RESPI AND URINARY PROCEDURES Flashcards
SUCTIONING RECOMMENDED POSITION; Conscious
Semi-fowlers
SUCTIONING RECOMMENDED POSITION; Unconscious
Side lying (prevent aspiration)
RECOMMENDED PRESSURE (WALL UNIT) Child
90 – 95
RECOMMENDED PRESSURE (WALL UNIT) Adult
100 – 120
RECOMMENDED PRESSURE (WALL UNIT) Infant
95 – 100
RECOMMENDED PRESSURE (PORTABLE) Adult
10 – 15
RECOMMENDED PRESSURE (PORTABLE) Adult
10 – 15
RECOMMENDED PRESSURE (PORTABLE) Infant
5 – 10
RECOMMENDED PRESSURE (PORTABLE) Child
2 – 5
APPROPRIATE SIZE OF SUCTION CATHETER; Adult
12 – 15
APPROPRIATE SIZE OF SUCTION CATHETER; Infant
8 – 10
APPROPRIATE SIZE OF SUCTION CATHETER; Child
5 – 8
LENGTH OF CATHETER
Measure from the tip of nose to the earlobe or about 13 cm (5-6 in) for adult
LUBRICATE CATHETER; Nasopharyngeal suction tip
Water soluble
LUBRICATE CATHETER; Oropharyngeal suction tip
Sterile water or NSS
Apply suction during removal to-
prevent trauma to mucous membrane
Apply suction for
5-10 secs, max = 15 secs
over suctioning
hypoxia and vasovagal stimulation
Hyperventilate client with oxygen before and after suctioning to
prevent hypoxia
Provide _____ and ______ hygiene
Provide oral and nasal hygiene
How to assess effectiveness of suctioning?
Auscultate breath sounds – absence of rales, crackles
Removal of fluid or air from the pleural cavity
THORACENTESIS
THORACENTESIS; Position
Sitting upright leaning forward
Thoracentesis: Instruct to remain still, avoid __________during insertion of needle
coughing
Normal due to infiltration of local anesthetic agent in thoracentesis
Pressure sensation
No more than_______ of fluid is removed
1000ml
Thoracentesis: Apply pressure to:
prevent bleeding
Thoracentesis: Position: After
Unaffected side (approximately 1 hour)
After Thoracentesis: Bed rest until VS become stable to?
prevent orthostatic hypotension
After Thoracentesis: Check for?
Expectoration of blood, Faintness, Vertigo, Tightness in chest, Blood-tinged frothy mucus and Signs of hypoxemia
Direct inspection and examination of the larynx, trachea, and bronchi
BRONCHOSCOPY
CARE BEFORE BRONCHOSCOPY: NPO 6 hours for?
clearer visualization
CARE BEFORE BRONCHOSCOPY: Pre-op med?
Atropine Sulfate (anticholinergic) – depress gag reflex
depress gag reflex
depress gag reflexAtropine Sulfate (anticholinergic)
CARE BEFORE BRONCHOSCOPY: Remove dentures and jewelry
prevent aspiration
CARE BEFORE BRONCHOSCOPY: Sprayed Local anesthesia/topical anesthesia
to numb area
a pre- op med to numb area
valium or diazepam – relax pt
CARE BEFORE BRONCHOSCOPY: Position:
Supine or sitting
CARE AFTER BRONCHOSCOPY: Position?
Side-lying
Why pt. to side lie after bronchoscopy?
promote drainage of secretions, prevent aspiration
CARE AFTER BRONCHOSCOPY: NPO until?
cough and gag reflex return
CARE AFTER BRONCHOSCOPY: Offer ice chips and fluids when?
cough reflex is demonstrated
CARE AFTER BRONCHOSCOPY: WOF:
hypoxia, hypotension, tachycardia, dysrhythmias, hemoptysis, and dyspnea
CARE BEFORE BRONCHOGRAPHY:
o Secure written consent
o Check for allergies
o NPO 6 to 8 hours
o Anticholinergics and Valium
o Have oxygen ready
CARE AFTER BRONCHOGRAPHY: Position?
