Jeopardy Topics: THE CLOT STOPS HERE (anticoagulants) SUGAR, SUGAR, HOW D YOU GET SO HIGH (insulins)

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1 Jeopardy Topics: THE CLOT STOPS HERE (anticoagulants) SUGAR, SUGAR, HOW D YOU GET SO HIGH (insulins) I HEAR YA KNOCKING BUT YOU CAN T COME IN (electrolytes) TAKE MY BREATH AWAY (Opiates-morphine) OUT WITH BAD IN WITH THE GOOD (chemotherapeutic agents) RUNNING ON EMPTY (adrenergic agonist: epinephrine and dopamine)

2 JEOPARDY QUESTIONS: ANTICOAGULANTS: Anaphylaxis, hypotension, Vasospasm, ecchymosis, Eczema, injection site pain, Tissue necrosis, hematoma, HIT (What are adverse reactions?) The maximum initial bolus dose of Heparin for patients receiving thrombolytic therapy or glycoprotein inhibitors is. (what is 0 units?) Must be checked by 2 RN s and/or LPNs at least once a shift & documented on the MAR. (what is a Heparin infusion per Bayhealth Policy B ) Nurse must complete this when initiating Heparin therapy. (what is the anticoagulant flow sheet?) This is recognized by a low blood platelet count resulting from the use of Heparin. It can be mild, serious and/or fatal. Tx is prompt withdrawal of Heparin and replacing Heparin with a suitable alternative anticoagulant. (what is HIT (heparin induced thrombocytopenia)

3 INSULINS: NO REAL PEAK, USUALLY GIVEN ONCE A DAY AT BEDTIME (CAN BE GIVEN TWICE A DAY) (what is Lantus or Levemir) I M THE ONLY INSULIN GIVEN AS A DRIP (WHAT IS REGULAR) I M AN ANALOG MIX INSULIN, I PEAK AT 1 TO 4 HOURS & CAN LAST AS LONG AS 18 HOURS (what is Novolog Mix 70/30) NPH (GREEN), NOVOLIN 70/30 (BROWN), &/or REGULAR R (YELLOW) CAN BE GIVEN ONLY WITH THIS DEVICE (what is the Innolet insulin delivery device) NAME ONE OF THE THREE INSULINS GIVEN VIA THE FLEXPEN INSULIN DELIVERY DEVICE (what is Novolog (orange), Novolog Mix 70/30 (blue) or Levemir (green))

4 Electrolytes: THIS PIECE OF EQUIPMENT IS ESSENTIAL WHEN POTASSIUM IS TO BE INFUSED (What is an IV pump) IV SITE IS RED, PAINFUL, & EDEMATOUS. MAY SEE A RED STREAK UP THE ARM (What is an IV Potassium infiltration) HELPS MAINTAIN ACID-BASE BALANCE, ACTIVATES NERVE & MUSCLE CELLS, & INFLUENCES WATER DISTRIBUTION (WITH CHLORIDE) (What is Sodium (NA)) PLAYS A VITAL ROLE IN MAINTAINING ACID-BASE BALANCE; COMBINES WITH HYDROGEN IONS TO PRODUCE HYDROCHLORIC ACID (What is Chloride (CL)) MAY RESULT IN CARDIAC ARREST AND DEATH! (what is injected undiluted IV Potassium)

5 OPIATES-MORPHINE: DEPRESSED RESPIRATORY STATUS, CONSTIPATION, URINARY RETENTION AND HALUCINATIONS (what are the side effects of morphine) TWO NURSES WITNESS THIS AND DOCUMENT IN PYXIS (what is the protocol for wasting narcotics) I AM A CONCENTRATED FORM OF LIQUID MORPHINE (What is Roxanol) PATIENT ON MORPHINE PCA: MONITORING WOULD INCLUDE (What are vital signs (esp. respirations), pain location, intensity, & character, monitoring fluid intake and output (urinary retention), monitor bowel evacuation pattern, & assess neurologic status) Roxanol 16MG = ML PO (YOU HAVE ROXANOL 20MG/ML) (What is 0.8 ml)

6 Chemotherapeutics: WEAR PROTECTIVE CLOTHING, AVOID SPLATTERING BODY FLUIDS, LABEL ALL LABORATORY SPECIMENS CAUTION: CHEMOTHERAPY OR BIOHAZARD (What are interventions to minimize risk of indirect exposure from body fluids of clients) PATIENT S CORRECT NAME, CORRECT DOSE (ON FRONT AND BACK LABEL) AT KGH, AND ON FRONT OF LABEL AT MMH (what are steps taken prior to administration) ORDERS FOR CHEMOTHERAPY SHOULD NEVER BE ACCEPTED BY THIS METHOD (what are verbal orders) ONLY CHEMOTHERAPY NURSES MAY ADMINISTER AGENTS BY THIS ROUTE (what is IV push) NAUSES/VOMITING (MILD TO DEBILITAKING), BONE NARROW SUPPRESSION LEADING TO NEUTROPENIA AND THROMBOCYTOPENIA (what are adverse effects of chemotherapeutic agents)

7 ADRENERGIC AGONISTS: (E.G. EPINEPHRINE & DOPAMINE) 1:0, 1:10,000 &1:,000 (what are concentrations for epinephrine) USED TO TREAT SHOCK & HEMODYNAMIC IMBALANCE UNRESPIONSIVE TO FLUID REPLACEMENT; HYPOTENSION (what is DOPAMINE) DO NOT USE FOR PATIENTS WITH NARROW ANGLE GLAUCOMA, CARDIAC DISEASE, CEREBRAL ATERIOSCLEROSIS (what is epinephrine) HEADACHE, HYPOTENSION, ANGINA, ECG CHANGES, PALPITATIONS, TACHYCARDIA, VASOCONSTRICTION, & ARRHYTHMIAS (what are adverse reactions) CAUSES NOREPINEPHRINE RELEASE, WHICH LEADS TO VASODILATION OF RENAL & MESENTERIC ARTERIES, EXERTS INOTROPIC EFFECTS ON HEART, -INCREASES HR, BLOOD FLOW MYOCARDIAL CONTRACTILITY, & STROKE VOL. (what is the mechanism of action of dopamine)

8 FINAL JEOPARDY Weight Based Heparin Protocol Orders Ms W has been admitted to a Med/Surg unit with a diagnosis of DVT Doctor marked the box for Non-Acute Coronary Syndrome on the Protocol orders Ms W is 5 4 and weighs 182 pounds Ms W s PTT on admission is 46. Calculate the following: 1. Initial bolus dose 2. initial IV infusion rate answers: weight=82.7 kg 80 units/kg X 82.7 kg = Round to 6600 units bolus (no maximum) 18 units/kg/hour 18 units X 82.7 kg X 1 hour = Round to 1 units/hour