Sunday, December 12, 2010

Day 3 at Grady

Up at 5:30 am without any problem, that in itself is scary!! Read up last night on Sickle Cell etiology, treatments, stats, in preparation for my peds patient today. I know I have done it a dozen times before but with stress I tend to forget. When the examiner did not have a coat on I had to ask if we were going across the street to the Children's Hospital. Image my utter relief when she informed me I had a "peds substitute" adult patient. YIPPEE!! I always want to cry when children are hurting or ill. I did it!!! I PASSED THE CPNE!!!!! Words can not express the joy I have. My husband and I shared some tears of joy as we quickly exited (never to return) Atlanta, GA!!!!!! Merry Christmas!

Saturday, December 11, 2010

Day 2 at Grady

I am still here.....A bit shaky but I passed both PCSs. A child tomorrow - I plan on reviewing again tonight after dinner with a dear friend and her hubby. I will be back.......Sat Nam

Friday, December 10, 2010

Day One at Grady

Shaking like a leaf!! I almost could not hit the stopper in the vial to do the IM. I took some deep breaths mentally said some mantras from my Kundalini teacher and then I could hear my dad's voice telling me to just take a few deep breaths and go slow - don't hurry use all of your time. Then I thought of my turtle anklet. Slow and steady like a turtle, don't lose my head like one of the turtles. Mark echoing my dad was in my head too. God Bless my honey he sat at Grady and waited for 3 hours for me to come down. Thinking of all of the tips and recommendations of those close to me I believe pulled me through. Daily lunchtime practices with Patty made my wound (the first station) a success in record time! Sheri and her confidence in me has given me the "guts" to try one last time, truely the last time. PASS PASS PASS and PASS. Now on to bed and get geared for day 2 - two adult patients. Keep the positive energy flowing! Sat Nam

Tuesday, December 7, 2010

Patient Teaching

Patient teaching is always co assigned with any other  area. Not wise to use as a care plan

determines the patient's readiness to learn
assess the patient's motivation and ability to learn or
identifying barriers to learn
ask questions to identify the patient's specific learning need
provides accurate information that is appropriate for and consistent with the identified learning need of the patient
ask questions to determine the patient's understanding of the information
assessment of learning readiness
information provided
patient response to information

calculations for iv rates and medicatons pg 296

 calculating gtt/m
ampicillin 500 mg in 50 ml /ns run over 20 minutes drop factor is 15 ml/m

flow rate (gtts/min)
volume to be administered (ml) x drop factor of the tubing (drop/ml)
Lengh of time to be administered (minutes)

50 x 15 = 750 = 75 =    37.5  ggt/min - round up or down to whole number
20             20      2

erythromycin 50 mg in 100 ml NS
run over 30 min
gtt factor 15

100 x 15 =  1500 = 150= 50gtt/min
30                 30        3   

to calculate ml/hr

divide 60 minutes by the time to infuse the med, multiply the answer by the volume

60/20 = 3
3x50 = 150 cc/hr

.66 x100 = 66ml/hr

Medications 17th edition CPNE study guide page 285

Medications must be administered at least once during the CPNE

Select the prescribed medication using the hospital MAR
  • know the side effects, actions and uses of any med you are to administer,
  • follow guidelines like apical pulse rate of BP
Measures the dosage
ID the patient immediately before administering the medication by comparing the MAR to the Bracelet on the patient with 2 identifiers - DOB, Name, MRN
Use the correct size needle
Use the correct dose
administer to the patient within 30 minutes of scheduled time

5 rights of medication administration
  • right med
  • right patient
  • right dose
  • right time
  • right route
records the correct flow rate in drops per minute for gravity flow or mls per hour for infusion control devices or the PCS Recording Form before administering the medication
assiss the insetion site for dislocation, infiltration or other complications by :
  • feeling the surrounding skin for changes in temperature
  • palpating the surrounding tissue for edema
clears air from tubing

when an intermittent venous access device is used:
  • aspirates for blood return unless contraindicated
  • flushes with the designated solution prior to medication administration
  • flushes with the designated solution after medication administration
  • records the fluch solution used on the pcs response form
refulates the flow to deliver the prescribed amount in the designated period of time within 5 gtts/min for gravity flow or the correct ICD setting

records the medications administered on the hospital MAR within 30 minutes after administration

