Bsbwor501 Final Exam
Summer 2013 Final Exam Study Guide
1 Discuss in general which assessment findings would alert you to the need for immediate intervention. (When you notify a physician immediately, or call the rapid response team).
Report ABNORMAL assessment findings to the physician immediately, such as; cardiovascular status, respiratory status, kidney function, neurologic status, musculoskeletal status, nutritional status, skin appearance and psychosocial abnormalities.
Notify the rapid response team immediately before a cardiac or respiratory arrest occurs. A sudden deterioration in a patient’s condition should stimulate activation of emergency efforts. The goal of a rapid response team (RRT) is to avert a cardiac arrest and to take action before the patient stops breathing. Here are some generally …show more content…
accepted reasons to call the RRT:
Acute change in heart rate - over 140/min or less than 40/min
Acute change in systolic BP - greater than 180 mmHg or less than 90 mmHg
Acute change in respiratory rate - over 28/min or less than 8/min
Acute drop in O2 saturation - less than 90% despite supplementation
Acute change in mental status Threatened airway
Drop in urine output - less than 50 cc over 4 hours
New, repeated, or prolonged seizures
Fractional inspired oxygen of 50% or greater
Failure to respond to treatment for an acute problem/symptom
2 Differentiate assessment findings that only require documentation versus those findings that need to be relayed to the health care team (i.e. normal findings).
Findings that only need to be documented are:
Age, normal assessment finding, drugs substance use, medical history (including cardiac and pulmonary), complementary / alternative practices, previous surgical procedures, anesthesia, blood donations allergies, general health, family history, support system, knowledge and understanding, discharge planning.
Findings that need to be relayed to the health care team are:
(This is done routinely at change of shift report)
The patient’s name, date of admission, diagnosis, attending physician, current health problems, potential complications related to health condition, physical and emotional assessment, diet and fluid status (PO or IV), effects of interventions/medications, any unusual occurrences/changes in client’s condition, changes in physician’s orders and client responses, any consults (e.g. PT, OT, social services, discharge).
3 Prioritize which patient to see first when given a report on multiple patients.
4 Prioritize treatments/interventions when given a list of orders for a patient.
3 and 4 are pretty similar so I combined the answer- the answers to these will change depending on the situation.
Tips for prioritizing care
Use Maslow’s Hierarchy of Need to rank based on the highest and lowest priorities.
1. Physiology
2. Safety
3. Love
4. Esteem
5. Self-Actualization
You will also need to rank to see which client is in need of your attention first by following the ABC's of care.
A: Airway
B: Breathing
C: Circulation
When you are prioritizing your care for a group of patients you will want to identify the problem of each patient, review your patients nursing diagnoses, determine which of your patients problems are most urgent (based on, basic needs, clients change in status, complexity of clients problem), anticipate the time that will be needed to properly care for client, combine activities when possible to use time wisely, and involve your patient as much as possible in their care, determine what you can delegate and always keep your patients safety as a priority. When choosing what orders to follow for a patient you have to make the decision based off the importance of the task and the patient’s current needs.
5 Discuss why you would reassess a person after an intervention and how to correlate your assessment findings with evaluating if the intervention was effective (outcome).
Patient care is measured by doing an assessment, administering interventions when necessary, and then reassessing the situation to make sure the intervention is working properly.
To provide an appropriate outcome you need to include your initial assessment findings to see if the original problem is resolved. To do this you will need to perform an assessment before the intervention and then after the intervention. For example, if you assessed that you patient was in pain, you would want to provide pain medication. You would then follow up and assess them again to see if that pain is gone; if the pain is gone then you have an effective patient outcome.
6 Discuss the general clinical manifestations assessed in a person with anemia.
Symptoms of Anemia includes - easy fatigue and loss of energy, tachycardia -particularly with exercise, shortness of breath and headache, difficulty concentrating, dizziness, pale skin/pallor, leg cramps, insomnia, hypoxemia, low urine output, cool to touch, intolerance of cold temps.
7 Develop a discharge plan for a person who has had a spleenectomy.
Activity
Increase activity gradually. Don’t overexert yourself to the point of fatigue -
REST!
Don’t lift or push anything heavier than 10 pounds for 4 to 6 weeks after surgery.
Don’t drive until after your first doctor’s appointment after your surgery.
