DONEskills- skills 1/2/3 Flashcards
underteeament when
older patients
older patients also
pain management
undertreament of pain may occur in critically ill patients due inability yo verbalize pain
older patients may be unable to verbalize pain
older pateints may also take other pain meds that can interfere with drug interactions
opioids
commonly
deaths
start w
follow
very commonly misused
over half of opiod death is related to legally acquired opioids
start with lowest effective dosage and no more then needed
follow up and discosntue if needed
physical dependence
state of
produced by
A state of adaptation that is manifested by a drug class–specific withdrawal syndrome
produced by abrupt cessation, rapid dose reduction, decreasing blood level of an opioid, and/or administration of a drug that can act as an antagonist.
Addictive behaviors include one or more of the following:
impaired
_ use
use despite
diminished
c
impaired control over drug use,
compulsive use,
continued use despite harm,
diminished recognition of problems related to one’s behavior,
and craving.
Drug tolerance:
A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the effects of the drug over time.
Addiction
primary
dysfunction
A primary, chronic disease of brain reward, motivation, memory, and related neurocircuitry
Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations.
administering pain meds
check
perform
patient
reassess
do what
prepare
provide
help
check MAR
perform hand hygiene
patient identifiers
reassess pain
hand hygiene and gloves
prepare analgesic
provide basic non pharm comfort
help in comfortable position and place call light in reach
purpose of iv therapy
provides
transfuses
administers
provides nutrition
transfuses blood products
adminster medications
The Pasero Opioid Sedation Scale (POSS)*
s
1
2
3
4
S = Sleep, easy to arouse
1 = Awake and alert
2 = Slightly drowsy, easily aroused
3 = Frequently drowsy, arousable, drifts off to sleep during conversation
4 = Somnolent, minimal-or-no response to physical stimulation
Remember—sedation precedes respiratory depression.
How to Administer Naloxone in an Emergency Setting:
When you find an individual who is suspected of overdosing:
attempt to
check for
V_ patient
give
if no
if no change
Attempt to waken patient. If no response, common signs of opioid overdose are constricted pupils, slow or no breathing, snoring sound, and blue, gray, or pale skin color.
- Check for pulse and respirations. Call 911.
- Ventilate patient (following CPR guidelines) for a few quick breaths (if the person is not breathing).
give them naloxone
If there is no breathing or breathing continues to be shallow, continue to perform ventilation while waiting for the naloxone to take effect.
- If there is no change in 3–5 minutes, administer another dose of naloxone and continue to ventilate the patient and initiate CPR if needed.
ways to adminster naloxone
affix
tilt
inject
Affix a nasal atomizer to the needleless syringe and then assemble the cartridge of naloxone (according to package directions).
- Tilt the individual’s head back and spray half of the naloxone into one naris (1 mL) and half into the other naris (1 mL).
- Inject 1 mL (100 units) of naloxone intramuscularly.
vascular access devices
to adminster
when selecting
to adminster iv solutions- vascular access devices is inserted into vein
when selecting appropriate vad- consider length of treatment and duration of device
Patient controlled analgesic
check
perform
check
explain
put
insert
wipe
secure
program
check mar
perform hand hygiene
check pt identifiers
explain to pt
put on gloves
insert drug into infusion device
wipe injection port
secure connection
program PCA pump
administer IV fluids carefully-isotonic
increased risk for fluid overload in renal or cardiac disease
administer IV fluids carefully-hypotonic
hypotonic can exacerbate a hypotensive state
administer IV fluids carefully-hypertonic
irritating to vein and can cause heart failure and pulmonary edema
Insertion of a short-peripheral intravenous device
identify
perform
prepare
hand
apply
select
release
hand
reapply
observe
stabilize
connect l
attach
observe
apply
identify patient
perform hand hygiene
prepare tubing- remove cap and attach syringe , reapply end caps
hand hygiene
apply tourniquet
select vein
release tourniquet
hand hygiene and gloves
reapply toruniqte and perform venipuncture
observe for blood return in catheter
stabilize with non dominate hand
connect luer lok
attach flush syringe
observe insertion site
apply sterile dressing
Regulating intravenous flow rates
identify
regulate gravity infusion-slowly and monitor
regulate eid- close, insert, secure, open, monitor
attach
teach
dispose
assist
identify pt
regulate gravity infusion-slowly open clamp and monitor drip rate
regulate eid- close clamp, insert tubing, secure port, open tubing, monitor infusion rate
attach label to iv solution container
teach pt purpose of Eid
dispose of extra supplies
assist pt and call light
Changing bag
hand
apply
prepare
prepare iv tubing with existing iv- roller , slow compress , invert insert , prime
