Chapter 17-21 Flashcards
3 major electrolytes our bodies need to function properly:
sodium Na
potassium K
chloride Cl
potassium imbalance can cause:
muscle twitching and irregular heartbeat
human body is mostly water consisting of:
60% of body weight is fluid
Other electrolytes:
magnesium
calcium
zinc
bicarbonate
phosphate
sulphate
2/3 of our body fluids are found:
within body cells (intracellular)
remainder of 1/3 of our body fluids found:
inside blood vessels (intravascular) and spaces between cells (ingerstitial)
electrolyes assist in transporting nutrients to and from cells within the body play a role in:
muscle & nerve function
The body fluid balance, and electrolyte composition are primarily maintained by the:
Respiratory system
gastrointesinal system
Circulatory system
renal system
integumentary system
doctors will order IV fluid in the following situations:
-The patient is unable to take fluids by mouth
-The patient has an abnormal loss of body fluids, such as from severe, vomiting or diarrhoea
-The patient is injured or has life-threatening conditions
-The patient has had major surgery
-The patient requires medication that can be given only intravenously
-The patient requires prophylactic antibiotics while undergoing surgical are invasive diagnostic procedures
-to restore the bodies acid base balance
-to restore blood loss by haemorrhage
-To stabilize patient with a bleeding disorder, such as haemophiliac
-To correct dehydration by restoring the bodies, water electrolytes in So on
-To provide nutrition when the patients gastrointestinal track is resting
ive equipment that contains solution for iv therapy?
IV bag (largest bag is 1000cc or ml)
to start an iv ——— needs to be inserted into a pt’s vein:
IV or catheter
a plastic tube usually attached to the puncturing needle, inserted into a blood vessel for infusion, injection or pressure monitoring, is called:
angiocatheter (angiocath)
farthest part from the body
distal
distal end of catheter has an adapter that attaches to tubing and connected to:
IV bag or solution
Device used to start an IV in smaller peripheral veins for short term IVs, and when fragile veins make insertion of a larger intra-catheter difficult;
butterfly
disadvantage of butterfly needle:
Can easily slip a ravine, and allow IV solution to seep into the surrounding interstitial tissues
Device used to deliver long term IV therapy ranging from weeks to years used for chemotherapy medication, blood or blood products hyper alimentation and monitoring central venous pressure. They’re also use for patients with poor veins to reduce the trauma of repeated IV starts. Increases patient comfort and helps reduce anxiety and patients who must have frequent venous access:
Central venous IV
Small, flexible, plastic tube, the tip of which is placed in the superior or inferior vena cava or the right atrium. It is inserted to a central vein that is one that lives in the chest cavity or that is linked directly to the right atrium the main access veins used, or the internal and external jugular in the sub, clavicle veins Sometimes the femoral vein:
Central venous access device or catheter CVD or CVC
An intravenous catheter that is inserted into a vein. Usually in the upper arm, called a peripheral vein and threaded into a larger be near the heart essential mean it is used with longer-term Ivy therapies needed such as for antibiotics, chemotherapy or total parenteral nutrition:
PICC or peripherally, inserted, central catheter
Complications that can arise from the insertion of a central line include:
development of an air embolism
An arrhythmia
Infection
Perforation of a vessel
components of a Dripset:
-a spiked end that inserts into the IV bag
-a drip chamber, through which you can see the solution dripping as a drains from the bag
-A roller clamp used to adjust the speed of the infusion
-Two or three access port, along the length of the tubing that I used to administer IV meds, or add a second IV line
Includes a length of tubing with a special spiked end used to pierce the port on the IV bag
Mainline IV administration set
Two ports that can accommodate TYV bags that allow the infusion of two separate solutions similtaneously
Y tubing set and blood infusion set
Blood and blood products must always be run with:
Normal Celine
When a separate or secondary infusion line is needed the most popular set up is a:
medication administration set or Add-a-line or mini bag
The device that controls the intravenous infusion rate by monitoring either the drops per minute the IV said delivers for the volume of fluid delivered:
controller
A number of these pumps are available operating on different principles to deliver IV solutions, conveniently and accurately some units comprise more than one pump, allowing for the delivery of multiple IV solutions for one. Patient concurrently these devices, exert pressure on the IV tubing providing accurate delivery of a program volume offer, read outs of how much solution has infused at how much remains to be absorbed and will set an alarm if some thing obstruct the infusion or if the IV bag runs dry
electronic fusion pump
A mechanism by which a patient can self administer analgesic intravenously with the assistance of a computerized pump. It allows for the introduction of specific doses of preset intervals into the IV line.
patient controlled analgesia
A chamber added to an IV line between the bag and the line to control volumes more closely. It is used to ensure safety when the volume of fluid delivered must be carefully monitored often with children.
