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NRSG 201 > 201 Midterm > Flashcards

201 Midterm Flashcards

1
Q

indications for a urinary catheter (short term)

A
  • acute urinary retention
  • bladder decompression during and following surgery
  • monitoring urinary output
  • residual urine > 500 mL post-void residual (PVR) in adults, and >250 mL in the frail elderly
  • In/out urine sample (C&S)
  • Epidural anesthesia
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2
Q

indications for a urinary catheter (long term)

A
  • urinary incontinence with urinary retention
  • chronic urinary retention
  • management of non-healing stage 3 or 4 PI in the perineal/sacral area with urinary incontinence
  • comfort care for palliative care
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3
Q

Types of catheters

A

1 way (in/out catheterization)

2 way (regular foley -> one channel for balloon, one for urine drainage)

3 way (bladder irrigation, one channel for balloon, one for urine drainage, and one for irrigation fluid)

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4
Q

Types of catheter composition

A
  • plastic
  • latex
  • silicone
  • silicone coated (silastic)
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5
Q

Crude tip catheter

A

used for males with an enlarged prostate

has an upturned end

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6
Q

urinary catheter sizes

A

6 Fr - 36 Fr in diameter

the higher the number the larger the diameter of the cath

age 0-12: 6 Fr - 12 Fr

female: varies, initially 12 Fr - 14 Fr

male: varies, initially 14 Fr - 16 Fr

Hematuria/CBI (continuous bladder irrigation): 20 Fr - 24 Fr

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7
Q

Catheter balloon sizes

A

10 mL for regular foley catheter

30 mL for 3 way catheters

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8
Q

stat lock

A

sticks to patients thigh

secures urinary catheter to prevent complications such as pulling it out

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9
Q

urinary drainage bags

A

always hang bag below the bladder

leg bag -> small
overnight drainage bag -> large
urine meter drainage bag -> provides accurate urine output measurements

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10
Q

benefits of urinary catheterization

A

improved
- skin integrity for incontinent pts
- regular drainage for urinary retention pts
- convenient for nurse assessments
- comfort measure for palliative pts
- constant monitoring for urine output
- helpful for surgical procedures

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11
Q

risks of urinary catheterization

A
  • infection, UTI
  • trauma
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12
Q

How to prevent UTIs

A

only use for specific medical reasons and not nurse convenience

consider other options -> condom cath, incontinence products

assess catheter daily

remove catheter as soon as possible

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13
Q

Nurse considerations to prevent UTIs

A

bladder irrigation is not recommended -> change catheter if plugged

empty drainage bad when less than 2/3 full (at least every 8 hours)

change catheter every 8 - 12 weeks, or more frequent

change cath bags monthly or when soiled

encourage client to drink 1.5 - 2L daily

avoid constipation

when switching from leg bag to overnight bag clean bags with soapy water or 1:2 vinegar solution

avoid opening the system at night -> you can attach night bag to leg bag with connection tubing at night

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14
Q

weighing urine

A

always remember to zero the weight of the container first, before filling it with urine

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15
Q

hourly urine output

A

hourly output should be >30 mL

24hr output should be 800 - 2000 mL

report to health care provider if output is <30mL for more than 2 hours or if its over 2000 - 2500mL daily

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16
Q

asepsis

A

the process for keeping away disease producing microorganisms

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17
Q

medical asepsis

A

aka. clean technique

includes procedures used to reduce and prevent the spread of microorganisms -> hand hygiene

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18
Q

contamination

A

after an object becomes unsterile or unclean, it is considered contaminated

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19
Q

C&S Urine Specimen Collection (principles of asepsis)

