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YEAR 3 > NURS 311 > Flashcards

NURS 311 Flashcards

1
Q

IVP Medications

A

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.

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2
Q

Steps for IVP (if med is compatible)

A
  1. Attach med syringe to Y-site port
  2. Occlude IV line
  3. Inject medication at correct rate
  4. Flush injection port with 0.9% sodium chloride
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3
Q

IVP Technique (if med is not compatible)

A
  1. Stop IV infusion and scrub Y-site
  2. Flush with 10mLs 0.9% sodium chloride
  3. Inject the medication at correct rate
  4. Scrub Y-site port and flush again with 10mLs 0.9% sodium chloride
  5. Re-establish infusion and ensure correct rate.
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4
Q

Potential Complications of IVP

A

Speed Shock
Infiltration
Extravasation
Thrombophlebitis
Allergic Reaction
Infection

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5
Q

Speed Shock

A

Sudden, toxic, adverse physiological reaction to IV medication or drugs administered too quickly

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6
Q

Signs of Speed Shock

A
  • flushed face
  • headache
  • tight chest
  • irregular pulse
  • loss of consciousness
  • cardiac arrest
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7
Q

Infiltration

A

IV fluids enter surrounding space instead of staying in the vasculature

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8
Q

Signs and symptoms of Infiltration

A
  • blanching
  • edema
  • coolness
  • pain
  • numbness
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9
Q

Extravasation

A

When interstitial medications causes damage to the surrounding tissues

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10
Q

Thrombophlebitis

A

Inflammation of the vein

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11
Q

Signs of Thrombophlebitis

A
  • pain
  • edema
  • redness
  • warmth
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12
Q

Allergic Reaction

A

Can cause histamine release at site

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13
Q

Signs and symptoms of infection

A
  • pain
  • warmth
  • redness
  • drainage
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14
Q

Pneumothorax

A

Accumulation of air in the pleural cavity that leads to partial or complete lung collapse.

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15
Q

Hemothorax

A

Accumulation of fluid or blood in the pleural cavity that leads to partial or complete lung collapse.

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16
Q

Pneumohemothorax

A

Accumulation of air AND blood/fluid in the pleural space

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17
Q

Chest tube insertion for pneumothorax

A

Placed anteriorly in the 2nd intercostal space

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18
Q

Chest tube insertion for hemothorax

A

Placed posteriorly through the 8th or 9th intercostal space

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19
Q

Dry Suction Water Seal System

A

A - suction/regulation
B - Water seal chamber
C - Air leak monitor
D - Collection Chamber
E - Suction monitor bellows

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20
Q

Nursing Care of Chest Tubes

A

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

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21
Q

When can Chest tubes be clamped for > 1 minute

A
  • to change drainage unit
  • to locate air leak
  • to assess bubbling and fluctuation (tidaling) of the unclamped chest tube
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22
Q

Nurses Assessment of Patient with chest tube

A

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

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23
Q

Complications r/t chest tubes

A
  • Chest tube placement (cause of tension pneumothorax)
  • infection at the insertion site
  • pneumonia
  • shoulder disuse
24
Q

PICC Line

A

Line in the basilic or cephalic vein and threaded through the subclavian vein into superior vena cava

25
Q

Nontunneled central venous catheter

A

At internal jugular OR subclavian vein

26
Q

Tunnelled catheter

A

Has cuff that tissue grows into to prevent movement of CVC

27
Q

Implanted Port

A

silicone catheter attached to metal or plastic reservoir which has self-sealing septum for needle access

28
Q

Nursing management of Implanted port, PICC, and CVC

A
  • manage and assess site
  • dressing changes and line/cap management
  • admin medications (IVP or intermittent)
  • withdraw blood
  • discontinue when ordered
29
Q

Each Shift Site Assessment of CVC, PICC, or implanted port

A

Skin: redness, swelling, leakage, phlebitis
S&S of infection
Length of Device (migration?)
Security of DRSG, sutures, or securing device

30
Q

When to flush PICC

A

After blood withdrawal, after blood admin, before & after med admin, maintenance of unused lumen.

31
Q

Withdrawing blood from CVC or PICC

A

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

32
Q

Removal of CVC

A

Remove on exhalation, apply pressure for 5 mins, lie flat for 30 mins following

33
Q

Removal of PICC

A

Extend arm out at 90 degree angle and do not manipulate arm above site - apply pressure for 15 mins

34
Q

Complications of CVADS

A

Infection, air embolism, VTE, catheter occlusion, displacement of catheter, pneumo/hemothorax (during insertion), phlebitis, extravastion

35
Q

Atherosclerosis

A
  • endothelial lining reactions to hyperlipidemia and HTN
  • inflammatory response
  • platelets activate and aggravate
  • macrophage infiltration - uptake of lipids
  • causes blockage
36
Q

CAD modifiable risk factors

A

elevated serum lipids, HTN, smoking, T2DM, stress, inactivity, obesity

37
Q

CAD non-modifiable risk factors

A

Gender (men> chance), T1DM, age, genetics, family hx, ethnicity

38
Q

Assessment of pt with angina

A

family hx
subjective/objective data
blood work
ECG
Echo
Exercise testing
Cardiac Cath

39
Q

Subjective Data for Angina

A
  • OPQRSTUV
  • MAY be normal VS and wt
  • MAY be no outward signs
40
Q

Objective Data for Angina

A

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)

41
Q

Serum Cardiac markers

A

Proteins released when damages have occured

42
Q

Blood work for Cardio

A

Serum Cardiac Markers
- CK
- CK MB
- Troponin 1

43
Q

CK’s

A

Cardiac muscle damage

44
Q

CK MB

A

Specific to myocardial tissue

45
Q

Troponin-1

A

MOST SPECIFIC N=<0.3ng/mL

46
Q

Electrocardiogram

A

Easy and cost-effective, identiy QRS or ST segment

47
Q

Changes in ST segment

A

Early stage of ventricular recovery - reflect ischemia of myocardial tissue

48
Q

Drugs given for angina

A

Beta-blockers
ACE-inhibitors
Vasodilators
Anticoagulant regiman
Calcium channel blockers
Other antiplatelets

49
Q

Beta-blockers

A

Slow HR, decrease workload and allow heart to fill

50
Q

ACE-inhibitors

A

decrease afterload, prevent ventricular remodelling

51
Q

Nitroglycerin

A

Coronary vasodilator, SL x3 doses

52
Q

Calcium channel blockers

A

Help heart beat more effectively

53
Q

Exercise stress test

A

Exercise while attached to ECG to evaluate myocardial tissue perfusion - pharm (drug-induced) if pt unable to exercise

54
Q

Thrombolytic therapy monitoring

A

BLEEDING and reperfusion arrythmias

55
Q

Coronary Artery Stent

A

Float cath into bloackage via femoral artery (usually)
Inflate balloon
Deflate balloon to leave cage in artery
Keeps artery open

56
Q

Pt education after anginal attack

A

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

YEAR 3 (14 decks)

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