1. wear sterile gloves whenever in contact with wound area. 2. Contact precautions use gloves and mask 3.

keeping sterile field within view 4. Never recap needles plsss.. 5. Using clean gloves to handle contaminated items blood 6. isometric exercises maintain muscle strength 7. Airborne precautions use N95 and gloves 8. not true. The nurse has less training than the doctor and clarifying orders are against protocol 9. Patient needing the health team is collaborative intervention 10. nurse in quandary in following a dnr order. Seek counselling session with nurse supervisor 11. avoid constipation eat brocoli 12. enema with cramping clamp the tubing 13. most important measure during suctioning is hyperoxygenating the client 14. body mechanics. Form a broad base of support flex the knees kepp feet wide apart use leg muscles and arm not the back 15. the DNR decision should be a subject of explicit discussion between the patient and the family (or designated surrogate) acting according to the patients wishes 16. The choices and values of the competent patient should always be given highest priority, even when these wishes conflict with those of HCPs and families. 17. DNR orders must be clearly documented, reviewed and updated periodically to reflect changes in the patients condition 18. Carrying out orders from physician assitant must be carried out. Unless 19. Nurses with alcohol dependency tend to drink before their shift, during lunch and coffee breaks, and in the bathroom, absenteeism, workplace accidents; Charting suffers with errors and omissions. Inadequate reporting and Discrepancies with what is charted may be apparent, When challenged, the nurse may offer implausible excuses for behavior or become defensive. Behavior changes may include mood fluctuation, sleeping on the job, or isolation.

20. It is your duty to report to nurse supervisor. Advocacy 21. Crutches, advances the crutches to go down the stairs then move affected leg afterwards 22. Traction. Impaired physical mobility 23. traction, child encourage play like wireless computer or texting 24. Orders written by non-licensed personnel (e.g., medical students) shall not be acted on until countersigned by a licensed physician, dentist, advanced practice nurse, or physician assistant. 25. Verbal and telephone orders may only be given by a provider 26. When verbal and telephone orders are issued, they must be written and read back to the physician 27. In the absence of the ordering provider, the inpatient attending physician or another physician on the same service can sign/authenticate the order. 28. If the order is determined to be incorrect but has already been given, the order must be immediately discontinued and an incident report completed to document the incident. 29. Verbal and telephone orders may not be given for: Cytotoxic chemotherapeutic agents Biological response modifiers Do Not Resuscitate order Investigational drugs 30. the following chain of command when questioning or clarifying provider orders for medication or treatment of patients. 1. Physician/Provider/Author Challenging or Disputing 2. Clinical Department Supervisor a Physician Order, 3. Supervising Faculty (residents only) continued 4. Division Chief 5. Department Chair 6. Chief of Staff

31. The Five Rights of Delegation One that is delegable for a specific patient. Right Circumstances Appropriate patient setting, available resources, and other relevant factors considered. Right Person Right person is delegating the right task to the right person to be performed on the right person. Right Direction/Communication Clear, concise description of the task, including its objective, limits and expectations. Right Supervision Appropriate monitoring, evaluation, intervention, as needed, and feedback. 32. Nurses may accept physician orders via telephone from office personnel designated by the physician provided they are health related professionals. If not ask to talk with MD. 33. Verbal orders are acceptable in emergent or urgent situationssuch as a code or trauma situation when it is difficult for the prescriber to document 34. A facsimile (fax) is a copy of the original order 35. Clinical protocols are established sets of procedures for the management of conditions and disorders which include prescribing medications 36. A notation in the nursing notes of the clients co-operation may be sufficient to indicate implied consent. Invasive techniques such as an injection may require verbal consent. 37. A client had abdominal surgery most likely experience paralytic ileus. 38. Assesing circulation First inspect color of foot 39. Client has difficulty breathing, to complete health assessment call family members to provide additional information. 40. Open ended questions are to further explore for information. What? 41. place arms across the chest when moving up in bed, to reduce surface area that come in contact 42. To reduce shearing force when moving a client up in bed is to use draw sheet, head of bed be kept low/flat 43. Bedridden client disoriented and attempts to remove ngt, ask a family member to stay with client, restraints are used as a last resort or urgent situations 44. Restraints should be signed within 4 hours not 24 hours. 45. in performing endotracheal suctioning, apply suction while rotating gently for not more than 10 secs

