Job Vacancies in Heritage Nursing Care

Dear all,

We are looking forward to see all the energetic people to work we us.

• SRN
• Midwive
• Driver
• General Clerk
• Human Resource
• Physiotherapy
• Laboratory
• Account Clerk

Please send your resume / CV to haroulmasdayana@yahoo.com

Short candidate will be calling for interview.

Drug Administration - General Principles for All Medications

• Verify all new or questionable orders on the medication administration record (MAR) against physician orders for completeness.
• Prepare medications in a quite enviroment.
• Wash your hands. Observe universal precautions, as appropriate.
• Collect all necessary equipment, including straws, water, stethoscope, etc.
• Review MAR for each client carefully to ensure safety; note medication, dosage, route, expiration date, and frequency.
• Research drug compatibilities,action, purpose, contraindications, side effects and appropriate routes.
• Find medication for individual client and calculate dosage accurately. Confirm normal range of dose, particularly in pediatrics.
• Check expiration date on medication and look for any changes that may indicate decomposition (color, odor, clarity)
• Compare label three times with the midication to decrease risk of error when removing package from drawer, before preparing medication and after preparing medication.
• Check need for PRN medications
• Be sure medications are identified for each client.
• Check for any allergies and perform all special assessment before administration
• Confim client's identity by checking at least two of three possible mechanisms for identification to ensure safety - ask client his/her name, check client's identity band, check bed tag (this is least reliable method)
• Provide privacy if needed (injection, NG feeding, enema, etc)
• Inform client of medication, any procedure, technique, purpose and client teaching as applicable.
• Stay with client until medication is gone, do not leave medication at bedside.
• Assist client as needed, and leave in position of comfort.
• Give medication within 30 minutes of prescribe time.
• Chart administration immediately in ink.
• Report any errors immediately and complete appropriate institutional documentation
• Liquid medications - all routes of administration - must not be mixed together unless compatibility is verified
• Observe for any reactions and document both positive and negative responses
• Observe the 6 rights - give the right dose of the right drug to the right client at the right time by the right route and last to document it at the right column.
• To ensure safety do not give a medication that someone else prepared. Institution policies may require having a colleague double check medications such as insulin and heparin. If you are unsure in anyway, have a colleague verify.
• Is using a computer comtrolled dispensing system, follow agency policy for administration and documentation.

Note: Hope this little info can help all of you to remember the 6 RIGHT whenever you are going to serve medications... Always ask...!!!!

MULTISYSTEM STRESSORS

1. A 27 years old adult is admitted for treatment of Crohn’s disease. Which information is most significant when the nurse assesses nutritional health?
a. Anthropometric measurements
b. Bleeding gums
c. Dry skin
d. Facial rubor

2. Total parenteral nutrition (TPN) is ordered for an adult client. Which nutrient is not likely to be in the solution?
a. Dextrose 10%
b. Trace minerals
c. Electrolytes
d. Amino acids

3. The nurse caring for an adult client who is receiving TPN will need to monitor for which of the following metabolic complications?
a. Hypoglycemia and hypercalcemia
b. Hyperglycemia and hypokalemia
c. Hyperglycemia and hyperkalemia
d. Hyperkalemia and hypercalcemia

4. Acetylsalicylic acid is being administered to an adult client. The nurse understands that the most common mechanism of action for nornarcotic analgesics is their ability to
a. Inhibit prostaglandin synthesis
b. Alter pain perception in the cerebellum
c. Directly affect the central nervous system
d. Target the pain producing effect of kinins

5. An adult has been taking acetylsalicylic acid (ASA) 650 mg four times a day for chronic back pain. The nurse assessing this client knows that a common side effect of high dose of ASA is
a. Liver failure
b. Paralytic ileus
c. Gastrointestinal bleeding
d. Retinal detachment

6. Ibuprofen (Motrin) is prescribed for an adult with chronic pain. The nurse must teach the client to observe which dietary precaution while taking ibuprofen?
a. Eat high fiber diet
b. Drink citrus juices daily
c. Take the medication with milk
d. Omit spinach and other green leafy vegetables from the client’s diet

7. A 48 years old woman has just returned to her room after having a hysterectomy. She has patient controlled analgesia (PCA). To reduce anxiety regarding receiving adequate pain relief, the client was most likely told that
a. PCA is almost always effective
b. Comfort will be assessed frequently
c. Additional IM medication will be available
d. Most therapies are better than frequent IM injections

