Test Strategies for Nursing Students

After a nursing student has managed to complete all their coursework and pass all their training seminars, the big qualifying tests loom ahead. So many years are spent attending lectures, taking practical training, and working to support the goal of the future, that the nursing exam can become almost larger than life. Then suddenly it’s next month. That faraway goal is now a reality.

After preparing for the big exam forvso long, the first test for proper formal nursing exams can be a shock to the system. Perhaps a nursing student that did so well on their nursing section tests got comfortable with their study habits and just soldiered on. They thought the final exam and State Board nursing exam would be the same. Yet all too often, even these test takers are jerked back to reality with a non-passing result.  There is little room for error on the state qualifying nursing exams.

Many of the nursing students being proctored for exams are top-notch nurses wirh fine minds. Yet the competition for placement on occupational qualifier tests is more fierce for nursing than  in almost every industry, from aviation to veterinary practice. The bar set by current occupational nursing test programs are very high. The cutting edges dividing qualified nurses (who pass the RN test), and successful nursing students (who don’t), are very sharp. The cracks through which the nursing exam lets its student fall are getting more and more rare and much more fine every day.

Nurses getting ready to take their NCLEX or other qualifying nursing exams need to optimise every minute spent before the test. The tests have grown in sophistication and complexity over the past few decades. Nurses looking to see the highest and best score possible  should use some strategies to ensure the best payoff for all their hard work.

Nursing exam applicants and nursing students should tailor their test taking strategies to what works for them. Nursing exams measure three things: memorized medical knowledge, ability to incorporate that knowledge into medical nursing scenarios, and ability to perform virtual nursing duties in a number of imagined scenarios. The test crams the demand for problem solving and quick thinking into every question.

1. Set a game plan based on past test results.

Nurses must be honest about where their strengths and weaknesses lie. Look at what your study habits were when you attained your best grades.  If you have trouble focusing on test preparation,  consider hiring a coach. If you have trouble absorbing new material, think about getting a tutor while there still time left. Getting coached on how to study ranges or develop symptoms into therapies can boost your confidence on test day.

This is why flash cards and mere rote memorization of lecture notes don’t work. The retention from cramming  is too low to matter.  Many nursing students become insulated by good test score experiences and relax their discipline towards the last and most important nursing exams there are. Often the test results can be disappointing for the top graders or ‘teacher’s pets’ in  each individual school’s class or lecture section. The formal test for certification is much more tough even than your nursing final for your entire degree program.

Nursing students generally depend on their notes and test review sections to prepare for their tests. But test finals and professional level final nursing exams do not match this format. These tests are conceived as a competitive challenge.  Commercial test prep materials suggest a more credulous practice format and compatible test example for preparation strategy.

Teachers and lecturers are required to assign and cover scheduled amounts of topics and book material over calendrical points of time. But the commitment to master the material must come from the nursing student themselves. Just re-reading the book a hundred times isn’t test preparation anymore. By the time the final sessions of test preparation occur, nursing students must have absorbed the knowledge and moved on to applying it to likely problems or scenarios. Test questions will likely ask which of two of the most likely nursing  interventions are best.  At that time, it is the comparative knowledge of both quantitative and qualitative factors that are required. In addition to general practice knowledge. Nurses struggling to remember primary themes will be left far behind on the scoring curve. Make a folder for every area of knowledge in which you need a soup-to-nuts indoctrination. Fill this folder with research and case studies that emphasize key concepts.

2. Plot your time use strategically.

About a month up to the final scheduled test date, plot allyour time on a master calendar. Break down your study time into hours. If you have a job, consider freeing up enough time at work to achieve test prep goals. Working while distracted can throw you off your game at work. That’s when mistakes happen.

And a major incident at work can distract you from using your personal time for best test preparation. Because now your work rhythms are thrown off. Some time planning issues will have come to the fore. Time maximization is crucial at this time.

