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Final Exam-Extra Material > Lab Info: Wounds, Tubes, and IVs > Flashcards

Lab Info: Wounds, Tubes, and IVs Flashcards

1
Q

If a patient has a pressure ulcer- what should you do to alleviate the pressure?

A

Upload- raise and take pressure off

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2
Q

How is a stage 1 pressure ulcer described?

A

Intact skin with nonblanchable redness

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3
Q

Where do pressure ulcers usually occur?

A

Over boney prominences

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4
Q

On a patient with dark skin- how can you tell they have a stage one pressure ulcer?

A

It may be seen as color hue changes

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5
Q

How is stage 2 pressure ulcer described?

A

Partial thickness loss of dermis or open/ruptured serum-filled blister

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6
Q

A stage 2 pressure ulcer can also be called this from a sheer effect.

A

A skin tear

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7
Q

How is a stage 3 pressure ulcer described?

A

Full thickness tissue loss but bone and muscle ARE NOT EXPOSED

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8
Q

On a stage 3 pressure ulcer- the depth of the wound depends on what?

A

Anatomical area of ulcer

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9
Q

How is a stage 4 pressure ulcer described?

A

Full thickness tissue loss with exposed bone, tendon, or muscle.

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10
Q

In a stage 4 ulcer- what may be present?

A

Eschar or slough

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11
Q

What is often included in a stage 4 pressure ulcer?

A

Tunneling

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12
Q

What is eschar?

A

Necrotic area that must be debated

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13
Q

How is tunneling described and what must you do to it?

A

It tracks from one area to another creating a whole.

YOU MUST PACK IT

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14
Q

A hydrophobic dressing does not absorb what?

A

Water

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15
Q

A hydrophilic dressing does absorbed what?

A

Water

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16
Q

hat are the 6 categories of wound dressings?

A
  • Wet-to-moist
  • Hydrocolloid
  • Impregnated Gauze
  • Alginate
  • Foams and Hydrophilic
  • Non-adherent or Hydrophobic
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17
Q

When should a wet to moist dressing?

A

When it is still moist

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18
Q

Why is it important to remove a wet to moist dressing while it is still moist?

A

Because It will destroy the granulated tissue when removed if it is dry

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19
Q

What does a wet to moist dressing do?

A

Debrides the wound

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20
Q

How does a wet to moist dressing work?

A

Water evaporated creating hypertonic solution drawing the fluid from the wound

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21
Q

What makes up the moist part of a wet to moist dressing?

A

Sterile saline

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22
Q

When placing a wet to moist dressing- what should you avoid?

A

Placing the moist portion on healthy skin

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23
Q

What types of wounds would you use a hydrocolloid dressing on?

A

Non-infected partial or full thickness wounds

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24
Q

What does a hydrocolloid dressing absorb?

A

Exudate

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25
Q

Hydrocolloid dressings are impermeable to what?

A

Water and bacteria

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26
Q

Hydrocolloid dressings create what to help generate granulation tissue?

A

Moisture

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27
Q

What is a main perk of a hydrocolloid dressing?

A

It conforms to the body shape

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28
Q

What should you be careful of when using a hydrocolloid dressing?

A

Getting stool to sit on it.

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29
Q

What is alginate dressings made of?

A

Highly absorbent seaweed

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30
Q

What do you need to have when using an alginate dressing?

A

A secondary dressing to secure it

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31
Q

the alginate dressing’s fibers turn into what when placed on a wound.

A

Gel

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32
Q

What are alginate dressings used for?

A
  • diabetic ulcers
  • burns
  • infected wounds
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33
Q

What is the down fall of using alginate dressings?

A

They’re really expensive

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34
Q

What must you need when using a foam/hydrophilic dressing and why?

A

A wrap or secondary bandage because there aren’t any adhesive boarders

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35
Q

What are the perks of foam/hydrophilic dressings?

A
  • Cushions wounds
  • Very absorbed
  • Traps exudates
  • Protects surrounding tissues
  • Can remove without trauma
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36
Q

What is required when using a non-adherent/hydrophobic dressing?

A

Tape or cover dressing to secure

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37
Q

What are non-adherent/hydrophobic dressings used for?

A
  • burns
  • skin
  • grafts
  • donor sites
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38
Q

What are the advantages of gauze dressings?

A
  • Inexpensive
  • Easily accessible
  • Can be impregnated with anti-microbial such as silver in use of burns
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39
Q

What are the disadvantages of gauze dressings?

A
  • Non-occlusive
  • Fibers left in wound can delay healing causing infection
  • Non-selective in tissue removal-removes necrotic and granulation tissue
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40
Q

What types of wounds do you use transparent film dressings on?

