EXAM #2 (9-22 → 9-29) Flashcards
If a line becomes displaced or removed, can it be life threatening?
yes
Does reinsertion of an accidentally removed device require another surgery or procedure?
yes
Patients are most vulnerable to accidental line removal during _____.
Patients are most vulnerable to accidental line removal during transport.
You should always be mindful of any tube, line and drain and take great precaution to maintain the integrity.
yes okay
Any _____ can be painful due to securing devices – i.e. a foley catheter is held in the bladder with an inflated balloon
Any tugging can be painful due to securing devices – i.e. a foley catheter is held in the bladder with an inflated balloon
Most tubes will have a _____ device to aid in keeping in place
Most tubes will have a securing device to aid in keeping in place
_____ must take place prior to MRI studies to assure compatibility with the magnet.
Screening must take place prior to MRI studies to assure compatibility with the magnet.
[IMPLANTED DEVICES]
Implanted
Surgically implanted under the _____
There IS OR ISN’T a presence externally
Example – ___________
Implanted
Surgically implanted under the skin
There may or not be a presence externally
Example – cardiac pacemaker
Percutaneous/peripheral
Placed in a _____ manner
Example – ______, _____
Percutaneous/peripheral
Placed in a minimally invasive manner
Example – nephrostomy tube, central venous catheters
When are endotracheal tubes used?
Used during general anesthesia to ventilate and provide oxygen delivery
For shock, disease that impairs gas exchanges, and upper airway obstruction
Impending gastric acid reflux or aspiration
To ventilate coma induced patients
When endotracheal tubes are used, what is done for short term and what is done for long term?
Intubation is achieved via laryngeal or nasal approach
For long term ventilation a tracheostomy is performed
Patients with endotracheal tubes and trachs often produce large amounts of _____
These _____ need to be _____ to maintain potency of the tube and prevent airway obstruction
Every imaging room should contain wall _____ and catheters to use in the event _____ is needed and/or a _____ machine must be very near by
Daily checks should always occur for the availability of emergency equipment
Patients with endotracheal tubes and trachs often produce large amounts of secretions
These secretions need to be suctioned to maintain potency of the tube and prevent airway obstruction
Every imaging room should contain wall suction and catheters to use in the event suctioning is needed and/or a suction machine must be very near by
Daily checks should always occur for the availability of emergency equipment
Why are Thoracostomy tubes used?
When _____ or _____ accumulation occurs in this space the lung fails to fully expand
Used to treat _____, ______, _____ and _____
Cause can be trauma, complication of a lung biopsy or central line placement, infection, rib fracture, rupture of an emphysema bleb
Always attached to a _____ or _____ valve
[*] Should the chest tube become dislodged a _____ dressing should be placed over the site to seal the puncture site
Always keep the pleuovac _____ than the chest to prevent reflux of drainage into the pleurospace
Used to re-establish negative pressure in the pleural cavity
When fluid or air accumulation occurs in this space the lung fails to fully expand
Used to treat pneumothorax, hemothorax, pleural effusion and empyema
Cause can be trauma, complication of a lung biopsy or central line placement, infection, rib fracture, rupture of an emphysema bleb
Always attached to a pleuovac or Heimlich valve
Should the chest tube become dislodged a Vaseline dressing should be placed over the site to seal the puncture site
Always keep the pleuovac lower than the chest to prevent reflux of drainage into the pleurospace
What is an NG tube
nasogastric tube
What is a PEG tube used for
used for feeding
[FOLEY]
Inserted into _____ via _____
Held in _____ with a _____
Attached to a _____ bag
Always kept level of drainage bag _____ the bladder level to prevent reflux back into bladder
Inserted into bladder via urethra
Held in bladder with a balloon
Attached to a drainage bag
Always kept level of drainage bag below the bladder level to prevent reflux back into bladder
[SUPRAPUBIC TUBE]
Tube that is _____ placed into the _____
Attached to _____ bag – most commonly used after _____ surgery
Always keep bag _____ level of bladder to prevent reflux
Tube that is surgically placed into the bladder
Attached to drainage bag – most commonly used after prostate surgery
Always keep bag below level of bladder to prevent reflux
[NEPHROSTOMY TUBE]
_____ inserted into the _____ of the kidney
Used to _____ kidney when an obstruction is present in the ureter – i.e. kidney stones
Attached to a drainage bag
Always keep bag _____ level of kidney to prevent reflux
Percutaneously inserted into the calyx of the kidney
Used to drain kidney when an obstruction is present in the ureter – i.e. kidney stones
Attached to a drainage bag
Always keep bag below level of kidney to prevent reflux
[VASCULAR ACCESS CATHETERS]
Traditional ______ catheters – nearly every hospital inpatient has one which may or not be connected to IV fluids.
These lines are always covered with a _____ dressing, alert nurse should dressing be loose or fall off
_____ devices are always present to maintain integrity of line
There are a variety of other types of lines which are utilized to provide access for the administration of fluids, medications and blood in those patients where a peripheral intravenous line is unable to be established or maintained, or where the patient requires lines for treatment. The insertion site is always maintained with sterile technique.
- PICC (peripherally inserted central catheter)
- PORT
- CVC’s (central venous catheters)
- Arterial lines
Traditional intravenous catheters – nearly every hospital inpatient has one which may or not be connected to IV fluids.
