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NRSG 214 Midterm
STUDY
| Question | Answer |
|---|---|
| What is a scope of practice document? | standards, limits, conditions |
| How does a nursing student sign charting? (second year) | J. Doe, UBCO SN2 |
| What is a standard? | minimum expectation |
| What is a limit? | can and can't do |
| What does regulatory supervision mean? | we always need to have an RN that knows the limits of what we can do |
| What are the parts of a syringe? | tip, barrel, plunger |
| How is a TB syringe calibrated? | up to 1ml in tenths and hundredths |
| What is a leur lock? | a tip that requires the needle to be twisted onto it to avoid accidental removal |
| What is a non-leur lock? | smooth graduated tip + needles are slipped onto it |
| What are the parts of a needle? | Bevel, hub, canuula/shaft |
| An SC needle with a blue hub is what size? | 1 inch |
| An SC needle with a black hub is what size? | 1.5 inch |
| An SC needle with an orange hub is what size? | 5/8 inch |
| If person is 60kg (130 to 152 lbs) what size needle is used? | 5/8 to 1 inch |
| If a woman is 70 to 90 kgs (152 to 200 lbs) what size needle is used? | 1 to 1.5 inch |
| If a man is 70 to 118 kgs (152 to 260 lbs) what size needle is used? | 1 to 1.5 inch |
| If a woman is over 90 kg ( >200 lbs) what size needle is used? | 1.5 inch |
| If a man is over 118 kg (>260 lbs) what size needle is used? | 1.5 inch |
| When are intradermal injections typically used? | allergy tests (right forearm) and TB tests (left forearm) |
| At what angle is an intradermal injection injected? | 15 degrees |
| What angle is an SC injection injected? | 45 degrees when 2.5 cm tissue can be grasped and 90 degrees when 5 cm tissue can be grasped |
| At what angle is insulin usually administered? | 90 degrees |
| How often do you use the same SC anatomical area for before switching? | 1 to 2 weeks |
| With what meds is aspiration performed for SC inj? | You do not have to aspirate, but for sure do not do it with insulin or heparin |
| How does one inj heparin? | 90 degrees, 30 seconds, do not massage, alternate sites of subsequent inj |
| How much fluid would an adult with well-developed muscles safely tolerate by IM? Where? | up to 3mL in gluteus medium and gluteus maximus |
| How much fluid would an adult with less developed muscles safely tolerate by IM? | 1mL to 2mL |
| How much fluid is recommended for the deltoid? | o.5 mL to 1mL |
| What are the different IM sites? | Ventrogluteal, vastus lateralis, rectus femoris. dorsogluteal, deltoid |
| Which site is most preferred for children? | vastus lateralis |
| Which site is most preferred generally? | ventrogluteal |
| How do you find the ventrogluteal? | heel of hand at greater trochanter, fingers to head, opposite hand to leg. index finger on client |
| How do you find the vastus lateralis? | anterior aspect of thigh, middle third of muscle between mid/front of thigh |
| How do you find the rectus femurs? | anterior aspect of thigh |
| Why is the rectus femurs not used? | it is painful |
| Why is the dorsogluteal not used? | it is close to the sciatic nerve and superior gluteal nerve and artery |
| How do you find the deltoid? | 3 to 4 fingers across the deltoid with the first finger on the accordion process; make a triangle with other hand |
| How do you use Z-track method? | use ulnar of non dominant hand to pull skin approximately 2 to 5 cm to the side; hold like a pen, be quick, smooth at 90 degree angle |
| Why is z-track method used? | it facilitates needle insertion, makes muscle more firm |
| When is rapid injection technique used? | when giving IM vaccines to children without aspiration -> used to decrease pain at time of injection |
| How is pain managed? | assess throughout shift, use fast acting analgesic .5 hour before pain causing activities, PRN analgesic at reg scheduled times in first 24 to 48 hours, effective combo of analgesics |
| What analgesics can be used? | non-opioid, anti-inflammatories and NSAIDs, adjuvants, opioids/narcotics |
| What are examples of non-opioid analgesics? | acetaminophen and tylenol |
| What are examples of anti-inflammatories/NSAIDs? | diclofenac, keterolac, ibuprofen |
