an L.PN starting a morning shift at a long-term care with 25 residents. You need

Question

an L.PN starting a morning shift at a long-term care with 25 residents. You need to Patient A needs pain medications for arthritis. Patient B complains of chest pain and Blood Pressure is 180/92. atient C is waiting for discharge. The family is waiting for the paperwork. Patient D needs her nasal cannula repositioned and O2 Sat is 88% in room air (patient has prioritize, for there are 4 patients needing your immediate attention. 2-liter oxygen through nasal cannula always). A) List the patients in the order you will address them and why.(4 points) 1) 2) 3) 4) 3. What the 6 Rights in administering medication? (3 points) 4. How do you mix Short-Acting (Clear) Insulin with Long-Acting (Cloudy) Insulin in one syringe? (3 points)

Explanation / Answer

2.

A) List of patients based on the priority:

1) Patient-D needs her nasal cannula to be repositioned and O2 saturation is 88% in room air.

This should be given first priority because hypoxia leads to serious complication and repositioning requires only 1 or 2 min. Patient already in oxygen supplementation. Check nasal prongs placed in a proper position and flow rate is set correctly. Ensure the tube is not kinked for blocking of oxygen flow. Check Oxygen saturation in pulse oximetry and it should be maintained above 92%.  

2) Patient B complaints of chest pain and Blood pressure is 180/92.

Next priority is given to this patient. The patient may develop myocardial infarction so the immediate medical attention is needed. Assess the patient pain level using pain scale. Check for vital signs, oxygen saturation, and administer oxygen as needed via a face mask. Inform the physician in the meantime connect monitors to detect any abnormalities in the rhythm and keep ready all emergency medication and all needed equipment.

3) Patient A needs pain medication for arthritis.

Nurses play a vital role in the management of pain. Stiffness, swelling, may cause pain in arthritis patient. Administer NSAIDS as per the physician order to relieve the pain.

4) Patient C is waiting for discharge. The family is waiting for paperwork.

It is also important but not an emergency need. So the LPN can give last priority to this patient.

3. 6 Rights in administering Medications:

4. Mixing of short-acting insulin with Long-acting insulin:

This is helpful for giving of both insulins in a single shot. Keep in mind always withdraw clear insulin first and then cloudy insulin to avoid mixing of cloudy insulin into clear insulin bottle. the sequence of mixing is as follows

Step 1:

Roll the bottle of cloudy insulin between the hands to mix well.

Step 2:

Clean both bottle tops with alcohol wipes.

Step 3:

Pull the plunger of the syringe as the dose needed for long-acting(cloudy) insulin. Then inserted the air into the Long-acting insulin by placing the insulin on the table and inserting the needle into rubber top.

For EX: Order of long-acting insulin is 12 units, then pull the plunger up to 12 units and inserted the air of 12 units into the Long-acting insulin bottle.

Step 4:

In the same way, pull the plunger up to the dose of short-acting insulin, so the air enters into the syringe. Then inject the air into short-acting insulin bottle.

For EX: The dose of short-acting insulin is 8 units, then pull the plunger up to 8 units and insert air into the short-acting insulin bottle.

Step 4:

Then placing the short-acting insulin bottle upside down and check the place the tip of the needle in the liquid. pull the plunger as the air goes upside, the insulin withdraws into the syringe until all the air pushes back from the bottle. check for the dosage. Then remove the needle from the bottle.

For EX: By placing upside down of short-acting insulin bottle, the air pushes back from the bottle, so that 8 units filled in the syringe.

Step 5:

Take the long-acting insulin, turn upside down, insert the needle into the rubber top and keep the tip of the needle in the liquid part, withdraw the plunger until it fills to the 12 units. check for correct dosage in the syringe and remove the needle and syringe.

For EX: In the same way, when inserting into the long-acting insulin as already pushed air into the bottle which pushes back into the syringe so the needed 12 units of insulin withdrawn into the syringe.

Step 6:

Check the total dose of insulin and administer.

For EX: Total 20 units should be withdrawn into the syringe before administration.

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