If you ride in a car for more than short trips, stop frequently to stretch your legs to reduce risk for DVT.
Preventing Infection
Remember, you have a higher risk of infection because you don’t have a spleen.
Talk to your doctor about certain vaccines because you will be more prone to infection after the surgery (i.e. flu).
Get medical attention even for mild illnesses such as sinus problems or colds.
Take ALL antibiotic medication after surgery as directed by your doctor.
Be sure to tell all your healthcare providers (dentist, primary care doctor, nurse practitioner, etc.) that you don’t have a spleen.
Stay away from large crowds the first week or two after surgery. This helps you to keep from getting an infection.
Consider getting a medical alert ID bracelet that says you don’t have a spleen.
Practice good hand hygiene!
Other Home Care
Wash your incision site with soap and water and pat dry.
Check your incision every day for redness, drainage, swelling, or separation of the skin.
Check your temperature daily for 1 week after your surgery.
Return to your regular diet as tolerated. Eat a healthy, well-balanced diet.
When to Call Your Doctor
Call your doctor right away if you have any of the following:
Fever above 101.5°F (38.5°C) or chills
Any unusual bleeding or an incision that opens up or pulls apart
Increased pain, warmth, redness, or drainage in or around your incision
8 Develop a teaching plan for a person undergoing a bone marrow biopsy.
Patient Prep Reduce anxiety and fears by providing accurate information and emotional support. The local anesthetic will feel like a tingling and there is heavy pressure during the procedure, sometimes a crunching sound can be heard or a scraping sensation can be felt. Explain that it can painful, but it is a brief sensation when they aspirate from the syringe. The procedure lasts 5-15 minutes, local anesthetic can be applied.
Follow up care
Prevention of excessive bleeding, cover the site with a dressing after bleeding is controlled and closely observe it for 24 hours for signs and symptoms of bleeding and infection. A mild analgesic (aspirin free) may be given for discomfort, and ice packs can be placed over the site to limit bruising. Instruct the patient to inspect the site every 2 hours for the first 24 hours and note the presence of bruising or active bleeding. Advise them to avoid activity that might cause trauma to the site for the first 48 hours.
9 Develop a plan of care for a person with thrombocytopenia.
Thrombocytopenia is a reduction in platelets and the patient is at an increase risk for bleeding.
Teaching
Handle the patient gently
Use a lift sheet when moving and positioning in bed
Avoid IM injections and venipuncture
When injections and venipuncture are necessary, use the smallest needle for the task
Apply firm pressure to the needle stick site for 10 minutes or until the site no longer oozes blood
Apply ice to all area of trauma
Test all urine and stool for the presence of occult blood
Observe IV sites every 2 hours for bleeding
Avoid trauma to rectal fissures- no enemas’, administer well lubricated suppositories with caution, advise patient not to have anal intercourse
Measure the abdominal girth daily
Advise the paint to use an electronic razor
Teach the patient to avoid mouth trauma – soft bristle tooth brush, no flossing, avoid dental work, avoid hard foods, make sure dentures fit correctly
Encourage patient not the blow nose or insert objects into the nose
Advise patient to avoid contact sports
Teach patient to wear shoes with firm soles while ambulating
10 Develop a plan of care for a person with an elevated or diminished white blood cell count.
A high WBC count is called leukocytosis, and a low WBC count is called leukopenia.
The main complication for both is an increased risk for infection. To prevent infection you can follow these guidelines:
Wash hand often
Shower every day. Or, take a bath if you are permitted. Use an antibacterial soap when bathing, then rinse thoroughly and pat your skin dry. Inspect your skin closely for cuts, rashes, redness, swelling, tenderness, itching, drainage or odors.
Brush your teeth after eating and before bedtime with a soft toothbrush. Swish and spit with a mouthwash that does not have alcohol in it. Inspect your mouth closely once a day with a flashlight. Report any redness, white patches, cuts, or bumps on the inside of your mouth, gums, or lips.
Use an electric razor to avoid cutting your skin.
Wear gloves when gardening.
Wear a mask or leave the room when it is being dusted, swept, or vacuumed.
Check your temperature two times a day, in the morning and at bedtime. Call your doctor or nurse if you have a fever over 100.5 degrees or as you are instructed. They also should be called if you are chilled, sweating a lot, or feeling more tired than usual.
