WK 1-6: LISA REVIEW Flashcards
Opthalmic drug administration
- explain procedure…..
- ask pt. to lie supine or sit back in chair with head slightly hyperextended
- if crust/drainage in inner canthus - gently wash away. wipe from inner to outer canthus by applying damp washcloth/cotton ball
- Hold cotton ball/clean tissue in non-dom hand to absorb medication that escapes eye
- with tissue resting lower lid, gently press downward with your thumb and forefinger against bony orbit, preventing pressure and traum to eyeball and touching eye
- Instilling eye drops:
- with dom hand resting on pt forehead, hold the folled medication approx. 1-2cm above conjunctival sac and instill as prescribed
- repeat procedure if pt. blinks or closes eye or if it lands on outer lid margin
- after installation, ask them to close their eyes
- apply gentle pressure with finger and clean tissue on pt nasolacrimal duct for 30-60 secs - Instill eye ointment
- Ask the patient to look at the ceiling.
- Holding the ointment applicator above the lower lid margin, apply a thin stream of ointment evenly along the inner edge of the lower eyelid on the conjunctiva from the inner canthus to the outer canthus.
- Have the patient close the eye and use a cotton ball to rub the lid lightly in a circular motion, which further distributes the medication if rubbing is not contraindicated. - Introcular disc application:
- Open the package containing the disc. Gently press your fingertip against the disk so that it adheres to your finger. Position the convex side of the disc on your fingertip.
- With your other hand, gently pull the patient’s lower eyelid away from the eye. Ask the patient to look up.
- Pull the patient’s lower eyelid out and over the disc.
why is gentle pressure applied on nasolacrimal duct
to prevent medication from entering nasal cavity
Administering ear drops
- Have the patient assume a side-lying position (if the patient’s condition does not contraindicate this position) with the ear to be treated facing up.
- Alternatively, the patient may sit in a chair or at the bedside.
- Perform hand hygiene. Put on gloves if drainage is present.
- Straighten the ear canal by pulling the auricle down and back (for children under 3 years of age) or upward and outward (for adults).
- Hold the dropper 1 cm above the ear canal and instill the prescribed drops.
- Ask the patient to remain in a side-lying position for 2 to 3 minutes. Apply gentle massage or pressure to the tragus of the ear with your finger unless contraindicated due to pain.
- If a cotton ball is needed, place the cotton ball into the outermost part of the ear canal. Do not press cotton deep into the canal. Remove the cotton after 1
Adminstering rectal suppository
1.Teach the patient about the medication. Explain the procedure to the patient regarding the positioning and the sensations to expect, such as feelings of needing to defecate. Ensure that the patient understands the procedure and that they can self-administer the medication.
2. Assist the patient in assuming Sims’ position to expose the anus and facilitate relaxation of the external anal sphincter. Keep the patient draped with only the anal area exposed.
3. Ensure the lighting is adequate to visualize the anus. Check for evidence of active rectal bleeding. Examine the condition of the anus externally and palpate the rectal walls to assess for feces, which may interfere with the suppository placement. Dispose of gloves in proper receptacles if they are soiled.
4. Put on a new pair of disposable gloves (if previous gloves were discarded).
5. Remove the suppository from its wrapper and lubricate the rounded end with a sterile water-soluble lubricating jelly to reduce friction when the suppository enters the rectal canal. Lubricate the index finger of your dominant hand with a water-soluble lubricant.
6. Ask the patient to take slow, deep breaths through the mouth and relax the anal sphincter.
7. Retract the buttocks with your nondominant hand. Insert the suppository gently through the anus, past the internal sphincter and against the rectal wall, 10 cm in adults, 5 cm in children and infants. Apply gentle pressure to hold the buttocks together momentarily, if necessary, to keep medication in place and to facilitate medication distribution and absorption.
