Exam 3 Blueprint Flashcards
Body fat distribution and risk
Central abdominal obesity poses a greater risk
Waist circumference is a good indicator of abdominal fat
- risk increases with a waist measurement of 40 inches+ for men and 35in+ for women
KNOW THE BRADEN SCALE
Sometimes my ass May fart nasty
Helps to assess patient risk for developing a pressure ulcer
6 subscales:
- sensation
- moisture
- activity
- mobility
- friction and shear
- nutritional status
Hypotonic
Lesser concentration of particles than plasma
Promoting Proper Breathing (exercises)
-Deep breathing exercises- make each breath deep enough to move the bottom ribs
-Incentive Spirometry- Encourages maximizing lung inflation and preventing/reducing atelectasis
-Pursed-lip breathing- prolongs expiration resulting in improved gas exchange and decreased dyspnea
Constipation (at risk patients)
In the older adult - constipation is a chronic problem; diarrhea and fecal incontinence may result form physiologic or lifestyle changes
Constipating foods: cheese, lean meat, eggs, pasta
Foods with laxative effect: fruits and veggies, bran, chocolate, alcohol, coffee
Those at high risk:
- patients on bedrest taking constipating medicines
- patients with reduced fluids or bulk in diet
- depressed patients
- patients with CNS disease or local lesions that cause pain while defecating
Osmosis
Water flows from lowers conc. to higher concent.
Oxygenation of body tissues depend on:
3
-Airway system to transport air to and from lungs
-Alveolar system to exchange oxygen and carbon dioxide
-Cardiovascular system and blood supply to carry nutrients and wastes to and from body cells
Isotonic solution & example
Definition: solutions with the same osmolality as body fluids
- do not enter the cells because there is no osmotic force to shift the fluids
- increases ECF volume
Example: 0.9% NS, LR
What do nurses need to do specially if they are giving blood to a patient?
NEED 2 NURSES
Stay with the patient for 15 minutes to watch for reaction
Check blood type and patient band
Respiratory Assessment- pulse ox
What does it measure
Measures the arterial oxyhemoglobin saturation
Diarrhea
Nursing measures
Nursing measures:
- answer call bell immediately
- remove cause of diarrhea when possible
- if impaction, obtain physician order for rectal exam
- give special care to region around anus
non rebreather
*non-rebreather- the one-way valve doesn’t allow you to breathe in any outside air.
What is the difference between a nebulizer and bronchodilator?
Nebulizer gets medication deeper into the respiratory tract
- Acute exacerbation of asthma: nebulizer may help
What is the total daily energy intake
Total calories for each food item eaten
Minerals information
- organic elements found in all body fluids and tissues
- some function to provide structure in the body, others help regulate body processes
- contained in the ash that remains after digestion - ash??
- macrominerals: calcium, phosphorus, sulfur, sodium, chloride, potassium, magnesium
- microminerals: iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, iodine
What are micronutrients what do they do
Regulate and control body processes: vitamins and minerals
TPN
Total parenteral Nutrition
Nutritional support, highly concentrated
Infused through central line
Used with clients who can’t meet nutritional needs PO or enteral.
Complications; infection, f/e imbalance.
NGT placement
Confirming placement:
- radiographic examination
- assessment of aspirate pH
- measurement of tube length and tube marking
- carbon dioxide monitoring
- confirming nasointestinal tube placement
Measure from tip of nose to ear to xiphoid process, inserted through nasal flares (assess to make sure no breakdown and which is better suited), thread through nose, have patient swallowing water to ensure goes down esophagus
What diet is recommended if someone is having diarrhea?
BRAT diet: banana, rice, applesauce, toast
What are some helpful techniques in teaching someone that has constipation?
Increase activity, increase fluids, consume fiber
What is one of your first nursing actions if you notice a patient using accessory muscles while sitting in a chair?
Check pulse ox, then listen to lungs
What is pursed lip breathing?