Side-lying
CARE AFTER BRONCHOGRAPHY:
-Side-lying
o NPO
o Cough and deep breath client
o Low grade fever
CARE AFTER BRONCHOGRAPHY: Cough and deep breath client- to?
promote airway clearance, expansion of lungs, cough of secretions
CARE AFTER BRONCHOGRAPHY: Low grade fever common
common irritate mucus membrane
Assess ventilation and Acid-base imbalance
ARTERIAL BLOOD GAS
ABG: Common site
radial artery, brachial and femoral
Done before withdrawing blood to determine adequacy of circulation or collateral circulation
Allen’s test
pinkish color should return within 6 secs, indicates?
good circulation
Amount of arterial blood obtained:
2mL in a 5-10 mL syringe
ABG Blood should sent to the lab within?
2 hours
Before sending ABG blood, place in a container with ice to?
prevent hemolysis – RBC breakdown)
Apply pressure over arterial site: To?
prevent bleeding
SPUTUM STUDIES
To identify pathogenic organisms and to determine whether malignant cells are present
SPUTUM STUDIES: Usual method:
expectoration (early morning)
Definitive test for TB
Acid Fast Bacilli
only tell exposure to bacteria but not active TB
Mantoux Test
Other names of Mantoux Test
Purified Protein Derivative or Tuberculin Skin Test
Mantoux test: Route?
Intradermal
Mantoux test: Induration
10 mm - mycobacterium tuberculae
5mm = HIV
mycobacterium tubercule is resistant to
rifampicin and isoniazid, mycobacterium africanum, mycobacterium bovis
determine the extent of lesion, parenchyma, determine if it is pulmonary or extrapulmonary
X-ray
In Sputum studies: Instruct to clear nose and throat and rinse mouth to
decrease contamination of sputum
In Sputum studies: After taking few deep breaths, patient ________ rather than spits using the __________ and expectorates into sterile container
Cough; Diaphragm
Deepest specimen from the base of the lungs: obtained in ________ after they have accumulated overnight
morning
Specimen delivered to the lab within 2hours: to?
prevents overgrowth of microorganisms
Offer oral hygiene after collection to?
decrease palatability of sputum
TB precaution
airborne (use N95) ;
Droplet (within 3 feet);
Contact = use gloves before and remove after
Detects fluids, tumors, foreign bodies, and other pathologic conditions
CHEST X-RAY
In Chest X-ray: Usually taken after ____________ or ____________.
full inspiration or deep breath
In Chest X-ray: Instruct to remove ________, ___________ and other materials that contains metal
jewelries, dentures,
An airway clearance technique (ACT) to drain the lungs
CHEST PHYSIOTHERAPY
CPT; Main goal:
remove or drain tracheobronchial secretions
In CPT it includes:
percussion (clapping), vibration, deep breathing, and huffing or coughing
In CPT: Not done for patients with
airborne infections
In CPT: Patient should _________ tight clothing, jewelry, buttons, and zippers around the neck, chest, and waist
remove
In CPT: Light, soft clothing, such as a T-shirt, may be________.
worn
Do not do CPT on_______.
bare skin
Length of CPT:
20-40 mins (ave = 30 mins)
Best time to perform chest physiotherapy:
a. Upon awakening
b. Before meals
c. 30 mins – 2 hours after meals (prevent possible aspiration)
d. At bedtime
CPT Classification:
POSTURAL DRAINAGE
PERCUSSION
VIBRATION
Involves positioning a person with the assistance of gravity to aid the normal airway clearance mechanism
POSTURAL DRAINAGE
POSTURAL DRAINAGE :Length of time to hold:
3-15 mins
Put 2 or 3 pillows over stomach for support.
Sitting Positions
Place a small pillow under head. Put 2 pillows under bent knees.
Trendelenburg Position
In PD: Breathe in through nose and out through mouth. Remember: always to breathe out for _________than breathe in.
longer- This allows lungs to empty as much as possible
Put 2 or 3 pillows under stomach so that chest is lower than hips
Prone
Place a small pillow under head and 2 or 3 pillows under hips.
Side-lying Position
Also referred to as cupping, clapping, and tapotement
PERCUSSION
This is accomplished by rhythmically striking the thorax/chest wall with a cupped hand or mechanical device directly over the lung segment (s) being drained
PERCUSSION
PERCUSSION: Length:
2-3 minutes (3-5 minutes)
Special attention must be taken to not clap over the?
