Lines and Tubes Flashcards
1
Q
Purpose & placement of nasogastric tube (NG tube)
A
- to provide feedings for patients who are unsafe to swallow food
- keeps the stomach empty after surgery & rests the bowel
- placed in the nose or mouth to the stomach
2
Q
Indications for a nasogastric tube
A
- enteral feeding &/or gastric drainage
- decompression of the stomach
- patients experiencing dysphagia
3
Q
Clinical implications for nasogastric tube
A
- check orders to see if it can be disconnected; have a nurse disconnect
- avoid lying the patient flat while feeding to avoid asphyxiation
- watch cognitively impaired patients very closely as the tendency is to pull at tubing
4
Q
Purpose & placement of nasal cannula
A
- delivers supplemental oxygen up to 6L/min
- fraction of inspired Oxygen (FiO2) designed for 24-44%
- placed in the nose
5
Q
Indications for a nasal cannula
A
- patients who require increased O2 levels either at rest or with activity
- patients who are unable to maintain Oxygen saturation on room air alone
6
Q
Clinical implications for a nasal cannula
A
- use portable oxygen tank for mobility outside of the room
- monitor oxygen saturation throughout session
- it is appropriate for therapists to titrate oxygen levels in order to assist patient in maintaining physician ordered oxygen saturation levels. Orders must be obtained from MD before changing titration levels
7
Q
Purpose & placement of a closed face mask
A
- form of supplemental oxygen mixed with room air
- allows for collection of O2 around nose and mouth
- fraction of inspired Oxygen (FiO2) designed for 40-60%
- placed over the patient’s mouth and nose by patient, therapist, or other personnel
8
Q
Indications for a closed face mask
A
- oxygen delivery at rest or during activity
- patients who are unable to maintain adequate Oxygen saturation with room air alone
9
Q
Clinical implications for a closed face mask
A
- use portable O2 tank for mobility outside of the room
- monitor oxygen saturation throughout session
- it is ok for physical therapists to titrate oxygen levels in order to assist patient in maintaining physician ordered oxygen saturation levels. Obtain physician orders before increasing oxygen concentration
10
Q
Purpose & placement for a tracheostomy collar
A
- provide supplemental humidified oxygen or air
- placed by a Medical Doctor in the trachea through an opening made in the neck called a stoma
11
Q
Indications for a tracheostomy collar
A
- mechanical ventilation or prolonged ventilatory support
- after a laryngectomy, tracheal resection, or other head and neck surgeries
12
Q
Clinical implications for a tracheostomy collar
A
- if the tracheostomy collar is not capped, the patient will be unable to talk
- coordinate therapy session dependent on respiratory needs
- when patient coughs, fluids may escape from stoma if it is not capped
13
Q
Purpose & placement for a ventilator
A
- provides maximum breathing support
- patient may be connected via tracheostomy tube or a less permanent endotracheal tube (ETT)
- connected during surgery by a Medical Doctor
14
Q
Indications for a ventilator
A
- replaces breathing during or after surgery to facilitate rest to the heart
- respiratory failure
15
Q
Clinical implications for a ventilator
A
- coordinate with nursing and respiratory therapists to determine appropriate level of activity
- if patient can tolerate out of room activities, consider the use of a portable ventilator
- patient will be unable to speak with the ventilator attached
- patient may tire more easily when weaning from ventilation
16
Q
Purpose & placement for a ventriculostomy
A
- assists with and monitors intracranial pressure drainage
- placed by a Medical Doctor in the anterior horn of the lateral ventricle via a burr hole
