Nursing Fundamentals Exam 1 Study Guide

Exam 1 Study Guide Fall 2020 Nursing Fundamentals 1. Know what to do if your glove gets a tear while you are rendering care ● Take off contaminated pair, perform proper hand hygiene and put on new pair of gloves using proper technique. Put the glove on the dominant hand 1st and then 2nd. 2. Know what it means to prepare a sterile field and what you should keep in mind ● Sterile field : an area free of microorganisms and prepared to receive sterile items (1-in border within sterile field is considered non-sterile). ○ Example: opening sterile packs. ■ Use ABHR or wash hands with soap and water before opening pack. ■ Clean surface to establish sterile field and keep above waist level. ■ Check pack for sterility (expiration date, if intact, any tears, pack should be dry). ■ Open pack from the top and pull to the sides or open away and then towards you, depending on packaging (make sure it is within sterile field). ● Also make sure arm is not above sterile field. ● Make sure to only touch the 1 in tips of the pack/drape. ● Requires a work area in which objects can be handled with minimal risk of contamination. ● A nurse can never turn their back on a sterile field or a sterile tray or leave it unattended. 3. Know what the chain of infection is and why it is Important to know. - - Chain of Infection Infectious agent or pathogen Reservoir- a place where microorganisms survive and multiply. - Human reservoir (2 types) - 1. Those with acute or symptomatic disease - 2. Those who show no signs but are carriers. Portal of exit Mode of transmission Portal of entry Susceptible host * A presence of a pathogen does not mean that an infection will occur* * It is important to know because to prevent germs from infecting more people, we must break the chain of infection . EX) Hand Hygiene. 4. Review communication strategies Verbal - Vocabulary - avoiding medical jargon. Use a translator if needed. If speaking to a child, or teenager, be aware how their vocabulary may vary - Denotative and Connotative meaning - select words carefully so they are not misinterpreted - Pacing - mind your pace, it can affect how the words are interpreted - Intonation - your tone - Clarity and brevity - be concise, speak slow, be clear in your meanings. Don’t say “you know” - Timing and relevance - when you deliver a message is nearly as important as what the message is Non-Verbal - Personal appearance - Posture and Gait - Facial expression - Eye contact - varies by culture - Gestures - Sounds - Territoriality and personal space 5. 6. Know what subjective data and objective data are ● Objective data : “what the nurse observes” observable and measurable data that can be seen, heard, or felt by the nurse (ex. temp, BP, or HR) ● Subjective : “what the patient says” information perceived only by the affected patient (ex. pain, feeling dizzy, feeling anxious) Know Florence Nightingale’s Environmental Theory ● Known as the first nursing theorist; described nursing as a profession that requires its own knowledge (as opposed to medical knowledge) ● Theory founded on belief that nursing could improve a PTs environment to facilitate recovery ● Environmental factors that affect health: fresh air, pure water, sufficient food, efficient drainage, cleanliness of PT and environment, and light (sunlight) 7. Know when you would administer a partial bed bath ● When patient have an accident in bed ● Partial Bed bath that consists of bathing only body parts that would cause discomfort if left unbathed, such as the hands, face, axilla, and perineal area. Partial bath also includes washing back and providing back rub. Dependent patients in need of partial hygiene or self-sufficient bedridden patients who are unable to reach all body parts receive a partial bed bath. 8. Know the concepts of the nursing metaparadigm ● The nursing metaparadigm includes the four concepts of person (or human beings), health, environment/situation, and nursing. ○ Person is the recipient of nursing care, including individual patients, groups, families, and communities. The person is central to the nursing care you provide. ○ Health has different meanings for each patient, the clinical setting, and the health care profession. It is a state of being that people define in relation to their own values, personality, and lifestyle. It is dynamic and continuously changing. ○ Environment/situation includes all possible conditions affecting patients and the settings where they go for their health care. There is acontinuous interaction between a patient and the environment. This interaction has positive and negative effects on a person’s level of health and health care needs. Factors in the home, school, workplace, or community all influence the level of these needs. ○ Nursing includes “care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people” 9. Know the various types of isolations • : require a gown and gloves • : require the wearing of a surgical mask when within 3 feet of the patient, proper hand hygiene, and some dedicated-care equipment • referred to as an : requires a specially equipped room with a negative air flow . •All health care personnel wear an N95 respirator every time they enter the room 10. Know what interventions should be done for a patient who is in bed and feeling short of breath *use critical thinking skills* (ch 29 pg 483 for a more in depth nursing process) (chapter 41, oxygenation, pg 3092 ) Assessment: Identify pt’s recurring & present signs & symptoms with impaired oxygenation, Determine presence of risk factors for alterations, Know patient’s medications, Know patient’s baseline range of vital signs. Assess the patient’s respirations (rate, rhythm, depth), respirations are tied to numerous functions in the body so consider all possible changes, assess diffusion and perfusion by measuring O2 saturation in the blood (pulse oximeter) and exhaled CO2 throughout exhalation (capnography) Factors influencing oxygenation: physiological (respiratory vs cardiac disorders, hypovolemia, anemia, musculoskeletal abnormalities, obesity, trauma, neuromuscular diseases, etc.), developmental (infants and toddlers at risk for URI, choking hazards, older adults undergo changes: calcification of heart valves, atherosclerotic plaques, vascular stiffening, increased left ventricular wall thickness, few SA nodes, costal cartilage stiffening, etc.), lifestyle (nutrition, hydration, exercise, smoking, substance abuse, stress, etc.), environmental (workplace/occupational pollutants, rural vs urban area living, COPD higher in rural areas, etc.) Diagnosis: Use assessment data to determine the patient’s problem. Possible problems: impaired airway clearance, impaired breathing, impaired gas exchange, environmental irritations, allergic reaction, pulmonary embolism from immobility, impaired cardiac output, activity intolerance, risk for activity intolerance, acute pain Planning/Implementation: develop a plan of care for each nursing diagnosis, set realistic expectations, measurable outcomes (SMART goal). Pts with impaired oxygenation require specific expected outcomes directed toward oxygenation needs (ex. Pt’s respiratory rate between 12-20 breaths/minute, pt achieves bilateral lung expansion, pt breaths without use of accessory muscles) Provide the patient with supplemental oxygen (oxygen may be given without a physician’s order), sit the patient up in a semi fowler or high fowler position to allow for optimal lung expansion, clear any airway obstructions (example: suction secretions - yankauer), administer bronchodilators if indicated, treat acute pain if causing SOB. Collaborate/consult with physicians, respiratory therapists, other professionals as needed Evaluation: Evaluate effectiveness of interventions implemented and the patient’s response (improve? Worsen? Stayed the same?) Consider physiological changes expected from interventions provided and reassess if indicated 11. Know when different types of hand hygiene are required A. When hands are visibly soiled, wash hands with soap and water B. If hands are not visibly soiled, use alcohol-based hand product or wash hands with soap and water C. Before and after treating each patient e.g. before and after gloving D. After touching instruments, equipment, and other objects that are likely to be contaminated by blood, saliva, or secretions with bare hands E. Before and after leaving a patient’s room F. Before and after using the bathroom G. Before and after eating and drinking 12. Know what HIPAA is and what types of behavior may cause a violation A. Health Insurance Portability and Accountability Act of 1996 (HIPAA) set standards for the protection and confidentiality of patient's personal health information. B. You can’t share information about a patient’s medical condition or personal information with anyone who isn’t involved in the care of the patient C. HIPAA’s Privacy Rule requires that disclosure or requests regarding health information are limited to the specific information required for a reason. Ex. if you need a patient’s personal phone # to reschedule an appointment, access to the health record is limited solely to telephone information D. HIPAA’s Security Rule specifies administrative, physical, and technical safeguards in place for protected health information (PHI) in electronic form. You must ensure that any electronic written materials in your practice do not include patient identifiers such as name, room number, DOB, demographic info E. Do not print material from an electronic health record (EHR) for personal use. Information that’s printed must be for professional use only and should not include identifiable information F. You can review patient health records only for information required to provide safe and effective patient care ex. You’re assigned to a patient and need to review the patient’s health record and plan of care. and 13. Know what is documented when assessing a patient’s breathing/respirations - Respiratory rate, heart rate, and pulse are documented - Also document how the person is breathing, is it labored? Are their lips pursed out? Are they wheezing? 