Term
| Intradermal (Parenteral): |
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Definition
| 26-27G small amounts of fluid, 10-15 degree angle. Bevel up -> small bleb |
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Term
| Subcutaneous (Parenteral): |
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Definition
| 3/8-5/8 inch, 27, 28-31G, 45 degree angle for average, 90 degree for obese |
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Term
| Intramuscular (Parenteral): |
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Definition
| 18-27 G, 1- 1.5 inches 90 degree angle |
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Term
| Intravenous (Parenteral): |
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Definition
| 16 G for trauma, 18 during Sx, 22-24 for children, older adults. Peripheral veins in arm or hand are preferable. Newborns use head, lower legs, feet |
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Term
Never 27: Since the initial never event list was developed in 2002, it has been revised multiple times, and now consists of 29 "serious reportable events" grouped into 7 categories:
Surgical or procedural events
Product or device events
Patient protection events
Care management events
Environmental events
Radiologic events
Criminal events |
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Definition
https://psnet.ahrq.gov/primer/never-events
Examples: Patient death or serious injury associated with a medication error (e.g., errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation, or wrong route of administration)
Patient death or serious injury associated with unsafe administration of blood products |
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Term
| Those at increased risk of falls: |
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Definition
| Those at increased risk: older adults, decreased visual acuity, weakness, urinary frequency, gait and balance problems, cognitive dysfunction, SE of meds |
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Term
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Definition
| Use call light, fall risk alerts, provide regular toileting, lighting, orient to setting, hourly rounding, place those at risk for falls near nurses station, keep items with in reach, keep bed low, brakes locked, nonskid footwear, use gait belts, keep floor clean and clutter free, keep assistive devices near by, use electronic safety monitoring devices, educate patient and families |
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Term
| Seizure precautions: implemented for those with history of seizures |
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Definition
Keep rescue equipment at bedside- 02, oral airway, suction equipment, padding of side rails, IV
Keep airway patent, remove items in environment that could cause harm, assist with ambulation,
Family education: do not put anything in mouth, do not restrain, lower patient to floor, protect head, remove nearby furniture, provide privacy, put on one side with head flexed slightly forward, loosen clothing |
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Term
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Definition
| Stay with patient, maintain airway and suction as needed, administer meds, note duration and sequence of movements, after seizure determine mental status and monitor VS, document |
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Term
| Seclusion and Restraints (Physical and Chemical): |
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Definition
Nurses responsibility: explain reason, consent, review instructions, assess skin integrity, offer food and fluids, hygiene, elimination, monitor VS< ROM. Pad bony prominences, 2 fingers between restraint and patient, remove to ensure good circulation, ongoing evaluation, determine need to continue,
Documentation: precipitating events, alternatives used, time of application and removal, type and frequency of care, condition of body part in restraint, response to removal, meds |
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Term
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Definition
Result of dysphagia
Some causes of dysphagia
CVA, muscular dystrophy, Parkinson’s, Myasthenia gravis, Guillain-Barre syndrome, trauma
Characteristics predictive of aspiration
Weak voice, drooling, difficulty initiating swallow, choking, coughing, gagging with food, poor tongue control, loss of gag reflex, nasal regurgitation, pain with swallowing, feeling of food stuck in throat, burping, heart burn
“Silent Aspiration” there may not be any outward signs of swallowing difficulty
Techniques for identifying dysphagia: bedside screening, videofluoroscopy, fiberoptic endoscopy
Have suction available in room |
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Term
| Aspiration Precautions (feeding the patient): |
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Definition
Apply pulse oximeter
Position patient upright in chair or bed at 90 degrees-or highest position allowed
Using penlight and tongue blade inspect for pocketed food
Have patient assume chin-tuck position- begin by having patient try a sip of water and monitor for swallowing and respiratory difficulties- if sips are tolerated, offer large volume of water and then different consistencies of foods and liquids
Add thickener to liquids if ordered
Place ½-1 teaspoon of food on unaffected side of mouth-allow utensil to touch the mouth or tongue
Provide verbal coaching and redirection while feeding patient- TAKE YOUR TIME
Observe for coughing, choking, gagging, and drooling- suction as needed
Do not rush a patient during feeding
Demonstrate chewing for dementia patients if needed
Have patient remain sitting upright for at least 30-60 minutes after the meal
Provide oral care after meals