17
Q
Indications for a ventriculostomy
A
- drainage or sampling of cerebrospinal fluid (CSF)
- monitoring of intracranial pressure (ICP) post trauma
18
Q
Clinical implications for a ventriculostomy
A
- head of bed should be elevated 30 degrees when unclamped
- prior to moving the patient, the drainage tube should be clamped; check with nursing and physician before clamping tubes
- when working with the patients, continue to monitor for changes in intracranial pressure
- be careful to monitor color changes in CSF; normal would be clear or straw-colored
19
Q
Purpose & placement for a sequential compression device (SCD)
A
- to prevent the risk of blot clots in the lower extremity
- to promote venous return
- full leg SCD is placed at the mid-thigh
- lower leg SCD is placed just distal to the patellar tendon
- both are usually applied to bilateral lower extremities
20
Q
Indications for a sequential compression device
A
- patients who are at a high risk for bleeding (i.e. multiple trauma victims)
- patients who are at increased risk for DVT due to prolonged bedrest or venous insufficiency
- patients receiving anticoagulant therapies
- patients who have limited ambulation capacity
21
Q
Clinical implications for a sequential compression device
A
- turn off machine and unwrap from extremities for mobilization
- place back on patient after therapy session
22
Q
Purpose & placement for a continuous passive motion machine
A
- to promote movement and attempt to reduce loss of Range of Motion (ROM) after surgery
- mainly used after joint replacement surgery in the hip or knee
- limitation of lost ROM following a surgical procedure
- placed on the target joint with the pivot point at the joint center
23
Q
Indications for a continuous passive motion machine
A
- promotion of cartilage growth and healing during NWB precautions
- may be used following fixation of fractures, joint sepsis, ligamentous reconstruction of the ACL, or other surgical procedures
- often seen post total knee arthroplasty
24
Q
Clinical implications for a continuous passive motion machine
A
- CPM will often come with a specific protocol from the surgeon or MD
- initially set to 0-40 degrees as tolerated, increasing 10 degrees per day
- CPM is ideally used 6-8 hours per day, depending on patient tolerance
25
Q
Purpose & placement for a pulse oximeter
A
- to monitor oxygen saturation at rest and during activity
- ear lobe, finger, toe, forehead, or bridge of nose
26
Q
Indications for a pulse oximeter
A
- acute respiratory patients
- patients on medications which may impair respiratory function
- patients who have undergone surgery, transplant, or are otherwise medically unstable
27
Q
Clinical implications for a pulse oximeter
A
- use clinical judgement to determine if patient’s oxygen saturation needs to be continually monitored
- therapist can connect/disconnect pulse oximeter
- will often set off alarm or be misread when patient is using hand/finger/foot during therapy session
28
Q
Purpose & placement for a BP cuff
A
- to assess patient blood pressure
- over the bare skin of the upper arm with the artery mark positioned directly over the brachial artery
- the distal edge of the cuff should be positioned one inch (2-3 cm) above the antecubital fold
29
Q
Clinical implications for a BP cuff
A
- use clinical judgement to determine if vitals are stable enough to remove blood pressure cuff
- therapist can don/doff cuff as needed
- record blood pressure before and after therapy session
30
Q
Purpose & placement for a peripheral IV line
A
- temporary administration of liquid medications or fluids, electrolytes, nutrients, or blood product transfusions
- any accessible vein (arm, leg, foot, etc.)
