Nursing Tips

Fundamentals (95)

A living will is an advance directive indicating a patient's desired or prohibited medical interventions (e.g., tube feeding, ventilation).

What is a Living Will?

Cathy Parkes

A living will is an advance directive indicating a patient's desired or prohibited medical interventions (e.g., tube feeding, ventilation).

What is a Living Will?

Cathy Parkes

A living will is an advance directive indicating a patient's desired or prohibited medical interventions (e.g., tube feeding, ventilation).

A home health nurse provides care in the patient's residence. Responsibilities include assessment, treatment, education, and care coordination.

Home Health Nursing Care

Cathy Parkes

A home health nurse provides care in the patient's residence. Responsibilities include assessment, treatment, education, and care coordination.

Home Health Nursing Care

Cathy Parkes

A home health nurse provides care in the patient's residence. Responsibilities include assessment, treatment, education, and care coordination.

A cultural assessment involves the identification of a patient's cultural and spiritual beliefs, practices, and preferences regarding medical interventions, illness, family, diet, pregnancy, death, and postmortem care.

Cultural Assessment

Cathy Parkes

A cultural assessment involves the identification of a patient's cultural and spiritual beliefs, practices, and preferences regarding medical interventions, illness, family, diet, pregnancy, death, and postmortem care.

Cultural Assessment

Cathy Parkes

A cultural assessment involves the identification of a patient's cultural and spiritual beliefs, practices, and preferences regarding medical interventions, illness, family, diet, pregnancy, death, and postmortem care.

A High-Fowler's position involves the patient sitting with the head of the bed at 60 - 90°. This is the ideal position to help with difficulty breathing.

High-Fowler's Position

Cathy Parkes

A High-Fowler's position involves the patient sitting with the head of the bed at 60 - 90°. This is the ideal position to help with difficulty breathing.

High-Fowler's Position

Cathy Parkes

A High-Fowler's position involves the patient sitting with the head of the bed at 60 - 90°. This is the ideal position to help with difficulty breathing.

A Durable Power of Attorney (DPoA) is a document that identifies another person responsible for medical decision-making. This person does not have to be related to the patient.

Durable Power of Attorney (DPoA)

Cathy Parkes

A Durable Power of Attorney (DPoA) is a document that identifies another person responsible for medical decision-making. This person does not have to be related to the patient.

Durable Power of Attorney (DPoA)

Cathy Parkes

A Durable Power of Attorney (DPoA) is a document that identifies another person responsible for medical decision-making. This person does not have to be related to the patient.

A Braden scale score ≤ 18 indicates a patient is at risk for pressure injuries. In this case, take measures to prevent injuries of this type.

Braden Scale: Pressure Injuries

Cathy Parkes

A Braden scale score ≤ 18 indicates a patient is at risk for pressure injuries. In this case, take measures to prevent injuries of this type.

Braden Scale: Pressure Injuries

Cathy Parkes

A Braden scale score ≤ 18 indicates a patient is at risk for pressure injuries. In this case, take measures to prevent injuries of this type.

Wound irrigation points to remember

Wound Irrigation

Cathy Parkes

Wound irrigation points to remember!

Wound Irrigation

Cathy Parkes

Wound irrigation points to remember!

When performing suctioning, apply suction intermittently while withdrawing the catheter and rotating it for 10-15 seconds. For endotrachial suctioning, hyperoxygenate patient prior to suctioning. Use a suction pressure between 120 - 150 mmHg.

Suctioning

Cathy Parkes

When performing suctioning, apply suction intermittently while withdrawing the catheter and rotating it for 10-15 seconds.

Suctioning

Cathy Parkes

When performing suctioning, apply suction intermittently while withdrawing the catheter and rotating it for 10-15 seconds.

Lead Exposure - LevelUpRN

Lead Exposure

Cathy Parkes

Lead exposure: Pre-1978 housing is at risk for lead-based paint! Check out these patient teaching tips.

Lead Exposure

Cathy Parkes

Lead exposure: Pre-1978 housing is at risk for lead-based paint! Check out these patient teaching tips.

