Term
| Nasogastric Tubes: go from the nasopharynx into the stomach. What 4 ways can they be used? |
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Definition
| DECOMPRESSION (remove secretions or gas) GAVAGE (instillation of liquid nutrition, internal application of pressure) LAVAGE (washing out of stomach contents) COMPRESSION (applying pressure internally with like the use of a balloon. Used for hemorrhage or to stop hemorrhage) |
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Term
| What NG tube would you use for an overdose? |
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Definition
| a LAVAGE b/c it washes out the stomach contents. |
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Term
| a __________ tube is an NG tube inserted into the stomach for nutrition. |
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Definition
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Term
| What are some characteristics of feeding tubes? i.e. small or large bore? soft or hard material? guide wire or not? What is an example of a feeding tube? |
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Definition
| Feeding Tubes: usually a SMALLER BORE, made out of SOFTER material, use a GUIDE WIRE during instillation otherwise will curl. DOBHOFF is a feeding, but it is bigger. |
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Term
| The nursing responsibility with feeding tubes is to ensure they're in the right place. What 3 ways do we do this? What is the best way? |
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Definition
| 1. x-ray (the best way) 2. Ausculate: use syringe & pump 15 cc of air into the tube, listen over the xiphoid process when you're pushing the air in. If you can hear that, then you know you're in the right place. 3. Aspirate gastric contents: measure the pH (usually about 4-5. Evolve said gastric contents should be 1-4. |
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Term
| How do we know how long the NG tubing should be? |
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Definition
| NEX Measurement. N=nasal, E=ear, X=xiphoid. Go from tip of nose to ear and down the the xiphoid. |
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Term
| Do we need sterile gloves for the NG tube? |
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Definition
| No, b/c the stomach is not sterile. It is NOT A STERILE PROCESS. it is a clean/medical asepsis process, of course. |
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Term
| What do you need to have on for an NG placement? |
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Definition
| clean gloves. you might come into contact with body fluids, bile, etc... you're hitting the gag reflex with the NG tube. |
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Term
| Why do we have the patient take drinks while placing the NG tube? |
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Definition
| If the pt. is swallowing, it goes down easier + closes the epiglottis over trachea & helps to move the tube into the esophagus. |
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Term
| If the NG tube is used for decompression then what is different? |
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Definition
| You're putting it in temporarily to remove secretions or gas so you're going to suck it all back out right away. |
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Term
| What do gastric contents look like? |
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Definition
| Gastric are greenish, yellowish. The intestinal contents are more orange, brown. If gastric contents are brown/red it's possible client is bleeding (maybe has an ulcer). Book actually said tho: gastric contents can be cloudy & green, but may be off-white, tan, bloody, or brown in color. aspiration of contents provides means to measure fluid pH and thus determine tube tip placement in GI tract. |
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Term
| How do we mark the tube to verify placement? |
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Definition
| Mark on the tube with a sharpie. Mark on the side closest to the end of the nose where it needs to stay. Tape is not used b/c it can slip off or move. |
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Term
| What NG tubes are used for suction (decompression)? |
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Definition
LEVIN (rubber hose w/ suction. problem is it would get stuck to the side of the stomach & cause ulcer or hole. So, the Salem sump was invented.)
