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68C Test 12

Labs, Pain, Death, Acid/Base, IV, Alt therapy, MA, Blood Products

QuestionAnswer
Barium enema consist of a series of x-ray films with contrast dye visualizing the colon:used to demonstrate the presence and location of polyps, tumors and diverticula.
Barium swallow barium contrast study provides a thorough examination of the esophagus.
Bronchoscopy endoscopic visualization of the larynx, trachea, and bronchi by either a flexible fiberoptic bronchoscope or a rigid bronchoscope; there are many diagnostic and therapeutic used for bronchoscopy.
Chest X-ray x-ray film of the pulmonary and cardiac systems
Fiberoptic colonoscopy the entire colon from anus to the cecum can be examined.
Sigmoidoscopy benign and malignant neoplasms, polyps, mucosal inflammation ulceration, and sites of active hemorrhage can be visualized.
Endoscopy radiographic visualization of the biliary and pancreatic ducts. Stones, benign strictures, cysts, ampullary stenosis, anatomic variations, and malignant tumors can be identified.
Complete Blood Cell Count (CBC) A series of test of the peripheral blood that provides information about the hematologic system and other organ systems.
Computed Tomography (CT) non-invasive x-ray with contrast dye
Abdomen, Computed Tomography (CT) to diagnose pathologic conditions such as: tumors, cysts, abscesses, inflammation, perforation, bleeding, obstruction, aneurysms, and calculi of the abdominal and retroperitoneal organs.
Brain, Computed Tomography (CT) provides three-dimensional view of the cranial contents.
Differential diagnosis of intracranial neoplasms, cerebral infarctions, ventricular displacement or enlargement, cortical atrophy, cerebral aneurysms, intracranial hemorrhage and hematoma, and arteriovenous (AV) malformation. Brain, Computed Tomography (CT)
Chest, Computed Tomography (CT) to diagnose and evaluate pathologic conditions such as tumors, nodules, hematomas, parenchymal coin lesions, cysts, abscesses, pleural effusion, and enlarged lymph nodes affecting the lungs and mediastinum.
Heart, Computed Tomography (CT) obtain information about the heart and coronary arteries
Cystoscopy irect visualization of the urethra and bladder through the transurethral insertion of a cystoscope into the bladder
Culture laboratory test involving cultivation of microorganisms or cells in a special grown medium.
Cytology study of cells, including their formation, origin, structure, function, biochemical activities, and pathology.
Echocardiogram noninvasive ultrasound procedure used to evaluate the structure and function of the heart.
Electrocardiogram (EKG/ECG) a graphic representation of the electrical impulses that the heart generates during the cardiac cycle.
Electroencephalogram (EEG) a graphic recording of the electrical activity of the brain.
Expectorate mucous, sputum, or fluids from the trachea and lungs by coughing or spitting
Fixative any substance used to preserve gross or histologic specimens of tissue for later examination.
Glucose Tolerance Test (GTT) a normal fasting blood glucose used to diagnose diabetes(retinopathy, neuropathy, diabetic-type renal diseases).
Hemoccult detects occult blood in feces
Intravenous pyelogram (IVP) x-ray study with contrast that uses radiopaque contrast material to visualize the kidneys, renal pelvis, ureters and bladder.
Lumbar puncture (LP) needle placed in the subarachnoid space of the spinal column, one can meaure the pressure of that space and obtain CSF (cerebral spinal fluid) for examination and diagnosis.
Examination of the CSF includes blood, bacteria, and malignant cells, along with quantification of the amount of glucose and protein present. Lumbar puncture (LP)
Magnetic Resonance Imaging (MRI) noninvasive diagnostic scanning technique that provides valuable information about the body’s anatomy by placing the patient in a magnetic field.
Midstream urine specimen urine collected after voiding is initiated (midstream) and before voiding is completed. This is the cleanest part of the voided specimen.
Occult hidden blood that is present in stool that cannot be seen without the use of a microscope.
Paracentesis an invasive procedure entailing the insertion of a needle or catheter into the peritoneal cavity for removal of ascitic fluid for diagnostic and therapeutic purposes.
Residual urine urine left in the bladder after voiding. Can be measured at the time of catheterization.
Sensitivity a laboratory method of determining the effectiveness of antibiotics, usually performed in conjunction with culture.
Urinalysis (UA) multiple routine tests on a urine specimen. Routinely includes remarks about the color, appearance, and odor of the urine.
BMP Basic Metabolic Panel (BMP): previously known as CHEM-7
BMP, Blood, urea and nitrogen (BUN) measures the amount of urea nitrogen in the blood.
BMP, Calcium (Ca) to evaluate parathyroid function ad calcium metabolism by directly measuring the total amount of calcium in the blood.
BMP, Carbon dioxide (CO2) to evaluate the pH status of the patient and to assist in evaluation of electrolytes.
BMP, Chloride (Cl) performed as part of a multiphasic testing in what is usually called “electrolytes”.
BMP, Creatinine measures the amount of creatinine in the blood. Creatinine is a catabolic product of creatine phosphate, which is used in skeletal muscle contraction.
BMP, Glucose controlled by insulin and glucagon. In the fasting state, glucose levels are low. In response, glucagon is secreted. Glucagon caused glucose levels to rise.
BMP, Potassium (K) the major cation within the cell.
BMP, Sodium (Na) sodium is the major cation in the extracellular space. Sodium content is a result of a balance between dietary sodium intake and renal excretion.
CMP Comprehensive Metabolic Panel: previously known as CHEM 12.
CMP, Albumin is a protein that is formed within the liver to maintain colloidal osmotic pressure. Albumin is synthesized within the liver and is therefore a measure of hepatic function.
CMP, Aspartate aminotransferase (AST, previously known as SGOT) evaluation of suspected coronary occlusive heart disease or suspected hepatocellular diseases.
CMP, Bilirubin bilirubin metabolism begins with the breakdown of red blood cells (RBCs) in the reticuloendothelial system. Heme is then catabolized to form biliverdin, which is transformed into bilirubin.
CMP, Phosphatase, alkaline (ALP) found in many tissues, the highest concentrations are found in the liver, biliary tract epithelium, and bone. Detection of this enzyme is important for determining liver and bone disorders.
CMP, Protein, total proteins are constituents of muscle, enzymes, hormones, transport vehicles, hemoglobin and several other key functional and structural entities within the body
CMP, Lactic dehydrogenase (LDH) Found in cells of many body tissues, especially the heart, liver, red blood cells, kidneys, skeletal muscle, brain, and lungs
LDH Lactic dehydrogenase
Lactic dehydrogenase (LDH) Found in cells of many body tissues, especially the heart, liver, red blood cells, kidneys, skeletal muscle, brain, and lungs.
Total LDH is not a specific indicator of any one disease affecting any one organ, Because? When disease or injury affects the cells that contain LDH, the cells lyse, and LDH is spilled into the bloodstream.
LDH-1 After a heart attack, blood levels begin to rise within 24 to 72 hours, peak at 2 to 5 days, and remain elevated for as long as 14 days.
megaloblastic anemia Since LDH-1 is also found in red blood cells, an LDH-1 level can be caused by folic-acid anemia
LDH-2 primarily from the reticuloendothelial system
LDH-3 from the lungs and other tissues.
LDH-4 from the kidneys, placenta, and pancreas
LDH-5 from the liver and striated muscle.
