Chapter 26: Subacute Care

Question 1

Central venous line

Answer 1

A type of intravenous line that is inserted into a large vein in the body

Question 2

Chest tubes

Answer 2

Hollow drainage tubes that are inserted into the chest to drain air, blood, pus, or fluid that has collected inside the pleural space/cavity

Question 3

Delirium

Answer 3

A sudden state of severe confusion due to a change in the body; also called acute confusional state or acute brain syndrome

Question 4

Gastrostomy

Answer 4

A surgically-created opening in the abdomen and stomach

Question 5

intubation

Answer 5

The insertion of a plastic tube through the mouth or nose and into the trachea or windpipe in order to place an artificial airway

Question 6

Mechanical ventilator

Answer 6

A machine used to inflate and deflate the lungs when a person cannot breathe on his own

Question 7

Nasogastric tube

Answer 7

A feeding tube that is inserted through the nose and into the stomach

Question 8

Percutaneous Endoscopic gastrostomy tube

Answer 8

A tube placed through the abdominal wall into the stomach to deliver liquid nutrients and medications

Question 9

Pulse oximeter

Answer 9

Device that measures a person’s blood oxygen level and pulse rate

Question 10

Sedation

Answer 10

The use of medication to calm a person

Question 11

Sepsis

Answer 11

A serious illness caused by an infection, usually bacterial, that requires immediate care

Question 12

Telemetry

Answer 12

Application of a cardiac monitoring device that transmits information about the heart rhythm and heart rate to a central monitoring station for assessment

Question 13

total parenteral nutrition

Answer 13

The intravenous infusion of nutrients in a basic form that is absorbed directly by the cells, bypassing the digestive tract

Question 14

What are the facts about subacute settings?

Answer 14

1) A subacute setting is a special unit or facility that is for people who need more care than most long-term care facilities can provide
2) Hospitals and long-term care facilities may offer subacute care
3) Residents in subacute care settings need a higher level of care than other residents. They will require more direct care and close observation staff

Question 15

What are the types of residents found in subacute units?

Answer 15

1) Residents who need more care and observation than other residents
2) Residents having had recent surgery and chronic illnesses, such as AIDS and cancer
3) Residents with serious burns, who need special administration of nutrients or medicine, or who need dialysis

Question 16

Important points about the pulse oximeter

Answer 16

1) Warns of low blood oxygen level before signs develop
2) Normal pulse oximeter reading is 95% and 100%, but it can differ
3) Report to nurse any change in oxygen levels

Question 17

Care Guidelines for pulse oximetry

Answer 17

1) Tell the nurse right away if alarm sounds
2) Do not place the sensor on an artificial nail
3) Be careful when moving and positioning so oximeter does not move or come off
4) Report difficulty breathing
5) Report pale, cyanotic, darkening, or grayish skin, or mucous membranes
6) Report signs of skin breakdown from the device
7) Check vital signs as ordered, and report changes to the nurse

Question 18

Guidelines for telemtry

Answer 18

1) Report to nurse if alarm sounds
2) Check vital signs, as ordered
3) Report if pads become loose
4) Do not get the unit, wires, pads, or electrodes wet during bathing
5) Check for signs of skin irritation under or around pads
6) Remind resident not to leave the monitoring area
7) Report change in vital signs, rapid pulse, chest pain or discomfort, shortness of breath, dyspnea, sweating, or dizziness to the nurse

Question 19

When is an artificial airway needed?

Answer 19

When the airway is obstructed due to illness, injury, secretions, or aspiration, and sometimes is needed when a person has surgery

Question 20

Sometimes what type of residents need an artificial airway?

Answer 20

A resident who is unconscious

Question 21

Guidelines for artificial airways

Answer 21

1) Tell nurse if tubing comes out
2) Follow order for positioning
3) Check vital signs as ordered
4) Perform oral care often, at least every two hours
5) Report biting or tugging on the tube
6) Write notes, draw pictures, and use communication boards and hand and eye signals if resident cannot speak

Question 22

More guidelines for artificial airways

Answer 22

1) Be supportive and encouraging
2) Do not move or remove spare artificial airway tubes or other equipment from the bedside
3) Report signs of respiratory distress, including wheezing or other unusual breathing sounds or difficulty breathing; cyanosis, pale, gray, or darkening skin or mucous membranes; change in vital signs; drainage; secretions in tubing; or nervousness or anxiety

Question 23

What is a tracheostomy?