SALEM SUMP (is the preferable tube for stomach decompression. The tube has 2 lumina: one for removal of substances and one for an air vent. A blue "pigtail" is the air vent. When connected to suction, the air vent permits free, continuous drainage of secretions. The air vent should never be clamped off, connected to suction or used for irrigation. The other tube can be clamped if you're going to ambulate-get air, but not secretions. be sure to clamp & make sure it's in place) |
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Term
| Gastric aspirate pH vs. intestinal pH... |
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Definition
| gastric is usually acidic (4 or less) and intestinal aspirate is usually greater then 4. Respiratory secretions are greater than 5.5. |
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Term
| Maintenance of NG tube involves irrigation... |
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Definition
| clean and apply gloves, check tube for placement in stomach (so not to put solution into lungs), reconnect NG tube to connecting tube, draw up 30 mL of NS into Asepto or cathether-tipped syringe, clamp NG tube. disconnect from connection tubing and lay end of connection tubing on towel, insert tip of irrigating syringe into end of NG tube. remove clamp. hold syringe with tip pointed at floor and inject saline slowly & evenly. do not force solution. If resistance occurs, check for kinks in tubing. Turn client onto left side. Repeated resistance should be reported to the physician. After instilling solution, immediately aspirate or pull back slowly on syringe to w/draw fluid. |
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Term
| What kind of syringe do we need to irrigate an NG tube? do we use a little syringe? what kind of liquid? |
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Definition
| No, we use a 60 - 90 cc syringe for irrigation. Can irrigate with regular water usually... otherwise the surgeon recommends NS then you use that. |
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Term
| Do you need a physicians order to irrigate an NG tube? |
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Definition
| Yes! You ALWAYS need a physicians order to irrigate. |
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Term
| What tube do you irrigate through? Do you put it in the blue colored "pigtail" air vent of Salem sump tube? |
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Definition
| No!!! Nothing goes in there or covers the blue, it for the air vent only. You will put it through the CLEAR. |
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Term
| Do we put potassium through NG tubes? |
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Definition
| No, it is the worst... little balls that expand & clump. Coke will dissolve it though - little trick. |
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Term
| What is an intermittent NG suction? What are the 2 types? |
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Definition
| intermittent suction will start & stop. depending on whether it is Low (less pressure) as opposed to High (greater pressure). High intermittent suction (HIS) or Low intermittent suction (LIS). |
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Term
| a continuous suction is _________. |
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Definition
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Term
| What will documentation of NG tube include? |
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Definition
| 1. chart the TIME 2. TYPE OF TUBE & SIZE 3. and RESIDUAL 4. the PATIENT TOLERANCE 5. CONFIRMATION of PLACEMENT (can be done by ausculation, x-ray, gastric pH) 6. CLAMPED/SUCTION (say tube placed to suction) 7. CONTINUOUS MONITORING of DRAINAGE (Say high or low and intermittent or continuous) |
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Term
| We usually pull residual out with syringe, then put it back in. When would we not return the stomach contents though? |
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Definition
| if DECOMPRESSING, but otherwise return it. |
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Term
| If the gastric contents fill the syringe all the way, then what? |
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Definition
| detach, put in graduate & continue... need an accurate amt of residual. then put it all back. |
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Term
| Why does the nurse ask the client to flex head toward chest after tube has passed the nasopharynx? |
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Definition
| It closes off the glottis and reduces risk of tube entering the trachea. |
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Term
| What pt's are at an increased risk of aspiration in procedure & subsequent tube feedings? |
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Definition
| clients with impaired LOC who may also have impaired gag reflex. |
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Term
| Procedure & tube feedings require a ____________ ______. |
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Definition
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Term
| Who are enteral feedings used for? |
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Definition
| They're used to provide nutrition for inadequate oral intake, NPO>5 days b/c of why??? surgery. if pt is aspirating they can't swallow b/c it'll just go into their lungs. Peg Tube: permanent, reverse suction cup holds in place (surgeon pulls off firmly - so pt. can remove too by mistake). |
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Term
| What angle of bed is best for tube feeding? WHy? |
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Definition
| 30-45 degrees for feeding... 30 is lowest. So, 30 & up really. If they were laying flat on their back then the feeding tube will be allowed to go right back up. If you need to turn the pt though? Stop feeding, put bed down, turn patient, go back up, turn feeding back on. |
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Term