Irrigation page 281 17th CPNE Study guide

Irrigations my be intermittent or continuous. Sterile technique is used to avoid introducing microorganism into a wound or body cavity such as the bladder.

determine the appropriate temperature of the solution
positions the patient
verifies the correct placement of the tube - ng instill 10-20 cc air if child 5 cc air and listen then aspirate gastric contents
instills the solution into the designated area
controls the flow rate
positions the receptacle
records the kind of irrigation solution  used and the amount of irrigation solution used, the patient's response or tolerance in the student pcs response form. check if irrigation solution is included in the i & o totals , ask what the hospital's policy is

Sunday, December 5, 2010

Care Plan Question

My question:

If i write a "risk for" care plan, can I use it as my priority and evaluate it if it does not become an actual problem? I think I can but I thought it was not allowed.

I am reading the 17th Edition Study Guide page 280 answer for:
" #6 Write a care plan for a patient receiving enteral feeding via a peg tube following oral surgery for removal of a cancerous lesion of the mouth. What are the possible related factors?
Label: Risk for imbalanced nutrition: less than body requirements related to impaired swallowing
Outcome: Patient will be free of gastric distress during tube feedings
1. Position patient to a 45 degree angle for feeling
2. Administer enteral feeding as prescribed"

My thought on the evaluation all the components are here -
the nursing dx
with the RT aspect
no s/s since it is not an actual problem
Outcome is measurable - no gastric distress during the feeding
importance - According to maslow, nutrition is a basic human need, required for cell regeneration. Without adequate nutrition cell growth and repair can not occur. If an individual experiences gastric distress they may not tolerate adequate nutrition thus preventing tissue repair, strength, and increasing the susceptibility of infection, inadequate circulation, and tissue breakdown.

evaluation of interventions -
effective as the patient was positioned at 45 degrees
the feeding was administered as prescribed

the patient denied any gastric distress.

Enteral Feeding - 17 th Edition CPNE Study Guide - Excelsior pg 270-271

Feeding by bottle, tube or other device to infants, children or adults.

  • For all feedings:
    • select the correct formula
    • position the patient
    • deliver the feeding
  • When assistance is designated:
    • choose the appropriate device
    • burp an infant under six months old periodically, as needed
  • Administer the feeding at room temperature unless otherwise directed.
  • intermittent Tube feeding:
    • determine the amount of feeding
    • calculate the gtts/min
    • verify the location of a NG by:
      • instilling 10-20 cc (5 mm for child <2) of air into the tube while listening to the abdomen
      • aspirate amount of gastric contents
      • record amount of gastric contents
      • reinstill gastric contents
    • initiate feeding within 30 minutes of scheduled time
    • regulate the rate to be within the specified time by
      • adjusting the flow rate to within 5 gtts/min
      • or setting the icd to the prescribed flow rate.
  • continuous tube feeding:
    • within the first 20 minutes
      • verify type of feeding
      • verify rate either by gtt/min or icd setting
        • regulate the flow if needed within 5 gtts/min
        • or adjusting the rate on an ICD to the ordered rate.
      • document same on the PCS recording form
    • verify the position at least once during the PCS by
      • instilling 10-20 cc (5cc for child <2) air and listening to abd and
      • aspirating gastric contents
    • when measurement of gastric residual is designated:
      • measure gastric residual
      • reinstill gastric residual unless contraindicated
      • determines the amount of feeding to be administered
  • Records the kind of oral feeding administered
  • Records the name and strength of the feeding product for a  patient receiving a tube feeding
  • Records the amount of feeding
  • Records the volume of gastric residual measured

Interesting or Not

Vickie's Views