered nurse can perform are as follows: a. Administering intravenous medications b. Leading others and managing the client care environment c. Teaching d. Using the nursing process: assessment, analyzing data, planning client care, implementing.care, and evaluating care

m. Test-Taking

Technique A. Identify the parts of a question. 1. Case situation 2. Question stem 3. Options B. Read the question carefully. LOok for ke ords or phrases in the case situation ana stem ofUie uestion . Examples: 1. What is an early sign of shock? (ee\-\e SSleSc; 2. What is the initial nursing action? .Indicates that options are correct and you have to prioritize' 3. Which statement by the client indicates understanding of the instruction? /Indicates a true response question.' 4. Which statement by the client indicates the need for additional teaching? Indicates a false response question .. C. Identif}t the issue. What is the question asking? D. Use tlie process ot:elimination. Involves reading each question and removing the options that are incorrect and do not address the issue of the question. E. Aoi<i asking ourselt: '~lmtin" or,"lleaamg into the Question" Means that you are considering issues beyond the information presented in the question. Moves you off track with regards to what the question is asking. F. ~daitionaI tips and strategies 1. Eliminate options that contain absolute words, e.g., all, always, never, none, only 2. Focus on nursing rather than medical interventions . 3. Ensure that all parts of an option are correct. 4. Look for an umbrella option. 5. Visualize the information. 6. Look for the option that relates to the question. 7. Don't expect the test to end after 75 questions.

EXCELL Nursing Review

-DRUG ADMIHISTRAT-ION .~ I I
X Stock II. DRUG PREPARATION 1. Crushed tablet or capsule should be added to small amount of pureed fruit to facilitate administration to children or adults with swallO'Ning difficulty. 2. Shake bottle of suspensions to evenly distribute drug. 3. Prevent incorrect dosage to avoid adverse reaction. Volume (or Tab)

Amount of Drugs

Uf.

RATIENr ASSESSME
1.

2. 3. 4.

Check that prescribed dose is within safe range. Assess emotional and physical state of patient Make sure concurrent therapies do not contraindicate Monitor patienfs response to drug therapy.

drug.

ESSENTIAL CONSIDERATIONS ORAtDRUGS I. GASTRIC IRRITA:rtON 1. Indigestion and Nausea are first indications followed by vomiting. 2. Give anti-emetic before drug administration. 3. Food or antacid may decrease gastric irritation but its effect on decreased drug must be considered. 4. 00 not crush or chew enteric-coated tablet..

aosorpnon of some

II.

SELECT CONTAAI~DICATION 1. Cough syrup nas glucose. Considered this in-patient with Diabetes Mellitus. 2. Sodium Bicarbonate and Sodium Penicillin are contraindicated inpatient restriction. Alternative is Potassium Penicillin ':> se~ l:l R ... tJ,.~ ~ V1~O:r:1 t 3. Elixir and Tincture - consist of alcohol. Considered this in alcoholic patient FOOD AND DRtJG INTeRACTION

with

Sodium

PRESENCE OF FOOD IN G. I. TRACT 1. May decrease drug absorption. 2. May inactivate drug. 3. May enhance therapy by decreasing G. I. Oistress. AI:>MINIST-ER ::r:aE FOE~OWING 9RUGS ON AN EMB:r:'l S-TOMACB 1. All penicillin and ampicillin. 2. Tetracycline --) tv\l l1'C1\:S Of ~o lovt G\ 't'rito..tim 3. Erythromycin 4. If G. I. distress occurs, give drug with food.

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ADMINISTER THE FOLLOWING DRUGS WITH FOOD TO PREVENT G. I. - STRESS. 1. Analgesic and anti-inflammatory agent (indocin and Butazolidin). 2. Anticonvulsant (DUantin) 3. Diuretics 4. Hematinics - FESO . - Food may decrease absorption of iron. 5. Steroids ;>COk'\ ca,vs-e c,t a"eeoi~ 6. Flagyl 7. Furadantin 8. Theophylline ANTICOAGULANT PLUS ASPIRIN MAY LEAD TO BLEEDING TENDENCIES.

IV.

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PARENTAL DRUGS l. INTRAMUSCULAR ADMINISTRATION IN GLUTEAL MUSCLES 1. Patient Position - muscle relaxed, prone with toes or feet pointed inward. 2. Encourage deep breathing. 3; Distract patient or ask him to wiggle toe. INTRAVENOUS FLUID THERAPY When the doctor orders an IV to be infused at a specific mUhr volume, you will need three pieces of information in order to calculate the flow rate in gttImln. These are the total volume to be infused in mt, the calibration of the tubing being used (which you just leamed locate). andthe time (in minutes) ordered for the infusion. This information is used in the following formula. FORMULA Flow Rate

II.

