Nursing Student Convention

http://www.nsna.org/meetings/midyear.asp

Hey everyone. I got an e-mail from the National Student Nurses' Association about their Midyear Conference in Reno. The convention is from November 13 to the 16th at the Nugget. They will have panels on nursing specialties, workshops on topics like pharmacology and nursing exams, and an exhibit hall with employers schools and other groups of interest to nursing students. The above link will take you to the National Student Nurses' Association web site for the conference which has a lot more information about specific presentations and activities.

For students from California, they are offering registration for the conference at $30 per day as long as we get 15 people interested in going. I've already got some people, but we are looking for more. This will be a good chance to talk to hospitals about what they look for when hiring new graduates as well as learning what you can do to score better in class. This is a national convention and I think we really need to take advantage of the fact that its so close. If you're interested in going, please e-mail me with your name, and which day(s) you would like to go. I've already got people who are interested in car pooling and going for Saturday only, but if you would like to stay up there for longer you're more than welcome. The following is the text of the e-mail I received about the event:

Attention Nursing Students and Pre-Nursing Students in California

Registration Special Sale!!

Share this e-mail with Classmates and Faculty

Attend NSNA’s 26th Annual MidYear Career Planning Conference —November 13-16, 2008, in Reno, Nevada

We don’t want you to miss the upcoming Career Planning Conference sponsored by the National Student Nurses’ Association. We know that students are impacted by the current economic crisis so we have created a sale just for you!

Groups of 15 or more nursing students and/or pre-nursing students from the same school may register to attend the MidYear Conference for just $30 per day for Friday and Saturday. This special daily registration fee includes the Keynote Speaker on Thursday, 5:00 – 6:30 pm. See the complete program description and schedule to see which day works best for you. The Career Fair with 100 exhibitors takes place on Friday and Saturday. Nursing Career Specialty Panels take place on Saturday.

Here’s what you need to do to take advantage of this offer—use the attached form to:

• Collect the names of at least 15 nursing students and/or pre-nursing students who will attend the Conference;
• Indicate the name of the school of nursing and contact information;
• Include the day(s) that the students will be attending.
• Have a faculty member at your school sign and date the form;
• Submit the form by Wednesday, November 5.

This offer is for both NSNA members and non-members. Our hope is that non-members will join when they learn about NSNA and experience what the organization offers to members.

Once we receive the list, we will prepare badges which can be picked up at the Pre-Registered conference desk. You may pay by cash, credit card, or check. You will need to show your student ID when you register. Note that walk-in daily registration is also available so that those who do not make it onto the list can also attend at the special rate.

If you have any questions, please call (718) 210-0705 or e-mail nsna@nsna.org

We look forward to seeing you!

Sincerely, Jenna Sanders, NSNA President

PS See more information about the conference below.

Career Fair –Friday and Saturday. Find your first RN position, summer internships, and residencies. There are over 100 exhibits—bring plenty of business cards and your resume!

Nursing Specialty Showcase—Saturday November 15

Hear from 12 nursing leaders in a variety of nursing specialty careers—ask questions and get the answers you need to help guide your career decisions

"Conquering Your Own Everest: Do You Have What It Takes?"

Patrick Hickey, DrPH, MSN, RN, CNOR, is the Keynote Speaker at the National Student Nurses’ Association (NSNA) MidYear Conference in Reno, NV, November 13-16-2008. Dr. Hickey became the first registered nurse to have climbed all Seven Summits when he reached the top of Mt. Everest on May 24, 2007. Known as a humorous and engaging speaker, Dr. Hickey’s keynote speech, promises to deliver a rousing kick-off to NSNA’s MidYear Conference. And be the first to view NSNA’s new Career Advancement Video!

Major General Patricia Horoho presents the Midyear Leadership Address You will not want to miss this important event and an opportunity to meet the Chief Nurse of the US Army Nurse Corps, Major General Patricia D. Horoho. The Leadership Address takes place on Saturday, November 15, immediately following the Leadership Breakfast sponsored by the US Army Nurse Corps Recruiting Command.

Nursing’s Future: Opportunities and Challenges—Friday, November 14

Hear from five top nursing leaders—ask the panel participants questions and discuss the issues that concern your future as a Registered Nurse.

Faculty Program—Earn Contact Hours.

Click here to see what we have in store for faculty.

Special workshops for faculty advisors and state consultants are also offered.

“Tube In To NSNA” & Wall of Fame Challenge

Special event with karaoke, networking, dancing, pizza, cup-cake decorating contest, raffles, and prizes. Event takes place on Friday at 7:00 pm. Admission: $5.00. Join us and help raise funds for the Foundation of the NSNA Disaster Fund.

Please car pool whenever possible! Click here to calculate driving distance to Reno.

pharm exam #3 grades posted on turnitin.com

pharm GRM week #12 (brief)

Week 12-Chapter 15

1. How is the effectiveness of a psychotropic drug therapy often measured?
a. verbal reports from patients regarding improvements in social and occupational functioning

2. What factors constitute ideal mental health?
a. emotional, psychosocial, and spiritual factors

3. What is psychosis and what is its hallmark?
a. severe emotional disorder impairing mental functioning impairing ADLs; hallmark is loss of contact with reality

4. What is another name for affective disorders?
a. mood disorders

5. What is the biochemical concept of mental illness?
a. abnormal levels of neurotransmitters

6. Which neurotransmitters play a role in maintaining mental health?
a. dopamine, norepinepherine, serotonine, and histamine

7. What advantages do newer antidepressants have over TCAs and MAOIs?
a. fewer and less severe systemic adverse effects and less drug-drug and drug-food interactions

8. How long does it typically take antidepressants to reach their maximum clinical effectiveness?
a. 4-6 weeks

9. How do TCAs work?
a. block reuptake of neurotransmitters to correct imbalance of concentrations

10. In general, how do antipsychotics work?
a. produce state of transquility and work on abnormally functioning nerves

11. What are the positive symptoms of schizophrenia?
a. hallucinations, delusions, and conceptual disorganizations

12. What are the negative symptoms of schizophrenia?
a. apathy, social withdrawal, blunted effect, poverty of speech, and catatonia

pharm GRM week #11 (brief)

