Week 5 Flashcards
Identify features involved in the RENAL System & their functions
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
Define Venipuncture
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.
Define Cannulation
It is a direct access into the bloodstream ( IV ) used for the administration of medication
Run through the venipuncture procedure
- 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.
Run through the Cannulation procedure
- 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
What is the ‘normal’ range of Oxygen Saturation in COPD or CO2 retaining patients?
88 - 92%
What is the ‘normal’ range of Oxygen Saturation in most patients?
94 - 98%
Identify reasons why many patients need high does oxygen to normalize saturation
- Severe pneumonia
- Severe LVF
- Major Trauma
- Sepsis & Shock
- Lung Collapse
- Pulmonary Embolism
- Lung Fibrosis
Talk to me about High Concentration Reservoir ( RMI )
- Non-Rebreathing
- Critical Illness / Trauma
- Post Cardiac or Respiratory Arrest
- Delivers Oxygen Conc. between 60,80 or above
- Effective for short term treatment
Talk to me about Nasal Cannulae ( N )
- Recommended for most patients
- 1 - 6 L/min approx 24 - 50 % Fi02
- Comfortable, easy to tolerate
- Non-Rebreathing
- Patient can eat & drink
Talk to me about Simple Face Mask ( SM )
- Type 1 Respiratory Failure
- 35 % & 60 %
- Low cost
- Flow 5 - 10 L/min
Talk to me about Traheostomy ( TM )
- Neck breathing pt
- Adjust oxygen flow
- Prolonged oxygen use = humidification
- Patient may need suction
Talk to me about Humidified Oxygen ( H )
- Tracheostomy
- Bronchiectasis
- Cystic Fibrosis
- Physiotherapists may advise
Talk to me about High Flow Nasal Oxygen ( HFN )
- Alternative to RM with acute respiratory failure without hypercapnia
- ITU, high dependency
Identify the reasons why a catheter may be needed?
- 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
What are the risks associated with catheterization?
- 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
Run through the procedure for female catheterisation
- 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
Run through the procedure for male catheterization
- 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
Identify the risks involved in using Oxygen
- Dry or bloody nose
- Tiredness
- Morning headaches
- Fire Risk
Long Term:
- Nasal Dryness
- Skin Irritation
Talk me through Seizure Resus
- 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
Walk through the first aid procedure for seizures
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
Identify the 7 different types of seizures
- Focal Aware Seizures
- Focal Impaired Awareness Seizures
- Focal To Bilateral Tonic Clonic Seizures
- Absence Seizures
- Tonic & Atonic Seizures
- Myoclonic Seizures
- Tonic Clonic & Clonic Seizures
Define Focal Aware Seizures
- 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
Define Focal Impaired Awareness Seizures
- 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
Define Focal To Bilateral Tonic Clonic Seizures
- sometimes affects both sides of the brain.
- it usually warns them that a tonic Clonic seizures may follow
Define Absence Seizures
the person becomes unconscious for a short time, they may look blank and stare, not responding to what is happening around them
Define Tonic & Atonic Seizures
Tonic: person’s muscles become stiff, falling if they stood
Atonic: person’s muscles suddenly relax and become floppy - usually falling forwards
Define Myoclonic Seizures
- Muscle Jerking
- The seizures involve jerking of a limb or part of a limb
Define Tonic Clonic & Clonic Seizures
- 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
Define Anaphylaxis
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 )
What is the bare minimum care that a patient experiencing anaphylaxis should recieve?
- 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
When carrying out an A - E assessment for an individual experiencing anaphylaxis, what might be some indicators when looking at AIRWAY
- Swelling
- Difficult Breathing
- ‘Closing – Up’
- Hoarse Voice
- Stridor
When carrying out an A - E assessment for an individual experiencing anaphylaxis, what might be some indicators when looking at BREATHING
- Shortness
- Increased RR
- Wheezing
- Confusion: hypoxia
- Cyanosis
When carrying out an A - E assessment for an individual experiencing anaphylaxis, what might be some indicators when looking at CIRCULATION
- Signs of shock: pale, clammy
- Tachycardic
- Hypotension
- Angina
- Cardiac Arrest
When carrying out an A - E assessment for an individual experiencing anaphylaxis, what might be some indicators when looking at DISABILITY
- Sense of ‘impending doom’
- Anxiety, Panic
- Decreased conscious level: airway, breathing, circulation
When carrying out an A - E assessment for an individual experiencing anaphylaxis, what might be some indicators when looking at EXPOSURE
- Skin changes
- Erythema, hives / articaria and angioedema
What is the treatment procedure for an individual experiencing ANAPHYLAXIS?
- 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
What must you NOT do with a patient experiencing ANAPHYLAXIS?
DO NOT STAND THEM UP!!!
Identify some conditions that may be confused for ANAPHYLAXIS
- 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