A

wear clean disposable gloves

use a sterile syringe, sterile container, and sterile C&S transfer straw kit when collecting sample

clean the port on the catheter tubing with an alcohol swab before drawing the sample

don’t contaminate the straw end by touching it or placing it on a surface

place the labelled specimen tube in a clean biohazard bag

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20
Q

How to obtain a sterile urine specimen from an indwelling urinary catheter

A

gather supplies, hand hygiene, and don clean gloves

apply clamp below the urine sampling port, to let urine collect in the top portion of the tubing

after 10-15 mins, re-perform hand hygiene, don gloves and swab port opening with an alcohol swab for 15-30 seconds

attach sterile 10 mL syringe to port and withdraw at least 5 mL of urine

transfer urine into a sterile C&S container (IH - pink top)

open straw transfer kit and put the tip into the urine on a stable surface

push the grey top tube into the transfer straw, piercing top of the tube

hold tube until it stops filling (3-4mL)

mix tube 8-10 times to mix preservative (boric acid)

label tube and put into the biohazard bag

DOCUMENTING
document in the Kardex and in the narrative notes

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21
Q

HOUDINI

A

indications for removal, allows for nurses to independently make a decision to remove a catheter without a doctor order

H = Hematuria (gross)
O= Obstruction/retention
U = Urology, gynaecology, vascular, or general surgery
D = Decubitus ulcer (PI) if incontinent with stage 3-4 injury
I = input/output in critically ill patients
N = nursing, end of life/comfort care
I = immobilization or prolonged peri-operative time

if yes to any of these, you can’t take the catheter out

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22
Q

removing a urinary catheter

A

check reason/order to remove catheter

wash hands

place blue pad between legs

detached catheter from where its attached to the leg

apply clean gloves

compress the plunger and the pull back 0.5 mL

gently insert the syringe into the balloon inflation valve

the plunger will fill up with fluid from the balloon

once all the fluid is out gently pull the catheter and fold the blue pad over and throw away

wash and dry perineal area

document the procedure and assessment date -> time removed, intactness of catheter, amount/colour/clarity of urine in the bag

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23
Q

febrile

A

having or showing the symptoms of a fever

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24
Q

Heart sound placements

A

aortic = right 2nd ICS
pulmonic = left 2nd ICS
erbs = left 3rd ICS
tricuspid = left 4th or 5th ICS
mitral/apex = 5th ICS