Review of study materials is essential. Nursing students should consider if the quality of their textbook is everything they need. Observe the results discussed by nurses attending other schools. Is there a book that explains things better? Often a coursebook can be the particular choice of the instructor, and not the most beneficial for nursing. Or nursing exam preparation.

When preparing for tests, the World Wide Web can be your friend. Join chat boards online and learn what other nursing students are saying about the quality of their own preparedness. Do students evaluate themselves as ready for some topics more than others?  Then identify which part of your nursing academic material needs a reboot.

3. Evaluate the best use of your time.

If you needed four weeks of additional chapter study and two weeks of terms memorization, as well as performing several weeks of part-time work, commuting, and/or childcare. three and a half weeks until test time isn’t going to work. Time management is key. Splurge for baby sitting and/or put yourself somewhere you can achieve a silo of concentration. Plan on less driving and unnecessary physical activity.

Many nurses try to take their current schedules into the test taking season. But the competition isn’t doing that. By ignoring time management challenges you let the competition get ahead.

Many nursing students respond to the freedom from lecture schedules as if they are on vacation. Suspend the party time until after the test. The need for constructive time management is too important. You can’t clone yourself and the pace of trying to do too much will wear you out just in time for the testing sessions.

4. Get enough sleep.

Nurses know from their studies thay shortages of sleep negatively affect diet,  sleep, temperament, concentration, and mood. Loss of sleep can affect short term memory and change in sleep patterns can erase the very mental sharpness nursing students need most for their tests.

Trying to stay up and force your brain to mentally absorb and retain quickly scanned information is impossible. Studies have shown that the human brain cannot accommodate these needs. Setting up the human body to fail during test time due to exhaustion. stress, or worry over preparedness is very common. Plot adequate meals, rest, exercise and sleep. Avoid crutches like caffeine, smoking, energy bars and junk food. These can alter your body chemistry and fool you into thinking yourself prepared by playing with your blood sugar. Make sure that sleep quality is a constant during your test prep phase.

5. Find A Study Buddy

A study partner can assist any nursing student to extend their study time and grow results. Students can put up notes at their school before lectures end or network during the session to get phone numbers of likely partners. Persons who have always depended on themselves for study results should not discount the benefits of active verbal  discussion of terms, examples and case studies. The active discussion can enable  positive  reinforcement of many important concepts and better enhance a student’s understanding of nursing course material. This leaves the test of their time free to focus on uniquely targeted “cribbing” information sets.

The grind of testing preparation can wear anybody down. This is not the time to get sidetracked! Both parties win by reinforcing proper use and discussion of topical nursing test subjects. The verbal intercourse with another nursing student is an efficient way for test prep to focus disciplined energy towards testing success.

 

Recognizing Medication Side Effects

Today a hot topic in nursing efficiency and best standards in healthcare is maintaining corporeal integrity and patient health despite heavy medication orders.  Nurses administering medication therapy to patients need to be watchful for side effects. Harmful side effects can be fatal. Any nursing performing 24 hour triple checks should converse with charge nurses and consult communication logs to verify any symptoms of a problem with a new medication that may have appeared.

Nurses should not wait to be directed by other staff or pharmacy advisors but verify from administrators,  Internet resources or the drug literature what the potential side effects are. Patients have a right to know what these side effects are before the medication is administered for the first time. If there is a potential drug-to-drug interaction, a delay may be in order while the physician is notified. Another drug may be substituted to eliminate potential problems, side effects, and patient discomfort.

The obvious benefits of nurses maintaining a rapport with their charges become evident here. A caring treatment nurse or observant and communicative med nurse can know what condition the patient’s skin normally is, what skin products the patients use, and under what circumstances irritation or rash incidents arise. Is the patient a complainer or do they hold back complaints?  Do they follow the same bathing and skin cleansing regimen daily? Does the patient use water that is hard, too hot, or for too long a period? Nurses should work closely with nurse’s aides to make sure unknown skin problems do not arise in conjunction with new medication administration. Both problems happening at once muddle the waters.