Cholesterol Main lipid associated with arteriosclerotic vascular disease. Required for the production of steroids, sex hormones, bile, acids, and cellular membranes
Accurate predictor of heart disease Lipoproteins
Lipoproteins Proteins in the blood whose main purpose is to transport cholesterol, triglycerides, and other insoluble fats.
Lipid profile Total cholesterol. Triglycerides, HDL: good cholesterol, LDL: bad cholesterol, VLDL
Prothrombin Time (PT) Evaluates the adequacy of the extrinsic system and common pathway in the clotting mechanism.
Measures the clotting ability of factors I fibrinogen), II (prothrombin), V, VII, and X. Prothrombin Time (PT)
used to monitor heparin therapy Activated Partial Thromboplastin Time (aPTT)
International Normalization Ratio (INR) Best lab value for monitoring anticoagulation therapy. Designed to standardize values.
Sputum Analysis collection from the secretions in the lung, which contain mucus, cellular debris, or microorganisms and may contain pus or blood.
Acid-Fact Bacilli (AFB) test test for organism responsible for tuberculosis of the lung.
UA a total urinalysis involves multiple routine tests on a urine specimen. This specimen is not necessarily a clean-catch specimen. Urinalysis routinely includes
UA, Appearance Normal urine should be clear. Cloudy urine may be caused by the presence of pus, RBCs, or bacteria. May be cloudy due to ingestion of certain foods (fats, ureates or phosphates).
UA, Color ranges from pale yellow to amber because of the pigment urochrome. Color indicates the concentration of the urine and varies with specific gravity. Abnormal color may result from ingestion of foods and/or medicines
UA, Odor aromatic odor of fresh, normal urine is caused by the presence of volatile acids.
Diabetic ketoacidosis urine has a strong, sweet smell of acetone
UTI (urinary tract infections) urine may have a foul odor
enterobladder fistula urine may have a fecal odor
pH acid/base balance of the patient
Urine pH Acid urine is considered normal. Alkaline urine is common after eating. useful in identifying crystals in the urine and determining the predisposition to form a given type of stone
Protein is a sensitive indicator of kidney function because? Proteinuria is the most important indicator of renal disease. It is not normally seen in the urine due to normal glomerular filtration. screens for complications of diabetes mellitus, glomerulonephritis, amyloidosis, and multiple myeloma
presence of glucose within the urine may indicate? the likelihood of diabetes mellitus or other causes of glucose intolerance.
Urine Specific Gravity measure of concentration of particles, including wastes and electrolytes in the urine. Refers to the weight of the urine compared with that of distilled water. Used to evaluate the concentrating and excretory power of the kidney.
Ketones end products of fatty acid breakdown, normally not found in urine
UA RBC Presence of RBCs suggests glomerulonephritis, tubular necrosis, pyelonephritis, renal tumor or trauma. Bleeding may be microscopic or gross
UA WBC should be negative unless there is a urinary tract infection
Urine Culture and Sensitivity Test obtained to determine the presence of pathogenic bacteria in patients with suspected urinary tract infections.
Stool Analysis collected for a variety of reasons, including the following: to determine the presence of infection, bleeding, or hemorrhage; to observe the amount, color, consistency, and presence of fats; and to identify parasites, ova, and bacteria.
Guaiac (Hematest stools) the presence of blood in body waste is abnormal.
Guaiac (Hematest stools), bright red indicates that the blood is fresh and that the site of bleeding is in the low gastrointestinal (GI) tract.
Guaiac (Hematest stools), black tarry indicate the presence of old blood and that the site of bleeding is higher in the GI tract.
Infections of the bowel from bacteria, virus, or parasites usually present? acute diarrhea, excessive flatus, and abdominal discomfort
Adenosine Triphosphate (ATP) Produced in the mitochondria from nutrients. It is capable of releasing energy that enables cells to work.
Active transport Force that moves molecules into cells without regard for their positive and negative charge and against concentration gradients. Requires energy.
Moves fluid and electrolytes from an area of lower concentration to an area of high concentration. requires energy Active transport
Examples of substances actively transported Sodium, Potassium, Calcium, Iron, Hydrogen, Amino acids, Insulin provides transport for glucose
Passive transport movement of substances through the cell membrane; does not require energy
Diffusion Movement of particles in all directions through a solution. Solutes move from an area of higher concentration to an area of lower concentrate ions, which eventually results in an equal distribution of solutes within the two areas
Osmosis Movement of water from an area of lower concentration to an area of higher concentration. Equalizes the concentration of ions or molecules on each side of the membrane
Flow of water will continue until the number of ions or molecules on both sides of the membrane is equal. Osmosis
Filtration Transfer of water and dissolved substances from an area of higher pressure to an area of lower pressure. Force behind filtration is hydrostatic pressure.
Hydrostatic pressure force of fluid pressing outward on a vessel wall. The pumping action of the heart determines the amount of pressure.
Isotonic A solution of same osmotic pressure as that of blood. Solution with the same amount of solutes as blood.
Hypertonic A solution of higher osmotic pressure than extravascular fluids. Contain more solutes than blood.
Hypotonic A solution of lower osmotic pressure. Solutions that contain less solutes than extravascular fluids.
Homeostasis balance
Intracellular Larger of the two compartments. Fluid inside the cells within the body.
Extracellular any fluid outside the cells.
Interstitial fluid between the cells or in the tissues.
Intravascular fluid within the vessels; plasma.
Bicarbonate (HCO3) Main anion of the extracellular fluid. Alkaline electrolyte whose major function is the regulation of acid base balance. Acts as a buffer to neutralize acids in the body. Kidneys regulate amount of bicarbonate by selectively retaining or secreting it.
Blood buffers one of the three systems that work to keep the body's pH within the narrow range of normal. Act as chemical sponges, they circulate through the body in pairs and neutralize excessive acids or bases by contributing or accepting hydrogen ions.
Newborn water content 70 to 80%.
Adult water content 50 to 60%.
Older adult water content 45 to 50%.
Because Fat contains little water? Females have more body fat than males; thus females have less water content. Obese and older adults have less body water content than average adults.
Functions of water Vehicle for the transportation of substances to and from the cells. Aids in heat regulation by providing perspiration that evaporates. Maintenance of acid-base balance. Serves as a medium for the enzymatic/chemical actions. Lubricant for tissues.
Approximately 1/3 of total body water. Transports water, nutrients, oxygen, waste and other substances to and from the cells.Infants have more extracellular fluid than adults (approximately 1/2 of TBW). Extracellular fluid
Contains 2/3 of body fluids. Fluid contained within the cell walls Intracellular fluid
Average daily intake of water 2500 mls
Sensible fluid loss fluid loss that can be measured. i.e. Kidneys, GI tract
Insensible fluid loss fluid loss that cannot be measured. i.e Skin, Lungs
Nornal Kidney Function Must excrete a minimum of 30 ml/hr of urine to eliminate waste products from the body. respond to fluid changes by increasing, decreasing, concentrating or diluting urine output.
To determine water balance a client must be weighed under these conditions Same time of day, Same clothing, Same equipment attachments
hypovolemia Fluid volume deficit
dehydration fluid deficit occurs, it causes loss of water from the cells
hypervolemia Fluid volume excess (1) An excess or increase in the body's fluid volume. High volume of fluid in the intravascular compartments.