| If your pt. has diarrhea while being enterally fed, what do you do? |
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Definition
| document and tell the doctor |
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Term
| If pt. has cramping during NG tube feeding, what do you do? |
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Definition
| lower height of bag to slow the feeding down (just like with enemas). |
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Term
| We check residual when tube feeding b/c if you're going to administer 75 mL & they have 250 mL in their stomach, then that is A LOT of residual! Should you give your meds & tube feeding on top of that? |
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Definition
| No, you should stop feeding b/c that is a ton of residual. You need to notify the physican. Recheck it in an hour, when residual has decreased less then specified parameters then you can go ahead and reinitiate feeding. Usually needs to be less then 50 mL. The 250 mL is a lot of residual. |
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Term
| There can be mechanical + metabolic complications when going back to eatingnormally. what will pt. start eating in the beginning? |
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Definition
| not going to give pt regulat food right after taking the NG out. start with clear liquids, ice chips |
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Term
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Definition
| percutaneous endoscopic gastrostomy (PEG) tube, used for patients who require longer use of the tube, it is customary to place the tube directly into the stomach through the abdominal wall. The tube is prevented from coming out of the stomach by one of several methods. Some brands have a small wire within the tube, which after insertion is pulled from the exterior end of the tubing causing the portion within the stomach to curl up or “pigtail,” preventing it from being pulled out. Other systems employ a very small balloon at the end of the tube which is inflated within the stomach after insertion, serving the same purpose. Removal of the tube simple involves cutting the wire which created the pigtail, or deflating the balloon section of the tube allowing it to slip easily from the stomach. |
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Term
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Definition
| A surgical operation to create an opening of the jejunum (a part of the small intestine to a hole (stoma) in the abdomen. |
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Term
| WHat is a gastrojejunostomy? |
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Definition
| There is a small tube (the J-tube) that will go into the jejunum. There is a balloon that will sit inside the stomach that will hold the tube in place. On the end of each tube are three ports: gastric, jejunal and balloon. |
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Term
| The different types of enteral feedings are.... |
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Definition
| continuous (just like a feeding tube, it is a type of pump), intermitttent (can also have a feeding overnight while asleep & then don't have to hassle with it during the day. can eat if they want with family. get nutrition for healing) and BOLUS (what we use our bags for. can get by gravity or give with syringe. If it is a small bore tube it might not work with gravity. THen can draw up & push with syringe. if it is small you can't put volume into stomach fast. .. that'll cause cramping & discomfort. |
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Term
| What temp should feedings & flushings always be? |
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Definition
| room temperature. Cold flushes will increase cramping... no time to warm before it hits stomach. |
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Term
| For instilling feedings, the head of the bed needs to be in what position? what degree? |
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Definition
| Semi-Fowlers. 30 degrees+. |
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Term
| When do we rinse the tubing? |
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Definition
| Before with 30 mL and after or whenever feedings are interrupted. |
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Term
| Do we weigh patients daily? |
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Definition
| Yes, to assess for correct nutrition. Too much? see wt. gain. With chronic disease like CHF they might get too much liquids b/c their bodies are retaining so much. |
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Term
| We change the bag & tubing every... |
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Definition
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Term
| We measure the amount of aspirate (residual) every |
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Definition
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Term
| We monitor finger-stick blood glucose every ___ hours until maximum administration rate is reached and maintained for __ hr. |
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Definition
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Term
| We monitor intake & output every .... |
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Definition
| 8 hours. and do 24 hour totals. |
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Term
| If pt. is turning bluish, what do you do? |
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Definition
| They're aspirating... so stop the feeding. put them on their side in case they start vomiting. suction (NEED AN ORDER TO SUCTION), elevate the head of the bed. ALWAYS WANT to NOTIFY PHYSICIAN. |
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Term
| If there is vomiting or regurgitation, what do you do? |
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Definition
| stop the feeding, HOB is at 30 degrees+ during and after feeding, check residual, assess your patient, notify the physician. |
