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Pt Care Skills_

Module 9 + 10 special equip/ emergencies

what is a roto rest bed? post trauma bed designed to maintain seriously injured pt in a stable posit + maintain proper alighnment. bed oscillates from side to side, in a caradle like motion to reduce prolonged pressure (0-62 degrees)
what are some advantages of the roto rest bed side to side motion assists in improving upper RESPIRATORY tract function and reduces the need to turn pt to relieve or prevent pressure ulcers. also reduces urinary stasis and improves bowel function a result of constant motion.
these beds are indicated for what types of pts? pts with restricted respiratory function or advnaced/multiple pressure ulcers, or for pts who require stabilization and skeletal alignment after extensive trauma or result of severe neurological deficits.
what are the disadvantages of a roto rest? motion sickness such as vertigo or nausea, and others may feel isolated from the enviro. bed is big and takes alot of room. contraindicated in ICP (intracranial pressure pts!) or multiple rib fxs!
what is a low air loss therapy bed? beds that have many segmented +separated air bladders that allow the limited escape of air. each bladder is Individ. controlled for each pt. based off size/weight/etc(mattress w/ inflate/deflate seat 2 assist w/ txrs+had the CPR button 4 max deflate
who would use the low air loss therapy bed pts who require PROLONGED immobilization, who are at high risk of developing pressure ulcers or already have them, or whose condition requires frequent elevation of trunk for proper respiration or who are obese
what are some of the advantages of the low air loss bed? can be adjusted based off pt preference, can change to accomodate position (hip/knee flex, sitting, semirecumbent)via electronic controls. pts wieght is measured by sensors, the air bladders inflate/deflate AUTOMATICALLY to distribute their weight.
disadvantages of the low air loss air bladders can be punctured. transfers are a big process- u have to lock the wheels, eleveate pts trunk 20-30 degrees, deflate seat section, perform transfer, turn off seat deflate to reflate seat.
y do you mobilize a pt in the ICU? Prevent lung infiltrates and resolve postoperative atelectasis Prevent skin breakdown Prevent venous stasis and DVT Prevent loss of joint ROM Help maintain muscle toneFacilitate return to function and assist with the recovery
most hospitals divide the ICU into several units. list some. Neuro, medical, cardiovascular, trauma or burn trauma
what does CHF stand for? Congestive heart failure
what does CAD stand for? Coronary Artery Disease
what does MI stand for? Myocardial infarction (aka a heart attack!)
what does CAGB stand for? Coronary Artery Bypass Gaff
what does AVR stand for? Aortic Valve Replacement
what does A-FIB stand for? Atrial Fibrillation
what does AAA stand for? Abdominal Aortic Aneurysm
what does AICD stand for? Automatic Implanted Cardiac Defibrillator
what does TEE stand for? Trans esophageal Echocardiogram
what does TIA stand for? Transient Ischemic Attack (aka mini stroke)
what does CVA stand for? Cerebrovascular Accident
what does GI stand for? Gastro Intestinal
what does DVT/PVT stand for? Deep (Peripheral) Vein Thrombosis
what does PE stand for? Pulmonary Embolism [the sudden blockage of a major blood vessel (artery) in the lung, usually by a blood clot . In most cases, the clots are small and are not deadly, but they can damage the lung. ]
what does MRSA stand for? Methicillin Resistant Staphylococcus Aureus
What does VRE stand for? Vancomycin Resistant Enterococcus :Vancomycin is an antibiotic that is used to treat some drug-resistant infections caused by enterococci .some instances, enterococci have become resistant to this drug. Most VRE infections occur in hospitals.
What does IV stand for? Intravenous
What does A LINE stand for? Arterial Monitoring Line - for REAL time blood pressure.
What does COPD stand for? Chronic Obstructive Pulmonary Disease
What does CPAP stand for? Continuous positive Airway Pressure: is the use of continuous pos pressure 2 maintain a continuous level of + airway pressure, typically used 4 people who have breathing probs, like sleep apnea OR preterm infants whose lungs havent yet fully developed.
