# Content That CBLNurse2Be Likes

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Joined Sep 29, '10. Posts: 366 (19% Liked) Likes: 106

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• May 9 '12

whether administering medications or hanging iv drips, nurses must accurately perform dosage calculations. this is a critical factor for patient safety, as a patient's life may depend on it.

nursing math requires a working knowledge of ratio-proportion and/or dimensional analysis. most of these type calculations are at the 6th or 7th grade level, involving addition, subtraction, multiplication, division, and decimals/ fractions. memorizing the most common conversion factors and knowing how to use them (such as converting kilograms to pounds or centimeters to inches) is essential. instructor specifications for rounding (whether to the tenth or hundredths) should be carefully clarified by the student prior to taking any dosage calculation examination.

this is an excellent nursing math resource from delmar publishers:
3 - 2 - 1 calc! comprehensive dosage calculations online it includes extensive internet tutorials and resources. it presents the material from both the ratio-proportion and dimensional analysis perspectives.

free internet nursing math resources:

free dosage calculation study ware from delmar publishing (interactive - great study tool!)

unc school of nursing tutorials (metric conversions, tablet dosage calculations, fluid dosage calculations, iv flow rate calculations)

conversion factors (centimeters to inches, etc.)

manuel's web nursing calculators - you can use this handy tool to double check your own calculations.

dimensional analysis

medication math for the nursing student - uses dimensional analysis

dosage help - a very useful tutorial for practicing dosage calculations

dosages quizzes from prentice hall! (at the completion of each quiz section you may submit your answers to receive an instant score of your results.)

chapter 1: review of arithmetic for medical dosage calculations

chapter 2: safe and accurate drug administration

chapter 3: dimensional analysis

chapter 4: systems of measurement for dosage calculations

chapter 5: converting from one system of measurement to another

chapter 6: calculating oral medications doses

chapter 7: syringes

chapter 8: preparation of solutions

chapter 9: parenteral medications

chapter 10: calculating flow rates and durations of enternal and intravenous infusions

chapter 11: calculating flow rates for intravenous medications

chapter 12: calculating pediatric dosages

comprehensive self-test

• May 4 '12

donning sterile gloves

http://www.piercing.org/training/don...es/donning.htm - donning sterile gloves. includes pictures.
http://www.ansellhealthcare.com/univ...gtsgloves.aspx - closed and open donning of sterile gloves
http://home.pineland.net/crsbna/html/donin.htm - pictorial on how to don sterile gloves

handwashing

http://pcchu.peterborough.on.ca/obappen8.htm - handwashing procedure
http://eaglevisioneditions.com/docum...%20asepsis.pdf - this nursing lab exercise has instructions on handwashing as well as drawings and explanations on how to apply and remove sterile gloves.

taking blood pressure

http://nursing.about.com/od/assessme...odpressure.htm - how to take a blood pressure
http://allnurses.com/forums/f50/hearing-bps-177877.html - hearing bps
http://www.ktl.fi/publications/ehrm/.../part_iii3.htm - blood pressure measurement where peak inflation level is determined first by palpating a radial pulse, inflating cuff and then determining the point at which the pulse is obliterated.
http://homepage.smc.edu/wissmann_pau...dpressure.html - how to take a blood pressure
http://www.uams.edu/csc/programs/ori...odpressure.htm - how to take a blood pressure
http://medicine.osu.edu/exam/ - from ohio state university college of medicine, an interactive guide to physical examination for 8 body systems and includes sounds. has an interactive blood pressure cuff (the link is toward the bottom of the page, "take a blood pressure") where you click on a blood pressure bulb to start the inflation of the cuff. you will then hear and watch the manometer and tell the program what the final blood pressure is. it re-cycles to give you lots of practice!
http://www.sweethaven.com/free-ed/he...&icode=fra0204 - taking and monitoring vital signs. from sweethaven's health care.

• May 4 '12

Quote from Hopefull2009

There were also two instances where she said you could get a false high or a false low. I just want to be familiar with that. It was in relation to using the wrong size cuff or pumping it incorrectly.

