question 21 of 39 where can you document the infusion details such as the rate dose and volume o

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Question 21 of 39 where can you document the infusion...

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Senorio: Nurse: HI Jenny, how's it going so far? Other nurse: So far, so good. Nurse: Good. I noticed we received new insulin orders for Mr. Jones. Mr. Jones's blood glucose level was just checked. The insulin orders have been updated on the MAR, and the blood glucose level is on the flow sheet. Mr. Jones has not received his pre-meal insulin. Other nurse: I'll get right on that. But first, can we review the updated MAR and the flow sheet? Nurse: Absolutely. Other nurse: Ok so Mr. Jones blood glucose level is 144. Mr. Jones will not need insulin coverage for a glucose of 144. And I see that Dr. Brady ordered 6 units of regular insulin and 12 units of NPH. Question: After checking the expiration date of the insulin vials and reviewing the prescription for regular and NPH insulin, the nurse prepares to draw the insulin into a syringe. What actions should the nurse take to prepare the insulin for administration safely?

James K.

1-the-patient-is-returned-to-the-unit-at-1000-after-removal-of-a-bladder-tumor-he-has-a-continuous-blas-irrigation-infusing-at-100-mlhr-he-starts-on-clear-liquids-and-has-240-ml-of-tea-and-6-ounces-of

1. The patient is returned to the unit at 1000 after removal of a bladder tumor. He has a continuous bladder irrigation infusing at 100 mL/hr. He starts on clear liquids and has 240 mL of tea, and 6 ounces of broth. His IV is infusing at 150 mL/hr until 1400, when the physician lowers the rate to 100 mL/hr. The nurse hangs an IVPB of cefoxitin 1 g in 50 mL D5W at 1300, and a second IVPB of famotidine 20 mg in 50 mL D5W at 1400. At the end of the shift, the nurse assistant reports that he has emptied 950 mL from the patient's indwelling catheter bag. What is the patient's total Intake & Output (I & O) starting at 1000 ending at 1500

Penny R.

Mr J. is a 44 year-old man with no previous medical history presents to the emergency department with a chief complaint of severe abdominal pain, fever, and chills. He is subsequently admitted to the critical care unit after an open exploratory laparotomy where it was found that he had a perforated appendix and diffuse peritonitis. Intraoperatively he had an estimated blood loss of 350 mL and he received 1 Liter of crystalloid solution in the OR. He arrives at the critical care unit intubated and sedated with a right radial arterial line, a five-lumen pulmonary artery catheter, and an indwelling urinary catheter in place. CASE SCENARIO QUESTIONS: 1.The charge nurse and CCU nurse receiving the patient from the OR team had just finished getting the patient settled. The CCU nurse performs her admission assessment and documenting vital signs and pressure. Before she records his arterial, pulmonary artery pressure and right atrial pressure readings, what should she do first? Why? 2.Right after recording the PAOP, what is most important nursing action to prevent complications of an indwelling PA line? 3.The cardiologist asks the CCU nurse to obtain and give him current CVP reading for Mr. J. Which port on the PA line will the nurse need to access in order to obtain these readings? What does the CVP reading measures? 4.The RAP is reading 1 mmHg. What does this mean? What may have caused this? What nursing interventions do you expect Mr. J needs? 5.The night CCU nurse is now performing her beginning of the shift assessment. She zeroes her arterial and PA line via the transducer to phlebostatic axis. What level does the stopcock needs to be positioned in relation to the patient in order for the pressure readings to be accurate? What pressure reading on the monitor indicates successful zeroing? 6.What is important for the CCU nurse to include in the documentation of Mr. J’s pressure lines? What nursing interventions should be included during routine assessment of patient in regards to pressure lines? What are the complications of PA and arterial lines? 7.Since Mr. J is being weaned off mechanical ventilation, the cardiologist has ordered follow-up ABG to evaluate his tolerance to the weaning parameters. What line will the nurse need to access to obtain the ABG readings? 8. It is 4 hours post-op and Mr. J’s current BP is 82/53, and HR 119. The nurse noticed that his blood pressure has dropped from earlier reading of 95/65 mmHg and heart rate increased from 110 bpm. Mr. J’s urine output for past 4 hours has been approximately 20mL/hr. The intensivist orders for the nurse to administer a 1000mL NS bolus and start Dopamine drip to keep BP WNL. Which pressure line is required for patients on vasopressor drips? 9.One hour after IV NS bolus given and Dopamine drip started, Mr. J’s BP is now 105/68 mmHg and HR is 108 bpm with urine output of 30mL/hr. However, nurse noticed on reassessment that patient still requires high FiO2 concentration to keep his SaO2 >95%. The nurse documents his SvO2 which is 57% and pale skin color. Is the SvO2 reading normal and what does it measure compared to SaO2? What may be a contributing factor to this reading? What should the nurse expect the patient needs? What labs will need to be obtained? 10.After the blood transfusion, the nurse is documenting current vital signs and pressure readings. She notices the PAP suddenly dropped and performed a dynamic response test. What abnormal response could the nurse expect to observe on the monitor? What nursing interventions may be done to troubleshoot? 11.The CCU nurse found the tubing to be kinked in multiple areas along the pressure tubing. After straigtening the tubing, a dynamic response test was done and is normal. The nurse then zeroes the transducer/stopcock to phlebostatic axis. She inflated the balloon of the PA line to obtain the PAOP but was met with resistance after 1 mL of air is injected. Is this normal? What is the next nursing action? What may have caused this? .

Sri K.

Transcript

00:01 To prepare insulin for administration safely, the nurse should follow a series of important steps.

00:10 Wash hands thoroughly with soap and water or use an alcohol -based hand sanitizer.

00:18 Assemble all necessary equipment, including insulin vials, syringes, alcohol swabs, and appropriate -sized needles.

00:28 Verify the insulin orders on the medication administration record to ensure accuracy.

00:33 Confirm the type and dosage of insulin prescribed by dr.

00:35 Brady.

00:41 Examine the expiration date on the insulin vials.

00:44 Do not use insulin that's past its expiration date.

00:53 If nph insulin is cloudy and needs mixing, gently roll the vial between the homes of the hands.

00:58 Avoid vigorous shaking as it may cause foaming.

01:07 Clean the rubber stopper of each insulin vial with an alcohol swab, allow it to dry before proceeding...

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