Chapter 26: Subacute Care Flashcards
Central venous line
A type of intravenous line that is inserted into a large vein in the body
Chest tubes
Hollow drainage tubes that are inserted into the chest to drain air, blood, pus, or fluid that has collected inside the pleural space/cavity
Delirium
A sudden state of severe confusion due to a change in the body; also called acute confusional state or acute brain syndrome
Gastrostomy
A surgically-created opening in the abdomen and stomach
intubation
The insertion of a plastic tube through the mouth or nose and into the trachea or windpipe in order to place an artificial airway
Mechanical ventilator
A machine used to inflate and deflate the lungs when a person cannot breathe on his own
Nasogastric tube
A feeding tube that is inserted through the nose and into the stomach
Percutaneous Endoscopic gastrostomy tube
A tube placed through the abdominal wall into the stomach to deliver liquid nutrients and medications
Pulse oximeter
Device that measures a person’s blood oxygen level and pulse rate
Sedation
The use of medication to calm a person
Sepsis
A serious illness caused by an infection, usually bacterial, that requires immediate care
Telemetry
Application of a cardiac monitoring device that transmits information about the heart rhythm and heart rate to a central monitoring station for assessment
total parenteral nutrition
The intravenous infusion of nutrients in a basic form that is absorbed directly by the cells, bypassing the digestive tract
What are the facts about subacute settings?
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
What are the types of residents found in subacute units?
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
Important points about the pulse oximeter
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
Care Guidelines for pulse oximetry
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
Guidelines for telemtry
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
When is an artificial airway needed?
When the airway is obstructed due to illness, injury, secretions, or aspiration, and sometimes is needed when a person has surgery
Sometimes what type of residents need an artificial airway?
A resident who is unconscious
Guidelines for artificial airways
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
More guidelines for artificial airways
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
What is a tracheostomy?
A common type of artificial airway that is held in place by a cuff that attaches to the end of the device.
What are the reasons tracheostomies are necessary?
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
If a resident cannot speak a nursing assistant must do what?
Use alternate methods of communication, and answer call lights promptly
Guidelines for tracheostomies
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
More guidelines for tracheostomies
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
Even more guidelines for tracheostomies
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
What are the causes of delirium?
Dehydration, malnutrition, fever, pain, poisons, alcohol and drug use, prescribed medication, hypoxia, head injury, illness, infections
What are the symptoms of delirium?
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
What is the treatment for delirium?
Medication, emergency care, hospital stay
Important points to know about mechanical ventilators
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
Care guidelines for residents with mechanical ventilators
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
More guidelines for caring or residents with mechanical ventilators
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
What are the signs of sepsis?
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
Important points to know about suctioning
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
Guidelines for assisting with suctioning
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
Important points to remember about chest tubes
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
Guidelines for chest tubes
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
Can nursing assistants insert tubes, give the feedings, or clean or suction the tubes?
No
What are the guidelines for feedings?
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
What are the signs to observe and report regarding TPN?
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
A gastrostomy is given to a person who has what?
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.
Guidelines for a new gastrostomy
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
Guidelines for an established gastrostomy
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
What is kidney dialysis?
A process that cleans the body of wastes that the kidneys cannot remove due to chronic renal failure
Dialysis can be done via what?
The arm, neck, abdomen, or leg
Care guidelines for dialysis
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
