Nursing Tips

Patients always have the right to refuse medication, even if they have been involuntarily admitted (except in an emergency)! Support the patient's right to autonomy.

A medication reconciliation is the process of compiling a complete and up-to-date list of medications a patient has been taking at home (including over-the-counter and herbal supplements) and comparing it with the provider's orders.

A child with Chickenpox (Varicella) is contagious until all lesions have crusted over. Educate families to keep them at home and away from others until this time.

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

Neuroleptic Malignant Syndrome (NMS) is a life-threatening condition by the use or withdrawal of antipsychotic medications.

A dry powder inhaler (DPI) does not require the patient to shake the device or use a spacer. Instead, the patient should breathe in rapidly and deeply to move the dry powder fully into the lungs.

A child with ADHD may be treated with CNS stimulants such as amphetamine mixtures or methylphenidate. 

Following a bronchoscopy (visualization of the structures of the airway with sedation), ensure the patient's gag reflex has returned prior to allowing the patient to eat or drink.

Educate patients about warning signs in pregnancy for which they should notify their provider: diarrhea, fever, chills, severe abdominal cramping or pain, severe vomiting, vaginal bleeding, and decreased fetal activity should be reported and assessed fully!

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.

Complicated grief is that which lasts longer than a year and interferes with the individual's daily functioning.

Combined oral contraceptive pills (contain estrogen and progestin) are contraindicated for patients who are breastfeeding, smoke, or have a history of blood clots, stroke, coronary artery disease, or hypertension.

Assertive Community Treatment (ACT) is useful for individuals with severe and persistent schizophrenia or major depressive disorder with psychosis.

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 child who presents with an abnormal tuft of hair, a dimple, or a birthmark on the spine should be evaluated for spina bifida occulta, a form of spina bifida. Report these findings to the provider.

Any pregnant patient complaining of unilateral stabbing pain in the lower abdomen/pelvis should be evaluated for ectopic pregnancy.

Bipolar I Disorder is characterized by episodes of severe mania and depression. Bipolar II Disorder is marked by episodes of hypomania (less severe than true mania) and depression.

A child who appears to be frequently "day dreaming" or often exhibits blank staring, eye fluttering, lip smacking, or picking at clothes should be evaluated for absence seizures.

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.

Any patient taking psychiatric medications should avoid St. John's wort, as this increases the risk for serotonin syndrome.

A child demonstrating oliguria, cola-colored urine, and signs/symptoms of hypervolemia following a recent streptococcal infection (strep throat) should be evaluated for Acute Glomerulonephritis.

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.

"Vesicular" breath sounds are a normal finding upon auscultation (i.e., the sound air makes flowing in and out of lungs). "Adventitious" breath sounds are always abnormal!

"Now" and "STAT" orders are similar, but have different time-frames for administration.

Wound irrigation points to remember!

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

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

KEY symptoms of Coarctation of the Aorta: elevated BP and bounding pulses in the arms, decreased BP and pulses in the legs.

KEY symptoms of a Patent Ductus Arteriosus: machine-hum murmur, bounding pulses, and wide pulse pressure.

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

Celiac disease is the inability to digest gluten. Patients with celiac disease CAN eat: dairy, rice, corn, potatoes, eggs, fruits and vegetables. Foods containing wheat, rye, and barley should be avoided.

Key signs/symptoms of Autism: Lack of eye contact Repetitive motions/actions Delayed speech and language skills Strict adherence to routines Unusual eating or sleeping habits Digestive problems.

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 in a population during a period of time

A negative nitrogen balance indicates insufficient PROTEIN intake (due to illness, malnutrition, or aging).

It means the patient is using protein faster than it is being synthesized.

Recognize behaviors that may indicate an intention to commit suicide . For example: Giving away prized possessions, sudden improvement of mood or calmness, and/or making of final preparations.

IMMUNIZATIONS IN FIRST 6  MONTHS Birth = "B" Hep B 2 Months = "B. Dr. HIP" Hep B, DTAP, RV, Hib, IPV, PCV 4 months = "Dr. HIP" DTAP, RV, Hib, IPV, PCV 6 months = "B. Dr. HIP" Hep B (6-12 months), DTAP, RV, Hib, IPV (3rd dose: 6-18 months), PCV

A key function of Vitamin D is that it helps with absorption of calcium.

Sunlight is a key source of Vitamin D! Other sources include: fortified milk, fatty fish, and eggs.

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

In toddlers, parallel play is expected. Parallel play means that children play independently NEXT to other children.

Alcohol withdrawal starts 4-12 hours after last drink and peaks at 24-48 hours. Be sure to ask the patient when they had their last drink!

3,500 calories = 1 pound.

To lose 1 pound a week, patients need to decrease their daily caloric intake by 500 calories.

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

Electroconvulsive therapy (ECT) is used to treat severe depression that is unresponsive to drug therapy.

A child who is crying without producing tears should be evaluated for severe dehydration.

Know your levels of prevention! Primary, Secondary, Tertiary

The DASH diet (for patients with hypertension) emphasizes low sodium, high potassium, and high calcium foods.

For bipolar patients experiencing mania: be sure to provide high-calorie portable snacks (finger foods).

For intramuscular injections under 1 year old, use vastus lateralis muscle!