Post mortem care + med routes Flashcards
3 elements to pronounce
Absence of vital signs, absence of response to noxious stimuli, absence of spontaneous movement - - Must be warm (not freezing) with absence of vital signs
under what circumstances can an RPN pronounce
with a physician’s order
- Generally, two nurses will listen for the absence of the apical heartbeat for one minute
- When both nurses have conducted their assessment time of death can be noted and additional hospital policies will be followed
RIGOR MORTIS
– stiffening of the body
– starts 2 hours after death, peaks at 8 hours, after 12 hours goes away
ALGOR MORTIS
– the cooling of the body 1 degree per hour until it reaches room temp
LIVOR MORTIS
– settling of the blood; the back of individual will all be pruple because of RBC settling into the bottom of the pt
What are some signs of impending death of a client?
- Sleeping more, decreased appetite, cool skin, labored breathing, changes in vital signs
- Cheyne-Stokes respirations - periods of fast shallow breathing followed by slow breathing or apnea
- Mottling- skin changes, extremities feel cool to touch
- Decreased urinary output
advantage of subcutaneous butterfly where do we put them
- Less injections with a needle – provides more comfort
- Upper arm, thigh, abdomen
- Insert needle at 30-degree angle — make sure there is no blood return
how would you prepare a subcutaneous medication for the first Time medication
- PRIME the tubing by adding an additional (0.4? video) 0.5 (Janice) mL to the dose
e.g. 2mg/1mL
What medications are most commonly given using SC butterflies
- Analgesics: morphine, hydromorphone
- Anticholinergic medications for reducing respiratory secretions in hospice patients: glycopyrrolate
- Only one the same medication can administered into the butterfly and must be the same concentration
size of SC
Size of the butterfly catheter is 24 g, 19 mm needle (smallest and shortest should be used)
what do you label the sc butterfly
- type of medication
- concentration of medication
- date (should only be in same site for 7 days)
what position for rectal medications
sims position left side
how do transdermal patches deliver medication
Atransdermal patch has systemic effects and allows transfer of medication through the skin.
Ophthalmic Medications
- medications into the eye – left eye is OS; right eye is OD
Otic route
- medication into the ear: usually done to treat ear infections.
- Children—down and back
Adults – up and outward
Vaginal Medication Administration
dorsal recumbent position
Vaginal Medication Administration
dorsal recumbent position
Use of Spacers for MDI
- A spacer traps medication released from the metered dose inhaler (MDI)
- The MDI is shaken 5-6 times and inserted into one end of the spacer
- The patient pushes down on the MDI and inhales the medication from the other side of the spacer
- The spacer slows down the medication particles, enhancing the amount of medication received by the patient
- Spacers are recommended for all types of patients from children to the elderly
MDI without Spacer
- Tell patient to tilt head back slightly, and inhale slowly and deeply through the mouth for 3-5 sec while depressing the canister fully
- Hold breath for 10 seconds—ensures full medication distribution
- Exhale with pursed lips
Dry Powder Inhaler
- Remove mouth-piece and do not shake
- Hold inhaler upright- and follow instructions which way to turn
- Patient to exhale before administering
- Pt to inhale deeply and forcefully through the mouth - deep inhalations create aerosolized medications
- Instruct the patient to hold their breath for 5-10 seconds and wait 20-30 seconds between next puffer
- Clean the inhaler and cap once a day with warm running water– must be totally dry before use AND twice a week the L shaped canister should be changed
Nebulized Medications
- Nebulized medications are a liquid form of inhaled medications that are aerosolized with the use of oxygen or medical air
- In the hospital setting, oxygen is used
- Pour nebule of medication into nebulizer chamber and place nebulizer mask on the patients face
- Turn up oxygen to a flowrate of 6L or until a steady mist is achieved
- When the medication is complete, turn off oxygen and remove the nebulizer mask
DNR-M1
no vital signs, comfort care only
DNR-M2
no resuscitation, can give meds (IV fluids, IV antibiotics, feeding tube, O2, diagnostic testing, but not moving to higher level of care but will treat them on the unit with what we have e.g., treating active pneumonia)
DNR-M3
sustain life and reverse medical problems as you can (surgery, transfer to high acuity but not ICU)
DNR-C2
resuscitate, CPR, keep pt alive
who determines all accidental deaths to investigate whether the death could’ve been prevented and what to do to stop it.
the coroner. Suicides always involve the coroner.
Profoundly unconscious
not responding to stimuli – loss of swallowing reflex =collection of fluid in the oral pharynx, when air passes through it crackles