Placed by a registered nurse
31
Q
Indications for a peripheral IV line
A
- patients who are dehydrated
- patients who require liquid medications
- pre and post surgery
32
Q
Clinical implications for a peripheral IV line
A
- avoid use of BP cuff on involved extremity
- nurse can often disconnect for therapy however, some medications must be continuous
- do not kink or put tension on IV
- if IV becomes displaced during therapy session put pressure on the site to control bleeding and notify nursing staff immediately
33
Q
Purpose & placement for a peripherally inserted central catheter (PICC)
A
- for long term IV administration of medications, fluids, blood products, or chemotherapy (i.e. 4 wks of home antibiotics)
- basilic vein is the most common placement
- may also be placed in the cephalic or median cubital vein to the superior or inferior vena cava
34
Q
Indications for a peripherally inserted central catheter (PICC)
A
- patients receiving chemotherapy
- acute Chron’s disease patients
- patients receiving frequent blood transfusions
35
Q
Clinical implications for a peripherally inserted central catheter (PICC)
A
- wait for X-ray confirmation of proper placement before mobilization of the extremity
- avoid use of axillary crutches if PICC line is placed in the Basilic vein
- avoid blood pressure measurements on the affected extremity, but encourage mobility
- nurse can disconnect IV if medication is not continuous
- no activity restrictions
36
Q
Purpose & placement for a patient controlled analgesia pump (PCA)
A
- IV pain medication that allows patient to determine when it is administered via a handheld button
- only administers medication once over set time limit in order to avoid overdose, excessive sedation, or abuse
- connected directly to a patient’s IV line
37
Q
Indications for a patient controlled analgesia pump (PCA)
A
- acute post-operative pain management
- end-stage cancer
38
Q
Clinical implications for a patient controlled analgesia pump (PCA)
A
- time physical therapy session with administration of medication
- maintain integrity of line during mobility
- do not allow battery to die (ensure it is plugged in at the end of therapy session)
- ensure button for PCA pump is within reach after treatment
39
Q
Purpose & placement for a chest tube
A
- removes air or fluid from the pleural or mediastinal spaces
- prevents drainage from returning to pleural or mediastinal spaces
- restores negative intrapleural pressure to promote lung expansion
- surgically placed in the chest between the ribs by a Medical Doctor
40
Q
Indications for a chest tube
A
- post cardio-thoracic surgery
- collapsed lung
- pleural effusion, pneumothorax, hemothorax, chylothorax
41
Q
Clinical implications for a chest tube
A
- chest tube may be connected to water seal or wall suction
- discuss with nursing staff if tube can be disconnected from wall suction and placed on water seal prior to treatment
- if tubing cannot be disconnected, the nurse must place the patient on portable suction or therapy can be done within confines of tubing
- keep collection box upright at all times
- do not put gait belt over chest tube site
- patient can roll onto tubing
- keep drain below level of the tube insertion to allow gravity assisted drainage
42
Q
Purpose & placement for a portable telemetry
A
- heart rate and rhythm are continuously monitored from a remote room at the facility
- nurse is automatically notified if patient’s rate/rhythm becomes abnormal
- colored electrode leads are placed on the upper body and trunk, each corresponding to different locations
43
Q
Indications for a portable telemetry
A
- patients who need continuous monitoring of vital signs
- acute myocardial infarction
- acute or subacute congestive heart failure
- major surgery
44
Q
Clinical implications for a portable telemetry
A
- secure telemetry box for mobilization
- if electrodes come off, notify nurse or telemetry technician
- speak with nursing or telemetry technician before and after working with patient
45
Q
Purpose & placement for a percutaneous endoscopic gastrostomy (PEG) tube
A
- can be a long-term or permanent form of nutrition, fluids, or medication delivery to bypass the gastrointestinal system
- surgically placed in the stomach or jejunum
- placed by a Medical Doctor
46
Q
Indications for a percutaneous endoscopic gastrostomy (PEG) tube
A
- long-term enteral feeding, medication administration, or fluid administration
- bowel cancer, Crohn’s disease, severe burns, bowel obstruction
- patient is unable to move food from mouth to stomach without significant aspiration risk
47
Q
Clinical implications for a percutaneous endoscopic gastrostomy (PEG) tube
A
- avoid placing gait belt directly on insertion site; gait belt should be biased above the insertion site to avoid excess pressure or sliding over it
- the tube feeds can typically be disconnected for therapy; check with nursing and have a nurse disconnect