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Term
| You receive an order to being enteral tube feedings. The first step you must take is... |
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Definition
| check to see if the tube is properly placed. |
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Term
| In an open system, the feeding is good for __ hours. |
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Definition
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Term
| On a bottle, food stays for __ hours. |
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Definition
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Term
| What are the types of small bore and large bore NG tubes? |
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Definition
| small bore=Dobhoff, Gastric Tube (G-tube), Percutaneous Endoscopic Gastrostomy (PEG) Tube. large bore=gastric decompression removing gastric secretions post GI surgery to allow wound healing. used for obtaining gastric content samples for analysis, Lavage stomach to remove ingested substance, monitor quantity of gastric bleeding. |
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Term
| large bore NG tubes used with Salem Sump? |
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Definition
| Yes, use large bore NG tube with double lumen with Salem Sump. Primary lumen is attached to suction (sump pump) and blue air lumen is kept above level of the stomach and allows atmospheric air to enter stomach, reducing negative suction that can damage wall of stomach. |
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Term
| Long term feedings use _____-bore NG tubes. |
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Definition
| small. they're less irritating. Tube is placed into small bowel requiring at least 40 inches to be inserted and carried into small bowel (tungsten weighted tip is radiopague). It is inserted using a metal stylet to stiffen the tube. |
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Term
| It is difficult to aspirate stomach contents in long-term small bore tube feedings b/c tube tends to collapse. what should you use? |
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Definition
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Term
| How do we ensure placement of long-term feeding tube? What kind of feeding is necessary? Can meds be administered there? |
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Definition
| Placement is verified by radiograph. Continuous feedings are usually administered rather than bolus d/t size of lumen. Yes, meds can be administered there. |
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Term
| How do we stabilize these tubes? |
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Definition
| Use either commercial tape or adhesive tape... split half way up, place on nose & then wrap around the tube. Also need to pin to gown to reduce tension on nose. Loop piece of tape around tube and pin "tail" to gown. Check patency of tape EACH SHIFT... to be sure tube does not fall out. |
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Term
| Gastric Tube (G tube) and Percutaneous Endoscopic Gastrostomy (PEG Tube) is used for what type of feeding? How are they put in? Are they visible? what's their advantage? |
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Definition
| Long-term, surgically through wall of stomach or jejenum, not visible, esophageal irritation is avoided. |
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Term
| PEG tube placement can be done under local anesthesia or general? How is it done? |
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Definition
| Local anesthesia is all that is necessary. Endoscope is passed into the mouth, down the esophagus and into the stomach. Surgeon can then see the stomach wall through which the PEG tube will pass. Under direct visualization with endoscope, a PEG tube passes through the skin of the abdomen, through a very small incision, and into the stomach. A balloon is then blown up on the end of the tube, holding it in place. PEG gastrostomy tubes avoid the need for general anesthesia, take about 20 minutes, eliminate need for a large incision. |
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Term
| How do you remove PEG tubes? How much is sticking out form incision area? |
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Definition
| Deflate the balloon section of the tube allowing it to slip easily from the stomach. About 3 inches sticks out from incision area in abdomen. |
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Term
| What kind of stoma care is necessary? |
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Definition
| The area around wound must be kept clean & covered with clean, gauze. The incision area must be observed daily for redness, swelling, necrosis or purulent drainage. Apply bacterial ointment to the insertion site after cleaning to help prevent infections (check hosp policy first), excessive tension on tube may result in pressure necrosis of interior abdomen wall. Excess tension on outside of abdomen by plastic disk can cause pressure sore on abdominal skin. |
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Term
| Bolus Feeding: what are its advantages? |
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Definition
| Provides nutrition to clients who are unable to normally ingest food (comatose, obstructive lesions, aphagia post stroke), gives supplemental nutrition to clients with protein or calorie malnutrition, gives supplemental nutrition to clients with high metabolic requirements, provides specialized dietary supplementation, maintains fluid & electrolyte balance. |
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Term
| How do we check placement & residual - which are very imp... |
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Definition