The Buritrol
No devices are needed. When gravity is used to deliver IV solution bag is on an IV port is held higher than the IV site solution drips into the tubing and into the patient vain by gravity, the nurse, regulates infusion rate by manually adjust in the roller clamp on the IV tubing to the required gtt/min
IV gravity based system
Device that provides intervenous access when needed without continuous infusion. It sits in the van, and must be flushed a specific intervals with saline solution or heparin solution.
Heparin, Hep-Lock, saline lock, PRN adaptor
A medication given into the vein or into an ongoing IV infusion, using a syringe and needle
IV push or IVP
Ivy orders must have the following components which provide the nurse with the information they required to carry them out:
flow rate
Start date
Stop date
Solution ordered
Common IV solutions:
Ringers lactate solution
2/3 and 1/3
D5W
Normal saline
5% dextrose and 0.9 NaCl.
0.45% NaCl.
IV solution containing water, electrolytes, sodium potassium, calcium chloride, used for milder cases of metabolic, acidosis for dehydration, and for shock, burn patients who have lost a lot of extra cellular fluid in order,l
Ringers lactate solution
IV solution one of the most frequently ordered, contains 3.3% glucose and 0.3% sodium chloride. Main purpose of the solution is maintaining adequate hydration, normal fluid balance. It is used for maintenance purposes versus restorative or resuscitative purposes.
2/3 and 1/3
IV solution also written as 5% DW means 5% dextrose in water solution is used primarily to replace water loss as in dehydrated patience and to provide some nutrients about 200 cal per liter. It is not provide electrolytes frequently used to keep the van open when the physician wants access to the van through an IV line but has not ordered a saline lock to keep the van open sometimes the physician order a certain amount of solution for hour and sometimes not.
D5W
Can also be written as 0.9% NaCl solution of pure ordinary salt made up of sodium and chloride in water, referred to as a physiological or isotonic because it will not alter normal electrolyte balance. It is used to treat patients who have lost a lot of body fluids as from hemorrhage, the solution restores electrolyte balance, but it’s not contain any calories, and unlike dextros solutions will not interfere with the sugar levels in a person with diabetes. It is the only intravenous fluid that may be run with blood. The moment the blood stops long, this solution will kick in. It is also used to flush the tubing … all IV meds are mixed in this solution and is used for keeping the vein open unless the patient is severely compromised with somesuch condition has congestive heart failure and should not have any also used to flush wounds and eyes because it’s not irritating
Normal Saline
The solution is used to treat, dehydration, another fluid for daily maintenance of body, fluids, and nutrition. It is similar to normal saline.
D5NS 5% dextrose and 0.9 NaCl
this has equal proportions of sodium and chloride, but half the sodium chloride of normal saline is often used to dilute acid in the blood when a patient is experiencing metabolic acidosis a condition in which the body is too acidic. It may be a better maintenance fluid, if larger amounts have to be administered.
0.45% NaCl
med given to hemophiliacs for clotting:
Factor VIII or 8 or cryoprecipitate
Why would a surgeon order prophylaxis
Blood usually packed cells available for patients having major surgery in case of excessive blood loss during surgery crossmatch for a patient and held in love for him or her
 When someone has two fewer red blood cells their number causes is usually treated with the infusion of packed cells
anemia
Any situation in which a person loses an excessive amount of blood usually over 750 cc is called hemorrhage. This causes the body to go into shock most effective way to treat massive haemorrhage is by blood replacement.
acute blood loss
Before receiving a blood transfusion, patient must have a:
Group and screen, and then the blood must be crossmatch
Types of blood products:
whole blood
Platelets
Fresh, frozen plasma
Packed cells
Albumin
Cryo-precipitate
Ordered as a unit of blood approximately 520 cc of donated blood maybe used to treat excessive blood loss resulting from trauma surgery or burns but is not frequently ordered
Whole blood
Extracted from whole blood in order for someone with thrombocytopenia or a low blood platelet count. Anyone with these is at risk for bleeding disorder in particular disseminated, intravascular coagulopathy, potentially fatal condition, characterized by widespread bleeding, and these are ordered by the unit.
