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NUR5079 > Week 5 > Flashcards

Week 5 Flashcards

1
Q

Identify features involved in the RENAL System & their functions

A

KIDNEYS: filter the blood to produce urine
URETERS: convey urine to the bladder
URINARY BLADDER: a storage organ for urine until it is eliminated
URETHRA: conveys urine to the exterior

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2
Q

Define Venipuncture

A

Venipuncture (Phlebotomy) is the act of drawing or removing blood from the circulatory system through a puncture to the vein in order to obtain a sample for analysis.

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3
Q

Define Cannulation

A

It is a direct access into the bloodstream ( IV ) used for the administration of medication

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4
Q

Run through the venipuncture procedure

A
  • Carry out the hand washing procedure
  • Check you’ve got the correct patient: name, date of birth, identification wrist band
  • Help patient into a comfortable position
  • Examine both arms & identify any areas to avoid, apply tourniquet around 7/8 cm above venipuncture site & identify a vein.
  • Release tourniquet, clean the chosen area following local policy. Once cleaned, do not re-palpate the vein. Use ANNT
  • Reapply the tourniquet
  • Prepare the needle
  • Anchor the vein and insert the needle at a 10 - 30 degree angle
  • Look for flashback, then advance the needle 1 - 2 mm further to ensure you’re in the lumen
  • Release the wings on the needle to secure
  • Attach a vacuumed blood collection tube into the plastic holder & push.
  • Once last tube is attached, remove the tourniquet & apply safety features on the needle
  • Have a gauze ready as you withdraw the needle, quickly applying to the site once needle removed
  • Immediately discard of the sharps and invert the collection tubes
  • Remove PPE & follow hand washing techniques, filling out blood request forms.
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5
Q

Run through the Cannulation procedure

A
  • Cleaned the prepared area, explain the procedure & gain consent from the patient.
  • Check right patient: name, date of birth & identification wrist band
  • Decontaminate your hands & exam the patients arm for any areas to avoid.
  • Apply the tourniquet around 7 - 8 cm above desired site, once identified appropriate vein release the tourniquet#
  • Select appropriate device based on size of vein, decontaminate your hands and prepare a sterile field ( ANNT )
  • Inspect the device, using ANNT when handling equipment
  • Prime the extension set with 0.9% sodium chloride
  • Clean the skin with antiseptic solution, leaving the skin to airdry
  • Decontaminate hands and apply gloves
  • Reapply the tourniquet, anchor the vein and insert the cannula at a 25 degree angle.
  • Watch for initial flashback along the stylet of cannula and a secondary in the shaft of the cannula.
  • Maintaining skin fraction with one hand, advance the cannula off the stylet into the vein
  • Release traction and the tourniquet
  • Advance the safety device on removal and immediately discard of sharps appropriately
  • Attach the extension kit and flush the cannula
  • Secure the cannula and apply the clip
  • Remove PPE and carry out hand washing procedure
  • Documentation: date inserted & time, the device, location, number of attempts, flushed
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6
Q

What is the ‘normal’ range of Oxygen Saturation in COPD or CO2 retaining patients?

A

88 - 92%

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7
Q

What is the ‘normal’ range of Oxygen Saturation in most patients?

A

94 - 98%

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8
Q

Identify reasons why many patients need high does oxygen to normalize saturation

A
  • Severe pneumonia
  • Severe LVF
  • Major Trauma
  • Sepsis & Shock
  • Lung Collapse
  • Pulmonary Embolism
  • Lung Fibrosis
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9
Q

Talk to me about High Concentration Reservoir ( RMI )

A
  • Non-Rebreathing
  • Critical Illness / Trauma
  • Post Cardiac or Respiratory Arrest
  • Delivers Oxygen Conc. between 60,80 or above
  • Effective for short term treatment
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10
Q

Talk to me about Nasal Cannulae ( N )

A
  • Recommended for most patients
  • 1 - 6 L/min approx 24 - 50 % Fi02
  • Comfortable, easy to tolerate
  • Non-Rebreathing
  • Patient can eat & drink
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11
Q

Talk to me about Simple Face Mask ( SM )

A
  • Type 1 Respiratory Failure
  • 35 % & 60 %
  • Low cost
  • Flow 5 - 10 L/min
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12
Q

Talk to me about Traheostomy ( TM )

A
  • Neck breathing pt
  • Adjust oxygen flow
  • Prolonged oxygen use = humidification
  • Patient may need suction
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13
Q

Talk to me about Humidified Oxygen ( H )

A
  • Tracheostomy
  • Bronchiectasis
  • Cystic Fibrosis
  • Physiotherapists may advise
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14
Q

Talk to me about High Flow Nasal Oxygen ( HFN )

A
  • Alternative to RM with acute respiratory failure without hypercapnia
  • ITU, high dependency
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15
Q

Identify the reasons why a catheter may be needed?