Prolonging expiration portion of the breathing cycle so that it reduces airway resistance
Working with people with chronic obstructive lung disease
What is special with a dry powder inhaler
Wash their mouth out
HIPAA gives patients the right to:
-See & copy their health record
-Update their health record
-Get a list of the disclosures of their records made by the healthcare institution
-Request certain restrictions on disclosures
-Choose how to receive health information
How do you teach someone to use an incentive spirometer?
They are supposed to exhale air and then inhale through the incentive spirometer.
The goal is to keep the ball between arrows on the side and see how high the patient can get and/or reach the level marker. When inspiration increases, they are improving.
How to take a stool specimen (lab ppt)
- Medical aseptic technique
– hand hygiene before and after glove use
– disposable gloves
– do not contaminate outside of container w stool
– obtain sample, package, label, and transport according to policy
Patient guidelines:
- void first so urine is not in stool sample
- defecate into container rather than toilet
- do not place toilet tissue in bedpan or specimen container
- notify nurse when specimen available
Bowel training programs
- manipulate factors within the patient’s control
– fluid and food intake, exercise, and time for defecation
– eliminate a soft, formed stool at regular intervals without laxatives - when achieved, continued to offer assistance with toileting at the successful time
Signs & Symptoms of IV Complications
Phlebitis
–Local acute tenderness
warmth, redness, edema above insertion site
Thrombus
–IV infusion sluggish or may cease
Heat, redness, tenderness at site
Infiltration
—Edema, pain, and coolness at site
Significant decrease in flow rate
—Sepsis
Red, tender insertion site
Fever, malaise, or other vs changes
—Fluid Overload
Increase BP
Distended jugular veins
Rapid breathing
Dyspnea
—Air Embolus
Respiratory Distress
Increased HR
Cyanosis
Decrease BP
Change in LOC
What are essential nutrients
Not synthesized in the body or are made in insufficient amounts
Must be provided in diet or through supplements
BMI classes
Underweight: <18.5
Normal: 18.5-24.9
Overweight: 25-29.9
Obesity class 1: 30.0-34.9
Obesity class 2: 35.0-39.9
Extreme obesity (class 3): 40.0
What is regional anesthesia
Anesthetic agent injected near a nerve or nerve pathway or around operative site
- nerve blocks
- spinal anesthesia
- epidural anesthesia
- IV anesthesia with pneumatic tourniqueting
What do you do if, legally, you gave medication and the computer system was down and then you never went back and documented it?
Legally, it didn’t happen because it wasn’t documented.
You can document late - remember to go back to document; it is your only defense
Regarding confidentiality, what do you have to worry about when writing yourself notes?
Cannot have any identifying information
What is the best way to do patient handoff?
SBAR
Types of physicians orders
Written/typed
Telephone
Verbal
Carbohydrate information #1 (total percentage daily)
- sugars and starches; organic compounds of carbon, hydrogen and oxygen
- serve as the structural framework of plants (lactose is only animal source)
Most abundant and least expensive source of calories in the world! - intake often correlated to income: as income increases, carb intake decreases
- classified as simple or complex sugars
- primary function is to supply energy
- RECOMMENDED AS 45-60% OF TOTAL CALORIES FOR ADULTS
IV complications - fluid overload s/s
- increased BP
- distended jugular veins
- rapid breathing
- dyspnea
How to (different ways) take a urine specimen (lab ppt) (5)
- Routine urinalysis
- Clean-catch or midstream specimens
- Sterile specimens from indwelling catheter
- urinary specimen from urinary diversion
- 24hr urine specimen
What is a nebulizer
Medication delivered in fine mist
Promoting comfort (oxygenation)
*Positioning-allow free movement of the diaphragm & expansion of chest wall
*Adequate fluid intake – to keep secretions thin
*Providing humidification – to protect against irritation & infection
What does a pulse ox do?
Measures blood oxygen level
Respiratory Acidosis
Primary excess of CARBONIC acid
Nutrients that regulate body processes
- Vitamins
- Minerals
- Water
What are topical and local anesthesia used on?