Week 11-Chapter 35

1. What causes the excessive mucus production in a URI?
a. inflammatory response by viral invasion

2. What causes nasal congestion in URI?
a. irritation of nasal mucosa resulting in dilated small blood vessels of the nasal sinuses

3. What 4 classes of drugs are used to treat URI?
a. antihistamines, decongestants, antitussives, and expectorants

4. What do histamine-1 receptors mediate?
a. smooth muscle contraction and dilatio of capillaries

5. What do histamine-2 receptors mediate?
a. acceleration of heart rate and gastric acid secretion

6. How does excessive histamine release cause a drop in blood pressure and edema?
a. vasodilation and increased capillary permeability, moving fluids from blood vessels into tissues

7. How do antihistamines work?
a. directly compete with histamine for specific receptor sites

8. What is the other term for antihistamines?
a. histamine antagonists or blockers

9. Which specific smooth muscle are histamine-1 antagonist particularly focused on?
a. smooth muscles surrounding blood vessels and bronchioles

10. What are the primary anticholinergic effects of antihistamines?
a. secretions of lacrimal, salivary, and respiratory mucosal glands

11. How does histamine cause pruritis?
a. stimulates nerve endings

12. What are the two main cells that release histamine?
a. basophils and mast cells

13. What do antihistamines do to smooth muscle in the bronchial tree?
a. cause extravascular muscle to contrict

14. Why is it most beneficial to give antihistamines early in a histamine-mediated reaction?
a. compete with histamine to occupy the unoccupied receptors

15. What are the consequences of histamine binding?
a. prevent consequences like vasodilation, increased secretions, and edema

16. What is the chief adverse effect of antihistamines?
a. drowsiness

17. How do the non-sedating antihistamines avoid causing drowsiness?
a. work peripherally without affecting the CNS

18. What is another name for non-sedating antihistamines?
a. peripherally acting antihistamines

19. What class of drug is loratadine (Claritin)?
a. non-sedating antihistamine

20. What class of drug is diphenhydramine?
a. antihistamine

21. Why is the use of diphenhydramine discouraged in the elderly?
a. hangover effect and increased risk of fall

22. What are the three classes of drugs used as decongestants?
a. adrenergics (sympathomimetics), anticholinergics (parasympatholytics), and corticosteroids

23. How do sympathomimetics produce decongestion?
a. constrict blood vessels to better drain nasal secretions

24. How do opioids reduce coughing?
a. suppress cough reflex

25. What are the two mechanisms of action for expectorants?
a. loosening and thinning of RT secretions and direct stimulation of secretory glands

Week 11-Chapter 36

26. Where does the oxygen-carbon dioxide exchange take place?
a. alveoli

27. What is the common feature of asthma, emphysema and chronic bronchitis?
a. obstruction of airflow through the airways

28. What is it that narrows bronchioles in asthma?
a. bronchospasm, inflammation, and edema of bronchial mucosa

29. What is the collective term for such substances as the histamines and leukotrienes?
a. inflammatory mediators

30. In asthma, what antibody sensitizes the patient to the offending allergen?
a. immunoglobulin E

31. How do bronchodilators work?
a. relax bronchial smooth muscle to dilate bronchi and bronchioles

32. What are the three classes of bronchodilators?
a. Beta-agonists, anticholinergics, and xanthine derivatives

33. How do each of the subtype beta adrenergic agonists work?
a. non-selective adrenergic drugs: stimulate alpha 1, beta 1, and beta 2 receptors
b. non-selective beta adrenergic drugs: stimulate beta 1 and beta 2 receptors
c. selective beta 2 drugs: stimulate beta 2 receptors

34. When a nonselective adrenergic agonist is given, what are the cardiovascular adverse effects?
a. increased HR, contractility, and BP

35. How are beta 2 agonists useful in treating hyperkalemia?
a. shifts potassium from blood stream to cells temporarily

36. List the adverse effects of alpha-beta agonists.
a. insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, and vascular headache

37. How does the parasympathetic autonomic nervous system bring about bronchoconstriction? a. releases Ach which binds to bronchial trees to constrict airways

38. How do anticholinergic drugs indirectly cause airway dilation?
a. blocks Ach which causes constriction

39. What is the therapeutic range for theophylline?
a. below 20 mcg/ml

40. What do leukotrienes cause in asthmatics?
a. inflammation, bronchoconstriction, and mucus production

41. How do antileukotriene drugs work?
a. prevent leukotrienes from attaching to receptors on circulating and local immune cells

42. How are inhaled corticosteroids used?
a. control inflammatory response believed to cause bronchospastic disorders

43. How is fluticasone administered?
a. intranasally

44. Is it safe to crush a sustained-release capsule for administration?
a. no

45. What is the relationship of caffeine and beta agonist drugs?
a. increase in adverse effects like tachycardia, hypertension, headaches, nervousness, and tremors

Week 11-Chapter 40

46. Describe MTB.
a. a rod shaped bacterium thriving in highly oxygenated sites like the lungs

47. How is TB spread?
a. inhaled droplets from infected hosts to new host

48. Why is MTB more difficult to treat than most bacterial infections?
a. slow growing organism

49. Why are slow growing microorganisms difficult to kill?
a. cells are not as metabolically active compared to faster growing organisms

50. What is the most widely used antitubercular drug?
a. isoniazid (INH)

51. What it the major effect of drug therapy with antitubercular drugs?
a. reduction of cough, and therefore infectiousness

pharm GRM week #10 (brief)

Week 10-Chapter 13

1. What are seizures, convulsions and epilepsy?
a. seizures: brief episodes of abnormal electrical activity in the nerve cells of the brain
b. convulsions: involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal and facial muscles
c. epilepsy: chronic, recurrent pattern of seizures

2. What is accurate diagnosis of seizure disorder based upon?
a. electroencephalogram (EEG)

3. What is an AED?
a. antiepileptic drugs

4. What other types of illnesses are AEDs used for besides seizures?
a. psychiatric disorders, migraine headaches, and neuropathic pain syndromes

