NCM 118 A REVIEW (RANDOM)

 ECG
 3-WAY WATERSEAL BOTTLE:
 For pt. suspected with myocardial
 B1 – for (-) pressure while the lungs
ischemia (poor oxygenated blood) –
in on (+) pressure
there is ST segment depression or
 B2 – for drainage
T-wave inversion.
 B3 – for suction
 MYOCARDIAL INFARCTION
 2-WAY WB:
 Nrsg. Respo: Do continuous cardiac
 B1 – for (-) pressure
monitoring.
 B2 – for drainage & suction
 CARDIAC COMPUTED TOMOGRAPHY – like
 1-WAY WB
CT scan.
 All functions
 This is contraindicated to pts. Who
 ADULT (ETT WITH CUFF) – to keep the ETT
have tachyarrhythmias.
in place/avoid dislodgement.
 Sinus bradycardia – HR is 
 CHILD (ETT W/OUT CUFF) – respiratory
60 bpm
centers of children are not yet fully
 Sinus tachycardia – HR is
developed.
bet. 120-160 bpm
 HOLTER MONITORING – to check for
 Supraventricular
arrythmias; monitor for 24-72 hours.
tachycardia – HR is  160
 CHRONIC OBSTRUCTIVE LUNG DISEASE
bpm
(COLD) – other term for COPD.
 HEMATOCHEZIA – bright red stool
 CHRONIC RESPIRATORY AIRWAY DISEASE
 MELENA – black, tarry stool
(CRAD) – other term for Asthma
 HEMATEMESIS
 HOW TO INFLATE THE CUFF OF ETT? –
 Nrsg. Int – assess the pt.’s status
inflate with air. (not water to avoid
(changes in LOC).
aspiration pneumonia).
 UPPER GI BLEEDING
 CATHETER – for removal, clamp/kink;
 Nrsg. Respo: take into account the
bladder training prior to removal using
lab findings (e.g. RBC, Serum
forceps wrapped with a sterile gauze;
Potassium); meds to be
retained; open if the pt. will urinate or void.
administered before, during, and
 INTRAAORTIC BALLOON PUMP – measure
after endoscopic (?) including IV
the urine output qhr – there should be at
Esomeprazole.
least 30cc of urine.
 Health Teaching: Avoid taking OTC
 CARDIOGENIC SHOCK
drugs such as aspirin which has
 If Lasix/diuretics is given
ingredients that may trigger the
(furosemide) – watch out for the
lacerations to occur or may irritate
serum potassium level of the pt ( the stomach.
3.0 – may cause cardiac  DIABETIC KETOACIDOSIS (DKA)
arrhythmia)
 “Hot and dry, sugar is high” –
 HYPERTENSIVE CRISIS HYPERGLYCEMIA
 Watch out for BP (180 (for  “Cold and clammy, sugar is low” -
systolic) and  120 (for diastolic)). HYPOGLYCEMIA
 Meds: Nitropress (Sodium  S/S – 3Ps:
Nitroprusside) – through IV;  Polydipsia – thirst
Corlopam (Fenoldopam)  Polyuria – urination
 CARDIAC CATHETERIZATION  Polyphagia - appetite
 Nrsg Respo: Always wear gloves  Ketones are present
and assess the groin site (where  Metabolic Alkalosis
the femoral artery is) where the  Treat for risk of serious
catheter is inserted. complications to avoid Diabetic
 Complications: Watch out for Coma
irregular heartbeats.  Type 1 – Non-Insulin Dependent
(more Hypoglycemic)
  Type 2 – Insulin Dependent (more
Hyperglycemic)
 Prio. care for rapid respiration with
deep inspiration – to avoid
respiratory arrest.
 Types of insulin to be administered:
 Regular insulin (usually) -
administered through IV.
 Rapid-acting – ex: Humalog
& Novalog (onset 15 mins /
works within 1-5 hrs).
 Short-acting – ex: Regular
Humulin and Novolin
(onset 30 mins / works
within 5-7 hrs).
 Intermediate-acting – ex:
NPH & Lente (onset 1-3
hrs / works within 24 hrs).
 Long-acting – ex: Lantus &
Ultralente (onset 6 hrs /
works within 24 hrs).
 Premixed Insulin – chronic
patients can inject
themselves.
 Nursing Interventions:
 Insulin – subcutaneously
(original) to promote
slower absorption and less
pain.
 RULE: If the pt. is receiving
2 insulins, always draw the
regular insulin (clear) first.
 GOLDEN RULE FOR
POTASSIUM FOR DKA: “NO
P(EE) NO K” – means that if
there is not enough urine
output, then do not give
potassium to the pt. to
prevent damaging of
kidneys (renal
failure/damage).
 LIVER FAILURE
 Characteristics:
1. Severe liver dysfunction
2. Hepatic Encephalopathy –
assess for  LOC – intubate the
pt. with ETT and/or connect to
mechanical ventilation.
3. “Liver flap” or “Flapping
tremor”
 ATTENTION!! – For severe liver
failure, anything that is given is
considered to be POISON for the pt.
