Psychomotor Skills Review Flashcards
Donning & Doffing PPE
Don (Put on)
- Hand hygiene
- Gown - tie to secure
- Mask - cover nose & chin
- Eye protection
- Gloves - cover cuff of gown
Doff (Take off)
- Gloves
- Eye protection
- Gown
- Mask
- Hand hygiene
- (Avoid touching outside of anything; considered contaminated.)
Sterile Field: Best Practices
- ever turn your back to sterile field or leave unattended.
- Do not reach over sterile field.
- Do not cough, talk or sneeze over sterile field.
- Check packaging & expiration dates.
- The 1” border of a sterile field is considered contaminated.
- Keep waist-level. Below waist? No longer sterile.
- Sterile may touch sterile.
- STERILE IS ABSOLUTE - IT EITHER IS OR IT ISN’T!
Emptying Closed Drain
(JP Drain, Hemovac)
- Open cap away from self to avoid fluid splashing on you.
- Pour contents into measuring container.
- Note amount, color, consistency, odor.
- Alcohol port before closing.
- Fully compress container & replace cap.
- Discard fluid in toilet.
- Empty drain before half full to ensure adequate suction while decompressed.
- Document output on I&O.
- Secure device to clothing to prevent pulling at insertion site.
Difference between enteral & parenteral nutrition.
- Enteral feeding = using the gut/GI tract to feed
- Parenteral feeding = using the IV route (example = TPN)
- IF THE GUT WORKS, USE IT!
What are the two reasons a nasoenteral tube is inserted?
- To feed the patient who will not, cannot or should not eat (sometimes referred to as “gavage”)
- To remove the gastric contents (sometimes referred to as “lavage”).
The reason why the patient is getting the tube will determine which type you will choose to insert.
Tube Feeding: Checking Residual & Best Practices
- Bolus vs. intermittent
- Before feeding (if bolus): perform abdominal assessment, confirm presence of bowel sounds, confirm tube placement
- Aspirate gastric contents with a syringe & measure gastric residual volume (if any). Follow agency policy re: holding feeding for large residual amount (250-500 ml) and return residual to stomach.
- Keep HOB 30-45 degrees to decrease aspiration risk during feedbaing & for an hour after feeding. At all times, if continuous.
NG insertion is a sterile procedure. True or False.
FALSE. NG insertion is a clean technique.
What is a “salem sump”? And purpose of air vent/blue pigtail?
It is a large-bore single lumen nasogastric tube that includes an air vent (blue “pigtail”) - that is inserted for the purpose of decompressing (suctioning) the stomach.
Purpose of air vent/pigtail = equalizes pressure in the abdominal cavity. Since the stomach is a closed cavity - without the air vent, the tip of the catheter would like be sucked up against the gastric mucosa & cause irritation/ulceration.
Low wall suction = 80-100 mm Hg
High wall suction = 100-120 mm Hg
(Follow agency policy)
- *You are assessing your patient with an NG, and find the abdomen is distended and
painful. What actions are you going to take?**
- Assess patency of tube. NG tube may be occluded or no longer in stomach.
- Irrigate tube.
- Verify that suction is on as ordered.
Midstream Clean Catch
- Provide instructions regarding wipes:
- Male: If uncircumcised, retract foreskin. Clean tip of penis starting at urethral meatus in concentric circles.
- Female: Separate the labira & wipe front to back. Continue to hold labia apart during urination.
- Urinate into toilet initially, then pause urination.
- Urinate 15-30 ml into sterile container.
- Withdraw container from stream & finish urinating into toilet.
- Close & label container.
- Take to lab immediately.
Collecting urine specimen from a foley catheter
- If ordered, collect urine specimen from drainage bag immediately after insertion. Otherwise, do NOT use drainage bag.
- Clamp tubing below the specimen collectin port for 10-15 minutse.
- Scrub the specimen port with antiseptic swab.
- Access speciment port using a 10 ml syringe (or device used at agency) & aspirate at least 3 ml of urine.
- Deposit urine in sterile container - & unclamp tubing.
- Label container & send to lab asap.
What are the three types of feeding tubes that may be inserted?
- nasoenterally (used for short-term feeding; less than 1 month); inserted by the RN at the bedside
- via endoscopy (used for long-term feeding; PEG- and PEJ tubes); inserted by the HCP
- via surgery (used for long-term feeding; G- and J-tubes); inserted by the HCP
Large Volume Cleansing Enema Administration
- Warm enema solution to room temp; prime tubing.
- With tubing clamped, elevate solution 18 inches above patient.
- Place patient in modified left lateral recumbent position (ie., Sims).
- Lubricate enema tip & insert 3-4 inches into anus, angling toward umbilicus.
- Administer enema slowly over 5-10 minutes.
- Lower container of solution (or clamp tubing) if cramping.
- After administration, patient to remain on side, retain contents & resist toileting for 10 minutes if possible.
When should the nurse empty an ostomy bag?
When it is 1/3 to 1/2 full.
Do you cut the gauze when you are placing a new dressing on the patient’s trach faceplate?
- No! (strings may fray & pReviewatient may inhale). Use pre-split gauze only.