5. Under what circumstances should an AED be abruptly stopped?
a. a severe adverse effect occurs

6. Under what circumstances would a patient with a seizure disorder be maintained on a subtherapeutic drug level?
a. decreases the risk for medication-induced adverse effects and interactions

7. What are the three pharmacologic effects of AEDs?
a. make it difficult for a nerve to be excited or reduce the nerves response to incoming electrical or chemical stimulation
b. limit the spread of seizure discharge from its origin
c. decrease the speed of nerve impulse conduction within a given neuron

8. At what time of day are AEDs typically given?
a. >?

9. Why should carbamazepine not be given with grapefruit?
a. >?

10. Why does IV phenytoin have to be given with normal saline?
a. avoid local venous irritation

11. Why does phenytoin IV have to be given slowly?
a. possible cardiovascular/respiratory collapse

12. What is the most common adverse effect of AEDs?
a. sedation, confusion, CNS depression

Week 10-Chapter 14

13. What does PD result from?
a. imbalance of dopamine and acetylcholine

14. What do dopamine and acetylcholine regulate?
a. proper regulation of posture, muscle tone, and voluntary movement

15. What are the classic PD symptoms?
a. slowness of movement (bradykinesia), rigidity, tremor, and danger of falling

16. What is the primary role of MAOs?
a. breakdown of catecholamines

17. What does selegiline do?
a. decrease amount of levodopa needed

18. What does levodopa do?
a. precursor for dopamine synthesis by the brain

19. How does amantadine (Symmetrel) exert its antiparkinsonian effect?
a. elicits release of dopamine from nerve endings

20. In PD, what are anticholinergic drugs useful in?
a. treat the muscle remors and muscle rigidity

21. What is the relationship of pyridoxine and levodopa?
a. B6: promotes levodopa breakdown and possibly reverse effects

22. Explain the concept of a drug holiday.
a. obtain more therapeutic effectiveness; allow patient to respond to lower doses of drug

pharm GRM week #9 (brief)

Week 9-Chapter 27

1. What are anticoagulants?
a. inhibits the action or formation of clotting factors thus preventing clots from forming

2. What are antiplatelet drugs?
a. prevent platelet plugs from forming by inhibiting platelet aggregation which is beneficial for preventing heart attacks and strokes

3. What do thrombolytic drugs do?
a. break down clots which have already formed

4. Why is frequent monitoring not necessary with LMWH?
a. low molecular weight heparins have a predictable anticoagulant response

5. How does warfarin work?
a. inhibits the four vitamin K-dependent clotting factors to prevent clot formation

Week 9-Chapter 28

1. How is cholesterol used in the body?
a. used to make steroid hormones, cell membranes, and bile acids

2. How doe statins lower serum cholesterol levels?
a. decrease rate of cholesterol production

3. What is rhabdomyolysis?
a. breakdown of muscle protein leading to myoglobinuria (urinary elimination of the muscle protein myoglobin

4. When assessing liver enzymes, which are it most important to assess when a patient is on statins?
a. activity of CYP3A4 in the liver to metabolize statins

that paper...

citing sources is probably the most time consuming and annoying part of papers. there is a wonderful link to a site called citation machine on the right side of the blog that will help you out so much if you feel the same way. all you have to do is input the info like article title, author, etc. and it will automatically format in apa or mla format...whichever you chose to do. its such a time saver!!

final grades are posted!

Disco Driven CPR

I thought some of you might like a little distraction after the final and I saw this interesting article online. The American Heart Association recommends a rate of 100 compressions per minute while performing CPR. The authors of a recent study practiced CPR while listening to different songs on ipods, and they found out that "Stayin Alive" by the Bee Gees has a beat of 103 per minute. 5 weeks later they practiced CPR again and were told to think of the song while giving compressions and it improved their compression rates.

The article http://ap.google.com/article/ALeqM5hwFew2vQ69x6-RFPFXQPyPFCceGgD93RU4DG0

The song on youtube http://www.youtube.com/watch?v=Fdv8Qi_k-I4

not to sound corny, BUT

while we are busy studying for the final, dont forget N001 is coming to an end tomorrow, too. remember the first 3 weeks we were driving ourselves crazy wondering how we were going to make it through anything at all? well, we have accomplished something huge, even if its only 9 weeks in. we plowed through these weeks like hot, garlic, mashed potatoes.

take the time to recognize the bumpy road you took to get here because being proud of your accomplishment is the most rewarding thing you can do for yourself. have a good dinner tonight and rest up...a half hour of sleep will do more good than 30 extra minutes of study time!

AMY!!!

Amy! Your delta email is not working!!! Can you email me on an alternate email or something??

:)

for the final

know:


1 liter=1 quart
2 pints=1 quart
1/2 pint=1 cup
250 ml=1 cup
500 ml=1 pint
60 mg=1 grain


*and the metric measurements

Study techniques for Pharmacology

Hey everyone. My desk is covered with Nursing 1 Study Notes and I am trying to get prepared for the final on Thursday. But I started thinking about Nursing 3 (my mind sometimes wonders). Anyways, I was just thinking about how I study for Pharmacology. On Test #2, I did all the reading and guided modules and studied for many hours but still made a poor grade. I was wondering how everyone went about studying for the test and class? Any suggestions would be greatly appreciated. Good luck on the final. Nursing 1 is almost under our belt.

study guide final exam (brief)

1. Discuss the risk factors for complications of the patient undergoing surgery. (Ch. 50, pp. 1369-1375)
-age, nutrition, obesity, obstructive sleep apnea, immunocompromise, F&E imbalance, pregnancy, medical history, lifestyle choices, and socioeconomic factors

2. Discuss the signs and symptoms of the patient experiencing dyspnea. (Ch. 40, pg. 920)
-clinical sign of poor tissue perfusion marked by shortness of breath
*exaggerated respiratory effort, increased depth and RR, and activity intolerance

3. Discuss the nurse’s responsibility to safe medication administration. (Ch. 35, pg. 687)
-evaluate the effects of medications on health status
-teach patients about medications and side effects
-ensuring adherence with medication regimen
-evaluate client’s ability to self-administer