Avoid crowds or people who have infections
Monitor water, such as water in flower vases, denture cups, soap dishes, and respiratory equipment.
Avoid contact with pet or human waste. Do not clean cat litter boxes, fish tanks or change diapers.
Avoid being near houseplants. Place these in a room that you do not use.
Rectal thermometers, enemas or suppositories should not be used.
Use stool softeners or laxatives to avoid being constipated. Try to have a bowel movement at least every other day.
Avoid using a razor blade or other sharp objects.
Do not keep cooked foods at room temperature for more than 2 hours. Refrigerate all foods. If they are left out at room temperature for over 2 hours, throw them out.
Never eat anything with mold on it.
Avoid all pre-cut fresh fruits and vegetables in delis, restaurants and grocery stores.
Avoid fresh fruits and vegetables that can’t be washed well, like berries and broccoli.
Always cook ground meat until it is well done.
Wash your utensils and disinfect cutting board with bleach between meats and other foods.
Monitor for fever and signs of infection. Check body secretions, sputum, & urine.
11 Understand the blood tests used to monitor therapeutic effect for the person on heparin, the person on Coumadin.
Heparin (PTT) - When taking Heparin the PTT level can get longer, so your PTT value needs to be closely checked. If you have a longer PTT, you may have a higher risk of bleeding. The heparin dose is changed so that the PTT or APTT result is about 1.5 to 2.5 times the normal value. The normal ratio is:
Partial thromboplastin time (PTT): 60-70 seconds
Coumadin (PT/INR) - When a person is taking Warfarin/Coumadin, the doctor will order periodic PT/INR tests to ensure that the prescription is working properly and that the PT/INR is appropriately prolonged. The result can be affect by a person’s Vitamin K intake. The Warfarin (Coumadin) dose is changed so that the prothrombin time is longer than normal (by about 1.5 to 2.5 times the normal value or INR value of 2 - 3). The normal ratio is:
Pro thrombin time (PT): 11-13 seconds
International normalized ratio (INR): 0.8 – 1.1
12 Discuss the transition of a patient from Heparin to Coumadin.
In the transition when you start on Coumadin, the patient may remain on Heparin until the therapeutic level is reached. To ensure continuous anticoagulation, it is advisable to continue full dose heparin therapy and that coumadin therapy to be overlapped with heparin for 4 to 5 days, until coumadin (Warfarin) has produced the desired therapeutic response as determined by pt/inr. When coumadin has produced the desired pt/inr or prothrombin activity, heparin may be discontinued.
13 Develop a discharge teaching plan for a patient going home on heparin or Coumadin.
Heparin/Coumadin are classified as anticoagulants. The main risk of taking these drugs is that your blood may become too thin. This is why your doctor will want you to have your blood drawn regularly to check the PT/INR and PTT. Signs and symptoms of abnormally thinned blood are bleeding from the gums, excessive bruising, black, tarry stools (very dark or black bowel movements the consistency of tar) and blood in your urine.
When you are taking Coumadin, there are some important things to remember. You should avoid an excessive diet of foods that are high in Vitamin K, such as green leafy vegetables, broccoli, green onions, asparagus and olive oil. Coumadin and Vitamin K work against each other. Vitamin K actually helps thicken the blood. It can be given in injection form when someone's blood is dangerously thin.
The patient at risk for bleeding:
Use an electric razor
Use a soft bristled toothbrush and do not floss
Do not have dental work done without consulting your doctor
Do not take aspirin-containing products
Wear shoes or slippers with a sole to avoid foot injury
Do not participate in contact sports that can cause trauma
If you are bumped - apply ice to the site for at least 1 hour
Notify physician of any unusual bleeding
Take a stool softener to prevent straining
Do not use enemas’ or rectal suppositories
Avoid bending over at the waist
Do not wear clothing or shoes that are too tight or rub
Avoid blowing your nose or placing objects in the nose; If you must blow your nose do gently
14 Know the norms for RBC, Hemoglobin/Hematocrit, WBC, and platelets.
RBC - 4.7-6.1 male, 4.2-5.4 female
Hemoglobin – 14-18 male, 12-16 female
Hematocrit – 42-52% male, 37-47% female WBC- 5,000- 10,0000
Platelets – 150,000-400,000
15 Develop a discharge plan for a person with acute myelogenous and acute lymphocytic leukemia.
Leukemia is a type of cancer with uncontrolled production of immature WBC’s in the bone marrow. They are classified by cell type:
In acute myelogenous leukemia the cells come from the myeloid pathways.