These lines are always covered with a protective dressing, alert nurse should dressing be loose or fall off
Securing devices are always present to maintain integrity of line
There are a variety of other types of lines which are utilized to provide access for the administration of fluids, medications and blood in those patients where a peripheral intravenous line is unable to be established or maintained, or where the patient requires lines for treatment. The insertion site is always maintained with sterile technique.
- PICC (peripherally inserted central catheter)
- PORT
- CVC’s (central venous catheters)
- Arterial lines
_____ are very commonly used for patients receiving chemotherapy
Ports are very commonly used for patients receiving chemotherapy
When are PICCS used?
Used where peripheral IV access is difficult or not possible
Placed when long term IV access is needed
[Arterial line (aka art line) ]
When are they used?
As a line for drawing of frequent _____ _____
Should line become dislodged direct constant _____ is required over puncture site
Used mainly for monitoring
As a line for drawing of frequent blood gases
Should line become dislodged direct constant pressure is required over puncture site
What are tissue drains used for?
Often placed after _____ to prevent the collection of fluid or blood within a wound
Used to drain collections of fluid, blood or infectious matter
Often placed after surgery to prevent the collection of fluid or blood within a wound
What are pain balls used for?
provide a continuous infusing to a wound for pain control
What are Pacemakers & Internal Defibrillators used for?
Some _____ pace the heart
Others are on _____ when the heart rate falls below a given rate – i.e.. Less than 50
_____ defibrillators used to shock the heart when it goes into a dangerous irregular rhythm
Must use caution in _____ environment
Implanted device used to maintain a constant regular heart rate
Some constantly pace the heart
Others are on demand when the heart rate falls below a given rate – i.e.. Less than 50
Internal defibrillators used to shock the heart when it goes into a dangerous irregular rhythm
Must use caution in MRI environment
[Greenfield filter (IVC filter) ]
Placed in the _____ to _____ and prevent them reaching the heart and lungs
Inserted through the _____ vein and placed just below the kidneys, usually in an _____ _____ setting
Caution must be taken for patient having an _____
Placed in the inferior vena cava to trap blood clots and prevent them reaching the heart and lungs
Inserted through the femoral vein and placed just below the kidneys, usually in an interventional radiology setting
Caution must be taken for patient having an MRI
What is coding
Prospective Payment System (PPS)
Diagnostic Related Groups (DRGs)
Conversion of diagnoses and procedures into a numerical classification system
Conversion to these codes must be accurate
Used for reimbursement from Medicare,
Medicaid and other insurance payers
What is ICD -10
used to code diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury/disease.
Health Record content (general to know)
Med reconciliation = complete list of medications taken
Patient Identification
Medical history - chief complaint, present illness or injury, relevant family and social history, inventory of body systems
Report of relevant physical exam
Diagnostic and therapeutic orders
Clinical observations, including results of therapy
Reports of diagnostic and therapeutic procedures and tests as well as results
Evidence of appropriate informed consent
Conclusions at termination of hospitalization or evaluation of treatment, including any pertinent instructions for follow up care
In radiology, you need to review patient’s _____ _____ prior to performing the particular study
In radiology, you need to review patient’s clinical history prior to performing the particular study
[Health record in radiology]
Must have a radiology _____ or request for service
Must include patient demographic information (what’s going on with patient)
Specific procedure requested
Physician ordering
Must have a radiology order or request for service
Must include patient demographic information (what’s going on with patient)
Specific procedure requested
Physician ordering
If something isn’t documented, then it wasn’t done!
If something isn’t documented, then it wasn’t done!
What’s an ABN?
advances beneficiary notice, a person signs to say if their payer doesn’t pay, then they’re responsible for the bill
Entries to medical record
If paper record, must be in ink
Only approved abbreviations can be use
Must be dated & timed
Signature with printed name (may use stamper) and legal title
EMR – date, time and signature are auto entered
Mammography Quality Standards Act (MQSA)
Mammography Quality Standards Act (MQSA)
must keep mammo for 10 years
When you talk with the patient, you should listen, first for what he wants to tell, secondly for what he does not want to tell, thirdly for what he cannot tell.L.J Henderson
When you talk with the patient, you should listen, first for what he wants to tell, secondly for what he does not want to tell, thirdly for what he cannot tell.L.J Henderson
objective vs subjective data
objective = realism
subjective = perceived by the person only, individualized, idealism
What are the Sacred Seven and what are they?
- Localization - precise area for the patient’s complaint - can use touch with the patient’s permission - touch for emphasis and touch for palpation
- Chronology - time element - duration since onset, frequency, course of the symptoms
- Quality - character of the symptoms - examples - color, consistency of body fluids, presence of clots or sores, size of lumps or lesions, type of cough, is pain constant or come and go
Pain can have descriptors such as dull, aching, burning, radiating, crushing, pressure
Pain is probably the most common complaint encountered as it usually drives patients to seek care - Severity - describes the intensity, the quality, or extensiveness of the problem
- Onset - what patient was doing when condition began
- Aggravating or Alleviating factors - circumstances that makes problem worse or modifies problem
- Associated Manifestations - do other symptoms accompany the chief complaint
