Download POST-TEST I

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NUR 1021 CLINICAL FOCUSES – WEEK 2
CLINICAL PREP: (This top section should be completed prior to your first clinical day.)
1. Download Clinical Homework Forms from Canvas.
2. Get patient assignment.
3. Complete Patient Data form and Trending Sheet. Complete timeline for day one. (Day two will
need to be completed for Friday morning.)
4. Complete a Medical or Surgical Diagnosis sheet for this patient’s primary diagnosis.
5. Complete a Secondary Diagnosis sheet for other patient diagnoses for which the patient is
receiving medications.
6. Begin Assessment Booklet (if applicable).
7. Bring all of the above, your clinical packet, and the Gulanick Nursing Care Plans book to clinical
each week.
___________________________________________________________________________________
CLINICAL FOCUSES:
Surgical Nursing
1. Discuss and/or demonstrate preparing a client
for surgery, including physical and emotional
preparation.
2. Identify nursing interventions used to promote
patient safety in the operating room.
3. Identify type of anesthetic agent and other
medications used during the surgical procedure
and effect on the patient.
4. Observe care given to patients in the PACU and
discuss rationale for nursing interventions
carried out; identify discharge criteria.
5. Plan and implement care for a postoperative
patient to prevent major complications such as
atelectasis, deep vein thrombosis (DVT), and
wound infection.
6. Implement dependent and independent nursing
interventions for a postoperative patient to
relieve nausea, vomiting, pain, and
constipation.
Nutrition:
1. Correctly assist patients to select foods for clear
liquid, full liquid, soft, or regular diets.
2. Discuss nutritional needs of the medical-surgical
patient.
Medications
1. Administer medications as assigned, with
assistance of instructor.
2. Identify your patient’s allergies and where to
POST-CONFERENCE TOPICS
 Review nursing process (concept map) with
students using their major diagnosis form as
a guide.
 Discuss “Care of Postoperative Patient
Receiving Anesthesia” (handout).
 Discuss “Surgery Post-Conference”
(handout).
 Review the rationale for the therapeutic
diets the patients are receiving for their
current medical/surgical condition
 Review procedure for passing medications
on specific hospital unit
 Review medication sheet example and
directions for administration of medications
(handout)
 Review dosage problems that involve
reconstitution
 Review the lab values on assigned patients
and correlate alterations with rationale
related to the patient’s health stressors
OVER
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locate on your patient’s record.
Mixing Powders:
1. Discuss how to reconstitute powders.
2. Complete dosage problems that involve
reconstitution of powders.
Lab Values:
1. Identify the significance and causes of abnormal
vital signs & lab values
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HOMEWORK (due the Monday of Week 3 by 0950)
1.
2.
3.
4.
5.
6.
7.
8.
Journal per “Clinical Journal Guidelines”.
Skill’s List – updated.
Patient Data Form and Trending sheet completed on this patient.
Medical or Surgical Diagnosis sheet(s) completed on this patient.
Secondary Diagnoses sheet completed on this patient.
Assessment Booklet completed on this patient (if applicable).
Care plan or concept map (if applicable).
Students completing surgical and other observations for this week:
- Objectives for each day
- Journal per “Clinical Journal Guidelines”
- Article summary with attached article
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NUR 1021
What should students know about meds they are administering?
EXAMPLE
GENERIC NAME:
BRAND NAME(S):
GALANTAMINE – ORAL (ga-LAN-tuh-meen) (They should know the generic name)
Razadyne, Reminyl
PRECAUTIONS: Tell your doctor your medical history, especially of: heart problems (e.g., bradycardia, AV
block, arrhythmia), stomach/intestinal problems (peptic ulcer disease, GERD), difficulty urinating, convulsions,
lung disease (severe asthma, obstructive pulmonary disease), liver or kidney disease, recent tobacco use,
recent/frequent alcohol use, any allergies (including allergy to daffodil plants). This drug may make you dizzy;
use caution when performing activities that require alertness such as driving or using machinery. Limit alcoholic
beverages because it may cause dizziness and make your stomach more likely to bleed. Caution is advised
when using this drug in the elderly, as they may be more sensitive to drug side effects. Galantamine should be
used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It is not
known if this drug passes into breast milk. Breast-feeding is not recommended while using galantamine.
DRUG INTERACTIONS: Tell your doctor of all prescription and nonprescription medication you may use,
especially: anticholinergic drugs (e.g., benztropine, scopolamine), cholinergic drugs (e.g., bethanechol), other
cholinesterase inhibitors (e.g., donepezil), succinylcholine-type muscle blocking drugs, aspirin, NSAIDS (e.g.,
ibuprofen, naproxen). Also report use of heart drugs (those which decrease heart rate or block AV impulse
conduction) such as: digoxin, beta-blockers (e.g., metoprolol, propranolol), calcium channel blockers (e.g.,
diltiazem, verapamil). Do not start or stop any medicine without doctor or pharmacist approval.
