Via is getting nervous. A few more days and she’ll be taking the test that would determine whether or not she’s fit to become a Registered Nurse. However, there’s a problem. She still can’t memorize some nursing concepts, such as the normal laboratory values. She develops a plan of making a cheat sheet that she could post on her wall and/or carry around for easier memorization, but what should she include in that cheat sheet?
When it comes to prioritization, ABCs are always the first priority.
Airway – Is it clear? If it isn’t, we’ll never get to the next letter:
Breathing – If this isn’t possible oxygen won’t reach the lungs and be transported around the body in the blood, know as:
Circulation – Without which hypoxia and cardiac arrest will ensue.
These are the basic life-saving principles and they combine with that only slightly lesser known phrase, “look, listen, and feel.” Look in the mouth to make sure airway is clear, listen for breath, and feel for pulse.
Maslow’s Hierarchy of Needs
Human needs are ranked on an ascending scale according to how essential those needs are for survival. They serve as a framework for assessing behaviors, assigning priorities to outcome criteria, and planning nursing interventions.
Abraham Maslow ranked human needs on five levels.
Physiologic Needs – Needs such as air, food, water, shelter, rest, sleep activity, and temperature maintenance, are crucial for survival.
Safety and Security Needs – The need for safety has both physical and psychological aspects. The person needs to feel safe, both in the physical environment and in relationships.
Love and Belonging Needs – The third level of needs includes giving and receiving affection, attaining a place in a group, and maintaining the feeling of belonging.
Self-esteem Needs – The individual needs both self-esteem (i.e., feelings of independence, competence, and self-respect) and esteem from others (i.e., recognition, respect, and appreciation).
Self-actualization – When the need for self-esteem is satisfied, the individual strives for self-actualization, the innate need to develop one’s maximum potential and realize one’s abilities and qualities.
The Nursing Process
The nursing process is a systematic, rational method of planning and providing individualized nursing care. The nursing process allows for RNs to use time and resources more efficiently, to both their own and their client’s benefit.
Assessing – Collecting data.
Diagnosing – Figuring out what is the problem.
Outcome/Planning – How to best manage the problem.
Implementing – Putting the plan into action.
Evaluating – Did the plan work?
The Six Rights
All medication errors can be linked, in some way, to an inconsistency in adhering to these “rights” when giving meds to patients.
Right Client – To identify a client correctly, the nurse must check the medication administration form against the client’s identification bracelet and ask the client to state his or her name to ensure the ID band is correct.
Right Medication – This is a multi-step process. The medication should be check against the medication order and the medication label. Nurses should only administer medications they prepare and verify. If an error occurs, the nurse who give the medication is the one responsible for the error.
If a client questions the medication a nurse is about to give it is important not to administer it until it can be rechecked against the prescriber’s order. An alert client will know if a medication is different from those received before.
Right Dose – The unit dose system is designed to minimize errors. If a medication must be prepared from a larger volume or strength than needed or when the prescriber orders an amount different than what the pharmacy supplies, the chance for a mistake multiplies. When performing medication calculations or conversions, have a colleague, another qualified RN check the calculated dose.
Right Time – The nurse must understand why a medication is ordered for certain times of day and whether that time schedule can be altered.
Right Route – If a prescriber’s order does not designate a route of administration such as orally or by injection or IV (intravenously) the nurse must consult the prescriber. If the prescribed route is not the recommended route the nurse should double check with the prescriber.
Right Documentation – This is a fairly new addition to the traditional “Five Rights” but has been widely adopted by facilities and caregivers. Many medication errors result from inaccurate documentation. The documentation should clearly reflect the patient’s name, the name of the ordered medication, the time the drug was given and the medications dosage, route and frequency. After giving the medication the MAR must be completed per facility policy.
Basic Lab Values
It is important for you to remember normal lab values because they might be included in questions throughout the test.
Magnesium: 1.6-2.6 mg/dL
Sodium: 135-145 mEq/L
Hemoglobin: 12–16 g/dL Women; 14–18 g/dL Men
Hematocrit: 37 – 48% Women; 45 – 52% Men
Arterial Blood Gases (ABGs)
pCO2: 35-45 mEq/L
HCO3: 24-26 mEq/L
Glucose: 70–110 mg/dL
Specific gravity: 1.010–1.030
BUN: 7–22m g/dL
Serum creatinine: 0.6–1.35 mg/dL (< 2 in older adults)