Module 5: Respiratory Management Flashcards
When does a patient start to have brain damage from not breathing?
3 minutes, 10 minutes patient unlikely to recover, 15 minutes no recovery possible
List the five parts of Maslow’s Hierarchy of Needs
Physiological, safety. social, self-esteem, self-actualization
Who is a bitch
Emily
5 first things to consider in an emergency
- airway 2. breathing 3. circulation 4. disability 5. exposure
Three most important things to consider when trying to adequately ventilate a patient
Ventilation, perfusion, compliance
respiratory physiology
structure, function, lung volumes, pulmonary circulation, resp gas exchange, regulation of ventilation
Define WORK OF BREATHING
The effort required to expand and contract the lungs
Define emphysema
When alveolar membranes break down and gas exchange doesn’t take place as well
Define chronic bronchitis
Inflammation and excess mucus in the airway passage.
Cardiovascular physiology
–Myocardial pump
–Myocardial blood flow
–Coronary artery
circulation
–Systemic circulation
–Blood flow regulation
conduction system
List conditions that affect chest wall movement
Pregnancy
*Obesity
*Musculoskeletal
abnormalities
*Trauma
*Neuromuscular diseases
*Central nervous system
alterations
*Influences of chronic lung
disease
diagnostic tests
Pregnancy
*Obesity
*Musculoskeletal
abnormalities
*Trauma
*Neuromuscular diseases
*Central nervous system
alterations
*Influences of chronic lung
disease
List common nursing Dx related to oxygenation
- Impaired gas exchange
- Ineffective breathing pattern
- Impaired airway clearance
- Impaired cardiac output
- Acute pain
- Activity intolerance
4 easiest ways to manage dyspnea
*Assessment
*Positioning
*Oxygen
*Medications
How do you maintain/promote lung expansion?
*Ambulation
*Positioning
–Good lung down
*Incentive spirometry
What are the components of a medication order?
–Patient’s full name
–Date and time of the order
–Medication name
–Dosage
–Route of administration
–Time and frequency of
administration
–Signature of the
healthcare provider
What are the seven rights to medication adminstration?
- Right medication
- Right dose
- Right patient
- Right route
- Right time
- Right documentation
- Right indication
How many identifiers must you confirm before administering medication?
2
How many times do you check for accuracy before administering medication?
3 times
Memorize the following
*Prn
*Stat
*now
*q.i.d.
*hs
*SQ
*TD
*cc
*gtt
*NPO
*q8h
*IM
*IV
*NGT
*EC
*NS
*ID
*Supp
*Cap
*IVPB
What are six things you need to do before administering medications?
- COMPARE THE MED LABEL TO THE ORDER
- CHECK THE EMR FOR ALLERGIES OR CONTRAINDICATIONS
- CHECK THE EXPIRATION DATE ON THE MEDICATION
- VISUALLY INSPECT THE MEDICATION FOR ANY LOSS OF INTEGRITY
- PERFORM HAND HYGIENE
- SEVEN RIGHTS OF MEDICATION ADMINISTRATION
- IF BAR CODE SCANNING – OPEN MAW (MEDICATION ADMINISTRATION
WINDOW) SCAN THE PATIENT’S NAME BAND (VERIFYING WITH PATIENT NAME
& DOB) SCAN MEDICATION BAR CODE. - GIVE MED IN APPROPRIATE VEHICLE (MED CUP, SYRINGE, G TUBE, NG TUBE)
- STAY WITH THE PATIENT UNTIL MED INGESTED
- PERFORM HAND HYGIENE
- RETURN WITHIN AN HOUR TO REASSESS RESPONSE
Seven rights to drug administration
- RIGHT PATIENT (CHECK NAME BAND AND ASK THE PATIENT, THEN SCAN NAME BAND)
- RIGHT MEDICATION
- RIGHT DOSE
- RIGHT ROUTE
- RIGHT TIME
- RIGHT DOCUMENTATION
- RIGHT INDICATION
* **CLIENTS HAVE THE RIGHT TO REFUSE (SAY NO) TO MEDICATION
Three rules of thumb you HAVE to abide by
- NEVER GIVE A MEDICATION POURED OR DRAWN UP BY SOMEONE ELSE
- NEVER RETURN UNWRAPPED OR PREPARED MEDICATIONS TO STOCK
CONTAINERS - REMEMBER, DISPOSAL OF CONTROLLED SUBSTANCES MUST BE CO-SIGNED
BY ANOTHER NURSE, AS MANDATED BY LAW
What is the line in a pill used for cutting equally called?
scored pill
Why do you hold the label in opposite direction of pouring stream?