ACTION:
Q:
How does galantamine work?
A:
It is a competitive inhibitor of acetylcholinesterase.
Q:
What is acetylcholinesterase?
A:
It is the enzyme that is responsible for the breakdown of acetylcholine.
Q:
Why do we care? (Also phrased, What does acetylcholine do?)
A:
Acetylcholine—part of the cholinergic system—helps memory, attention, and modulates
(regulates) excitatory impulses.
So. . . , if we have more acetylcholine, it can help with transmission of impulses for memory, attention,
and response to stimuli.
And. . . , by taking an acetylcholinesterase inhibitor, we can keep more acetylcholine in our brain.
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REVISITING DRUG INTERACTIONS:
Q:
Why are anticholinergic drugs listed in drug interactions (previous page)?
A:
Anticholinergics and galantamine work against each other.
Q:
Why are cholinergic drugs listed in drug interactions (previous page)?
A:
Too much of a good thing.
Q:
Why are beta blockers listed in drug interactions (previous page)?
A:
We don’t want to give something (galantamine) that could speed the heart when the other med
is trying to slow the heart.
ADDITIONAL QUESTIONS:
1.
Are we giving a safe dose?
2.
Why is this patient on this drug?
3.
Is the patient allergic to this drug?
4.
How will you evaluate effectiveness of this drug?
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DIRECTIONS FOR PREPARATION
IN GIVING MEDICATIONS
A.
Preclinical Preparation
1.
2.
3.
4.
5.
B.
List all medications (dosage, time, and route) to be given to assigned patient.
Check med sheet against the doctor's order sheet to see that all drugs were correctly
ordered and still current.
Bring your drug book for reference. If drugs are not in your book, you must use the
PDR, Lexicomp or other acceptable reference.
Bring med sheets to clinical (from Assessment Booklet).
If you are giving a med, you must have looked it up prior to clinical!
Clinical Day
1.
2.
3.
4.
5.
6.
7.
8.
9.
Bring your drug book for reference.
Be able to state why the patient is on this drug, action, dose, and nursing considerations
for all drugs.
Before pre-conference, again check med sheet or MAR against doctor's order sheet for
new or cancelled orders.
Assess patient as necessary (example: BP, apical pulse) before instructor is present to
check meds. Get fresh water, straw, anything else needed to give meds. Review the
patient allergies for any possible contraindications.
Have hands washed before instructor gets there.
Students must accept responsibility to give medications within accepted time allowance.
It may be necessary for student to seek out instructor to supervise medication
administration.
Do not use nursing staff as preceptor for assisting with medications administration.
You never give a med until your instructor has “checked your meds” with you.
See sample Medication List for information to come prepared with (over). Often it is
helpful to make condensed “focus” note cards on medication information that organizes
the major points about the medications you are administering.
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NUR 1021 –Post-Conference
Care of Postoperative Patient Receiving Anesthesia
1.
Describe type of anesthetic administered to patient:
2.
List side effects of anesthetic(s):
a.
Major SE:
B.
Common SE:
3.
Describe how anesthetic can impact your patient’s recovery (i.e., effect on major organ systems such as lungs, kidneys,
liver, etc.):
4.
What are some potential complications that can occur in patients receiving general anesthesia?
5.
How would you prevent these complications?
6.
What are potential complications associated with epidural or spinal anesthetics?
7.
List nursing measures to take when working with a patient after:
8.
a.
General anesthesia
b.
Epidural anesthesia
c.
Spinal anesthesia
d.
Local anesthesia
List other medications patient received during surgery related to anesthesia.
Drug
Classification
Action
Side Effects
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SURGERY POST-CONFERENCE
List how surgery affects different body systems based on: Categories of Human Functioning and Nursing Interventions to Prevent Potential
Complications.
Categories of
Human Functioning
Comfort and Rest
(Sleep/Rest/Pain/Comfort)
Sensory Perceptual Function
(Neurological)
Fluid Gas Transport Function
(Cardiovascular)
Fluid Gas Transport Function
(Respiratory)
Elimination Function
(Gastrointestinal)
Elimination Function
(Genitourinary)
Nutrition Function
(Nutrition/Metabolic)
Protective Function
(Hygiene, Skin, Integumentary)
Activity/Mobility/Movement Fnct.
(Musculoskeletal)
Growth and Development Fnct.
(Male or Female)
Psycho/Social/Cultural/Spiritual
Function
(Role Relationships, Psycho-Social
Behavior, Values/Beliefs/Spiritual)
Protective Function
(Education/Discharge Planning)
NUR 1021 Spring 2016
Effects of Surgery and
Potential Complications
Nursing Interventions to Prevent
Potential Complications