Patient Intervention Flashcards
Hypoxemia
Inadequate level of oxygen in arterial blood.
eg: PaO2 is < 60mm Hg/ Hb saturation is < 90%
Hypercapnia
CO2 retained in arterial blood
Hazards of oxygen administration
Mild oxygen toxicity : reversible tracheobronchitis
Severe oxygen toxicity: irreversible parenchymal lung injury
What happens when excessive amount of oxygen is present in the blood of patient with COPD?
*Depress the respiratory drive and pt may stop breathing.
*Because they have chemoreceptors that does not respond respond to the stimuli of CO2
* Their respiratory stimulus is hypoxemia.
Oxygen delivery systems
wall outlet: 60 to 80 lb per square inch
Full tank: 2000 lb per square inch
Flow rate of oxygen through Nasal Cannula
Adults: 1-4 LPM
Children: 1/4 to 1/2 LPM
Flow rate of Nasal catheter
1-5 LPM
Flow rate of oxygen Face mask
at least 5 LPM
*Non rebreathing mask - 100% oxygen
*Partial rebreathing mask - 60% - 90%
* Venturi mask - 24% - 50% by mixing room air and O2
* Aerosol Mask - 60% - 80% O2 mixed with water particles
Types of Nasogastric tubes
- Levin
- Sump
- Nutriflex
- moss
- Sengstaken- Blakemore
Levin tube
Single lumen, plastic tubes passed through the nose into the stomach.
Use: gastric decompression
Sump tube
2 Lumen, Radiopaque tube with a plug pigtail that lets airflow to the stomach
Use: Drain fluid from the stomach
Nutriflex
1 lumen, mercury weighted tip; gastric secretion activated lubricant.
Use: Feeding
Moss tube
3 lumen
one has inflatable balloon to anchor it in the stomach;
second lumen is used for aspiration of fluids;
third lumen for duodenal feeding.
Sengstaken- Blakemore
Thick catheter with two lumens of balloons to exert pressure on the esophageal varices. Third lumen is used for lavage and to monitor hemorrhage.
Types of NE Tubes
- Cantor
- Harris
- Miller-Abbott
Cantor tube
Single lumen; Long tube with a small mercury-filled bag at the end; contains drainage holes for aspiration.
Use: relieves obstruction in the small intestine.
Harris tube
Single lumen
Mercury weighted tube passed through the nose and carried through digestive tract by gravity.
Use: Gastric & intestinal decompression
Miller- Abbott tube
2 lumen; radiopaque tube.
Long small-caliber catheter; one is perforated metal tip and other has a collapsible balloon.
Use: Decompression
Gastrostomy tube
- A tube placed through surgical opening from inside of the stomach to the abdominal wall.
- Chances of infection; use sterile gloves if contact with open area is needed.
Central Venous Catheter(CVC)
-Used in patients with long-term meds administration, blood transfusion, hyperosmolar solutions or Total Parental solution(TPN).
-Also for measuring Central venous pressure(CVP)
-Placed at Brachiocephalic vein at the junction of SVC or at SVC itself.
- placement visualized with mobile radiography or C-arm fluoro at the time of insertion.
- The CVC line should be just medial to the anterior border of 1st rib.
Large gauge catheter
Inserted to large peripheral vein in the arm.
- Parenteral solution with a combination of lipid emulsion and amino acid is administered
Total parenteral nutrition(TPN)
- Delivered through Central vein
-TPN is hyperosmotic; so would damage the intima of peripheral vein. - Fluid imbalance occurs if TPN is administered too rapidly; so administration is controlled by pump.
Types of central venous catheters
Tunnel type:-
1. Hickman catheter
2. Broviac Catheter
Others:-
3. Peripherally inserted central catheter(PICC)
4. Groshong catheter
Indications for suctioning
- Profuse vomiting in a patient who cannot change position voluntarily.
- Audible rattling or gurgling sound from pt’s throat
- signs of respiratory distress
contraindication for suctioning
Head and facial injuries
bleeding esophageal varices
nasal deformities
trauma
cerebral aneurysms
tight wheezing
bronchospasm
croup
Tissue drains
Placed near wounds or operative sites where drainage is expected.
Types of tissue drains
- Penrose: secured with safety pin to avoid slipping to wound. drains to surgical dressing.
- Jackson-Pratt and Hemovac catheters maintain constant, low negative pressure.
- ConstatVac is sued in total knee or hip replacement, to decrease Hematoma