| What is a common side of anti-inflammatories and NSAIDs? | stomach upset, heart burn |
| What should anti-inflammatories and NSAIDs be given with? | food or milk |
| What organ should be monitored when on anti-inflammatories and NSAIDs? | kidneys |
| What are adjuvants? | they are originally designed to treat different conditions but are used in combination with opioids to reduce post pain and constiation |
| What are examples of adjuvants? | gabapentin and amitriptyline |
| What are opioids/narcotics used for? | not useful for mild pain |
| What are examples of opioids/narcotics? | morphine, codeine, oxycodone, hydromorphone, fentanyl |
| What is the reversal agent for narcotics/opioids? | narcan/naloxone |
| What are nonpharmalogical management of post-op pain? | turning and position, massage, heat of cold therapy, distraction, muscle relaxation, guided imagery |
| What are some common post-op complications? | pain, n/v, bleeding, fever, dizziness/fainting, DVT, urinary retnetion, post-op delirium, fluid/E4 imbalance |
| What are non pharmaceutical methods or decreasing N/V? | change position slowly, encourage slow deep breaths, encourage visual imagery to distract, cool, damp cloth to forehead or back of neck, smell of peppermint, ginger ale, NG tube |
| What may cause nausea? | gastric stasis (ileus), chemoreceptor trigger zone (CTZ) stimulation |
| What may stimulate the CTZ? | fear, anticipation, memory, senses, motion sickness, sudden change in position, decrease BP, blood substances |
| What neurotransmitters are involved with N/V? | histamine, dopamine, serotonin, |
| What are common anti-nausea meds? | histamine blockers, dopamine blockers, serotonin blockers, dexamethasone, cannabinoids, lorazepam |
| What is an example of histamine blockers? | dimenhydrate (gravol) |
| What is an example of dopamine blockers? | prochlorperazine (stemetil), haloperidol (haldol), metoclopramide (makeran) |
| What is an example of serotonin blockers? | ondansetron (zofran) |
| What is an example of cannabinoids? | weed, dronabinol |
| Why may a person be vomiting bile? What colour is it? | green and slimy; bile enters GI through small intestine, if backing up to stomach, indicates gastric stasis -> paralytic ileus or obstruction |
| Why may a pt be vomiting coffee ground emesis? When may you see this? | blood in upper GI; in patient who had surgery on esophagus, stomach or small intestine |
| When is a bleeding wound a concern? | if dressing must be changed 2 to 3 times a shift |
| In an open abdomen sx, what might the blood look like? | mod amount of serosang, may need to be changed a few times per shift |
| In a laparoscopic sx, what might the blood look like? | small incisions, very little drainage, may not have a dressing |
| In a orthopedic sx, what might the blood look like? | moderate amount after sx, may need to reinforce dressing with abdo pads |
| In a vascular sx, what might the blood look like? | should be very little |
| In a neruosx, what might the blood look like? | usually very little |
| What is a normal temperature post op? | lowgrade fever <38 degrees during first 48 hours |
| What causes a low grade fever after a surgery? | normal inflammatory response, increase in metabolism to meet demands from surgery and healing |
| What are the five Ws that may cause fever? | wind, water, walking, wound, wonder drugs |
| What does wind refer to in terms of fever? When is it most common? | atelectasis (the collapsing of the small a/w and bottom of lungs) treated by incentive spirometer q1h while awake and mobilization; PO #1-2 |
| What does water refer to in terms of fever? When is it most common? | UTI, particularly catheterized patients if suspected, obtain specimen; PO #3-5 |
| What does walking refer to in terms of fever? When is it most common? | development of DVT which may cause low grade fever; prevented by ambulation ASAP TID; PO# 4-5 |
| What does wound refer to in terms of fever? When is it most common? | wounds; PO#5-7; if pt. d/c before this time, teach them how to recognize signs of wound infections (redness, swelling, pain, purulent drainage); take culture if suspected |