46. esophagojejunostomy is total gastrectomy, bilroth I is gastro Duodenostomy, Bilroth II is Gastro Jejunostomy 47. Post op Bilroth, report rigid abdomen, pain, direct and rebound tenderness 48. PACU priority Patency of airway, Ineffective airway clearance. 49. Abdominal pain, nausea and vomiting, with abdominal distension, Do NPO and NGT gastric decompression. 50. Return flow enema to remove flatus 51. Paint doors and their trim a contrasting color from the walls 52. Stairs/Ramps Mark all steps both inside and outside the house with contrasting colors. Paint the handrails a contrasting color from the wall. A good way to mark steps is to paint a yellow stripe on the edge of the step. Red and green and also green and blue are contrasting colors. 53. High quality florescent lighting is the best bet for the kitchen, laundry room, and shop. 54. T Tube can be emptyed without a doctors order. 55. Components of medication include dosage, route and frequency, name of client, medication, date and time the medication was ordered, physician sihnature and PRC licensure numberExcept the physician specialty. 56. Stress can elevate blood sugar 57. nurses as witness in court if they dont state the truth could be cited for Perjury. 58. Antineoplastic agents are chemotherapy for cancer/ if they leak this is extravasation. Stop the chemotherapy, then call the physician. M.D might inject antidote sodium bicarbonate , sodium etc to the IV site. 59. Dextran 40 with wheezes ..stop the infusion. 60. Metabolic acidosis, give crystalloids LRS/Lactated ringers solution a alkalynating solution. 61. Hypovolemic shock give 0.9 Na Cl of LRS 62. Body image disturbance expected outcome. Learns to take care of site independently/ touches the dressing/looks at the site/changes and clean tube/etc 63. Virus disease include AIDS/HIV, Dengue virus , SARS virus ,infectious mononucleosis virus, meases/rubeola virus, rubella virus , mumps virus BUT NOT malaria or typhoid 64. Endotracheal tube measure cuff pressure using aneroid manometer every 8 hours/shift maintain at 25 mmhg. Keep call light within reach. 65. A cuff air leaks of an endotracheal tube is usually a compromised cuff or pilot balloon or an improperly positioned tube. Many times, the airway simply needs to be advanced. There could be other rare reasons for cuff leaks, such as a malformation of the tracheal or an esophageal-bronchial.

66. Suctioning the tracheostomy needs sterile gloves. 67. Tidal volume , volume of air in and out 68. Sigh, periodic deep breath in ventilator 69. FI 02 , oxygen concentration delivered thru ventilation 70. Position of choice in CHF is sitting with legs dangling 71. Acute head injury. Priority. Ineffective airway clearance related to depressed sensorium 72. GCS does not include pupil size and reaction it only include motor, eye opening and verbal response 73. Cervical implant. CBR, Foley catheter, bowel cleansing or enema before insertion, CBR, low resideue or low fiber, isolate, 74. Bronchoscopy, Alert for Stridor 75. Edler client with multiple bruises. Document findings, report to authorities 76. ICP increases causing ineffective breathing pattern cause by brain stem herniation. Apnea. And decreased tissue perfusion 77. Acute heart failure causing acute pulmonary edema. Priority is hypotension skin is cool and diaphoretic, crackles all over the lungs, .Lasix and morphine is given and digoxin 78. Atrial Flutter saw tooth appearance of P waves. 79. fibrillation pattern, first check electrodes, then pulse 80. Preservatives in eye drops can cause allergic reactions 81. Signs of Increase ICP, slowing of the heart rate, increase pulse pressure, irregular breathing, increased BP 82. earliest most sensitive indicator ICP is change in Level of consciousness 83. Sign of basal skull fracture, Ecchymosis behind the ear, and around the eyes or peri orbital 84. Hypophysectomy, avoid suctioning the nose, kepp head at semi folwer, monitor BP and Urine output/I and O 85. Osteoporosis, weight bearing activities 86. Least appreciated by alzheimers is playing a game which frustrates him/ board game 87. which variables is sufficient for effect to occur is injection of corticosteroid

88. TQM, Qulaity is achieved by involving participation of everyone, continuous process improvement, focus on the work process, patient satisfaction is foremost, decision by fact NOT by majority rule. 89. Removing dressing. Dont use sterile gloves when removing dressing. Use sterile glove when touching the site. After Applying the dressing you should tape then you can remove gloves. 90. Ear irrigation. First make sure tymphanic membrane is intact. Tell client that there is warm uncomfortable feeling. Place client after procedure on the affected ear for the solution to drain. It is Wrong to place client on the unaffected ear after irrigation 91. Thyroid crisis. High fever , place cooling blanket and antipyretics. Tachycardia and hypertension, give Propanolol or inderal to slow down heart rate, and give PTU to prevent formation of thyroid hormones 92. To assess for pain with speech impairment or problem ask to write in magic slate 93. The wheelchair is place parallel to the bed as close as possible. 94. Stretcher should be placed lower than the bed. NOT higher or equal. 95. Measuring crutches. Client supine measure from axilla to the foot and add 1 inch/2.5cm 96. Bryant traction. The hips are flexed 90 degrees and buttocks should not touch mattress 97. Traction, weight should not touch the floor. If touching the floor it needs further assessment or except option. 98. Phelbitis, infiltration. Discontinue iv 99. Percussion when done properly should produce a hollow popping sound. 100. In COPD, beta adrenergic blocking agents may constrict airways loike propanolol/inderal/ betaloc 101.Avoid clamping the chest tube/closed chest drainage bec it may cause tension pneumothorax 102. Aldactone inhibits aldosterone, avoid taking oranges, bananas, salt substitute. Which contains potassium causing hyperkalemia 103. Thiazide diuretics, lasix aldactone all causes generalized muscle weakness, fatigue. 104. in hypokalemia , best diuretic to give is aldactone to increase k while on diuretic therapy 105. Sub judicata means a person cannot be sued again for the same offense after he is found innocent