In acute lymphocytic leukemia the cells come from the lymphoid pathways.
Complications are fatigue, infection, & bleeding risks. There is also a risk for Pancytopenia - a medical condition in which there is a reduction in the number of red and white blood cells, as well as platelets. Self-care includes:
Get plenty of rest: Rest as much as you need to. Match your activity to the amount of energy you have.
Prevent constipation - eat high-fiber foods, extra liquids, and regular exercise can help you prevent constipation.
Eat nutrient rich foods: Healthy foods may help you feel better and have more energy.
Drink liquids: You may need to drink extra liquids to avoid dehydration, especially if you are vomiting or have diarrhea from cancer treatments.
Prevent infection:
Wash your hands often, especially after you go to the bathroom and before you eat.
Bathe daily: Make sure to wash between the folds of your skin. Use an electric shaver to prevent nicking your skin when shaving.
Avoid people who are sick: Stay away from people who have a cold or the flu. Also try to stay away from large groups of people to decrease your risk of getting a cold or flu.
Brush your teeth: Gently brush your teeth and gums using a brush with soft bristle toothbrush.
Clean humidifiers: Change the water in your humidifier or other respiratory equipment daily.
Prevent bleeding and bruising:
Avoid sharp objects: Use an electric razor to shave. Use a nail file to keep your nails short and smooth.
Care for your mouth: Use a soft toothbrush. Do not floss your teeth while your platelet count is low. Do not use toothpicks.
Choose light activities: Avoid any activity that may cause chest pain or trouble breathing. Do not play contact sports such as football or soccer. Avoid high altitudes.
Blow your nose gently: Do not pick your nose.
Avoid NSAIDS: They thin blood and make it easier to bleed.
Do not use tampons: Use sanitary pads instead. Count the number of pads you use during your monthly period.
Contact your primary healthcare provider or oncologist if:
You see blood in your spit or vomit.
You have coughing or shortness of breath.
You feel dizzy or your heart begins to beat very fast.
You have sores or white patches in your mouth or throat.
You have rectal pain or hemorrhoids.
You have diarrhea or bloody bowel movements.
You have frequent nose bleeds or your gums bleed.
You have blurred vision, or blood spots in the whites of your eyes.
You have questions or concerns about your condition or care
Neutropenic precautions refers to limitations or preventative measures placed upon a patient who is neutropenic (diagnosed with neutropenia) in the hope of preventing a serious infection.
Dietary – It is recommended that the following foods should be avoided:
Raw fresh fruits, meats and vegetables
Uncooked peppers
Raw or unpasteurized dairy products
Deli foods or raw eggs
Environment –the patient should be placed in a private room, or semi private room depending on the approval of the attending physician. The patient should not be visited by anyone with a transmittable disease. There should not be any fresh flowers or plants in the room or near the vicinity of the patient. This is because anything grown/growing in dirt contains bacteria.
In addition to these 3 strategies, general hand washing protocols should be adhered to at all times. This involves regular and good hand washing by both the patient anyone who come into contact with them.
16 Understand the proper safeguards to ensure you administer a blood product to the correct patient.
Before infusion
Assess laboratory values (platelet count, hemoglobin) and verify blood type with blood specimen.
Verify medical prescription
Assess the patients vitals, urine output, skin color, and history of transfusion reactions
Obtain venous access, use a central catheter of at least a 20 gauge needle if possible
Obtain blood products for the blood bank and transfuse as soon as possible after performing all the required safety check
With another registered nurse verify the patent by name and number, check blood capability and note expiration time
Match patient name/birthdate/blood donor bracelet with actual blood product
During infusion
Administer the blood product using the appropriate filtered tubing to remove possible contaminates.
Dilute products with only normal saline solution, watch for fluid overload – a potential problem of rapid infusion.
Remain with the patient the first 15- 30 minutes of the infusion
Monitor vital signs – take 15 min after infusion started, then if stable take every hour until the transfusion is done.