Volume

x Calibration Time (min)

Calculate the ftow rate using

EXAMPLE 1

The doctor orders an IV to infuse at 125 mllhr. set calibrated at 10 gtVmL . Start by converting 1 hour to 60 minutes 125 (mL)

10 (gttImL)

60 (min) 125 x 10
./

60 EXAMPLE 2

20.8

21 gttlmin

Administer an IV of 100 mLln 40 min using a set calibrated at 15 gttImL. 100

x
-iO

15

= 37.5

38 gUlmin

EXAMPLE 3

15 mL of an IV medication is ordered to infuse In 30 min. The set canbration Is 60gUlmL 15

x
30

60

30 gUlmin

When an IV order is written specifying volume to be administered in more than one hour the formula can stili be used. However, in order to keep the numbers you are working with as sma. and simple as possible it is best to add a preliminary step. and determine how many mLlhr the ordered volume will represent. EXAMPLE 1 Calculate the ftow ralefor calibrated at 2Ogtt/mL an IV of 1000 mLlo run il') over 8 hrs with a set .

1000 mUShr

1000 + 8

125 mUhr

125 (mL) x 20 (gttImL)

= 41.6 = 42 gttJmin
60 (min)

IMPLICATIONS: I.

PENICILLINS AND CEPHALOSPORIN -

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HISTORY OF DRUG ALLERGY: Assess the following a) Allergy to any drug. b) Infant under 3 months of age. c) Cross-sensitization to both drugs. DRUG ADMINISTRATION a) Oral form binds with food. b) Poor1yabsorbed in acidic medium.

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I.V. ADMINISTRATION a) Penicillins are NA or K Salts. 1. Check for signs and symptoms of Hyperkalemia or Hypematremia. 2. Assess renal insufficiency. 3. Assess heart action. ADVERSE REACTIONS OF ALLERGIES MAYBE IMMEDIATE AND MAY OCCUR WITHIN ONE HOUR. A. CLINICAL MANIFESTATIONS 1. Urticaria 2. Bronchospasm 3. Laryngeal Edema 4. Hypotension B. TREATMENT 1. Epinephrine 2. Airway 3. Antihistamines 4. Treabnent of shock TETRACYCLINES

IV.

I.

FORM NON-ABSORABLE COMPOUND WITH: 1. Milk and milk products 2. Antacids 3. FE preparation 4. NSG IMP. Don't give with milk, antacid ~ GIVE WITH FOOD IF WITH G. I. SIDE EFFECT.t.i

II. III. IV.

DISCOLORS TEETH AND DELAYS BONE GROWTH UNDER 7 YEARS OF AGE. DON'T ADMINISTER TO PREGNANT MOTHER. DECOMPOSES IN FOLLOWING CONDITION: 1. Age 2. Exposure to light 3. Extreme heat and humidity '> G\\le c fCOd Il'G t O\S\~'E~~ PATIENT TEACHING> NO\l) $U~ 'E."'XPOSUR.'E

V.

VI.
VII.

ADVERSE REACTION 1. Nausea, vomiting. 2. Diarrhea 3. Phototoxic skin reaction (sunburn)

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AMINOGl:YCOSIDES 7 p~ ~\)'(" ~ (Stregtom)'dn, Gentamicin, Kanamycin, Neomycin, Amikasln) ~

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11 a) Intake and output - >\l9unO\

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b) Urinalysis c) Renal function - BUN (~ro-tel< -fc Ci:iiiitinine III.

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Serum Concentration a) Therapeutic blood level - 4-10 ug' ml b) Toxic blood level - above 1ctug' mI Withdraw blood specimen a) Peak - 30 minutes after a. ~Vi lojection..- , lie-.. IfFrGI!n ~ b) Trough - Just before administration l ~t-) ANTI-FUNGAL AGENT I. AMPHOTERICIN B (FUNGIZONE) Moniliasis amp~1eroC(\"Ie Histoplasmosis ')
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NYSTATIN (MYCOSTATIN) .OraHy for suppression of Candida AJbicans

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adverse reaction _ Amp\tOl"E-R l C\ 1? Ototoxicity and Nephrotoxicity Skin rashes Nausea' Vomiting Hypokalemia Dlarmea Fever Thrombocytopenia, Anemia

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URINARY OUTPUT a) Monitor frequently b) For crystaI5 c) Increased fluids. >

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HEMATOLOGIC EFFECT a) Blood Count b) Rash, Sore Throat, Purpura DON'T ADMINISTER a) Last trimester b) Nursing mothers

III.

c) Infants d) If with hypersensitivity to anyone' agent.

./ IV.

DECREASE ABSORPTION IF WITH ANTACIDS.

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