Key points when taking a patient's blood glucose: Place hand in dependent position; Pierce the outer edge of the fingertip (not the pad); Wipe away first drop of blood; Hold test strip NEXT to the blood drop (do not smear blood on strip).

Blood Glucose Key Points

Cathy Parkes

Key points when taking a patient's blood glucose: Place hand in dependent position; Pierce outer; Wipe away first drop of blood; Hold test trip NEXT to the blood drop

1 comment

Blood Glucose Key Points

Cathy Parkes

Key points when taking a patient's blood glucose: Place hand in dependent position; Pierce outer; Wipe away first drop of blood; Hold test trip NEXT to the blood drop

1 comment
Incidence Vs Prevalence

Incidence Vs Prevalence

Cathy Parkes

Incidence vs. Prevalence: Incidence is the number of NEW cases of disease/injury in a population during a period of time. Prevalence is the number of ALL cases (new and pre-existing) of disease/injury...

Incidence Vs Prevalence

Cathy Parkes

Incidence vs. Prevalence: Incidence is the number of NEW cases of disease/injury in a population during a period of time. Prevalence is the number of ALL cases (new and pre-existing) of disease/injury...

For abdominal wound dehiscence with evisceration (protruding internal organs): Place saline-soaked gauze over wound and protruding organs; Do NOT try and reinsert organs!; Notify provider and prepare the patient for possible surgery (NPO).

Abdominal Wound Dehiscence

Cathy Parkes

For abdominal wound dehiscence with evisceration: Place saline-soaked gauze over wound; Don't try to reinsert organs!; Prepare patient for possible surgery.

Abdominal Wound Dehiscence

Cathy Parkes

For abdominal wound dehiscence with evisceration: Place saline-soaked gauze over wound; Don't try to reinsert organs!; Prepare patient for possible surgery.

Airborne precautions require the patient to have a NEGATIVE airflow room. Caregivers and visitors need to wear N95 masks when going in the room.

Airborne Precautions

Cathy Parkes

Airborne precautions require the patient to have a NEGATIVE airflow room. Caregivers and visitors need to wear N95 masks when going in the room.

Airborne Precautions

Cathy Parkes

Airborne precautions require the patient to have a NEGATIVE airflow room. Caregivers and visitors need to wear N95 masks when going in the room.

Know your levels of prevention!
Primary: Focuses on prevention of disease from occurring. 
Secondary: Focuses on early detection/screening for diseases.
Tertiary: Focuses on rehabilitation of those already diagnosed with a disease.

Know your levels of illness prevention!

Cathy Parkes

Know your levels of prevention! Primary, Secondary, Tertiary

Know your levels of illness prevention!

Cathy Parkes

Know your levels of prevention! Primary, Secondary, Tertiary

Applying Restraints

Applying Restraints

Cathy Parkes

When applying restraints, make sure 2 fingers can fit between restraint and patient, se a quick release knot, and don't place restraints on side rail.

Applying Restraints

Cathy Parkes

When applying restraints, make sure 2 fingers can fit between restraint and patient, se a quick release knot, and don't place restraints on side rail.

REPORT urine output that is less than 30ml/hr!  Decreased urine output can be indicative of shock, sepsis, and kidney failure.

Reporting Urine Output

Cathy Parkes

REPORT urine output that is less than 30ml/hr! Decreased urine output can be indicative of shock, sepsis, and kidney failure.

Reporting Urine Output

Cathy Parkes

REPORT urine output that is less than 30ml/hr! Decreased urine output can be indicative of shock, sepsis, and kidney failure.

Key points about maintaining a sterile field:  1" edge of field is NOT sterile. Never turn your back on, reach across, or walk away from a sterile field. Objects held below the waist is consider non-sterile.

Maintaining A Sterile Field

Cathy Parkes

Key points about maintaining a sterile field

Maintaining A Sterile Field

Cathy Parkes

Key points about maintaining a sterile field

Enteral feeding (NG or G-tube): Confirm placement with x-ray before feeding! Measure gastric contents every 4 hours. Hold feeding if residual exceeds ~500ml. Flush tubes with 30 mL sterile water every 4 hours.