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25
QPA (quick priority assessment)
usually done after report helps to prioritize patient needs (especially if you have multiple patients) go to highest acuity patients first check that pt. has name band, allergy band, and blood band on and check ABCDEs document findings create a plan for the day based on assessments
26
bedside safety equipment checks
make sure the correct equipment is in the bin above the pts. bed oxygen face mask yankauer suction suction tubing nasal cannula extra suction canister also check oxygen flow meter medical air suction
27
when is a H2T performed
client admission to hospital pt. transfer to new ward beginning of a shift
28
when to do a focused assessment
during a H2T when client status is not within normal limits to reassess a current problem when a new problem presents itself
29
EENT
eye/ear/nose/throat
30
hubers focused assessment flow chart
helps assist nurse in determining if a focus assessment is necessary
31
fowlers position
sitting up right low = 15-30 degrees semi = 30-45 degrees standard = 45-60 degrees high=60-90 degrees
32
prone
laying on stomach
33
semi prone
aka sims recovery position
34
supine
laying on back
35
slider sheets
used after pt. has been assessed for 3 things - frequency of repositioning - size of client - level of dependence
36
positioning clients affected by stroke
when laying supine: - support the head in a neutral position - put pillows behind the scapula of the AFFECTED arm and under the arm and hand - a pillow can be placed in-between the legs to prevent them from crossing when sitting in fowlers: - support the head in a neutral position at midline - support the pt. in an upright position with pillows on the affected side to prevent leaning when laying on the AFFECTED side (unaffected leg will be bent on top): - ease the affected shoulder blade forward, laying kind of on the scapula - support the UNAFFECTED leg with pillows (the leg that is on top) when laying on the UNAFFECTED side (unaffected leg is bent on the bottom) - make sure head and trunk are straight - affected shoulder and pelvic girdle are forward - AFFECTED arm and leg are supported with pillows
37
getting a stroke pt out of bed
movement should always happen to the pts unaffected side
38
NWB
non weight bearing
39
WBAT
weight bearing as tolerated
40
PWB
partial weight bearing
41
restrictions after hip surgery
can't bend more than 90 degrees at the hip -> don't pick up objects off the ground can't rotate hip joint -> turning the foot or knee inward can't cross their legs or adduct (move towards midline) the affected leg
42
positioning post op hip pt
laying supine: place a pillow in between legs to keep them slightly abducted (away from midline) rolling to unaffected side: - lift the affected leg, support under knee and ankle - 2nd nurse places 2-3 pillows under the affected leg - encourage client to reach over and use the side rail to pull themselves over - nurse uses slider sheet to shift hips over - place 1-2 pillows behind clients back - check pts alignment and make sure they are at about a 30 degree angle
43
getting hip post op pt out of bed
pt always gets out of bed on the operative side -> prevents dislocation always assist the affected leg, as pt moves from laying to sitting on the edge of the bed encourage pt to do the moving with their good leg
44
assessments to do before moving a client
Point of care risk assessment and patient mobility assessment
45
POCRA
environment worker patient care plan
46
palms up or down when using slider sheets
palms up protects shoulders and back
47
instructions for clients experiencing orthostatic hypotension
sit up in bed for at least one min and then sit on the edge of the bed for at least one min before standing
48
nosocomial/HAI
a disease originating in the hospital
49
ARO
antibiotic resistant organism MRSA VRE CPO ESBL
50
AGMP
aerosol generating medical procedures
51
ABHR
alcohol based hand rub hand sanitizer
52
routine precautions
hand hygiene POCRA appropriate use of PPE cleaning equipment after use proper disposal of contaminated items
53
airborne precautions
for particles smaller than 5 microns pt must be in a private room with the door closed -> negative pressure room if available (prevents particles from flowing out of the room if door is open) PPE = N95 mask illnesses = measles, TB, small pox, monkey pox
54
APF
assigned protection factor N95 = APF 10
55
N95
N = not oil resistant filter 95% of airborne particles @ 0.3 microns better a filtering larger and smaller microns wear when in contact with airborne illnesses (varicella, measles, TB) and during AGMP if pt is on droplet precautions
56
aerosol generating procedure
- CPR - intubation - nebulized meds - positive pressure ventilation (BIPAP) - CPAP - high flow 02 - tracheostomy and trach care
57
droplet precautions
larger than 5 microns PPE= mask and eye protection surgical mask illnesses: mumps, pertussis, meningitidis
58
contact precautions
transmission is direct or indirect PPE= gloves/gown illnesses: CPO, MRSA, VRE, lice, scabies
59
contact plus
used for C diff PPE= gown/ gloves use dedicated equipment in pt room use sporicidal disinfectant (not on gluctometers) BID cleaning of high touch surfaces wash hands with soap and water
60
cytotoxic precautions
handling cytotoxic meds handling bodily fluids during/ 48hr after cytotoxic meds PPE= moisture resistant gown, 2x nitrile gloves, eye protection specialized waste containers
61
screening for AROs in acute care