| What does wonder drugs refer to in terms of fever? When is it common | adverse drug reactions, may not cause fever until patient is taking drugs for +7 days |
| Besides the 5 Ws, what may cause fever? | sepsis, dehydration |
| What does sepsis look like? Who is at higher risk? | moderate to high fever, at any time, higher risk in trauma pt or pt with GI leaks into peritoneum, puts with invasive procedures |
| What does dehydration look like? Who is at higher risk? | low grade fever, puts who are NPO, vomiting, urine output decrease and con'c, decreased skin turgor |
| What patients are most susceptible to dizziness and fainting? | patients with spinal anesthetics -> nerves are frozen so vessels don't contract and blood does not go to head |
| What is a vasovagal episode? | dilated blood vessels, vagus nerve stimulation = slow heart |
| What may stimulate the vagus nerve? | holding breath and bearing down, inserting rectal sup, inserting IV catheter or administering an inj |
| What events may occur in a vasovagal episode? | orthostatic hypotension, sudden decrease in BP & HR, sudden LOC, mild jerking of limbs |
| What are the 3 causes of DVT? AKA virchow's triad? | blood pooling in veins/sluggish moving; damage to blood vessesls; blood that clots too easily |
| What are s/s of a DVT? | reddness, tenderness, swelling on limb with DVT, low grade fever, woman's sign |
| What are some fluid/e4 imbalances that may occur postop? | hypovolemia, hypervolemia, hypokalemia, hyponaturemia, |
| What are common s/s of hypovolemia? | decreased BP, increased HR, decreased LOC, dizziness, light headedness, nausea, skin and mucose membrane pale |
| How is hypovolemia managed? | monitor VS, use caution when mobilizing pt, administer isotonic IV fluids |
| What are common s/s go hypervolemia? | increased BP, RR, HR, O2l dyspnea, crackles, edema |
| What is the normal intake of potassium that people need? | 60mEq |
| Why may a surgical pt be at risk for hypokalemia? | decrease intake of K, increase excretion of K due to diuretics, increase GI losses of K due to vomiting or diarrhea |
| What are common s/s of hypokalemia? | serum potassium less than 3.5, weakness, decreased GI, weak, irregular pulse |
| Why is potassium not given as a bolus dose? | can cause cardiac arrests |
| What are common s/s of hyponatremia? | serum sodium is les than 135 mEq/L; usually no s/s until Na+ levels are low, n/v confusion, seizures |
| What usually causes urinary retention? | anesthetic agents, narcotics especially EPIs |
| When is a full bladder too full? | bladder holds approximately 300 to 600 ml |
| What are the benefits to an indwelling catheter? | continuous monitoring of output, useful in pt that is continuously receiving meds that is likely to cause retnetion |
| What are the drawbacks of an indwelling catheter? | increase risk UTI |
| What are the benefits of an I&O catheter? | decrease risk UTI, fewer steps |
| What are the drawbacks of an I&O catheter? | if patient has ongoing retention, nurse may need to perform multiple times (increase work for hrs, increase discomfort for pt. |
| What does post op delirium look like? | acute onset with fluctuation symptoms, difficulty focusing attenting, disorganized, illogical, altered LOC or hypoactive, common and serious |
| What are common delirium meds? | loxapine, quetiapine, haldol -> NO BENZOS |
| What are crystalloids? | solutions with small molecules that flow easily from bloodstream into cells and tissues |
| What are isotonic solutions? | approximately same concentration of osmotically active particles as extracellular fluid |
| What is osmolarity usually for isotonic solutions? | 240 to 340 mOsm/kg |
| What are examples of isotonic solutions? | D5W, NS |
| What are hypotonic solutions? | osmolarity < 240 mOsm/kg; fluid moves from extracellular space into cells, causing swelling |
| What are examples of hypotonic solutions? | half normal saline solution |
| When are hypotonic solutions contraindicated? | pt at risk for increased intracranial pressure |
| What are hypertonic solutions? | osmolarity >340 mOsm/kg; fluid moves from intracellular space, cells shrink, extracellular space expands |
| What are examples of hypertonic solutions? | D5W in half NS; 3%NaCl, D10 in NS |