| Check placement by assessing abdomen for distention & assess abdomen for bowel sounds. Flush the tube with 30 cc air and listen with stethescope below xiphoid process for "whoosh." Check residual after flushing, withdraw and check for presence of gastric contents. If there is more then 100cc aspirated (check agency policy), hold the feeding. If there is less then 100 cc aspirated, return aspirate and flush with 30 cc water. Begin feeding per routine. |
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Term
| Before we administer meds or feeding we must.... |
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Definition
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Term
| After we administer meds or bolus feeding we must.... |
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Definition
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Term
| How do tubes usually get clogged?? OOPS... |
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Definition
| Failure to do one of the following can clog tubes.. properly flush with 30-50 mL after each bolus feeding or med administration, adequately crush and dissolve medication - give liquid form when possible, use only nutritional products made for enteral feedings. |
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Term
| How do we clear a blocked tube? |
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Definition
| Flush the tube with syringe filled with lukewarm WATER using gentle pressure on plunger. Or can milk tube with fingers to loosen food or medicine particles. Flush a carbonated drink through the tube. The bubbles may help to loosen the blockage. If all above fail, may need to remove and place new tube. |
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Term
| What should the nurse do if do if difficulty is encountered placing an NG tube b/c the client is gagging? |
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Definition
| Nurse should pull the tube back till coughing subsides and look in oropharynx to see if the tube is coiled. Allow the client to take several breaths and relax. Then, have client tuck their chin, suck water through straw and swallow when nurse advances the tube. |
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Term
| Then nurse is having difficulty administering meds through a dobhoff tube. Should the nurse use a large piston syringe with the plunger inserted to assist in propelling the meds? If not, what are the other options? |
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Definition
| Larger syringes (such as a 50 cc) will produce less force as well as less possibility of rupturing end of dobhoff tube d/t excessive pressure. Always be sure meds are completely dissolved and crushed. If this is difficult, consult the pharmacy for a liquid form of the med. |
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Term
| When the client is on a continuous tube feeding at 50 mLs/hour and the nurse obtains a residual of 100 mLs or greater, what should the nurse do? |
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Definition
| Return up to 100 cc of residual (to avoid upsetting patient's electrolyte balance) and follow institutional policy which may recommend holding the TF for a specified amt of time or notifying the physician. Ensure head of bed is elevated at least 30 degrees. |
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Term
| What should the nurse do if upon entering the room, the large bore NG tube appears to have slid most of the way out of the client's nose and the tape that was on the nose is now 6 inches from the nose, still attached to the NG tube? |
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Definition
| Look in the oropharynx for current location. If the tip is not visible aspirate any fluid that is in tubing and discard, then follow standard procedure for reinsertion and verification of placement. If this had been a Dobhoff tube, it should be completely removed and reinserted using styet following protocol. |
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Term
| Is there anythin the nurse should do prior to removing an NG tube? WHy? |
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Definition
| Instill 50 cc of air into the tube to decrease risk of aspiration of fluids during removal. |
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Term
| What should the nurse do if the aide has just poured 2 cans of tube feeding into your client's continuous feeding bag and the bag's tag says it was hung 32 hours ago? |
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Definition
| Discard all feeding and old bag and hang new bag and tubing and refill again. Be sure to label new tubing with date and time it was hung. |
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Term
| You are assessing your patient at the beginning of the shift and note that the site around your clients PEG tube is red with crusty drainage. What should be done? |
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Definition
| Wash gently with soap and water and use Q-tip as needed to clean areas immediate to PEG tube! Check institutional policy for application of antibacterial ointment. Most institutions discourage the use of "drain sponges" as they can place too much tension on PEG tube, causing it to pull out of the stomach. |
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Term
| What are the purposes of NG tubes? |
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Definition
| GASTRIC DECOMPRESSION (applying pressure internally w/ balloon) for intestinal obstruction or ileus. GAVAGE (instillation of liquid nutrition) LAVAGE (taking out stomach contents + can also remove ingested substance, wash out), REMOVAL OF GASTRIC SECRETIONS POST GI SURGERY TO ALLOW WOUND HEALING, TO OBTAIN GASTRIC CONTENT SAMPLES FOR ANALYSIS |
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Term
| What is the NEX measurement? |
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Definition
| Naso, to Ear, to Xiphoid process measured in advance of tube being inserted. |
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Term
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Definition
| it is used to provide nutrition. NG=nasogastric, PEG=percutaneous endoscopic gastrostomy, or Dobhoff=small bore nasogastric tube, J-tube=jejunostomy, or Gastrojunostomy used. |