A

non-draining wounds and IV sites

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41
Q

What is created when using a transparent film dressing?

A

A moist environment

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42
Q

What are the two perks of a transparent film dressing?

A
  • impermeable to bacteria

- Easy to access wound

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43
Q

What does a wound V.A.C. increase and how?

A

Increased circulation by using negative pressure

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44
Q

What is the two perks of a wound V.A.C.?

A

Causes continuous debridement and increasing circulation

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45
Q

What is the perk of wound irrigation?

A

Removes bacteria without injury to healthy tissue

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46
Q

What supplies are need for wound irrigation?

A
  • Irrigation kit
  • Irrigation fluid
  • Absorbent pad
  • Clean gloves
  • New dressing supplies
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47
Q

What type of syringe is provided in an irrigation kit?

A

A piston syringe

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48
Q

What type of solution is usually used when irrigating a wound?

A

Saline solution

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49
Q

When obtaining a wound culture what must you make sure you do with the swab?

A

Get all side of swab as well as all surfaces of wound

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50
Q

What are the steps of obtaining a wound culture?

A
  • Rise wound with sterile saline
  • Rotate swab while obtaining specimen
  • Crisscross wound top to bottom
  • Don’t take specimen from exudate or eschar
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51
Q

What are the supplies used for taking a wound?

A
  • Wound packing gauze
  • Clean and sterile gloves
  • Sterile q-tips
  • Sterile scissors and forceps
  • Sterile dressings
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52
Q

What is packing used for?

A

A tunneling wound

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53
Q

What does packing a wound create?

A

A wick to pull the fluid from the bottom of the wound up

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54
Q

When removing a suture what should you do?

A

Pull up by the knot and just cut from there to slip up

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55
Q

How many prongs are on a staple remover?

A

3

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56
Q

What is montgomery straps used for?

A

A delayed incision closure

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57
Q

How often do dressing usually get changed when using a montgomery straps?

A

q4-6 h

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58
Q

What do spiral turns in spiral bandaging prevent?

A

Tourniquet effect

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59
Q

What is spiral bandaging used for?

A

TO secure a wound dressing or applying compression

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60
Q

What are the two things you should do when using a spiral bandaging technique?

A
  • Elevate part to be bandaged

- Wrap extremity upward applying uniform pressure

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61
Q

How much of the bandage on a spiral bandage should overlap?

62
Q

When is a figure-eight bandage used?

A

To support and limit joint movement

63
Q

What is the first thing you do when applying a figure-eight bandage?

A

1st anchor bandage around extremity

64
Q

What should you frequently asses for after applying a figure eight bandage?

A

Assess for changes in CMS

65
Q

What are the steps of applying figure-eight bandage?

A
  • Anchor bandage around extremity
  • Make circular turn around heel and back
  • Continue to wrap with two-thirds overlap
66
Q

A piggy back medication is prepared in bags that are in this range.

A

50ml to 250ml

67
Q

What do you do if the primary IV solution is incompatible with your IVPB medication?

A

You must disconnect the primary IV solution. Cleanse IV port for 15 seconds and flush with 10 ml saline.

68
Q

If there is no primary fluids running in a patient’s IV- what should you do before and after administering the IVPB drug?

A

Pre-flush and post-flush

69
Q

What is the equation used to get a drop factor of an IV solution?

A

Volume to be infused x drop factor / minutes administered

70
Q

What is the equation used to get the correct dosage of medications needed to administer?

A

desired/available x volume

71
Q

How long should you clean the IV insertion site with antimicrobial swabs?

A

15 seconds

72
Q

When post flushing an IVP drug- how long should you flush the first ml of saline?

A

At the same infusion rate at the IVP medication

73
Q

What do you do if the IV infusion is not compatible with the IVP medication?

A

Shut off the IV fluids and clamp the line above the injection site

74
Q

If there is no primary IV solution running what do you need to do before and after administering IVP medications?

A

Pre and post flush with 10 ml of saline

75
Q

If a new PICC line is placed how must the placement be confirmeD?

A

Through X-Ray

76
Q

What types of flushes are needed with administering medication to a PICC line?

A
  • 10 ml pre-flush
  • 10 units/ml heparin flush
  • 10 ml post flush
77
Q

What should you follow when administering medications to a PICC line?

78
Q

What does SASH stand for?

A
  • Salne
  • Additive (MEDICATION)
  • Saline
  • Heparin
79
Q

When administering an IVP medication through a PICC line what must all the medication be prepared in?

A

10 ml syringe

80
Q

When pushing any types of solution through a PICC line what kind of method should you follow?