| When are hypertonic solutions contraindicated? | cardiac or renal disease; cellular dehydration |
| What are colloids? What do they do? | plasma expanders; they pull fluids into bloodstream |
| When giving colloids, what is monitored? | increased BP, dyspnea, bounding pulse, signs of hypervolemia |
| What are peripheral lines? | short term or intermittent therapy through vein in arms, hand, leg, foot |
| What are the main types of peripheral lines? | steel winged, indwelling catheters over a steel needle, plastic catheters |
| Describe steel winged infusion needles | inserted easily but infiltration is common. Small, non flexible, only used when access with another device is unsuccessful. For short-term therapy in adults, especially for IV push |
| Describe indwelling catheters inserted over a steel needle | easy to use, less likely for infiltration. once in place, catheters are more comfy for patient |
| Describe plastic catheters | inserted through hollow needle. longer, more common for central-vein infusions, thread through vein for greater distance, makes catheters more difficult to use |
| What are central lines? | catheters placed in a central vein (usually subclavian or internal juglar |
| What are the three types of central lines? | traditional central venous, peripherally inserted central catheter, vascular access port |
| Explain traditional central venous catheter | multilane used for short term therapy. Lumen size may very, multilane provides multiple IV access using one insertion site |
| Explain PICCS | certified nurse inserts through vein in antecubital area at bedside; fewer and less severe adverse effects than traditional central venous catheter. May be left in place for several months |
| Explain vascular access ports for extended therapy | implant in pocket surgically constructed in subq tisse or tunnelled catheter (Hickma, broviac, groshong) |
| When are micro drip sets used? | infuse rates lower than 100ml/hr |
| What is the drip rate for micro drips? | 60 gtt per ml |
| When are macro drip sets used? | infusion rates greater than 100 ml/hr |
| What is the drip rate for macro drip sets | 15gtt/ml |
| What are complications of IVs? | iniltration, infection, phlebitis & thrombophlebitis, extravastion, severed catheter, allergic rxnair embolism, speed shock, fluid overlod |
| What is infiltration | fluid may leak from vein to surrounding tissue; occurs when access device dislodges from vein |
| What are signs of infiltration? | coolness at site, pain, leaking, lack of blood return |
| What are s/s of infection? | purulent drainage at site, tenderness, erythema, warmth, hardness on palpitations, fiver, chills, increased WBC |
| What is phlebitis and thrombophlebitis | inflammation of vein and irritation of vein with formation of clot |
| What may cause phlebitis and thrombophlebitis | poor insertion or PH or osmolarity of solution or med |
| What are s/s of phlebitis and thrombophlebitis? | pain, redness, swelling, induration ant site, red line streaking along vein, fever, sluggish flow |
| What is extravasation | leakage of fluid into surrounding tissues; occurs when meds seep through veins and produce blistering and eventually necrosis |
| What are the s/s of extravastion | discomfort, burning, pain at site, tightness, blanching, lack of blood return, inflammation, pain, ulcers, necrosis |
| What are s/s of a severed catheter? | pain at fragment site, decreased BP, cyanosis, loss of consciousness, weak and rapid pulse |
| What are s/s of allergic run? | red streak up arm, rash, itching, watery eyes and nose, sob, wheezing |
| What may an air embolism cause? | decrease BP, increase HR, rest distress, increased ICP, loss of consciousness |
| What are nursing interventions if a patient has an air embolism? | place patient on left side and lower head to enter right atrium where it can disperse more safely by pulmonary artery |
| What are s/s of speed shock? | immediate facial flushing, irregular pulse, severe headache, decreased BP, loss of consciousness and cardiac arrest |
| What are s/s of fluid overload? | neck distension, puffy eyelids, edema, weight gain, increased BP, RR, SOB, cough, crackles |