4. Discuss the responsibility of the nurse when a medication error has occurred. (Ch. 35, pg. 705)
-prepare written occurrence report or incident report to be filed within 24 hours
-feel comfortable and fear no repercussions; safety of the patient first

5. Discuss the nursing actions that will maintain dignity and respect to patients.
-good communication skills
-following through
-knowledgeable

6. Discuss the nursing interventions to promote communication with a patient with aphasia. (Ch. 24, Table 24-10)
-be patient and attentive
-ask simple questions, allowing time to answer
-encourage conversation
-do no speak loudly
-use communication aids and collaborate with speech therapists
-let patient know if you do not understand

7. Discuss the purpose of the implementation phase of the nursing process. (Ch. 19, pg. 279)
-achieve goals and expected outcomes to support or improve the patient’s health status

8. Discuss the purpose of open-ended questions when obtaining subjective data. Provide examples. (Ch. 16, pg. 239)
-technique leads to the patient actively describe their health status and strenghthen the nurse-client relationship
*tell me how you are feeling
*your discomfort affects your ability to get around in what way
*describe how your wife has been helping you
*give me an example of how you get relief from your pain at home

9. Discuss the nursing interventions to prevent vascular complications for an immobile patient. (Ch. 47, pg. 1247)
-mobilize the patient as soon as their physical condition allows for them to do so
-teach client to breathe out while repositioning themselves in bed
-lower extremity exercises, frequent fluids, and position changes

10. Differentiate between evaluation and assessment. (Ch. 20, pg. 291).
-evaluation is ongoing and whenever there is contact with the patient
-to compare the status before the assessment stage and after a nursing intervention to redirect nursing care if necessary

11. Explain autonomy. Provide examples. (Ch. 24, pg. 348 and Ch. 22, pg. 314)
-self-direction of nurses to make choices and accept outcomes of action like owning medication errors if they occur
-inclusion of patients in all aspects of care like signing consent forms before surgery

12. Discuss the nursing responsibilities for the patient while in the PACU. (Ch. 50, pg. 1394)
-focuses on monitoring and maintaining airway, respiratory, circulatory, and neurological status and on managing pain

13. Discuss strategies to ensure safe administration of medication. (Ch. 35, pp. 705-709)
-standards: right medication, right dose, right client, right route, right time, right documentation
-medical reconciliation: verify client’s current list of medications, clarify the list is accurate with as many people as necessary, reconcile discrepancies between new medication orders and current medications, and transmit updated and verified list to caregives and client

14. Discuss the assessment needed for the patient with fluid imbalance. (Ch. 41, pp. 978-984)
-age
-medical history including present medication
-lifestyle
-socioeconomic factors
-daily weights and I&Os

15. List the criteria for writing a correct outcome or goal. (Ch. 18, pg. 265-267)
-client centered and is specific and measureable reflecting wellness and independence
-realistic
-mutually set by nurse and patient

16. Discuss the criteria needed for writing an accurate nursing diagnosis. (Ch. 17, pg. 252)
-client centered problem based on validated objective and subjective data
-within nursing scope of practice
-includes diagnostic label, related factor (related to…), and etiology (as evidenced by…)

17. Discuss strategies that promote effective communication. (Ch. 24, pp. 348-355)
-use therapeutic communication techniques
-use active listening
-use professional communication
-provide comfortable and safe environment with favorable conditions

18. Discuss the role of the health care team when developing an initial plan of care. (Ch. 18, pp. 268-269)
-which interventions will be dependent nursing interventions
-communicate nursing care priorities to other health care professionals

19. Compare and contrast legal decision making and ethical and moral principles. (Ch. 22, pp. 314- and Ch. 23, pp. 328-332)
-legal decision making: advance directives, standards of care, informed consent, mental health parity act
-ethical and moral principles: autonomy, benefiecience, maleficience, justice and fidelity; code of ethics including advocacy, responsibility, accountability, and confidentiality

20. Discuss the nursing care of the patient with a urinary catheter. (Ch. 45, Table 45-3)
-prevent bacterial growth
-promote comfort, check for displacement
-assess purpose and need for catheter

21. Discuss the patient education needed for the patient scheduled for surgery. (Ch. 50, pp. 1379-1380, 1386)
-understand pre-op instructions and exercises
-state the time of surgery
-understand to post-op location and where family will be able to wait during and after surgery
-understand the post-op monitoring and therapy
-understand surgical procedures and post-op treatment
-understand post-op activity resumption
-understand pain-relief measures
-can openly express feelings about surgery

22. Discuss the nursing care of the patient who is confused. (Ch. 41, pp. 973-974)
-may be evidence of electrolyte imbalance
*monitor I&Os, daily weights, vital signs…
*per physician order: correct imbalance by administering diuretic or IV fluid electrolytes

23. Discuss the complications of general anesthesia. (Ch. 50, pg. 1392)
-side effects of anesthetic agents like cardiovascular depression or irritability, respiratory depression, and liver/kidney damage

24. Discuss the nursing interventions to prevent thrombophlebitis in the post-operative patient. (Ch. 50, pp. 1401-1403)
-leg exercises unless contraindicated
-apply stocking or devices to prevent circulatory stasis
-encourage ambulation as soon as possible after monitoring vital signs and safety measures
-reposition effectively
-anticoagulant drugs as ordered
-adequate hydration

25. Discuss the risk factors of the elderly patient undergoing surgery. (Ch. 50, Table 50-4)
-reduced cardiac function, skin integrity, respiratory function, renal function, metabolic function and sensory loss
-good vs. harm of patient going to surgery

26. Discuss the assessment needed for the patient with diarrhea. (Ch. 46, pp. 1185-1188)
-assess frequency, volume, and consistency
-inspect mouth and abdomen
-assess usual elimination patterns of patient

27. Discuss the nursing interventions for the patient with impaired skin integrity. (Ch. 48, pp. 1301-1305)
-maintain skin care, reposition to improve circulation and use devices if necessary to avoid further impairing skin integritry and educate the patient

