Fundamentals

- Rest and sleep: interventions to promote sleepo Establish a routine bedtimeo Limit waking clients during the nighto Help with personal hygiene needs or a back rub prior to sleep to increase comforto Instruct client to:

Exercise regularly at least 2 hours before bedtime Arrange the sleep environment for comfort Limit alcohol, caffeine, and nicotine at least 4 hr before bedtime. Limit fluids 2-4 hr before bedtime

- Pharmacokinetics and routes of administration: selecting intramuscular siteo Ventrogluteal, dorsogluteal, deltoid, and vastuc lateralis (pediatric)

1-3 mL otherwise it needs to be divided into separate syringes.- NG intubation and enteral feedings: evaluating proper function of NG tube

o Aspirate and x-rayo pH up to 4.5

- Mobility and immobility: appropriate use of crutcheso Do not alter crutches after fittingo Follow the prescribed crutch gaito Support body weight at the hand grips with the elbows flexed at 30*o Position the crutches on the unaffected side when sitting or rising from a chair

- Urinary elimination: performing closed intermittent irrigationo 50 cc sterile solution

- Nutrition and oral hydration: findings to reporto Nausea, vomiting, diarrhea, constipationo Flaccid muscleso Mental status changeso Loss of appetiteo Change in bowel patterno Spleen, liver enlargemento Dry, brittle hairo Loss of subcutaneous fato Dry, scaly skino Inflammation, bleeding of gumso Poor dental healtho Dry, dull eyeso Enlarged thyroido Poor posture

- Pressure ulcers, wounds, and wound management: preventing delays in healingo Encourage intake of 2,000 to 3,000 mL of fluids/day

o Provide education about good resource of proteino Lack of protein increases the risk for a delay in wound healing and infectiono Provide nutritional supporto Clean wounds from least contaminated towards the most contaminatedo Use gentle friction when cleansing or applying solution to the skino Use a piston syringe or a sterile straight cath for deep wounds with small openings 30-

60 mL syringe with a 19 gauge needle. - Nursing Process – Family Concerns- Infection Control: Contact Precautions

o Person to person, object to person, fecal oral routeo Protect visitors and caregivers when they are within 3 ft of the client (Respiratory

synctytial virus, shigella, wounds, herpes simplex, impetigo, scabies.o Private room or a room with other client with the same infection.o Gloves and gownso Infectious dressing material into a single, nonporous bag without touching the outside

bag- Mobility and Immobility: benefits of applying ice to extremity

o Decreases inflammationo Prevents swellingo Reduces bleedingo Reduces fevero Diminishes muscle spasmso Decrease paino Assess every 5-10 minutes

- Vital Signs – Calculating pulse pressureo Systolic – Diastolic

- Thorax, heart, abdomen: auscultating closure to the Aortic Valveo Beginning of ventricular diastole and produces the S2 sound (Dub). Place the diaphragm

of the stethoscope at the aortic area.

Adult Med-Surg

- Cancer treatment options: Discharge teaching for myelosuppressiono Monitor the client’s temperature and WBCo Fever greater than 100*F (37.8*C) should be immediately reported to the provider.o If WBC drops below 1000/mm3, place client in a private room and initiate neutropenic

precautions.o Place mask during transporto Protect client from possible sources of infection.o Frequent hand hygiene, have no ill visitors

o Avoid invasive procedures that can cause a break in tissue unless necessary (rectal temp, injections are a no no)

o Avoid crowdso Avoid yard work, gardening, or changing a pet’s litter boxo Avoid fresh fruitso Wash toothbrush daily in dishwasher or rinse in bleach solutiono Avoid fluids that have been sitting out for over 1 hr

- Meningitis: appropriate actions for bacterial meningitiso Isolate the client as soon meningitis is suspected.o Droplet precautions which requires a private room or a room with cohorts, wearing of a

surgical mask when within 3 feet of the client, appropriate hand hygiene, and the use of designated equipment, such as blood pressure cuff and thermometer. Continue until antibiotics have been administered for 24 hrs.

o Implement fever-reduction measures, such as cooling blanket.o Report to the public health department.o Decrease stimulio Maintain bedrest w/ head elevated at 30*o Seizure precautionso Replace fluid and electrolytes

- Hepatitis and cirrhosis: evaluating nutritional needs for hepatic encephalopathyo Encourage high calorie and high carb with supplemental vitamins, folic acid, and iron.

