SBAR Review

The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient's condition. SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety.
From: SBAR Technique for Communications -- a Situational Briefing Model

Other SBAR information:

• Talking the Talk: How Hospitals Use SBAR to Standardize Communication
• A Sample of How to Use SBAR
• SBAR report to physician about a critical situation (pdf)

Tis the Season

There's a Christmas tree in upper Danner that Gloria and her team of elves put together, and a toy drive for the kids at Family Ties is underway. SNA is looking for donations and volunteers!

Read more about these activities at http://sjdcsna.blogspot.com/

Also, the Student Nursing Association has just elected new officers. That information will be posted on the SNA blog soon...

Peds Cardiovascular Questions

1. which might be found indicating a cardiac defect when assessing a 1 month old infant?
a. Weight gain
b. Hyperactivitry
c. Poor nutritional intake
d. Pink mucous membranes
2. which statement about PDA is correct?
a. HF is uncommon
b. The ductus normally closes completely by age 6 wks
c. An open ductus arteriosus causes decreased blood flow to the lungs
d. It represents a cyanotic defect c decreased pulmonary blood flow
3. which drug is recommended for a preterm neonate to close a PDA?
a. Indomethacin
b. Prostaglandin E1
c. Surgical ligation
d. Cardiac cath
4. which finding is expected in a child c PDA?
a. Weak peripheral pulses
b. Machine like murmur
c. Narrowed pulse pressure
d. RV hypertrophy
5. which may be seen in a child c VSD?
a. Cyanosis of nailbeds
b. Above average height on growth chart
c. Above average weight gain on growth chart
d. Pink nailbeds c cap refill les than 2 secs
6. which conditions best describes VSD?
a. Narrowing of the aortic arch
b. Failure of the septum to develop completely between the atria
c. Narrowing of the valves at the entrance of the pulm artery
d. Failure of the septum to develop completely between the ventricles
7. which curative surgical intervention is recommended for a child c VSD?
a. Surgery c PA banding
b. Defect repair thru cardiac cath
c. Surgery c purse string suture or dacron patch repair
d. Surgery when severe pulm HTN is noted
8. a child c VS repair is receiving dopamine post op. which response is expected?
a. Decreased HR
b. Decreased UO
c. increased CO
d. Decreased contractility
9. which produces left to right shunt?
a. ASD
b. Pulmonic stenosis
c. Tet of fallot
d. Total anomalous pulmonary venous return
10. a child c AS respire is entering postop day 3. whch intervention would be most appropriate?
a. Child to be NPO
b. Maintain strict bedrest
c. Take VS q 8 hrs
d. Admin analgesic prn
11. which condition best describes coarctation of th aorta?
a. Absent tricuspid valabe
b. Narrowing in the area of the aortic valve
c. Localized constrxn or narrowing of the aortic wall
d. Narrowing at some location along RV outflow tract
12. what assessment finding would be expected c Coarc of aorta?
a. Normal BP
b. Increased BP in upper extremities
c. Decreased BP in upper extremities
d. Decreased or absent pulses in upper extremities
13. which procedure is recommended to tx coarc?
a. Drug therapy
b. Balloon angioplasty
c. Surgery s CPbypass
d. Surgery c CP bypass
14. which is an important assessment for a child c a possible cardiac anomaly?
a. HR
b. Temp
c. BP
d. BP in 4 extremities
15. which intervention is recommended post op for a pt c coarc repair?
a. Vasoconstrictor
b. Main hypothermia
c. maintain a normal to low BP
d. Gove a bolus of IV fluids
16. which is expected when assessing a child c tet of fallot?
a. Machine like murmur
b. Eisenmenger’s complex
c. Increasing cyanosis c crying or activity
d. Higher pressures in the upper extremities than lower
17. which is correct for achild c tet?
a. The condition is commonly referred to as “blue tets”
b. They experience hypercyanotic or “tet” spells
c. They experience frequent respiratory infxns
d. They experience decreased or absent pulses in lower extremities
18. which best describes transposition of the great arteries?
a. The body receives only saturated blood
b. Its classified as an acyanotic defect c increased pulmonary blood flow
c. the PA leaves the LV and the aorta exits the RB
d. It’s a condition in which the RA and the LA empty into one ventricular chamber
19. which statement about transposition is correct?
a. Dx is made at birth
b. Dx can be made in utero
c. CXR can show an accurate view of the defect
d. HF isn’t a related complication
20. which defect is associated c transposition of the great arteries
a. mitral atresia
b. ASD
c. Patent foramen ovale
d. Hypoplasia of the LV
21. which surgical prodecure is recommended for repair of transposition?
a. Jatene operaqtion
b. Fontan procedure
c. Balloon atrial septostomy
d. Blalock-taussig operation

Here are a couple of links related to shock I found on Bonnie's site:

• CCM tutorial
• Study stack

Also, back in October, Trina posted two sets of NCLEX-style questions below if you want to test yourself. (Just scroll down the page...)

