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105 test #2

nasal cannula 1-6 L/min; 24-44% O2
simple mask provides reservoir 5-8 L/min; 50 -60%
non-rebreather mask large reservoir; 8-10 L/min; 60-100%
pulse oximetry non-invasive measurement of oxygen level in hemoglobin
tracheostomy a surgical opening in the trachea just below the larynx
endotracheal tubes most commonly inserted in clients who have had general anesthetics or for those in emergency situations in which mechanical ventilation is required
tracheostomy care know the type of trach tube patient has, clear out mucus every 8 hours
suctioning aspiration of secretions through a catherter that is connected to a suction machine or wall suction outlet
suctioning purpose remove secretions and clear the airway
pressure for orolpharyngeal, nasopharyngeal, endotracheal, and tracheostomy suctioning 80 - 100 mmHg
Oral suctioning is a ________ procedure non-sterile
Nasal suctioning is a _________ procedure sterile
Endotracheal/Tracheostomy suctioning is a _______ procedure sterile
Types of catheters flexible and rigid/yankauer
flexible catheters sized by outer diameter, less than 1/2 diameter of artificial airway
Rigid/Yankauer catheters pre-oxygenate 100% 1 min before suction, advance quickly, suction time 10-15 sec, may need to reoxygenate
Deep breathing techniques incentive spirometery
deep breathing technique goals inflate the lung, prevent alveolar collapse (atelectasis), treat or prevent complications (related to post op or lack of mobility)
Coaching a patient for IS fowler's or semi-fowler's, encourage max effort, push stomach out, hold breath at end inspiration for 3-5sec, relax and exhale
Goals for IS deep breaths are the goal, not fast deep breaths which may hyperventilate the patient, low CO2 cause dizziness, may cause fainting
Make sure you do this with IS take frequent breaks to prevent hyperventilation, encourage the patient to cough, use a pillow to splint any incisions during coughing
Procedure of IS introduce the device, seal lips around mouthpiece, breathe slow and deep, flow or volume indicator as a motivator, breath hold, splint/cough
medication administration 6 rights right drug, right dose, right time, right route, right patient, right documentation
must know medication action, duration, expected effect, contra-indications, normal dose range, compatibilities, side effects
a medication error is a right gone wrong...if it happens what do you do? care for patient, call MD/supervisor, and document
Non-parenteral routes oral and topical routes
oral routes sublingual/buccal and enteral
topical routes dermatologic, ophthalmic/otic, nasal, rectal/vaginal, inhalers
key points for giving injection no recapping, "scoop" method, restrain children if needed, if you aspirate blood, withdraw needle, throw away, and prepare another syringe
Luer-Lok syringe needle is twisted on the tip
non Luer-Lok syringe smooth, graduated tip
Check what for vial medication multi or single dose and check date and time opened
Reconstituting medication from a powder reminders Draw up correct amount and kind of diluent, mix medication completely, multi-dose vials - document concentration of dose on label, date, & time, and change needle
Intradermal injection examples TB testing and allergy testing
Intradermal angle 5-15 degrees
intradermal needle size small size needle 26-27 gauge, 1/4" to 1/2"
intradermal volume of solution 0.01 - 0.1 ml
intradermal sites create a bleb on the ventral forearm, upper chest or the back beneath the scapula
how do you want the needle tip facing in an intradermal injection? bevel up
subcutaneous injection angle 45 to 90 degrees - body mass
subcutaneous needle size small size needle 25 gauge ( 1/2 - 5/8 inch)
subcutaneous injection volume 0.5 - 1 ml
what dont you do with subcutaneous injections and why? do not aspirate because it can cause tissue trauma
intramuscular injection needle size needle size for average adult is 21-25 gauge with 1-1 1/2"
intramuscular injection angle 90 degrees
intramuscular injection volume 1-2 ml recommended
intramuscular sites deltoid, ventrogluteal, vastas lateralis
deltoid injections typically are used for what? vaccines
vastis lateralis injections are usually used on who? < 1 years of age
z-track method prevents seepage of the medication into the subcutaneous tissues and subsequent discomfort
surgical asepsis absence of all microorganisms and spores