THANKS!
here's a list of many ways to find a false high or false low BP reading:

1) taking BP when the person is anxious or angry or has just been active - falsely high because of sympathetic nervous system stimulation
2) faulty arm position: if above level of the heart - falsely low because this eliminates the effect of hydrostatic pressure
if below level of the heart - falsely high because of additional force of gravity added to brachial artery pressure
3) person supports own arm - falsely high diastolic because sustained isometric muscular contraction
4) faulty leg position - falsely high systolic and diastolic because translocation of blood volume from dependent legs to thoracic area
5) examiner's eyes are not level with meniscus of mercury column:
looking up at meniscus - falsely high because of parallax
if looking down on meniscus - falsely low
6) inaccurate cuff size:
if cuff too narrow for extremity - falsely high because needs excessive pressure to occlude brachial artery
if cuff is too loose or uneven or baldder balloons out of wrap - falsely high because needs excessive pressure to occlude brachial artery

7) failure to palpate radial artery while inflating:
inflating not high enough - falsely low systolic - because miss initial systolic tapping or may tune in during auscultatory gap
inflating cuff too high - causes pain

8) pushing stethoscope too hard on brachial artery - falsely low diastolic because excessive pressure distorts artery and the sounds continue
9) deflating cuff:
too quickly - falsely low systolc and/or falsely high diastolic because insufficient time to hear tapping
too slowly - falsely high diastolic because venous congestion in forearm makes sounds less audible
10) halting during descent and reinflatintg cuff to recheck systolic - falsely high diastolic because venous congestion in forearm
11) failure to wait 1 - 2 minutes before repeating entire reading - falsely high diastolic because of venous congestion in forearm
12) any observer error:
examiner's "subconscious bias", a preconceived idea of what blood pressure reading should be
examiner's haste
faulty technique
examiner's digit preference "hears" more results that end in zero than would occur by chance alone
diminished hearing acuity
defective or inaccurately calibrated equipment

• May 4 '12

Quote from Hopefull2009
I was kidding my neice that I needed her and her sister to come down so I could practice injections...they eventually came down for my VS practice.

I knew somebody who kept a BP cuff at the front door and you basically couldn't com in unless you had your BP taken.

• Mar 17 '12

Now I finally get why nursing experience can prove invaluable in NP school, yet actually means nothing. It appears that nursing experience gives a valuable base from which to relate but does absolutely nothing for helping one think through a disease process as a provider. I may be simply stating the obvious, but I am amazed at how different the two roles are. I am be no means an old pro, but some conditions I can take care of in my sleep - as a nurse. As a potential provider though, even a simple cold is not so simple. It is amazing how a myriad of disease processes and conditions can present with mostly the same symptoms, only differentiated by some seemingly obscure item in their history. I can see how some are making a mistake in pursuing a NP degree though. Listening to them, what they really want is to further their bedside nursing career. A degree as a NP CHANGES your career, not furthers it. The confusion manifests itself in the struggle to move away from the bedside nursing thinking process, to that of a provider. We all have that struggle, but some seem to not realize that their struggle is not with the material, but the role itself. All that being said, I love NP school. I can see one why, generally, a couple of year's experience nursing is good but also why decades of experience is not necessary. It truly does come down to the individual.

• Jan 4 '12

Congrats to you!!! I will be starting my full nursing schedule next week, will keep you updated.

• Oct 16 '10

• Oct 16 '10

my skin is really thick. i've seen alot of things between being a nurse and a paramedic. i've seen abuse, neglect and death before. today, i got a patient from the emergency room with a massive infarct. the report i got never could have prepared me well for this patient. he truly broke my heart.

when he arrived to the floor, i couldn't honestly tell if he was breathing. his gaze was fully deviated, he was contracted to one side, and had incredibly shallow, laborered mouth breathing. i pulled him from the stretcher to the bed, got down to his eye level, held his hand and said "i'm allison, i'm going to be your nurse today." he pulled his hand away from me, completely frightened, and yelped out. i asked him a series of questions, but he had no answers. just a wide eyed, terrified, deviated stare.

he was 88 years old and he looked like he was a survivor from auschwitz. he was so emaciated, he may have weighed 80 pounds soaking wet.... upon assessment, i could actually see his guidewires from his pacemaker bulging through his skin. his skin turgor was so poor and he was so dehydrated that we were unable to place a peripheral line... and after two sticks from me, i gave up. he had been hurt enough.

