Patient Care Flashcards
temperature
oral: 98.6
tympanic +1
axillary -1
rectal +1
pulse rate
60-100 bpm
blood pressure
systolic: 100-120
diastolic: 60-80
respiratory rate
12-20 breaths per min
pulse oximetry
90% to 100%
P wave
electrical activity through atria
QRS complex
movement of electrical impulse through ventricles (systole)
ST segment
ventricle contracting, no electrical activity
T wave
ventricles are resetting electrically (diastole)
Kidney function tests
BUN; creatnine; GFR
BUN
blood urea nitrogen
normal: 7-21 (higher is lower functioning)
above 50 might mean renal failure
creatnine
normal: 0.7-1.5
above 1.5 is indication kidneys are not fit to filter out iodinated contrast
GFR
glomerular filtration rate
normal: 90-120
GMR below 90 is indication of low function
water-soluble iodine
- only contrast agent that is safe for IV injection
- will be ionic or non-ionic
- will be high or low osmolar
ionic contrast
- contrast agent molecule will break apart in fluid
- individual particles will become charged
non-ionic contrast
- contrast agent molecule will not break apart in fluid
- more desirable because less damaging to body
osmolarity
concentration of particles in a fluid
-we want an osmolarity that is as close to that of blood (around 300 mOsm/L)
Premed for contrast
commonly uses corticosteroid (prednisone) or anti-histamine (Benadryl)
Extravasation
leakage of contrast outside of the vessel (most common contrast complication) which causes swelling, tightness, or burning at the site of injection
Steps to take after extravasation
- inform radiologist
- elevate extremity
- apply hot and cold compresses
Mild reactions to contrast
- scattered hives
- pruritus (itching)
- rhinorrhea (runny noes)
- coughing
Steps to take after mild reaction to contrast
- monitor patient for 20-30 minutes
- check vital signs
- antihistamine (will be given by doctor)
Moderate reactions to contrast
- diffuse hives
- persistent vomiting
- laryngeal edema (swelling of throat)
- tachycardia
Steps to take after moderate reaction to contrast
- monitor patient for 20-30 mintues
- check vital signs
- ensure secure IV access
- antihistamine (will be given by doctor)
Severe reactions to contrast
- altered mental status
- pulmonary edema
- laryngeal edema
- life-threatening tachycardia
- death
Steps to take after severe reaction to contrast
- code blue (immediately)
- epinephrine (will be given by doctor)
Order of events for ALL contrast reactions
- discontinue contrast
- call for nurse and physician immediately
- assess patient’s ABCs (airway, breathing, circulation)
- acquire vital signs
- prepare reaction kids and O2
- prepared to call a code blue
nephrotoxicity
decrease in renal function following IV contrast administration
risk factors for nephrotoxicity
- preexisting renal insufficiency
- diabetes
- dehydration
- heart disease
- diuretic use
- age
- multiple myeloma
barium sulfate
used almost exclusively for GI system
Enteral
goes into GI tract without being absorbed by body
parenteral
intrathecal, intra-articular, intravenous
intrathecal
ex: myelograms
intra-articular
ex: arthrograms
intravenous
ex: IVP, urograms
most common contraindication for barium sulfate
perforated bowel
