Mark Klimek Nuclex Review
5/9
Prioritization & Delegation
• Completely get rid of age and gender, they do not matter. A two year old is not more valuable that a 90 year old, men are not more valuable than women
• Modifying phr...
, 5/9
Prioritization & Delegation
• Completely get rid of age and gender, they do not matter. A two year old is not
more valuable that a 90 year old, men are not more valuable than women
• Modifying phrase is always more important
1. An acutely ill person is higher priority than chronic
2. Fresh post op beats medical or other
surgical 3. Unstable beats stable
4. The more vital the higher the priority. Is it the organ of the modifying phrase?
• What makes an answer stable? Use of the world stable. What makes an answer
unstable? Use of the world Unstable
• Stable- Chronis Illness, post op greater than 12 hrs, local or regional anesthesia, lab
abnormalities of an A or B level, ready for discharge, to be discharged, or admitted
longer
than 24 hours ago, unchanged assessments, experiencing the typical expected signs and
symptoms of the disease with which they diagnosed.
Unstable- Acute, post op less than 12 hrs, general anesthesia, Lab values of an C or a D,
not ready for discharge, newly admitted, newly diagnosed, or admitted less than 24 hours
ago, changed assessments, experiencing unexpected signs and symptoms. Hemorrhage,
always bad even if its expected. High fever of over 105. Hypoglycemia. Pulselessness,
breathlessness. Witness the event.
• When you get a symptom on a question do not look how bad it is, look if it is expected
in the disease.
Delegation
• Do not delegate the following to an LPN:
o Starting IV’s
o Hanging or mixing IV meds
o Pushing IV meds
o Administer blood or anything having to do with a central line
o Plan of care
o Perform or develop teaching
o Not allowed to take care of unstable patients
o Can not do the first of anything
o Admission assessments
o Discharge or transfers
o
• Do delegate the following to an LPN:
o Maintain and document the flow of IV meds
o Implement care plan
o Reinforce teaching
• Do not delegate the following to an UAP
o Cant chart on patients care
o Not allowed to give meds
, o Not allowed to do assessments
o No treatments except enemas
• Do delegate the following to an UAP
o Topical over the counter barrier cream
o ADL’s
o Bed baths
• Do not delegate the safety of a patient to a non hospital person, for example the family
of a patient.
Staff Management
• You never ignore inappropriate staff behavior
• Is what they are doing illegal? Tell supervisor.
• Is anyone in immediate danger of physical or psychological harm? Confront
immediately and take over.
• Is the behavior not illegal, not harmful but inappropriate, approach them later on and
talk to them
Point and Click
• Aortic - second intercoastal space at the right sternal border
• Pulmonic- second intercoastal space left sternal border
• Tricuspid- 4th intercoastal space left sternal boarder
• Mitral valve- 5th intercoastal space mid clavicular line *apical point*
How to guess
• Establishing a trusting relationship in psych
Nutrition
• In a tie, pick chicken! Not fried chicken
• Pick fish, not shellfish.
• Never pick casserole for children.
• Never mix meds in children’s food
• If you do mix meds in adult food, you need permission
• For toddlers, finger foods
Pharmacology
• If you know the drugs you don’t know the side effects? Pick a side effect of the
same system the drug is asking about
• If its PO pick a GI side effect
OB
• Assess fetal heart rate
Medsurg
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