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NURS 412 Med Surg
Hi Everyone! Welcome back! I hope everyone has had a relaxing break and plenty of time to recharge for the semester ahead! As you all know, I'm Jess Paulus the Fundamentals tutor coming back to help you all in Medsurg! :)
First off my times are as follows:
Wednesdays: 2:00-4:00
Sundays: 6:00-10:00
Medsurg is a very fast moving class and it is very important to master the material because it will follow you in any specialty you may find yourself practicing in. You will have about 14 tests and weekly quizzes between Medsurg I & II so it is very important to understand how to take a Medsurg quiz/test! So please please please come to me if you do not understand or are struggling before it is too late!
First off let's talk about delegation...
In medsurg and on NCLEX you will have a lot of delegation questions. Delegation is who can do what, and who cannot. Below are some tips to help you all out...
RNs- Let's think about this. Most RNs have had ATLEAST two years of school and a lot of them have BSNs. The biggest job of the RN is education because of their schooling they are expected to have exceptional levels of critical thinking and knowledge. Anytime you see the words "educate" or "teach", a light should go off and you should think "that's a RNs job". Also they are expected to do all initial accessments. **Important, when you delegate..you delegate the task not the responsibility!!!**
LPNs- I going to state this now, I AM NOT TRYING TO OFFEND ANYONE!!! As some of you know, I have weird little tricks/expressions for remembering things. This is one of them, and again no offense to any LPN or LPN family member!!!!! I think of LPNs as being a nursing body without a brain and kinda being an "RN helper". They cannot do initial assessments, teach/educate, make a nursing diagnosis, analyze or plan without RN supervision. They can, however, do ongoing assessments and collaborate with the RN on planning. They can do any practical task a nurse can aside from administer narcotics or give IV push medications.
UAPs- I kinda think of UAPs is everything a nursing student can do on their own without their nurse around. They can take vitals, bathe patients, change linens, help with toileting, ambulation of a stable client, collect urine specimens, do I&Os, etc. They cannot do ANYTHING invasive (ie. irrigating a foley, but they can drain a foley bag for I&O). I ask myself, can a patient get an infection if the UAP does it wrong? Then you know it is invasive (do not read to much into this, its just a helping tool)
Also there will be a lot of questions on about "floating" nurses. A float nurse is a nurse who comes from another unit when there is a staffing shortage (for example an OB nurse going to the ICU for a shift). Here's some tips to consider with these types of questions...
1.) Do not give the float nurse any patients that may require specialized care. For example, if a nurse floats from the ICU to a labor and delivery floor do not expect them to be able to read contractions/fetal heart rate strips. Or if a L&D nurse comes over to the ICU do not expect them to know how to calibrate an arterial line.
2.) Do not give a high acuity/unstable patient to the float nurse. Patients that have just returned recently from surgery, has a lot of medications, is having chest pain, has a multi-system condition, etc. should be given to a nurse accustomed to that floor.
3.) Consider the age of the client. If a nurse is being floated over from a med-surg unit to the peds floor, giving that float nurse an infant probably is not the smartest choice. They are unfamiliar with the differences in care and overall system management/expectations for a young child.
4.) Ask yourself, is what I'm asking the nurse to do a universal nursing task? Try to give the nurse something that the procedure would be the same on any floor or any unit. For example giving IV antibiotics would be the same on a peds or medsurg floor, same with giving blood.
There will be questions on room assignments. They like to ask "what client should be placed closest to the nurses station?" or "what two clients can room together?" Biggest thing with this is think about the risk for the client! Here are some more tips..
1.) Clients undergoing radiation should be in a private room (obviously)
2.) Immunocompromised patients should be placed in the appropriate isloation
3.) Easily transmitted infections such as GI, respiratory, skin or wound should be by themselves
4.) Depressed or combative clients should be in a private room. You don't want them hurting their roomate!
5.) Clients that need low stimuli environments (such as a patient at risk of seizures or increased intercranial pressure) need to be by themselves
6.) Consider gender
7.) Consider age, putting a six year old with another six year old both of which are post op and infection free may be a good choice
8.) Place the clients who need to be watched closely near the nurses station. A confused, old man who has left sided weakness trying to get out of bed to catch his blue cat running out of the room, probably doesn't really undestand his surroundings and needs to be watched.
Prioritizing is big too. Remember your ABCs!! I always ask myself, will something bad happen if I don't see this client right now?
Respiratory Medications
Beta 2s Inhaler
Tetracyclines
ABGs
When doing uncompensated/partial/compensated ABGs, your first step is to look at the pH and ask yourself is it normal? If it is, it is automatically compensated.
If pH is abnormal next look at the Bicarb/CO2. If the bicarb and co2 are on opposite ends of the spectrum (one is basic and the other is acidic, both abnormal) it is partially compensated. If either the bicarb OR the co2 is lined up with the pH and abnormal while the other is normal, it is uncompensated.
First off my times are as follows:
Wednesdays: 2:00-4:00
Sundays: 6:00-10:00
Medsurg is a very fast moving class and it is very important to master the material because it will follow you in any specialty you may find yourself practicing in. You will have about 14 tests and weekly quizzes between Medsurg I & II so it is very important to understand how to take a Medsurg quiz/test! So please please please come to me if you do not understand or are struggling before it is too late!
First off let's talk about delegation...
In medsurg and on NCLEX you will have a lot of delegation questions. Delegation is who can do what, and who cannot. Below are some tips to help you all out...