28. Discuss causes of bradycardia. (Ch. 40, pp. 918-922)
-age, lifestyle choices, and socioeconomic factors may cause decreased elasticity of heart muscle, thicker and stiffer heart valves, and calcification of vessels

29. Discuss the assessment needed for the patient with the diagnosis of Activity Intolerance. (Ch. 47, pg. 1240)
-extent of ROM, ability to perform ADLs, varying degrees of pain perception/tolerance before and during activity

30. Discuss the signs and symptoms of severe hypoxia/hypoxemia. (Ch. 40, pg. 917)
-cyanosis, declined RR, low SpO2 as a result of respiratory fatigue

31. Discuss the nursing interventions needed to promote oxygenation of the post-operative patient. (Ch. 50, pg. 1401)
-breathing exercises: diaphragmatic breathing, coughing exercises, and incentive spirometer
-use respiratory devices when/if patient uses them at home or oxygen if ordered
-promote comfort: assist in turning and oral hygiene
-remove secretions

32. Discuss the preparation needed to safely transfer the patient to the operating room. (Ch. 50, pp. 1389-1391)
-use stretcher
-double checks for identification
-standards to prevent falls; rails up after medication administration
-void before surgery

33. Discuss the nursing interventions needed to promote ambulation. (Ch. 47, pp. 1246-1275)
-maintain circulation and muscle use to prevent ambulation complications
*ROM exercises, repositioning, breathing exercises, devices designed to improve circulation

34. Discuss the assessment needed for the patient who has been on bed rest and has an order to begin ambulation. (Ch. 47, pg. 1230-1237)
-assess mobility of the patient including range of motion, gait, exercise/activity tolerance, and body alignment
-ask or observe
-assess to protect patient safety: orthostatic hypotension

35. Discuss the purpose of bed rest. (Ch. 47, pg. 1225)
-reduce physical activity and oxygen needs of the body
-reduce pain
-allow ill or debilitated patients to rest
-allow exhausted patients uninterrupted rest

36. Discuss the correct procedure for administering a subcutaneous medication. (Ch. 35, pp. 744-750)
-use the rights of medication administration before giving injection and assess purpose and need for medication
*draw up syringe, cleanse proper injection site, pinch site and inject at 45-90 degree angle
*DO NOT RUB HEPARIN

37. Discuss the nursing care for the post-operative patient who had a nasogastric tube. (Ch. 50, 1404-1405)
-for decompression, not feeding, because stomach becomes paralyzed after surgery
-listen to BS, look BM, distension
-safely remove stomach contents to provide comfort for patient

38. Discuss the purpose of using an assistive device when moving patients. (Ch. 47, pg. 1224)
-reduce number of work-related injuries
-avoid unnecessary injury to nurse and patient

39. Discuss the correct procedure for suctioning a patient. (Ch. 40, pp. 934-941)
-suction to clear secretions a patient is unable to produce or clear

40. Discuss the physiological effects of prolonged bed rest. (Ch. 47, pg. 1239)
-poor circulation and muscle weakness
*slow wound healing, slowed or impaired GI/GU activity, activity intolerance, impaired respiration, lack of ROM, and muscle/fat loss

41. Discuss dependent nursing interventions for the patient experiencing nausea. (Ch. 41, pg. 975)
-may be evidence of fluid volume deficit or excess
*per physician order: diuretics, administering IV fluids, blood transfusions, laboratory tests…

42. Dosage and Calculations (Ch. 35, pp. 696- 698)
Can you calculate pills/tablets/injections?
-(dose ordered)/(dose on hand) x amount on hand = amount to administer
Can you calculate safe dosage ranges?
Can you safely administer medication (using the correct equipment)?

43. Can you utilize the nursing process given a specific case scenario?

Study guide for final...

Hey everyone, here's my portion of the questions I answered from the study guide. Feel free to add in your two cents... and Don't be shy to SHAARREEE!!!

1. Discuss the risk factors for complications of the patient undergoing surgery.
(pp. 1369-1372)
Age- anesthesia can cause vasodilation and heat loss in underdeveloped young pts.
-Less physical capacity due to deterioration of body functions in older adults.
Nutrition- malnourished pts more prone to poor tolerance to anesthesia, negative nitrogen balance from lack of protein, delayed blood-clotting, infection, poor wound healing, and potential for multiple organ failure.
Obesity- reduced ventilation and cardiac function can lead to sleep apnea, hypertension, coronary artery disease, DM, and CHF à embolisms, atelectasis, and pneumonia.
Obstructive sleep apnea (OSA)- often results in sleep-associated oxygen desaturation.
Immunocompromise- increase risk for infection due to suppressed immune system.
F & E Imbalance- body responds to surgery as trauma, therefore the body retains sodium and water and loses potassium within the first 2-5 days post-surgery.
Pregnancy- all major system of the body affected during pregnancy due to increased metabolic rate and body’s response to trauma. Surgery only done on emergent or urgent basis.

***Cardiac conditions; respiratory disorders; bleeding disorders; DM; liver disease; neurological disease; mental retardation; anxiety; dementia (NOTES: Perioperative Nursing)


2. Discuss the signs and symptoms of the patient experiencing dyspnea.
(p. 920)- shortness of breath; clinical sign of hypoxia.
Exaggerated respiratory effort
Use of the accessory muscles of respiration
Nasal flaring
Marked increases in the rate and depth of respirations
Orthopnea



3. Discuss the nurse’s responsibility to safe medication administration.
(p. 696) –To safely administer medications to pts, nurses need to know how to calculate medication doses ACCURATELY. They also need to understand the different roles that members of the health care team play in the prescribing and administering of meds.
Prior to administration (NOTES)
-therapeutic effect
-side effects
-drug toxicity
-drug allergies
-cumulative effects
-drug interactions

4. Discuss the responsibility of the nurse when a medication error has occurred.
(p.705)*When an error occurs, the client’s safety and well-being being are TOP PRIORITY.
-assess and examine the client’s condition and notify the physician or prescriber of the incident as soon as possible.
-once client is stable, report incident to appropriate person in institution
-nurse is responsible for preparing written occurrence or incident report that usually needs to filed within 24 hours of the error. (includes client id info; location and time of incident; accurate, factual description of what occurred and what was done; nurse signature)
** Report all MEs, including those that do not cause obvious or immediate harm or near misses.