Hint: SBSL
Spine
Breastbone
Stomach
Lower ribs or back
Involves the application of a fine tremorous action/ rapid vibratory impulse.
VIBRATION
Vibration: Length:
approximately 15 seconds
Highly infectious chronic disease caused by tubercle bacilli
PULMONARY TUBERCULOSIS
tuberculosis among children
Primary Complex
PULMONARY TUBERCULOSIS; Causative Agents:
Mycobacterium tuberculae
Mycobacterium africanum
Mycobacterium bovis
TB: Mode of transmission
Airborne
Droplet
Direct Invasion – rare
Ingestion of unpasteurized milk or dairy products
Pasteurized?
63°C = 30 mins;
71.6◦C = 15 secs
What is Incubation Period?
s/s not yet specific = from entrance to appearance of s/s
TB Incubation Period
2-8 weeks
PERIOD OF COMMUNICABILITY
-While bacillus in the sputum
-Good compliance to regimen – not contagious 2-4 weeks’ after
Enclosed space (3 months)
Close Contact
Closed environment (prison)
High Risk Group
with AIDS, HIV, DM, Renal failure
(immunocompromised)
High Risk Clinical Group
5 CARDINAL SIGNS OF PTB
C
NS
WL
A
H
LGF-PM
DSSM
DIRECT SPUTUM SMEAR MICROSCOPY
Early morning sputum collection
Conventional Strategy (Spot)
3 times of sputum collection
Spot-Spot
o One Spot – turkak now
o Second Spot – turkak after 1 hour
o Third Specimen – turkak early morning tomorrow
SPUTUM ANALYSIS: 2 positive
Positive
SPUTUM ANALYSIS: 1 positive and 1 negative
for X-RAY
Never been diagnosed and taken anti TB drugs (last 2 months)
NEW
Treated but diagnosed again (positive)
RELAPSE PATIENTS
Undergone treatment but treatment failure
TREATMENT AFTER FAILURE PATIENTS
Loss contact
TREATMENT AFTER LOSS TO FOLLOW-UP PATIENTS
o No known treatment
o Return after default
OTHER PREVIOSULY TREATED PATIENTS
Does not fit to 5 categories
PATIENTS WITH UNKOWNS PERVIOUS TB TREATMENT HISTORY
DOTS
DIRECTLY OBSERVED TREATMENT SHORT COURSE
DOTS: Intensive phase
2 months
DOTS: Maintenance Phase
4 months (C2 = 5 months)
MAINTENANCE phase: Meds?
HRZES
Extensive parenchyma lesions, (+) smear, newly diagnosed, seriously ill
C1
C1 Drug: Intensive Phase
2HRZE
C1 Drug: Maintenance Phase
4HR
Relapse, treatment failure, return after default, others
C2
C2 Drug: Intensive Phase
2 HRZES
C2 Drug: Maintenance Phase
5HRE
New TB but minimal parenchyma lesions, not seriously ill
C3
C3 Drug: Intensive Phase
2HRZ
C3 Drug: Maintenance Phase
4HR
Chronic PTB, (+) TB and (+) Sputum smear after supervised treatment
C4
SECOND LINE DRUGS (INJECTABLES)
AMINOGLYCOSIDES & FLUROQUINALONESS
AMINOGLYCOSIDES
Amikacin
Kanamycin
Capreomycin
FLUROQUINALONESS
Ciprofloxacin
Moxifloxacin
Levofloxacin
SE of Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
Jaundice
SE of Ethambutol
Visual Impairment
SE of Streptomycin
Tinnitus and hearing impairment
SE of Rifampicin, Isoniazid
Oliguria and albuminuria
SE of Isoniazid
Psychosis and Convulsion
SE of Rifampicin
Thrombocytopenia and anemia
DR – TB
Isoniazid
MDR – TB
Isoniazid and Rifampicin
XDR – TB
Isoniazid, Rifampicin, Fluoroquinalones
XXDR – TB
Isoniazid, Rifampicin, Fluoroquinalones
TDR - TB
Isoniazid, Rifampicin, Fluoroquinalones
Treatment pf choice for renal failure = particularly oliguria or anuria
DIALYSIS
Remove the end products of protein from metabolism from the blood
DIALYSIS
Maintain safe levels of electrolytes
DIALYSIS
DHN: Serum Osmolality?
