NURS 3120 - Test 2 Material LECTURE MATERIAL Medication Administration (Chapter 29) Drug Preparations: ● Oral → Capsule, pill, tablet, extended release, elixir, suspension, syrup ○ Absorbed in stomach or SI (take with 4oz of fluid) ■ Enteric coated cannot be chewed or crushed! ○ Do not give: unconscious, dysphagia, NPO ● Topical (Enteral/Nonparenteral) ○ DO NOT wash off skin immediately ○ Eyes → tilt head back, pt look up, pull down lower lid ○ Ears ■ Child: pull pinna down and back ■ Adult: pull pinna up and back ■ Stay on opposite side for 5 minutes ○ Nasal → blow nose before, close opposite nostril ○ Vaginal (suppository) → lay on back, knees bent (10-15 mins) ○ Rectal → left side (sims position) with knees bent ● Injectable (Parenteral) ○ Criteria for Choosing Equipment: ■ Route ■ Viscosity/thickness ■ Quantity (mLs needed) ■ Body size → larger needles for larger pts ■ Type of med → insulin vs steroid ○ Insertion Angles: ■ IM = 90 ● Ventrogluteal ● Dorsogluteal → not recommended anymore ● Vastus lateralis (thigh) ○ For most children and infants ● Deltoid ○ Vaccines in adults and children ○ NOT given under 3! ■ SQ = 45-90 ● In adipose tissue ○ Outer back upper arm ○ Abdomen ○ Anterior (front) thigh ○ Upper back ○ Upper ventral or dorsogluteal area ■ ID = 5-15, ¼” - ½”, 25-27 gauge → less than .5mL ● Longest absorption time! ● Used for sensitivity/allergy tests, local anesthesia, and botox ● Sites ○ Inner forearm or upper back ■ IV ● Directly into bloodstream → immediate ○ Often used in emergencies ● Aseptic Technique ○ Preparing Injected Meds ■ Ampules → filter needle required ■ Vials ■ Prefilled Cartridges or Syringe → single dose (flick out bubbles!) ■ Mixing in 1 syringe ● Make sure they are compatible ● Never mix more than 2! ■ Mixing Insulins → N to R (air), R to N (drawing) ● clear before cloudy Factors Affecting Drug Action ● Developmental ○ Pregnancy ○ Infants/children → decreased size (watch dosage) ○ Elderly ● Weight ○ Increase surface area → might need more drug ● Gender ○ Women/hormonal fluctuation ● Genetics/Cultural ● Psychological ○ “Placebo effect” ○ Attitudes toward medication ● Pathology ○ Disease can affect drug action ■ Liver → drug metabolism ■ GI → absorption ● Environment/Nutrition ● Timing of Administration ○ With/without meals Orders ● EVERY med must have an order, even if it is OTC ● Parts: ○ Name and ID (MRN or DOB) ○ Date/time ○ Name of drug ○ Dose ○ Route ○ Frequency ○ Signature Medication Supply Systems ● Stock Supply → different for unit/specialties, large quantities ● Individual unit dose supply → supply for each patient ● Medication Cart → nursing homes (individual drawer for each patient) ● Computerized automated dispensing system → based on stock supply ● Bar code–enabled medication cart (BCMA) ○ Barcode for nurse, patient, and med ○ Improves pt safety Med Administration ● 3 Checks → Read Label: ○ When reaching for container ○ After grabbing from drawer ○ Before giving to patient ● Right ○ Medication ○ Patient ■ Check armband ● Name = 1st identifier ● ID, MRN, or DOB = 2nd identifiers ■ Ask patient to state name and DOB if possible ○ Dosage ○ Route ○ Time ○ Reason ○ Assessment date (lab values) ○ Documentation ○ Response ○ Education ○ To refuse ● Safety ○ Stay with patient until completely swallowed (choking hazards) ○ Never leave meds unattended ○ WEAR GLOVES ● Documentation ○ Name of med ○ Dose, route, time ○ Name of person administering ○ Site used ○ Omitted drugs (intentional or unintentional) ■ Document why it was missed ○ Refuse drugs ○ Medication errors Controlled Substances ● Information required: patient, amount, hour/time, provide, nurse administering ● Wasting → requires 2nd nurse Labs and Diets (Chapter 36) Energy nutrients = carbs, proteins, lipids Regulatory nutrients = vitamins, minerals, water Food Intake: ● Increased = obesity (BMI >30) ○ Depression, anxiety, stress eating ● Decreased = anorexia (lack of appetite) ○ Meds, depression, anxiety, cancer/illness Nutrition Assessment: ● History → 24 hr recall, average calories and # of times eating certain food groups ● Physical Assessment ● Lab Data ○ Low Hg (anemia) ○ Elevated Hematocrit (dehydration) ○ Low albumin (malnutrition) → from decreased protein intake Factors