Enteral Feeding

Cathy Parkes

Enteral feeding: Confirm placement with x-ray; Measure gastric contents; Hold feeding if residual exceeds ~500ml; Flush feeding tubes.

Enteral Feeding

Cathy Parkes

Enteral feeding: Confirm placement with x-ray; Measure gastric contents; Hold feeding if residual exceeds ~500ml; Flush feeding tubes.

Windshield Survey:
Collect data by literally driving around and looking out your windshield. Assess people and environment. Use the data to develop a Community Health Plan.

Windshield Survey

Cathy Parkes

Windshield Survey: Collect data by literally driving around and look out your windshield.

2 comments

Windshield Survey

Cathy Parkes

Windshield Survey: Collect data by literally driving around and look out your windshield.

2 comments
Smallpox Signs/Symptoms include RASH that begins on the FACE and spreads down, High fever, Headache, Vomiting

Smallpox Symptoms

Cathy Parkes

Smallpox: Symptoms include a RASH that begins on the FACE and spreads down, high fever, headache, vomiting.

Smallpox Symptoms

Cathy Parkes

Smallpox: Symptoms include a RASH that begins on the FACE and spreads down, high fever, headache, vomiting.

Injury prevention in the home:  Make sure water heater setting is set to LESS than 120 degrees F to prevent burns.

Water Heater Settings

Cathy Parkes

Injury prevention in the home: Make sure water heater setting is set to LESS than 120 degrees F to prevent burns.

Water Heater Settings

Cathy Parkes

Injury prevention in the home: Make sure water heater setting is set to LESS than 120 degrees F to prevent burns.

Community Oriented Nursing is focused on health promotion and disease prevention in the community. No direct care for individuals!  Community Based Nursing is focused on illness care for individuals and families.

Community Nursing

Cathy Parkes

Community Oriented Nursing is focused on health promotion and disease prevention in the community. No direct care for individuals! Community Based Nursing is focused on illness care for individuals and families.

Community Nursing

Cathy Parkes

Community Oriented Nursing is focused on health promotion and disease prevention in the community. No direct care for individuals! Community Based Nursing is focused on illness care for individuals and families.

Best practices for telephone orders: Have second RN listen in on call. Repeat prescription back. Have provider sign prescription within 24 hr.

Telephone Orders

Cathy Parkes

Best practices for telephone orders

Telephone Orders

Cathy Parkes

Best practices for telephone orders

A patient is POSITIVE for orthostatic hypotension if: The SBP decreases more than 20mmHg when changing position AND/OR the DBP decreases more than 10mmHg

Orthostatic Hypotension

Cathy Parkes

A patient is POSITIVE for orthostatic hypotension if: The SBP decreases more than 20mmHg when changing position AND/OR the DBP decreases more than 10mmHg

Orthostatic Hypotension

Cathy Parkes

A patient is POSITIVE for orthostatic hypotension if: The SBP decreases more than 20mmHg when changing position AND/OR the DBP decreases more than 10mmHg

For enteral feeding tubes (Nasogastric tubes, G-tubes): Flush tubing with 15-30ml of water before, after, and in between medications

Enteral feeding tubes

Cathy Parkes

For enteral feeding tubes, flush tubing with 15-30ml of water before, after, and in between medications

Enteral feeding tubes

Cathy Parkes

For enteral feeding tubes, flush tubing with 15-30ml of water before, after, and in between medications

Triage for a Mass Casualty event: Class I (red tag): Immediate threat to life. Class II (yellow tag): Major injury. Class III (green tag): Minor injury. Class IV (black tag): Patient is expected, allowed to die.

Triage for a Mass Casualty event

Cathy Parkes

Triage for a Mass Casualty event: Class I (red tag), Class II (yellow tag), Class III (green tag), Class IV (black tag)

Triage for a Mass Casualty event

Cathy Parkes

Triage for a Mass Casualty event: Class I (red tag), Class II (yellow tag), Class III (green tag), Class IV (black tag)

Non-opiod analgesics are use to treat MILD to MODERATE pain. NSAIDs carry risk of GI bleeding, renal toxicity, and GI upset. Opioid analgesics are used to treat MODERATE to SEVERE pain. Monitor for respiratory depression. Naloxone is the antidote!