When the transfusion is complete d/c blood and tubing and document.
1 Discuss in general which assessment findings would alert you to the need for immediate intervention. (When you notify a physician immediately, or call the rapid response team).
Report ABNORMAL assessment findings to the physician immediately, such as; cardiovascular status, respiratory status, kidney function, neurologic status, musculoskeletal status, nutritional status, skin appearance and psychosocial abnormalities.
Notify the rapid response team immediately before a cardiac or respiratory arrest occurs. A sudden deterioration in a patient’s condition should stimulate activation of emergency efforts. The goal of a rapid response team (RRT) is to avert a cardiac arrest and to take action before the patient stops breathing. Here are some generally …show more content…
accepted reasons to call the RRT:
Acute change in heart rate - over 140/min or less than 40/min
Acute change in systolic BP - greater than 180 mmHg or less than 90 mmHg
Acute change in respiratory rate - over 28/min or less than 8/min
Acute drop in O2 saturation - less than 90% despite supplementation
Acute change in mental status Threatened airway
Drop in urine output - less than 50 cc over 4 hours
New, repeated, or prolonged seizures
Fractional inspired oxygen of 50% or greater
Failure to respond to treatment for an acute problem/symptom
2 Differentiate assessment findings that only require documentation versus those findings that need to be relayed to the health care team (i.e. normal findings).
Findings that only need to be documented are:
Age, normal assessment finding, drugs substance use, medical history (including cardiac and pulmonary), complementary / alternative practices, previous surgical procedures, anesthesia, blood donations allergies, general health, family history, support system, knowledge and understanding, discharge planning.
Findings that need to be relayed to the health care team are:
(This is done routinely at change of shift report)
The patient’s name, date of admission, diagnosis, attending physician, current health problems, potential complications related to health condition, physical and emotional assessment, diet and fluid status (PO or IV), effects of interventions/medications, any unusual occurrences/changes in client’s condition, changes in physician’s orders and client responses, any consults (e.g. PT, OT, social services, discharge).
3 Prioritize which patient to see first when given a report on multiple patients.
4 Prioritize treatments/interventions when given a list of orders for a patient.
3 and 4 are pretty similar so I combined the answer- the answers to these will change depending on the situation.
Tips for prioritizing care
Use Maslow’s Hierarchy of Need to rank based on the highest and lowest priorities.
1. Physiology
2. Safety
3. Love
4. Esteem
5. Self-Actualization
You will also need to rank to see which client is in need of your attention first by following the ABC's of care.
A: Airway
B: Breathing
C: Circulation
When you are prioritizing your care for a group of patients you will want to identify the problem of each patient, review your patients nursing diagnoses, determine which of your patients problems are most urgent (based on, basic needs, clients change in status, complexity of clients problem), anticipate the time that will be needed to properly care for client, combine activities when possible to use time wisely, and involve your patient as much as possible in their care, determine what you can delegate and always keep your patients safety as a priority. When choosing what orders to follow for a patient you have to make the decision based off the importance of the task and the patient’s current needs.
5 Discuss why you would reassess a person after an intervention and how to correlate your assessment findings with evaluating if the intervention was effective (outcome).
Patient care is measured by doing an assessment, administering interventions when necessary, and then reassessing the situation to make sure the intervention is working properly.
To provide an appropriate outcome you need to include your initial assessment findings to see if the original problem is resolved. To do this you will need to perform an assessment before the intervention and then after the intervention. For example, if you assessed that you patient was in pain, you would want to provide pain medication. You would then follow up and assess them again to see if that pain is gone; if the pain is gone then you have an effective patient outcome.
6 Discuss the general clinical manifestations assessed in a person with anemia.
Symptoms of Anemia includes - easy fatigue and loss of energy, tachycardia -particularly with exercise, shortness of breath and headache, difficulty concentrating, dizziness, pale skin/pallor, leg cramps, insomnia, hypoxemia, low urine output, cool to touch, intolerance of cold temps.
7 Develop a discharge plan for a person who has had a spleenectomy.
Activity
Increase activity gradually. Don’t overexert yourself to the point of fatigue -
REST!
Don’t lift or push anything heavier than 10 pounds for 4 to 6 weeks after surgery.
Don’t drive until after your first doctor’s appointment after your surgery.