Patients in hospitals and long-term care  facilities usually do not handle their medications and thus cannot read the warning advice. They may not have Internet access or know how to spell the name of the medication. It is irresponsible and unprofessional for a nurse to force, trick, or dispense new medication to a patient without advising them of these risks and getting their permission. Violation of these rights can result in oversight agency scrutiny,  facility citation, and/or a nursing  license revocation.

For these reasons, any nurse should be mindful of the potential side effects of new medications. And over time, patients may develop allergies or new unpleasant and painful drug reactions. Before nurses sign off on pharmacy memoranda detailing potential interactions with the medication, they should review the nurse assistant’s body check documentation as well as the licensed nurse progress notes from every shift since the inception of the drug’s administration.

While some people have faith in homeopathic medicine, medical science is predicated on conservative and well-tested treatment advice. Unless the patient is utilizing off-label benefits of the drug for conditions other than those initiating the drugs’ order, nurses should follow the exact dosages and administration schedules the physician recommends.

Patient healthcare involves ongoing maintenance of functioning body systems. This includes circulation and muscle support to the dermis, musculature, and epidermis.  These systems undergo changes when systemic alteration occurs. Drug administration via the vein, orally, or topically is encountered by the body as a systemic alteration. Patients receiving therapeutic care require new and additional surveys to maintain the integrity of the skin.

The skin is the largest organ in the human body. The color, texture, febrile nature, friable veins, diffusion of capillary circulation, and moisture content of the skin tells the story. Changes can be tracked and documented to show the progress of a treatment for a condition or illness.

Nurses learn anatomy to understand how the heart and muscles drive the circulatory system. These functions are involuntary. They also stimulate immune system responses that are designed to protect the body’s regular functions.  The response of the immune system and the hypothalamus is governed by genetic  rules which are predetermined at birth. Generally these operate for everyone the same way.

But due to the infinite variation between one human body to another, individuals will differ when a foreign substance, such as a toxin or strain of bacteria is inserted into the bloodstream. The body’s response should be reviewed for the things the patient can communicate, and the things that can be observed.

Thus,  Person A may have no response to ingesting plant spores. But Person B may have no tolerance for plant spores. This intolerance is not a cognitive communication. It is expressed by changes in body functions exclusive of other medical problems.

The body dysfunction  evinces itself in a set of symptoms visible to the eye. It might be a rash, bumps, and/or itchy patches of skin . Sometimes the condition will irritate the patient to comment. For nonverbal or inert patients, symptoms such as swelling, striations, “weeping”, bumps or other dermal eruptions may occur.

Patients may not be able to see what is going on. A full body check is in order at least daily, before and after treatment. These data items should kept well documented in the patients chart for physician review. Symptoms such as nausea, inflamed throat, vomiting, loss of appetite, rash, hives, unusual numbness of extremities and more should be noted carefully. Nurses suspicious of side effectsvof medications should chart an intervention in the patient’s care plan. Wellness should  be achieved without the above mentioned side effects. It is for the doctor to determine whether or not the benefit of such medication outweighs the irritation and discomfort the patient undergoes.

Symptoms of side effects should be evaluated with reference to the patient’s normal condition and status. Failure to chart regular full body checks and regular medical examinations can cloud the issue. And only the facillty being alerted to signs of anaphylactic shock, observed by a nurse,  can save a patient when extreme side effects (akin to allergies) are present. Immediate medical attention is triggered by the predictive and denoted set of side effects described on the warning labels required by law to accompany all medications.

Patients receiving new orders for ongoing conditions or diseases with new symptoms must be protected from the natural occurrence of allergies and untenable side effects. Signs of side effects of given medications is nature’s way of making sure the body does not ingest any more harmful material.

Patient medication forms part of therapeutic intervention for serious conditions. Antibiotics are an accepted and highly recommended response by physicians to lab tests, clinical consultant, and referrals to a specialist. Antibiotics are adminiatered to the human body three ways, internally, orally, and topically. Creams, gels, sprays and powders can be applied directly to the skin or affected area. Oral antibiotics are administered  by mouth and sometimes by other means.