8. Preoperative teaching for an adult who is to have client controlled analgesia following surgery includes telling the client:
a. “You will not be drowsy”
b. “You will experience no pain”
c. “Pain control will be adequate”
d. “You will not have incisional pain but you may have muscle pain”

9. The client’s family expresses concern that the client could overdose with a PCA. What protective mechanism prevents drug overdose with a PCA?
a. The nurse controls the amount administered with each dose
b. Extensive client teaching precedes its use
c. The client can stop drug administration but not initiate it
d. After a bolus is administered, there is a mandatory waiting period before another dose is given

10. The nurse is the first professional to arrive at the scene of a multivehicle accident. An adult was riding a motorcycle. Upon impact, he fell off the bike and it fell back on his legs. Priority care for the client should be directed toward
a. Assessing blood loss
b. Monitoring respiratory status
c. Obtaining vital signs
d. Organizing lay people on the scene

11. The nurse is at the scene of a multivehicle accident. A young man was injured when his motorcycle was hit by a car. He fell off the bike and then it fell back on his legs. He is bleeding profusely from a 4 inch gash on his left leg. Which of the following is the best approach for the nurse to take to stop the bleeding?
a. Apply direct pressure to the wound
b. Move the motorcycle off his legs
c. Raise the extremity
d. Wrap a tourniquet above the wound

12. The nurse is caring for a client who is receiving IV fluids. Which observation the nurse makes best indicates the IV has infiltrated?
a. Pain at the site
b. A change in flow rate
c. Coldness around the insertion site
d. Redness around the insertion site
13. The nurse is caring for a client whose arterial blood gases indicate metabolic acidosis. The nurse knows that, of the following, the least likely to cause metabolic acidosis is
a. Cardiac arrest
b. Diabetic ketoacidosis
c. Hypokalemia
d. Renal failure

14. An adult client is admitted with metabolic acidosis. Which set of arterial blood gases should the nurse expect to find in a client with metabolic acidosis?
a. pH 7.28, PCO2 55, HCO 26
b. pH 7.50, PCO2 40, HCO3 31
c. pH 7.48, PCO2 30, HCO3 22
d. pH 7.30, PCO2 36, HCO3 18

15. A 93 years old adult is hospitalized for the treatment of gastroenteritis complicated by dehydration and hyponatremia. The nurseexpects that an early symptoms of hyponatremia exhibited by the client was
a. Ataxia
b. Hunger
c. Thirst
d. Weakness

16. An adult has just been brought in by an ambulance after a motor vehicle accident and has moderate anxiety. When assessing the client, the nurse would expect which of the following from sympathetic nervous system stimulation?
a. A rapid pulse and increased respiratory rate
b. Decreased physiologic functioning
c. Rigid posture and altered perceptual focus
d. Increased awareness and attending

17. An adult has received an injection of immunoglobulin. The nurse knows that the client will develop which of the following types of immunity?
a. Active natural immunity
b. Active artificial immunity
c. Passive natural immunity
d. Passive artificial immunity

18. The nurse knows which of the following is true about immunity?
a. Antibody medicated defense occurs through the T-cell system
b. Cellular immunity is mediated by antibodies produced by the B-cells
c. Antibodies are produced by the B-cells
d. Humoral or circulating immunity is lost with AIDS

19. An adult is on a clear liquid diet. The nurse can offer
a. Milk
b. Jello
c. Freshly squeezed orange juice
d. Ice cream

20. An adult is being taught about a healthy diet. The nurse explains that the food pyramid can guide the client
a. By indicating exactly how many servings of each group to eat
b. On how many calories the client should have
c. In making daily food choices
d. To divide food into four basic groups

21. Before administering a tube feeding the nurse knows to perform which of the following assessments?
a. The gastrointestinal (GI) tract, including bowel sounds, last bowel movement and distention
b. The client’s neurological status, especially gag reflex
c. The amount of air in the stomach
d. That the formula is used directly from the refrigerator

22. The nurse knows which of the following indicates protein deficiency?
a. Negative nitrogen balance
b. Koilonychias (spoon shape nails)
c. Magenta tongue
d. Bleeding gums

