Acute Care: Physiological Monitoring-Lines and Tubes Flashcards
what are the general goals of lines and tubes?
to to measurements and or provide access to internal body systems
what are the specific goals of lines and tubes?
rapidly deliver important meds
obtain real-time measurements of physiological fxn
collect bodily fluids
facilitate tissue healing
minimize secondary infections from lines and tubes
what is peripheral venous access?
an IV (flexible catheter inserted into a vein) used to deliver meds, fluids, or nutrition
also used to remove blood for sampling/testing
what are common problems associated with peripheral venous access?
inflammation/pain due to phlebitus/infection, dislodging IV, infiltration (leaking of fluid under the skin), clotting
t/f: we should avoid taking BP on the arm with a peripheral venous access IV
true
is taking BP on the arm with peripheral venous access IV in it contraindicated?
no, but we should avoid it if possible
can the line with peripheral venous access be disconnected?
sometimes, unless it is a continuous infusion like heparin, ask the nurse
what is a peripherally inserted central catheter (PICC)?
IV access for longer time (antibiotics, chemo, total parenteral nutrition (TNP) support)
catheter inserted peripherally and the tip is advanced to the superior vena cava
what are the typical peripheral vein insertion points for PICC lines?
basilic, cephalic, or brachial veins
should we take BP on the arm with the PICC line?
no
t/f: we should wait for an x-ray confirming the location of a PICC line b4 mobilizing a pt
true
what are the precautions with a PICC line?
don’t lift more than 10 lbs
no swimming, contact sports, shoveling, vacuuming, etc
what is hemodialysis?
a way to artificially perform the normal fxn of the kidneys where blood crosses a semi-permeable membrane (dialyzer), allowing metabolic waste products to diffuse into correction fluid (dialysate)
what is the dialyzer in HD?
the semi-permeable membrane
what is the dialysate?
the correction fluid in HD
what does HD do?
correct fluid or electrolyte abnormalities
remove toxic materials
maintain acid-base balance
what does HD do?
filters out byproducts from the blood that gets eliminated through urine and then the rest is filtered back into the blood
t/f: HD is accomplished through vascular access that allows high flows and repeated cannulation, while minimizing infection and clot formation
true
should you take BP on the arm with HD?
no
what are the access sites for HD?
central vein (ie the subclavian vein)
arterio-venous fistula
arterio-venous grafts
what is an arterio-venous fistula?
artificially created communication bw an artery in the arm and an adjoining vein
what is an arterio-venous graft?
uses an interposed synthetic graft that is less durable than an AV fistula
what is continuous renal replacement therapy (CRRT)?
nonstop veno-venous or arterior-venous hemodialysis
extracorporeal blood circulation through a small-volume, low resistance filter to provide continuous removal of solutes and fluid
where is the only place you will see CRRT?
in the ICU
t/f: CRRT is an absolute contraindication to PT
false, pts just tend to tolerate PT less so we need to coordinate with the team and closely monitor vitals and plan the session to allow sufficient line slack
what is peritoneal dialysis (PD)?
uses the peritoneum as the semi-permeable membrane and the diasylate is infused into the abdomen
the peritoneum is highly vascularized, allowing waste products and fluids to pass from the blood into the dialysis solution
diasylate remains in abdomen for several hours prior to drainage
t/f: mobilization with HD is typically contraindicated
true
why is mobilization with HD typically contraindicated?
bc of pt fatigue post dialysis
what should we assess with HD prior to PT?
labs on fluids and electrolytes status
t/f: we should monitor hemodynamics and activity tolerance closely with HD mobilization
true
t/f: we should avoid placement of BP cuff over an AV fistula or graft site
true
what is the purpose of wound drainage devices?
to collect fluid from internal cavities
what is negative pressure wound therapy (wound VAC)?
application of localized negative pressure by controlled suction to the wound surface
noninvasive therapy to promote healing in difficult wounds that fail to respond to established Rx modalities
t/f: wound VAC provides a closed, moist wound healing environment
true
what are the benefits of wound VAC/negative pressure wound therapy?