5. Discuss the nursing actions that will maintain dignity and respect to patients.
(pp. 100-103)
-promoting caring nurse-patient relationship/therapeutic communication
-nurses need to learn culturally specific behavior
-providing presence and active listening
-using the comforting approach such as touch
-providing privacy as well as advocacy
-providing client-centered care
-active listening
-getting to know your patient
-spiritually caring
-involving family and loved ones upon client’s request or consent


6. Discuss the nursing interventions to promote communication with a patient with aphasia.
(pp.1358-1359) **aphasia- unable to speak
Listen to the client, and wait for the client to communicate.
Do not shout or speak loudly.
Use simple, short questions and facial gesture to give additional clues.
Speak of things familiar and of interest to the client.
Simple yes or no answers. Offer pictures or communication board so client can point.
Be calm and patient; do not pressure or tire the client.
Avoid patronizing and childish phrases.


7. Discuss the purpose of the implementation phase of the nursing process.
(pp. 279)
The nurse initiates interventions that are most likely to achieve the goals and expected outcomes needed to support or improve the client’s health status.
Designed to improve patient’s level of health.


8. Discuss the purpose of open-ended questions when obtaining subjective data. Provide examples.
(p. 239) Open-ended questions prompts clients to describe a situation in more than one or two words. This leads to a discussion in which clients actively describe their health status. Open-ended questions strengthen your relationship with your pts because it shows you want to hear their thoughts and feelings.
**encourage and let client tell the story all the way through
**use good eye contact and listening skills
** back-channeling (“uh-huh,” “go on,” “all right”)
EXAMPLES: Tell me how you are feeling. Your discomfort affect your ability to get around in what way? Describe how your wife has been helping you. Give me an example of how you get relief from your pain at home. Tell me about the problems you are having. What might be causing this problem?
***Probe until exhaustion.

9. Discuss the nursing interventions to prevent vascular complications for an immobile patient.
(pp. 1247-1248 & NOTES) ***Clients who are immobile often experience orthostatic hypotension, increased cardiac workload, thrombus formation, deep edema, venous vasodilation and stasis, diminished cardiac reserve.
For a pt with orthostatic hypotension, mobilize pt as soon as they physical condition allows, even if it’s only dangling at the bedside or moving to a chairàmaintains muscle tone and venous return.
Discourage use of Valsalva Maneuver (baring down) as this decreases venous return and cardiac output.
In prevention of thrombus formation, interventions include: elevate lower extremities; leg, foot, and ankle exercises such as ankle pumps, foot circles, and knee flexions; regularly providing fluids; position changes; flexing and extending of feet; medications, Tedhose, SCDs require doctor’s orders.
ROM exercises reduce the risk of contractures and aid in preventing thrombi.

10. Differentiate between evaluation and assessment.
Assessment encompasses gathering information about the client’s condition both subjectively and objectively, as well as analyzing and clustering the data as a basis for developing nursing diagnoses, identifying collaborative problems, and developing a plan of individualized care.
Evaluation is a determinant of whether goals are met and outcomes are achieved. The key is to determine if you met your expected OUTCOMES, not if nursing interventions were completed.

11. Explain autonomy. Provide examples.
(p. 314) In regards to Professional Standards in nursing practice, autonomy refers to the commitment to include clients in decisions about all aspects of care.
Obtaining a signed consent after explaining potential procedures.
Involving client in end-of-life decisions.
Advance Directives: Living Wills & Durable Power of Attorney

stridors, bronchi, and wheezing...and no heart sounds?

a patient has a tracheal artificial airway and is having non-productive coughs. upon ascultation of the lungs on the back, the student nurse hears coarse crackles and wheezing. when the student ascultates for the heart sounds, she cannot hear any because the crackles and wheezing sounds make it difficult for her to do so.

what should the student nurse do?

since the patient is having non-productive coughs, the sputum is ineffectively clearing from the patient's airway. the student can say so because there is lack of sputum present when the patient coughs, and crackles indicates this as well. the student should deep suction the artificial airway as necessary to remove the sputum effectively. the sputum removed should be observed for quantity and quality. to ensure the student nurse performed efficient suctioning, she should ascultate the lung sounds again to check for improvement.

*can this be put into ADPIE format?

pharmacology GRM week #9 (brief)

Week 9-Chapter 21

1. What do inotropic drugs do
a. change the force of myocardial contraction

2. What do positive chronotropic drugs do?
a. increase the rate at which the heart beats

3. What are the two main classes of positive inotropic drugs?
a. cardiac glycosides and phosphodiesterase inhibitors

4. What is the definition of heart failure?
a. abnormal condition in which cardiac pumping is impaired as a result of myocardial infarction

5. What is ejection fraction and what is the normal value?
a. amount of blood ejected with each contraction, normally 65% of the blood volume in the ventricle

6. When a person is in heart failure, which of their organs are the last to be deprived of blood?
a. those most dependent on blood, the brain and heart

7. What is the relationship of sodium and potassium to heart function?
a. depolarize the heart

8. Define systolic dysfunction and diastolic dysfunction.
a. systolic dysfunction: inadequate ventricular contractions during pumping of the heart
b. diastolic dysfunction: inadequate ventricular filling during ventricular relaxation

9. How does a cardiac glycoside improve myocardial contractility?
a. inhibits the ATPase pump, increasing calcium concentration

10. What are the inotropic, chronotropic, dromotropic and other cardiac effects of digoxin?
a. positive inotropic effect: increase in force and velocity of contractions without increasing oxygen consumption
b. negative chronotropic effect: lowers HR
c. negative dromotropic effect: decreases automaticity at SA node, decreases AV node conduction, reduces conductivity at the bundle of His, and prolongs the atrial and ventricular refractory periods
d. other cardiac effects: increase in stroke volume, reduction in heart size during diastole, decrease in venous BP and engorgement, and increase in coronary circulation