If you ride in a car for more than short trips, stop frequently to stretch your legs to reduce risk for DVT.
Preventing Infection
Remember, you have a higher risk of infection because you don’t have a spleen.
Talk to your doctor about certain vaccines because you will be more prone to infection after the surgery (i.e. flu).
Get medical attention even for mild illnesses such as sinus problems or colds.
Take ALL antibiotic medication after surgery as directed by your doctor.
Be sure to tell all your healthcare providers (dentist, primary care doctor, nurse practitioner, etc.) that you don’t have a spleen.
Stay away from large crowds the first week or two after surgery. This helps you to keep from getting an infection.
Consider getting a medical alert ID bracelet that says you don’t have a spleen.
Practice good hand hygiene!
Other Home Care
Wash your incision site with soap and water and pat dry.
Check your incision every day for redness, drainage, swelling, or separation of the skin.
Check your temperature daily for 1 week after your surgery.
Return to your regular diet as tolerated. Eat a healthy, well-balanced diet.
When to Call Your Doctor
Call your doctor right away if you have any of the following:
Fever above 101.5°F (38.5°C) or chills
Any unusual bleeding or an incision that opens up or pulls apart
Increased pain, warmth, redness, or drainage in or around your incision
8 Develop a teaching plan for a person undergoing a bone marrow biopsy.
Patient Prep Reduce anxiety and fears by providing accurate information and emotional support. The local anesthetic will feel like a tingling and there is heavy pressure during the procedure, sometimes a crunching sound can be heard or a scraping sensation can be felt. Explain that it can painful, but it is a brief sensation when they aspirate from the syringe. The procedure lasts 5-15 minutes, local anesthetic can be applied.
Follow up care
Prevention of excessive bleeding, cover the site with a dressing after bleeding is controlled and closely observe it for 24 hours for signs and symptoms of bleeding and infection. A mild analgesic (aspirin free) may be given for discomfort, and ice packs can be placed over the site to limit bruising. Instruct the patient to inspect the site every 2 hours for the first 24 hours and note the presence of bruising or active bleeding. Advise them to avoid activity that might cause trauma to the site for the first 48 hours.
9 Develop a plan of care for a person with thrombocytopenia.
Thrombocytopenia is a reduction in platelets and the patient is at an increase risk for bleeding.
Teaching
Handle the patient gently
Use a lift sheet when moving and positioning in bed
Avoid IM injections and venipuncture
When injections and venipuncture are necessary, use the smallest needle for the task
Apply firm pressure to the needle stick site for 10 minutes or until the site no longer oozes blood
Apply ice to all area of trauma
Test all urine and stool for the presence of occult blood
Observe IV sites every 2 hours for bleeding
Avoid trauma to rectal fissures- no enemas’, administer well lubricated suppositories with caution, advise patient not to have anal intercourse
Measure the abdominal girth daily
Advise the paint to use an electronic razor
Teach the patient to avoid mouth trauma – soft bristle tooth brush, no flossing, avoid dental work, avoid hard foods, make sure dentures fit correctly
Encourage patient not the blow nose or insert objects into the nose
Advise patient to avoid contact sports
Teach patient to wear shoes with firm soles while ambulating
10 Develop a plan of care for a person with an elevated or diminished white blood cell count.
A high WBC count is called leukocytosis, and a low WBC count is called leukopenia.
The main complication for both is an increased risk for infection. To prevent infection you can follow these guidelines:
Wash hand often
Shower every day. Or, take a bath if you are permitted. Use an antibacterial soap when bathing, then rinse thoroughly and pat your skin dry. Inspect your skin closely for cuts, rashes, redness, swelling, tenderness, itching, drainage or odors.
Brush your teeth after eating and before bedtime with a soft toothbrush. Swish and spit with a mouthwash that does not have alcohol in it. Inspect your mouth closely once a day with a flashlight. Report any redness, white patches, cuts, or bumps on the inside of your mouth, gums, or lips.
Use an electric razor to avoid cutting your skin.
Wear gloves when gardening.
Wear a mask or leave the room when it is being dusted, swept, or vacuumed.
Check your temperature two times a day, in the morning and at bedtime. Call your doctor or nurse if you have a fever over 100.5 degrees or as you are instructed. They also should be called if you are chilled, sweating a lot, or feeling more tired than usual.