when to use sterile technique during procedures that require intertional perforation of the skin, skin integrity is broken, and entering a sterile body cavity
Maintaining a sterile field only sterile items on sterile field, open dispense and transfer items w/o contamination, do not reach across sterile field, if sterile barrier has been cut wet or torn consider contaminated, do not place near open windows or doors
Principles of surgical asepsis movement in and around sterile field must not contaminate sterile field, must be established immediately, never before, not covered, always be in view, no touch technique
golden rule of surgical asepsis when in doubt, it is contaminated
key points of sterile gloves find the thumb, keep thumb of gloved hand out of the way when donning the second glove, and be aware of closeness of gloves to table
staple removal 1) place tip under staple, 2) squeeze handle, 3) gently lift, 4) release handles, 5) assess for healing edge ridge
steri strips gently cleanse suture line, inspect incision, apply tincure of benzion in not allergic, apply steri strip, remove backing
dry wound dressing indications drainage, direct pressure, support, immobilize, protection
how do you clean a wound? cleanest to dirtiest
wound assessment location, size, and edges approximated
wound appearance color, pink, beefy red granulation tissue
eschar black, dead tissue
slough yellow dead tissue
purulent pus
serous clear drainage
serosanguineous clear, bright bloody; "new"
sanguineous dark red blood, usually old blood
where would you culture an aerobic wound? on the surface
where would you culture an anaerobic wound? deep in the tissue
2nd most common wound infection nosocomial infection
a wound is infected if...? purulent drainage is present
signs and symptoms of infection warmth, redness, pain, swelling, purulent drainage
surgical wound infection can happen in? 4th or 5th day
contaminated wound can get infected in? 2 or 3 days
primary intention wound clean wound, edges well approximated, capillary bridge in 3-4 days
secondary intention wound extensive tissue loss, longer healing time, > chance of infection, more scar tissue
wound dehiscence separation of wound edges at suture line, appearance of underlying tissues, occurs 6-8 days post surgery
wound evisceration protrusion of internal organs and tissues through incision
intervention for wound evisceration cover with sterile moist saline, call doc ASAP, surgical emergency
principles of wound cleaning use separate swab for each stroke, circular motion moving outward, least contaminated to most contaminated
solutions to avoid hydrogen peroxide and betadine
best solution to use normal saline
why use dressings? prevent infection, provide comfort, support wound healing
types of dressing absorbent (gauze), non-abherent (telfa), transparent (tegaderm), and hydrocolloid (duoderm)
wound packing moist vs dripping wet, dressing in contact with wound bed, not packed to tight, and no dead air spaces
montgomery straps commonly used for wounds requiring frequent dressing changes
montgomery strap rationale prevent skin irritation and discomfort caused by removing the adhesive each time the dressing is changed
types of drains penrose, jackson-pratt, hemovac/constavac
penrose drain a flat, thin, rubber tube inserted into a wound to allow for fluid to flow from the wound; it has an open end that drains onto a dressing
Jackson-Pratt drain a portable drainage suction device used in closed wound drainage systems
Hemovac drain a portable drainage suction device used in closed wound drainage systems
ostomy types bowel diversions and urinary diversions
bowel diversions are? certain diseases cause conditions that prevent normal passage of feces through rectum
what do you do for a bowel diversion? temporary or permanent artificial opening are created in the abdominal wall - i.e. colostomy or ileostomy
indications for urinary diversion? bladder cancer, trauma, bladder injury d/t radiation, neurogenic bladder or chronic cystitis
urinary stoma is created to? divert the flow of urine from the kidneys directly to the abdominal surface
purpose of pouching contain effluent or drainage and to protect the skin surrounding the stoma
stoma artificial opening of the bowel into abdominal wall
colostomy surgical opening of colon
ileostomy surgical opening of ileum
ostomy care drainage system, skin care, odor control, monitor for leakage, self-image
Created by: laurenkraemer