What is Humalin 70/30?
- Mix of insulin N and R … 70% = N … 30% = R
o So, if 100 units of 70/30 is given to a pt … the pt gets 70 units of N and 30 units of R
o Or, for 50 units—35 units of N and 15 units of R
o To remember the bigger number, think of a fraction … The numerator N is on top;
therefore, Insulin N is the bigger number
Can you mix insulin in same syringe and
how?
- Yes, insulin can be mixed in the same
syringe - How do you mix insulin?
o (1) Pressurize vial and (2) Draw up
insulin
(1) To pressurize the vial … Inject
air into N, the into R, Draw up R
(2) To draw up insulin … Think of
RN
Know what needle to use for giving an IM injection
o Pick answer in which both answers
have a “1” in them
o “I” in IM looks like the “#1”
o Use a 21-gauge, 1-inch long needle
- Giving a SubQ injection
o 5 looks like an “S” in “SubQ”
o Pick the answer that has “5s” in it
o Use a 25-gauge, 0.5 inch needle
Heparin length of timer to be given and route, onset, antidote, labs, pregnancy
- Given IV or SubQ
- Works immediately
- Cannot be given for more than 3 weeks (21 days)
o Except for Lovenox
(enoxaparin)
- Antidote: Protamine sulfate
- Labs: PTT
- Can be used during pregnancy—
Class C medication
Coumadin length of timer to be given and route, onset, antidote, labs, pregnancy
- Given only PO
- Takes few days to a week to work
(likely 4 to 5 days) - Pts can be on Coumadin for their
entire life - Antidote: Vitamin K
- Labs: PT/INR
- Can’t be used during pregnancy—
Class X medication
how to tell if it is K-wasting and K-sparing diuretics
- Any diuretic ending in “X,” “Xes” out K
o So, it wastes “K” like Lasix
o PLUS Diuril - If it does not end in “X,” it is a sparer
- Examples
Brand Generic
o Aldactone Spinorolactone
o Adactazide Spinorolacone-Hydrochlorothiazide
o Modurectic Amiloride-Hydrochlorothiazide
o Lasix Furosemide
o Bumex Bumetanide
o Clotrix Clotrimazole
o Esidrex Hydrochlorothiazide
o Demadex Torsemide
o Diuril Chlorothiazide
2 muscle relaxants to know for the NCLEX
o Lioresal Baclofen
o Flexeril Cyclobenzaprine
The 2 things being tested on the board for muscle relaxants sE are
(1) Fatigue/Drowsiness
(2) Muscle weakness (paresis)
o The 3 things to teach
(1) Don’t drink
(2) Don’t drive
(3) Don’t operate heavy machinery
Piaget’s Theory of Cognitive
Development—4 Stages
- Sensorimotor—0 to 2 years
2.Preoperational (Preschooler)—3 to 6 years - Concrete Operations—7 to 11 years
4.Formal Operations—12 to 15 years
Sensorimotor—0 to 2 years teaching
- They only think about what
they are sensing right now - You can teach only in the
present (while you are doing it)
o Think Present Tense
o Just tell them
o Children at this age don’t understand play
o Tell them as it is happening
Preoperational (Preschooler)—3 to 6 years
- They are fantasy-oriented, imaginative, and illogical, there thinking obeys no rules
- However, they understand the future and they understand the past
Concrete Operations—7 to 11 years
- “7/11 Grocery Stores are surrounded by concrete”—no trees, no flowers
- Children in this age group are rule-oriented
o Live and Die by the Rules and Cannot Abstract
o There is one way to do things … Everything else is wrong - Teach them a day or two ahead of time
- Teach them what you’re going to do and how to do skills
- Use age-appropriate reading and demonstration (skill)
Formal Operations—12 to 15 years
- They can abstract and think Cause and Effect
- As soon as children become twelve, teach them like an adult
o This is now a regular Med-Surge question - When is the first age a child can manage his care?
o 12 years old
o Manage means making decisions which require the person to abstract
A 19-month-old infant is about to have a lumbar puncture (LP) for csf analysis and culture. How
would the nurse teach the child?
- Tell the child how the LP is done while it is being done.
- There is no such thing as preop teaching for this age group
- Preop teaching are only for the parents—mom and dad—or guardian
A 3-year-old child is schedule for a lumbar puncture (LP) for csf analysis and culture. What is the
nurse’s best action to teach the child about the procedure?
- Teach 2 hours before …, the morning of …, or the day of the procedure how it will be
performed - They are in the “imaginative” stage … Don’t give them a whole lot of time to imagine the
worst - Teach them what will be done … Future Tense
- They can learn by playing
An 8-year-old child is schedule for a lumbar puncture (LP) for csf analysis and culture. What is the
nurse’s best action to teach the child about the procedure?
- Use age-appropriate demonstration 1 or 2 days before the procedure
Which of the following 4 children will be able to manage his own care?
a. A 7-year-old with Cystic Fibrosis
b. An 8-year-old with Diabetes Mellitus
c. A 10-year-old with a scraped knee
d. A 13-year-old with Chronic Renal Failure
Answer: (d)
* A 10-year-old with a scraped knee as one of the answer choices is a diversion to fool the exam
taker. Answer to these questions is not about the severity of the condition but about the age-
appropriateness to make decision
o The 10-year-old will Wash, Dry, apply Neosporin and Bandaid the wound as thought … He
will continue to do the same thing if the wound becomes is exudating pus and swollen the
4th day … A 12-year-old will likely stop and seek help
* A 13-year-old with chronic renal failure will get help if they are thought to auscultate for a
bruit over a shunt and heard nothing on day 3
o This is managing
o This means that knowing what you can do when you can, and seek help when you cannot
