Merry Christmas

Merry Christmas

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!

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

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

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
record
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

16a
60/30=2
2x100=200ml/hr
16b
60/90=066
.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

IV MEDICATIONS
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