Low protein!- Posterior Pituitary Disorder: complications following a hypophysectomy

o Monitor glucose levels as drop can be caused by abrupt drop in cortisolo Check weighto ADH and oxytocin is secreted by posterior pituitary o Secondary addisons’s and hyperlipidemia can occur.

- Electrocardiography and dysthymic monitoring: Sinus tachy

- Inflammatory Disorders: Pericarditiso Inflammation of pericardiumo Follows respiratory infectiono Findings include chest pressure/pain, friction rub auscultated in the lungs, shortness of

breath, and pain relieved when sitting and learning forwardo ECG doneo Auscultate for murmurs and friction rubo Cardiac enzymes can be elevated with pericarditis

- Cancer treatment options – providing client teaching for radiation therapyo Do not eat any red meato Instruct the client about the administration of antiemetics and schedule them prior to

meals.o Suggest that the client select foods that are served cold and do not require cooking,

which can emit odors that stimulate nausea.o Encourage high protein, high calorie, nutrients-dense foods and avoidance of low- or

empty-calorie foods. Use meal supplements as needed.o Encourage the use of plastic eating utensils, sucking on hard candy.o Fatigue is commono Wash the irradiated area with mild soap and water. Try the area using patting motions.o Do not remove tattooso Do not apply powders, ointments, lotions, or perfumes to the irradiated skin.o Wear soft clothing over the irradiated skin and avoid tight or constricting clothes.o Do not expose it to sunlight.

- Electrocardiograpghy and dysrhythmia monitoring: indicators for use of cardioversiono Given to those with atrial dysrhythmias, supraventricular tachycardia, and ventricular

tachycardia with pulse. They are alive and but are dropping fast! De fib is pulseless.- Fractures: Interventions for Sprain- Bacterial, Viral, Fungal, and Parasitic Infections: Caring for a client who has clostridium difficile

o Contact isolationo Wash hands with soap with water

- HIV/AIDS: Caring for a client who has neutropeniao Assess skin integrityo Monitor vital signs (especially temperature)o Monitor labs (CBC,WBC, LFT)o Instruct client to practice good hygiene and frequent hand hygiene to reduce the risk of

infectiono Encourage the client to avoid raw foods, such as vegetables and meat.

- Diabetes Mellitus Management: Clinical Manifestations of Hyperglycemiao Hot, dry skin, and fruity breath

- Chest Tube insertion and monitoring: Identifying complications

o Air leaks Monitor water seal chamber for continuous bubbling (bad) Suction control

- Heart failure and pulmonary edema: Decreased cardiac outputo Left sided heart failure

- Fractures: Assessing for acute compartment syndromeo Pressure within one or more of the muscle compartmentso Paino Ischemiao Tight caseo Accumulation of blood or fluid within the muscle compartment

- Esophageal Disorders: GERDo Gastroesophageal reflux disease

- Hyperthyroidism: prioritizing care of cliento Minimize client’s energy expenditure by assisting with activities as necessary and by

encouraging the client to alternate periods of activity with rest.o Promote a calm environmento Monitor ECG of dysrhythmias.o Monitor I/O

- Gastrointestinal therapeutic procedures: dietary planningo Bariatric surgery – small meals, high protein ; nutrition dense foods.

- Renal Diagnostic: IV Urographyo Used to detect obstruction, assess for a parenchymal mass, assess size of the kidney. o IV contrast dye (iodine-based) is used to enhance images.o Encourage increasing fluids the day before procedures.o Bowel cleansing with lax or enema to remove fecal content.o NPO after midnighto Hold metformin (Glucophage) for 24 hr before procedure

- DM management: Appropriate test to manage client conditiono GTT

- Fracture Priority Finding: Associated with casto Compartment syndrome

Mental Health

- Cognitive disorders: use of restraintso Use only as a last resorto Use caution when administering medications PRN for agitation or anxiety.

- Family and community violence: domestic partner abuseo Tension-building phase

The abuser has minor episodes of anger and may be verbally abusive and responsible for some minor physical violence. The victim is tense during this stage and tends to accept the blame for what is happening.

o Acute battering phase The tension becomes too much to bear and serious abuse takes place. The

victim may try to cover up the injury or may get help.o Honeymoon Phase

The situation is defused for a while after the violent episode. The abuser becomes loving, promises to change, and is sorry for the behavior. The victim wants to believe this and hopes for a change. Eventually, the cycle begins again.

o Periods of escalation and de-escalation usually continue with shorter and shorter periods of time between the two. Emotions for the abuser and victim, such as fear or anger, increase in intensity. Repeated episodes of violence lead to feelings of powerlessness.

o All states have mandatory reporting laws that require nurses to report suspected abuse; there are civil and criminal penalties for not reporting suspicions of abuse.

o Help client develop a safety plan, identify behaviors and situations that might trigger violence, and provide information regarding safe places to live.