his body was covered head to toe in bruises, in various stages of healing. they looked like palm prints and hand prints. his skin was totally ecchymotic and he had so many skin tears it took 12 pages of wound photos to document them all. his skin peeled back like the skin on a banana just by touching it... and on his back and his shoulders, a purple hand print that was probably very fresh.

i turned him over to assess his back. he yelped out again. his anus was excoriated and bleeding and was probably the size of an apricot or small plum... it appeared that something was forced in it. he shook in fear and moaned loudly as the CNA and i gave him a good bath, combed his matted hair, put him in a clean gown and applied lotion to soothe his dry skin.

i called the abuse hotline. i never intended to point a finger of blame... but someone had forgotten to treat this man like a human being. social services came and did their own assessment and took lots of photos. he continued to moan, louder and louder. he pulled away everytime we touched him as if we were going to hurt him. what happened apparently was he was at a nursing home until his medicare ran out... but made too much for medicaid, so he had been paying a "caregiver" to see to his needs at home. i didnt see this caregiver.. and i'm glad i didn't.. because i may have said something very bad.

lab called.... his troponin was 17. his infarct had spread to over 4 leads. his BP was dropping and his urine output was 0. i chased the doctor down to the ICU to get a hospice referral and a DNR. i was not about to have to call a code on this man. the least i could have done was to get him a comfortable death. paperwork was signed and hospice came to see the patient and agreed to take him at the end of my shift this evening.

i documented and documented. i turned him every hour, swabbed his mouth, made sure his skin was clean and dry, and went and sat for just a minute by the bed, to make sure he knew that if i he wanted to go, i would be there to sit with him. i didn't want him to die alone, not like that.

the paramedics came to pick him up and bring him to the hospice home. i signed his papers and helped them place him on the stretcher. he just kept moaning, and letting out these yelping noises. i walked them to the elevator and grabbed his hand and said "they are going to take you to the hospice house, so you can be cared for and comforted. it's ok to let go now." his eyes didn't move, but i knew he knew i was there.... because tears started rolling down his cheeks.

and without saying a word for 12 hours, my patient made me cry.
may god bless him. i hope his ending is peaceful and that he is moved on to a much better place than was ever provided to him here. today i remembered why i became a nurse.

• Oct 12 '10

Quote from knzaku
I didn't see any humor in any of these comments at all except ignorance in the posting! You don't expect people who aren't nurses or medical experts to understand and discuss medical issues like you do. You too make funny comments on other fields everyday but you don't realize. The title "stupid things said by..." is even hilarious!! You think your spouses are fools and you are the nerd? If only we can be sensitive to different backgrounds and occupations then we will understand that our relatives and friends don't have to be medics
Why are you even on this thread? We in the professsion love to find humor in what we do on our OFF time. Are you so hardened and cynical that you can't appreciate that? I'll tell you what I (jokingly) love to tell my DH, "Mind you're business!"

• Oct 12 '10

"If only we can be sensitive to different backgrounds and occupations then we will understand that our relatives and friends don't have to be medics."

Kind of on the same note, if we all could try to have a little less stick up our butts, we could share little things that make us giggle without being bashed. Lighten up. This is a fun thread!

• Oct 12 '10

I like to retell the story of my mother's hospital stay when she was in labor with me. Here it is: My mom was 17 when she had me (35 years ago) and had never been in a hospital. She was terrified about being in the hospital as it was all so new to her. She said she was woken many times in the night to the term "Dr. such and such- ICU " which she took to mean " I see you" She had the covers pulled up to her neck round the clock as she thought someone was watching her every move!

• Oct 12 '10

Ok have any of you ever watched the comedian Jeff Dunham? Anyways he has a puppet named Achmed The Dead Terrorist, he is a skeleton. Ok we were watching him on comedy centeral one night and Achmed made a joke saying that he was having a bad time and he thought he had Scoliosis. My DH breaks out laughing like it is the FUNNIEST thing he has ever heard. Well I know my husband and I said "Do you know what Scoliosis is?" to which he replied, " Yea it is a flesh eating disorder, Achmed is a skeleton dear, shouldn't you know this being a nursing student?!" And continues to laugh as hard as he can.......Had to set him straight on that one....

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