NCLEX Tip of the Day 2/7

[SkateBetty]

Some things to think about today:

With portal hypertension or cirrhosis think "bleeder" because of esophageal varices, and also reduced or no clotting factors being produced by the sick liver. While we're talking about the liver, remember it is highly vascular, which means when it is injured by trauma, or even a needle biopsy it will bleed right out. Position a patient on the right side after a liver biopsy to help splint the injury.

For everybody wanting to 'Maslow' nutrition ahead of safety with a depressed client, just toss your pyramid right out the window, and choose safety first. Suicide precautions.

While we're talking about priorities don't think you must always choose an assessment over an intervention if both are options. Use your instincts and your logic! If the options are listed to "suction copious secretions" or "monitor O2sat" you better get the secretions out, especially if the stem says you've assessed the patient already and what is the next nursing action.

Don't push all those dangerous objects out of the way first when your kid is on the floor seizing. Turn him on his side. Airway first, then remove hazardous objects.

Prolonged hypoxia in kids, like with tetralogy of fallot, does bad stuff. For starters the body tries to compensate for low O2 by pushing out more immature rbc's, which hypercoagulates the blood increasing the kids risk of seizures and CVA's. The kid is also at risk for cardiac arrest and respiratory failure. Remember, nothing's getting oxygen.

Don't you 'schedule frequent rest periods' for that kid newly diagnosed with CF. He needs exercise, which is a good adjunct to the chest physiotherapy in keeping his lungs clear. Now if your CF kid is exercising with a sickle cell kid, make sure that one doesn't get over-heated. Dehydration triggers sc crisis. Keep his fluids up. No demerol with sickle cell either.

Steroids complicate things while they're reducing inflammation. They increase the risk for osteoporosis, increase glucose, and delay wound healing. They also cause weight gain (have ya'll seen Tonya Harding lately? She says it's the prednisone) and increase the risk of infection. Watch sore throats and fevers for pts. on steroids.

Ever touched a colostomy bag? Me either. Just know to remove flatus by opening the bottom of the bag, and to empty it when it is approximately 1/3 to ½ full.

That's enough for today.

[2005grad]

SKATEBETTY KEEP THEM COMING!!!! I'M ENJOYING THEM. :specs:

THANK YOU

FAITH RN

[dancingfem1952]

thanks for the tips.. very interesting.. bobbi

[nursemomruns]

Some things to think about today:

With portal hypertension or cirrhosis think “bleeder” because of esophageal varices, and also reduced or no clotting factors being produced by the sick liver. While we’re talking about the liver, remember it is highly vascular, which means when it is injured by trauma, or even a needle biopsy it will bleed right out. Position a patient on the right side after a liver biopsy to help splint the injury.

For everybody wanting to ‘Maslow’ nutrition ahead of safety with a depressed client, just toss your pyramid right out the window, and choose safety first. Suicide precautions.

While we’re talking about priorities don’t think you must always choose an assessment over an intervention if both are options. Use your instincts and your logic! If the options are listed to “suction copious secretions" or "monitor O2sat" you better get the secretions out, especially if the stem says you’ve assessed the patient already and what is the next nursing action.

Don’t push all those dangerous objects out of the way first when your kid is on the floor seizing. Turn him on his side. Airway first, then remove hazardous objects.

Prolonged hypoxia in kids, like with tetralogy of fallot, does bad stuff. For starters the body tries to compensate for low O2 by pushing out more immature rbc’s, which hypercoagulates the blood increasing the kids risk of seizures and CVA’s. The kid is also at risk for cardiac arrest and respiratory failure. Remember, nothing’s getting oxygen.

Don’t you ‘schedule frequent rest periods’ for that kid newly diagnosed with CF. He needs exercise, which is a good adjunct to the chest physiotherapy in keeping his lungs clear. Now if your CF kid is exercising with a sickle cell kid, make sure that one doesn’t get over-heated. Dehydration triggers sc crisis. Keep his fluids up. No demerol with sickle cell either.

Steroids complicate things while they're reducing inflammation. They increase the risk for osteoporosis, increase glucose, and delay wound healing. They also cause weight gain (have ya’ll seen Tonya Harding lately? She says it’s the prednisone) and increase the risk of infection. Watch sore throats and fevers for pts. on steroids.

Ever touched a colostomy bag? Me either. Just know to remove flatus by opening the bottom of the bag, and to empty it when it is approximately 1/3 to ½ full.

That's enough for today.

SkateBetty, what was the rationale for no meperidine with sickle cell specifically? I am curious as it is still used for sickle cell pain. It shouldn't be given orally and it should not be the first line treatment (unless there is a morphine or hydromorphone allergy/intolerance), but it can still be used. I am not a fan of meperidine, but that's beside the point. I looked in our textbooks at work and could not find anything. I would greatly appreciate the info.

As for children with cystic fibrosis, normal activities should be maintained as much as possible; however, adequate rest is still needed. These kids have problems with lung function. They get dyspneic with exercise, which leads to fatigue. Also, they are probably going to have some right side heart enlargement due to the increased pressure in the pulmonary artery. You have to be careful about how much exercise they're getting because their hearts can only compensate so much. They'll end up in cardiac failure if they exercise without resting. Children with cystic fibrosis need rest periods during the day. You have to spread out their activities, procedures, etc. so they don't get exhausted. They need rest before meals so they have the energy to eat. They need a longer rest period before chest physiotherapy; otherwise they won't tolerate the whole session.

[SkateBetty]

SkateBetty, what was the rationale for no meperidine with sickle cell specifically?

Demerol reduces the seizure threshold during sickle cell crisis.

[nursemomruns]

Demerol reduces the seizure threshold during sickle cell crisis.

It can cause seizures in anyone, not just sickle cell.

[oldnurse newnurse]

thanks skatebetty ilove what you are doing this is really helpful and we really need this so just to tell you keep up the good work. and i really really appreciate it,

[SkateBetty]

:chuckle You're funny! It's helping me to reinforce my own weak areas by writing them down for you. I'll keep it up until I pass.

Wendy

NCLEX 2/15