8. Withdraw your finger and wipe the anal area with tissue.
9. Remove gloves, dispose of medication supplies in the appropriate receptacle, and perform hand hygiene.
10. Ask the patient to remain flat or on the side for 5 minutes to prevent expulsion of the suppository.
11. Place a call light within the patient’s reach if the suppository contains a laxative or fecal softener.
12. Document medication administration on the MAR or computer record.
13. Evaluate the effectiveness of the medication by observing the patient for a response to the suppository (e.g., bowel movement, relief of nausea) at times that correlate with the medication’s onset, peak, and duration.
for otic (ear) administration what should you do to straighten out the ear canal in adults and children
- Straighten out the ear canal. Infant/young child, pull pinna of the ear gently downward and backward. Adult, pull pinna gently upward and backward.
should a client blow their nose after administration of nose drop to help better with airway?
- NO, Instruct the client not to sneeze or blow his or her nose and to keep the head tilted back 5 minutes untill the medication is absorbed.
Metered dose/dry powder inhalers
- Assess the patient’s respiratory pattern and auscultate the patient’s breath sounds to establish a baseline.
- Instruct the patient in a comfortable environment, for example, by sitting in a chair. 3. Allow the patient to manipulate the inhaler, the canister, and the spacer device. Explain and demonstrate how the canister fits into the inhaler. 4. If the patient uses an MDI with or without a spacer and the inhaler is new or has not been used for several days, push a “test spray” into the air. A test spray is not needed for a DPI.
- Explain to the patient what a metered dose is and warn the patient about overuse of the inhaler, including medication adverse effects.
- Explain the steps for administering squeeze-and-breathe inhaled dose of medication MDI (demonstrate steps when possible):
a. Insert the MDI canister into the holder and remove the mouthpiece cover from the inhaler.
b. Shake the inhaler vigorously five or six times. This ensures that fine particles are aerosolized.
c. Have the patient take a deep breath and exhale. This empties the lungs and prepares the patient’s airway to receive the medication.
d. Instruct the patient to position the inhaler in one of two ways.
e. Close the mouth around the MDI with the opening toward the back of the throat.
f. Position the device 2–4 cm in front of the mouth. This directs the aerosol spray toward the airway. (best deliver).
g. With the inhaler properly positioned, have the patient hold the inhaler with the thumb at the mouthpiece and the index finger and middle finger at the top. This arrangement is called a three-point or lateral hand position.
h. Instruct the patient to tilt the head slightly and inhale slowly and deeply through the mouth for 3–5 seconds while depressing the canister fully. Medication is disturbed to the airway upon inhalation.
i. Instruct the patient to hold their breath for approximately 10 seconds. This helps reach the deeper branches of the airways.
j. Instruct the patient to remove the MDI from the mouth and to exhale through pursed lips. Pursed lips keep the small airways open during exhalation. - Explain the steps to administer MDI by using a spacer, such as an AeroChamber (demonstrate when possible):
a. Remove the mouthpiece cover from the MDI and the mouthpiece of the spacer. Inspect the spacer for foreign objects. If the spacer has a valve, ensure the valve is intact.
b. Insert the MDI into the end of the spacer. The spacer traps the medication; the patient will then inhale the from the device, which breaks up and slows down the medication particles, enhancing the amount of medication received.
c. Shake the inhaler vigorously five or six times, ensuring the fine particles are aerosolized.
d. Have the patient exhale completely before closing the mouth around the mouthpiece of the spacer. Avoid covering small exhalation slots with the lips.
e. Have the patient depress the medication canister, spraying one puff into the spacer. The spacer allows finer particles to be inhaled, and larger droplets are retained.
f. Instruct the patient to inhale deeply and slowly through the mouth for 3–5 seconds; this maximizes the amount of medication entering the lungs.
g. Instruct the patient to hold their breath for 10 seconds; this allows full medication distribution.
h. Instruct the patient to remove the MDI and spacer before exhaling. - Explain the steps to administer DPI or breath-activated MDI.