What does BiPAP stand for? Bilevel positive Airway Pressure: is a continuous positive airway pressure (CPAP) mode used during noninvasive positive pressure ventilation, used in pts with taking a breath is difficult. These include pneumonia, COPD, asthma
What does ABG stand for? Arterial Blood Gasses
What does ICP stand for? Intracranial Pressure
What does CCU stand for? Cardiac or Critical Care Unit
What does NICU stand for? Neuro-ICU or Neonatal-ICU
What does PACU stand for? Post anesthesia Care Unit
list some monitors typically seen in the ICU? display (usually analog) measures vital signs continuously, BP, O2 sat, HR, RR temp, ABG, ICB, A-line, cardiac patterns, dialysis, Swan-Ganz
in Ventilation, whats the dif btwn endotracheal tube (orotracheal or nasotracheal), tracheostomy or orophayrngeal tube endotracheal tube is placed in the MOUTH/NOSE 2 keep airway open. tracheostomy is SURGICAL OPENING thru neck into trachea, 4 open airway AND allows 4 secretions/easy suctioning. oro/nasopharyngeal is a wider thicker shorter tube 2 keep tongue outta way.
most mechanical ventilators,aka respirators, use ___ pressure to move/propel gas into pts lungs positive
what are the types of ventilators (3) volume cycled, pressure cycled, neg pressure device (very rarely used- iron long/turtle shell)
explain volume cycle vs pressure cycle volume- LONG TERM ventilation, predetermined amt of air during inspiration. pressure cycled is used for SHORT term- a predetermined amt of PRESSURE during inhalation. both PASSIVE DURING EXHALATION!
when a pt is using a ventilator, keep their head above __ degrees 15- 30 degrees (cant find this in the book, only the slides)
what activities should u limit when a pt is on a ventilator? limit exertion activities. limit mobility to ROM therex. AVOID neck flexion- this can cutt off the airway or dislodge tube!
what is a central line or swan-ganz? Pulmonary artery catheter goes in through the internal jugular (R) or femoral vein. Can detect even subtle changes in the cardiovascular system. these are more sensitive than IV line, but are VERY uncomfortable for pt.
what should u avoid when a pt is on an ICP? avoid exertion activity (isometrics) or valsalva; avoid neck flexion or hip flexion beyond 90. Do not flatten the bed, keep head 15 degrees above horizontal. Call nurse if monitor goes off
describe the various feeding devices dobhoff:thru nose 4 continous/interval feeding, gets dislodged frequently. NG: nasogastric tube used 2 REMOVE fluid/gas,/EVAL GI/ADMINISTER meds/FEED directly 2 stomach. G tube: directly inserted 2 stomach. PEG-into stomach/small Int. pump or gravity fed
describe the various feeding devices, cont. Total Pareneral Nutrition (TPN)- directly into blood, avoids GI. used for pts that are highly nutrient deficient. IV- into superficial veins, gives nutrients/meds, electroyltes.
can u exercise pts with all of these feeding devices. yes, but use caution and be aware not to remove the tube. with an NG- AVOID flexing neck and head. with an TPN, may need avoid shoulder Abd or flex. with an IV, if in antecubital of elbow, avoid elbow flex.
can a pt ambulate with a Wound VAC? yes it can be detached from wall, it can run on battery.
amb with drains? yes, just make sure they are safely situated for transfers or ambulation. Drains can dislodge easily. They are not always visible so check or ask if possible Activities limited to patient status only
what is an ostomy device? surgically produced opening in the abdomen to allow the elimination of feces.
what is traction? applied to extremity to align fx segments, stretch soft tissue, reduce mm spasm or contractures and immob pt.
can u move a pt who is hooked up to some sort of traction? yes, contralateral side! just make sure to not change their body posit.
whats a HALO? can u move them? Attached 2 skull with brace that is secured to upper torso, 2 STABILIZE CERVICAL SPINE. Patient may get OOB, ambulate and perform therex Be sure NOT to pull on halo to get patient up. Patient may have balance deficits with reduced UE and neck immobility
can u move a pt with an external fixator? if so, how? Patient may mobilize as soon as able Do not lift limb from under fixator You CAN USE THE FRAME to assist in mobilizing the extremity
can u do PT with a pt who has an internal fixator? if so how? yes, just Look for WB and ROM precautions!