Answer 23

A common type of artificial airway that is held in place by a cuff that attaches to the end of the device.

Question 24

What are the reasons tracheostomies are necessary?

Answer 24

1) Obstruction
2) Cancer
3) Infection
4) Severe injuries
5) Serious allergic reaction
6) Coma
7) Facial burns
8) Gunshot wounds
9) To prevent aspiration in an unconscious person

Question 25

If a resident cannot speak a nursing assistant must do what?

Answer 25

Use alternate methods of communication, and answer call lights promptly

Question 26

Guidelines for tracheostomies

Answer 26

1) Answer call lights promptly
2) Use alternate methods of communication
3) Follow orders for positioning
4) Do not tire resident
5) Check vital signs as ordered
6) Inspect ties or tape often

Question 27

More guidelines for tracheostomies

Answer 27

1) Keep the dressing dry, and do not cover the tracheostomy opening
2) Report kinks or disconnected tubing
3) Perform oral care often, at least every two hours
4) Observe for mouth sores, cracks, breaks, or sores on skin
5) Provide careful skin care
6) Observe for pale, bluish, or darkening skin or mucous membrane

Question 28

Even more guidelines for tracheostomies

Answer 28

1) Do not move spare tracheostomy tubes or bag valve mask
2) Report disconnected tubing; signs of respiratory distress, including wheezing or other unusual breathing sounds or difficulty breathing; cyanosis, pale, gray, or darkening skin or mucous membranes; change in vital signs, especially respiratory rate; mouth sores or discomfort; cracks, breaks, or sores on the skin; or loose or wet tape or dressings

Question 29

What are the causes of delirium?

Answer 29

Dehydration, malnutrition, fever, pain, poisons, alcohol and drug use, prescribed medication, hypoxia, head injury, illness, infections

Question 30

What are the symptoms of delirium?

Answer 30

Disorganized thinking; inability to concentrate; problems with speech, agitation, anger, or irritability; drowsiness or sleep disturbances; decrease in short-term memory; lack of attention span; disorientation; changes in consciousness; decrease in ability to move; pulling out tubing; hallucinations

Question 31

What is the treatment for delirium?

Answer 31

Medication, emergency care, hospital stay

Question 32

Important points to know about mechanical ventilators

Answer 32

1) Resident will not be able to speak, which can greatly increase anxiety
2) Being on a ventilator has been compared to breathing through a straw
3) Be supportive. Enter the room so the resident can see you often
4) Use other methods of communication
5) Act and speak as if resident can understand everything, even if he or she is unconscious or heavily sedated
6) Being on a ventilator puts a person at a higher risk for developing complications, including a type of pneumonia, considered a ventilator-associated event

Question 33

Care guidelines for residents with mechanical ventilators

Answer 33

1) Wash hands thoroughly
2) Answer call lights promptly
3) Tell nurse right away if alarm sounds
4) Report biting or pulling on the tube
5) Give oral care often. Report mouth sores or discomfort
6) Reposition at least every two hours. Follow positioning orders

Question 34

More guidelines for caring or residents with mechanical ventilators

Answer 34

1) Give regular skin care to prevent pressure ulcers
2) Allow time for rest
3) Follow orders for ROM exercises
4) Be patient during communication
5) Provide emotional support

Question 35

What are the signs of sepsis?