23. The nurse knows that a client understand a low residue diet when he selects which of the following from a menu?
a. Rice and lean chicken
b. Eggs and bacon
c. Pasta with vegetables
d. Tuna casserole

24. An adult is receiving total parenteral nutrition (TPN). The nurse knows which of the following assessments is essential?
a. Evaluation of the peripheral intravenous (IV) site
b. Confirmation of the tube is in the stomach
c. Assessment of the GI tract, including bowel sounds
d. Fluid and electrolyte monitoring

25. The nurse knows which of the following statements about TPN and peripheral parenteral nutrition (PPN) is true?
a. TPN is usually indicated for clients needing short-term (less than three weeks) nutritional support, while PPN is for long term maintenance
b. A client needing more than 3000 calories would receive PPN, whereas TPN is given to those requiring less than 3000 calories
c. TPN is often given to those with fluid restrictions, whereas PPN is used for those without constraints on their fluid intake
d. TPN is given to those who need to augment oral feeding, whereas PPN is used for those who are nothing by mouth (NPO)

Drug and Nursing Implications Answer

DRUGS AND NURSING IMPLICATIONS

Factors Affecting Drug Action

1. A – Taking food will decrease the rate of absorption. Furthermore, taking dairy products with an antibiotic such as tetracycline will cause calcium (Ca+) to bind to the drug and decrease absorption.
2. B- Toxic drug effects occur because there is less albumin or protein for the drug to bind to in the elderly.
3. B – The blood brain barrier is not fully developed in infants and CNS depressants can readily penetrate.

Drug Administration

1. 1.5 tablets. The formula to use is desired over have time quantity.
0.375 mg
----------- X 1 tablet = 1.5 tablets
0.25 mg

2. 2 capsules. First convert grams to mg.
1000 mg = 1 g
1000 mg X 0.1 g = 100 mg

Then use desired over have time quantity
200 mg
--------- X 1 capsule = 2 capsules
100 mg

3. 0.5 ml. The formula to use is desired over have time volume.
50,000 units
----------------- X 5 ml = 0.5 ml
500,000 units

4. 0.7 ml. First convert pounds to kg. 38.5 pounds divided by 2.2 pounds/kg = 17.5kg. Calculate total mg to be given.
0.4 mg
--------- X 17.5 kg = 7 mg
Kg
The uses desired over have time volume.
7 mg
--------- X 1 ml = 0.7 ml
10 mg

5. 0.7 ml. First convert pounds to kg. Divide 40 pounds by 2.2 pounds/kg for a weight of 18.18 kg. Multiply 5 mg/kg for a total daily dose of 91 mg. Calculate the dose using desired over have times volume.
91 mg
---------- X 1 ml = 0.7 ml
125 mg

6. 2 ml.
1,200,000 units
------------------- X 1 ml = 2 ml
600,000 units

7. 26 gtts/minute. Divide 2500 ml by 24 hours. Then divide the result by 60 minutes per hour and multiply by 15 gtts/ml.

8. 83 gtts/ minute.
2000 ml
---------------- X 60 = 83.3 ml
1440 minute

9. 0.25 ml. Desire is 25 mg. Available is 30 mg in 0.3 ml.
25 mg
-------- X 0.3 ml = 0.25 ml
30 mg

10. 0.7 ml. Desire is 50 mg. Available is 75 mg/ml.
50 mg
-------- X 1 ml = 0.66667 ml
75 m

11. C - Divide 500 cc by 20 cc to determine the number of hours of the infusion (25 hours). Next divide the 15,000 units into 25 hours to get units/hour (600 units of heparin/hour)

12. C
Total volume infused
---------------------------- X drop factor = gtts per minute
Time in minutes

50 cc 10 gtts
------------ X -------- = 16.6 = 17 gtts/minute
30 minute 1 cc

Local Anesthetics

1. A – Epinephrine prolongs anesthetic action. While shortening the onset of action and reducing blood flow to injection site.
2. C – Viscous lidocaine can interfere with swallowing reflex and clients should wait at least 60 minutes after use before eating.

Non Narcotic Analgesics and Antipyretics

1. A – Indomethacin may cause visual field changes or corneal cloudiness. Clients should have periodic ophthalmic examinations to monitor for visual change.
2. C – Acetaminophen (Tylenol) is as effective as aspirin in reducing fever. Both have similar antipyretic actions.
3. B – Due to aspirin’s antiplatelet effect, aspirin can be used to decrease TIA.
4. D – Ibuprofen (Motrin) is the drug of choice to treat primary dysmenorrheal.