11. What are the primary indications for cardiac glycosides?
a. heart failure and supraventricular dysrhythmias

12. What is the normal therapeutic drug level for digoxin?
a. 0.5-2 ng/ml

13. How do low serum potassium levels affect digoxin therapy?
a. increase potential for toxicity

14. What are the common adverse effects of cardiac glycosides?
a. dysrhythmias, headache, fatigue, malaise, confusion, convulsions, colored vision, halo vision, flickering lights, anorexia, nausea, vomiting, and diarrhea

15. What is the step-by-step management of digoxin toxicity?
a. discontinue administration of the drug
b. begin continuous ECG monitoring for cardiac dysrhythmias, administering appropriate drugs as ordered
c. determine serum digoxin and electrolyte levels
d. administer potassium supplements for hypokalemia if indicated, as ordered
e. institute supportive therapy for GI symptoms like nausea, vomiting, or diarrhea
f. administer digoxin antidote if indicated, as ordered

16. How does digoxin immune Fab (Digibind) work?
a. binds to unbound digoxin to reverse effects and symptoms of toxicity

17. What are the results of inhibition of phosphodiesterase?
a. positive inotrophic response and vasodilation

18. What is an inodilator?
a. a drug producing positive inotrophic response and vasodilation

19. What is the effect of inhibition of phosphodiesterase on the
availability of calcium, systemic and pulmonary vessels and cardiac workload?
a. increases availability of calcium for heart to use for muscle contraction, dilates systemic and pulmonary vessels which decreases cardiac workload

20. How do PDI’s reduce afterload?
a. dilate blood vessels

21. What are the two most common PDI’s?
a. inamrinone and milrinone

22. What serum lab values should the nurse investigate before giving a cardiac glycoside?
a. serum potassium

23. What heart rates in the adult should cause the nurse to withholding a cardiac glycoside?
>?

24. What is the relationship between bran and digoxin?
a. bran in large amounts may decrease the absorption of digoxin

25. What is the safe infusion rate for IV digoxin?
a. usual digitalizing dose: 1-1.5mg/day
b. usual maintenance dose: 0.125-0.5 mg/day

Week 9-Chapter 23

26. How is the heart’s oxygen supply met?
a. delivered by coronary arteries

27. What is angina pectoris?
a. chest pain

28. Define coronary artery disease, myocardial infarction, chronic stable angina, unstable angina, and vasospastic angina.
a. coronary artery disease: supply of oxygen and energy-rich nutrients needed for the heart to meet its demands is decreased due to atherosclerosis
b. myocardial infarction: heart attack; blood flow through the coronary arteries to the myocardium is completely blocked so that part of the heart cannot receive oxygen from blood-borne nutrients
c. chronic stable angina: triggered by exertion or stress causing intense pain for 15 minutes and usually subsides
d. unstable angina: pain episodes increase in severity and frequency
e. vasospastic angina: spasms of the smooth muscle surrounding atherosclerotic coronary arteries often happening during rest

29. Which are two example classes of drugs that aim to correct the imbalance between myocardial oxygen supply and demand and how do they do it?
a. nitrates and nitrites: dilate all blood vessels
b. beta blockers: slow heart rate and reduce blood pressure

30. Explain the process that results in angina.
a. oxygen deprivation of the myocardium under ischemic conditions cause the heart to work anaerobically producing lactic acid and stimulating pain receptors surrounding the heart

31. What is it that actually causes the heart pain called angina?
a. lactic acid causes pain receptors to be stimulated

32. How do nitrates and nitrites vasodilate?
a. relaxes the smooth muscle cells of venous and arterial wall structure

33. What does dilation of coronary arteries by nitrates result in?
a. reverses or prevent exercise induced spasms, encouraging healthy physical activity in patients
34. Explain the way in which nitrates/nitrites reduce preload.
a. cause venous dilation and reduces venous return

35. Why are nitrates/nitrites contraindicated in persons with severe anemia, closed-angle glaucoma, hypotension and severe head injury?
a. conditions can be worsened

36. Why specifically is it risky to give nitrates/nitrites to a person with severe anemia?
a. cause drug-induced hypotensive episode

37. What is reflex tachycardia?
a. cardiovascular overcompensation marked by increased heart rate

38. What is the purpose of the regimen of removing transdermal patches at night for 8 hours and then applying a new patch in the morning?
a. prevent tolerance to nitrates

39. How do beta blockers improve the chances of survival in patients following an MI?
a. block harmful effects of the high levels of circulating catecholamines from irritating the heart

40. How do calcium channel blockers work?
a. promotes muscle relaxation causing coronary artery dilation increasing blood flow and oxygen supply

41. What is the primary beneficial antianginal effect of amlodipine and nifedipine?
a. indicated for angina and hypertension

42. What is the onset time for sublingual nitroglycerine?
a. 2-3 minutes

43. What systolic BP should be reported before giving a nitrate?
a. less than 60 mm Hg

44. Why is it unsafe to take nitrates when taking erectile dysfunction drugs?
a. worsens hypotensive response, paradoxical bradycardia, and increased angina with risk of cardiac or cerebrovascular complications from decreased perfusion

45. When receiving a nitrate, what position should the person be in?
a. seated to avoid falls

46. Where should nitroglycerine ointment be placed?
a. upper arms or body

47. Should nitroglycerine ointment be rubbed in and what is done with it when the dose is changed?
a. it should not be rubbed in and should be cleaned with soap and water and patted dry before applying the changing the dose

pharmacology GRM week #8 (brief)

Week 8-Chapter 22
1. What is it that results in disturbances in cardiac rhythm?
a. abnormally functioning cardiac cells