Answer 35

1) Elevated heart rate and respiratory rate
2) Slightly elevated temperature or low temperature
3) Chills
4) excessive sweating
5) Feeling of sickness or weakness
6) Low blood pressure
7) Decreased urine output
8) Headache
9) Skin rash
10) Shortness of breath
11) Confusion or change in mental status

Question 36

Important points to know about suctioning

Answer 36

1) Necessary when a person has increased secretions that he cannot expel
2) Suctioning can be performed orally, nasally, and through the trachea and bronchi
3) Nursing assistants do not perform suctioning
4) Suction comes from wall or pump and bottle collects suctioned material
5) Sterile water or sterile saline is used to rinse suction catheter
6) Signs of respiratory distress are gurgling, high respiratory rate, shortness of breath, dyspnea, pallor, or cyanosis

Question 37

Guidelines for assisting with suctioning

Answer 37

1) Follow Standard Precautions
2) Monitor vital signs closely
3) Report signs of respiratory distress immediately
4) Observe for pale, bluish, or darkening skin or mucous membranes
5) Answer call lights promptly
6) Follow orders for positioning
7) Place pad or towel under chin before suctioning
8) Give oral and nasal care after suctioning
9) Give emotional support during difficult periods
10) Report signs of abnormalities

Question 38

Important points to remember about chest tubes

Answer 38

1) Can be inserted at bedside or during surgery
2) Drain, air, blood, pus, or fluid
3) Allow a full expansion of the lungs
4) Conditions requiring chest tubes include pneumothorax, hemothorax, empyema, surgery injuries
5) System must be airtight when attached to suction

Question 39

Guidelines for chest tubes

Answer 39

1) Report signs of respiratory distress and pain
2) Check vital signs as directed and report changes
3) Be aware of where chest tubes are located
4) Keep drainage system below level of chest
5) Keep drainage containers uprights and level
6) Keep tubing coiled neatly
7) Report clots in tubing
8) Observe chest drainage for amount, color, and consistency
9) Observe dressings for drainage, saturation, or bleeding
10) Do not remove equipment in the area
11) Follow orders for positioning
12) Encourage deep breathing exercises
13) Provide rest periods

Question 40

Can nursing assistants insert tubes, give the feedings, or clean or suction the tubes?

Answer 40

No

Question 41

What are the guidelines for feedings?

Answer 41

1) Wash hands thoroughly
2) Observe carefully for signs of aspiration
3) Notify the nurse if the alarm sounds
4) Follow orders for positioning
5) Follow fluid and weight orders. Be aware of NPO orders.
6) Give frequent mouth and nose care
7) Do not pull or tug on tubing. Keep tubing free of kinks
8) Observe for clip falling off
9) Make feeding time a social time
10) Report anything that has changed or is not normal

Question 42

What are the signs to observe and report regarding TPN?

Answer 42

1) Fever
2) Headache
3) Swelling
4) Redness
5) Bleeding
6) Leaking at insertion site
7) Signs of fluctuation in blood sugar
8) Making sure there is not interruption of TPN delivery

Question 43

A gastrostomy is given to a person who has what?

Answer 43

Swallowing difficulties, tumor of the throat, birth defects, or the tendency to choke or aspirate on food or fluids. Also, for someone who is comatose or unconscious.

Question 44

Guidelines for a new gastrostomy

Answer 44

1) watch for bleeding or drainage at the surgical site. Observe the dressing for saturation
2) Observe for pain or discomfort
3) Take vital signs as ordered and report any change, especially fever
4) Follow instructions from the nurse on additional post-operative signs and symptoms to report

Question 45

Guidelines for an established gastrostomy

Answer 45

1) Wash hands before touching area near insertion site
2) Listen carefully for the sound of the alarm
3) Answer the call light promptly
4) Carefully monitor all vital signs, especially temperature and blood pressure
5) Be alert for signs of aspiration or choking
6) Give oral hygiene as needed. Excellent oral care must be performed when a gastrostomy is in place. Apply lubricant to the lips as necessary

Question 46

What is kidney dialysis?

Answer 46

A process that cleans the body of wastes that the kidneys cannot remove due to chronic renal failure

Question 47

Dialysis can be done via what?

Answer 47

The arm, neck, abdomen, or leg

Question 48

Care guidelines for dialysis

Answer 48

1) Wash hands thoroughly
2) Keep the access arm area clean
3) Help residents dress in proper attire
4) Encourage residents to follow their special diets
5) Follow orders for fluid restrictions
6) Measure intake and output (I&O) and weight carefullt
7) Check vital signs as ordered
8) Make sure the resident has reading material, the TV remote, and the call light within reach