A
  • Empty the content of the bladder
  • To determine residual urine
  • Allow irrigation of the bladder
  • Bypass an obstruction
  • Relieve retention of urine
  • Enable bladder function tests to be performed
  • Measure urinary output accurately
  • Relieve incontinence
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16
Q

What are the risks associated with catheterization?

A
  • Risk of catheter associated UTI which is caused by bacteria colonisation
  • CAUTI leading to bacteraemia / sepsis
  • Body image issues for the individual
  • Risk of trauma
  • Haematuria from trauma or infection
  • Issues regarding sexual function
  • Dependence
  • Encrustation causing blockage or kidney stones
  • Bladder irritation / allergy
  • Bypassing
17
Q

Run through the procedure for female catheterisation

A
  • Explain the procedure & check right patient: name, date of birth and identification wrist band
  • Chose an appropriate drainage system
  • Carry out hand hygiene & prepare a sterile field
  • Arrange equipment ( keep the batch number of the catheter on the lower shelf of the trolley ) done PPE and uncover the patient. Wash hands again and put on sterile gloves
  • Place a sterile paper towel under the patients buttocks
  • Using your non-dominant hands separate the labia do ensure you do not contaminate your dominant hand.
  • Cleanse the labia and urethral meatus in a downwards motion
  • Insert the Anaesthetic gel into the urethra, keeping the syringe in place for 3 to 5 minutes
  • Change gloves
  • Unwrap the catheter ( just the top part ), insert the catheter using the packaging to protect the catheter & observe for urine drainage
  • Advance a further 2 cm
  • Inflate the balloon & attach drainage system
  • Dispose of equipment and remove PPE
  • Document
18
Q

Run through the procedure for male catheterization

A
  • Explain the procedure & check right patient: name, date of birth and identification wrist band
  • Chose an appropriate drainage system
  • Carry out hand hygiene & prepare a sterile field
  • Arrange equipment ( keep the batch number of the catheter on the lower shelf of the trolley ) done PPE and uncover the patient. Wash hands again and put on sterile gloves
  • Place a sterile paper towel under the patients buttocks
  • Prepare the Anaesthetic gel
  • Clean the urethral meatus according to local policy, using sterile gauze to wrap around the penis when cleaning it, taking care not to contaminate your dominant hand.
  • Use the gauze to retract the foreskin if present to visualize the urethral opening before cleaning
  • Administer the anesthetic gel into the urethra, remove syringe but hold the glans penis closed for 3 - 5 minutes
  • Put on new sterile gloves, maintain sterile field and open top part of catheter
  • Insert the catheter, keeping the penis upright .
  • Watch for urine drainage, advance a further 2cm.
  • Inflate the balloon and attach a drainage system
  • Document
19
Q

Identify the risks involved in using Oxygen

A
  • Dry or bloody nose
  • Tiredness
  • Morning headaches
  • Fire Risk

Long Term:

  • Nasal Dryness
  • Skin Irritation
20
Q

Talk me through Seizure Resus

A
  • Attach the Defibrillator as soon as it is available and Analyse the Rhythm (pause CPR for <5seconds during rhythm analysis)
  • Decide if the Rhythm is Shockable or Non- Shockable
  • Continue CPR immediately
  • If Shockable immediately initiate hands on charging
  • Pause only to deliver the shock (ensure no one is touching the patient)
  • If Non-shockable continue CPR
  • Analyse the Rhythm every two minutes
  • During each cycle consider which drugs are required
  • During each cycle consider reversible causes and relevant interventions
21
Q

Walk through the first aid procedure for seizures

A

Assess danger ( safety is priority )
- Shout / call for help
- Only move the individual if they are in danger or move objects that may cause the individual to hurt themselves.
- Note the time ( it is important to note how long seizures last for )
- Gently support the individual’s head or place something soft underneath, such as: a jumper
- Loosen any tight clothing ( alleviate restrictions )
- Prevent crowding
- DO NOT hold them down, allow the seizure to happen
- DO NOT put any objects in their mouth, they will not swallow their tongue, and this may cause trauma.
( IMMEDIATELY POST SEIZURE )
- Check for signs of life ( A – B – C ) for 10 seconds, start CPR if no signs of life
- If not fully conscious place them in recovery position, ensuring patent airway
- If possible, wipe face and over any incontinence
- Keep NBM until fully conscious, avoid aspiration
- Stay with them