2. What is the term for spontaneous electrical excitability found in cardiac cells?
a. automaticity
3. What are the three main ions involved that move across the cell membrane causing cardiac electrical activity?
a. calcium, sodium, and potassium
4. What mechanism maintains the polarized distribution of ions in the myocardium?
a. sodium-potassium adenosine triphosphatase (ATPase) pump
5. How are antidysrhythmic drugs categorized?
a. Class 1, 1a, 1b, 1c, class II, class III, class IV
6. In general, how do antidysrhythmic drugs work?
a. affect the resting membrane potential (RMP) and sodium channels, in turn influencing the rate of impulse conduction
7. Be able to recognize from the pictures on pages 335 – 337 and defined on page 338, the following dysrhythmias:
a. atrial fibrillation: supraventricular dysrhythmia characterized by rapid atrial contractions that only incompletely pump blood into the ventricles

-rapid, ineffective atrial contractions: QRS complex separated by squiggly lines

b. ventricular tachycardia: rapid heartbeat from impulses originating in ventricles

-photo of sustained VT: uniform mounds

c. ventricular fibrillation: worsened ventricular tachycardia which can be fatal if not reversed

-rapid, ineffective ventricular contraction: small, irregular, bumpy hills

*photos from learntheecg.com

8. What are the therapeutic responses to antidysrhythmic drugs that the nurse should see in the patient?
a. improved cardiac output, decreased chest discomfort, decreased fatigue, improved vital signs, skin color, and urinary output

Week 8-Chapter 24
1. List all of the drug categories that are used to lower the blood pressure in those with hypertension.
a. Loop diuretics, potassium sparing diuretics, beta blockers, ACE inhibitors, alpha 1 antagonists, ARBs, CCBs and vasodilators

2. In Figure 24-1 on page 369, be familiar with the values that represent normal as well as the different classifications of hypertension. Know columns 1, 2 & 3 of the table.
BP Classification: SBP (mm Hg) / DBP (mm Hg)
a. normal: less than 120/less than 80
b. prehypertension: 120-139/80-89
c. stage 1 hypertension: 140-159/90-99
d. stage 2 hypertension: 160 or higher/100 or higher
3. Know Figure 24-3 on page 372 you need to know only the classes of antihypertensives, not the drugs that represent each class. Essentially, what I want you to know is where each anti-hypertensive class works in the body.
a. centrally-acting alpha 2-receptor agonists: vasomotor center
b. centrally and peripherally acting allergenic neuron blocker: vasomotor center and sympathetic ganglion --> blood vessel
c. peripherally acting alpha 1-receptor antagonists: blood vessel
d. direct-acting arteriolar dilators: blood vessel
e. direct-acting arteriolar and venous dilator: blood vessel
f. diuretics: kidney
g. angiotensin II receptor blockers (ARBs): angiotensin II
h. angiotensin-converting enzyme (ACE) inhibitors: angiotensin-converting enzyme
i: beta-adrenergic blocking drugs: heart

Week 8-Chapter 25
1. What do diuretics remove from the body?
a. sodium and water
2. What are the mechanisms that make diuretics hypotensive drugs?
a. direct arteriolar dilation which decreases peripheral vascular resistance
b. reduce extracellular fluid volume, plasma volume, and cardiac output
3. What is the main problem with diuretic use?
a. excessive fluid and electrolyte loss

4. How are diuretics classified?
a. carbonic anhydrase inhibitors, loop diuretics, osmotic diuretics, potassium-sparing diuretics, and thiazide and thiazide-like diuretics
5. List the diuretic subclasses according to their potency in the order of most potent to least potent.
a. loop diuretics, osmotic, thiazide-like diuretics, thiazides, and potassium sparing
6. Fill in the blanks. The more sodium and water diuretics inhibit from resorption, the greater the amount of diuresis.

7. What are the beneficial hemodynamic effects of loop diuretics?
a. reduction of preload and central venous pressures
8. What are the cardiovascular effects of loop diuretics?
a. reduces blood pressure, pulumonary vascular resistance, systemic vascular resistance, central venous pressure, and left ventricular end-diastolic pressure
9. What are the electrolyte losses associated with diuretic administration?
a. loss of sodium, potassium and some calcium
10. How do osmotic diuretics work?
a. produces osmotic pressure in the glomerular filtrate which pulls fluid (mostly water) into renal tubules from surrounding tissue
b. inhibits tubular resorption of water and solutes producing rapid diuresis
11. How does spironolactone lead to diuresis?
a. competitively binds to aldosterone receptors thus blocking the resorption of sodium and water induced by aldosterone secretion
12. How do thiazide diuretics work?
a. inhibit resorption of sodium, potassium, and chloride resulting in osmotic loss

bye, bye convalescent homes

pharm grades are available to view on turnitin.com, good luck!

Hi Ann,

Thanks again for the study guide.

Rose

week seven is over!!

updated exam #3 grades are up if you have not yet checked docushare and the study guide for the final is also posted. dont be shy to post your study guide here too if youd like to share it...but of course dont feel obligated to!!

and just in case you didnt notice there is a link to docushare on the right column for your convenience :)

Opps! I think I spelled your name wrong, sorry about that.

Thanks For The Invite

Thank you Ann for taking the time to organize this blog, and thanks for inviting me. This really is a more user friendly website, it's cool. Oh and I just want to shout out that I hope everyone did well on the third exam, and good luck on the Pharm exam everyone!

Welcoming TEA

Hello everyone!

I know I have been buggin you guys about the TEA. It will be here before you know it!! I know alot of you have already secured donations. However we need more donations, now is the time to get them, the holiday season is approaching and people are too busy to give!!.

Ideas on the theme for the TEA would be great! Mandy suggested a Fiesta, if you have any additional ideas please share.

Ann volunteered to do the video presentation. If you have any pictures or ideas please give them to Ann (the brilliant person who created this blog).

Please get ahold of me If you would like to help out with the TEA. I am not in charge I am just getting it going! I will help to do what I can, so if you feel so inclined to head up this endeavor speak up!!

You can email me at hloehrer704@students.deltacollege.edu

Thank Heidi

thanks for taking the time

thanks a. ha for taking the time to incorporate Nurses 2010 blog in with the previous years blogs. I was thinking about investing in a PDA. Does anyone have any suggestions on the model that is most beneficial in buying for our purposes? How much memory would be adequate? And the programs that you like so far? Good luck on the test #3 to everyone.