Nursing Tips

Calcium (Ca) expected range: 9 - 10.5 mEq/L HINT: California (CA) is due for a big earthquake that may measure 9 - 10.5 on the Richter scale.

Filgrastim is a medication used to stimulate the growth of neutrophils in patients with neutropenia.

A patient who experienced a long-bone fracture is at risk for a fat embolism. Immediately report any dyspnea, confusion, tachypnea, tachycardia, or chest pain to the provider.

Authoritarian parents are those who are strict and require high control but offer little warmth. Authoritative parents have moderate-high control, but offer high amounts of warmth. 

Because oxybutynin is used to treat overactive bladder by inhibiting acetylcholine in the bladder, assess for anticholinergic symptoms. These include dry mouth, urinary retention, constipation, and blurred vision.

A patient with appendicitis is likely to have RLQ pain at McBurney's Point along with rebound tenderness, nausea/vomiting, and fever.

A patient undergoing hemodialysis may have an arteriovenous fistula in the arm. Educate patient that blood pressures, IVs, and blood draws must be done from the arm without the shunt. Also educate patients not to sleep on the arm with the fistula, and perform hand exercises to mature a new fistula.

Patients taking corticosteroids (e.g., prednisone, hydrocortisone) are at increased risk of infection. Monitor for signs of infection, and educate patients taking these medications to avoid crowded areas and perform frequent hand hygiene.

Written educational materials should be provided in the patient's primary language using layman's terms and an appropriate reading level.

When performing a Snellen exam for visual acuity, an adult should stand 20 feet away from the chart, but a child should stand 10 feet from the chart.

Because of the unpleasant GI side effects of metformin, educate patients to take this medication with a meal.

Vitamin B9 (folic acid) is needed to prevent neural tube defects in a developing fetus.

A patient with asthma who is experiencing airway obstruction unresponsive to usual therapy is experiencing status asthmaticus. Administer oxygen and prepare for emergency intubation!

Avoid recapping needles to prevent sharps injury. If recapping is unavoidable, use the scoop method to minimize the risk of injury.

When caring for a child with appendicitis, report to the provider any sudden relief of pain. This may indicate that the appendix has perforated and requires emergency surgery!

A patient who experiences prolonged standing (like nurses!) is at risk for developing varicose veins. Educate patients with this risk factor to wear compression stockings and elevate the legs when possible.

Because hypokalemia increases a patient's risk of digoxin toxicity, be sure to closely monitor the potassium levels for patients taking digoxin!

Patients receiving enemas may report cramping. Lower the solution container if cramping is reported.

With Cushing's Syndrome, restrict fluid and sodium but increase the patient's intake of protein, calcium, and vitamin D.

A patient reporting a loss of central vision should be evaluated for macular degeneration.

Atropine is a medication that can be administered to patients with sinus bradycardia or heart block in order to increase heart rate.

Car seat safety for newborns includes installing the car seat in the back/middle seat, using a rear-facing seat with a 5-point harness until at least age 2, installing the seat at a 45 degree angle, positioning straps at or below the level of the child's shoulders, and ensuring the chest clip is at the nipple level (NOT resting on the abdomen!)

A patient using crutches should be taught to ascend stairs leading with the strong leg and descend by leading with the weaker leg.

Assess any skin lesions for potential cancerous changes using ABCDE.

When caring for a child with pheochromocytoma, be sure not to palpate the abdomen. Palpation can cause a sudden release of catecholamines, triggering severe hypertension!

Patient Controlled Analgesia (PCA) pumps should only be used by the patient. Educate families/visitors not to press the button for the patient!

Because ipratropium is an anticholinergic medication, educate patients that they should increase their fluid intake and suck on candy for dry mouth.

Cardiac Enzymes are released in response to cardiac ischemia. They include CK-MB, Myoglobin, Troponin T, and Troponin I. Troponin is the most specific!

Carbohydrates and protein each provide 4 kcal of energy/gram. Lipids provide 9 kcal of energy/gram.

Word Salad is a type of disorganized speech seen in schizophrenia (e.g., "happy green friendly running monkeys").

Acetylcysteine is a mucolytic used to treat pulmonary disorders with thick mucous secretions (e.g., cystic fibrosis). It is expected that this medication smells like rotten eggs; this is not an indication it has expired!

A patient presenting with a chancre (ulcer) on the genitals should be evaluated for syphilis. The chancre should be cultured, and a blood test should be done to assess for this sexually transmitted infection.

A patient who is practicing how to administer their own insulin injections is functioning under the psychomotor domain of learning, as they are not just thinking, but performing an action.

At approximately 1 year of age, a child should begin using "holophrases," which are one-word sentences. By age 2 the child should use more than 50 words and 2 - 3 word phrases.

Assessing skin turgor should be done by gently pinching/lifting the skin on the sternum. If the skin "tents," (i.e., stays lifted for a prolonged period and doesn't quickly return to its original place) it could indicatedehydration.

Audits are an effective way to measure and evaluate performance when carrying out quality improvement.

Acetylcysteine, a respiratory medication, is also used as an antidote for acetaminophen toxicity!

Acrocyanosis is the bluish discoloration of fingers/hands and toes/feet and is an expected finding in the newborn. Report persistent central cyanosis to the provider.

A patient with Chronic Obstructive Pulmonary Disease (COPD) is likely to have a "barrel chest" appearance, use accessory muscles to breathe, have clubbing of the fingernails, and exhibit hyperresonance upon percussion.

A patient on protective/reverse isolation should be provided a private room withpositive-pressure airflow. Do not allow flowers or live plants into the room, and screen all visitors for illness.

When assessing the eyes, the sclera should be white. The tympanic membrane of the ears, however, should be pearly gray.

Potassium (K) expected range: 3.5 - 5.0 mEq/L

Ask your patient about any dietary considerations they may have in relation to their religion rather than assuming!

Beneficence is the ethical principle of promoting good, while nonmaleficence is to avoid causing harm.

A patient undergoing a paracentesis (drainage of fluid from the peritoneal cavity using a needle) must empty their bladder prior to the procedure.

A patient taking oseltamivir to treat Influenza A and B must begin therapy within 48 hours of the onset of symptoms.

Two types of ultrasonography used in pregnancy are transvaginal (ultrasound transducer placed in the patient's vagina) and abdominal (transducer placed on the outside of the abdomen). 

Asking the patient to stick out their tongue and move it side to side is an effective way to assess the function of Cranial Nerve XII (Hypoglossal).