Opioid and Non-opioid Analgesics

Cathy Parkes

Non-opiod analgesics are use to treat MILD to MODERATE pain. Opioid analgesics are used to treat MODERATE to SEVERE pain.

Opioid and Non-opioid Analgesics

Cathy Parkes

Non-opiod analgesics are use to treat MILD to MODERATE pain. Opioid analgesics are used to treat MODERATE to SEVERE pain.

Key points about Therapeutic Communication: Avoid asking "Why...?" Ask OPEN ended questions. Ex: "Tell me more...." Do not offer your opinion, give false reassurance, or change the subject.

Therapeutic Communication Key Points

Cathy Parkes

Key points about Therapeutic Communication: Avoid asking "Why...?" Ask OPEN ended questions. Don't offer opinion, give false reassurance, or change subject.

Therapeutic Communication Key Points

Cathy Parkes

Key points about Therapeutic Communication: Avoid asking "Why...?" Ask OPEN ended questions. Don't offer opinion, give false reassurance, or change subject.

Who can give informed consent? An unimpaired adult (i.e. not under the influence of drugs/alcohol, not experiencing command hallucinations). Emancipated minor. Parent or legal guardian of a minor.

Giving Informed Consent

Cathy Parkes

Who can give informed consent? An unimpaired adult (i.e. not under the influence of drugs/alcohol, not experiencing command hallucinations). Emancipated minor. Parent or legal guardian of a minor.

Giving Informed Consent

Cathy Parkes

Who can give informed consent? An unimpaired adult (i.e. not under the influence of drugs/alcohol, not experiencing command hallucinations). Emancipated minor. Parent or legal guardian of a minor.

Hyperkolemia & Hypokolemia

Hyperkolemia & Hypokolemia

Cathy Parkes

The MOST important side effect to know for BOTH hyperkalemia and hypokalemia is DYSRHYTHMIAS.

Hyperkolemia & Hypokolemia

Cathy Parkes

The MOST important side effect to know for BOTH hyperkalemia and hypokalemia is DYSRHYTHMIAS.

Hospice Care

Hospice Care

Cathy Parkes

Hospice care is focused on palliative care (i.e. symptom management), NOT on curing a disease.

Hospice Care

Cathy Parkes

Hospice care is focused on palliative care (i.e. symptom management), NOT on curing a disease.

Types of Immunity

Types of Immunity

Cathy Parkes

Types of immunity: Active natural: Body produces antibodies in response to exposure to a live pathogen. Active artificial: Body produces antibodies in response to a vaccine.  Passive natural: Antibodies are passed from the...

2 comments

Types of Immunity

Cathy Parkes

Types of immunity: Active natural: Body produces antibodies in response to exposure to a live pathogen. Active artificial: Body produces antibodies in response to a vaccine.  Passive natural: Antibodies are passed from the...

2 comments
BP Cuffs

BP Cuffs

Cathy Parkes

Blood pressure cuffs: If the cuff is too large, you will get a falsely low reading. If the cuff is too small, you will get a falsely high reading.

BP Cuffs

Cathy Parkes

Blood pressure cuffs: If the cuff is too large, you will get a falsely low reading. If the cuff is too small, you will get a falsely high reading.

Oxygen Safety

Oxygen Safety

Cathy Parkes

Oxygen safety: Use COTTON bedding and clothes (vs. synthetic fabrics or wool).

Oxygen Safety

Cathy Parkes

Oxygen safety: Use COTTON bedding and clothes (vs. synthetic fabrics or wool).

FIRE-RACE

FIRE-RACE

Cathy Parkes

Response to a FIRE: Use the RACE sequence. R = rescue (move patients to safer location). A = alarm (activate alarm system). C = contain (close doors/windows, turn off oxygen...

