Procedures Flashcards
Regional anesthesia (spinal anesthesia)
Adequately hydrate to prevent hypotensive problems
Not NPO
Amniotomy
Artificial rupture of membranes
Increase efficiency of contractions
Appendectomy
Large amount of serosanguineous drainage so ask if tissue drain placed during surgery.
Complains of pain: after administering analgesic, elevate head of bed 30-45 degrees to reduce stress on suture line and provide comfort
Arteriogram
Injecting radiopaque contrast agent directly into vascular system to visualize vessels
Shows location of obstruction and collateral circulation
Biofeedback
Useful for reducing stress associated with physiologically based disorders
Prepare for breast feeding
Wash breasts with water and rub with a towel every day
The pill suppresses production of breast milk, pick another contraceptive
Bronchoscopy
Assess for respiratory distress from swelling due to procedure (tachypnea, tachycardia, respiratory strider and retractions)
Brudzinskis reflex
Gently flex child's head and neck onto chest Positive response (flexion of hips and knees) indicates meningeal irritation
Bucks traction
Patient with fractured femur keeps sliding down in bed: elevate the foot of the bed on blocks bc it will keep leg straight and counter the pull of the weights
Immobility leading cause of problems so turn client every 2 hrs to unaffected side
Head of bed 15-20 degrees
Strict bed rest
No footboard bc it would interfere with traction
No pins
Assess elastic bandages are not too loose or too tight to make sure circulation is not being compromised
Bulge test
Lie down and extend your legs
Confirms presence of fluid in knee
Cane
Sprained right ankle
Nurse should stand on client’s left side and slightly behind
Use gait belt to assist patient
Cardiac cath
Check pedal pulses after procedure every 15 min for 1 hr, then every 30 min for 2 hr, then every 4 hr
NPO after midnight
Bed rest 8 to 12 h after procedure with pressure dressing applied over catheter insertion site
May feel burning sensation when dye injected
May feel fluttery sensation when catheter passed into left ventricle
Cardioversion
Elective procedure to treat dysrhythmias; is a synchronized countershock
Conducting agent between skin and paddles
Call “clear” before discharging electrical current
Paddle placed directly on skin
Apply approx 20-25 lb of pressure on each paddle
Record the electrical current delivered and resulting rhythm
Administer versed for procedure
Cataract surgery
Immediate post op: position client on back or unaffected side with head slightly elevated to prevent trauma to surgical eye
Chest tube
If water-seal chamber doesn’t fluctuate - indicates re-expansion of lung, x-Ray will confirm
Keep water seal chamber with 2 mL of water to maintain negative pressure
Constant bubbling in water seal chamber would indicate air leak
Clamp tube if checking for air leaks or changing equip
Crackling under skin after chest tube removed yesterday describes subcutaneous emphysema which indicates pneumothorax
Cholecystectomy
Incision high on abdominal wall
Decreased breath sounds post op might indicate complication of pneumonia
Contractions stress test
Negative: normal
CPR
Depress sternum 2”
Reposition airway if chest wall fails to rise
4-6 min to respond to prevent permanent brain damage
100 compressions/min
Defibrillator
Check it every 8 hrs
Don’t touch bed when using to prevent accidental countershock
Ear irrigation
Warm the irrigant; if too cool it can elicit dizziness
ECT
General anesthesia-NPO after midnight
Enema
Hold irrigation set 12-18 inches above rectum
Insert irrigation tube 3-4 inches into rectum
Patient in sims position, descending colon at lowest point
Warm water to slightly higher than body temp (105)
EPS (electrophysiology studies)
Study hearts electrical system
Invasive procedure
Special wire is introduced into heart to produce dysrhythmia
NPO for 6-8 hrs before test
Antidysrhythmics held for at least 24 hrs
Sedation avoided since clients verbal response is extremely important
Hemodynamic monitoring
Swan-ganz catheter
Indirectly measures the pressure in the ventricles
Ileostomy
Laxatives (miralax) contraindicated
Enteric coated contraindicated
Intravenous pyelogram (IVP)
Ask client about allergies, iodine
May experience hot feeling and my skin may feel flushed and nausea caused by dye injection
Lumbar puncture
Remain flat in bed for 8 hrs after test to prevent post-lumbar headache
No general anesthetic
Fluids not restricted before test
Guthrie blood test
Evaluates neonate for PKU
Give lofenalac formula bc it is low in Phenylalanine
NG tube
Check pH
Large barreled syringe to aspirate
Flush with 30 mL of air before aspirating
Tube feeding at room temperature
Check tube placement prior to giving medication