Used on mucous membranes, open skin, wounds and burns
Enteral feeding techniques (not sure if this is what she meant but..) (4)
-bolus feeding (delivering a large volume of formula at once using a syringe), -continuous feeding (administering a steady stream of formula over a long period using a pump),
-cyclic feeding (delivering a large volume of formula over a shorter period, often several hours, using a pump), -intermittent feeding (giving smaller volumes of formula at regular intervals, usually with a pump or gravity) depending on the patient’s needs and the placement of the feeding tube (stomach vs. small intestine)
Respiratory complications peri/post-op
Atelectasis
Pneumonia
Pulmonary embolism
What is polyuria
Frequent urination
What is one of the first things you would do if you saw that your patient is short of breath?
Increase the bed angle to sit them up
What is oliguria
low urine output, or when someone is producing less urine than normal
If you have someone with a catheter and the patient wants to connect it to a leg bag, when do you teach them to empty it?
When it is 3/4ths full
Don’t want it to get totally full especially because leg bags don’t hold as much urine
IV complication - air embolus s/s
- respiratory distress
- increased HR
- cyanosis
- decreased BP
- change in level of consciousness
Clear liquid diet
Temporary use
- broth
- gelatin
- popsicles
- carbonated beverages
- coffee and tea
* avoid red liquids if GI concerns because looks like blood
Older material (5-9 questions)
Just study older flashcard decks?
What are some safety things if your patient is going home on oxygen?
(Skin)
No open flames
No smoking
No gas stoves or fireplace
Monitor for skin breakdown around ears with cannula; around nose with CPAP
How will proper placement of a central venous catheter be established?
chest xray
Pain in GI/GU/peri-op (idrk what to do for this one)
CA warning signs (idk what CA means)
- change in bowel pattern
- blood in stool
- rectal/abdominal pain
- change in stool
- sensation of incomplete post bowel movement
teaching to patients with altered oxygenation due to conditions such as asthma and COPD. Which measures would the nurse recommend?
-Reduce anxiety
-Eat a high-protein/high-calorie diet
-Maintain a high fowlers position when possible/
Cardiovascular complications in peri-op
Hemorrhage
shock
thrombophlebitis
Thromboembolism
- DVT
- pulmonary embolus
Assisting patients with sensory deficits
use clock face language to tell a patient where something is.
making sure they dont trip on the IV line
clearing paths
clear communication
Medications that can decrease the rate and depth of respirations
opioids and sedatives
Occult blood
hidden blood in stool
can check for blood – turns blue when positive
a noninvasive procedure, taking precedence over invasive
What is an example of an outcome if you are doing a bowel training outcome?
“Patient will have ___ by ____”
Has to be measurable
Ideally is made as a goal without laxatives
Example: “patient has a soft, formed bowel movement every 1-3 days without disocmfort”
- explains relationship between BM and diet, fluid and exercise
- patient should seek eval if changes in color or consistency that persist
What does occult blood mean?
Hidden; blood in the stool that is hidden
What is moderate sedation/analgesia (conscious)
used for short term, minimally invasive procedures
What Patient information is confidential?
-Name, address, phone, fax, social security
-Reason the person is sick
-Treatments patient receives
-Information about past health conditions
–All information about patients written on paper, spoken aloud, saved on computer
Be sure to be able to interpret order - looking at it, what does it mean
NPO - nothing by mouth
be sure to clarify orders
Know how to teach someone to use an inhaler
Remove the cap, shake the inhaler, breathe out fully, place the mouthpiece in your mouth, press down on the inhaler while breathing in, hold your breath, breathe out slowly, and replace the cap
Diet orders: types of diets (T4 & M3)
Therapeutic diets:
- consistent carbohydrate
- fat or sodium restricted (cardiac)
- high or low fiber (GI)
- renal (monitor potassium)
Modified consistency diets:
- clear liquid (juice, broth, water, coffee)
- pureed (usually for swallowing issues)
- mechanically altered (finely chopped, thickener in liquids)
Oxygen delivery systems: (giving patients oxygen)
-** check on this
Nasal cannula
Face masks
Oxygen tent
Before putting something into an NG tube, check the…
placement initially before putting something through it
Check residual volume later when putting something in it
What is anuria
very little urine output; 24 hour urine output is less than 50 mL
HOWEVER, online it says when kidneys aren’t producing urine. which makes sense because of the prefix
Effects of Medications on stool
(Anticoags, iron, antacids, antibiotics)
Aspirin, anticoagulants: pink to red to black stool
Iron salts: black stool
Antacids: white discoloration or speckling in stool
Antibiotics: green-gray color
Water information
- accounts for 50-60% of adult’s total weight
- 2/3rds of body water is contained within the cells (intracellular fluid - ICF)
- remainder of body water is extracellular fluid (ECF) and body fluids (plasma, interstitial fluids)
- provides fluid medium necessary for all chemical reactions in the body
- acts as a solvent and aids digestion, absorption, circulation and excretion
Documentation Guidelines
-Be timely
-Include Date and time
-Never document before its done
-Always document upon admission, transfer, discharge, procedure, post-op, communication with provider about critical result or information, any change in patient status
-Use military time
What are some factors that can affect lung disease?