I found a good PowerPoint presentation -- Identification of shock states that Caralee Bromme put together when she taught N7, plus our ATI book's got a nice little review starting on page 341.

So -- once again -- we have lots of good information, just too little time to absorb it all!

Ah... the last exam of the third semester...

More respiratory for visual learners

Many of the following videos have more than one part. If you like the first part, look for the other parts once you're in YouTube. They should be listed nearby.

• Respiratory system (good overview)
• Gas exchange
• Microanatomy of the lungs
• Intubation during general anesthesia
• Mechanical ventilation
• Ventilator types and modes
• Mechanics of breathing
• Oxygen transport
• CO2 transport
• Flail chest - paradoxical breathing
• Chest tube insertion/pneumothorax
• Tracheostomy dressing change
• Tracheal suctioning
• Understanding COPD
  

Respiratory resources

Need a little refresher on ABGs? Here are a couple good links:

• ABG interpretation quiz
• ABG tutorial

Here's another good one:

• Pulmonary system (CCM tutorial)

The above links are on Bonnie Boss' Test Bank, along with lots of NCLEX practice.

Also, don't forget to check out Bromme's old N7 lectures. There are two good PowerPoint presentations there on the respiratory system.

Oxyhemoglobin dissociation curve links:

• Interactive tool
• The curve described

For visual learners

Videos you might find interesting...

• PCI (stenting)
• LVAD (left ventricular assist device)
• VADs for lifetime use
• VAD how it works
• CABG surgery (patient education)
• Bypass surgery
• Actual CABG surgery
• CAD treatment lifestyle changes
• Myocardial infarction
• Internal jugular vein catheter insertion
• Atrial fibrillation
• PR Interval
• Basic gross anatomy of the heart
• Cardiac cycle
• Myocardial infarction
• T wave inversion (diagnostic MI)
• ST elevation (MI)
• Understanding heart disease
• Cholesterol
• What is a heart attack?
• What is angina?
• Congestive heart failure
• Understanding cholesterol
• Emergency echocardiography

Plus...
Nursing 7 stuff on Docushare (C. Bromme, RN, MSN)

hemodynamics

Links to some handy resources:

• Swan-Ganz catheterization (article)
• Swan-Ganz catheters (article)
• Hemodynamics (article)
• Pressure changes (same as image above)
• Catheter placement (image)
• The catheter (image)
• Hemodynamic insufficiency
• Nurse Bob's hemodynamic overview (article)
• Hemodynamic monitoring (interactive)
• Good instructional videos -- scroll down to "hemodynamic monitoring" and "PA line insertion"

EKGs

Link here for EKG fun!

• EKG quizzers #1 and #2
• ECG rules quiz
• Six-second ECG (dynamic simulator)
• Waves (illustration)
• Remember the J point? (illustration)
• Cardiac rhythm interpretation
• ECG patterns in MI (image from heart attack treatment)
• What is wrong with this EKG? (a colorful printable pdf)

pediatric nursing and development questions

Click on the comments section to take a pediatric development quiz.

The answers are also in the comments section.

good luck!

Nursing 7 resources

Trina has posted lots of good stuff on this blog for Nursing 7, including the link to an explanation of the RAAS on Wikipedia. It was so helpful to me, I thought I should repost it, closer to the top... Check it out at this link... Renin-Angiotensin-Aldosterone System. (Thanks, Trina!)

Note: the author's starting point on the diagram is a decrease in renal perfusion, but -- in his/her notes -- points out there are other ways RAAS can be activated -- "...by a low NaCl concentration in the macula densa or by sympathetic activation."