Infusion Vein therapy (Intra Venous therapy)  is administered by access to the vein. The needles’s access to a skin based channel allows direct systemic delivery of antibiotic material. Yet an etiquette prevails to ensure patient safety, operator efficiency, and an optimum outcome.

Dosages of antibiotics in the above mentioned methods are governed by strict standards. The I.V. medication is calculated by laboratory tests, “peak and trough” reports, creatinine levels and patient weight. Maintenance of kidney function is imperative.

Nurses who follow the signs of allergy, medication symptomatology of side effects and problems of specific medication types can offer their patients a wholly beneficial skill set that will enhance treatments and drug administration. Patients can enjoy greater quality of life,  without dosing errors, unnecessary discomfort,  or negative drug interaction.

 

Intra Venuous Therapy

Nurses from time to time will be required to perform tasks that demand mastery of a technical equipment procedure. To deliver a programmed regimen of medication, when a patient is a hard stick, to prevent repeated needle stick trauma and injuries to the epidermis, an intra venuous line is used. The vein inside the hand or arm is located and mapped.
An ideal site for connection of the vein to the external delivery device is located. This is where the vein will be connected to an attached ( or hung) intra-venuous line. Thus liquid medication can be set up to line-drip into the body via a plastic catheter.
After this site is located, the first attempt is executed. The procedure to install the exterior I.V. (catheter) is begun by setting up surgical drapes for infection control. Masks, gowns, and gloves should be worn. The internal vein location is sited on-screen using live EKG or radiographic video photography. This internal site is evaluated for positive and consistent blood flow and the successful circulation of the medication.
This attribute of vein quality is needed for best distribution of the treatment material throughout the corpus. If the ideal site cannot be mapped, the procedure should be rescheduled.
The vein physically is reached via needle treated with Lidocaine. After a few moments a burn and a mild pain will be felt. Pre-medication against patient discomfort should be anticipated. The catheter ligation is then performed. If the venal connection is not successful a repeated attempt may be made as long as site integrity is maintained. The ultimate site must be clean and free from lesions or irritation.
The catheterization must now take place. Usually I.V. lines are put in during in-patient visits to or in a hospital radiography lab. But specialty nurses are now licensed to do this as part of a mobile health services arrangement. The plan of care adapts to include I.V. therapy.
After images of the vein assist the surgeon, nurse, or technician in mapping the best external route from a vein, then the vein is connected to the epidermis via an exterior cannula and channels of plastic or vinyl tubing. The patient may require a PICC line, a Heplock, or a formal intra venuous line catherization.
The infusion of catheterization for Hep lock, I.V., and PICC line devices requires formal technical training. Physicians and other providers learn the I.V. technique, sterile procedure etiquette, and the immediate I.V. environmental infection control. The administration of an I.V. and the facility policies must be followed to the letter for site hygiene, optimum infection control, and medical treatment etiquette.
I.V. administration is a critical nursing skill that can save many lives.
. Focus on anatomy and needle stick skill sets is critical. Student nurses should petition for radiography internships if they are interested in I.V. catheterization as a career.
The site injection procedure is done via E.K.G. placement or radiology X-ray. Siting should be done by a nurse that knows or has become familiar with the patient.
The efficient I V. nurse will appraise how infusions will alter the patient’s daily routine. Minute details can affect placement success. Discussion of the patient’s daily routine is essential.
Will the patient eat before or after the medication? Will the rolling I.V. rack allow for bathroom access? Which arm or hand is best for the siting? How dies the patient sleep? Viability of the overall catherization effort for intra venuous infusion must be evaluated with respect to specific patients.
How old is the patient? How well can they manage to sit and be still and maintain drip flow? Have they managed an I.V. before? Are they in a skilled nursing or long term care facility? Do they thrash around uncontrollably during slumber? Patients can do damage to themselves or the I.V. line while moving during sleep.
Do they take a sleeping pill at night that limits control of the arm with the I.V. in it? How alert and ambulatory is the patient?Exploring these issues can ward off problems necessitating repeating the procedure. Conversation with the patient and issuing verbal prompts during the procedure can help I.V. line patients feel more in control.
All these factors can play a major role in the successful siting of an intra venous catheter device.
The epidermis is very sensitive to the strong adhesives used in the catheter site securement. Nurses should be careful not to strip the skin at the site. Attention should be paid to any allergies or past problems with bandages, metals, or tape. If the adhesives used in the I.V. siting cause an irritation, the dressing can come loose, the skin can over-adhere, or a site lesion cause an infection to spring from access to the vein.