If stomach contents draining from the air vent, insert 30 ml of air to reset abolish proper suction
Incentive spirometer
Quantifiable method of assessing respiratory effort with deep breathing exercises
Mouthpiece in mouth, exhale normally, seal lips around mouthpiece, inhale slowly and deeply, keep balls or cylinder elevated 2-3 sec, exhale
Position for Liver biopsy
Supine with arms raised above head
On right side with small pillow under puncture site for 3 hrs after procedure
Knee gatch post surgery
Knee gatch: don’t use bc would compromise circulation and predispose to thrombus formation
Two pillows behind knee: don’t because it would compress the vessels behind the knee
Total laryngectomy
Communicate in writing initially then by artificial larynx or esophageal speech
Feeding tube: Requires nutritional support for 10 days until wound heals, then gradually resumes oral intake
Will require laryngectomy tube to prevent scar tissue contracture
May develop some difficulty with taste and smell after surgery
Cough and deep breath after surgery
Suction: client to take several deep breaths before suction catheter is inserted
Not able to sing, whistle or laugh using laryngeal communication
Paracentesis
Client to void before procedure to prevent puncture of bladder
NPO not needed
Bowel prep not needed
Radium implant
Evaluate position of applicator every 8 hrs
Strict bed rest
High fluid intake
Low residual diet to decrease bowel movements (BMs can dislodge it)
MRI
nitroglycerine patch to be removed before test
Peritoneal dialysis
Cloudy or opaque dialysate output is earliest sign of peritonitis
Non-stress test
Reactive: normal
Myelogram
Dye injected into subarachnoid space before x-Ray of spinal cord and vertebral column to assist in identifying spinal lesions
Drink extra fluids after test to replace CSF lost during test
NPO 4-6 hrs
Bed rest after for as long as 24 hrs
HOB 30 degrees for 24 hrs
Pacemaker
Avoid lifting post-op arm above shoulder for 1 wk
Takes 2 mo for full range of motion to return
Microwaves don’t interrupt
Avoid heavy lifting until approved by HCP
Any time the pulse rate drops below the preset rate on the pacemaker, the pacemaker is malfunctioning; the pulse should be maintained at a minimal rate set on the pacemaker
Packed cells
1 Obtain history of transfusion reactions
2 Start IV gauge 19
3 Obtain blood product
4 Begin transfusion
Rombergs sign
Have the child stand with his eyes closed, his arms at his sides, and his feet and knees close together.
Assesses equilibrium and cerebellar functions
Subclavian triple lumen catheter
Supine with the clients head low and turned away from the insertion site. This produces dilation of neck and shoulder vessels, making entry easier and preventing air embolus
Systemic desentization
Form of behavior modification for learned disorders
Best for phobic disorders, learned disorder
Sengstaken Blakemore tube
If patient in respiratory distress, cut the balloon ports and remove the tube.
Fractured right femur
Thomas splint and Pearson attachment
Weights on floor
Feet touching foot of bed
Steady traction and ask child to bend the left leg and push up in bed
Don’t release weights
Don’t pull on weights
Suppository
Pt to breath through mouth to relax for insertion
Inserted 3-4 in into rectum
Positioned to touch wall of rectum
Lubricant applied to tip of suppository prior to insertion
Tracheostomy
Suction 90-120 mm Hg
#12 or #14 French catheter
Hyper oxygenate
If it dislodges, immediately replace to secure airway
Thyroidectomy
Monitor for signs of respiratory distress every hour
Head of bed elevated
Check trousseau’s and chvostek’s in case parathyroid was damaged
Tonsillectomy
Observe for frequent swallowing indicating post op hemorrhage
Transcutaneous electrical nerve stimulation (TENS)
Place electrodes over, above or below painful area
Apply Conducting gel to electrodes
Client turns up voltage until feels prickly pins and needles sensation
Client adjusts voltage based on relief of pain experiences
Transcutaneous pacing
Non-invasive
temporary means of pacing a patient’s heart during a medical emergency. It is accomplished by delivering pulses of electric current through the patient’s chest, which stimulates the heart to contract.
3 electrodes, 2 pads
Wound irrigation
Sterile field that includes the irrigating equip
Wash hands, prepare sterile field and remove soiled dressing
Uterine relaxed
Put infant to breast
Transition phase of 1st stage of labor
Shallow respirations during contractions (pant breathing)
Crutches
Strong leg lead the way going upstairs; when going downstairs, the crutches are advanced to the lower step, the weak leg is advanced, and then the strong leg follows
Suctioning
80-120 mm Hg