Pitting A depression in the skin that occurs when a fingertip is pressed into the tissue over a bony prominence and held for 5 secs..
loss of 5% of body fluid is significant. 15% is fatal. Fluid loss in infants
A loss of 10% body fluid is serious. 20% is fatal. Fluid loss in Obese patients
Electrolytes substances that develop electrical charges when they dissolve in water
Ion particles that electrolytes break up into when dissolved in water.
Anion ions with a negative charge.
Cation ion that is positively charged
For each positively charged cation in a fluid compartment, there must be? there must be a negatively charged anion so that balance is maintained.
Milliequivalent (mEq): measure of chemical activity or chemical combining power of an ion.
Non-electrolytes substances that remain bound together when dissolved in body fluids.
Normal Ratio of circulating blood volume depending on body size and sex 4 to 6 liters
Any condition that alters body fluid volume also alters? plasma volume of the blood.
Sodium (NA) The major extracellular electrolyte (cation).
Sodium (NA) normal range 134-142 mEq/L
Functions of Sodium (NA) Regulate/distribution of fluid volume in the body. Regulates osmotic pressure, water follows sodium in the body. Stimulates nerve impulses and helps maintain neuromuscular irritability. Important in controlling contractility of muscles like the heart
Hyponatremia A less than normal concentration of sodium in the blood. Occurs when there is a sodium loss or a water excess.
As sodium levels decrease in the extracellular fluid? water is pulled into the cells; this causes them to swell.
Sodium loss The body compensates by decreasing water excretion
Water excess dilutes all blood components
Hyponatremia Causes Loss through skin, diaphoresis. Large open lesions, burns. Massive edema, shifting of body fluids, ascites
Loss of GI fluids, vomiting, diarrhea. GI or biliary drainage via nasogastric tube. Fistulas, small bowel obstructions Hyponatremia Causes
Hypernatremia Greater than normal concentration of sodium. Occurs when there is an excess of sodium or a decrease in body water.
Potassium (k) Dominant intracellular cation
Potassium (k), Normal Range 3.5 to 5 mEq/L
Potassium (k) Functions Main function of potassium is regulation of water and electrolyte content within the cell. Promotes transmission of nerve impulses. Promotes the function of skeletal muscles. Regulation of acid-base balance.
Hypokalemia Decrease in the body's potassium level. Occurs when kidneys do not conserve potassium or large amounts of potassium is lost through GI system.
very dangerous because of cardiac arrest, which is caused by potassium's over stimulation of the cardiac muscle Hypokalemia
Chloride (Cl-) Normal Range 96 to 105 mEq/L
Chloride (Cl-) Functions Necessary for the formation of hydrochloric acid in gastric juices. Assists in regulation of osmotic pressure between the compartments. Assists in the regulation of acid-base balance
Hypochloremia decreased chloride in the body. Usually occurs when sodium is lost because sodium and chloride are frequently paired. Most common causes are vomiting and prolonged nasogastric or fistula drainage
Hyperchloremia increased chloride in the body. Rarely occurs but can be seen when bicarbonate levels fall. Chloride anions attempt to compensate to maintain equal number of cations in the body fluid
Calcium (Ca+) Normal Range 9 to 11 mg/dl
Calcium (Ca+)Functions Required for the formation and maintenance of strong bones and teeth. Necessary for normal clotting. Establishes the thickness and strength of cell membranes. Acts as an enzyme activator for chemical reactions in the body
Has a depressing or sedating effect on neuromuscular irritability and thus promotes normal transmission of nerve impulses. It helps regulate normal muscle contraction and relaxation. Calcium (Ca+)Functions
Hypocalcemia decreased calcium levels in the blood
Chvostek's sign contraction of facial muscles in response to a light tap over the facial nerve in front of the ear
Trousseau's sign arpal spasm induced by inflating a blood pressure cuff above the systolic pressure for a few minutes.
Hypercalcemia increased levels of calcium
Phosphorus Normal Range 2.7 to 4.5 mg/dl
Phosphorous Functions Supports the maintenance of bones and teeth. Acts as a buffer to regulate the body's acid-base balance. Promotes the effectiveness of many of the B vitamin. Assist in normal nerve and muscle activity. Participates in carbohydrate metabolism
Hypophosphatemia decreased levels of phosphorus in the blood
Muscle weakness, especially the respiratory muscles, and muscle spasms can be caused by? Hypophosphatemia
Hyperphosphatemia increased levels of phosphorus
Tetany and muscle spasms may occur Hyperphosphatemia
Magnesium Normal Range Normal range: 1.5 to 2.4 mEq/L
Magnesium Location 60% is found in the bone, 39% in muscle and soft tissue, 1% in extracellular fluids.
Magnesium Function Cofactor in the activation of many enzymes. Promoted regulation of serum calcium, phosphate and potassium levels. Essential for integrity of nervous tissue, skeletal muscle and cardiac functioning.
Hypomagnesemia decreased level of magnesium in the blood.
Hypermagnesemia increased levels of magnesium in blood
Bicarbonate Normal Range 22 to 24 mEq/L
Bicarbonate Functions Regulation of acid-base balance. Acts as a buffer to neutralize acids in the body and maintain homeostasis
Acid-base balance homeostasis of the hydrogen ion concentration in the body fluids
Alkaline (base) fewer hydrogen ions in a solution; causes the pH to increase greater than 7.45
Acid increase in hydrogen ions in a solution; causes the pH to decrease less than 7.35.
Normal pH 7.35 to 7.45
carbonic acid Addition or subtraction of acid substances
bicarbonate Addition or subtraction of base
bicarbonate imbalances cause metabolic acidosis or alkalosis
carbonic imbalances cause respiratory acidosis or alkalosis
Respiratory acidosis A retention of carbon dioxide occurs with resultant increase in carbonic acid in the blood; pH decreases.
Respiratory alkalosis Loss of excessive amounts of carbon dioxide with a resultant lowering of the carbonic acid level in the blood. pH rises because of the decrease in carbonic acid being blown off with each exhalation
Respiratory alkalosis Mode of compensation kidneys will excrete increased amounts of base to lower pH
Metabolic acidosis Gain of hydrogen ions or loss of bicarbonate
Metabolic alkalosis Significant amount of acid is lost from the body or an increase in the bicarbonate level occurs. Depresses the central nervous system
Acute pain intense and short in duration, usually lasting less than 6 months. Generally, provides a warning of actual or potential tissue damage.
Creates an autonomic response with a surge of epinephrine- "fight or flight" response. Acute pain
Chronic Pain generally lasts longer than 6 months. Can be continuous or intermittent.
Not a warning of tissue damage in process; unknown cause for some forms Chronic Pain
Referred Pain felt at different site than injured or diseased organ or body part.
Gate Control Theory Pain signals that reach the nervous system excite a group of small neurons that form a "pain pool." When the total activity of these neurons reaches the minimum level, a theoretic gate opens and allows the pain signals to proceed to higher brain centers.
Pain impulses are regulated and even blocked by gating mechanisms located? along the CNS at the dorsal horn of the spinal cord.
What can temporarily block the "pain gate"? application of other forms of cutaneous stimulation.
The Brain and Pain it doesn’t have the capacity to acknowledge pain while it’s interpreting other stimuli
Nursing interventions related to gate control Back rub, Warm compress, Ice application, Auditory or visual distraction
What can distract from pain Auditory or visual stimuli
Subjective pain data is obtained from where? from the patient in the patient's own words. Obtaining accurate information is critical.