Smoking!!! (have to offer smoking cessation to any patient that smokes)
Environmental - pollution
Working with chemicals
S/S of hypoxia
dyspnea, increased BP, Tachycardia, pallor, cyanosis, anxiety, restlessness, confusion, drowsiness
Know sterile vs nonsterile: If you needed an extra piece of gauze that was outside the sterile field, how do you get it?
Someone would have to open it and drop the gauze into the sterile field
Cough medications (3)
Expectorants
Suppressants
Lozenges
Lifestyle considerations that effect oxygenation
-sedentary activity patterns
-exercise
-smoking
-
partial rebreather
*Partial rebreather-A partial rebreather mask has two-way valves instead of one-way valves. This means you rebreathe a small amount of outside air.
What is dysuria
pain when urinating; difficulty
When administering blood and blood byproducts consider…
*Typing and cross-matching
*A, B, AB, and O type blood
*Rh factor
*Selecting blood donors
*Initiating transfusion
*Transfusion reactions
What does a bronchodilator do
Opens airways
Hypertonic solution & example
Definition: solutions that are more concentrated or have a higher osmolality than body fluids
- concentrate ECF and cause movement of water from cells into ECF by osmosis
- monitor for fluid overload, but used to treat hypovolemia and replace fluid and electrolyte
don’t want to dehydrate cells - they can shrivel
Example: 5% dextrose in 0.9% normal saline
Example: 5% dextrose in LR
What would you do if you were giving medication and the patient spoke limited english?
Get a translator
IV complication - infiltration s/s flow rate
- edema, pain and coolness at site
- significant decrease in flow rate
How do you do a 24 hour urine collection?
First, you discard urine
If you empty the urine at 0600, you’ll collect the urine 24 hours later at 0600
Foley - i think you have the bag on ice
24-hour urine
Discard first urine
Collect for 24 hours
At the end, ask patient to void and add to collection
Corticosteroids
reduce inflammation in the airway
SDOH
Economic stability
Education Access and Quality
Healthcare Access and Quality
Social and Community Context
Neighborhood and Built Environment
What are nutrients
specific biochemical substances used by the body for growth, development, activity, reproduction, lactation, health maintenance and recovery from illness or injury
What is general anesthesia + 3 stages
administration of drugs by inhalation or IV route
induction: from administration of anesthesia to ready for incision
maintenance: from incision to near completion of procedure
emergence: starts when patient emerges from anesthesia and is ready to leave OR
What is a comfort measure to use if someone is complaining that oxygen delivered is dry or giving them nosebleeds?
Humidify it
If someone can’t see, how do you tell them where everything is?
Clockface (xyz is at 12 o’clock)
Electronic Health Record (EHR)
Benefits
Improvement of quality & convenience
Increase in patient participation
Improved accuracy
Improved coordination of care
Increased efficiency & cost effectiveness
What are factors that decrease BMR
aging, prolonged fasting, sleep
Focused questions (S/S)
Oxygenation/Respiration (6)
Cough
Sputum
Pain
Dyspnea
Fever
Fatigue
Hypertonic
Greater concentration of particles than plasma. causing water to move out of the cells and to be drawn into the intravascular compartment, causing the cell to shrink.
