Excelsior Flashcards
(27 cards)
What are the 2 overriding AOC’s for the CPNE?
Plan of Care
Safe patient Care
20 minute checks are specific to which AOC’s?
Fluid Management
Oxygen Management
During medication administration (IVP) how much volume of flush should be used?
Will be listed on the MAR by the CE
How far should a catheter be inserted for male and female?
Male: 5-7 inches
Female: 2-3 inches
How much leeway is allowed when calculating drip medications?
+/- 5 drops/min
Basic steps of IV meds
Aspirate for blood
Pre-flush
Med
Post flush
What action should be taken when clinical alarms go off?
Notify assigned nurse or CE
What consideration should be made with kids in cribs?
- Keep within reach when side rail is down
- In visual sight when side rail is down.
- Secured to seat/high chair when out of bed
- Do not leave unattended when out of bed
What are the 5 different contours of the abdomen?
Concave, flat, convex/round, distended
List 4 adult comfort interventions
- Relaxation techniques
- Distraction techniques
- Heat or cold
- Positioning
List 3 pediatric comfort interventions
- Swaddle
- Pacifier
- Comfort object
How is breastfeeding volume measured?
Time on each breast
Only have the prescribed amount of flush in the flush. What should you do with the waste?
Ask the CE if you can dispose in the trash.
Is aspiration needed for IM injection?
No. Current evidence shows that aspiration can cause injury to the tissue.
How much leeway is allowed when checking a pulse?
+/-5 for 2years up
+/- 10 for less than 2 years
How much allowance is given when assessing blood pressure?
+/- 6
Can medications be given at any time during the PCS?
No, medications will have a specific assigned time. Medications must be administered within 30 minutes of the assigned time and documented immediately after.
When giving insulin, should you massage the area first?
No - apply gentle pressure after injection
What are the 6 areas of assessment for the Morse Fall Scale?
- History of falls within 3 months?
- Secondary diagnosis?
- Ambulatory aid?
- IV/Heparin lock?
- Gait/Transferring?
- Mental status (to own ability)
6 rights of medication administration
Person Place Time Drug Dose Documentation
Which AOC’s do not require pt. teaching?
Abdominal Assessment
Neurological assessment
Vitals
When should the MAR be filled out?
Immediately after giving meds
Which AOC’s require “20 min. checks”
Fluid Management
Oxygen Management
What side of pt. Should you be on for catheter insertion?
Right Handed = right side