Avoid crowds or people who have infections
Monitor water, such as water in flower vases, denture cups, soap dishes, and respiratory equipment.
Avoid contact with pet or human waste. Do not clean cat litter boxes, fish tanks or change diapers.
Avoid being near houseplants. Place these in a room that you do not use.
Rectal thermometers, enemas or suppositories should not be used.
Use stool softeners or laxatives to avoid being constipated. Try to have a bowel movement at least every other day.
Avoid using a razor blade or other sharp objects.
Do not keep cooked foods at room temperature for more than 2 hours. Refrigerate all foods. If they are left out at room temperature for over 2 hours, throw them out.
Never eat anything with mold on it.
Avoid all pre-cut fresh fruits and vegetables in delis, restaurants and grocery stores.
Avoid fresh fruits and vegetables that can’t be washed well, like berries and broccoli.
Always cook ground meat until it is well done.
Wash your utensils and disinfect cutting board with bleach between meats and other foods.
Monitor for fever and signs of infection. Check body secretions, sputum, & urine.
11 Understand the blood tests used to monitor therapeutic effect for the person on heparin, the person on Coumadin.
Heparin (PTT) - When taking Heparin the PTT level can get longer, so your PTT value needs to be closely checked. If you have a longer PTT, you may have a higher risk of bleeding. The heparin dose is changed so that the PTT or APTT result is about 1.5 to 2.5 times the normal value. The normal ratio is:
Partial thromboplastin time (PTT): 60-70 seconds
Coumadin (PT/INR) - When a person is taking Warfarin/Coumadin, the doctor will order periodic PT/INR tests to ensure that the prescription is working properly and that the PT/INR is appropriately prolonged. The result can be affect by a person’s Vitamin K intake. The Warfarin (Coumadin) dose is changed so that the prothrombin time is longer than normal (by about 1.5 to 2.5 times the normal value or INR value of 2 - 3). The normal ratio is:
Pro thrombin time (PT): 11-13 seconds
International normalized ratio (INR): 0.8 – 1.1
12 Discuss the transition of a patient from Heparin to Coumadin.
In the transition when you start on Coumadin, the patient may remain on Heparin until the therapeutic level is reached. To ensure continuous anticoagulation, it is advisable to continue full dose heparin therapy and that coumadin therapy to be overlapped with heparin for 4 to 5 days, until coumadin (Warfarin) has produced the desired therapeutic response as determined by pt/inr. When coumadin has produced the desired pt/inr or prothrombin activity, heparin may be discontinued.
13 Develop a discharge teaching plan for a patient going home on heparin or Coumadin.
Heparin/Coumadin are classified as anticoagulants. The main risk of taking these drugs is that your blood may become too thin. This is why your doctor will want you to have your blood drawn regularly to check the PT/INR and PTT. Signs and symptoms of abnormally thinned blood are bleeding from the gums, excessive bruising, black, tarry stools (very dark or black bowel movements the consistency of tar) and blood in your urine.
When you are taking Coumadin, there are some important things to remember. You should avoid an excessive diet of foods that are high in Vitamin K, such as green leafy vegetables, broccoli, green onions, asparagus and olive oil. Coumadin and Vitamin K work against each other. Vitamin K actually helps thicken the blood. It can be given in injection form when someone's blood is dangerously thin.
The patient at risk for bleeding:
Use an electric razor
Use a soft bristled toothbrush and do not floss
Do not have dental work done without consulting your doctor
Do not take aspirin-containing products
Wear shoes or slippers with a sole to avoid foot injury
Do not participate in contact sports that can cause trauma
If you are bumped - apply ice to the site for at least 1 hour
Notify physician of any unusual bleeding
Take a stool softener to prevent straining
Do not use enemas’ or rectal suppositories
Avoid bending over at the waist
Do not wear clothing or shoes that are too tight or rub
Avoid blowing your nose or placing objects in the nose; If you must blow your nose do gently
14 Know the norms for RBC, Hemoglobin/Hematocrit, WBC, and platelets.
RBC - 4.7-6.1 male, 4.2-5.4 female
Hemoglobin – 14-18 male, 12-16 female
Hematocrit – 42-52% male, 37-47% female WBC- 5,000- 10,0000
Platelets – 150,000-400,000
15 Develop a discharge plan for a person with acute myelogenous and acute lymphocytic leukemia.
Leukemia is a type of cancer with uncontrolled production of immature WBC’s in the bone marrow. They are classified by cell type:
In acute myelogenous leukemia the cells come from the myeloid pathways.