14. Know how to provide basic hygiene for the eyes - Like physical assessment, the bath is given from head to toe. The first area to be washed is the inner canthus of each eye; the neck area is the face and neck, after which the bath is given downwards towards the toes. - When washing the eyes, wash from the corner out NEVER wash from out to in as it will cause irritation and increase likelihood of bacteria getting into the eye leading to an infection. - You can use two seperate wipes for the eyes so that you are not using the same wipe for each eye to reduce spreading any bacteria. 15. Know the principles of assessment, palpation, inspection, percussion and auscultation Inspection- Close, careful scrutiny, first of individual as a whole and then of each body system ● Inspect each area for size, shape, color, symmetry, position, and abnormality ● REQUIRES good lighting, adequate exposure, occasional use of instruments Auscultation- to listen to sound produced by the body ● REQUIRES stethoscope ● Frequency ● Loudness ● Quality ● Duration Palpitation- use of touch to gather information ● Start with light palpation, end with deep palpation Percussion- to tap to produce a vibration o Sound determines location, size, density of structures, and detects superficial abnormal mass 16. Know what to do to get a patient out of bed if the patient has not gotten up for several days ● Assess the patient to see what activities they can physically perform & the skin ● Plan for some ROM activities ● Allow legs to hang over the bed to increase circulation to the feet ● Take patient for a short walk w/ a gait belt ● Evaluate for effectiveness 17. Know the signs and symptoms of localized and system infection ● Systemic ○ Affects entire body instead of just one single organ ○ Can become fatal if undetected and untreated ○ Fever, fatigue, nausea/vomiting,malaise ○ Enlarged, swollen, tender lymph nodes when palpated ● Localized infection ○ Localized symptoms: pain, tenderness, warmth, redness at wound site ○ Most common in areas of skin or mucous membrane breakdown ■ Surgical and traumatic wounds, pressure injuries, oral lesions, abscesses 18. Know what serous, sanguineous, and serosanguineous, purulent, serous are Serous: clear, watery, like plasma Sanguineous: containing red blood cells purulent : containing white blood cells and bacteria, thick and opaque, pus 19. Review how to write nursing diagnosis PES P- Problem (NANDA-1) Example: Impaired physical mobility E- Etiology or related factor Example: incisional pain S- Symptoms of defining characteristics Example: evidenced by restricted turning and positioning “Impaired physical mobility related to incisional pain as evidenced by restricted turning and positioning” 20. Know the nursing process ADPIE Assessment- identify area of interest or clinical problem Diagnosis- develop research questions/hypotheses Planning- determine how study will be conducted Implementation- conduct the study Evaluation- analyze results of the study 21. Review the various phases of critical thinking Basic level of critical thinking: •The learner trusts that experts have the right answers for every problem •Thinking is concrete and based on a set of rules or principles. Complex critical thinkers: •Begin to separate themselves from experts and analyze the clinical situation and examine choices more independently; thinking becomes more creative and innovative •Each solution has benefits and risks that you weigh before making a final decision; there are options •You learn to gather additional information and take a variety of different approaches for the same therapy Commitment level thinkers: •Anticipate when to make choices without assistance from others and accept accountability for decisions made 22. Review body mechanics and how a Patient should be moved in bed 23. Know what areas should be assessed when determining activity tolerance in a patient Activity tolerance is the type and amount of exercise or work that a person is able to perform without undue exertion or injury ● Observe patients after ambulation, self-bathing, or sitting in a chair for several hours and assess their verbal report of fatigue and weakness. ● Do they show difficulty breathing or report being short of breath after exercise? ● Assess heart rate and blood pressure response