a. Remove the cover from the mouthpiece. Do not shake the inhaler.
b. Prepare the medication as directed by the manufacturer (e.g., hold the inhaler upright and turn the wheel to the right and then to the left until a click is heard, load the medication pellet, etc.).
c. Instruct the patient to exhale away from the inhaler before inhalation, preventing powder loss.
d. Position the mouthpiece between the patient’s lips.
e. Instruct the patient to inhale deeply and forcefully through the mouth; this creates aerosol.
f. Instruct the patient to hold their breath for 5–10 seconds to ensure medication distribution.
g. Instruct the patient to wait at least 20–30 seconds between inhalations of medications. The first inhalation opens the airways and reduces inflammation. The second and third inhalation penetrates the deeper airways. If two medications are to be administered, give the bronchodilator first.
Stages of wound healing
primary intention - wound that is closed - surgical incision wound that is sutured/stapled. Healing occurs via epithelialization and heals quick with minimal scar formation
secondary intention - wound edges are not approximated, pressure wounds are surgical wounds that have tissue loss. Wound heals by granulation tissue fromation, wound contraction and epithelialization
tertiary intention - wound is left open for several days. Wounds that are contaminated and require observation for signs and symptoms. Closure of wound is delayed until risk of infection is resolved
what is proliferation
growth of tissue cells
partial thickness wound repair (IER - I eat rice)
- Inflammatory response
- Tissue trauma causes an inflammatory response, which, in turn, causes redness and swelling to the area, as well as a moderate amount of serous exudate.
- Normally, this response is limited to the first 24 hours after wounding. Epithelial cells begin to regenerate, providing new replacement cells. - Epithelial proliferation (reproduction) and migration
- This epithelial proliferation and migration start at the wound edges and the epidermal cells lining the epidermal appendages, allowing for quick resurfacing. Epidermal cells begin migrating across the wound bed soon after wounding.
- A wound left open to air can resurface within 6 to 7 days, whereas a wound that is kept moist can resurface in 4 days. - Re-establishment of the epidermal layers
- New epithelium is only a few cells thick and must undergo re-establishment of the epidermal layers:
- The cells slowly re-establish normal thickness and appear as dry pink tissue.
principles of surgical asepsis
Sterile fields must always be kept in sight to be considered sterile.
- Never turn your back on a sterile field.
- All objects on a sterile field must stay sterile. o Never reach over your sterile field.
- Any puncture, moisture, or tear that passes through a sterile barrier must be considered contaminated.
- When pouring sterile solutions, only the lip and inner cap of the pouring container is considered sterile. The pouring container must not touch any part of the sterile field. Avoid splashes.
- 2.5 cm (1 inch) border.
- Sterile from waist to shoulders o Sterile items that are below the waist level or items held below waist level, are considered non-sterile.
- Keep sterile objects above waist level.
suspected deep tissue injury
Intact or nonintact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration, or epidermal separation revealing a dark wound bed or blood-filled blister.
Pain and temperature changes often precede skin colour changes. This injury results from intense or prolonged pressure and shear forces at the bone muscle interface.
The wound may evolve rapidly to reveal the actual extent of tissue injury, or it may resolve without tissue loss.
stage 1 pressure injury
Intact skin with a localized area of no blanchable erythema.
The presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes.
Colour changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury.
The area may be painful, firm, soft, warmer, or cooler as compared with adjacent tissue
stage 2 pressure injury
Partial-thickness loss of skin with exposed dermis.
The wound bed is viable, pink or red, and moist and may also present as an intact or ruptured serum-filled blister.
Adipose (fat) is not visible, and deeper tissues are not visible. Granulation tissue, slough, and eschar are not present.
These injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel.
stage 3 pressure injury
Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough, eschar, or both may be visible.
The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds. Undermining and tunnelling may occur. Fascia, muscle, tendon, ligament, cartilage, and bone are not exposed.