Be sure to scroll down for all the Nursing 7-related information. There are lots of other good posts by Trina and others, like Bonnie's links to information on hemodynamic basics or links to videos to refresh your clinical skills, next to the Starbucks IV bag below. Drink it up, y'all!

Nursing 7 is the perfect time to reacquaint yoursef with (or introduce) the information available on Bonnie Boss' "original" student blog she created for fellow SJDC nursing students. In addition to her excellent test bank, bringing us tons of NCLEX practice, she includes many links to supplementary information on a variety of relevant topics under "practice tests and quizzes" and "helpful links." Get to know what's out there. Bonnie's already done a lot of the legwork for us.

(Muchas gracias, Bonnie!)

FYI, Bonnie's now a full-time RN working in ICU at Lodi Memorial.

more shock

1. Which is the most important goal of nursing care for a pt who is in shock?
a. Manage fluid overload
b. Manage increased CO
c. Manage inadequate tissue perfusion
d. Manage vasoconstrxn of vascular beds
2. Which nursing assessment finding indicates hypovolemic shock in a pt who has had a 15% blood loss?
a. Pulse <> 30mL/hr
b. Systolic bP > 110
c. Diastolic > 90
d. RR of 20 braeths/min
4. which is a risk factor for hypovolemic shock?
a. Hemorrhage
b. Antigen antibody rxn
c. Gram neg bacteria
d. vasodilation
5. what is a priority assessment for the pt in shock who is receiving an IV infusion of PRBC and NS?
a. Fluid balance
b. Anaphylactic rxn
c. Pain
d. ALOC
6. the pt who does not respond adequately to fluid replacement has an order for an IV infusion of dopamine hydrochloride at 5u/kg/min. the desired fx of the drug is
a. increased renal and mesenteric BF
b. increased CO
c. vasoconstrx
d. reduced preload and afterload
7. A male pt who has been taking coumadin has been admitted c severe acute rectal bleeding and the following lab results: INR 8, Hmg 11, hematocrit 33%. Which MD orders would the nurse expect to implement initially? Select all that apply.
a. IV D5 ½ NS
b. Schedule pt for sigmoidoscoy in the AM
c. Give 1 unit FF plasma
d. Admin vitamin K 2.5 mg PO
e. Begin polyethylene glycol-electrolyte solution in preparation for signoidoscopy
f. Admin fleet’s enema
8. the nurse in perop holding area keeps a pt c gastric bleeding in a dimly lit environment c one family member present. What is the primary rationale for these nursing interventions?
a. Stabilize fluid and lyte balance
b. Minimize O2 consumption
c. Increase pt and family comfort
d. Prevent infxn
9. when assessing a pt for early septic shock, the nurse observes for which of the following?
a. Cool clammy skin
b. Warm flushed skin
c. Decreased systolic bp
d. hemorrhage
10. a pt c toxic shock has been receiving ceftriaxone sodium, in add’n to culture and sensitivity studies. What other lab finding does the nurse monitor?
a. Serum creat
b. Spinal fluid analysis
c. ABG
d. Serum osmolality
11. what intervention is most important in preventing septic shock?
a. Admin IV fluid replacement therapy as orderd
b. Obtaining VS q 4 hrs for all pts
c. Monitoring RBC counts for elevation
d. Maintaining asepsis of indwelling urinary catheters
12. which is a indication of a complication of septic shock?
a. Anaphylaxis
b. ARDS
c. COPD
d. Mitral valve prolapse

Congenital Heart Defects

Thanks, Crista for the link to Mayo Clinic's slideshow on common congenital heart defects.

There are also some handy little animations of blood flow through various defects on our textbook's CD for chapter 48.

Peds was fun but we are definately ready to get 7 over with. How is it so far??

Shock it to me!!

1. DIC often results in complications initially associated c which of the following organs?

a. brain

b. kidney

c. lung

d. stomach

2. Which conditions is not caused by DIC?

a. organ tissue damage

b. depletion of circulating clotting factors

c. thrombus formation in the large vessels

d. activation of the clotting dissolving process

3. A 19yo pt admitted c heat stroke begins to show signs of DIC. Which lab finding is most consistent c DIC?

a. low platelet count

b. elevated fibrinogen levels

c. low levels of fibring degradation product

d. reduced PT time

4. Vasopressors may be indicated in which type of shock?
a. neurogenic
b. hypovolemic
c. respiratory
d. metabolic

5. For every unit of blood lost in trauma, how much crystalloid must be infused?
a. twice as much
b. equal amount
c. half as much
d. three times the amount