what do you do if pt pulls out IV and starts bleeding stop the bleeding first and call for help, Do not leave the patient alone, Let appropriate personnel take over if needed Doc what happened/what was done/who was present. Dont discuss incident w/ pt or family, Notify immediate superior/call physician
T/F ace wraps are used for stability. FALSE. Ace wraps are not for stability, used more to control swelling or protect wound dressing
when making a sling for a pt, where do you want the elblow in relation to the wrist/ Make sure elbow is lower than the wrist in the sling. used to support upper extremity.
describe the sx of an alergic reaction? Mild and moderate reaction: Itchy skin, redness, rash, hives, itchy, watery eyes, sneezing
what should u do if a pt has a mild/mod alergic reaction? Identify allergen and avoid further contact Antihistamine cream or calamine If more required, contact physician
how do u define a severe alergic reaction Swelling of face or mouth; difficulty swallowing, speaking, breathing; wheezing, nausea, vomiting, dizziness or syncope
what do u do for a severe alergic reaction? Check airway, call for assistance Assist with injecting emergency medicine (Epipen) Position to prevent shock (on back and elevate feet)
how do u treat for shock? determine cause + remedy if possible. monitor vitals. supine with head slightly lower than extremities. cool compress or light blanket to prevent loss of body heat. keep pt calm. after sx's relieved, return pt 2 sitting. take to ER or call 911 if necesary
what is an automatic hyperreflexia (dysreflexia)? what are the signs sx? Occurs in newer SCI to T6 level; Sympathetic response that cannot be controlled in the brain causes widespread. peripheral arterial vasoconstriction. sx: HTN, fast HR, diaphoresis above SCI lesion (sweating!), headache, piloerection, red skin blotches.
causes of dysreflexia? Noxious stim below the lesion, bladder distention, fecal impaction, open pressure wounds, tight straps or clothing, EXERCISE
whats the treatment for dysreflexia? Considered a medical emergency Place patient in sitting or semirecumbant position Look for cause first – remove Monitor vitals Call for help when patient is stable
whats orthostatic (postural) hypotension? what kind of pts is this common in? Decrease in BP when you change position from supine to sit to stand Common with all SCI, increased with T6 and above
what causes orthostatic (postural) hypotension? Causes: SCI, dehydration, cardiac problems DM, Parkinson's, MS anything that disrupts the body’s BP regulating system
whats the Rx for orthostatic (postural) hypotension? : take time when changing position. Supine to sit and then wait a few minutes Sit to stand, wait before ambulating Compression – use Ace wraps on BLE with SCI, TED or other compression stockings Medication
what causes heat exhaustion + stroke? dehydration, response to hot humid enviro, excess physical activity, decreased electrolytes.
T/F heat exhaustion does NOT lead to heat stroke false. it can lead to heat stroke if not treated.
what are the initial signs of heat ILLNESS? cramps in abdoment or legs
how do u treat heat exhaustion + stroke? Stop activity and move to a cool and shady environment Cold compress HYDRATE, HYDRATE, HYDRATE Observe for shock Remove or loosen clothing
explain the differences in sx btwn heat exhaustion and stroke heat exhaustion: profuse sweating, shallow RR, weak rapid HR, pale, slight temp, NORMAL PUPILS. stroke: DRY skin, labored RR, STRONG + rapid pulse, flushed skin (maybe gray), VERY elevated temp, Pupils CONTRACT then DILATE, collapse/convulse
what similarities are there btwn heat exhaustion and stroke both cause nausea headache exhaustion
whats the dif btwn hypoglycemia and hyperglycemia? which is more serious? hypo is insulin shock, hyper is acidosis-more serious!
how long does it take for a pt to recover from hypoglycemia? if givin glucose/glucagon injection can take up to 20 mins to return to normal BG levels.
what can hyperglycemia lead to? diabetic coma which can lead to death. insulin is required. give them lots of water to flush ketones
what are the main differences btwn hypoglycemia and hyperglycemia? hypo: sudden onset, moist skin, agitated, normal breath, hunger, not thirsty, no glucose in urine. hyper: GRADUAL onset, DRY skin, DROWSY, FRUITY odor breath, DEEP RR, Nausea, no appetite, excessive thrist, lots glucose in urine.
Created by: tpostrel
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