Skills - Module 5 Flashcards
What size of suture do you use for the scalp
3-0
What size of suture is generally used for the face?
6-0
How to confirm an NG tube?
Auscultate over epigastrium while injecting 30-50ml of air/or observe for gastric contents. Confirm with an x-ray when possible.
Fresh frozen plasma is primarily used for
Patient’s requiring plasma coagulation factors. Patient’s on coumadin requiring emergency invasive procedures before vitamin K, can reverse it’s effects. Or patients with plasma protein deficiencies.
Indwelling urinary catheters are?
A folly catheter that is designed to rest securely in the bladder for a longer period of time.
Appropriate aseptic technique for urinary catheterization includes?
Sterile gloves, sterile drapes, sterile skin antiseptic.
If your patient is experiencing lumbar pain, fever, hypotension, hemoglobinuria during transfusion you must?
Stop the infusion, removed blood admin set, attach normal saline, symptomatic support, notify receiving facility, and be sure to keep the blood and notify the blood bank that issued the product.
At what angle should the needle enter the skin during sutures.
90 degrees
Why should skin be well dried prior to replacing an ostomy wafer?
Dampness can cause irritation, infection, and cause the wafer not to properly adhere.
When is external jugular vein cannulation indicated?
In a critically ill patient >12 years of age who requires intravenous access for fluid or medication administration and in whom an extremity vein was not attainable.
What are the absolute contraindications to Nasogastric tube insertion? (4)
- Mid-facial trauma
- Basal skull fracture
- Recent surgery (nasal, throat, fascial, esophageal, or upper GI)
- Transsphenoidal pituitary resection
What is the most common NG tube
Salem Sump - Typically used for stomach decompression
What is the most common OG tube for treatment of esophageal varices?
Sengstaken-Blakemore
The most common adult sizes for NG/OG tube
12 to 18 French
*Note: Smaller gauge equals smaller size in the French measurement system
When suctioning (lavage) from an NG/OG tube, what must you remember to do prior to adding suction?
Ensure to have the air vent open. The air vent should never be clamped off, connected to suction, or used for irrigation.
When suctioning (lavage) from an NG/OG tube, what must you remember to do prior to adding suction?
Ensure the air vent is open.
When placing sutures of any size be sure to?
Evert the skin edges and avoid applying excessive crushing force on the tissue that can further damage the area and impair healing.
What would a curved or straight suture needle generally be used?
Curved:
-Designed to be held with a needle holder and for most suturing
Straight:
-Often hand held and to secure percutaneously placed devices (ie: central and arterial lines)
Taper-point needle point needle (suturing)
Round body. Used to suture soft tissue, excluding skin (e.g. GI tract, muscle, fascia, peritoneum).
Cutting needle (suturing)
Triangular body. Sharp edge toward inner circumference. Used to
suture skin or tough tissue
Suturing skin prep
General flushing with focus on removal of foreign material. Cleanse with provodine-iodine solution (or similar) and drape using sterile technique. Apply disinfectants from the wound edges outward in order to avoid cytotoxic exposure of non intact skin.
What are the indications to utilize NG/OG tubes? (10)
- Gastric Decompression
- hydration
- nutrition
- obstruction alleviation from bowels
- medication administration
- aspiration of toxic materials
- traumatic injuries
- paralytic ileus
- metastatic gastric diseases
- failed swallowing study/high risk aspiration
What is the kaofeed NG tube for and what diagnostic measure is required post insertion?
It is used for intra stomach feedings, and requires a guide wire and an xray to confirm placement
What is the major complication associated with Kaofeed insertion?
pneumothorax
What is the normal presentation of a stoma?
pink, moist and round.
The output from a stoma is called?
effluent
What is a colostomy?
A stoma created from Large Bowel (colon)
What is an ileostomy
A stoma created from Small bowel (ileum)
What is a urostomy
The ureters are reconnected to a small piece of the intestine to be rediverted.
Do individuals with colostomies, ileostomies or urostomies have any sense of sensation or control of output?
no
What is a flange used for in relation to the stoma?
It is used as a skin barrier between the bag and the skin.
Contraindications for external jugular vein cannulation?
- Patient cannot tolerate being flat
- Actively vomiting
- Patient is agitated, moving head
- Has a neck mass
- Has a VP shunt on the side of the intended insertion
- Soft tissue neck trauma
- Cervical trauma
- Circumferential burns to the neck
- Inability to identify landmarks for cannulation
- Infection at or near the intended insertion site
Potential complications with external jugular vein cannulation
Inadvertent puncture of the carotid artery, a rapidly expanding hematoma if infiltration occurs, air embolism and infection.
Where do you landmark for a external jugular vein canula insertion?
Midway between the angle of the jaw and the midclavicular line with the
cannula pointed toward the shoulder.
How do you position a patient for external jugular vein cannulation?
Place the patient in supine head down position with the head turned 90 degrees away from the insertion site if c-spine not suspected and stabilize the vein by placing a finger lightly on top of it just above the clavicle.
When must a pouching system from a stoma be changed?
Leaking, odor, skin exposure, signs of irritation, or patient complains of itching or burning sensation.
If no complications, the bag must be changed every 4-7 days
How do you measure a flange for the stoma?
Ensure that the tracing template allows for 2 mm excess space from the edge of the stoma
Why must you apply paste to the edges around the stoma prior to inserting the ostomy bag
It prevents skin exposure to feces. Feces, if exposed to skin for too long will cause the skin breakdown.
