Posts

PAIN SCALE ASSESSMENT / MEDICATION ERRORS IN THE CLINICAL SETTING

Image
  The Numerical Pain Scale is a useful tool when assessing pain. It is based on a scale of 0-10. A ladder starts from the ground and escalates to| the highest point, so does pain start from 0-10. It is important to do a pain assessment after pain medication has been given. See image for more information. Scenario : In the above image, a patient was brought into the   Emergency room with complaints of  chest pain  and a drop in   blood pressure. The doctor ordered Morphine for the pain and    Dopamine for the  hypotension.  Both medications were given      as ordered. The nurse in the green top (left) gave the Morphine and started the Dopamine infusion. Next  : What  went wrong ? The nurse forgot to put a label on the  IV bag and did not document what time both medications were   given. It is very  important  for the nurse to pay  close attention  to the time that medicatio...

RECOGNIZING STOKE AND ITS PREVENTION

Image
  Scenario : In the image above, Ann is an opera singer. While on stage, she suddenly starts having trouble getting her words out. Her right arm also feels weak. These symptoms are classic of someone experiencing a stroke. Signs and stroke  symptom s: - sudden ,  severe headache - slurred speech, mental confusion -  nausea  and vomiting -  visual disturbances ,  hearing loss - facial weakness -  weakness  in arm or leg on one side A CAT scan or  MRI  or both may be done to  confirm  diagnosis. Scenario : In the image a waitress is busy at work.  She suddenly develops stroke symptoms.  What is a stroke ? A  stroke  is also known as a brain attack. It may be hemorrhagic ( caused by bleeding) or ischemic ( embolic), caused by a clot  or plaque. Can a stroke be prevented? It is suggested that a stroke can be prevented. People who smoke frequently, eat a diet rich in cholesterol foods and do not exerci...

UNDERSTANDING THE HEART'S ELECTRICAL CONDUCTION SYSTEM - QUIZ QUESTIONS

Image
The Electrical Conduction System of the heart The SA   (sinoatrial) node is the pacemaker of the  heart and is part of the electrical conduction system. It is located in the upper part of the right atrium. When the SA node fires, the right and left atria contract simultaneously and  blood is forced into the right and left ventricles. The electrical stimulus then travels to the AV ( atrio- ventricular) node which is located in the lower part  of the right atrium. The AV node fires, causing the  right and left ventricles to contract simultaneously.   Scenario : Jim was admitted to the medical floor, with complaints of  abdominal pain.  The nurse arrives at his bedside and finds him unresponsive. She presses the code button, to alert the code team. She then begins CPR. What does CPR mean?  CPR  means Cardiopulmonary resuscitation. When the heart stops beating and there is no circulation of blood throughout the body, CPR is initiated. ...

UNDERSTANDING THE CONSEQUENCES OF POOR CIRCULATION / QUIZ QUESTIONS

Image
  The consequences of poor circulation Poor circulation   may occur for a number of reasons. Any obstruction to the flow of blood may lead to conditions such as stroke,  heart failure , and or  renal failure  .The  diabetetic  patient is also at risk. What is a stroke? A stroke is also known as a brain attack. Identifying strokes and treatment A stroke may be hemorrhagic (caused by bleeding) or ischemic ( embolic ) caused by a clot or plaque in a blood vessel.  Bleeding  ( hemorrhagic) into the brain may be caused by  trauma  or rupture of a blood vessel due to high blood pressure. ICP monitorin g may be necessary for  the patient with a hemorrhagic stroke. In the case of an embolic stroke, a blood clot may obstruct the flow of blood in the brain. This will also affect oxygen to the brain. Embolic strokes are usually treated with drugs such as TPA ( Tissue Plasminogenic Activator). Antihypertensive drugs and anti-  seizure...

HEPATIC ENCEPHALOPATHY - QUIZ QUESTIONS

Image
The Clinical setting step by step is no longer available. Liver failure may be acute or chronic. Causes include: certain drugs, alcohol abuse and certain chemicals . Hepatic Encephalopathy Hepatic Encephalopathy is a complication of liver failure. The damaged liver loses       the ability to remove ammonia and other toxic waste.These products build up in the           blood and can migrate to the brain, resulting in encephalopathy. Patients may become       confused , lethargic and even comatose.  Typically, Lactulose is ordered by the doctor,     to remove excess ammonia. ICP monitoring is sometimes done for the patient with  hepatic encephalopathy.                                                                      ...

THE NURSE'S CRITICAL THINKING/ PRECEPTOR ROLE

Image
  The critical thinking of a new nurse can be a challenge in the clinical setting . Knowing how to put the pieces of the puzzle  together can make this challenge easy. Here are some helpful hints: - Gather relevant information about history, diagnosis and treatment for the patients you are assigned to. - Familiarize yourself with the plan of care . - Delegate responsibilities to other staff members, if you are in charge. - Know your unit's policies and procedures. - Assess patient / family needs for social services. - Familiarize yourself with the medications the patient is receiving / its uses and side effects - If a blood transfusion is ordered, follow your Institution's policies and procedures for transfusion.    Helpful information for the clinical nurse      In the image above, Lynn is a new graduate who   is full of expectation. She arrives early on her new . unit. But her hopes are shattered when her preceptor   suggested that she i...

THE CIRCULATORY SYSTEM - QUIZ QUESTIONS

Image
The Circulatory System is made up of: The heart, lungs, capillaries, arteries, veins  and the lymphatic system.                   The Circulatory System The heart is a pump which supplies blood to all the body's cells. It is made of four chambers. The two upper chambers are the right and left atria. The two lower  chambers are the right and left ventricles.  The heart is a small organ that has a lot of work to do. If the heart fails, all the body's organs like the brain and kidneys as well as the body's tissues will be affected. An overview Deoxygenated  blood returns to the heart via the veins. The blood comes in through the right atrium via the Superior and Inferior vena cava. It is then pumped into the right ventricle.  The deoxygenated blood is pumped to the  lungs  via the Pulmonary Artery. Inside the lungs, the deoxygenated blood  is exchanged for oxygenated blood and is pumped  to lef...