Narcotic Analgesics

1. C – Narcotic drugs should be taken before pain becomes intense so the client can receive the fullest analgesic effects. By adhering to this, the client will have good pain control and will not be requesting additional doses.
2. B – Respiratory rate needs to be assessed before giving the client a narcotic as narcotics can have a life threatening.
3. C – An adverse effect of narcotic analgesic is hyperglycemia. The nurse would not expect to see hypoglycemia.


Narcotic Antagonists

1. C – Tremors are an adverse effect of naloxone hydrochloride (Narcan) and indicate an overdose of the drug.
2. A – If naloxone hydrochloride (Narcan) is given to a client who is addicted to narcotics, the client will experience withdrawal syndrome. Thus, narcotic addicts should use this drug cautiously.

Sedatives and Hypnotics

1. D – Adverse effects of pentobarbital sodium (Nembutal) do not include dry mouth and urinary retention. These effects are more typical on an anticholinergic drug.
2. B – Barbiturates are teratogenic and are contraindicated for pregnant women.

Anticonvulsants

1. C – Gingival hyperplasia is a common adverse effect of phenytoin (Dilantin) seen most often in children and adolescents.
2. D – Diazepam (Valium) is the drug of choice for status epilepticus.

Muscle Relaxants

1. B – Due to the depressant effects of baclofen (Lioresal), the client should not engage in any potentially dangerous activities until the client response to the drug is known.

Antipsychotic Agents

1. B – Handling the parenteral or liquid forms of chlorpromazine (Thorazine) may cause contact dermatitis.
2. A – Chlorpromazine (Thorazine) during initial use can cause orthostatic hypotension; ambulation should be supervised to prevent falls until tolerance develops.
3. C – Promethazine (Phenergan) is used as an antiemetic and rarely causes extrapyramidal symptoms.
4. A – Haloperidol (Haldol) is alsi used to treat Tourret’s syndrome and causes fewer sedative effects than other phenothiazine.
5. C – Clients need to maintain sodium intake (usually 6-10 g daily) to prevent lithium toxicity.
6. C – Imipramine (Tofranil) can cause drowsiness; the client should avoid driving or operating machinery
7. C – It takes several weeks (2-4 weeks) before clients may see improvement of depression.
8. A – Foods such as cheese that contain tyramine or tryptophan should be avoided while taking MAO inhibitors to prevent hypertensive crisis.
9. B – A skin rash resulting from use of fluoxetine (Prozac) indicates an allergic reaction and should be reported to the physician immediately.

Risk Factors Associated With Respiratory Health Problems

1. Obstructive pulmonary disorders such as asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, bronchitis.

• asthma - allergies, genetic disposition
• COPD - primarily smoking, exposure to lung irritants, immunological factors
• cystic fibrosis - genetic transmission
• bronchitis - smoking, exposure to pulmonary irritants, air pollution, exposure to infectious disease

2. Restrictive pulmonary disorders such as atelectasis, acute respiratory distress syndrome (ARDS), flail chest, pulmonary contusion and sleep apnea.

• atelectasis - surgery, trauma, penumonia or other respiratory disorders (COPD), prolonged bedrest, mechanical ventilation
• ARDS - shock, trauma, smoke inhalation, any cardiac or repiratory event, often unknown
• sleep apnea - obesity, COPD, smoking, aging process

3. Pneumonia - aging process, compromised respiratory conditions, debilirating diseases, lack of vaccine in at risk individuals.

4. Tuberculosis - individuals positive for human immunodeficiency virus (HIV), immirants and disadvantaged group, environment (overcrowding, poor ventilation)

5. Pleural effusion - surgery, trauma, inflammation, malignancy or other respiratory disorder

6. Pleuritis - none, usually secondary to other respiratory conditions

7. Pneumothorax - smoking, taruma, men (tall, young, thin chest), family history, underlying respiratory diseases (COPD, ARDS, cystic, fibrosis, asthma)

8. Pulmonary embolism - deep vein thrombosis (DVT) or blood clots in other areas, chronic bedrest, hypercoagulability, surgery, heart conditions (CHF), myocardial infarction (MI), obesity, women taking oral estrogen, hormones or contraceptives