FIRE-RACE

Cathy Parkes

Response to a FIRE: Use the RACE sequence. R = rescue (move patients to safer location). A = alarm (activate alarm system). C = contain (close doors/windows, turn off oxygen...

Apical Pulse

Apical Pulse

Cathy Parkes

Apical pulse is taken at the fifth intercostal space at the left midclavicular line.

Apical Pulse

Cathy Parkes

Apical pulse is taken at the fifth intercostal space at the left midclavicular line.

ABCDE Principle

ABCDE Principle

Cathy Parkes

With the ABCDE principle in Nursing, A is for "airway". Ensure the patient has a patent airway AND the cervical spine is stabilized if neck/head trauma is suspected.

ABCDE Principle

Cathy Parkes

With the ABCDE principle in Nursing, A is for "airway". Ensure the patient has a patent airway AND the cervical spine is stabilized if neck/head trauma is suspected.

Left Shift in WBCs

Left Shift in WBCs

Cathy Parkes

If labwork indicates there is a "Left Shift" in WBCs, this means that the body is fighting an infection and releasing many immature WBCs in response.

Left Shift in WBCs

Cathy Parkes

If labwork indicates there is a "Left Shift" in WBCs, this means that the body is fighting an infection and releasing many immature WBCs in response.

Contact Precautions

Contact Precautions

Cathy Parkes

Contact precautions require caregivers and visitors to wear a gown and gloves when going into the patient's room.

Contact Precautions

Cathy Parkes

Contact precautions require caregivers and visitors to wear a gown and gloves when going into the patient's room.

Speech Language Pathologist

Speech Language Pathologist

Cathy Parkes

The  Speech Language Pathologist is a key member of your interprofessional team. In addition to helping patients with speech and language issues, they evaluate and assist with SWALLOWING issues.

Speech Language Pathologist

Cathy Parkes

The  Speech Language Pathologist is a key member of your interprofessional team. In addition to helping patients with speech and language issues, they evaluate and assist with SWALLOWING issues.

Discharge Planning

Discharge Planning

Cathy Parkes

DISCHARGE planning for a patient starts at ADMISSION.

Discharge Planning

Cathy Parkes

DISCHARGE planning for a patient starts at ADMISSION.

Try less invasive interventions first

Try less invasive interventions first

Cathy Parkes

Always try LESS invasive interventions FIRST. Example: Move a patient at risk for falls to a room near the nursing station vs. placing restraints.

Try less invasive interventions first

Cathy Parkes

Always try LESS invasive interventions FIRST. Example: Move a patient at risk for falls to a room near the nursing station vs. placing restraints.

Incident Reports

Incident Reports

Cathy Parkes

Incident reports should NOT be part of the patient's chart, and incident reports should NOT be referenced in the patient's chart.

Incident Reports

Cathy Parkes

Incident reports should NOT be part of the patient's chart, and incident reports should NOT be referenced in the patient's chart.

Preventing falls

Preventing falls

Cathy Parkes

Preventing falls: Do not place all 4 bed rails UP for patient who try to get out of bed on their own.

Preventing falls

Cathy Parkes

Preventing falls: Do not place all 4 bed rails UP for patient who try to get out of bed on their own.

Suspicion of Abuse

Suspicion of Abuse

Cathy Parkes

Nurses are required to report suspicion of abuse.  You do not need to gather more information or provide proof.

Suspicion of Abuse

Cathy Parkes

Nurses are required to report suspicion of abuse.  You do not need to gather more information or provide proof.

Informed Consent

Informed Consent

Cathy Parkes

In order to give informed consent, a patient must be an unimpaired adult (ex: no drugs, alcohol, hallucinations) or an emancipated minor.

Informed Consent

Cathy Parkes

In order to give informed consent, a patient must be an unimpaired adult (ex: no drugs, alcohol, hallucinations) or an emancipated minor.

Older adult home safety

Older adult home safety

Cathy Parkes

When assessing HOME safety for older adults, it is important to remove scatter rugs!

Older adult home safety

Cathy Parkes

When assessing HOME safety for older adults, it is important to remove scatter rugs!