ehatchett71

Hemodialysis nursing.

I would follow the first poster's directions, but would also state that you should shut off the TPN and wait 30 minutes before drawing your sample. That's the P&P at the hospital at which I work.

Try these steps. They helped me a lot: "Ivory Tower Nursing" - Do not compare to the real world. Do everything by the textbook. You have time for all of your patients! "Don't Pass The Buck" - Do not pass the task to anyone else. It's the RN's task. Relaying the task to a physician is 99% wrong. Unless the RN has done everything he/she can do, they can "notify the physician." Passing the buck also includes PT and OT. Always think about the SAFETY of your patient in the back of your mind. Ask yourself "Is this action safe for my patient? Always communicate verbally first, then in writing/documenting. Verbal communication allows others to clarify with questions up front. Always choose the answers that are the most complete. Ex: Tasks completed and uncompleted that need to be done. Priority Strategy "Who are you going to see first?" Select the most acute or less/least stable out of the four. "Can I delegate this task to an LPN, CNA?" "Is the patient acute or unstable?" "Who has a serious problem?" Select a patient that is developing complications from their condition. Ex: Pt with HTN that complains of pain between the shoulder blades. Prolonging assessment may develop into an MI or angina. When there is no acute or unstable patient or no one is developing complications, you need to pick a patient you need to perform RN duties on (cannot delegate). Assessment Teaching (Includes psychosocial support)! Evaluation (nursing judgement) FYI: TRIAGE - Trauma Respiratory Intracranial pressure An infection GI problems Elimination Floating Assignment: Float RN's will get the LPN type assignments because he/she is unfamiliar with unit specifics. Ex: Med-Surg RN floats to PEDS/OB unit. Assessment vs. Implementation Strategy When a mix of assessment and implementation are in the answer choices, the first step is always assessment (like the nursing process). Exception: In cases of emergency, you must implement first! If all answers are implementation, choose the answer that is the most desired outcome for the patient. Early vs Late Sign - Look for the earliest sign of a complication. Assessment of local findings is more important than systemic findings. Subjective vs Objective Strategy - Always go with objective findings because they are more reliable! Ex: Monitoring, lab results. Take care of the patient first, then equipment, and then paperwork. Stop the cause, then treat the problem. If everything is normal, just document! Positioning Strategy - Know different types of ROM and assistive devices. First decide what you are trying to prevent or promote. Maslow's Hierarchy of Needs Strategy - Used when physical and psychosocial choices are present in the question. Psychosocial answers are eliminated first! Pain is considered a psychosocial aspect. One choice will not make any sense. It has nothing to do with the question. If you see any of the five basic physical needs, it is usually correct. Nutrition Fluid Oxygen Elimination Rest/Sleep Exception: In pain being psychosocial, Do Not Discard in: Spinal cord injuries Sickle Cell Anemia/Crises Kidney Stones You must respond ASAP!!!!! ABC Strategy - Whenever a questions deals with Airway, Breathing, or Circulation, it is the most important answer. Exception: ABCs do not apply to spinal cord injury! (Think autonomic dysreflexia). Supervision Strategy Always stay with the patient. Patient under supervision is always a good idea. Find an appropriate outlet for the patient's energy. Dietary Strategy - "What is the appropriate diet for my patient?" Decide what nutrient you need to deal with in the question. Give it a (+) or (-). "Most Concerned" Strategy This applies when there is "most concerned" in the question. 3 out of the 4 will be expected findings. 1 will have a complication. Anytime an RN has to respond or intervene, it is a teaching question. Give the patient/LPN/CNA concrete, specific answers. Avoid vague, nonspecific terms. Ex: anytime, when comfortable, sometimes "At Risk" Questions Choose the one that CANNOT be modified Modified Ex: diet, smoking cessation, quit job Cannot Modify Ex: heredity, race Therapeutic Communication Strategy Open-Ended Questions Reflection Clarification Silence If you have two therapeutic communication choices, chooses silence (always best) Never leave the patient alone (includes family members). Non Therapeutic Communication Shifting The Focus - Relating "I" or someone you know is always wrong. False Reassurance Word "should" should never be present as your correct answer. Dismissive - avoiding the discussion "Why"-ended questions - the patient may get defensive Closed-ended questions Exception: Reflection is the only type of communication to use in psychotic patients. Do not use any other type - you will feed into the patient's psychotic experience. Instead, reorient the patient to reality! Comma, comma Strategy - When you have several statement in the answer choice,make sure all components of the answer are correct/all fit together. When one part is wrong, the whole answer is wrong. Here and Now Strategy - Don't postpone any tasks or patient needs/care. Know labs and expected outcomes. Ex: Hyper- and Hypo- FYI: BUN, think hot dogs (end by product of metabolism) Increase in BUN=dehydration, renal failure, GI bleed Use associations to remember values. Ex: BUN- 8-25 y/o eat hot dogs. You always have a physician's order. Ex: RN can stop med or inflate/deflate cuff Know pharmacology - indications, expected side effects, adverse effects, contraindications. Ask yourself. "What signs do I look for?" & "What should I teach my patients about the drug?" Use acronyms for certain drug families (Ex: benzodiazepines) LEAVES L-Librium E-Equanil A-Ativan V-Valium E-Equanil S-Serax

That should be a good sign, as a test that ends in a shorter amount of time in which the questions were progressively harder means that you quickly answered questions above the passing line and you remained there throughout your test. Good luck to you.