Platelets
derived from whole blood contains all coagulation or clotting factors and is given to patients with coagulation defects. One unit is approximately 225 cc
Fresh, frozen plasma
This most commonly ordered blood product, red blood cells separated from whole blood by a process, called centrifugation may be used to correct anaemia when extra volume is not desirable for a patient because it does not contain white blood cells opposes less risk of minor reactions doctor might order crossing type for two units
Packed cells
This is a protein extracted from the blood, and is often used to expand fluid volume within the blood vessels
Albumin
Part of the fresh, frozen plasma that contains a clotting factor called factor VIII it is most commonly given to patients with haemophilia to help control bleeding
cryoprecipitate
If someone is going to have blood ordered, a patient will be:
cross-matched and typed (group & cross)
factors affecting nutritional needs:
genetics
age
gender
pregnancy
activity
illness
how does genetics affect nutritional needs?
basal metabolic rate is amount of energy expended in a given period
how does age affect nutritional needs?
metabolic rate usually slows with age, fewer calories required
how does gender affect nutritional needs?
men tend to need more calories than woman because they are larger and have more muscle mass
how does pregnancy affect nutritional needs?
Adjust daily caloric intake to ensure health/well nourished baby. Diet high in protein is important
how does activity affect nutritional needs?
uses more calories/increases metabolic rate…less activity means u require less calories
how does illness affect nutritional needs?
extra calories/protein are needed to promote tissue repair & recovery. Fever raises metabolic rate as does trauma such as surgery
clinical secretary will interact with nutritional services regularly to ensure pts are:
getting the diet ordered for them
oversees the provision of nutritious diets specifically ordered for pt’s including special diets:
dietician
clinical secretary responsible for ensuring that diet changes are recieved in nutritional services including:
when diet needs to be held for pt having certain tests & discontinuing diet orders when pt is discharged
many pts lose their appetite because they are:
ill or cuz the food is different from what they are use to and may not reflect cultural norms
related responsibilities of clinical secretary:
may be asked to help deliver trays & set up the pt
call nutritional services to correct any errors or omissions in pt diets
to save time when contacting food services:
check with all nurses make a list of required changes and make a single phone call
types of diets ordered:
regular
therapeutic
other diets
restricted diets
soft diet
diet with no restrictions
DAT no restrictions
diet part of treatment for disease. Ex fluid retention/congestive heart failure require no added salt NAS:
therapeutic diet
cardiac/heart health diet/diabetic diet/gluten free diet fall under:
other diets
diet that puts limitations on calories/fat/salt and other substances (diabetes inproper use glucose):
restricted diet
mechanical diet consists of foods soft in texture/low fiber & processed by grinding or pureeing to allow for lil or no chewing:
soft diet
examples of soft diet:
postop introduced gradually to food
NPO
Ice Chips
Full Fluids
Soft diet to DAT
clinical secretary routine responsibilities include:
-being aware of short forms
-completing electronic reqs & send to nutritonal services
-may still have to call even if CPOE sent
-if pt has procedure diet may need to be cancelled or delayed
-put NPO sign by pts bed
short forms include:
NPO
CF
FF
NAS
DAT
A pt is required to be NPO 8-10 hrs before:
-any test requring anesthetic
-test involving visualizing the gastrointestinal tract
-certain blood tests (cholesterol)
the diet can contribute to ______ in the immediate postop period depending on type extent of surgery and pts response to anesthetic.