- Suicide: appropriate nursing responseo When questioning the client about suicide, always use a follow- up question if the first

answer is negative. For example: the client says, “I’m feeling completely hopeless.” The nurse says, “Are you thinking of suicide?” Client: “No, I’m just sad.” Nurse: “I can see you’re very sad. Are you thinking about hurting yourself?” Client: “Well, I’ve thought about it a lot.”

- Anxiety disorders: assessing the client w/ PTSDo

- Schizophrenia: expected findingso Hallucinationso Delusionso Alterations in speecho Bizarre behavioro Affect- bluntedo Alogia- poverty of thought or speecho Anergia – lack of energyo Anhedonia – lack of pleasure or joyo Avolition – lack of motivation in activities and hygieneo Memory deficits

long term memory Working memory, inability to follow directions to find an address

o Difficulty concentration to perform taskso Poor problem-solving ability

o Inability to make decisionso Disordered thinkingo Hopelessnesso Suicidal ideation

- Schizophrenia: Analyzing client interpretation- Schizophrenia: signs and symptoms- Bipolar disorders: intervening for a client who is manic

o Abnormally elevated mood, which may also be described as expansive or irritable.o Focus is on safety and maintaining physical healtho Therapeutic milieu (within hospital facility)o Provide safe environmento Assess regularly for suicidal thoughts, intentions, and escalating behavior.o Decrease stimulation without isolating the client if possible. Beware of noise, music,

television, and other clients, all of which may lead to an escalation of the client’s behavior.

o Have rest periodso Provide outlets for physical activity, do not involve other clients.o Maintenance of self careo Provide for consistency with expectations and limit setting.

- Chemical and other dependencies: clinical findingso Blackout or loss of consciousnesso Changes in bowel movementso Weight loss or weight gaino Experience of stressful situationo Sleep problemso Chronic paino Concern over substance useo Cutting down on consumption or behavior

- Chemical and other dependencies: Planning care for a client with alcohol withdrawal syndromeo Starts within 4-12 hr of the last intake of alcohol, peak after 24-48 hours, and then

suddenly disappear.o Manifestations include abdominal cramping, vomiting, tremors, restlessness and

inability to sleep, increased heart rate, transient hallucinations or illusions, anxiety, increased blood pressure, respiratory rate, temperature, and tonic clonic seizures.

o Alcohol withdrawal delirium may occur 2-3 days after cessation of alcohol and may last 2-3 days. This is considered a medical emergency. Symptoms include severe disorientation, psychotic symptoms, severe hypertension, cardiac dysrhythmias, and delirium.

- Medications for Psychoses: Long-term adverse effects of Haldolo Parkinsonism – 1 month

o Tardive dyskinesia Involuntary movements of the tongue and face, such as lip-smacking and tongue

fasciculation Involuntary movement of the arms, legs, and trunk Give medication as low as possible to control manifestations

- Medication for psychoses: Discharge teaching for clozapineo Notify physician for indications of infection (fever, sore throat, outh lesions)o High risk of weight gain, diabetes, and dyslipidemiao Orthostatic hypotensiono Anticholinergic effectso Do not take with immunosuppressive medications, such as anticancer medications, can

further suppress immune function.o Risk for fatal agranulocytosis

Baseline and weekly monitoring of WBC- Medications for Bipolar disorder: evaluating client understanding of Sertraline (Zoloft)

o Advise the client that adverse effects may include nausea, headache, and CNS stimulation (agitation insomnia, anxiety)

o Instructor sexual dysfunction may occuro Advise the clients of serotonin syndrome, withhold if it does occuro Avoid use w/ St. John’s wort, which can increase the risk of serotonin syndromeo Instruct the client to follow a healthy diet because weight gain can occur

- Effective communication: response to grieving cliento Don’t be retarded, ask about her feelings