prepare
reestablish
remove
teach
identify pt
hand hygiene
apply clean gloves
prepare iv tubing with new container
prepare iv tubing with existing iv- roller clamp in off, slow rate of infusion, compress and fill drip, inver container and remove old tubing, insert spike into new container, prime air out
prepare tubing
reestablish infusion- disconnect old tubing, attach tape and secure to arm
remove old iv tubing
teach pt how to move arm with iv tubing
Administering medications by intravenous bolus
perform
take
identufy
perform
administer-select, clean, insert, pinch, release
stay
perform hand hygiene
take meds to pt at correct time
identify pt
perform hand hygiene and gloves
adminster iv push- select injection port, clean with swab, insert tip of srygne , pinch tubing above injection port, release tubing and inject medication
stay with pt for a few minutes to monitor for allergic reactions
Changing intravenous solutions
identify
change solution when
prepare
close remove
quickly
hang
check
check
regulate
place
dispose
identify pt
change solution when fluid remains only in neck of container
prepare new solution for changing
close roller clamp, remove iv solution
quickly remove spike from old solution and put in new
hang new solution on pole
check for air
check drip chamber
regulate flow
place time label on side
dispose of all contaminated supplie
Changing a short-peripheral intravenous dressing
identify
remove
assess vad
if catheter remain in place,
when stabilizing perform
when stabilizing
anchor
identify pt
remove existing dressing
assess vad for s/s of complications
if catheter remain in place, assess integrity of stabled device
when stabilizing perform skin antisepsis
when stabilizing apply sterile dressing over sire
anchor tubing or iv along arm and secure with tape
Administering intravenous medications by piggyback and syringe pumps— pre stuff
perform
take
identify
compare
adminster
perform hand hygiene
take meds to pt at correct time
identify patient
compare mar
adminster infusion, apply clean gloves
Administering intravenous medications by piggyback and syringe pumps–Piggyback infusion:
Connect
hang
connect
regulate
label
check
Connect infusion tubing to medication bag- once tubing is full close clamp and cap end od tubing
hang piggyback
connect tubing og piggyback to appropriate connecter
regulate flow rate of medication solution by adjusting regulator clamp
label tubing
check flow rate
Administering intravenous medications by piggyback and syringe pumps–Volume-control administration set
fill
close
clean
remove
regulate
label
fill volutorll with desired amount of iv fluid
close clamp
clean injection port with antiseptic wipe
remove needle cap or sheath
regulate iv infusion rate to allow meds to infuse
label
Administering intravenous medications by piggyback and syringe pumps–Syringe pump administration:
connect
carefully
place syringe
connect
set pump
check
connect pre filled syringe
carefully apply pressure to srynge plunger
place syringe into mini infusion pump
connect end of mini infusion tubing to main iv line
set pump tp deliver meds within time
check flow rate
purpose
allogenic
autogolous
blood stored where
Allogenic-someone else//\
autogolous- from your own blood
Blood is stored in living tissue and stored in controlled enviorment
Prevention of tranfsusion reactions-
identify
use
knowledge
Identify pts blood type
Use proper labeling
Knowledge pf pts prior history woth blood
preadminstration of blood
obtain
check
verify
review
obtain blood,
check for contamination,
verify correct blood/pt,
review putpsoe of transfusiom,
administration of blood
hand
open
all
spike/and
prime w
prepare/invert
spike
close
prime/ attach
regulate
monitor for
hand hygiene,
open y tubing,
all clamps in off,
spike ns bag and put on iv pole,
prime with ns,
prepare blood-invert2-3 times,
spike blood,
close ns,
prime with blood, attach to vad,
regulate blood flow,
montor for reaction
If you suspect transfusion reaction:
immeduatly
remove
replace
maintain
remain
notify
notify
obtain
return
adminster
immediately stop transfusion,
remove blood component and tubing,
replace with new bag of ns
,maintain patent vad with ns,
remain with pt fot continuous monitoring and assessment,
notify healthcare provider
, notift blood bank,
obtain blood samples from opposite extremity,
return blood to blood bank,
admister meds
Epinephrine when used in blood transfusion
releives
relieve resp distress in anaphalxis
Antihistamine when used in blood transfusion-
diminishes
diminsihes allergic response
3Antibiotics when used in blood transfusion-
when what is suspected
when bacterial contamination/ sepsis is suspected
Antipyretics when used in blood transfusion-
receives
relieve fever and discomfort
Diuretics/ morphine when used in blood transfusion-
treats
treats circulatory overload
6Corticosteroids when used in blood transfusion-
admisntred when
admisntered in severe allergic reactions
iv fluids when used in blood transfusion-
counteracts some what
counteracts some symptoms of anyphactic shock