A

The push-pause method

81
Q

When doing a post flush on a PICC line what should you do?

A

Administer the first ml at the same rate as the previous medication then use the push pause method for the remaining 9 ml.

82
Q

What dictates the amount of heparin you administer to a PICC line?

A

Hospital protocol

83
Q

What supplies are needed for changing central line dressing?

A
  • Central line dressing kit
  • 2 masks
  • Clean gloves
  • Sterile gloves
  • Chloraprep swabs
  • Tape
  • Sterile occlusive dressings
84
Q

What should you do if the patient has an allergy to chlorhexidine and they need a central line dressing change?

A

Use 70% alcohol followed by povidone iodine

85
Q

Before you open the central line dressing kit what must you do with the patient?

A

Apply their mask and ask them to turn their face away from the central line

86
Q

Before you take off the old dressing on a central line what should you do?

A
  • Place the mask on the patient
  • Place the mask on you
  • Wash hands
  • Place on clean gloves
87
Q

What do you need to inspect the central line IV site for?

A

Loose sutures, inflammation, infiltration, and length of catheter.

88
Q

What type of motion should you use when cleaning a central line site?

A

A back and forth scrubbing motion for at least 30 seconds

89
Q

Before securing a new dressing on to a central line what should you do?

A

Clean with chloraprep and allow to dry

90
Q

If a central line site is bleeding and you need to place a new dressing on it -what should you do?

A

Use a 2x2 gauze

–Use 2 inch tape and tape all across to make occlusive

91
Q

What are the typical sizes of NG tube used?

A

14-16 french

92
Q

What type of lubricant should be used for an NG tube?

A

Water-soluble

93
Q

What are the supplies that are needed to insert a nasogastric tube?

A
  • NG tube
  • Lubricant
  • Clean gloves
  • Stethoscope
  • Tape
  • Safety pin
  • Irrigation kit
  • Towel
  • Suction equipment
  • Glass of water if patient can take fluids
94
Q

What position should the client be placed in before inserting an NG tube?

A

High fowlers

95
Q

How should you select the nostril you will be inserting the NG tube?

A

Ask the patient to breathe through one nostril while occluding the other and insert in the one with the greatest airflow

96
Q

How do you determine the length of the nasogastric tube to be inserted?

A

Measure the tube from the tip of the clients nose, to the earlobe, and to the typhoid process

97
Q

What should the patient do with their head when you are going to insert an NG tube?

A

Tilt their head forward and support the back of their head to maintain position

98
Q

What should you ask the client to do so you can advance the NG tube to the desire level?

A

Swallow or drink water if not NPO

99
Q

How do you assess NG tube placement?

A
  • Auscultation with stethoscope over left upper abdomen
  • Inject 10-20 ml of air into tube noting air sound in gastric region
  • Aspirate to visualize gastric fluid
100
Q

Once the placement of the NG tube is secure what should you do?

A
  • Connect to suction

- Instill 10-20 ml of air into air vent to ensure patency

101
Q

What supplies do you need to irrigate an NG tube?

A
  • Irrigation kit
  • Bottle of normal saline irrigation solution
  • Clean gloves
  • Saline
  • Stethoscope
  • Protective pad
102
Q

Before you irrigate an NG tube what should you do first?

A

Assess placement by auscultation and aspiration

103
Q

How much normal saline solution should you pour into the irrigation container when going to irrigate an NG tube?

104
Q

How much normal saline should you draw up out of an irrigation container to irrigate the NG tube?

A

30 ml in a 60 ml irrigation syringe

105
Q

After you insert the irrigation solution into the NG tube what should you do?

A

Aspirate to ensure latency and reconnect to suction

106
Q

After irrigating the NG tube and you have reconnected it to the suction what should you do?

A

Inject 10-20 ml of air into air vent

107
Q

What position should you place the patient in when removing an NG tube?

A

Semi-fowlers

108
Q

When removing an NG tube- after removing the tube from suction what should you do?

A
  • Instill 50 ml of air into drainage port
  • Clamp the tube by pinching it
  • Ask client to take a deep breath and hold it
109
Q

Before administering medication to a PEG tube what should you do?

A

Crush solid medications and dilute each med separately in 30 ml of water

110
Q

When diluting medications before administering to a patient with a PEG tube- how many ml should you use?

111
Q

If the patient cannot be placed in a Fowler’s position and they need medication administered to a PEG tube- what should you do?

A

Position the client to be slightly elevated in a right side lying position

112
Q

Before administering a medication through a PEG tube what should you do?

A

Check the location, insertion site and latency of PEG tube

113
Q

If a patient is receiving Continuous Tube Feedings and you need to give them medications what should you do?

