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NUR437 MIDTERM COMPLETE ANSWERS
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NUR437 MIDTERM COMPLETE ANSWERS
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NUR437 MIDTERM COMPLETEANSWERS
CURE acronym for prioritizing patient care - Answer-Critical- potentially life-threatening.
I.e. Respiratory distress, chest pain.
Urgent- safety needs and pain control.
Low blood sugar, pain medication..
Routine responsibilities
Assessments, vitals, scheduled medications
Extras- patient requests
Ice chips, warm blankets etc.
Five "F's" of Prioritization - Answer-Fatal- failure to do could cause death or injury
(respiratory distress)
Fundamental- essential to professional definition of job (assessments)
Frequent- must be done many times (vitals)
Fixed- must be done within a certain time frame (medications)
Facility- aspects of the job set as standards by the organization. (charting)
This is the best way to prioritize patient care, and should be done immediately after
receiving report/reviewing the patient chart. - Answer-Assess the patient, this is the best
way to determine pt well-being. From there, use your assessment and knowledge
gained during report to determine your to-do list in an urgent to nonurgent approach.
The role of vital signs in prioritization - Answer-Another predictor to help determine the
order of patient assessment is to review the patient vitals from the previous hour. (High
blood pressure, increase/decrease HR, increase Temp, decrease Sp02, increased
oxygen required etc).
Prioritization summary - Answer--Always use urgent to nonurgent approach
-Be thorough during report and make sure you are given a full picture of your patient(s)
-Review orders thoroughly when constructing to-do list
-Assessment is the best indicator of what needs to be done first
Lab value monitored with Coumadin - Answer-INR
Patient education r/t Coumadin - Answer--Steady, consistent vitamin K intake
, -Soft toothbrush
-No bladed razors for shaving
-Report unusual bleeding/bruising
-No alcohol/aspirin/NSAIDS
Nursing considerations r/t coumadin - Answer--Assess for bleeding (including internal
bleeding signs such as random tachycardia)
-Educate (previous card)
Normal INR - Answer-1.0
INR w/coumadin therapy - Answer-The general goal is to maintain an INR between 2.0-
3.0.
Buprenorphine (Subutex/Suboxone) - Answer--Partial opioid agonist
-Given to those in acute opiate withdrawal on a tapered schedule to slowly ease them
through the withdrawal process instead of all at once
-Also sometimes used longer-term in chronic relapsers to manage withdrawal
symptoms and reduce craving for drug(s) of choice
Buprenorphine method of administration - Answer-Sublingual (under the tongue, no
drinking/eating for at least 20 minutes after administration)
Considerations/education r/t buprenorphine - Answer--High affinity for opioid receptors
and will "bully" existing opiates like heroin off the receptors if they are taken together
-Because of this, it's IMPERATIVE the patient is in FULL WITHDRAWAL (no opiates in
system) before taking buprenorphine or withdrawal will immediately precipitate
-Many forms of buprenorphine, such as suboxone, come with a small amount of
naloxone (narcan) added to the pill in a 4:1 ratio. The narcan acts as a deterrent to
abusing the medication and will immediately precipitate withdrawal if administered
intravenously (when taken sublingually, the narcan is dizzolved and inactivated because
it can't be absorbed under the tongue)
Potassium chloride indications/uses - Answer--K+ replenishment
-Don't use with potassium-sparing diuretics/ACE inhibitors/ARBS
-Assess for cardiac changes
-K+ level before giving
-With or after meals to decrease GI irritation
-Avoid salt substitutes which often have K+
Potassium antidotes - Answer--Discontinue potassium
-Sodium bicarb can be given if acidosis has developed
-Dextrose + insulin will pull K+ back into cell
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