Subjective Characteristics of pain Site, Severity, Duration, Location
Subjective Questions to ask about pain Pain relief measures? Interventions that don't relieve pain?
What makes pain worse? Pain medications taken? (name, dose, frequency and effectiveness) Subjective Questions to ask about pain
Objective data on is obtained? through close observation of the patient
Physiologic signs of pain Pallor and diaphoresis. Dilated pupils. Increased muscle tension. Nausea and vomiting with severe pain
Tachycardia. Increased depth and rate of respirations. Increased BP Physiologic signs of pain
Behavioral signs of pain Changes in facial expression, Clenching of fists, Crying, Moaning
Tossing in bed, Assuming fetal position, Clutching the effected body part Behavioral signs of pain
Pain scales allow the patient to rate the pain so that the nurse can measure pain intensity. This also allows the nurse to plan proper nursing interventions to assist in pain control, comfort, and mitigate further pain
What are commonly used to qualify the intensity of the pain experience Categorical scales, numerical scales, and visual analog scales
Categorical scales patient associates a given number (0-5) with a degree of pain intensity
0 No pain > 1 Mild Pain > 2 Discomforting pain> 3 Distressing pain > 4 Horrible pain > 5 Excruciating pain Categorical scale
Numerical scales patient selects a number from 0 to 10 with 0 being no pain and 10 being the worst pain imaginable.
Wong-Baker Faces pain rating scale match degree of pain to facial expression. Used in the pediatric setting or when there’s a language barrier between the patient and the health care provider.
Reduce the patient's anxiety level due to pain by? telling them that you believe they are in pain and you will assist them in their pain relief
As soon as the patient states that he or she is in pain what should the nurse do? Begin immediate pain intervention
Effective patient advocate regarding pain requires. Believe the patient is in pain and gain his/her trust. Discuss what you’re going to do and what patient & family are expected to do.
Accept the right of the patient to respond to the pain in the necessary manner. Encourage patient to use coping techniques that have been effective in the past. Be with patient often to reassure or distract the patient at times. Effective patient advocate regarding pain requires.
The founding principle of effective pain management is? "the failure to treat pain is inhumane and constitutes professional negligence."
The ultimate goals of pain management Provide pain relief by implementing immediate intervention to relieve or decrease the pain. Enable patient to resume ADLs as pain free as possible.
Improved feelings of self-esteem after implementation of pain management. Pain can deprive sleep. Adequate pain control can improve quality and consistency of sleep. The ultimate goals of pain management
Provide pain relief measures for your patient by? Using more than one therapy has an additive effect in reducing pain. Applying physical and psychological approaches and or analgesics and relaxation techniques will help control all components of the pain experience.
Provide pain relief measures before pain becomes severe by? Administer pain meds 30 minutes prior to doing any activities such as ADLs/walking. Administer PRN pain medication around the clock for moderate to severe pain.
If the pain therapy is ineffective at first? encourage the patient to try again before abandoning it.
What can prevent pain relief? Anxiety or doubt
If the pain management interventions are not working what should the nurse do? Keep trying. Don't become frustrated when efforts fail. Don't abandon the patient when the pain persists. Reassess and consider alternative therapies.
TENS (transcutaneous electric nerve stimulation) uses pocket-sized device that provides continuous mild electric current to the skin via electrodes to stimulate large nerve fibers to “close the gate” in the spinal cord to block transmission of pain impulses. (refer to gate control theory)
Massage is effective of reduction of? mild to moderate pain.
Distraction allows patient to focus on something else other than the pain. Relaxation by listening to music. Hypnosis Psychological Techniques of pain management
Psychological Techniques of pain management Guided imagery patient concentrates on image that helps relieve pain. Meditation. Biofeedback
Nonopioids such as NSAIDS and Acetaminophen, Opioids such as Morphine, Oxycodone and Hydromorphone Medications used for Pain Mangement
Medications used for Pain Mangement Adjuvant analgesics such as antidepressants and anticonvulsants relieve pain by a variety of mechanisms
Medications used for Pain Mangement can be administered how? oral (PO), IV, IM, PCA and epidural
When using a heating pad for pain management the Temperature should not exceed? 105 degrees F
When using a heating pad for pain management how long should you wait to check on the patient after application? Check the skin after 2-3 minutes for reaction to the hot pad
When an aquathermic pad is used for heat therapy? keep the dressings warm, treatment may be ordered for longer than 20 minutes.
When should the nurse discontinue cold therapy for pain management? Remove the ice pack after 30 minute, when the moisture-proof pad becomes wet, or if shivering occurs and report it to the charge nurse.
After administration of cold therapy how often should VS be re-assessed? Continue to take the vital signs every 1-2 hours until the temperature is stabilized.
who is responsible for pronouncing the death of the patient? Usually Hospital Policy states, The physician is the best qualified and is usually responsible for declaring a person dead
Post Mortem info Documented in patient record Time of death, Description of actions taken
Post mortem a Physician may request from the family? permission for an autopsy
U.S. laws require that a death certificate be prepared for? each person who dies.
Death certificates are sent to? local health departments, which compile statistics from the information.
Who signs the death certificate? A physician is usually responsible for declaring a person dead and is required to sign the death certificate
The death certificate is a permanent record of? the fact of death, and depending on the State of death, may be needed to get a burial permit. State law specifies the required time for completing and filing the death certificate
The death certificate provides important personal information about? the decedent and about the circumstances and cause of death. This information has many uses related to the settlement of the estate and provides family members closure, peace of mind, and documentation of the cause of death.
The death certificate is the source for? State and national mortality statistics and is used to determine which medical conditions receive research and development funding, to set public health goals, and to measure health status at local, State, national, and international levels.
Who are free to donate their bodies or organs for medical use. Legally competent people
The medical part of the death certificate includes? Date and time pronounced dead , Date and time of death , Question on whether the case was referred to the medical examiner or coroner
Cause-of-death section including cause of death, manner of death, tobacco use, and females’ pregnancy status items. Injury items for cases involving injuries. Certifier section with signatures The medical part of the death certificate includes?
If an inquiry is required by a State Post-Mortem Examinations Act? a medical examiner or coroner is responsible for determining cause of death
Patients who express a wish to donate functional organs after death should? be provided an organ donor consent card.
The family of a deceased client may decide to donate the client’s organs and should? be provided with information and consent forms
Autopsy examination performed after a person’s death to confirm or determine the cause of death
If the death was caused by accident, suicide, homicide, or illegal therapeutic practice? the coroner must be notified and he will decide if an autopsy is necessary.
Post mortem, Many relatives find comfort when? they are told that the knowledge gained from an autopsy may contribute to advancements in medical science as well as establish the exact cause of death
after death who becomes the patient The Family
Post Mortem, what must the LPN do if the the death was due to a contagious disease? attach special label to the corpse
Post mortem, When removing the tubing from the patients body Remove them as you would from a living person, (3) Make sure you deflate the balloon tips so as not to injure the body tissues upon removal
Post Mortem, what position is the patient left in? Place patient in supine position, Elevate the head. Do not place one hand on top of the other. (This can lead to discoloration.)
Post Mortem, what is done to prevent odor Replace soiled dressings with clean ones. Using plain water, wash the areas of the body that may be soiled with blood, feces, or emesis.
If drainage occurs around the rectum, urethra or vagina, place a gauze 4 X 4 over each opening and secure it with tape to prevent further soiling Post Mortem, what is don to prevent odor
Post Mortem what is done to prepare the body for viewing? Close patient’s eyes and mouth if needed. Remove all tubing if prudent. Perform anti-odor interventions, Brush or comb hair. Apply clean gown.