 ACUTE PANCREATITIS
 3 Mgt for AP:
1. Insert NGT – pt. can’t
tolerate normal feeding and
due to nausea.
2. NPO – to let the pancreas
rest.
3. Manage pain by giving
Pethidine or Nubain.
 Review/verify order for giving of
Morphine Sulfate because it is a
respiratory depressant which may
cause respiratory arrest.
 Other than giving analgesics,
position the pt. on his side and
elevate the HOB to 45º for comfort.
 BARIATRIC SURGERY – art and science of
weight management that helps reduce the
weight of severely obese (BMI is 40) pt.
 Take into account pt.’s body image
distortion - treat
depression/anxiety.
 INTRAABDOMINAL HYPERTENSION –
pressure is created in abdominal cavity.
 Complication: ABDOMINAL
COMPARTMENT SYNDROME
 Ischemia
 Leads to muscle
damage/organ dysfunction
 Mgt: abdominal
decompression
 Meds to reduce abnormal
arrhythmias: Manitol and
Sodium Bicarbonate.
 Complication: Bladder is comprised
– to prevent this, check for any
transurethral bladder pressure.
 FOR UNSCONSCIOUS PT. IN THE ER
 No relatives – make the doctor affix
his/her signature to be witnessed
by another doctor or HCP.
 With relatives – it should be
nearest kin’s (wife, husband,
brother, sister, mother, father, etc.)
signature.
 PHYSICAL ASSESSMENT – the top prio
should be assess for the respiratory rate (if
25, the pt. is a candidate for mechanical
ventilation).
 RA 10173 (DATA PRIVACY ACT) – main
context is that the personal data is
considered to be sensitive personal
information.
 PT. W/MECHANICAL VENTILATION W/PEEP
OF 5 (which is the highest)
  Assessment to reduce PEEP – pt.
develops surgical subcutaneous
emphysema – accumulation of air
 Mgt: Prick the site w/needles to
release air.
 PNEUMONIA – occurs when there is
inflammation (1st sign), fever, cough, etc.
 Elderly pts. – the 1st sign/s is
alterations in LOC and dehydration.
 ACUTE RESPIRATORY DISTRESS SYNDROME
– to know if the pt. is responding well,
check for proper position of the pt.
w/mechanical ventilation and monitor ABG
values.
 NURSING PRACTICE (PROFESSIONAL
DEVELOPMENT) – consider the ff:
1. Latest updates/changes,
modifications in the nrsg practice
2. Latest technology, management,
practices.
3. Be an advocate – nurse as mediator
between the pt. and family or pt. and
HCP. – take everything into acct except
confusing policies of the hospital.
 CRITICAL CARE UNIT - improve quality of
care, patient safety through clinical support.
 Assess pt.’s LOC, personal, and
family values
 CRITICAL CARE NURSES – provides care that
is always respectful and responsive to the
needs and values of the pt. and his/her
wishes.
 They are experts on:
1. Giving good judgment
2. Having respectful behavior
(GMRC)
3. Specialized training (speed &
accuracy)
 The action to maintain high standard of
professional decorum is to prioritize pts.
with disturbed sensory perception.
 ETHICAL DILEMMAS
1. Gather relevant data
2. Outline ethical issues
3. Goals to modify
 1 principle of ethics – autonomy
(self-governing) – Ex: assess pt. and
consider his/her wishes.
 END STAGE OF LIVER FAILURE – encourage
the pt. to interact with the family for
comfort measures.
 STANDARDS OF PROFESSIONAL PRACTICE
1. Establish competencies
2. Evaluate using EBP
3. Identify barriers in quality of care
4. Modify using creativity for upgrade
 NURSE RESEARCHERS – should have good
interpersonal relationship. However:
 They cannot assume total
responsibilities in the research.
 Other members should help and
must have their own
responsibilities.
 MAIN REASON FOR NURSING RESEARCH –
validating and refining practices; upgrade
or develop innovations.
 EBP (PICOT and SPIDER)
1. Improves pt.’s outcome
2. Reduce cost
3. Contribute to the practice
 CARE BUNDLES – Ex: checklist before
performing any procedures.
 VAP – when pt. is on ventilator for
prolonged period of time.
 CAUTI – when pt. is on catheter for
prolonged period of time.
 RA 9173 (PHILIPPINE NURSING ACT OF
2002) – scope of nursing practice is that our
profession exists to achieve the most
positive outcome keeping in mind our
social contract and obligation to our
society.
 Nurses should be: educated,
competent, and assumes authority,
roles, functions, or responsibilities.
 COMPUTERIZED PROVIDER ORDER ENTRY
(CPOE) – includes the medications for each
patient, diagnostic exams, laboratory
findings, EXCEPT: doctor’s professional fee
 CLINICAL GOVERNANCE – report/review
any adverse events/misses in our
profession for upgrading.
 Venous Bleeding – dark red (unoxygenated)
 Arterial Bleeding – bright red
 Capillary Bleeding – few