Affecting Nutrition Assessment ● Dietary data (how much, what, when → eating and drinking) ● Medical/socioeconomic ○ Illness, cultural diet, food prep ○ Drug use ○ Illiteracy (or financial setbacks) ● Anthropometric Data ○ Ht, Weight, BMI ● Clinical Data ○ Difficulty eating/swallowing, poor dentition, aspiration, dementia Therapeutic Diets: ● Physician writes diet order! (works with nurse and dietician) ● Nurses Role ○ Reinforce instructions ○ Provide comfortable place (eye level, privacy) ○ Assist with eating → and administer enteral/parenteral feedings as ordered ○ Monitor appetite and dietary intake ○ I & Os ● Things that can alter diets ○ Disease process ■ Cancer/diabetes ■ Alcoholism → banana bag ○ Developmental (age 0-1 = rapid development, more hungry often) ■ BMR decreases with age (fewer calories/nutritional need in elderly) ○ Sex ■ Pregnant = need more iron ■ Males = higher metabolism, more muscle mass ○ Test, exams, surgery ○ Dentition ○ Weight modification ● Modifications ○ Consistency or texture ○ Kilocalories ○ Specific Nutrients ■ Flatus ● Too little → increase fiber ○ Seasonings ■ WATCH salt in cardiac patients Types of Diets: EDUCATE PATIENT!! ● NPO ○ Reasons → post surgery/anesthesia, labor, dysphagia ○ Hold meds ○ Assess blood sugar and weakness ○ Monitor for N/V ● Clear Liquid ○ Foods ■ Black coffee/tea ■ Juices without pulp (ex: apple/cranberry) ■ Jello ■ Clear broths ○ Reasons ■ Relieves thirst, prevents dehydration, minimizes GI stimulation (no residue) ■ Provides cards, fluid, electrolytes ○ Short term = 24-36 hrs ● Full Liquid ○ Foods liquid at body temperature (ex: cream soups, milk products) ○ Reasons ■ Provides fluids, calories, protein, vitamins/minerals, and dairy ● Milk leaves residue in gut ● Be cautious with lactose intolerant pt ■ High cholesterol intake ○ Short term ● Regular ○ No restrictions (but can modify for a patient, ex: low salt or calorie restricted) ○ Diet is modified as patient worses or improves ■ MUST HAVE ORDER ● Soft/low residue ○ Easily chewed/digested (ex: puree meats) ○ Low fiber → watch for constipation Dysphagia ● Difficulty Swallowing (meds, foods, fluids) ● Speech therapist evaluates swallowing and gives diet recommendations ○ Thicken liquids are better!!!! (swallow test) ● HOB > 45 degrees! THICKNESS: ● Nectar = thinnest ● Honey ● Pudding = thickest Nutritional Support ● Short-term = nasogastric (NG) ○ Confirm placement with x-ray or pH aspiration ○ Deviated septum → put in orally ● Nasoenteric ○ In small intestine ● Long-term = PEG or PEJ ○ PEG (gastrostomy) = preferred route for enteral nutrition in comatose patients ○ PEJ = gastric issue present ● NURSES ROLE: ○ Assess placement and check residual ■ Monitor I & Os/labs ○ Assess site/change dressing ○ Change bags/tubing daily → on pump ○ Oral care → clean and moisten mouth/lips ○ Assess: diarrhea, hyperglycemia ○ LABEL ■ Time on date on bottle/bag Parenteral Feedings ● Used when GI is non functional ○ IV preferably central line ● PPN or TPN ○ TPN is most common (usually yellow bag) ■ Need a pic or central line ■ Provides calories and nutrition ■ Complications ● Insertion issues = thromboembolism or pneumothorax (collapsed lung) ● Infection/sepsis → change dressings often ● Altered metabolic status ● Fluid/electrolyte/acid-base imbalances ● Phlebitis (irritation to IV site) ● Hyperlipidemia ● Liver/gallbladder disease LABS: very important → we monitor patient based on their lab values - Know what lab, when it’s ordered, and when the result is due! - Report results to MD Types of Labs ● Hemoglobin → anemia ● Hematocrit → anemia or hydration ● Albumin → proteins ○ Prealbumin ● Transferrin → anemia, ID ● 24 hr urine ● Urea (BUN) & creatine → renal dysfunction ● PT/INR = warfarin ● aPTT = heparin BLEEDING PRECAUTIONS!!! Dehydration ● Causes: (SODIUM OR WATER LOSS) ○ N/V, diarrhea → decreased fluid and electrolytes ○ Diabetes Insipidus → excessive fluid loss ○ Extreme diet/low-sodium diet or no sodium diet (electrolyte deprivation) ○ Inadequate fluid intake ● S/Sx ○ Dry/sticky mucous membranes ○ Thirst ○ Decreased skin turgor ○ Hypovolemia ○ Tachycardia + hypotension ○ Weak pulse ○ Confusion ○ Weight loss ○ Concentrated Urine Fluid Volume Excess → can be life