In acute lymphocytic leukemia the cells come from the lymphoid pathways.
Complications are fatigue, infection, & bleeding risks. There is also a risk for Pancytopenia - a medical condition in which there is a reduction in the number of red and white blood cells, as well as platelets. Self-care includes:
Get plenty of rest: Rest as much as you need to. Match your activity to the amount of energy you have.
Prevent constipation - eat high-fiber foods, extra liquids, and regular exercise can help you prevent constipation.
Eat nutrient rich foods: Healthy foods may help you feel better and have more energy.
Drink liquids: You may need to drink extra liquids to avoid dehydration, especially if you are vomiting or have diarrhea from cancer treatments.
Prevent infection:
Wash your hands often, especially after you go to the bathroom and before you eat.
Bathe daily: Make sure to wash between the folds of your skin. Use an electric shaver to prevent nicking your skin when shaving.
Avoid people who are sick: Stay away from people who have a cold or the flu. Also try to stay away from large groups of people to decrease your risk of getting a cold or flu.
Brush your teeth: Gently brush your teeth and gums using a brush with soft bristle toothbrush.
Clean humidifiers: Change the water in your humidifier or other respiratory equipment daily.
Prevent bleeding and bruising:
Avoid sharp objects: Use an electric razor to shave. Use a nail file to keep your nails short and smooth.
Care for your mouth: Use a soft toothbrush. Do not floss your teeth while your platelet count is low. Do not use toothpicks.
Choose light activities: Avoid any activity that may cause chest pain or trouble breathing. Do not play contact sports such as football or soccer. Avoid high altitudes.
Blow your nose gently: Do not pick your nose.
Avoid NSAIDS: They thin blood and make it easier to bleed.
Do not use tampons: Use sanitary pads instead. Count the number of pads you use during your monthly period.
Contact your primary healthcare provider or oncologist if:
You see blood in your spit or vomit.
You have coughing or shortness of breath.
You feel dizzy or your heart begins to beat very fast.
You have sores or white patches in your mouth or throat.
You have rectal pain or hemorrhoids.
You have diarrhea or bloody bowel movements.
You have frequent nose bleeds or your gums bleed.
You have blurred vision, or blood spots in the whites of your eyes.
You have questions or concerns about your condition or care
Neutropenic precautions refers to limitations or preventative measures placed upon a patient who is neutropenic (diagnosed with neutropenia) in the hope of preventing a serious infection.
Dietary – It is recommended that the following foods should be avoided:
Raw fresh fruits, meats and vegetables
Uncooked peppers
Raw or unpasteurized dairy products
Deli foods or raw eggs
Environment –the patient should be placed in a private room, or semi private room depending on the approval of the attending physician. The patient should not be visited by anyone with a transmittable disease. There should not be any fresh flowers or plants in the room or near the vicinity of the patient. This is because anything grown/growing in dirt contains bacteria.
In addition to these 3 strategies, general hand washing protocols should be adhered to at all times. This involves regular and good hand washing by both the patient anyone who come into contact with them.
16 Understand the proper safeguards to ensure you administer a blood product to the correct patient.
Before infusion
Assess laboratory values (platelet count, hemoglobin) and verify blood type with blood specimen.
Verify medical prescription
Assess the patients vitals, urine output, skin color, and history of transfusion reactions
Obtain venous access, use a central catheter of at least a 20 gauge needle if possible
Obtain blood products for the blood bank and transfuse as soon as possible after performing all the required safety check
With another registered nurse verify the patent by name and number, check blood capability and note expiration time
Match patient name/birthdate/blood donor bracelet with actual blood product
During infusion
Administer the blood product using the appropriate filtered tubing to remove possible contaminates.
Dilute products with only normal saline solution, watch for fluid overload – a potential problem of rapid infusion.
Remain with the patient the first 15- 30 minutes of the infusion
Monitor vital signs – take 15 min after infusion started, then if stable take every hour until the transfusion is done.
When the transfusion is complete d/c blood and tubing and document.