9. Pulmonary hypertension - young women in their 30s to 40s (primary), smoking, chronic lung disease, sleep apnea, obesity, neuromuscular disease, heart conditions leading to hypoxemia (secondary)

10. Lung cancer - smoking, lung irritants, family history, air pollution

11. Respiratory failure - other respiratory conditions or respiratory dysfunction (COPD, pneumonia)

Respiratory Health Problems

Review at a glance:

• Asthma - an obstructive airflow disorder where narrowing and inflammation of airways cause respiratory distress.
• Atelectasis - collapse of a portion of lung with limited gas exchange.
• Bronchiectasis - an irrevesible state of bronchial dilation and destruction of bronchial walls.
• Bronchitis - inflammation of mucous membranes of bronchial airways; another term for chronic bronchitis is "blue bloater" because of hypoxemia that leads to cyanosis.
• Chronic Obstructive Pulmonary Disease (COPD) - a group of pulmonary diseases involving obstuction of airflow that is chronic and recurrent, usually associated with asthma, emphysema and bronchitis.
• Cor Pulmonale - a disorder mannifested by hypertrophy of right ventricle caused by pulmonary hypertension; manisfests by as right heart failure.
• Cystic fibrosis (CF) - autosomal recessive disease of exocrine glands that manifests itself in multiple organs, characterized by excess production of mucus and COPD in early childhood.
• Emphysema - a chronic disorder of lungs resulting in overinflation of air spaces, loss of elasticity and decreased gas exchange; another term for chronic emphysema is "pnik puffer" because client does not become cyanotic until end stages of disease.
• Flail Chest - instability of chest wall usually caused by trauma or fractured ribs with a reverse in chest wall movement from normal; chest wall contracts on inspiration and expands outward on expiration.
• Hemothorax - collection of blood or fluid in pleural space.
• Obstructive Pulmonary Disorders - any respiration of parietal space of lungs, also known as pleurisy.
• Pneumonia - inflammation of lungs caused by bacteria, viruses, fungi or other pathogens.
• Pneumothorax - collapse of a portion or all of lung due to trapping of air in pleural space.
• Pulmonary embolism - blockage of a pulmonary artery by an embolus of fat, blood or other foreign body.
• Pulmonary hypertension - a sustained elevation of pulmonary artery pressure, greater than 20mmHg.
• Restrictive Pulmonary Disorders - any disease that limits expansion of lungs or chest wall movement.
• Sleep Apnea - having periods of delay or lack of breathing (usually longer than 10 seconds) during sleep.
• Status Asthmaticus - an acute emergency of a prolonged or repetitive asthma attack.
• Tuberculosis (TB) - infection of lung with an acid-fast bacillus, Mycobacterium Tuberculosis.

Critical Thinking & the Nursing Process

Nursing process is a systematic method of providing quality nursing care. It consists of 5 dynamic phases:

• assessment
• diagnosis
• outcome identification and planning
• implementation
• evaluation

Critical Thinking Question for Nursing Process Step

Assessment

Are the data complette? What other data do I need? What are some possible sources of those data?What assumptions or biases do I have in this situation? What is the client's point of view? Are there others point of view?

Diagnosis

What do these data mean? What else could be happening? Are there any gaps in the data? How are these data similar and how are they different? What assumptions or biases do I have in this situation? Have my assumptions affected my interpretation of the data? If so, in what way?

Outcome identification and planning?

What are the goals for this client? What do I want to accomplish? How are my goals related to what the clients wants to accomplish? What are the expected? outcomes for this client? What interventions are to be used? Who is the best qualified person to perform these interventions? How much involvement can the client and family or significant others have at this time? How much involvement does the client wish to have at this time?

Implementation

What is the client's current status? What are the most critical steps in this interventions? How much I alter the intervention to best meet this client's needs and maintain principles of safety? What is the client's response during and after the interventions? Is there a need to alter the intervention in anyway? If so, why and how?

Evaluation

Were the intervention successful in assisting the client to achieve the desired goals? How could things have been done differently? What data do I need to make new decisions? Where will I get the data? Were there assumptions, biases or point of view that I missed that affected the outcomes? What can be done about these assumptions, biases or point of view?

To all my students, please remember this step while you doing the assessment on your clients.