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Nursing

Sterile Technique III

QuestionAnswer
Purpose of irrigation To clean the area and promote healing. To instill antiseptic solution or medication. To remove excess drainage.
Clean irrigation technique Throat, ear, vaginal, bowel, stomach
Sterile Irrigation technique Bladder, eye, open wounds, puncture, lacerations, dog bites, postop surgical wounds
Eye irrigation guidelines Use sterile technique. Used to remove foreign bodies from eye, injurious fluids from eye, secretions caused by infections
Eye irrigation procedure Position pt: supine, head turned with eye to be irrigated down. Place emesis basin below eye, introduce sterile irrigation fluid into lower conjunctival sac at inner canthus.
Wound irrigation guidelines Use sterile technique. Position pt: with wound exposed. Direct fluid to all parts of wound.
Wound irrigation procedure Position pt, place waterproof pad under pt, wash hands, don clean gloves, remove old dressing, inspect wound
Wound irrigation procedure cont Pour warm irrigating solution into sterile container. Open syringe. Place sterile syringe into sterile container with solution. Place second basin or container distal to wound to catch contaminated irrigant. Don sterile gloves. Fill syringe with solution
Wound irrigation cont Hold syringe 1 inch away from wound, gently flush all areas, continue to flush until irrigation solution is clear. Dry surrounding area. Apply sterile dressing. Remove and discard gloves. WASH HANDS
Ear irrigation guidelines Use clean technique. Check intactness of eardrum before irrigating: do not irrigate if eardrum is not intact. Used to remove cerumen, foreign bodies.
Ear irrigation procedure Position pt. Tilt head forward. Pull ear up and back for adults. down and back for children.
Documentation of irrigation Date and time. Wound assessment if wound irrigated. Nature of care given. Results of procedure. Pt tolerance/response
IV assessment Signs and symptoms of swelling, pallor, coolness around site, pain: infusion must be disconnected, raise the extremity, apply warm compresses
Phlebitis Inflammation of vein. Signs and symptoms: pain, edema, erythema, increase skin temperature, redness traveling path of vein. Infusion must be disconnected, raise extremity, apply warm compresses. Risk of developing blood clot.
How is phlebitis risk reduced Routine removal and rotation of IV site
Nursing Diagnoses Risk for injury, pain, auditory sensory deficit, risk for infection
Created by: senmark