Before scheduling the I.V. procedure, the patient’s chart and medical history must be reviewed. Sensitivity to the prescribed medication and success with previous regimens if intra venuous therapy should be evaluated. Upon efficient administration of a midline catheter or intravenuous line, repeated inspection and evaluation of the site should ensue. Then caretaking literature should be available for distribution, to the chart or to patient or resident.
If the veins have become occluded or blocked, the effort to site the catheter may need to be redone. The cost of these procedures to be repeated may be oppressive, not to mention the inconvenience, expense, and interruption of the ordered I.V. treatment.
There is some debate as to whether or not EKG or radiography siting procedure is preferable at the commencement of the ligation order. Hospital or facility policy must govern whether or not mobile services can be used in place of stationary institutional surgery centers. Specialty licensed and specially qualified nurses and technical personnel must be staffed for all of the above procedures.
Nurses should constantly monitor the catheter midline site for redness, stiffness, swelling and unusual pressure around the line-in. Remove and re-apply the sterile dressing as needed. Prevent loss of sterile I.V. conditions by using iodine or alcohol to clean residues or backflow from the insertion lesion.
When changing the adhesive tapes and cleaning the I.V. site cap, inspect the site area for unconventional blood spotting, movement of the line too far in or out of the I.V. site, or stained or fouled adhesive material next to the skin.
Always make sure to wash the hands in warm soapy water before contact with the site area and dressing materials. Allow adequate time for refrigerated material to come to room temperature. Check tags and labels upon fresh presentation of pharmaceuticals to the I.V stand, inside the patient room or clinic area.
Nurses and intra venuous medication administrators should always flush the line clean and make sure fouled tubing is removed from the site attachment immediately. Saline flushing schedules should be found on the patient’s chart or in the endorsement sheet. Counter signatures should reviewed for dressing and taping checks. I.D. tags and site condition checks should be conducted before the next I.V treatment.
Never flush against resistance. Review the infuaing catheter to adjust flow pressure. Advise the patient to notify nurses or caregivers to administrate prescribed anti-nausea medication if symptoms present.
Report unusually distressed wound sites to a charge nurse or physician for further instructions. Patients, nurses, and caregivers should be watchful for side effects throughout the duration of the I.V. administration. Upon successful completion of the I.V. treatment, nurses can refer back to the prescribing physician for further orders.