- avoid lying the patient flat during feeding to avoid aspiration; have a nurse place feedings on hold if the patient must lie flat
48
Q
Purpose & placement for a Foley catheter
A
- to drain urine from the bladder
- urinary bladder
- placed by Registered Nurse
49
Q
Indications for a Foley catheter
A
- patient is unable or contraindicated to perform volitional bladder drainage
- patient with bladder dysfunction
50
Q
Clinical implications for a Foley catheter
A
- keep collection bag below insertion site to reduce risk of back flow and to allow from gravity to assist drainage
- avoid tension on insertion site; keep bag secured to patient’s leg or clothing before ambulation
- avoid mobilizing with a full collection bag
51
Q
Purpose & placement for an external urinary catheter (condom catheter)
A
- used to collect urine when patient is incontinent
- reduces the risk of urinary tract infection
- directly on the penis, attached with adhesive, foam, glue, or velcro
52
Q
Indications for an external urinary catheter (condom catheter)
A
- urinary incontinence
- overactive bladder
- other urological problems which cause issues with urinary retention or voiding
53
Q
Clinical implications for an external urinary catheter (condom catheter)
A
- keep collection bag below insertion site to reduce risk of back flow and to allow from gravity to assist drainage
- avoid tension on insertion site; keep bag secured to patient’s leg or clothing before ambulation
- avoid mobilizing with a full collection bag
- take care during mobilization as the condom catheter can be easily disrupted
54
Q
Purpose & placement for a closed suction drain with bulb (Jackson Pratt drain)
A
- device used to drain blood/fluid after surgery or infection
- placed at a surgical site by a Medical Doctor
55
Q
Indications for a closed suction drain with bulb (Jackson Pratt drain)
A
- often seen post knee surgery
- often seen post mastectomy
56
Q
Clinical implications for a closed suction drain with bulb (Jackson Pratt drain)
A
- secure drain with safety pin prior to mobility
- avoid placing gait belt over drain site
- if drain opens during the therapy session, close the lid, notify and inform the nurse the amount, if any, that escaped the bulb (the drainage amount is tracked to notify the surgeon when it is safe to remove the drain)
- remove safety pins from the bulbs after treatment
57
Q
Purpose & placement for a hemovac
A
- to collect blood/fluid after surgery
- similar to Jackson Pratt (JP) drain, allowing more suction
- placed at surgical site by a Medical Doctor
- can be gravity or suction setup
58
Q
Indications for a hemovac
A
- for larger amounts of exudate post surgery or infection
- for patients who require more suction than a JP drain
- often seen post knee surgeries
59
Q
Clinical implications for a hemovac
A
- secure drain with safety pin prior to mobility
- avoid placing gait belt over drain site If drain opens during the therapy session, close the lid, notify and inform the nurse the amount, if any, that escaped the bulb (the drainage amount is tracked to notify the surgeon when it is safe to remove the drain)
- remove safety pins from the bulbs after treatment
60
Q
Purpose & placement for a rectal tube
A
- continuous collection of feces
- placed in the rectum by a Registered Nurse
61
Q
Indications for a rectal tube
A
- for those who are incontinent or unable to mobilize out of bed to the bathroom
- prevention of skin breakdown secondary to loose stools
- promotes skin integrity as perianal area does not come into contact with feces
62
Q
Clinical implications for a rectal tube
A
- avoid any tension at insertion site; this device can be easily dislodged
- patients may be uncomfortable in seated positions
- keep collection bag below level of insertion
- use a draw sheet when moving patient in bed
63
Q
Purpose & placement for wound vac
A
- used to promote wound healing by “pulling” wound edges together via negative pressure
- decrease air pressure on the wound
- removal of fluid from the wound to reduce swelling and remove bacteria
- placed in the operating room by a Medical Doctor
64
Q
Indications for a wound vac
A
- patients with burns, wounds, or pressure sores
- wounds that are infected or are not closing properly
65
Q
Clinical implications for a wound vac
A
- dressing must be changed every 24-72 hours
- device can run on battery power for use during therapy sessions
- no mobility restrictions
66
Q
Purpose & placement for an ostomy
A
- surgically re-rout stool collection
- placed in the colon by Registered Nurse after surgery
67
Q
Indications for an ostomy
A
- bowel elimination when colon is obstructed or not functioning
- fecal material needs to be diverted
68
Q
Clinical implications for an ostomy
A
- do not put gait belt over ostomy bag
- bag may need to be emptied prior to mobility, patient might be able to do this independently. If not, ask the nurse to assist
- notify nursing immediately if the bag becomes disconnected