22
Q

Identify the 7 different types of seizures

A
  • Focal Aware Seizures
  • Focal Impaired Awareness Seizures
  • Focal To Bilateral Tonic Clonic Seizures
  • Absence Seizures
  • Tonic & Atonic Seizures
  • Myoclonic Seizures
  • Tonic Clonic & Clonic Seizures
23
Q

Define Focal Aware Seizures

A
  • the individual is conscious and usually know that the seizure is happening
  • it could be an unusual smell or taste, twitching of an arm, strange rising feeling in the stomach etc
24
Q

Define Focal Impaired Awareness Seizures

A
  • they affect more of the brain and consciousness is affected, may be confused or not know what is happening.
  • the individual may wonder around, behave strangely, pick up objects or make chewing movements.
  • can last a couple seconds or a few minutes
25
Q

Define Focal To Bilateral Tonic Clonic Seizures

A
  • sometimes affects both sides of the brain.

- it usually warns them that a tonic Clonic seizures may follow

26
Q

Define Absence Seizures

A

the person becomes unconscious for a short time, they may look blank and stare, not responding to what is happening around them

27
Q

Define Tonic & Atonic Seizures

A

Tonic: person’s muscles become stiff, falling if they stood
Atonic: person’s muscles suddenly relax and become floppy - usually falling forwards

28
Q

Define Myoclonic Seizures

A
  • Muscle Jerking

- The seizures involve jerking of a limb or part of a limb

29
Q

Define Tonic Clonic & Clonic Seizures

A
  • the person goes stiff ( tonic ) and usually falls to the ground, shaking or jerking ( clonic )
  • breathing can be affected, they can go pale or blue, particularly around their mouth
  • they might bite their tongue
30
Q

Define Anaphylaxis

A

It is a severe, life-threatening generalised or systematic hypersensitivity reaction.

  • sudden onset & rapidly progression of symptoms
  • airway / breathing / circulation problems
  • skin / mucosal change ( flushing, urticaria, angioedema )
31
Q

What is the bare minimum care that a patient experiencing anaphylaxis should recieve?

A
  • Recognition they are seriously unwell
  • A-E full assessment
  • Call for help early
  • Treatment of greatest threat to life first
  • Initial treatment should not be delayed due to lack of history
  • Urgent adrenaline therapy if needed,
  • Investigation & follow up
32
Q

When carrying out an A - E assessment for an individual experiencing anaphylaxis, what might be some indicators when looking at AIRWAY

A
  • Swelling
  • Difficult Breathing
  • ‘Closing – Up’
  • Hoarse Voice
  • Stridor
33
Q

When carrying out an A - E assessment for an individual experiencing anaphylaxis, what might be some indicators when looking at BREATHING

A
  • Shortness
  • Increased RR
  • Wheezing
  • Confusion: hypoxia
  • Cyanosis
34
Q

When carrying out an A - E assessment for an individual experiencing anaphylaxis, what might be some indicators when looking at CIRCULATION

A
  • Signs of shock: pale, clammy
  • Tachycardic
  • Hypotension
  • Angina
  • Cardiac Arrest
35
Q

When carrying out an A - E assessment for an individual experiencing anaphylaxis, what might be some indicators when looking at DISABILITY

A
  • Sense of ‘impending doom’
  • Anxiety, Panic
  • Decreased conscious level: airway, breathing, circulation
36
Q

When carrying out an A - E assessment for an individual experiencing anaphylaxis, what might be some indicators when looking at EXPOSURE

A
  • Skin changes

- Erythema, hives / articaria and angioedema

37
Q

What is the treatment procedure for an individual experiencing ANAPHYLAXIS?

A
  • Adrenaline ( IM for a,b,c problems )
  • repeat after 5 minutes if no improvement
  • Steroids & antihistamines
  • Lay the patient flat with their legs elevated
  • Sitting if it is more comfortable
  • If pregnant then lay on the left side
38
Q

What must you NOT do with a patient experiencing ANAPHYLAXIS?

A

DO NOT STAND THEM UP!!!

39
Q

Identify some conditions that may be confused for ANAPHYLAXIS

A
  • Foreign body aspiration (in children)
  • Acute/chronic urticaria
  • Food poisoning
  • Panic attacks
  • Vasovagal reactions
  • Mastocytosis
  • Carcinoid syndrome
  • Pheochromocytoma
  • C1 esterase inhibitor deficiency
  • Serum sickness
  • ACE inhibitor-induced angioedema
  • Inducible laryngeal obstruction
  • Asthma
  • Hypotension

NUR5079 (5 decks)

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