To make sure that the label doesn’t get dripped on and become obscured.
When do you reassess the patient after medication administration?
1 hour after administration
Why should you be careful about administering medication to older adults?
Stacking meds that they may have not completely passed because they have slower body function can cause overdose.
scanner must be within ____ft of COW
33
What needle gauge/length do you use for ID injections?
25-27 gauge needle with 3/8 to 5/8 inch length small 1 inch syringe
How do you administer ID injections?
Pull skin taunt and insert needle at 15 degree (parallel to patient skin) and with bevel facing up. Insert needle about 1/8 inch. Give the injection slowly and look for wheal on the skin. When finished withdraw needle and apply dry gauze. Do not rub site. If no bleeding or wheal the injection was not given properly.
How do you administer SC injections?
Pinch the loose fatty area with non-dominant hand and insert needle @ 45 to 90 degrees (90 for obese). Release pinch after needle inserted. After injection remove needle at same angle at insertion and cover with dry gauze and apply gently pressure. Do not rub.
What needle gauge/length do you use for SC injections?
25-30 gauge, 3/8 to 5/8 inch length
What needle gauge/length do you use for IM injections?
(typical 18 to 25 guage and length of 5/ 8 to 1 1/2 inch)
How do you administer IM injections?
Pull skin and tissue and hold firmly, while a long needle is inserted into the muscle at 90 degree angle.
Inject slowly. Hold for 10 seconds to disperse medication
Release skin and tissue after injection. Cover with dry gauze
A needle track forms during this procedure takes the shape of the letter “Z,”
The zigzag track line prevents medication from leaking from the muscle into surrounding tissue.
When do you use filter needles?
When drawing up medication. Not meant for administration
how to calculate ml per hour iv
TOTAL VOLUME OF SOLUTION IN ML / TOTAL NUMBER OF HOURS TO RUN
Do you administer eye drops or ointment first when both are ordered?
Drops
How do you ensure medication is effectively administered to both ears?
Put drops in ear, wait for a few minutes, then have pt turn over and apply other
At what age down you start pulling ear down and back
3 years old
What kind of pen should you use to write date and time on transdermal patches?
Not ball point ink because it can interfere with medication admin
DO NOTs for transdermal patches
none on breast tissue, no heating pads, be sure ot wear gloves during admin
How should you apply topical medication?
Expose the affected area while keeping unaffected areas covered.
Wash, rinse, and dry the affected area before applying medication.
If the skin is excessively dry and flaking, apply the topical agent while the skin is still damp.
Remove your gloves, perform hand hygiene, and apply new clean gloves. long strokes in the direction of hair growth
How should you apply transdermal medication?
Apply clean gloves and remove the old patch.
Fold the sticky sides of the patch together and dispose according to agency policy. Policy may require that the patch be cut in half prior to disposal.
Apply clean gloves.
Apply new patch to a clean, dry area, avoiding the previous site for at least a week. The new site must be relatively free of hair, burns, cuts, or any kind of skin irritation, and must not be too oily.
To apply the new patch, carefully remove the plastic liner by holding the patch around the edges without touching the adhesive.
Apply the patch immediately to the selected site, pressing it firmly with your hand for 10 seconds to ensure that it adheres well.
What are the four different types of inhaled medication?
Aerosolized Nebulizers in hospital* Some inhaled medications can be mixed together (check before mixing)
* Some medications may need to be diluted
* Attach to medical air at 6 to 10 L; If medical air is not available, attach to Oxygen
* Position patient sitting up or at a 45 degree angle unless contraindicated
* Use a mask if patient cannot tolerate mouthpiece or hold the handheld device
* Rinse the mask/device out once completed
* If the medication was a steroid, have the patient rinse their mouth with water and gargle
Pressurized metered-dose inhalers (pMDIs) – Aerosol Need sufficient hand strength for use
May be used with a spacer
Breath-actuated metered-dose inhalers (BAIs) – Mist Release depends on strength of patient’s breath
Dry powder inhalers (DPIs) – Spiriva is an example Activated by patient’s breath
When instructing a patient to inhale a powder that has a steroid in it it is important to…
Swish and spit steroid out because it can cause a fungal infection