to activity by comparing with baseline rates at rest. ○ Both heart rate and blood pressure should increase. ● When you care for a patient who is relatively healthy and able to exercise regularly, assess what he or she sets as a target heart rate during exercise. ○ Use this finding to determine whether the patient has set an adequate target rate for exercise training 24. Review how to make an occupied bed See box 40.15 Procedural guidelines for making an occupied bed. There are 43 steps. To summarize those steps: 1. It can be done by assistive personnel but nurse should instruct AP about: a. Any positive or activity restrictions b. Looking for wound drainage or loosened equipment c. When to obtain help, importance of safe patient handling and supporting patient alignment d. Using special precautions for aspiration precautions of tube feeding 2. Gather the equipment (bottom sheet, top sheet, draw sheet, blank, pillowcases, clean gloves, antiseptic cleaner, washcloth) 3. Review medical record for restrictions 4. Organize supplies and give patient privacy 5. Assess environment 6. Perform hand hygiene 7. Explain procedure to patient 8. Raise bed to comfortable height, lower head of bed as tolerated a. If aspiration precaution or has tube feeding, keep HOB 30 degrees or higher at all times 9. Lower side rail, loosen linen, maintain patient privacy and change out the top blankets 10. Position patient turned onto side and facing away from you, then loosen bottom linen and tuck under patient (remove disposable pads) 11. Apply clean linens to exposed mattress (clean mattress first if necessary)-- hem side of sheets should be down 12. Add pad on top of clean linens 13. Roll patient over while patient is aligned (keeping patient covered) 14. Raise side rail and move to opposite side of bed then lower that side rail 15. Remove soiled linen (clean mattress if required) 16. Pull clean sheets toward you and help patient roll back to supine (reposition pillow) 17. Change blankets and make toe pleat, miter the corners 18. Change pillowcase (do not hold against uniform) 19. As changing linens, inspect skiing for irritation and observe patient for fatigue, dyspnea, pain or other discomfort 25. Know the nursing theories of Orem, King, Henderson & Nightingale (p.46-48;10th edition) Nightingale Environmental Theory - (Grand Theorist)Focused on the patient's environment. Nurses should manipulate(ventilation, lights, noise levels, hygiene and nutrition) so nature is able to restore a patient to health. Orem’s Self Care Deficit Nursing Model- (Grand Theorist) A nurse continually assesses patients ability to perform self-care and intervenes as needed to ensure that patients meet physical, psychological,, sociological, and environmental needs. Patients who participate in self-care are more likely to improve their outcome.Nursing care becomes necessary when they are unable to complete self tasks. ASSESS, INTERVENE, EVALUATE. Henderson Principles and Practice of Nursing- (Grand Theory) Nurses assist patients with 14 activities( breathing,eating, drinking, eliminating, movement, sleep, clothing, body temp, hygiene, safety, communication,play, practice of faith, learning,) until patient can meet their own needs or help patient have a peaceful death. King’s Goal Attainment- (Grand Theory) Nurses view their patients as part of a system. This system (i.e. the nurse, family and friends) help patients become active participants in their care. Through setting goals that are attainable, the patient can help with restoring and maintaining their own health. 26. Know the parts of the PICOT question PICOT format is used as a part of a step by step system to develop EBP. PICOT format assists you in finding the right evidence to answer a question. The aim is to ask a question that contains as many of the PICOT elements as possible. a. Assessment i. Gathering data (objective and subjective) b. Nursing Diagnosis/nursing problem i. Differentiates medical and nursing professions- North American Nursing Diagnosis Association International c. Plan i. Realistic ii. Communicate the plan with pt and family. iii. S.M.A.R.T. goals: E> pecific (simple, sensible, significant) F> easurable (meaningful, motivating) G> chievable (agreed, attainable) H> elevant (reasonable, realistic and resourced, results-based) I> ime bound (time-based, time limited, time/cost limited, timely, time-sensitive) d. e. Implementation i. Carry out the plan ii. Document results Evaluation i. Was the plan accomplished? If not you have to revise your plan! Infection occurs in a cycle that depends on the presence of all of the following elements: • An infectious agent or pathogen • A reservoir or source for pathogen growth • A port of exit from the reservoir • A mode of transmission • A port of entry to a host • A susceptible host · Infection can develop if this chain remains uninterrupted. · Preventing infections involves breaking the chain of infection. 