threatening! ● S/Sx ○ Wet lung sounds ○ Confusion/decreased LOC ○ Edema ● Monitor ○ Daily weights ○ Restrict fluids ○ LOC ○ Cardiovascular checks Stool: ● Specimen Can Detect: ○ Steatorrhea → fat excretion in stool ■ bad absorption, bowel acid deficiency, SI disease ○ Ova/parasites ○ Occult → blood hidden in stool ■ Hemoccult ● Thin smear! Use applicator stick provided ● Apply to both box A and B (apply fecal material from different areas of specimen) ● Wait 3-5 mins ● Apply 2 drops of developer over each smear ● Read results within 60 seconds ○ Blue = positive for occult blood! Urine: ● Clean voided urine = clean catch or midstream ● Indwelling specimen (only when first placed) Nursing Process ANA Standards of Nursing Practice → promote critical thinking in clinical setting ● Critical Thinking ○ Higher level reasoning ○ Promotes safe practice ○ Reduces errors in clinical judgment ■ Helps patient be part of the decision making (based on age and development) Nursing Process ● Identifies health status and actual/potential health care problems/needs ● Makes a plan to meet the problem or needs ○ Deliver specific nursing interventions ● 5 Types ○ Comprehensive initial = new admission, looks at everything ○ Focused = one system (ex: neuro) ○ Emergency (might not have time for all the details) ○ Time-lapsed = over time ○ Communities and special populations ● Medical vs. Nursing ○ Med → pathologic conditions ○ Nursing → patient’s response to health problems ● 5 Phases ○ Assessing ■ 1st phase ■ Preparation ■ Collection of data (used to make judgment/dx) ● Objective: what you find ● Subjective: what the patient tells you ○ PRIMARY SOURCE OF INFO = PATIENT ■ Record and report data ○ Diagnosing ■ DX = statement/conclusion regarding the problem/need ● Clinical reasoning (analyzing, synthesizing, reflecting, judgements and drawing conclusions) from assessing helps you reach dx ● Nurse prioritizes a list of diagnoses ■ Predict, prevent, manage, and promote ● Known problems → predict most dangerous complications, identify risk factors, ensure safety and learning needs are met ■ Nursing vs. Medical diagnoses ● Nursing Benefits ○ Individualized patient care ○ Defining domain of nursing ○ Seeking funding for nursing and reimbursement for nursing services ● Formulation of Nursing Diagnosis ○ Diagnostic statement (problem/title) → alterations in the patient's health status ○ 1. Problem ■ Must be from NANDA list ○ 2. Etiology ■ "related to" (r/t) → connects the nursing diagnosis and etiology statements ○ 3. Defining characteristics ■ "as evidenced by" (aeb) → connects the etiology and defining characteristic statement ■ cluster of subjective and objective signs and symptoms that indicate a nursing diagnosis ○ ● Types ○ Problem Focused ■ 1. Problem ■ 2. Etiology ■ 3. Defining characteristics ○ Risk Focuses ■ 1. Problem ■ 2. Etiology ■ indicate a problem will develop without nursing intervention ○ ○ Planning ■ Preparation of a nursing plan of care (establishing a goal!) ● Priorities ○ Based on Maslow’s Hierarchy of Human Needs ■ Physiologic (lower level = highest priority) ■ Safety ■ Love and belonging ■ Self-esteem ■ Self-actualization (high level = lowest priority) ● Write patient outcomes ● Evidence-based nursing interventions ● Communicate care plans to patients! ■ Benefits ● Individualizes care, sets priorities, communication, promotes continuity/coordination of care, evaluates, creates a record, promotes nurse’s professional development ■ Outcomes ● Cognitive → increases in patient knowledge/intellectual behavior ● Psychomotor → achievement of new skills ● Affective → changes in patient values, beliefs, and attitudes ■ Characteristics of Goals ● Client centered = “client will…” ● Reflect the nursing diagnosis = “client’s pain will decrease…” ● Contain action verb ○ Walk, state, identify, drink, inject ● Specific and measurable, realistic ○ Short-term vs. long-term ○ Date and time for achievement should be identified ■ Nursing Interventions ● Nurse-initiated ○ Monitor health status ○ Reduce risks (resolve, prevent, manage problems) ○ Facilitate independence and assist with ADLs ○ Promote optimum physical, psychological, and spiritual well being ● Physician-initiated ● Collaborative ○ Initiated