NURS 311 Flashcards
IVP Medications
Manual admin of a relatively small volume of a concentrated solution or medication directly into the venous system via a peripheral or central venous access device.
Steps for IVP (if med is compatible)
- Attach med syringe to Y-site port
- Occlude IV line
- Inject medication at correct rate
- Flush injection port with 0.9% sodium chloride
IVP Technique (if med is not compatible)
- Stop IV infusion and scrub Y-site
- Flush with 10mLs 0.9% sodium chloride
- Inject the medication at correct rate
- Scrub Y-site port and flush again with 10mLs 0.9% sodium chloride
- Re-establish infusion and ensure correct rate.
Potential Complications of IVP
Speed Shock
Infiltration
Extravasation
Thrombophlebitis
Allergic Reaction
Infection
Speed Shock
Sudden, toxic, adverse physiological reaction to IV medication or drugs administered too quickly
Signs of Speed Shock
- flushed face
- headache
- tight chest
- irregular pulse
- loss of consciousness
- cardiac arrest
Infiltration
IV fluids enter surrounding space instead of staying in the vasculature
Signs and symptoms of Infiltration
- blanching
- edema
- coolness
- pain
- numbness
Extravasation
When interstitial medications causes damage to the surrounding tissues
Thrombophlebitis
Inflammation of the vein
Signs of Thrombophlebitis
- pain
- edema
- redness
- warmth
Allergic Reaction
Can cause histamine release at site
Signs and symptoms of infection
- pain
- warmth
- redness
- drainage
Pneumothorax
Accumulation of air in the pleural cavity that leads to partial or complete lung collapse.
Hemothorax
Accumulation of fluid or blood in the pleural cavity that leads to partial or complete lung collapse.
Pneumohemothorax
Accumulation of air AND blood/fluid in the pleural space
Chest tube insertion for pneumothorax
Placed anteriorly in the 2nd intercostal space
Chest tube insertion for hemothorax
Placed posteriorly through the 8th or 9th intercostal space
Dry Suction Water Seal System
A - suction/regulation
B - Water seal chamber
C - Air leak monitor
D - Collection Chamber
E - Suction monitor bellows
Nursing Care of Chest Tubes
Monitor suction (ordered by Dr)
Drainage units below chest level in upright position and tubing in nondependent loops on the bed
Bottle of sterile water at bedside
Two chest tube clamps at bedside
When can Chest tubes be clamped for > 1 minute
- to change drainage unit
- to locate air leak
- to assess bubbling and fluctuation (tidaling) of the unclamped chest tube
Nurses Assessment of Patient with chest tube
Inspection: Distress, calm, SOB, cyanotic
VITALS
Resp and O2: auscultation, LOC, ABGs, Sp02, skin, mucous membranes, resp effort
Level of pain
Chest tube insertion site: D&I, occlusive, excessive bledding, subcutaneous emphysema.
Encourage DB&C
Complications r/t chest tubes
- Chest tube placement (cause of tension pneumothorax)
- infection at the insertion site
- pneumonia
- shoulder disuse
PICC Line
Line in the basilic or cephalic vein and threaded through the subclavian vein into superior vena cava
Nontunneled central venous catheter
At internal jugular OR subclavian vein
Tunnelled catheter
Has cuff that tissue grows into to prevent movement of CVC
Implanted Port
silicone catheter attached to metal or plastic reservoir which has self-sealing septum for needle access
Nursing management of Implanted port, PICC, and CVC
- manage and assess site
- dressing changes and line/cap management
- admin medications (IVP or intermittent)
- withdraw blood
- discontinue when ordered
Each Shift Site Assessment of CVC, PICC, or implanted port
Skin: redness, swelling, leakage, phlebitis
S&S of infection
Length of Device (migration?)
Security of DRSG, sutures, or securing device
When to flush PICC
After blood withdrawal, after blood admin, before & after med admin, maintenance of unused lumen.
Withdrawing blood from CVC or PICC
Order required!!
Withdraw from any lumen except from one dedicated to parenteral nutrition/meds
All IV infusions turned off before withdrawal
Lumen flush immediately following sampling using turbulent flow
Removal of CVC
Remove on exhalation, apply pressure for 5 mins, lie flat for 30 mins following
Removal of PICC
Extend arm out at 90 degree angle and do not manipulate arm above site - apply pressure for 15 mins
Complications of CVADS
Infection, air embolism, VTE, catheter occlusion, displacement of catheter, pneumo/hemothorax (during insertion), phlebitis, extravastion
Atherosclerosis
- endothelial lining reactions to hyperlipidemia and HTN
- inflammatory response
- platelets activate and aggravate
- macrophage infiltration - uptake of lipids
- causes blockage
CAD modifiable risk factors
elevated serum lipids, HTN, smoking, T2DM, stress, inactivity, obesity
CAD non-modifiable risk factors
Gender (men> chance), T1DM, age, genetics, family hx, ethnicity
Assessment of pt with angina
family hx
subjective/objective data
blood work
ECG
Echo
Exercise testing
Cardiac Cath
Subjective Data for Angina
- OPQRSTUV
- MAY be normal VS and wt
- MAY be no outward signs
Objective Data for Angina
Vitals
Focused CV and pulmonary assessment (auscultate heart and lungs, skin color, edema, peripheral tissue perfusion, pulses, wt, JVD, signs of HF, level of functional ability)
Serum Cardiac markers
Proteins released when damages have occured
Blood work for Cardio
Serum Cardiac Markers
- CK
- CK MB
- Troponin 1
CK’s
Cardiac muscle damage
CK MB
Specific to myocardial tissue
Troponin-1
MOST SPECIFIC N=<0.3ng/mL
Electrocardiogram
Easy and cost-effective, identiy QRS or ST segment
Changes in ST segment
Early stage of ventricular recovery - reflect ischemia of myocardial tissue
Drugs given for angina
Beta-blockers
ACE-inhibitors
Vasodilators
Anticoagulant regiman
Calcium channel blockers
Other antiplatelets
Beta-blockers
Slow HR, decrease workload and allow heart to fill
ACE-inhibitors
decrease afterload, prevent ventricular remodelling
Nitroglycerin
Coronary vasodilator, SL x3 doses
Calcium channel blockers
Help heart beat more effectively
Exercise stress test
Exercise while attached to ECG to evaluate myocardial tissue perfusion - pharm (drug-induced) if pt unable to exercise
Thrombolytic therapy monitoring
BLEEDING and reperfusion arrythmias
Coronary Artery Stent
Float cath into bloackage via femoral artery (usually)
Inflate balloon
Deflate balloon to leave cage in artery
Keeps artery open
Pt education after anginal attack
diet: lower LDL (fat intake <30% oof intake, increase omega 3 FA’s)
Smoking cessation: (increased blood carbon monoxide, decreased HGB = increased workload, nicotine raises HR and BP from norepinephrine release, increases platelet adhesion)
Exercise: cardiac rehab program