Pyoderma Gangrenosum

Pyoderma Gangrenosum is a serious condition of the skin commonly denoted by cellulitis, ulcerous lesions, or wounds. Daily or weekly dressings are required as well as frequent I.V. infusions to combat secondary infections.
Pyoderma Gangrenosum is an exclusive diagnosis. This is unfortunate, as it leads many temporary and urgent care physicians to bypass the seriousness of the damage by referring to the lesions as ulcers, skin tears, and other superficial tissue damage events to the dermis and subdermis. Pyoderma Gangrenosum lesions are characterized by erosion of healthy via an enlarging or group of lesions. As the skin and nerves deteriorate the intense and the copious drainage make the patient’s life difficult.
Pyoderma Gangrenosum treatment plans require an extraordinary commitment of resources, supplies, nursing hours, consult dates, I.V. PICC line insertion, and even hospital stays or Emergency Room visits. The consult visits can become highly technical and a patient with Pyoderma Gangrenosum is well served to obtain a client advocate to meet their needs.
While Pyoderma Gangrenosum does present a flat-edged, wide-lesion wound area similar to some kinds of bed sores, they are much more infectious and extremely susceptible to Sepsis, C. differens infections and contagious MRSA infections. Pyoderma Gangrenosum patients should observe the best possible hygiene and infection control standards possible. Powdered, sterile, and/or Latex-free gloves must be worn by physicians and consultants present at an examination of the wounds or during any wrapping or re-wrapping of the wounds.
General advice given to patients with Pyoderma Gangrenosum is to diet, lose weight, exercise, and elevate the legs if the affected area is in bilateral lower extremities. Daily or twice daily dressing changes may be ordered as the drainage demands. Because the drainage causes the periwound to succumb to ongoing maceration, when the patient feels the bandages fill with liquid, they must report this to the nurse for a wound care session. Nurses must grow accustomed to checking in with the patient about how the wounds are draining and when another dressing is due. Such patients should be monitored for pain to allow direct contact with the wounds at the scheduled wound care time.

Gloves should be worn by all nursing staff during dressing changes, and even by the patient. Washing and shaving of the skin in the periwound may be necessary. Bathing should only take place immediately before a scheduled dressing change to preserve best standards of infection control.
During the wound care dressing change session, light bathing of the periwound skin can be conducted before placement of sterile topical gels and creams. For the heated skin symptom that often accompanies Pyoderma Gangrenosum, Silvadene silver cream has been shown effective to soothe the extreme pain present at the wound sites.
Because of the erosion of skin and nerve tissue during infection, a regimen of nerve pain medication is advised. Baclofen or Neurontin may be part of a 24 hour cycle of pain medication. NSAID therapy can also be used to lessen potential dependence on PRN opiate painkillers. As the Pyoderma improves or the skin infection conditions worsen, this regimen may need to be adjusted.
Pre-medication may be required for dressing changes when nerve and tissue damage has been severe. The pre-medication order should be arranged by the debridement doctor, the consulting physician, or the patient’s Primary Care Provider. Perspiration through hair follicles draws bacteria into the skin. Shaving and bathing of patients should be coordinated with nursing aides or personal residence staff accordingly.
Any situation where total cleanliness of the wound dressing area and sterility of medications is not present should be reported to the wound care team or the charge nurse immediately.
Although the Pyoderma lesions may present as what some nurses might consider mere “Pressure ulcers” that is not what they are.