assists granulation
helps remove interstitial fluid
helps remove infectious materials
what is a major precaution with wound VAC/negative pressure wound therapy?
don’t break the seal!
what is a foley catheter (indwelling catheter)
a urinary drainage tube
thin, sterile inserted into the bladder to drain urine with a balloon at the end filled with sterile water to hold it in place
t/f: foley catheter may be placed for urinary retention
true
what lines and tubes need to be kept below the level of the waist?
chest tubes and foley catheters
what are the considerations for PT with urinary drainage tubes?
need to maintain the foley catheter below the level of the bladder
drain any urine in the tubing b4 mobilizing for prevention of backflow
make recommendations to the team when the catheter bag needs to be emptied or a pt is mobile enough to use the commode
what is the purpose of feeding tubes?
to deliver nutrition when GI is obstructed, aspiration, or calorie supplementation is needed
what is a Dobhoff tube?
short term nutritional needs while intubated or if the pt is at risk for aspiration
what is a gastrostomy (G) tube/percutaneous endoscopic gastrostomy (PEG) tube?
a small, flexible, hollow tube w/a balloon or flared tip surgically inserted and secured into the stomach for nutrition
what are the considerations for NG tubes?
determine if the tube is to suction or gravity drainage and whether the tube can be disconnected for out of bed mobility
determine if the tube can be disconnected prior to and/or during therapy session
t/f: NG tube and feeding tubes are the same thing
false
what are the CV consequences of bed rest and immobility?
decreased exercise tolerance/VO2max
decreased CO
decreased resting HR
decreased resting and max SV
increased venous compliance
decreased orthostatic tolerance
venous pooling
t/f: anytime there is blood pooling, there is an increased risk for clotting
true
what are the hematologic consequences of bed rest and immobility?
decreased blood volume
decreased RBCs
increased DVT risk
what are the MSK consequences of bed rest and immobility?
muscles atrophy (can happen very quickly)
decreased mitochondria density and aerobic enzymes
bone demineralization, osteopenia, osteoporosis
what are the psychiatric consequences of bed rest and immobility?
increased anxiety
increased agitation
increased delirium
increased depression
what are the pulmonary consequences of bed rest and immobility?
decreased lung volumes and capacities
decreased respiratory muscles strength
increased risk for pneumonia/PE
what are the metabolic/endocrine/electrolyteconsequences of bed rest and immobility?
increased insulin resistance
increased urinary excretion of sodium, potassium, calcium, and phosphorus
hypercalcemia/renal stone formation
what are the nutritional consequences of bed rest and immobility?
cachexia/malnutrition
obesity
why is there a loss of respiratory strength and endurance with bed rest and immobility?
bc the pts are not taking deep breaths
t/f: pts can lose their sense of upright with bed rest and immobility
true
why is the digestive system influenced by bed rest and immobility?
bc the body cant mechanically break down food or absorb nutrients well in supine
what is sitting upright good for?
prevention of aspiration, breathing, and orientation
in pts who are highly mobile b4 admission, what % are disabled at d/c?
13%
in pts who are moderately mobile b4 admission, what % are disabled at d/c?
35%
in pts who are of low mobility b4 admission, what % are disabled at d/c?
71%
what % of pts over 90 y/o lose their ability to do their daily activities following hospitalization?
65%
what can we do for a pt if they CAN walk?
walk the pt to the bathroom instead of using the bedside commode
encourage family/friends to walk with the pt
take a walk down the hallway b4/after each meal;
walk to and from the door
brush teeth in the bathroom
what can we do if a pt CAN’T walk?
help the pt uses the bedside commode instead of the bed pan
increased total amount of time spent outside of bed
help the pt sit in a chair for all meals
why is bed rest so bad?
bc it can cause thromboembolic disease, jt contractures, atelectasis, skeletal muscle atrophy/weakness, and pressure ulcers