| When do IVs usually expire? | 24 hours |
| What are the different equipment needed for IVs? | IV catheter, catheter stabilization devices, solution containers, IV administration sets, IV filters, IV poles, |
| Before preparing an IV, what must be determined first? | type and amount to be infused, dose of meds to be added, rate of flow or time over which infusion is to be completed |
| How high should the tourniquet be? | 15 to 20 cm above the venipuncture site |
| How many ml/hr is KVO? | less than 50ml/hr |
| How do you calculate ml/hr | total infusion volume/total infusion time -> check infusions q1h |
| How do you calculate gtt/min? | (total infusion volume * drop factor)/infusion time |
| What does an electronic infusion device do? | regulates infusion rate a preset limits and has an alarm when solution is low or if there is air in tubing or is occluded |
| What does a dial a flow inline device do? | manually regulates control, controls amount of fluid to be administered. May be used if pump is not available or required but prevention of fluid overload important |
| When is volutrol used? | used if vol of fluid administered is to be carefully controlled. set holds max 100ml solution, attached below solution containers and drip chamber placed below set |
| What is infusion pump? | delivers fluids by IV exerts positive pressure on tubing or on the fluid, increases pressure if needed |
| What is volumetric infusion controller? | sole by gravitational force. Delivery pressure depends on height of container in relation to venipuncture site -> must be at least 76cm above site |
| When should primary admin sets and secondary tubing be changed if continuous? | every 72 hours |
| When should intermittent infusion sets without primary infusion be changed? | every 24 hours |
| What is the maximum time for a catheter in the same peripheral vein? | 3 days max |
| What is a large volume infusion? | med may need to have large volume for dilution or administered as continuous drip |
| What is intermittent IV infusion? | administer med mixed in small amount of IV solution |
| What is a tandem? | second container attached to line of first at lower, secondary port -> meds administered intermittently or simultaneously |
| What is a piggyback? | second set connects second container to tubing of primary container at upper port -> used solely for intermittent drug administration |
| What is syringe pump/mini infuser? | med mixed in syringe that is connected to primary IV line via mini infuser |
| What are volume control infusions? | small fluid containers attached below primary infusion container so med is administered through cl IV line |
| What is an IV push? | IV administration of undiluted drug directly into systemic circulation -> when drugs cannot be diluted or in emergency |
| What are the care areas of 48/6? | functional mobility, pain management, medication management, nutrition/swallowing and/or hydration, bowel/bladder management, cognitive functioning |
| What care area did IHA add to 48/6? | psychosocial |
| What are red flags for cognitive change? | changes in thinking, mood, function, behaviour |
| What is IDRAW? | ID pt (2 identifiers), diagnosis, recent changes, anticipated changes, what to watch for |
| What is SBAR? | situation, background, assessment, recommendation |
| What is the most common drug error? | not given when indicated or delayed |
| When do you give a saline lock flush? | before and after med, start of every shift, q12h if neutral, q24 if positive cap |
| When do you change a percutaneous, non-tunneled IV? | every 2 weeks |
| How old do you have to be to have 48/6 done on you? | 17 |
| What gauge size for ID? | 26 |
| What gauge size for SC? | 25 |
| What gauge size for IM? | 23-21 |
| When do you use micro drip? | patients with kidney problems and infants |
| How long do you leave an angiocath if it is put in during an emergency? not an emergency? | in 48 hours; 72 hours |
| What needle is used to enter a portacath | huber needle |
| How long can peripheral lines be used for? | 72 to 96 hours |
| How long can PICC lines, tunnelled central lines be used for? | months to year or more |
Created by:
db5k