RNs- Let's think about this. Most RNs have had ATLEAST two years of school and a lot of them have BSNs. The biggest job of the RN is education because of their schooling they are expected to have exceptional levels of critical thinking and knowledge. Anytime you see the words "educate" or "teach", a light should go off and you should think "that's a RNs job". Also they are expected to do all initial accessments. **Important, when you delegate..you delegate the task not the responsibility!!!**
LPNs- I going to state this now, I AM NOT TRYING TO OFFEND ANYONE!!! As some of you know, I have weird little tricks/expressions for remembering things. This is one of them, and again no offense to any LPN or LPN family member!!!!! I think of LPNs as being a nursing body without a brain and kinda being an "RN helper". They cannot do initial assessments, teach/educate, make a nursing diagnosis, analyze or plan without RN supervision. They can, however, do ongoing assessments and collaborate with the RN on planning. They can do any practical task a nurse can aside from administer narcotics or give IV push medications.
UAPs- I kinda think of UAPs is everything a nursing student can do on their own without their nurse around. They can take vitals, bathe patients, change linens, help with toileting, ambulation of a stable client, collect urine specimens, do I&Os, etc. They cannot do ANYTHING invasive (ie. irrigating a foley, but they can drain a foley bag for I&O). I ask myself, can a patient get an infection if the UAP does it wrong? Then you know it is invasive (do not read to much into this, its just a helping tool)
Also there will be a lot of questions on about "floating" nurses. A float nurse is a nurse who comes from another unit when there is a staffing shortage (for example an OB nurse going to the ICU for a shift). Here's some tips to consider with these types of questions...
1.) Do not give the float nurse any patients that may require specialized care. For example, if a nurse floats from the ICU to a labor and delivery floor do not expect them to be able to read contractions/fetal heart rate strips. Or if a L&D nurse comes over to the ICU do not expect them to know how to calibrate an arterial line.
2.) Do not give a high acuity/unstable patient to the float nurse. Patients that have just returned recently from surgery, has a lot of medications, is having chest pain, has a multi-system condition, etc. should be given to a nurse accustomed to that floor.
3.) Consider the age of the client. If a nurse is being floated over from a med-surg unit to the peds floor, giving that float nurse an infant probably is not the smartest choice. They are unfamiliar with the differences in care and overall system management/expectations for a young child.
4.) Ask yourself, is what I'm asking the nurse to do a universal nursing task? Try to give the nurse something that the procedure would be the same on any floor or any unit. For example giving IV antibiotics would be the same on a peds or medsurg floor, same with giving blood.
There will be questions on room assignments. They like to ask "what client should be placed closest to the nurses station?" or "what two clients can room together?" Biggest thing with this is think about the risk for the client! Here are some more tips..
1.) Clients undergoing radiation should be in a private room (obviously)
2.) Immunocompromised patients should be placed in the appropriate isloation
3.) Easily transmitted infections such as GI, respiratory, skin or wound should be by themselves
4.) Depressed or combative clients should be in a private room. You don't want them hurting their roomate!
5.) Clients that need low stimuli environments (such as a patient at risk of seizures or increased intercranial pressure) need to be by themselves
6.) Consider gender
7.) Consider age, putting a six year old with another six year old both of which are post op and infection free may be a good choice
8.) Place the clients who need to be watched closely near the nurses station. A confused, old man who has left sided weakness trying to get out of bed to catch his blue cat running out of the room, probably doesn't really undestand his surroundings and needs to be watched.
Prioritizing is big too. Remember your ABCs!! I always ask myself, will something bad happen if I don't see this client right now?
Respiratory Medications
Beta 2s Inhaler
- Albuterol, Ventolin, Terbutaline
- Relaxes bronchial smooth muscles to decrease airway resistance
- Watch for cardiac dysrhythmias along with tremors, restlessness, and tachycardia--> All adverse effects
- 1-3 minutes between each puff
- Flovent, Nasonex
- Watch for thrush, rinse out mouth to prevent
- Not for acute attacks--only long term
- Always take bronchodilator first
- Taper gradually and report signs of infection
- Singulair
- Chronic treatment of asthma, not acute attacks
- Watch for GI upset
- Take in evening
- End in "floaxcin"
- Watch with children
- Do not take with theopylline, digoxin, or anticoags
- Do not take with meals (2 hours before or after)
- Watch sunlight
- GI upset is big adverse effect, take with food if problems
- No fruit juices
- Ideally do not take with meals
- Azithromycin, clarithromycin
- Notify provider of rash or diarrhea or superinfection (black furry tongue)
- Do not give with food, milk is ok
- "cillin"
- Do not give with allergy to cephlasporins!!
- Do not take with meals ideally
- Can take with food if GI upset
- Increase fluids
Tetracyclines
- "cycline"
- Stains teeth of kids under 8yrs
- Watch sunlight exposure
- Avoid antacids, dairy, and iron
- Empty stomach
- Different contraceptives other than birth control
ABGs
When doing uncompensated/partial/compensated ABGs, your first step is to look at the pH and ask yourself is it normal? If it is, it is automatically compensated.
If pH is abnormal next look at the Bicarb/CO2. If the bicarb and co2 are on opposite ends of the spectrum (one is basic and the other is acidic, both abnormal) it is partially compensated. If either the bicarb OR the co2 is lined up with the pH and abnormal while the other is normal, it is uncompensated.
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Latest page update: made by JLPaulus
, Feb 22 2011, 4:27 PM EST
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