by physician in response to medical diagnosis but carried out by nurse in response to physician orders ○ Implementing ■ Action phase ● Evidence based (need rationale) ● Consistent with professional standards & safe! ■ Nurse will… carry out plan, continue collecting data, modify plan of care as needed, set priorities, perform interventions, document ■ Ex: ● B/P Q4H ● Backrub before bed ● Administering morphine to decrease pain ● Assessing wound size and changing dressing to promote wound healing ○ Evaluating ■ Purpose: allow the patient's achievement of expected outcomes to direct future nurse–patient interactions ● Nurse and patient measure together! ■ Terminate, modify, or continue ■ Goal Eval: ● Met, not met, partially met ● Include patient behaviors ○ Ex: ■ Goal: abulate 50 ft without SOB ■ Partially met: client walked 25 ft and ℅ SOB Ex: Sources of Data: ● ● ● ● ● ● ● ● Patient Family and significant others Patient record Medical history, physical examination, progress notes Consultations Reports of laboratory and other diagnostic studies Reports of therapies by other health care professionals Nursing and other health care literature Documenting Data ● Verbal report ● Database recording ● Summarizing ● Proper grammar Documentation (Chapter 19) Purpose of pt Records: - Communications - Education - Research, decision analysis Reimbursement Legal and historical documentation Care planning Effective documentation: - Consistent with hospital standards - Complete, accurate, and concise - Organized and timely - Confidential !!! - All information that is written, spoken, or saved on computer is confidential - Personal Info, reason they are sick, treatments, past health concerns ***Use 24 hour military time for documentation!*** CONFIDENTIALITY BREACHES: - Displaying information on a public screen - Sending confidential email messages via public networks - Sharing printers among units with differing functions - Discarding copies of patient information in trash cans - Holding conversations that can be overheard - Faxing confidential information to unauthorized persons - Sending confidential messages overheard on pagers Rights of the Patient: - See and copy their own record - Update their record - Obtain a list of charges for financial reasons - Request a restriction on certain information - Choose how to receive their health information (email, paper, etc.) **Patients cannot edit their records! Receiving Verbal Orders in an Emergency 1. Record the order in patients medical record 2. Read back the order (verify) 3. Date and time of the orders 4. Record verbal order and name of provider, filled by your name and initials 2 Types of Personal Health Records: § Standalone personal health records: Patients fill in information from their own records; the information is stored on patients' computers or the Internet. § Tethered/connected personal health records: Linked to a specific health care organization's electronic health record (EHR) system or to a health plan's information system. Problem-Oriented Medical Record - Defined Database - Problem List - Care plans - Progress notes - SOAP Format (Subject, Objective, Assessment, Plan) Medicaid Requirements for Home Healthcare: 1. Patient is homebound and still needs skilled nursing care. 2. Rehabilitation potential is good (or the patient is dying). 3. The patient’s status is not stabilized. 4. The patient is making progress in expected outcomes of care. Resident Assessment Tool Components 1. Minimum Data Set 2. Triggers 3. Resident assessment protocols 4. Utilization guidelines SBAR Situation Name, Room, Problem Background Vital signs, PMH, dx, etc Assessment Reason for calling Recommendation New orders Important Components of Rounding -Use Opening Key Words (C-I-CARE) with PRESENCE. → Connect, Introduce, Communicate, Ask and anticipate, respond, end with excellence § Accomplish scheduled tasks. § Address four Ps. § Address additional personal needs, questions. § Conduct environmental assessment. § Ask “Is there anything else I can do for you? I have time.” § Tell the patient when you will be back. § Document the round. Legal Issues Nurse Practice Act - protects public, legally defines nursing practice Credentialing - determines and