6. Which drug is a parasympathetic antagonist?
a. lidocaine
b. atropine
c. digoxin
d. dopamine

7. A heat exhaustion patient is suffering from what type of shock?
a. cardiogenic
b. neurogenic
c. hypovolemic
d. metabolic

ARDS and ABGs

1. which intervention would be most likely to prevent ARDS?
a. Teach cigarette smoking cessation
b. Maintaining adequate serum K levels
c. Monitoring pts for signs of hypercapnia
d. Replacing fluids, adequately during hypovolemic states

2. Which ND would be a priority for a pt c ARDS?
a. Ineffective breathing pattern
b. Pain
c. Ineffective health maintenance
d. Risk for infxn

3. Early sign of ARDS in a pt at risk?
a. Elevated CO2 level
b. Hypoxia not responsive to O2
c. Metabolic acidosis
d. Severe, unexplained lyte imbalance

4. pH 7.52, PaO2-50, PaCO2-28, HCO3-24
a. hypoxemia
b. hypoventilation
c. hyperventilation
d. o2 toxicity

5. Same condition as above, which conclusion accurate?
a. Pt severely hypoxic
b. O2 low but poses no risk for pt
c. Pt’s paO2 c/in normal range
d. Pt requires O2 c very low O2

6. same condition, possible cause?
a. COPD
b. DKA c kussmaul’s
c. MI
d. PEmbolus

7. which intervention should the nurse anticipate in a pt c ARDS?
a. Tracheostomy
b. Intermittent positive pressure breathing
c. Mechanical vent
d. Insertion of a chest tube

8. Which condition can put a pt at risk for ARDS?
a. Septic shock
b. COPD
c. Asthma
d. HF

9. which assessment would be most appropriate for determining correct placement of ETT in a mech vent pt?
a. assess skin color
b. monitor RR
c. verify amount of cuff inflation
d. auscultate lung sounds bilaterally

10. which nursing intervention would promote effective airway clearance in a pt c ARD?
a. Administer O2 q 2hrs
b. Turn pt q 4hrs
c. Admin sedatives
d. Sxning if cough ineffective

11. which is a complication associated c mechanical ventilation?
a. GI hemorrhage
b. Immunosuppression
c. Increased CO
d. P Emboli

12. The nurse would anticipate which of the following ABG results in a pt experiencing a prolonged, severe asthma attack?
a. low PaCO2, high PaO2, low pH
b. High paco2, low pao2, low pH
c. High paco2, high pao2, high pH
d. Low paco2, low pao2, high pH

13. A pt’s ABG values are as follows:
pH 7.31, paO2-80, PaCO2-65, HCO3-36
Which s/sx would the nurse expect?
a. cyanosis
b. flushed skin
c. irritability
d. anxiety

Answers in the comments section.

Brush up on Acid-Base imbalance

Acid - Base Quiz

Memorial for one of our own

One of our fellow SJDC nursing students passed away on September 5th in a motor vehicle accident. Melissa was a nursing 4 student from Tracy. Her obituary is below. Donations can be made to Tracy federal credit union, acct #22363.

Melissa Granados
05/23/1981 — 09/05/2008
Services will be Friday for lifelong Tracy resident Melissa Granados, 27, who died Sept. 5 in a car accident that also led to the death of her 5-year-old son, Ayden Weaver. Ms. Granados was born in Tracy and lived here her entire life. She was a nursing student at San Joaquin Delta College and had received a scholarship to study nursing from the National Trucking Association’s San Joaquin County chapter. She was also involved in breast cancer awareness activities, in remembrance of her mother, Darlene, who died of the disease in 2002. Ms. Granados was also an avid San Francisco Giants and 49ers fan and enjoyed playing basketball and soccer. Ms. Granados is survived by her father, Donald Granados, of Tracy; sisters, Tricia Rittger and Staci Granados, both of Los Osos; and many aunts, uncles, nieces and nephews. She was preceded in death by her mother, Darlene Granados; and grandmother, Connie Basruto. Friday’s services, which will include a service for Ayden, will begin at 1 p.m. at Fry Memorial Chapel, 550 S. Central Ave. Burial will be private. Donations in Ms. Granados’ name may be sent to the Ayden Weaver and Melissa Granados Memorial Fund, Tracy Federal Credit Union, account No. 22363.
Published on 09/10/2008

Heart Dz Quiz

1. Which condition most commonly results in CAD?

a. atherosclerosis

b. DM

c. MI
d. Renal failure

2. Atherosclerosis impedes coronary artery blood flow by:

a. plaques obstruct vein

b. plaques obstruct artery

c. Blood clots form outside vessel wall

d. Hardened vessels dilate to allow blood to flow thru.