29. Review concepts related to patient hygiene ● ● ● ● ● ● ● ○ ● ○ ○ ○ ● ○ ● ● ● ○ ● 30. Know in which patient populations rectal temperatures are contraindicated Temp range: ° ° •Don’t want to use Rectal: Hypothermic, extreme hyper or underlying conditions or rectal trauma, Oncology (hematology) , don’t have an anus (pt has a colostomy), diarrhea, bleeding tendencies or who had rectal surgery, rectal disorders 31. Know the following positions: Dorsal recumbent, Lateral, Fowler’s, Sim’s, Side-lying, Prone, Supine 32. Know what instinctive, scientific, authoritative and traditional knowledge are - - Traditional knowledge is the part of nursing practice passed down from generation to generation, often without research data to support it. Scientific knowledge is that knowledge obtained through the scientific method(implying thorough research). Authoritative knowledge comes from an expert and is accepted as truth based on the person's perceived expertise. Instinct is not a source of knowledge. 33. Know the steps for critical thinking ○ ○ ○ ○ ○ ○ ○ ○ 34. Know Erikson’s stages Development occurred throughout the lifespan, and it focused on psychosocial rather than psychosexual stages. Believed that problems in adult life resulted from unsuccessful resolution of earlier stages. Stage 1: Trust vs mistrust (birth to 1 year) Stage 2: Autonomy vs shame and doubt (1-3 years) Stage 3: Initiative versus guilt (3-6 years) Stage 4: Industry versus inferiority (6-11 years) Stage 5: Identity vs role confusion (puberty) Stage 6: Intimacy vs isolation (young adult) Stage 7: Generative versus self-absorption and stagnation (middle age) Stage 8: Integrity versus despair (old age) 35. Know when human growth and development begin Human growth and development-Growth encompasses the physical changes that occurs from prenatal period through order adulthood demonstrating advancement and deterioration. Development refers to the biological, cognitive, socioemotional changes that begins at conception and continue throughout a lifetime. 36. Review safety considerations for infant care 37. Know the symptoms of hypoxia Apprehension Restlessness - often an early sign Inability to concentrate Decreased levels of consciousness Dizziness Behavioral changes Unable to lie flat Appears fatigued and agitated 38. Know the effects of different foods on the body’s water balance (ch 42 table 42.3 on pg 985) Increased amounts of sodium or insufficient amounts of sodium in an individual's diet influence an osmolality imbalance. In an osmolality imbalance body fluids become hypertonic or hypotonic causing osmotic shifts of water across cell membranes HYPERNATREMIA (water deficit): caused by loss of more water than salt or a gain of more salt than water. Hypertonic interstitial fluid, where salt goes water goes, water moves from inside the cells to the outside environment and the cells shrivel HYPONATREMIA (water excess): caused from gain of relatively more water than salt or loss of relatively more salt than water. Hypotonic interstitial fluid (dilute conditions and more salt inside cell), where salt goes water goes, and water enters cells by osmosis causing the cell to swell 39. Know the difference between actual problems and at-risk problems for nursing diagnosis. ● Risk nursing diagnosis: A clinical judgement concerning the vulnerability of an individual, family, group, or community for developing an undesirable human response to health conditions/life processes. ○ This type of diagnosis applies when there is an increased potential or vulnerability for a patient to develop a problem or complication as outlined by NANDA-I. ○ Ex. “risk for fall”, “risk for unstable BP” ● Problem-focused diagnoses or negative diagnoses identify an undesirable human response to existing problems or concerns of a patient. ○ Ex. “acute pain”, “impaired urination”, “urinary retention” 40. Know the five values that the American Association of Colleges of Nursing identified that depict the professional nurse ● Altruism ○ Concern for the welfare and well-being of others. In professional practice, altruism is reflected by the nurse's concern for the welfare of patients, other nurses, and other health care providers. ● Autonomy ○ Right to self determination. Professional practice reflects autonomy when the nurse respects patients' rights to make decisions about their health care. ● Human Dignity ○ Respect for the inherent worth and uniqueness of individuals and populations. In professional practice, human dignity is reflected when the nurse values and respects all patients and colleagues. ● Integrity ○ Acting in accordance with an appropriate code of ethics and accepted standards of practice. Integrity is reflected in professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession. ● Social Justice ○ Upholding moral, legal, and humanistic principles. This value is reflected in professional practice when the nurse works to ensure equal treatment under the law and equal access to quality health care. 41. Know which organization governs the NCLEX exam rofit organization through which nursing regulatory bodies act and counsel together on matters of common interest and concern affecting public health, safety and welfare, including the development of nursing licensure examinations. 