maintains competent nurses Standards of Care - skills and learning Informed Consent ● Complete information, including benefits and risks ● Person performing the procedure must obtain the consent (usually physician or NP) ○ Nurses are witnesses ● No coercion ● 18 years old, conscious, oriented Delegation ● “transfer of responsibility for the performance of an activity from one person to another while retaining accountability for the outcome” (ANA) Death-Related Issues ● Advance Health Care Directives = Patient specifies their wishes in event they are unable to make or communicate their preferences ○ Living Will ■ specific medical treatment guidelines ○ Health Care Proxy ■ durable power of attorney ■ appoints someone else to manage a patient’s health care treatment ● Do-Not-Resuscitate Orders = aka “no-code” ○ Can be reversed ○ If you dont know status: you must resuscitate until you can can verify or obtain a DNR order Torts: ● Civil wrong committed against a person or person’s property ● Intentional or unintentional ○ Intentional Torts ■ Assault ● attempt or threat (proceeds battery) ■ Battery ● willful touching ■ False Imprisonment ● unjustifiable detention of person without legal warrant to confine the person ■ Invasion of privacy ● violating confidentiality ■ Defamation ● False communication about a person (fake news) ● Libel ○ print, writing, and pictures ● Slander ○ Spoken words ○ Unintentional Torts ■ Negligence ● misconduct or practice ● puts another person at risk for harm ■ Malpractice ● “professional negligence” ● professional wrongdoing or remarkable lack of skill Legal Protections in Nursing ● Good Samaritan Act ○ protect health care providers who provide assistance at the scene of an emergency ○ Unless there is willful wrongdoing or deviation from normal standard ● Professional Liability Insurance ○ covers the cost if a nurse is sued for negligence ● Carrying out the Physician’s Orders ○ nurse is responsible for validating and ensuring that an order is correct and valid for patient ○ Incorrect dosing, allergies, etc. ● Providing Competent care ● Documentation ○ Patient’s record is a legal document ○ Improper documentation could be negligence ● Incident Report ○ “unusual occurrence report” → NOT part of patient's medical record ○ Fill out immediately! (Date and time is important) LAB MATERIAL Lab 2 Content Important → BMI 18.5-25 is considered normal ➢ DIETS AND FEEDING MATERIAL ○ NPO → Nothing by mouth ○ Clear Liquid → Transparent to light and liquid at body temperature ■ Often used before colonoscopies or before and after surgery ● Water, broth, fruit juice, tea ● Gelatin ● Black coffee ● Hard candy ○ Full Liquid → Clear or Opaque, liquid foods at body temperature ■ For patients with difficulty chewing or swallowing, after surgeries ● All clear liquids ● Ice cream ● Fat free and 1% milk ● Pudding ● Sherbet ○ Pureed Diet → Foods that require NO chewing ■ Patients with trouble chewing, mouth pain, bad dental health ● All full liquid items ● Mashed potatoes ○ Mechanical Diet → Foods that require little to no chewing ■ Patients recovering from head, neck, or mouth procedures ● Chopped, group, pureed foods ● Tender fruits and veggies (Bananas) ● Tender meats ○ Low Residue/Low Fiber → limiting fiber intake to 10g per day ■ For pts with bowel issues, Chrons, Ulcerative colitis, or bowel surgery ● White rice ● White bread ● Refined cereals and pastas ○ High Residue/High Fiber → fiber intake of 20-35g per day ■ For constipated patients, sometimes used for IBS or Ulcers ● Whole grain products ● Fruits and vegetables ○ Consistent Carb → Diabetic Diet ■ Used to maintain blood sugar of diabetic patients ● Limit scratches, fruit, juice, milk, and sugars ● Control carb intake ○ Cardiac → created to minimize effect on heart health ● Limit fat and sodium intake ○ Sodium-Restricted ■ Patients with High blood pressure, kidney disease, heart problems ● Limit sodium to a set amount ● Avoid canned, frozen, boxed, processed foods Lab 3 Content ➢ OCCULT BLOOD TESTING ○ Hemoccult → a convenient, qualitative procedure that uses a guaiac paper slide test blood in the ■ For hospital patients to monitor gastrointestinal bleeding in patients with iron deficiency anemia, or recovery from