3. Which serum cholesterol level increases risk of CAD?

a. 100mg/dl

b. 150

c. 175

d. 200

4. which is done first for a pt exhibiting s/sx of CAD?

a. decrease anxiety

b. enhance myocardial O2ation

c. Admin sublingual NTG

d. Educate pt about sx

5. Landmark for obtaining apical pulse

a. left 5th intercostal space, midaxillary line

b. left 5th intercostal space, midclavicular line

c. left 2nd intercostal space, midclavicular line

d. left 7th intercostal space, midclavicular line

6. which blood test is most indicative of cardiac damage?

a. lactate dehydrogenase

b. CBC

c. Troponin I

d. Creatine kinase

7. Primary reason for administering Morphine to MI pt?

a. sedate

b. decrease chest pain

c. decrease anxiety

d. decrease O2 demand on heart

8. Most commonly responsible for MI?

a. aneurysm

b. HF

c. coronary artery thrombosis

d. renal failure

9. Which Dx tool used to most commonly deterine location of myocardial damage?

a. cardiac cath

b. cardiac enzymes

c. echo

d. ECG

10. First intervention for pt experiencing MI?
a. morphine

b. O2

c. sublingual NTG
d. obtain ECG

11. Most common complication of MI?

a. cardiogenic shock

b. HF

c. arrhythmias

d. pericarditis

12. which sx might a R sided HF pt exhibit?

a. adequate UO

b. polyuria

c. oliguria

d. polydipsia

13. Dyspnea, cough, expectoration, weakness, and edema are classic s/sx of:

a. pericarditis

b. htn

c. MI

d. HF

14. after undergoing cardiac cath, pt has a puddle of blood under his buttocks. which step should you take first?

a. call for help

b. obtain VS

c. Ask the pt to "lift up"

d. apply gloves and assess the groin

15. which type of pain characteristic of angina?

a. knifelike

b. sharp

c. shooting

d. tightness

16. drug of choice for angina pectoris?

a. aspirin

b. lasix

c. NTG

d. nifedipine

17. predominant cause of angina?

a. increased preload

b. decreased afterload

c. coronary arty spasm

d. inadequate O2 supply to the myocardium

18. which dx test used most often to dx angina?

a. CXR

b. echo

c. cardiac cath

d. 12 lead EKG

19. Primary tx goal for angina?

a. reversal of ischemia

b. reversal of infarction

c. redxn of stress and anxiety

d. redxn of associated risk factors

20. Earliest sign of Cardiogenic shock

a. tachycardia

b. decreased UO

c. presence of 4th heart sound

d. ALOC

CV questions

1. which of the following is a compenstory response to decreased CO?
a. decreased BP
b. ALOC
c. dec. BP & diuresis
d. inc. BP and fluid volume

2. which is used to describe the amount of stretch on the myocardium at the end of diastole?
a. afterload
b. cardiac index
c. CO
d. preload

3. one hour after administering IV lasix to a pt c HF, a short burst of Vtach appears on the monitor. which lyte imbalance should the nurse suspect?
a. hypoCa
b. HyperMg
c. hypoK
c. hyperNa

4. to reduce risk of coronary artery spasms, whicy type of med is the physicial most likely to prescribe?
a. Beta blocker
b. ACE inhibitor
c. inotropic vasodilator
d. Ca channel blocker

5. pt c HF is receivfing lasix 40mg IV. the MD orders 40 mEq KCl in 100mL D5W, to infuse over 4 hr. the pt's serum K level is 3.0. at which infusion rate should the nurse set the pump?
a. 25mL/hr
b. 10
c. 100
d. 50

6. a pt being tx'd 4 Vtach, why should teaching include eating foods such as bananas?
a. bananas high in carbs
b. high in K
c. low in Na
d. high in fiber

7. BP 126/80, MAP is

Also, links to test bank questions
med I
med II
med III
med IV
med V