Pyoderma Gangrenosum is not “gangrene”, as more ignorant members of the medical field are slow to grasp. Instead the Latin term refers to the spread of the immune disease through the tissues. Pyoderma can often be co-existent with systemic infections such as respiratory tract infections, colitis, cystic acne, and sepsis.
Treatment of Pyoderma Gangrenosum is a multipartite, multilayer effort best done with cooperation of the primary care provider, dermatologist, infectious disease specialist, vascular surgeon, and wound care team. The more sophisticated physicians in metropolitan and urban areas will have the experience treating pyoderma.
The systemic approach to ridding the body of pyoderma gangrenosum is to introduce as many cycles of antibiotic therapy as possible. Identifying the treatment method and material to be used is best done using blood tests and wound culture analyses from the affected lesions.The concurrent treatment for extreme site pain, nerve pain, and control of blood sugars must keep time with the infectious disease treatment.
A typical treatment therapy might be Vancomycin and Doripanem via intravenuous infusion, Bactrim
daily as oral antibiotic, and topical treatment of the skin lesions using the complementary spectrum of hydrogels as appropriate.Other nedications may be assigned as they register in sensitivity to the bacteria from the lab culture.
Sometimes Doxycycline or Cyclosporine is used to treat the Pyoderma condition. A key part of any treatment plan for a systemic condition of Pyoderma Gangrenosum is Prednisone. This use of a steroidal supplement can functiom to arrest the immune system disorder that causes the Pyodermic lesions to erupt. While an initial dose of Prednisone therapy can effectively battle back the worst of new lesions forming, the ongoing struggle to keep blood sugar low continues. Without controlled blood sugar, infection treatments will have
The would culture lab result will point the wound care team in the right direction concerning the effective treatment plan and schedule for wound care changes. One new and trending treatment is Tacrolimus to temper swelling and infection control. New studies have shown that Tacrolimus mixed with the Hydrogel Mupirocin retain highly effective resistance to pseudomonas, a common secondary infection.
Because Pyoderma starts as a lesion with no origin, many physicians and nurses speculate about the patient having contracted Pyoderma Gangrensum through contact
with pets or other animals. Dogs, for example, have been diagnosed with Pyoderma Gangrenosum. Due to the very high probability of bacteria contagion, victims of Pyoderma Gangrenosum cannot live with pets and expect any certain degree of recovery.
It requires a well-educated and proactive physician set to envision and implement a care plan for this disrase. The therapeutic relief of Pyoderma Gangrenosum. needs a patient and consistent evaluator of the effectiveness of current therapies. The patient may not always be ready to hear that a certain medication, device, or treatment is no longer working. In some cases a patient suffering from Pyoderma Gangrenosum will be referred to an amputation and limb preservation clinic for evaluation.

PICC Line Administration Facts

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A variety of skills are brought to bear on a daily multiple patient regimen, but nurses may need some more than others at critical junctures in the patient’s care plan. The most valuable skill a nurse can get trained on is opening a pick line in a patient. This is often referred to as finding a vein, or setting up a PICC line. The necessity for keeping the “pick” line in for every patient is a requirement for institutionalized healthcare practices and sound care plan advice.

The tap-in should be clean and free from swelling, tension, stiffness,’and/or causing discomfort for the patient. Blood, water, liquid of any type collecting under the dressing should be examined at once. Once affixed, tapes should be annotated with the date of line-in for future reference. Finding peripheral lines in veins must accord with circulatory norms. Nurses cannot begin to rely on easy veins and many long-term patients will need the best pick line insertion techniques when their pick line sites will begin to dry up.

The PICC line is not an easy skill to master. Connecting with the Superior Vena Cava is essential, and thus not just “any” vein can be used. In long term patients the proper veins ”hide” or “become smarter”, evading nurse’s or a technician’s search. This the need for mechanized equipment to find the proper vein is often required. A sonogram machine can be used to generate a visualization of the vein location for technical insertion point.

Nurses categorically check the line on every patient they have in their care roster, whether they are on IV drugs or not. Infection can start if a pick line is left in for too long. This is due to the procedural adaptation in every patient’s medical status whereby IV drug therapy becomes necessary. Grooming a patient’s line and monitoring its condition must be done at all times. Re-insertion of the line must be performed at once if problems arise.

Yet time and again the need for a re-insertion of a patient’s line can shed light on just how few nurses on the ward, if any, can find a vein and insert the pick line in a manner which will be sustained over a number of days. Patients may pull the line out, loosen it, or even worse, injure themselves. Nurse should explain to patients why they need to be conscientious about their line and work towards not straining it or causing tears at the skin’s opening.

This is a serious problem and could cause further delays and inefficiencies in nursing care down the line. Hunting through various staff wards for a nurse who can insert a pick line without the assistance of a sonogram is a seriocomic statement of what training nurses are expected to have versus what the actually bring to the job each day. Nurses should note in their charts the condition if each pick line and notify patient services if additional assistance is required.

Of course the heplock can always be used but that required a clean set of tubes every 72 hours and a clean insertion site. Many patients do not have the skin integrity or the vein strength for this. For this reason the PICC line is favored. To avoid delay in adminitrating an ordered dosage or maintenance regimen of material, make sure the entire case history of the patients dermal integrity is reviewed before any perforation is commenced.

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