Nursing Care of Children

- O2 therapy- appropriate intervention with pulse oxo Place the child in a semi-Fowler or Fowler’s position to maximize ventilationo Encourage deep breathingo Probe site must be dry and have adequate circulation. Remove polish from nails or

remove earring if using the earlobe.o Support arm if a finger is used as a probe site.o Anything less than 86% is a life-threatening emergency. The lower the SaO2 value, the

less accurate the value.- Renal disorders: intervention for chronic renal failure

o Monitor I/O. Urine for protein.o Monitor daily weights; weigh the child on the same scale with the same amount of

clothing.o Monitor edema and measure abdominal girth daily. Measure at the widest area, usually

at or above the umbilicus.o Low protein, low sodium

- Gastrointestinal, structural, and inflammation disorders: cleft palate, post opo Change the infant’s position frequently to facilitate breathing. The infant may be placed

on the abdomen in the immediate postoperative period.o Maintain intravenous fluids until the infant is able to eat and drink.o Monitor packing, which is usually removed in 2 to 3 days.o Avoid placing objects (tongue depressor, pacifier) in the infant’s mouth after cleft palate

repair.o Elbow restraints may needed to be used to prevent the infant from injuring the repair.o There are special seats for kids

- Acute infectious gastrointestinal disorders: evaluating effectiveness of dehydration interventionso Hct,Hbg, BUN, creatinine, and urine-specific gravity levels are usually elevated with

dehydration.o Obtain baseline height and weight.o Weight the babies nakedo Weight same time everyday.o Assess cap refillo Oral rehydration

Mild: 50 mL/kg rehydration fluid every 4-6 hr Moderate 100 mL/kg rehydration fluid every 4-6 hr

o Administer parenteral fluid therapy as prescribed 20 mL/kg IV bolus with repeat for isotonic and hypotonic dehydration. Hypertonic dehydration rapid fluid replacement is contradicted because of the

risk of cerebral edema.- Communicable disease: infectious mononucleosis

o Standard care not airbourne or droplet. Spread through saliva

o Incubation period is 4-6 weekso Kinda like esptein barr virus (I think…)o S/S

Fever, sore throat, swollen lymph glands, increased WBC, atypical lymphocytes, splenomegaly, and enlarged liver.

o Administer an antipyretic for fever. NOT ASPIRIN due to risk of Reye syndrome.o Acyclorvir (Zovirax) is given (antiviral)o Can complicate to ruptured spleeno Mono spot blood test given

- Cardiovascular disorders: monitoring laboratory valueso Increased CRP and ESR indicates a response to an inflammatory reactiono ASO titer for RF – Strepo GABHS (Group A (beta)-hemolytic strep) from the throat

- Immunization: contraindication of MMR immunizationo Pregnancy

o Allergy to gelatin and neomycino Immunosuppressiono Recent transfusions with blood products or immunoglobulino History of thrombocytopenia

Pharmacology

- Intravenous anesthetics: assess allergy to medication- Medications affecting the reproductive tract: contraindications for use of combination oral

contraceptiveso Clients who are: smokers and over the age of 35

Has a history of thrombophlebitis and cardiovascular events Family history or risk factors for breast cancer Experiencing abnormal vaginal bleeding Antibiotics, antifungals, antipsychotics, antianxiety Use cautiously with those that have hypertension, diabetes mellitus, gall

bladder distention, seizures, and migraine headaches.- Angina: contraindications to the use of Isosorbide mononitrate (Imdur)

o Contraindicated in clients who have hypersensitivity to nitrates.o Contraindicated in clients who have traumatic head injury because the medication can

increase intracranial pressureo Glaucoma o Use cautiously in clients takes antihypertensive medications and clients who have renal

or liver dysfunction.- Gastrointestinal Disorder: Managing side effects of metroclopramide (REGLAN)(DOPAMINE

ANTAGONIST)o Extrapyramidal symptoms (EPS)

Inform clients of possible adverse effects (restlessness, anxiety, spasms of face and neck)

Advise clients to stop the medication and inform the provider if EPS occur. Administer an anticholinergic medication, such as diphenhydramine (Benadryl)

or benztropine (Cogentin), to treat symptoms.o Hypotension

Monitor clients receiving antihypertensive medications for low blood pressure.o Sedation

Advise clients to avoid activities that require alertness, such as drivingo Anticholinergic effects( Dry mouth, urinary retention, constipation)

Increase fluid intake Increase physical activity by engaging in regular exercise. Tell clients to suck on hard candy or chew gum to help relieve dry mouth

Stimulant laxative such as senna (Senokot) to counteract a decrease in bowel motility, or stool softeners such as docusate sodium (Colace) to prevent constipation.