Mucolytic agents
liquefy or loosen thick secretions
Intradermal injection: gauge, angle, length
1/4 to 1/2 inch needle
gauge: 25-28
dose small, less than 0.5 mL
angle: 5-15 degrees
sites: inner surface of forearm, upper arm, upper back (no hair)
Point of care - hematest
Blood test performed at the patient’s beside; using a portable device to analyze basic hematology parameters
often though simple finger prick
rapid blood test done to assess blood status quickly
PVC-Peripheral Venous Catheter
Used when therapy…
Dwells less than 3” in peripheral vein
Not appropriate for chemo, irritants, or TPN
Rotate site every
Smallest gauge to do the job.
What is force fluids?
Increased fluids; providing access to fluids and explaining to the patient why they need to drink a lot
Venturi face mask
*venturi-A medical device that delivers a specific oxygen concentration to a patient using color-coded entrainment devices. The correct flow rate for a venturi mask depends on the desired oxygen percentage, and is indicated on the mask. (good for COPD patients)
Metabolic Acidosis
Proportionate deficit of Bicarb
Hypotonic solution & example
- should be administered slowly to prevent cellular edema
– causes cells to swell - used for dehydration
- definition: solutions that are more dilute or have a lower osmolality than body tissues
Example: 0.45% NSS
IV complications - sepsis s/s
- red, tender insertion site
- fever, malaise, other vital changes
Phlebitis s/s
- local acute tenderness
- warmth, redness, edema above insertion site
What is a spacer that is used with an inhaler?
Used because medication stays longer in the spacer and helps patient with still getting the same amount of medication over different breaths so it can be used comfortably
Helpful especially with kids and older adults who can’t take a deep enough breath
Factors affecting IV Flow Rates (4)
Height of solution
Position of extremity
Condition of vein
Viscosity of solution
Respiratory Alkalosis
Primary Deficit of carbonic acid
Metabolic alkalosis
Primary excess of Bicarb
Edited this - originally said deficit but think when pH is high like alkalosis, metabolic cause is also high. If metabolic cause, it moves the same way pH does. high pH - high bicarb
What are some signs of hypoxia?
- Cyanosis
- Low capillary refill
- Confusion
- Tachycardia
- Increased BP
- Dyspnea
- Can have hyperventilation
Protein information #1
NEEDED FOR HEALING
- vital component of every living cell; required for formation of all body structures
- more than 1K different proteins are made in body by combining various of the 22 amino acids
- COMPLETE PROTEINS contain sufficient essential amino acids to support growth
– incomplete proteins are deficient in one or more essential amino acids
– animal proteins are complete; plant proteins are incomplete (except soy and quinoa)
– vegetarians can combine different plant proteins to make a complete protein
Full liquid diet
“Clears” plus:
- milk
- pudding and custard
want pourable
liquid supplements
We lose fluids through… (4)
Urine, Feces, Perspiration, Insensible water loss
Simple face mask
*Simple-A low-flow system that delivers 35–50% oxygen with a flow rate of 6–10 L/min
What is the total daily energy expenditure
All of the calories used to perform physical activity, maintain metabolism, and digest, absorb and metabolize food
Providing supplemental 02 (how to hook up the oxygen)
wall 02 outlet
portable cylinder or tank
02 concentrator
What kinds of problems are you worried about if someone is experiencing diarrhea for 4 days? (4)
- Fluid volume deficit
- Dehydration
- Electrolyte imbalance
- Skin breakdown
Bronchodilators
open narrowed airways
Tests at the bedside - point of care GI/GU
Occult blood test at bedside
Confidentiality and talking about patients?
