Post mortem care + med routes

Question 1

3 elements to pronounce

Answer 1

Absence of vital signs, absence of response to noxious stimuli, absence of spontaneous movement - - Must be warm (not freezing) with absence of vital signs

Question 2

under what circumstances can an RPN pronounce

Answer 2

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

Question 3

RIGOR MORTIS

Answer 3

– stiffening of the body
– starts 2 hours after death, peaks at 8 hours, after 12 hours goes away

Question 4

ALGOR MORTIS

Answer 4

– the cooling of the body 1 degree per hour until it reaches room temp

Question 5

LIVOR MORTIS

Answer 5

– settling of the blood; the back of individual will all be pruple because of RBC settling into the bottom of the pt

Question 6

What are some signs of impending death of a client?

Answer 6

• 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

Question 7

advantage of subcutaneous butterfly where do we put them

Answer 7

• 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

Question 8

how would you prepare a subcutaneous medication for the first Time medication

Answer 8

• PRIME the tubing by adding an additional (0.4? video) 0.5 (Janice) mL to the dose

e.g. 2mg/1mL

Question 9

What medications are most commonly given using SC butterflies

Answer 9

• 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

Question 10

size of SC

Answer 10

Size of the butterfly catheter is 24 g, 19 mm needle (smallest and shortest should be used)

Question 11

what do you label the sc butterfly

Answer 11

• type of medication
• concentration of medication
• date (should only be in same site for 7 days)

Question 12

what position for rectal medications

Answer 12

sims position left side

Question 13

how do transdermal patches deliver medication

Answer 13

Atransdermal patch has systemic effects and allows transfer of medication through the skin.

Question 14

Ophthalmic Medications

Answer 14

• medications into the eye – left eye is OS; right eye is OD

Question 15

Otic route

Answer 15

• medication into the ear: usually done to treat ear infections.
• Children—down and back
  Adults – up and outward

Question 16

Vaginal Medication Administration

Answer 16

dorsal recumbent position

Question 17

Vaginal Medication Administration

Answer 17

dorsal recumbent position

Question 18

Use of Spacers for MDI

Answer 18

• 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

Question 19

MDI without Spacer

Answer 19

• 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

Question 20

Dry Powder Inhaler

Answer 20

• 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

Question 21

Nebulized Medications

Answer 21

• 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

Question 22

DNR-M1

Answer 22

no vital signs, comfort care only

Question 23

DNR-M2

Answer 23

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)

Question 24

DNR-M3

Answer 24

sustain life and reverse medical problems as you can (surgery, transfer to high acuity but not ICU)

Question 25

DNR-C2

Answer 25

resuscitate, CPR, keep pt alive

Question 26

who determines all accidental deaths to investigate whether the death could’ve been prevented and what to do to stop it.

Answer 26

the coroner. Suicides always involve the coroner.

Question 27

Profoundly unconscious

Answer 27

not responding to stimuli – loss of swallowing reflex =collection of fluid in the oral pharynx, when air passes through it crackles