42. Know what it means to take the NCLEX exam - NCLEX-RN stands for the National Council Licensure Examination for Registered Nurses. Graduates of associates, baccalaureate, and masters degree programs (entry level) are eligible to take the NCLEX to become RNs in the state in which they will practice. The NCLEX provides a standardized minimum knowledge base for nurses. 43. Know what it means to be a Magnet Hospital ● H ealth care organizations that achieve excellence in nursing practice. Must demonstrate quality patient care, nursing excellence, and innovations in professional practice. Nurses practice with a sense of empowerment and autonomy to deliver quality nursing care. The organizational culture is focused on nurse engagement, commitment to quality improvement, clear strategic direction, shared governance, and trust in leadership. Five components: (1) Transformational Leadership, (2) Structural Empowerment, (3) Exemplary Professional Practice (4) New Knowledge, Innovation, and Improvements (5) Empirical Quality Results 44. Review caring with touch and how to approach it. ● Touch: provides comfort, creates a connection. (Touch conveys many messages, use with discretion) ● Contact touch (therapeutic touch) - task-oriented touch, caring touch, protective touch ○ Caring touch: Lay hand on patient’s hand and let them know you are there to listen to them and support them, back massage, participation. Connect with patient physically/emotionally. ○ Task-oriented touch: When performing a task or procedure. Skillful and gentle performance of nurse conveys security and sense of competence ○ Protective touch: Form of touch that protects nurse and/or patient. Patient views positively or negatively. Most obvious form of protective touch is holding and bracing a patient to avoid a fall (positive touch). Protective touch can protect nurses emotionally by leaving a room when a patient is suffering or escaping a situation causing tension (elicits negative feelings in the patient). ● Non-contact touch - refers to eye contact 45. Review your vocabulary up to week 4 Week 1 Week 2 Week 3 Week 4 – – 46. Review math chapters up to week 4 Chapter 4- Ratio and Proportion Ratios A ratio is used to indicate a relationship between two numbers. These numbers are separated by a colon (:). Example 1: 3:4 The colon indicates division; therefore a ratio is a fraction. Example 2: In a nursing class, if there are 25 male students and 75 female students, what is the ratio of male students to female students? 25 male students to 75 female students = 25 male students per 75 female students = = ⅓. This is the same as a ratio of 25:75 or 1:3. Ratio Measures in Solutions Ratio Measures in Solutions Some medications express the strength of the solution by using a ratio. Ratio measures are commonly seen in solutions. Ratios represent parts of medication per parts of solution, for example, 1:10,000 (this means 1 part medication to 10,000 parts solution). Example 1: 91 A 1:5 solution contains 1 part medication in 5 parts solution. Example 2: A solution that is 1 part medication in 2 parts solution would be written as 1:2. Proportions A proportion is an equation of two ratios of equal value. The terms of the first ratio have a relationship to the terms of the second ratio. A proportion can be written in any of the following formats: Example 1: 3:4 = 6:8 (separated with an equals sign) Example 2: 3:4::6:8 (separated with a double colon) Example 3: ¾ = (written as a fraction) Solving for x in Ratio and Proportion Because the product of the means always equals the product of the extremes, if three numbers of the two ratios are known, the fourth number can be found. The unknown quantity may be any of the four terms. In a proportion problem, the unknown quantity is represented by x. After multiplying the means and extremes, the unknown x is usually placed on the left side of the equation. Begin with the product containing the x, which will result in the x being isolated on the left and the answer on the right. Example: 12:9 = 8:x Steps: 12x = 72 Applying Ratio and Proportion to Dosage Calculation Now that we have reviewed the basic definitions and concepts relating to ratio and proportion, let’s look at how this