Intravenous (IV) pertaining to the inside of a vein as in inserting a hollow-bore needle into the lumen of a vein to deliver fluids and medications.
Infiltration presence of intravenous fluids within the subcutaneous space surrounding a venipuncture site.
Lumen the inside of the hollow shaft of a needle or a catheter
Patency a condition of being open and unblocked
Peripheral pertaining to the outside surface, or surrounding area of an organ or other structure or fluid of vision.
Vasoconstriction when the lumen of the vessel narrows, thus hindering blood flow and resulting in less edema.
Vasodilatation when the lumen of the blood vessel widens, thus increases the blood flow.
Venipuncture most common method of drawing a blood sample, involving inserting a hollow-bore needle into the lumen of a large vein.
Gauge a standard or scale of measurement of the needle
Percutaneous through the skin or mucous membrane
Occlusion an obstruction or closing off in a canal, vessel, or passage of the body
Three categories of central venous access devices (CVADs) Percutaneous CVCs, Tunneled CVCs, Implanted infusion ports
Percutaneous Central Venous Catheters: Inserted through the chest wall into the subclavian vein, Inserted through the neck into the internal or external jugular vein
Peripherally Inserted Central Catheters (PICC) enter the central venous system, usually the subclavian vein via the larger cephalic or basilica veins.
Peripherally Inserted Central Catheters (PICC) Use Alternative to CVCs for patients requiring IV access beyond the length of time that peripheral IVs can be maintained. Poses less risk of complications than CVCs (pnuemothorax, hemothorax, and air embolism).
Poses less risk of phlebitis and infiltration than peripheral lines and Less expensive to maintain than CVCs Peripherally Inserted Central Catheters (PICC)
How long can Peripherally Inserted Central Catheters (PICC)remain in place (7 days – 3 months)
Why May a PICC have several different ports? facilitates simultaneous infusions of different solutions
PICCs enter the central venous system via? the subclavian vein, the larger cephalic or basilica veins in the upper arm.
Describe a PICC Catheter A long venous catheter 40 to 65 cm in length (16-26 inches)
Tunneled CVD/ Central Venous Tunneled Catheters (CVTC) Implanted surgically through a subcutaneous tissue. Creates space between catheter and vein. Allows catheter to stay in place for indefinite period. Then it is advanced into the subclavian vein and into the superior vena cava
Central Venous Access Devices (CVADs) Implated infusion ports
It is threaded into the superior vena cava and the port can be easily palpated Central Venous Access Devices (CVADs)
It is necessary to heparinize CVADs every? 4 weeks
Four parts of CVAD ports the body of the port, the central septum, the reservoir, and the central line catheter
How are CVAD Ports accessed? with a Huber needle, along a straight or with a 90 degree angle
Why must a Huber needle be used to access a CVAD so that pieces of the port septum are not removed each time the needle is inserted through the septum and into the reservoir
for the administration of solutions via a vascular access device? Always use an infusion Pump
Interventions for Pneumothorax with recent placement of CVC Administer 100% oxygen, position client in left Trendelenburg position and notify physician.
Intervention for a Thrombus occlusion of a CVC Thrombolytic therapy will be initiated with a drug such as streptokinase to break up the clot. Keep tubing free of kinks
Precipitate occlusion of a CVC Drugs that interact may cause precipitate that blocks catheter tubing. Pharmacist can assist in determining the composition of the precipitate and the proper solution to dissolve it.
Mechanical occlusion of a CVC Catheter may have moved out of proper placement. Opening at catheter tip may be up against wall of vessel.
Interventions for a Mechanical occlusion of a CVC Reposition client to see if catheter tip is moved. Notify physician who may manipulate/reposition the catheter. X-ray is performed to ensure proper placement of catheter
Acupressure Uses gentle pressure at similar points on the body. Pressure is sometimes applied with a finger and sometimes with a small, blunt object primarily for prevent and relief of symptoms of muscle tension
Acupuncture a method of stimulating certain points (acupoints) on the body by the insertion of special needles to modify the perception of pain, normalize physiologic functions, or treat or prevent disease
Allopathic medicine traditional or conventional Western medicine
Alternative therapy Include the same interventions as complementary therapies, but frequently become the primary treatment modality that replaces allopathic medicine.
Aromatherapy uses pure essential oils, produced from plants, to provide health benefits.
Biofeedback a noninvasive method of determining patient’s neuromuscular and autonomic nervous system response by measuring body functions such as blood pressure, pulse, muscle tension, and skin temperature with the use of electronic or electromechanical equipment.
Chiropractic therapies chiropractic doctor adjusts the joints of the body by gentle manipulation of the musculoskeletal system to put an area of disturbed structural integrity back in proper alignment
Heparin Flush for VAD's solution of 1:100
Complimentary therapies therapies used in addition to conventional treatment recommended by a person’s health care provider. Do not substitute but rather complement conventional treatment.
Herbal therapy the use of herbs and natural supplements to treat illness and maintain health
Holistic nursing addresses and treats the mind-body-spirit of the patient. Nursing interventions include: relaxation therapy, guided imagery, music therapy, simple touch, massage and prayer
Heparin-Induced Thrombocytopenia (HIT) is the development of thrombocytopenia (a low platelet count), due to the administration of various forms of heparin, an anticoagulant. HIT predisposes to thrombosis, the abnormal formation of blood clots inside a blood vessel,
Idiopathic thrombocytopenic purpura (ITP) occurs when certain immune system cells produce antibodies against platelets. Platelets help your blood clot by clumping together to plug small holes in damaged blood vessels
Imagery visualization techniques which use the conscious mind to create mental images to evoke physical changes in the body, create a sense improved well-being, and enhance self-awareness.
Reflexology a system of applying pressure to specific areas of the feet based on the premise that there are zones and reflexes in different parts of the foot that correspond one-to-one to each part, gland, and organ of the body
Relaxation the state of generalized decrease in cognitive, physiologic, or behavioral arousal
Therapeutic massage message performed by trained professionals to manipulate the soft tissues of the body and assist with healing.
Yoga any of the methods prescribed which include a series of postures and breathing exercises practiced to achieve control of the body and mind to promote health, reduce stress, and improve feelings of well-being and the healing of disease
SASH Saline, Adminster, Saline, Heparin
They are not used for an immediate cure for all illness or acute injury but provide an ongoing method of maintaining maximum health? Alternative therapies
Examples of CAM's Exercise, Message, Reflexology, Prayer, Guided Imagery, Creative Therapies, Relaxation Strategies, Therapeutic Touch, Chiropractic therapy, Biofeedback, Acupuncture, Herbalism.
Conventional therapy refers to traditional western medicine.
Office of Alternative Medicine 1992, established with a primary goal to facilitate the evaluation of alternative medical treatment, specially acting as a clearinghouse to distribute information to the public, media, and professionals
Pharmaceutical therapy drugs that are derived from herbs include only the active ingredients thus making them more potent and likely incurring more adverse effects
Blood A viscous (thick) red fluid that consists of a liquid portion called plasma and formed elements that include red blood cells, white blood cells and platelets.
Hematocrit: measurement of total blood volume, (Male) 42 - 52%.
Hematocrit: measurement of total blood volume, (Female) 37 - 47%.
