Acute Care

Question 1

Different Types of Isolation

Answer 1

Standard (contact)

Droplet

Respiratory

Question 2

Intravenous Line

Answer 2

Remains in place for ~3 days

Common Problems:

• Inflammation
• Pain due to infection
• Dislodging
• Infiltration
• Clot formation

Question 3

Feeding Tubes

Answer 3

Gastrostomy

Jejunostomy (lower risk of asperation)

Question 4

External Pacemaker

Answer 4

Post-Open Heart Surgery

Post-MI

Patient waiting for permanent pacemaker

Question 5

Precautions with Pacemakers

Answer 5

Note heart rhythm and pacer settings (rate responsive?)

Always check vital signs

No electromagnetic interference unless cleared by MD (e-stim, MRI, microwave, etc…)

Question 6

Precautions: Temporary Pacemakers

Answer 6

Wires taped securely?

After removal close monitoring for cardiac tamponade

(1-2 hours bedrest post-removal)

Question 7

Precautions: Permanent Pacemakers

Answer 7

Limit weight bearing and leavy lifiting (>10lbs) of the involved UE 6-8 weeks after placement

Shoulder elevation of the involved UE is limited to <90 for 6-8 weeks after placement

No driving until cleared by MD

Check Incision daily

Monitor for fever

Question 8

Artificial Airway

(disadvantages)

Answer 8

Bypasses respiratory defence mechanisms

Increased risk of infection

Decreased cough effectiveness

Interference with communication and nutrition

Loss of dignity

Tracheal stenosis (bleeding risk)

Question 9

Peripherally Inserted Central Catheter

Answer 9

PICC

Intravenous access that can be used for a prolonged period of time

Catheter is inserted peripherally and the tip is advanced to the superior vena cava

Typically: basilic, cephalic, or brachial veins

Question 10

Central Venous Catheters

Answer 10

CVS

Central venous pressure monitoring

Administration of medications

Mixed venous blood sampling

Typically: external jugular, subclavian, or femoral veins

Question 11

CVC Considerations

Answer 11

Hemodynamic Instability!

Limited ROM

Consider mobilization…

Question 12

Arterial Catheter

Answer 12

Indewelling catheter which provides measurements of systolic, diastolic, and mean arterial pressures continuously

Allow for access for arterial blood gas sampling

Precautions:

• high pressure system (hemorrhage)
• transducer height

Question 13

Chest Tube Collection System

Answer 13

Collection chamber

Water Seal Chamber

Suction Chamber

Question 14

Chest Tube Precautions

Answer 14

Maintain collection reservoir and tubing below the level of insertion

Avoid traction on the tubing

Maintain adequate suction