pt being admitted for >24hr must be screened for MRSA and CPO
62
What is the difference between ARO colonization and infection?
colonization mean an ARO lives on your skin but doesn't cause health problems infection is when an ARO causes symptoms such as pain and fever
63
ARO positive
pt will be placed on contact or contact/droplet precautions in a private room or cohort ARO positive pt with the same ARO in the same room dedicate equipment to a single pt if equipment must be shared, has to be cleaned after each use do not take the chart in the pts room and don't take in extra supplies
64
ARO pt education
pts are NOT to wear gloves/isolation gown when outside the room should no use common areas of the hospital remind them of the 4 C's - clean hands - clean clothes - contained wounds/body fluids - co-operative
65
droplet and contact precautions
PPE= mask, eye protection, gown, gloves illnesses: influenza
66
airborne and contact precautions
PPE= N95 mask, gown, gloves illnesses: varicella
67
communication stats
communication gaps in healthcare are the cause of 80% of adverse events communication errors contribute to 60% of med errors
68
quality documentation/reporting
- factual -accurate - complete - current - organized - compliant with standards
69
IDRAW
for patient handover - change in level of care - temporary transfer of care - shift report - discharge I = identify pt and MRP d = diagnosis/current problems r = recent changes and up to date vitals a = anticipated change in next few hrs w = what to watch for
70
SBAR
urgent communication - urgent orders - advice required - ICU outreach - pt is deteriorating S = situation B = background A = assessment R = recommendation
71
taking an order over the phone
1. obtain prescribers name, license number and contact info 2. immediately transcribe order into the permanent record 3. have prescriber state the indication 4. clarify any par of the order that is unclear 5. read the complete order back to the prescriber for verification 6. request confirmation that the read-back matches the intended order
72
CUS
I am Concerned I am Uncomfortable This is a Safety issue use a tool if you see something that you are worried about, such as a action start with concern, then uncomfortable, and then safety for pts using CUS, change this is a safety issue to Im scared
73
dermal vs transdermal
transdermal = patch placed on skin or a topical cream dermal = needle just below the skin, TB test
74
types of meds that should not be cut or crushed
SR (slow release) drugs hazardous meds meds that can irritate mouth, stomach, skin
75
idiosyncratic reaction
individual reactions to drugs
76
HAMs
high alert meds drugs with a heightened risk of causing significant, devastating, pt harm when used in error ex. heparin, warfarin, insulin, narcotics
77
tall man lettering
technique using uppercase letters to help differentiate look-alike drug names
78
controlled substance
any drug categorized by the federal government as having potential for abuse or addiction -> narcotics and benzodiazepines requires a count and a co-signature
79
IDC (independent double check)
2 health care providers separately check each component of prescribing, dispensing, and verifying prior to administering the drug ex. insulin
80
STAT
must give med immediately
81
now
must give drug within 90 mins
82
prn
as needed, still need to have a time frequency to prevent overdose. Not a real order if there isn’t a time frame
83
essential parts of a med order
id any of these are missing the order is not valid - on physicians order sheet in permanent ink - pt identifier - date and time of order - generic (or trade) name of drug - dosage - route - time and frequency - signature of person writing the order
84
MAR
medication administration record transcribed orders must be double checked by a nurse never photocopy a mar new mar is printed and double checked every q24 hr
85
documenting on the mar
nurse who administers must be the one who initials if given PRN, add the time/route and initial if pt self administers, document self administered and initial if med is not administered, document O and initial, document reason in nursing notes if IDC is required, that nurse will also initial
86
10 rights
these 5 are checked minimum 3 times right pt right med right dose right time/frequency right route right reason right to refuse right education right evaluation right documentation
87
when to do the 3 checks
1. removal 2. preparation, dot the MAR after this check 3. bedside -> take the MAR to the bedside
88
daily, BID, TID, QID, Q12H
all start at 0900
89
time critical meds
administer at the exact time indicated whenever possible must be given 30 mins before or after scheduled dose may cause harm or suboptimal therapy if too early or late ex. ordered more frequently than Q4H, scheduled opioids, meal time related meds, any med to treat a worsening or emergency medical condition
90
non-time critical scheduled meds
more frequently than once a day but no more frequently than q4h = give within one hour of scheduled time daily, weekly, or monthly = give within 2 hours of scheduled time
91
basic med calculation
dose ordered/dose on hand x amount on hand = amount to administer OR dose/stock x amount = amount to administer
92
DS
double strength
93
CR
controlled release
94
SR
sustained release
95
LA
long acting
96
supp
suppository
97
susp
suspension
98
gtt
drops
99
MDI
metered dos inhaler

NRSG 201 (2 decks)

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