Blood pH Range 7.35 - 7.45, slightly alkaline
Blood Composition contains chemicals and three main types of formed elements called red blood cells (erythrocytes), white blood cells (leukocytes), and platelets which are also called thrombocytes.
Blood plasma The liquid part of blood, or blood minus the formed elements. The liquid part of blood that consists of water and the chemicals (nutrients, hormones, clotting agents, antibodies) needed by cells to stay alive.
Plasma proteins The most abundant type of solute in plasma that consists of three main types
Albumins help thicken and maintain blood volume
Globulins includes the antibodies that help protect us from infection
Fibrinogen is necessary for blood clotting
Varies with body size, changes in fluid and electrolyte concentrations, and the amount of adipose tissue. A big person has more blood than a small person, and a man has more blood than a woman. Blood Volume
Blood Volume Most adults probably have between 5 and 6 liters of blood: 5000-6000mL. Blood volume normally accounts for about 7% -9% of the total body weight. Examples of normal blood volumes are
Blood Plasma Volume 2.6L (2600mL)
Blood Cells and Platelets Volume 2.4L (2400mL).
Total blood volume 5L (5000ml)
erythrocytes Red Blood Cells (RBCs)
leukocytes White blood cells (WBC's)
Granular leukocytes Neutrophils, Eosinophils, Basophils, have granules in their cytoplasm
Nongranular leukocytes Lymphocytes, Monocytes, do not have granules in their cytoplasm
RBC Count (Male) 4.7-6.1 million/mm3
RBC Count (Female) 4.2 – 5.4 million/mm3
First Function of RBC's transports oxygen and nutrients to the cells and waste products away from the cells. It also transports hormones from endocrine glands to tissues and cells.
Second Function of RBC's regulates the acid-base balance (pH) with buffers, and helps regulate body temperature because of its water content, and controls the water content of its cells as a result of dissolved sodium ions.
Third Function of RBC's protects the body against infection with special cells and prevents blood loss with special clotting mechanisms.
Hemoglobin is a compound in the blood that? (1) Is continuously produced in the red bone marrow and carries oxygen from the lungs to the cells Carries carbon dioxide away from the cells to the lungs
RBC Normal level (Males) 14 - 18 g/dL
RBC Normal level (Females) 12-16 g/dL
RBC Average life span 120 days
Erythropoiesis process of RBC production that depends on several factors
Dietary Requirements of Erythropoiesis iron and copper, plus essential amino acids, vitamins such as folic acid, riboflavin (B2), pryidoxine (B6), B12
Erythropoietin enzyme released by the kidneys when the amount of oxygen delivered to tissues by RBCs is decreased. It’s carried to the bone marrow, where it initiates the development of mature RBC
defend the body against bacteria and viruses. Leukocytes (WBC)
WBC Count 5,000 - 10,000 mm3 of blood
developed from the red bone marrow and contains granules in their cytoplasm Granulocytes
phagocytosis Ingest bacteria and dispose of dead tissue
Neutrophils Leukocytes essential for phagocytosis (Ingest bacteria and dispose of dead tissue). Primary phagocytic cells involved in acute inflammatory response. Release Iysozyme, an enzyme that destroys certain bacteria.
Neutrophils Normal value 60 - 70%.
Eosinophils Play a role in allergic reactions. Effective against certain parasitic worms
Eosinophils Normal value 1 - 4%.
Basophils Essential to the nonspecific immune response to inflammation because of their role in releasing histamine during tissue damage or invasion
Cytoplasmic granules contain? heparin, serotonin, and histamine.
Cytoplasmic granules Normal values 0.5 - 1%.
Monocytes Engulf foreign antigens and cell debris. Second type of WBC to arrive at the scene of an injury. Useful in removing dead bacteria and cells in the recovery stage of acute bacterial infections
Monocyte Normal values 2 - 6%.
Lymphocytes Responsible for formation of antibody, special protein that combats foreign invaders, or antigens. They set up antigen-antibody process, which protects the body
B cells search out, identify and bind with specific antigens
T cells divide rapidly and produce large numbers of new cells that are sensitized to the antigen it was exposed to
Three basic steps in the platelet clotting mechanism Clotting factors are released from injured tissue cells and platelets > Formation of thrombin occurs > Formation of fibrin and trapping of RBCs occur to form a clot
Platelets (Thrombocytes) Smallest cells in the blood, Life span: 5 to 9 days, Produced in the red bone marrow, Functions in the process of hemostasis by arresting the flow of blood and prevents hemorrhage.
Platelets (Thrombocytes)Normal Value 150,000 - 400,000 mm3 of blood
Plasma Clear, straw-colored liquid, A complex mixture of water, amino acids, proteins, carbohydrates, lipids, vitamins, hormones, electrolytes, and cellular waste.
Plasma functions Transpots nutrients, gases, and vitamins. Regulates fluid and electrolyte balance. Maintains favorable pH.
Blood Type A (40% of Americans), RBCs contain type A antigen, Plasma contains anti-B antibodies.
Blood Type B RBCs contain type B antigen. Plasma contains anti-A antibodies.
Blood Type AB RBCs contain both type A and B antigen, Plasma contains neither anti-A or B antibodies, Universal Recipient
Blood Type O RBCs contain neither type A nor B antigen Plasma contains both anti-A and B antibodies. Universal Donor
Packed RBCs Transfused when whole blood could result in circulatory overload. Symptomatic Anemia, Hemoglobin < 6 g/dL
Deglycerolized or Washed RBCs Washed in NS to remove most of the plasma proteins Given to patients with repeated hypersensitivity reactions to blood components despite prophylactic administration of antihistamines. Approx loss of 20% of red cells
Fresh-Frozen Plasma (FFP) Replaces plasma without RBCs or platelets. Contains most coagulation factors; use in control of bleeding. Given to patients with documented coagulation factor (PT/PTT > 1.5 times normal) deficiencies who are actively bleeding
Plasma Exchange (Plasmapheresis) removal of plasma that contains components causing or thought to cause disease
Cryoprecipitate Factor VIII treatment of hemophilia A
Cryoprecipitate Factor IX Treatment for Hemophilia B (Christmas Disease)
Cryoprecipitate Contains clotting factors
A blood product must be infused within ______of leaving the blood bank 30 minutes
one unit of PRBC should be infused within _____ because of the danger of bacterial growth 4 hrs
Acute Hemolytic transfusion reaction Transfused blood is incompatible with the patient’s blood type. Antibodies in the recipient's plasma attach to antigens on transfused RBCs, causing intravascular destruction transfused RBCs
Febrile Non-hemolytic transfusion reaction sensitivity of recipient to leucocytes and platelets in donor’s blood
Allergic reaction (mild/moderate)transfusion reaction recipient allergy to plasma proteins in donor’s blood
Allergic reaction (Severe)/ Anaphylaxis transfusion reaction recipient’s allergy to donor antigen (IgA). Agglutination of RBCs obstructing capillaries and blood flow.
Circulatory Overload transfusion reaction Occurs when transfusion of excessive volume or excessively rapid rate; can lead to pulmonary edema.
