Five rights of delegation
Right person
Right task
Right circumstance
Right direction and communication
Right supervision and
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Non-delegatable tasks
Nursing process
Client education
Tasks that require nursing judgement (care of unstable patients)
LPN delegation
Tracheotomy care
Suctioning
Inserting urinary catheter
Checking NG tube patency
Medication administration
Sterile specimen colection
Reinforce client teaching
AP delegation
ADLs
Ambulating
Feeding
Positioning
Vital signs
I&Os
Autonomy
The right to make ones own decisions
Beneficence
The obligation to good for others
Confidentiality
The obligation to observe the privacy of another and maintain strict confidence
Fidelity
The obligation to be faithful to agreements and responsibilities, to keep promises
Justice
The obligation to be fair to all people
Nonmaleficence
The obligation to do no harm to others
Paternalism
Assuming the right to make decisions for another
Veracity
The obligation to tell the truth
Nurses role of informed consent
Ensure the provider gave the necessary information
Ensure the client understands the procedure
Patient must be competent to sign informed consent
Witness the clients signature
Notify the provider if clarification is needed
Mandatory Reporting
Abuse - vulnerable populations
Communicable diseases
Malpractice
The failure of a person with professional training to act in a reasonable an prudent manner within the identified scope of practice
Negligence
The omission to do something that a reasonable person would do or something that a reasonable person would not do
Emergency class 1 (red tag)
Immediate threat to life
Do not delay care
Urgent class 2 (yellow tag)
Major injuries that require treatment
Delay of 30 minutes to 2 hours
Non-urgent class 3 (green tag)
Minor injuries that do not require immediate attention
Delay of 2-4 hours
Expectant class 4 (black tag)
Expected/allowed to die
Prepare for morgue
TPN
Monitor serum glucose ever 4-6 hours
Change dressing every 48 - 72 hours
Change IV tubing and fluid every 24 hours
If solution is temporarily unavailable, administer 10% dextrose in water to prevent hypoglycemia
Acetaminophen (antidote)
Acetylcysteine (antidote)
Benzodiazepine (antidote)
Flumazenil (antidote)
Curare (antidote)
Edrophonium (antidote)
Cyanide poisoning (antidote)
Methylene blue (antidote)
Digitalis: (antidote)
Digoxin immune FAB (antidote)
Ethylene poisoning (antidote)
Fomepizole (antidote)
Heparin and enoxaparin (antidote)
Protamine sulfate (antidote)
Iron (antidote)
Deferoxamine (antidote)
Lead (antidote)
Succimer (antidote)
Magnesium sulfate (antidote)
Calcium gluconate 10% (antidote)
Narcotics (antidote)
Naloxone (antidote)
Warfarin (antidote)
Phytonadione (vitamin K)(antidote)
Calcium channel blockers
Suffix: dipine
Causes: arterial dilation and decreased BP
For: angina and HTN, verapamil and diltazem can be used for a-fib, a-flutter, svt
Precautions: digoxin and beta blockers
Contraindication: heart failure, heart block, of bradycardia
Side effects: reflex tachycardia, peripheral edema, and toxicity
Monitor: BP and HR
Do not drink grapefruit juice
Do not crush/chew
IV administration 2-3 minutes
ACE inhibitor
Suffix: pril
For: hypertension, heart failure, MI, and diabetic nephropathy
Monitor potassium, BP, angioedema
Captopril should be taken 1hr before meals
ARBS
Suffix: tan
For: hypertension, heart failure, MI, and diabetic nephropathy
Monitor potassium, BP, angioedema
Beta 2 adrenergic agonists
For: Respiratory
Albuterol - short acting (inhaled) for acute bronchospasm, onset 5-15 min
Formoterol - long acting/long-term control (inhaled), onset 1-3 min, duration 10hr
Salmeterol - long acting/long-term control (inhaled), onset 10-20 min, duration 12hr
Terbutaline - long acting/long-term control (oral)
Precautions: increased heart rate, tremors, beta blockers will decrease effect, MAOIs will increase effect
Antilipemic
Suffix: statin
For: reduction of formation of cholesterol precursors
Drug interactions: digoxin, warfarin, thyroid hormones, thiazide diuretics, phenobarbital, NASIDs, tetracycline, beta blockers, gemfibrozil, glipizide, glyburide, oral contraceptices, and phenytoin
Do not administer with grapefruit juice
Glucocorticoids
Suffix: one, ide & ate
For: Prevention of inflammatory responses by suppression of airway mucus production
Interaction: DM may require higher doses
Side effects: insomnia, psychotic behavior, hyperglycemia, peptic ulcer, fluid retention, withdrawal symptoms, increased appetite, risk for infection (prednisone & methotreaxate), risk for osteoporosis (prednisone)
Administer medication with meals
Do not take with NSAIDs
Beta blockers
Suffix: olol
For: decreased cardiac excitability, cardiac output, myocardial and oxygen demand
Use: primary HTN, angina, tachydysrhythmias, heart failure, and MI
Contraindications: AV Block and sinus tachy, asthma, bronchospasms, or heart failure
Side effects: nasal stuffiness, bronchospasms
Monitor blood glucose with propranolol
Do not administer labetalol in same IV as furosemide
Do not crush/chew
Hold medications if pulse is less than 60 or systolic BP is less than 100
Vasodilators
Nitroglycerine, enalaprilat, nitroprusside, hydralazine
For: vasodilation of arteries and veins resulting in decreased blood pressure
Precautions: hepatic and renal disorders, older adults, electrolyte imbalances
Side effects: cyanide toxicity
Nitroprusside may not be mixed with any medication
Continuious ECG and BP monitoring
Insulin
Lispro: rapid acting, 15-30 min
Regular: short-acting, 30min-1hr
NPH: intermediate acting, 1-2hr
Insulin glargine (lantus): 70 minutes
Do not mix lantus with other insulin's (in syringe)
Draw up regular and then NPH
Regular insulin is the only insulin given IV (used for DKA) [Show Less]