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Nov. 4th, 2011

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We had an exam in our theory class this week--mostly on respiratory disease, but also covering diabetes, pain, and arthritis, and the Lab topics of subcutaneous injections, medications via NG [nasogastric] tubes, and sterile gloves..  This exam was a little harder--in part because there were more "mulitple multiple response" questions.  Apparently there are a lot of these on the NCLEX certification exam.  If you don't get every response correct, you get the whole question wrong.  An example: 

Which of the following actions are correct for a patient receiving medications via NG tube?
A)  If the tube is connected to suction, meds cannot be given via this route
B)  The head of the bed must be elevated at least 30° at all times
C)  Mix powdered medications into liquid feeding solution to prevent gastric irritation
D)  Flush the tube q4-6h [every 4-6 hours] with 30-60mL sterile water
E)  Confirm placement of tube in stomach by aspirating gastric residual before delivering medication.

B, D, and E are all correct--but if you missed any of them (or add in a wrong answer), then the whole question is wrong.  MMR questions are definitely harder...I find it much easier to pick out one right or one wrong answer!  However, I guess I shouldn't complain too much, since I had a top score (the ranking system makes it unclear, but I believe that several people can share the same rank.  I wish they'd tell us the average instead, but they don't.)

In clinical this week my patient actually had an NG tube!  They're pretty rare on our floor, because we mostly get ortho patients, but this patient had a lot of GI trouble recovering from surgery and they inserted an NG tube to relieve pressure in his stomach.  He was also NPO except for medications (nothing to eat or drink--IV fluids and nutrition).  So, I got to give his meds down the NG tube and also got to give my first subcutaneous shot.

Today I validated on my final skill for the semester--after this we have simulations during our lab time instead.  The last skill was a sterile dressing change, which involves setting up a sterile field, putting on sterile gloves, and then using one hand to pack dressing into the wound (which makes that hand unsterile) while keeping the other sterile.  The sterile/unsterile hand thing will reappear a lot next semester--the 2nd semester students were practicing inserting catheters (a sterile procedure) and suctioning tracheostomies (also a sterile procedure) today.  Check out the link I posted last week--the next video down should be the sterile dressing change demo. 

This weekend I need to study for our next A&P exams which are next week, in addition to a psych exam, and start writing my paper.  Today, though, I'm too sleepy for any of that...I think I'll clean the kitchen and fish tank instead.

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