Infectious disease transmission transfusion reaction Transfusion of microorganism contaminated blood
Agglutination 1.The clumping of cells such as bacteria or red blood cells in the presence of an antibody. The antibody or other molecule binds multiple particles and joins them, creating a large complex. when people are given blood transfusions of the wrong blood group
hemolyzation The production or occurrence of hemolysis. is the rupturing of erythrocytes (red blood cells) and the release of their contents (cytoplasm) into surrounding fluid
Hematocrit test that determines PRBC's
the six rights of medication administration Right client, Right medication, Right time, Right route, Right dose, Right documentation
When identifying the "Right Patient" never? go by the room, bed number or last name only
When checking for the "Right Medication" the LPN must? 1) Perform 3 label checks on the medication against the medication administration record (MAR) when preparing medication for administration
The nurse must know the following for every drug prior to administration? Generic/trade name. Classification. Expected action. Reason for Taking. Dosage range. Contraindications. Side effects. Special precautions. (Critical Nursing Implications.)
When making sure meds are given at the "Right Time" the LPN should? administer them within 30 minutes before or after the scheduled time.
If the nurse does not have the correct medication the administer by the "Right Route" what should they consider/ Do not assume which route is appropriate . One dose form should never be substituted for another unless the physician is consulted and an order for the change is obtained.
Patients have the right to do what with their medications? Patients have the right to refuse medications
What client specific parameters must be considered when the nurse ensures the "Right Dose" will be administered? Correct calculation performed based on client, weight, dose, etc
The LPN must never give a medication? That they have not prepared themselves
If a medication error is made, what must happen? It should be reported should be analyzed with an emphasis on how the system allowed the error to reach the client, not on who made the error. Reporting errors helps identify and correct recurring problems.
The routes of drug administration can be classified into three categories? enteral, percutaneous, and parenteral
Enteral routes through the GI tract via PO: by mouth. Tubal: by nasogastric, gastrostomy, or jejunostomy tube. Suppository: by rectum, vagina, or urethra. Enema: by rectum
Powder form of Medication often mixed with a liquid (diluent) before administration
Pill form of Medication Round, solid form. Must be broken down into solution form in the stomach.
Tablet form of Medication round, spherical or oddly shaped forms that dissolve in the stomach
Caplet form of Medication a tablet that has an elongated shape like a capsule and is coated for ease of swallowing.
Enteric coated tablet form of Medication a tablet with a special coating that protects them from the effects of gastric secretions and prevents them from dissolving in the stomach. They are dissolved and absorbed in the intestines.
Scored tablet form of Medication a tablet that has an indentation or marking that allows you to break the tablet into halves or quarters
Sublingual Tablet form of Medication designed to be placed under the tongue, where they dissolve in saliva and the medication is absorbed.
Capsule form of Medication a form of medication that contains a powder, liquid, or oil enclosed in a hard or soft gelatin.
Lozenge/troche form of Medication a sweet mucilage-type tablet that dissolves in the mouth to release medication.
Liquid form of Medication solid particles and liquid that must be shaken to disperse solid particles throughout the liquid portion before absorption by the body can occur.
Suspension form of Medication one or more drugs finely divided into a liquid such as water
Elixir form of Medication alcohol solution that is sweet and aromatic
Syrup form of Medication medication dissolved in concentrated solution of sugar and water.
Suppositories form of Medication drugs mixed with a lubricated substance molded to insert into body cavities such as the rectum or vagina. Must dissolve at body temperature to be absorbed.
Percutaneous form of Medication through the skin or mucous membranes
Topical Route of Medication applied to the skin
Sublingua Route of Medication underer the tongue. used when fast acting medications are indicated.
Buccal Route of Medication in the cheek. absorption into the capillaries of the mucous membranes of the cheek gives rapid onset of the drug's active ingredient because of its direct entry into the systemic circulation
Inhalation Route of Medication aerosolized liquids and gases
Instillation form of Medication applied to the mucous membranes of the mouth, eyes (ophthalmic), ears (otic), nose (nasal), and vagina.
Lotion form of Medication aqueous preparations. Soothing agents. Protect the skin. Cleanse the skin. Act as astringents
Ointment form of Medication oil-based semisolid medication
Cream form of Medication semisolid, non-greasy emulsions
Topical Disk (Transdermal patch) form of Medication adhesive-backed medicated patches
Ophthalmic route used for irrigation to remove foreign bodies, pupil dilation and administering of antibiotics.
Otic route used for irrigation to remove foreign bodies and to soften cerumen for removal and administer antibiotics
Nasal route used to shrink the mucosa or administer antibiotics.
Parenteral method of medication administration methods other than the digestive system route
Parenteral routes IM: intramuscular; within the muscle. SC, SQ, Subq: subcutaneous; under the dermis. ID: intradermal; within the dermis. IV: intravenous: within the veins
Ampules Glass containers that are opened by snapping of the top part of the bottle. Intended for one dosage use
Vials Glass or plastic containers that are sealed with a metal cap with a rubber diaphragm in the middle of the cap. The rubber diaphragm permits a needle to enter the vial for multidose use.
Why can the LPN not administer liquid medications to an unconscious patient? Concerns of aspiration
NG tubes are used to administer medications to? clients who are unconscious, dysphagic and too ill to eat.
How is a crushed tablet administered Mix in 30 ml of water prior to administration.
Suppositories dissolve at? body temperature and are absorbed directly into the bloodstream
Expose lower conjunctival sac by? having client look upward while gentle traction is applied to lower eyelid.
Eardrops must be at ________ when applied? room temperature
Otic medication Administration For adults and for children over 3 years old. Pull earlobe upward and back to straighten external auditory canal
Otic medication Administration for children under 3 years old Pull earlobe downward and back
When Administering Nose drops for an adult Position client lying down, handing head backward over edge of bed or with pillow under shoulders to hyperextend the neck if client can tolerate it
When Administering Nose drops for a younger child? Position child on bed with head backward and downward
When Administering Nose drops for an infant Hold infant with head backward and downward
MDIs (multidose inhalers) deliver a measured dose of drug with each push of the canister
An aerochamber (spacer) can be attached to an MDI to improve delivery of proper dosage of medication
Sublingual administration of medications reduces the time it takes for the drugs to produce the desired action by? bypassing the liver
Range of Syringe Barrels 1 mL to 50 mL, Calibrated in milliliters and insulin units
Tuberculin syringe Holds a total of 1 mL. Measured in milliliters (mL). Uses for giving small doses of epinephrine, intradermal skin tests and subcutaneous medications.
Insulin syringe 1) Calibrated in units. Only used for administration of insulin with concentration to match calibration of syringe.
U100 Insulin syringe used for insulin with concentration of 100 units per 1
U50 Insulin syringe used for insulin concentrations of 50 units per .5 mL.
Needles consist of hub, shaft and beveled tip
Position to put patient in when administering a suppository Sim's Position exposes the anus
Gauge selection is based on? the viscosity of the medication, injection site, client weight and the route of administration
Needle Gauge Diameter inside of the needle's shaft. Smaller the gauge - larger the diameter of the needle (i.e.) 16g is > 18g
Needle length for Intradermal 3/8 - 5/8 inch
Needle length for Subcutaneous 1/2- 5/8 inch
Needle length for Insulin 5/16-1 /2 inch
Needle length for Intramuscular 1 - 1 1/2 inch
2 tpyes of IV Needles Butterfly and Over-the-needle catheters
Angiocaths plastic catheters over a stainless steel needle stylet
Stylet sharp, bevel tipped metal guide that is used to pierce the skin and vein.
Butterfly Needle Known as: scalp needle or wing-tipped needle. Administration of IV fluids for a short amount of time. Used in pediatric cases in which veins are hard to find except in the scalp.