Cannot talk about them in common, public areas
Nutrients: six classes
Nutrients that supply energy:
- Carbohydrates
- Proteins
- Lipids (fats)
Nutrients that regulate body processes
- Vitamins
- Minerals
- Water
Enteral nutrition (monitoring)
Enteral feeding
- Feeding schedule and formulas, and pumps
- monitor for tolerance
– gastric residual volume (GRV)
- promote patient safety
- monitor for complications
- provide comfort measures
- provide education
What are factors that increase BMR
growth, infections, fever, emotional tension, extreme environmental temperatures, elevated levels of certain hormones
Subcutaneous injection: gauge, angle, length, sites
length: 3/8 to 1 inch (based on subcutaneous tissue)
25-30 gauge (dose no more than 1 mL)
angle: 45-90 degrees (based on needle length/adipose tissue)
sites: upper arm, anterior thigh, abdomen, upper back and upper dorsogluteal
be sure to rotate sites
Be able to prioritize patients
Acute vs chronic
ABC
Emergent > urgent
When do we do patient handoff?
- Changing shift
- Discharge
- Any time the patient is changed to a different level of care like to ICU, floor to floor, floor to long-term rehab
-Provider change
Focused assessment
(Questions general)
Oxygenation/Respiration
Patterns of respiration
Meds
Health hx
Recent changes
Lifestyle and environment
Protein information #2 total percentage daily
- dietary protein is broken down into amino acids by pancreatic enzymes in small intestine - absorbed and transported to the liver
– in liver: amino acids are recombined into new proteins or released for use by tissues and cells
– protein tissues in constant state of flux
– tissues continuously broken down and replaced (catabolism and anabolism) - RDA FOR ADULTS IS 0.8 G/KCAL OF BODY WEIGHT – 10-35% TOTAL CALORIE INTAKE
What is BiPAP?
It is similar to CPAP, but CPAP doesn’t always have oxygen and may just be pressure.
BiPAP has oxygen and pressure; the goal being to keep someone from intubation
KNOW THE STAGES OF PRESSURE ULCERS
Stage 1: skin is unbroken but inflamed; nonblanchable erythema of intact skin
Stage 2: skin is broken to epidermis or dermis; partial-thickness skin loss - shallow, open ulcer
Stage 3: ulcer extends to subcutaneous fat layer; full-thickness skin loss - subQ fat may be visible
Stage 4: ulcer extends to muscle or bone; undermining is likely; exposed bone, tendon, or muscle
Unstageable: base of ulcer covered by slough and/or eschar in wound bed
Deep tissue pressure injury: persistent nonblanchable deep red, maroon, or purple discoloration
Types of liquid diets
Clear and Full
MDI (Metered Dose inhaler) - handheld aerosol device (how to use)
Without a spacer: Hold the inhaler upright, tilt your head back slightly, and breathe out fully away from the inhaler.
With a spacer: Hold the mask over the patient’s mouth and nose, press down on the inhaler, and hold the mask in place for five to ten breaths.
Fats information #2 (saturated fat daily intake)
- digestion occurs largely in small intestine
- bile (secreted by liver and stored in gallbladder) emulsifies fat so pancreatic enzymes can break it down for digestion
- fats absorbed into lymphatic circulation and transported to liver
- most concentrated source of energy in diet!!!!
- recommended intake: LIMIT SATURATED FATS TO LESS THAN 10% OF DAILY CALORIES AND INTAKE OF TRANS FATS TO AS LOW AS POSSIBLE
Complications of an IV (6)
- phlebitis
- thrombus
- infiltration
- sepsis
- fluid overload
- air embolus
Thrombus s/s IV complication (infusion rate?)
- IV infusion sluggish or may cease
- heat, redness, tenderness at site
Types of IV therapy (Vascular access devices) (4)
*PICCs (peripherally inserted central cath- can stay in a few weeks and can give large amounts of fluid)
*Nontunneled percutaneous central venous catheters (high risk of complications)
*Tunneled central venous catheters
*Implanted ports (usually in chest area/ can also draw blood
Isotonic
Same concentration of particles as plasma
What are macronutrients
Supply energy and build tissue: carbs, fats, proteins
What provides energy (of nutrients)
Carbohydrates, fats, proteins
IV Complications
Infection
Tissue damage
Phlebitis
Thrombosis
Catheter embolus
Overload
Hematoma
Air embolus
Infiltration, extravasation
Where are central lines placed?