might be applied in dosage calculation. In dosage calculation, ratio and proportion may be used to represent the weight of a medication that is in tablet or capsule form. Example 1: This may also be expressed by stating the weight of the medication first: This means that 1 tablet contains 0.125 mg or is equal to 0.125 mg of medication. Example 2: If a capsule contains a dosage of 500 mg, this could be represented by a ratio as follows: This may also be expressed stating the weight of the medication first: This may also be expressed stating the weight of the medication first: Another use of ratio and proportion in dosage calculation is to express liquid medications used for oral administration and for injection. When stating a dosage of a liquid medication, a ratio expresses the weight (strength) of a medication in a certain volume of solution. Example 1: A solution that contains 250 mg of medication in each 1 mL could be written as: 1 mL contains 250 mg of medication Chapter 5 Percentages Converting Percentages to Fractions, Decimals, and Ratios Example 1: Example 2: Example 1: Example 2: Example 3: Example 3 is an alternative method. Drop the percent sign. Write the remaining number as the numerator. Write “100” as the denominator. Reduce the result to lowest terms. Divide the numerator by the denominator to obtain a decimal. Example 1: Example 2: Example 1: Example 2: Example 1: Example 1: Example 1: Chapter 6- Metric System Basic Units of Metric System Table of Measure Basic Unit Abbreviation Weight (solid) Gram g Volumme (liquid) Liter L Length Meter m Prefix Numerical Value Meaning Kilo* 1,000 One thousand times Hecto 100 One hundred times Deka 10 Ten times Deci 0.1 One tenth Centi* 0.01 One hundredth part of Milli* 0.001 One thousandth part of Micro* 0.000001 One millionth part of *Prefixes used most often in medication administration. *Seen in the expression of laboratory values (e.g., hemoglobin, creatinine levels) These rules are critical to the prevention of errors and ensure accurate interpretation of metric notations when used in medication orders [never assume]. Conversions Between Metric Units Example 1: Example 2: Example 1: Example 2: Chapter 7- Apothecary and Household System s 1. Normal saline solution (0.9%)—2 teaspoons of salt to 4 cups of water 2. Acetic acid solution (0.25%)—3 tablespoons of white vinegar to 4 cups of water for wound/dressing care and cleaning equipment Household measures are most commonly used Other Medication Measurements Used in Dosage Calculation Units : express the amount of medication present in 1 milliliter (mL) of solution and are specific to the medication for which they are used. Units measure a medication in terms of its action. Medications such as heparin, insulin, and penicillin are measured in the United States Pharmacopeia unit (USP unit). USP unit has been standardized between manufacturers and has been determined by the United States Pharmacopeia (USP). USP is a government agency that sets standards for medications. International unit represents a unit of potency used to measure things such as vitamins and 151 chemicals. These International units represent the amount of medication needed to produce a certain effect and are standardized by international agreement. Milliunit is 1/1,000 of a unit. 1 unit is equal to 1,000 milliunits. Nurses may need to convert units to milliunits. For example, oxytocin (Pitocin) is available in units (10 USP units per 1 mL). Very small doses of oxytocin may be ordered in milliunits. When oxytocin is used to augment labor, the intravenous infusion rate can be 0.5 to 2 milliunits per minute (0.0005 = 0.002 USP units). Milliequivalents (mEq) are used to measure electrolytes (e.g., potassium) and the ionic activity of a medication. The milliequivalent is one thousandth (1/1,000) of the equivalent weight of an ion. The chemist or pharmacist defines milliequivalents as an expression of the number of grams of medication contained in 1 mL of normal solution. Other electrolytes measured in mEq include calcium, magnesium, and sodium. Chapter 8- Converting Within and Between Systems Converting Within the Same System Example: Solution: Answer: 0.12 kg is equivalent to 120 g Converting Between Systems Example: Answer: 120mL Chapter 12- Medication Administration Records and Medication Distribution Systems 1. A medication order, whether handwritten or done by computer entry, must have the following components: • Client’s name • Name of the medication • Dosage • Route frequency and any special instructions for medications if needed; for example, for moderate pain, hold for pulse less than 60. • Signature of the prescriber In institutions in which handwritten records are still used, after the medication order has been verified, the order is transcribed to a medication administration record (MAR). 