nausea/vomiting
a pt NPO for a period of time and starts progressive diet starts with:
ice chips/sips of water/clear fluids
pt who had gastric surgery may have a _____ in place for a period of time
NG tube
_____ determine when to advance pt’s diet
Nurse
there is no designated time for advancing a diet it depends on:
what a pt can tolerate
an enteral (tube) feed is one that is administered directly by tube into the:
gastrointestinal system
bypass a person’s swallowing mechanism & carry food directly into the stomach or bowel:
tube feedings
tube feedings are used on pt’s who:
cannot swallow (stroke)
cannot digest food (malabsorption syndrome)
cannot take food orally for prolonged periods or those getting TPN (total parenteral nutrition)
enteral foods can be:
temporary or permanent
feeding tubes can be inserted to these sites;
-nasogastric (N/G or Levine)-nose-stomach
-gastrostomy tube (G tube)-inserted incision through abs
-jejunostomy tubes (J tube)-placed in small bowel
-percutaneous endoscopic gastromy tube (PEG)-inflated tube once inserted in abdomen
-Bard button-surgically implanted in stomach thru abs
enteral feeds can be given in 2 ways:
continuous or periodic intervals
nurse will infuse solution in sm quantities measured every hr. Well tolerated but restrictive as pt cannot easily move around:
continuous feed
nurse administer certain volume of perscribed solution every few hrs following a schedule made by dietician:
periodic feed
what is TPN
Total parenteral nutrition delivered through a central line or PICC
TPN is given to pts who:
-are severely malnourished and being prepped for surgery
-receiving radiation/chemo and malnourished or unable to eat
-had major surgery/burns/multiple fractures and unable to absorb nutrients with oral or enteral feeding
-prolonged coma
-severe anorexia
-severe bowel inflammation
-terminally ill unable to eat
In the past people were kept in bed, when ill, or recovering from surgery, childbirth advancement and techniques in philosophy of shift at the focus to activities doctors not realize that bedrest unlimited activity have:
harmful effects on most body systems
when ordering a patient’s activity level physicians, consider a number of things, including:
physical energy
Physical capabilities
Nature of the illness
Consciousness and cognition
Surgery
activity orders usually appear on the E Cardex your responsibility would be to______ in both environments with, and without CPOE ambulation orders can change as the patient’s condition changes
remove old orders
patient must eat, eliminate waste in bed bed must be changed with the patient in it:
complete bed rest
Sometimes the patient is allowed to get up if necessary:
bedrest
Patient is allowed up to the bathroom as necessary, and sometimes to shower or wash
BRP bathroom privileges
patient can get out of bed to a chair or walking, but must have someone assisting him or her:
up with one assist
patient can be up and out of bed as he or she can tolerate the activity:
Activity as tolerated AAT
this means the patient can be up sitting in a chair. The physician may stipulated designated number of times per day, such as up in chair TID. Sometimes a patient requires a special chair called a Geri chair.
Up in chair
Use of any type of _____ in a healthcare facility is controversial in most cases use as a last resort, and most frequently on patients who are confused or suffers from dementia, and her pose, a danger to himself or others
restraints
Family members should be involved in the decision to use _____ and may oppose their use even if recommended by the healthcare team. Can be physical or chemical for example, sedation.
Restraints
An alternating pressure mattress, egg, crate, mattress, or sheepskin pad all distribute the patient sweet and relieve pressure
special mattresses
Use elastic support to augment circulation in the legs, helpin King, River, and blood clots misfit the patient measurements are taken by the nurse or physiotherapist
Antiembolic stockings
Responsibility of clinical secretary to obtain ______ from the nurse and call Central supply for the stockings
pt’s measurements
patient pushes the feed against them at the bottom of the bed, exercise or assist, sitting upright in bed
foot boards
cradle is a Hwy that fits over the bottom of the bed to keep the covers off the patient’s legs
bed cradle
gives patient something to grab onto to assist with exercising position, self in bed or getting in and out of bed
Trapeze bar
A long wedge shaped firm pillow used primarily right after hip surgery to keep the legs apart
Abduction pillow
all hospital bed should have these to help patients position themselves. They’re kept up when a patient has been sedated or is confused or unconscious.
Side rails
Device used to assist the care providers in transferring a patient from one location to another like bed to chair, minimizing efforts for the patient and operates as a series of supports and lovers operated by a hydraulic pump, found primarily in long-term care rehab and chronic your settings, but sometimes in acute care setting as well
Hoyer lift
usually the ____ make that decision and decide on any necessary safety measures in regards to equipment related to rest and activity
nurse
Assistive devices include:
Wheelchairs walkers/canes
Patience, sometimes bringing their own assistive devices or have what they need assigned to them
do not use a patient’s ____ for another pt
device
activities carried as part of our daily routine include:
Getting up in the morning
Going to the bathroom
Brushing teeth and personal grooming
Washing face shower bath
Eating breakfast, lunch, supper
Getting ready for bed
Performing daily routine activities independently is important psychologically affording the patient a sense of:
dignity and privacy
A patient’s ability to perform activities of daily living reflects the _____ of nursing care, and other assistance a patient needs
type and extent
following surgery, most patients rely on the nurse for much of this care, but quickly progress to accomplishing most of their _____ independently
Daily activities
Patient status may be classified as:
Independent
Self
Self with assistance
by nurse
IV tubing is called:
drip set or infusion set
Most commonly used iv tubing with spiked end used go pierce the port on the IV bag:
mainline iv set
Device that control the intravenous infusion rate by monitoring either drops per minute at the IV said delivers of the volume of fluid delivered:
Electronic flow regulators