Subclavian, jugular, PICC line
she noted: IV in hand is not a central line
Vitamin information
- organic compounds needed by the body in small amounts; do not provide calories
- needed for metabolism of carbs, protein and fat
- fresh foods higher in vitamins than processed
- WATER SOLUBLE: C and B-complex vitamins (not stored in body; excreted)
- FAT SOLUBLE: A, D, E, K (can be toxic)
- absorbed through intestinal wall directly into bloodstream
Foley catheter!!! - inserting on woman (male is basically the same, but make sure to use fenestrated drape for man)
needs to be sterile
Female:
- sterile gloves
- graps corners of drape and unfold without touching nonsterile areas
- sterile tray on drape between patient thighs
- open all supplies; attach syringe to inflation port for balloon
- antiseptic swabs or cotton balls: prepare
- lubricate 1-2 inches of catheter tip
- spread labia and identify meatus – keep one hand there until catheter is inserted
- use dominant hand to pick up swaps or cotton balls and clean one labial fold top to bottom, discard, and use clean one for each following stroke
- slowly insert catheter into urethra with dominant hand and advance until return of urine
- once urine drains, advance catheter another 2-3 inches
- rotate slightly if needed
- use dominant hand to inflate catheter balloon with sterile water from syringe attached to port
- pully gently after inflation to make sure in place
- attach catheter to drainage bag if not preattached
- remove gloves; secure catheter tubing to patient’s inner thigh with securing device
- secure drainage bag below level of bladder; ensure tubing is not kinked or clamped
Carbohydrate information #2
- more easily and quickly digested than protein and fat
- 90% of carbs intake is ingested
- converted to glucose for transport through blood
- efficient fuel that certain tissues rely on almost exclusively for energy (nervous system)
- transported from GI tract, through portal vein, to liver
– liver stores glucose and regulates entry into blood
– cells oxidize glucose to provide energy, carbon dioxide and water
Hypoxia
-often caused by..?
-Inadequate amount of 02 available to cells
-Hypoventilation
-atelectasis
Factors affecting cardio/oxygenation
Environmental
-Air pollution, environmental/occupational exposure to pollutants/chemicals/carcinogens
Psychological health (stress)
-Hyperventilation (c02 down)
- bronchospasms
anxiety
Need to match images of oxygen things
Know what nasal cannula, simple breathing, partial rebreather, and nonrebreather look like
Fats information #1
- insoluble in water and blood; composed of carbon, hydrogen, oxygen
- 95% of lipids in diet are triglycerides
- contain mixtures of saturated (raise cholesterol levels) and unsaturated (lower cholesterol levels) fatty acids
– MOST ANIMAL FATS ARE SATURATED
– MOST VEGETABLE FATS ARE UNSATURATED
Intramuscular injection: gauge, angle, length
5/8 to 1 1/2 inches (based on site and patient age)
needle gauge: 18-25
angle of insertion: 72-90 degrees
sites: Vastus lateralis (thigh) - 4mL max
Deltoid (upper arm) - 1mL max
Ventrogluteal (hip area) - 4mL max
Using an incentive spirometer - edit: you exhale first and then inhale through incentive spirometer to raise the marker
- inhale slowly through your nose
- Purse your lips as you would to whistle
- Exhale slowly while keeping your lips pursed
Selecting a vein
*Accessibility of a vein (avoid places that bend)
*Condition of vein
*Type of fluid to be infused (blood products need bigger access)
*Anticipated duration of infusion
What are the three phases of perioperative period?
Perioperative: begins with decision to have surgery, lasts until patient is transferred to OR or procedural bed
Intraoperative: begins when patient is transferred to OR bed until transfer to post anesthesia care unit (PACU)
postoperative: lasts from admission to PACU or recovery to complete recovery from surgery and last follow-up health care provider visit
what information do you have to worry about with confidentiality?
any identifying information
If someone comes in with abdominal pain, how do you rate it?
Scale 0-10
PQRST
Depending on where can give you clues; determine quadrants
Try to use objective words