2. Medication Administration Record The medication administration record (MAR) is a form used to document medications a client has received and is currently receiving. MARs are legal documents that may be handwritten (Figure 12- 1) or electronic (Figure 12-2). Electronic medication administration records (eMARs) are viewed and charted on the computer. 3. Documentation is the sixth “right of medication administration.” Documentation should follow the administration of medication and include not only medications administered but also documentation regarding refusals, delays in administration, and responses to medication administration (including adverse effects) Essential Components on a Medication Record If a handwritten MAR is used, the information on the medication record must be legible and transcribed carefully to avoid errors. In addition to client information (name, date of birth, medical record number, allergies), the following information is necessary on all MARs regardless of the format: 1. Dates . This information usually includes the date the order was written, the date the medication is to be started (if different from the order date), and when to discontinue it. 2. Medication information . This includes the medication’s full name, the dosage, the route, and the frequency. Abbreviations used on the medication record should be standard abbreviations and follow the guidelines and restrictions of The Joint Commission (TJC), ISMP, and the health care institution. 3. Time of administration . This will be based on the desired administration schedule stated on the order, such as t.i.d. The desired administration time is placed on the medication record and converted to time periods based on the institution’s time intervals for scheduled or routine medications. (Thus t.i.d. may mean 9 AM, 1 PM, and 5 PM at one institution and 10 AM, 2 PM, and 6 PM at another.) A nurse should always become familiar with the hours for medication administration designated by a specific institution. Medication times for p.r.n. and one-time dosages are recorded at the time they are administered. Abbreviations for time and frequency should adhere to TJC and ISMP guidelines. 4. Initials. Most medication records have a place for the initials of the person transcribing the medication to the MAR and the person administering the medication. The initials are then written under the signature section to identify who gave the medication. Some forms may request the title as well as the signature of the nurse. The policy regarding initialing after each administration varies by institution and by charting system used. See Figures 12-1 and 12-3 for examples. 5. Special instructions (parameters) . Any special instructions relating to a medication should be indicated on the medication record. For example, “Hold if blood pressure less than 100 systolic” or “p.r.n. for pain.” Refer to the Percocet and Tylenol order shown on the MAR in Figure 12-3. Documentation of Medications Administered Handwritten MARs: After administering the medication, the nurse or other qualified staff member must record his or her initials next to the time the medication was administered. For scheduled medications, a complete schedule is written out, and the initials are recorded next to each given time Electronic MARs/ eMARs: the documentation of medications administered is done in the computer. The computerized MAR also allows the nurse to document comments regarding the medication administration at the computer terminal. Explanation of Medication Administration Records ● The MAR is used to determine what medications are ordered and the dosage, route, and time at which each is to be given. In institutions where personnel other than the nurse transcribe orders, the nurse must double-check 261 the transcription to make sure there are no discrepancies. Regardless of the variation in format for MARs, the information common to all is as follows: 1. The name of the client and pertinent data related to the client 2. Medication (dosage, route) 3. Time/frequency desired for 4. A place to indicate allergies 5. A place for date, the initials of the person who administers the medication, and a section to identify the name of the person administering the medication. Barcode Medication Delivery ● Barcode medication delivery is increasing in some health care facilities. Studies have shown that barcode medication administration can reduce medication errors by 65% to 86%. ● The basic system of barcoding verifies that a client 268 receives the right dosage of the right medication by the right route at the right time. ● This system requires that each client wear an ID with a unique barcode to identify the individual Commonly Used Abbreviations for Scheduling Medications Abbreviation Meaning *Base on mealtimes