surgery, peptic ulcer, ulcerative colitis, and in screening programs for colorectal cancer ● Negative → No color change ● Positive → Blue ring around fecal matter, indicates blood in the stool Lab 4 Content ➢ OBTAINING URINE SPECIMENS (goes with Labs & Diets lecture) ○ NOT via Catheter 1. Wash hands, ID patient, clean gloves 2. Separate labia/retract foreskin and clean area 3. Have patient void about 30mL into toilet or bed pan 4. Position sterile specimen cup near but not touching the patient 5. Have patient void 10mL into specimen cup 6. Remove cup before patient finished emptying bladder 7. Package specimen and send to lab ○ Via Catheter ■ Can only take from the bag if it is right after you insert the catheter ■ Preferred method is to use syringe to draw from access port on tubing Lab 5 Content ➢ Medication Administration (non-parenteral & parenteral) ○ 5 Rights of medication administration → right patient, medication, route, dose, and time ○ 3 checks of medication administration 1. When the nurse reaches for the unit dose package or container 2. After retrieval from the drawer and compared with the eMAR/MAR, or compared with the eMAR/MAR immediately before pouring from a multidose container 3. Before giving the unit dose medication to the patient, or when replacing the multidose container in the drawer or shelf ○ NON-PARENTARAL ■ Make sure to note is pill is extended-release or enteric coated → do not cut these pills ■ For buccal and sublingual, offer the ot a drink before administering to ensure it can dissolve ■ For enteral feeding → check residual volume before feeding ■ For enteral medication → be sure to flush tube before and after ■ Always lubricate rectal and vaginal suppositories ○ PARENTERAL ■ Ampule → always use filter needle to draw up medication ■ Always insert air into the vial and then draw medication ■ Always clean the top of the vial ■ One hand recap to avoid needle sticks ■ Z-tract method → deep IM method for irritating medications ■ PCA → Patient Controlled Analgesia ■ Epidural → into the space outside the dura mater ■ IVPB is usually for antibiotics or electrolytes Subcutaneous Intramuscular Intradermal Syringe size 1-3 mL 3-5mL 1mL Tuberculin syringe Needle gauge #24-#26 #20-#25 #25-#27 ⅜-⅝ inch 1-1.5 inch ¼-½ inch 45-90 degrees 90 degrees 15 degrees 1 mL or less Deltoid = max 1 mL Gluteal = 1-3mL .1 - .2 mL Yes No No AIRLOCK HEPARIN Insulin syringe = orange cap only Aspiration not needed any more Bevel up, mark site Needles Length Angle Amount per injection Pinch? Special Considerations ➢ Blood Sugar Check ○ Scan test strip and insert in machine ○ Clean finger ○ Prick finger and wipe first blood drop with cotton ○ Squeeze finger for second blood drop ○ Place strip perpendicular to blood drop ➢ Transcribing Orders ○ Ac → Before meals ○ Pc → after meals ○ Bid → twice a day ○ Gtt → drops ○ Pr → per rectum ○ Q3h → every 3 hours ➢ PINCH Drugs ○ Potassium ○ Insulin ○ Narcotics ○ Chemotherapy ○ Heparin ***PINCH drugs have to be double checked with another nurse!!*** INTRAMUSCULAR INJECTION SITES Lab 6 Content ➢ Medication Administration – Mixing Insulins ○ Cloudy to clear → Clear to cloudy ○ NPH (Long acting) → Regular → Regular → NPH ➢ Sliding Scale Insulin ○ Insulin administered is based on pre-meals time glucose levels ○ If mixing insulin for sliding scale → The amount of long acting insulin always stays the same Tips for Studying: When you study, think deeper than memorization. If you are studying a complication of something, how would you know this complication is occurring? How do you prevent the complication? What should you do first? READ. When you read the question – are there key words to help you? Is there something about THIS patient that makes them different than others? Note key words/phrases such as NOT or FIRST or EXCEPT or NEED FOR FURTHER TEACHING. Consolidate notes and begin taking out information that you know. Spend your time concentrating only the items that you don’t know. As you know more, take out that information. Studying Resources: Practice questions available for each chapter in textbook You can create flashcards easily sorted by topic with online resources of textbook Kaplan website has practice questions & videos available