Improper site selection for an intramuscular injection can result in? Damaged nerves, Abscesses, Necrosis, Sloughing of skin, Lingering pain, Periostitis: Inflammation of the lining covering the bone
Periostitis Inflammation of the lining covering the bone
Site Characteristics for intramuscular injection, Vastus Lateralis Preferred site for children < 3 yrs of age; Free of nerves and blood vessels, Also used in adults, Possible to inject up to 3 ml of medication; rapid drug absorption occurs.
Site Characteristics for intramuscular injection, Ventrogluteal Preferred site for infants, children, and adults older than 7 months. Provides the greatest thickness of gluteal muscle. Does not have nerves and blood vessels penetrating it. Has the most consistent and thinnest layer of adipose tissue.
Site Characteristics for intramuscular injection, Dorsogluteal No longer a recommended site due to risk of injury. Possibility of striking the sciatic nerve, the greater trochanter, and the superior gluteal artery. Permanent or partial paralysis is possible if a needle hits the sciatic nerve.
Site Characteristics for intramuscular injection, Deltoid Site easily accessible. The deltoid is too small in children and older adults. Inject no more than 1 ml into this muscle. Potential for injury to brachial vein and artery as well as the radial nerve.
Up to 3 mLs can be administered via this site? Vastus Lateralis Muscle
If not using an aerochamber or spacer when using an inhaler The lips do not touch the inhaler. It should be 1/2 to 1" from the lips.
Administer mixtures of insulin? within 5 minutes of preparation
Intramuscular injections involves inserting a needle into the muscle tissue to administer medications. Because muscle tissue has a large blood supply, absorption of an IM medication is faster than a subcutaneous injection.
Intramuscular injections, needle size 20 - 22 gauge with needle length of 1 to 1 1/2 inches
Intramuscular injections, Amount No more than 3 mL (except deltoid that can only tolerate to 1 mL).
Intramuscular injections, Sites dorsogluteal, vastus lateralis, ventrogluteal and deltoid
Intramuscular injections, Insertion Insert needle at a 90 degree angle quickly in a dart-like motion
Intramuscular injections, Z-track method Used for injecting medications that is irritating to the tissues. It keeps tissue irritation to a minimum by sealing the medication deep within muscle tissue. It prevents staining or tracking of medication into tissue as the needle is withdrawn.
Intradermal injections Introduction of a hypodermic needle into the dermis for the purpose of instilling a substance such as serum, vaccine or skin test agents. Do not aspirate this type of injection. Absorption is slow.
Intradermal injections, Amount Small volumes of 0.1 mL or less are given via this route
Intradermal injections, Sites Upper chest, inner aspect of lower arm and scapula area.
Intradermal injections, Insertion Insert bevel up directly under the skin. Advance needle through epidermis to approximately 1/8 inch (3 mm) below the skin surface. Make a small bubble-like (wheal) with solution. Insert needle at approximately a 15 degree angle.
Intradermal injections, needle Size 25 gauge that is 3/8 to 5/8 inch long
Subcutaneous injections Injections are made into the loose connective tissue between the dermis and the muscle layer. Because subcutaneous tissue is not richly supplied with blood and muscles, drug absorption is somewhat slower than with IM injections
Subcutaneous injections, Amount No more than 1 mL may be administered through this method.
Subcutaneous injections, Sites Upper arm, abdomen, thigh and scapula area. Sites must be rotated to prevent damage to tissues. Sites must be rotated to prevent damage to tissues
Subcutaneous injections, Needle Sixe 25 gauge with needle length of 1/2 to 5/8 inch
Subcutaneous injections, Insertion Insert needle at 45 degrees angle for a thin patient or a child to ensure medication reaches subcutaneous tissue rather than muscle
Preparation for Intravenous Therapy Uses Provide fluid and electrolyte maintenance, restoration and replacement. Administer medications and nutritional feedings to include patient controlled analgesics (PCA). Administer blood and blood products.
IV Push Medication is given directly into the vein via heparin/saline lock or injection port of an existing IV tubing. Used most often in emergency situations. Must be done by RN
Intermittent Venous Access Devices Commonly called Saline locks or Heparin locks. Must be flushed with 3 mL of saline before and after use and/or q shift to ensure patency (follow local hospital policy).
Continuous infusion Medication is added to a bag of IV fluid and is infuses over the time the same period as the IV fluid
Patient Controlled Analgesia (PCA) Drug delivery system that dispenses a preset IV dose of an opioid analgesic into a client's vein when the client pushes a button on an electrical cord. RN programs the pump
Nursing responsibilities, medication administration via PCA monitor number of doses received by patient, respiration and BP; monitor for signs of oversedation; monitor for pain relief, document total volume infused and remaining every shift; ensure reversal agent Narcan is at the bedside.
Parenteral nutrition Also known as hyperalimentation Bypasses the entire GI system which eliminates the need for absorption, metabolism, and excretion. Hypertonic IV feedings to meet nutritional needs. Administered through a peripheral vein or a central vein
Bypasses the entire GI system which eliminates the need for absorption, metabolism, and excretion. Parenteral nutrition
Two types of parenteral TPN (Total parenteral nutrition) and PPN (Peripheral Parenteral nutrition)
PICC line peripherally inserted central cathether, (subclavian, Internal jugular vein)
TPN (Total parenteral nutrition) This is a preferred method for patients who are unable to tolerate and/or maintain adequate enteral or oral intake. Use for nutritional needs greater than 14 days. given through a central line
PPN (Peripheral Parenteral nutrition) May be administered through a peripheral intravenous line. Used as a temporary means (< 14 days) of delivering nutrients to patients who need more nutrients than their current oral intake can supply.
IV Lipid Emulsions Given in conjunction with TPN/PPN. Two functions: provides essential fatty acids and are sources of energy or calories. Prevents essential fatty acid deficiency which can delay wound healing
Parenteral nutrition, Nurse Monitoring, Infusion rate Infusion should be continuous; new bag and new tubing required Q 24 hrs. If infusion is discontinued abruptly, rebound hypoglycemia may result
Parenteral nutrition, Nurse Monitoring, Peripheral/central line Site monitor q4 hrs for patency, intactness, and appearance (redness, swelling, or drainage from site).
Parenteral nutrition, Nurse Monitoring, Client response monitor for signs of restlessness or discomfort. Evaluate client's response
Parenteral nutrition, Nurse Monitoring, Blood glucose check several times each day or as ordered. Regular insulin on a sliding scale may be ordered to keep blood glucose below 200 mg/dl.
Parenteral nutrition, Nurse Monitoring, Weight daily or weekly as ordered to evaluate client's response to therapy.
Parenteral nutrition, Nurse Monitoring, Intake and Output Ensure accurate and done at least every shift. Abnormal urinary output may signal hyperglycemia or altered kidney function.
Parenteral nutrition, Nurse Monitoring, Labs total protein, albumin, electrolytes, CBC, BUN are ordered daily or as needed.
Infiltration/Phlebitis wetness, pallor, pain, and coolness to touch indicate possible infiltration. Erythema, edema, inflammation often means onset of phlebitis.
Signs of systemic infections sudden onset of chills, fever, headache, nausea/vomiting.
Signs of fluid overload anxiousness, dyspnea, weak and rapid pulse.
Allergic reactions mild rash to respiratory distress, restlessness, wheezing, hives, decreased blood pressure, nausea, vomiting, diarrhea, changes in mental status.
Created by: 68C14006