A

Place the Tube Feeding Pump on Hold

114
Q

If a Tube Feeding Pump is on hold how long will it take the pump’s alarm to go off it is not resumed?

115
Q

Why should you clamp the PEG tube or turn on the 3 way stop to the off position before administering medication?

A

It prevents air from entering the stomach

116
Q

How do you verify the patency of a PEG tube before administering medications?

A

Instill 15-30 ml of warm water to verify

117
Q

How do you administer medication to a PEG tube?

A

Slowly pour the diluted medication into the syringe and allow it to flow through the PEG tube by gravity

118
Q

After administering medication through a PEG tube- what must you do even in between medications?

A

Slowly pour in 15-30 ml of water then clamp the tube

119
Q

Can you administer medications back to back in a PEG tube?

A

No- you must flush with water. Clamp. Then admin

120
Q

What should you do about the fluid given pre, between, and post last medications through a PEG tube?

A

Record it on the Intake Record

121
Q

If a patient is on a Continuous Tube Feeding- what should you do after administering medication?

A

Restart Continuous Tube feeding and verify correct rate

122
Q

If Continuous Tube Feeding is contraindicated by a medication what was given via PEG tube- what should you do?

A

Administer medication. Then clamp PEG tube or plug the PEG tube to prevent leakage.

123
Q

What is a CVC?

A

Central Venous Catheter

124
Q

How is a central venous catheter (Central line) described?

A

A long single or multi-lumen intravenous catheter inserted into the arm or chest and threaten into the large superior vena cava to just above the right atrium

125
Q

How long can a PICC be left in for?

126
Q

Where is a PICC inserted and what does it stand for?

A

Peripherally Inserted Central Catheter- in arm

127
Q

What are central lines used for?

A
  • Long term intravenous therapy
  • Chemotherapy
  • Parenteral Nutrition
  • Infusion of blood products
  • Dialysis
  • Hemodynamic monitoring
  • Frequent blood draws
128
Q

What are the types ov CVC?

A
  • Non-tunneled Central line
  • Peripherally Inserted Central Line
  • Implanted Ports or Vascular Access Device
  • Tunneled Central Line
129
Q

What are the two types of Tunneled Central lines?

A

Hickman or Broviac

130
Q

Where can non-tunneled Central lines be placed?

A

Subclavian
Jugular
Femoral

131
Q

How is a Vascular Access Device (VAD) placed

A

Under the skin into vena cava placed during surgery

132
Q

Implanted Vascular Access Devices have the lowest rate of?

133
Q

What are implanted vascular access devices used for?

A

Long term use accessed with a huber needle

134
Q

If a patient has a PICC line what can you not do to that arm?

A

Take BP or venipuncture

135
Q

What is placed on a tunneled central line and what is it used for?

A

A dacron cuff and decreases infection

136
Q

What is required to maintain patency of a central line?

137
Q

Never use less than what ml syringe when accessing a central line?

138
Q

You must use what when infusing on a central line?

A

An intravenous pump must be used

139
Q

What type of technique must be used when touching a central line catheter or administering dressing care to it?

A

Strict aseptic care

140
Q

What type of pressure must be maintained on a central line catheter

A

Positive pressure

141
Q

How can you maintain a positive pressure on a central line catheter?

A

Clamp before removing the flush

142
Q

When taking blood from a central line what must you do?

A

Waste the first draw due to it being contaminated with heparin

143
Q

If a patient is on TPN through a central line- when should their tubing be changed?

144
Q

What are the potential complications of a central catheter?

A
  • bleeding
  • hematoma
  • pneumothorax
  • hemothorax
  • arterial puncture
  • dysrhythmias
  • Infection
  • Air embolism
  • Thromboembolism
  • Brachial nerve injury
  • Thoracic nerve injury
  • Venospasm
145
Q

The ideal blood pressure cuff size should have a bladder length that is what percentage of the patients arm circumference?

146
Q

The ideal blood pressure cuff size should have a width that is at least what of the arm circumference?

147
Q

The ideal blood pressure cuff size should have a length-to-width ratio of what?

148
Q

For an arm circumference of 22 to 26 cm what type of blood pressure cuff should they wear?

A

small adult size

149
Q

For an arm circumference of 27 to 34 cm what type of blood pressure cuff should they wear?

A

adult size

150
Q

For an arm circumference of 35-44 cm what type of blood pressure cuff should they wear?

A

large adult size

151
Q

For an arm circumference of 45-52 cm what type of blood pressure cuff should they wear?

A

adult thigh size

Final Exam-Extra Material (7 decks)

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