High
High Serum Osmolality activate?
Thirst Mechanism in Hypothalamus
thirsty: Increase?
ADH
ADH; High?
Water Reabsorption
High h2o reabsorption leads to?
Decrease UO
water moves from___________ concentration to____________ concentration
low solute; high solute
D5LRS; Shrink cells
Hypertonic
0.45 NaCl;
Swell/bursts cells
Hypotonic
IV fluid: Do not give to DHN
Hypertonic
IV fluid: for DHN
Hypotonic
NSS
0.9 NaCl
Isotonic
Correct acidosis and replenish the blood bicarbonate system
DIALYSIS
Remove excess fluid from the blood
DIALYSIS
Purpose of Dialysis
RMCR
PERITONEAL DIALYSIS; Site of insertion:
2 inches below umbilicus
PERITONEAL DIALYSIS; Area:
avascular
PERITONEAL DIALYSIS: Weigh patient before and after the procedure
best indicator of hydration
Have patient_______ just before dialysis begins
void- for comfort
The dialysate solution should be ______ at body temperature
warm
The dialysate solution should be warm at body temperature
for the capillary permeability of peritoneum, prevent abdominal discomfort
Cycle of peritoneal dialysis
Infusion time
Dwell time
Drainage time
Infusion time
= 10 minutes
Dwell time
= 4-6 hours
Drainage time
= 30 minutes
In peritoneal dialysis: First few bottles of drainage will normally be___________.
pink-tinged
In peritoneal dialysis: If drainage stops,
turn client to the sides
If drainage stops, turn client to the sides because?
colon may just be occluding the lumen of catheter
Peritoneal Dialysis: Observe for_________, ___________, and _____________, _______________.
Observe for fluid leaks, signs of hypovolemia, and hyperglycemia, disequilibrium syndrome
disequilibrium syndrome
rapid removal of waste products from the blood than brain
S/SX of disequilibrium syndrome
headache, HPN, dec LOC, irritable, confusion
Following dialysis, apply__________ and observe site for _________.
dressing; drainage
board-like or rigid abdomen
Peritonitis
Watch out after Peritoneal Dialysis
Peritonitis and Respiratory Difficulty
S/Sx of Peritonitis
board-like or rigid abdomen, fever, ↑WBC, ↑body temp, chills, abdominal pain and tenderness
When in Respiratory Difficulty?
Introduce fluid to compress diaphgram
Position after Peritoneal Dialysis
Semi-fowlers to promote Lung expansion
Requires vascular access
HEMODIALYSIS
HEMODIALYSIS; Duration:
2-3 hours per day
HEMODIALYSIS; Frequency:
3-4 times a week
HEMODIALYSIS; 4 SITES
AV fistula
AV graft
AV shunt
Femoral vein catheterization
Before and During Hemodialysis:
-Have client void
-Chart client’s weight
- VS q5mins
-Inform client that headache and nausea may occur
-Ensure bed rest
- Monitor for signs of bleeding
Length of time for initial hemodialysis:
30 mins
Arm precaution
No BP taking on affected
No BP taking on affected because?
disrupt AV fistula patency = pale, arm pain
In Hemodialysis : Assess for patency by auscultating _______and palpate for ________.
Bruit; thrill
Assess for steal syndrome, this includes:
hand numbness, pain, coldness and weakness
In Hemodialysis: Blood transfusion should be administered ________the procedure
during
In Hemodialysis: ________________meds are omitted.
Anti-hypertensive (↓BP)
o Adherence to well-balanced diet
o Importance of periodic blood chemistries
o Daily weights
CONTINUOUS AMBULATORY PERITONEAL DIALYSIS
BENEFITS OF DIALYSIS
Improves the following problems:
Hint: 4E
-Edema
-Elevated BUN, serum creatinine
-Elevated electrolytes
-Elevated blood pressure
HEMODIALYSIS MEDS
o Insulin
o Dextrose (glucose)
o Calcium gluconate
o Sodium bicarbonate
o Kayexalate
o Aluminum hydroxide