Collaborate with RD and speech therapist for safe advancement of diet |
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Term
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Definition
Developmental
-Infants and toddlers: explore world with their mouths
-Pre school and school aged: limited coordination
-Adolescents: increase desire for independence
-Young and middle adult: MVA
-Older adults: remember physical and possible cognitive changes
Fire safety
CO
Food poisoning |
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Term
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Definition
ABCDE principle
Airway/cervical
Breathing
Circulation
Disability
Exposure |
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Term
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Definition
Bleeding
Fractures and splinting
Sprains
Heat stroke
Frostbite
Burns
Altitude-related illnesses |
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Term
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Definition
Nurses role
Emergency response plans: involved in developing disaster plan
Triage: casualties are separated in relation to potential for survival
Emergent or immediate: highest priority for life threatening with high chance for survival
Urgent or delayed: can wait 30 min-2 hours
Non-urgent or minimal category: minor injuries
Expectant: who are not expected to live- comfort measure provided |
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Term
| Emergency Preparedness Events: |
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Definition
Fire
Severe thunderstorms
Biologic pathogens
Chemical incidents
Hazardous materials
Radiologic incidents
Bomb threats
Active shooter |
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Term
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Definition
Be empathetic and nonjudgmental: pay attention to the persons feelings
Respect personal space: stand 1.5-3 feet away from person who is escalatingdecrease anxiety
Use nonthreatening nonverbal behaviors: be mindful of gestures, facial expressions, movements and tone of voice
Avoid overreacting-remain calm, rational, professional: how you respond will directly impact if situation escalates or defuses
Focus on feelings
Ignore challenging questions: results in power struggle- redirect attention to issue at hand
Set limits: offer concise and respectful choices and consequences
Choose wisely what you insist upon
Allow silence for reflection: give person chance to reflect
Allow time for decisions: allow person to think through actions
Use concise, simple language |
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Term
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Definition
Absorption: movement of medication into blood
Route of administration: topical=slow, oral=slow, respiratory=quick, IM and SQ=quicker than PO, slower than IV, IV=most rapid absorption
Influenced by: route, ability of medication to dissolve, blood flow to site of administration, body surface area, lipid solubility of medication
Distribution: depends on circulation, membrane permeability, protein binding
Metabolism: metabolized into less active or inactive forms
Excretion: exit body through kidneys, liver, bowel, lungs exocrine glands. |
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Term
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Definition
Goal to maintain plasma levels between MEC and toxic concentration
Therapeutic index: high TI have wide safety margin. Trough levels (obtain blood sample immediately before next dose)
Half life: time it takes medication to drop by 50%. Usually takes 4 half lives to achieve a steady blood concentration |
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Term
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Definition
Mechanism of Action
Agonist: can mimic receptor
Antagonist: block usual receptor activity
Partial agonist: agonist and antagonist- limited affinity to receptor sites |
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Term
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Definition
CNS
Extra Pyramidal Symptoms
Anticholinergic
Cardiovascular
GI
Hematologic
Hepatotoxicity
Nephrotoxicity
Toxicity
Immunosuppression |
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Term
| Hypersensitivities / Allergies: |
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Definition
Rapid: immediate-acute inflammation, histamine release,
Allergic asthma
Angioedema: swelling of lips, face, neck- NSAIDs and ACEI
Anaphylaxis: rapid systemic reaction. GI cramping, itching, hives, angioedema. Respiratory (crackles, wheezing, stridor, respiratory failure and even death)
Tx: diphenhydramine for rashes. Epi for severe RRT-epi, bronchodilators, antihistamines, respiratory support for anaphylaxis. Can experience extensive vasodilation and capillary leak- tachy weak pulse. |
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Term
| Pharmacology in Children: |
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Definition
Use BSA
Newborns and infants have immature liver and kidney, alkaline gastric juices, immature blood brain barrier-especially sensitive to CNS affects
Increased risk for errors: accurate for BSA, initial doses are approximation, limited sites for IV
Decreased gastric acid production and slower gastric emptying time, decreased first pass absorption, increased topical absorption, higher body water, decreased protein binding sites->increased blood level |
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Term
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Definition
Increased gastric pH
Decreased GI motility and emptying-->slower rate of absorption
Decreased blood flow through CV, liver, kidneys
Decreased kidney function
Decreased hepatic enzyme function
Decreased protein binding sites
Decreased body water, increased body fat |
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