Advise client to void every 4 hr. Monitor I&O and palpate the lower abdomen area every 4 to 6 hr to assess the bladder.

- Opioid agonist and antagonist: Evaluating client understanding of methadoneo Given to patients with biliary colico Do not increase dosage without consulting with the providero Do not discontinue abruptly. Opioids should be withdrawn slowly, and the dosage

should be tapered over a period of three days. o Do not give with kidney failure patients, will cause accumulation of normeperidine –

results in seizures and neurotoxicityo Effectiveness may be evidenced by:

Relief of moderate to severe pain Cough suppression Resolution of diarrhea

- Medications affecting BP: ACE inhibitorso Blocks the conversion of angiotensin I to angiotensin II

Vasodilates Excretion of sodium and water, and retention of potassium by actions in the

kidneyo Therapeutic use

HTN Heart failure MI Diabetic and nondiabetic nephropathy

o First-dose orthostatic hypostatic Take off diuretic 2-3s prior to the start of ace inhib Monitor 2 hr after initial treatment

o Cough – dry cough (bradykinin)o Rash and dysgeusia (altered ngtaste)o Angioedemao Neutropenia

Monitor ABC every 2 weeks for 3 monthso Potassium supplements and potassium sparing diuretics increase the risk of

hyperkalemiao NSAIDS decrease antihypertensive effect of ACE inhibit

- Medications affecting coagulation: Administration of Lovenoxo Music be given subcutaneous injection or IV infusiono Obtain baseline vitals signso Obtain baseline and monitor CBC, platelet count, and hematocrit levels.

o Subcutaneous injections use a 20-22 gauge needle to withdraw medication from the vial. Then change to a smaller needle (25-26 gauge)

o Administer deep subcutaneous injections in the abdomen; ensure a distance of 2 inches from the umbilicus. Do not aspirate.

o Do not rub the site for 1-2 after the injection.o Soft toothbrush with electric razor!o Do not expel the air bubble from the prefilled syringe.

- Antilipidemia agent: Atorvastatino Decrease LDL and increase HDLo Adverse effects

Hepatotoxicity Myopathy (Muscle pain) Peripheral neuropathy

o Use cautiously w/ renal diseaseo Oral route with evening meal

- Affecting Blood pressure: Indications to withhold propranololo Low blood pressureo Low heart rateo Greater than first degree heart block, bronchial asthma, cardiogenic shock, or heart

failure- Medications affecting urinary output: evaluating client’s understanding of Lasix

o Ototoxicityo Hypokalemiao Hypotension

- Endocrine disorders: therapeutic effects of synthroido Used for myxedema comao Thyroid hormone replacement for the treatment of hypothyroidismo Monitor t3 and TSH levels

- Airflow disorders: Leukotrine modifiers o Montelukast

Obtain baseline liver function test and monitor LIVER DAMAGE Suppressing inflammation, bronchoconstriction, airway edema, and mucus

production Take daily at bedtime

Leadership and Management

- Coordinating client care: recognizing need for swallowing evaluationo A speech therapist assists a client who has speech and swallowing problems.

- Clinical manifestations of small pox

o High fevero Fatigueo Severe headacheo Rasho Chillso Vomitingo Delirium

- Indications for incident reporto Assess the individuals for injuries and institute any immediate care measures necessary

to decrease further injury.o Forwarded to the risk management department or officer after being reviewed by a

nurse manager. NURSE MANAGER FIRSTo Medication errorso Procedure/treatment errorso Needlestick injurieso Client falls/injurieso Visitor/volunteer injurieso Threat made to client or staffo Loss of property

- Stages of team formationo Forming – Members of the team get to know each other. The leader defines tasks for

the team and offers directiono Storming – conflict arises, and team members begin to express polarized views. The

team establishes rules, and members begin to take on various roles.o Norming – the team establishes rules. Members show respect for one another and

begin to accomplish some of the task.o Performing – the team focuses on accomplishments of task.