106. exhibit / chart/ evidence 107. Power of attorney designates a person to decide for somebody. A type of living will that must be honored. 108. Advance directives shall be honored. 109. Chain of infection. Washing of hands breaks the mode of transmission. 110. Chain of infection. Autoclaving instruments breaks the etiologic agent. Destroying the etiologic agent. 111. Chain of infection. Immunization decreases susceptibility of host. 112.Chain of infection. Eliminating stagnant water to reduce mosquito breaking the reservoir. 113. Intrathecal pain medication, priority is assess vital signs. 114. Enema, if there is resistance, allow the solution to flow. 115. Post op client, splint the incision with pillow to facilitate coughing post op 116. Cold compress prevents edema and reduces pain 117. effects of cold last longer than warmth 118. Dengue is transmitted to humans by the bite of an Aedes mosquito which feed during the day time. the classic picture is high fever of sudden onset dengue has an incubation period of 3-14 days (average 4-7 d) 119. Dengue fever is usually a self-limited illness, and only supportive care is required. Acetaminophen may be used to treat patients with symptomatic fever. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be avoided. Bec of anticoagulant properties. 120. Starch (hetastarch, 6% hydroxyethyl starch) Hydroxyethyl starch is a sterile solution of starch responsible for colloid oncotic pressure of blood. Infusion of albumin results in a shift of fluid from extracellular space into circulation, thereby decreasing hemoconcentration and blood viscosity. This is also used in shock as a plasma expander. 121. In Cancer patients. Telling the truth. Veracity vs Non maleficience. 122. Traction. Proper alignment ensures good circulation and respi movement 123. Hypocalcemia. Chvostek. Trousseau 124. Thyroidectomy. Palpate for dampness

125. Lugols solutionbefore thyroidectomy has metallic taste in the mouth. Can cause decreased libido and gynecomastia. Use preop to minimize bleeding. 126. High pressure alarm in mechanical ventilation is caused usually by secretions. Auscultate and suction ET tube. 127. Dependent variable is the outcome variable. 128. Research client right to full disclosure means knowledge of extent of research. 129. Summary is prepared for the transition to another health care setting. Example. To a long term health care facility. 130. Legs crossed at the knee causes the bp to be elevated. 131. Deflate the cuff of BP 2-3 mmhg/sec 132. Inflate the cuff 20-30mmhg above 133. Assessing pulmonary/respi function.Assess ABG or pulse oximetry. 134. A chronic carrier of infection like chronic heap B. block the portal of exit will succeed in preventing infection..remember the carrier person is the reservoir you cant eliminate the reservoir. 135. Goggles can be reuse when caring for a single client for one shift. 136. Oral care. Use NSS 137. Raynuad phenomenon, severe cases there are trophic changes, nails may become brittle. Skin thickens. 138. Peripheral arterial disease. Most commonly affected are femoral and popliteal. Person with diabetes mellitus experience more extensive and progressive vascular disease. There should be at least 50% narrowing. Walking slowly until the point of claudication is encouraged ton increase collateral circulation. 139. A subtle sign of cardiorespiratory distress in infants and children is irritability, lethargy, change in responsiveness. 140. Short stature in children one cause is deficiency of growth hormone. To assess bone age take xrays. In classic GH defieciency, clients has normal intelligience, short stature, obesity, immature facial features, delayed puberty and microphallus.. GH is administered SQ. 141.Pancreatitis. Svere pain . epigastric radiates to the back. Aggravated by supine position. Less sevre when sitting and leaning forward. Test include serum amylase, WBC is increased, Blood sugar is increased, elevated bilirubin, hypo calcemic occurs in 25 % of cases. Increase LDH, Increased alkaline phosphatase, Inc Serum Transaminases. PAPAverine is used to relax muscle. 142. Major advantage of laparoscopic cholecystectomy is resume work after 1 to 2 weeks. 143. In pacreatitis CT scan are used to detect necrosis and fluids.