- Managing client care: Delegating task to an assistive personnelo Activities of daily living (ADLs)

Bathing Grooming Dressing Toileting Ambulating Feeding Positioning Bed making

o Specimen collectiono Intake and outputo Vital signs

- Managing client care: Reassigning delegated task

- Managing client care: emergency department- Managing client care: identifying highest priority findings to report

o Prioritize systemic before localo Prioritize acute before chronico Prioritize actual problems before potential future problemso Recognize signs of medical emergencies and complications versus “expected client

findings”- Managing client care: staff development and performance improvement- Professional responsibilities: client understanding of advanced directives- Responsibilities: ethical consideration following a medication error- Facility Protocols: Prioritizing care during mass casualty triage

Maternal Newborn

- Client education and discharge teaching: Engorgemento Wear a well-fitting, supportive bra continuously for the duration of lactationo Emphasize the importance of hand hygiene prior to breastfeeding to prevent infectiono Relieve engorgement have the client completely empty her breast at each feeding.

Allow the infant to nurse on demand, which would be about 8-12 times in 24 hr period. Massage the breasts during feeding can help with emptying. Allow the infant to feed until the breast softens. If the second breast not softens after the infant’s feeding, the breast may be emptied with a breast pump. Alternate breast with each feeding.

o Apply cool compress between feedings and warm compress prior to breast feeding.o Have the client apply breast creams as prescribed and wear breast shields in her bra to

soften her nipples if they are irritated and cracked. - Infections: clinical findings w/ bacterial vaginosis

o Excessive grayish white vaginal dischargeo Fishy odor occurring after sex

- Infections: planning care for HSV-2o Monitor fetal well beingo PAP testo Droplet infection, virus found in semen, breast milk, urine, feces, and blood.o Administer antibiotics

Treatment includes sulfonamides or a combination of pyrimethamine and sulfadiazine

- Newborn assessment: manifestations of cold stresso Increased oxygen demandso Acidosis can occuro Temperature above 37.2 or 98.9o Rapidly use up brown fat reserveso Hypoxia

o Hypoglycemiao Respiratory distresso Increased respiration

- Fetal assessment during labor: early decelerationso Remember VEAL CHOPo Compression of the fetal head resulting from uterine contractiono No intervention required

- Labor and delivery process: latent phaseo BP, pulse, and respiratory measurements every 30-60 minuteso Cervix 0 – 3 cmo Irregular, mild to moderate contractionso Contractions q5-30m, duration 30-45 secondso Talkative and eagero Some dilation and effacement

- Bonding and integration of infant into family system: interveningo Apathy when the infant crieso Disgust when the infant voids, stools, or spits upo Expresses disappointment in the infanto Turns away from the infanto Does not seek close physical proximity to the infanto Does not talk about the infant’s unique featureso Handles the infant roughlyo Ignores the infant entirelyo Assess for signs of mood swings, conflict about maternal role, and/or personal

insecurity. Feeling anxiety related to ineffective breastfeeding Feeling down Feeling of inadequacy Flat affect and being withdrawn Unable to care for infant

- Pain management: nonpharmacologic relaxation techniques o Aromatherapyo Breathing techniqueso Imageryo Musico Use of focal pointso Subdued lightingo Effleurage

Gentle circular stroking of the client’s abdomen with the fingertipso Back rubs and massage

o Sacral counterpointo Acupressure

- Nursing care of the newborn: care and deliveryo Vital signs should be checked on admission/birth and every 30 minutes x 2, every 1 hr x

2, and then every 8 hr- Postpartum Physiological Adaption RhoGAM administration

o Administer around 28 weeks of gestation for clients who are Rh-negative

Nutrition

- Modified diet: client who has dysphagiao Thickened liquids

Start with nectar, then honeyo Avoid thin liquids and sticky foodso Apple Juiceo Foods that are liquid at room temperatureo Can have all forms of milk, soups, strained fruits and vegetables, vegetable and fruit

juices, eggnog, plain ice cream and sherbet, refined or strained cereals and puddings.- Guidelines for healthy eating: Weight reduction

o 500 calories per pound- Managing client care: sources for nutrition- Cultural, ethnic, and religious influences: Kosher observance

o Do not mix dairy and meet- Enteral Nutrition: Intermittent Tube Feedings- Parenteral Nutrition: Monitoring Client receiving TPN

o Monitor serum and urine glucose levels. Sliding scale insulin may be prescribed to intervene for hyperglycemia

o IV 10% dextrose if TPN runs outo Send TPN back to lab if there are two different colors in bag (separation of lipids)

12 lead

Contraceptives: miss two days- double dose for next 2 days. If more, then you have to restart