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Term
| When is a feeding tube inserted? |
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Definition
| Inadequate oral intake, NPO>5 days. Ex: dysphagia-painful swallowing. |
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Term
| What must you do prior to starting a tube feeding to a newly inserted feeding tube? |
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Definition
| Verify placement. x-ray is most accurate. |
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Term
| What are the 3 different types of feeding times/ways? |
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Definition
| Continuous (kangaroo pump), Intermittent (overnight can get nutrition & then eat or not with fam during day. good for wound healing), Bolus (Bolus feedings are essentially the equivalent of a meal, consisting entirely of formula. A "bolus" is a set amount of formula run down the feeding tube at specific times during the day via gravity or syringe. Bolus feedings are essentially the equivalent of a meal, consisting entirely of formula. A "bolus" is a set amount of formula run down the feeding tube at specific times during the day.) |
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Term
| How much tube feeding in an open system? |
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Definition
| 4-8 hours worth. 8 hours is max. |
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Term
| How much tube feeding in a closed system? |
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Definition
| can be up to 24 hrs worth, usually about a liter |
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Term
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Definition
| gastric contents removed via feeding tube. Do not return if decompression is being used! If residual filled tube, remove, place in container and then do it again. When complete, return all liquid to Pt unless on decompression. |
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Term
| What is the purpose of residuals? |
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Definition
| Helps identify the rate of food being digested. If excessive, stop feeding and consult Physician. |
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Term
| What should you do if you suspect the patient has aspirated the tube feeding? (they have wet lung sounds, cyanotic, coughing) |
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Definition
| Stop the feeding! Place the patient in a SIDE-LYING POSITION, Suction (may need order), Elevate HOB, Notify Physician |
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Term
| What is the routine precaution that helps to prevent aspiration? |
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Definition
| Raise head of bed 30-45% to help reduce aspiration. Stop continuous feeding when lowering pt to turn, then resume. |
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Term
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Definition
| Used for LONG-TERM enteral feedings, Surgically placed directly through wall of stomach or jejunum, Tube is NOT visible under clothes, esophageal irritation is avoided. Only need local anesthesia, take about 20 minutes, eliminates need for large incision. |
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Term
| What is a Salem Sump tube? |
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Definition
| an NG tube used for suction |
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Term
| What is a Salem Sump tubes claim to fame? |
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Definition
| Suction with no air can ruin the lining of stomach by creating a vacuum seal. The Salem Sump provides an extra tube for air and prevents ulcers. One way valve prevents peaking. |
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Term
| WHy do you irrigate NG tubes? |
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Definition
| to clean out any clumps. We use a big syringe (60-90 cc) can irrigate with regular water unless surgeon recommends NS then use that. Remember, you ALWAYS need a physicians order to irrigate. Types of suctions used for NG suctioning: Intermittent (either Low-LIS-low pressure or High-HIS-greater pressure) or Continuous |
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Term
| What is "nociceptive" pain? |
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Definition
| This is normal pain transmission. The pain is typically well localized, constant, and often with an aching or throbbing quality. Ex's are: sprains, bone fractures, burns, bumps, bruises, inflammatio |
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Term
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Definition
| Somatic pain is caused by the activation of pain receptors in either the cutaneous (body surface) or deep tissues (musculoskeletal tissues). Ex's Betty gave --> bone, muscle |
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Term
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Definition
| "Viscera" refers to the internal areas of the body that are enclosed within a cavity. Betty gave ex. of: organs. Common causes of visceral pain include pancreatic cancer and metastases in the abdomen. Visceral pain is not well localized and is usually described as pressure-like, deep squeezing. |
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Term
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Definition
| Referred pain is a term used to describe the phenomenon of pain perceived at a site adjacent to or at a distance from the site of an injury's origin. Simply, you're feeling it somewhere else then where it is. Pathology is in one place & pain is in another... happens b/c of nerve tracks. |
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Term
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Definition
| Pain that might go down the sciatic nerve. Radiating pain is a pain that moves from the original area outwards to another part of the body. An example is lower back pain that can radiate down into a leg. |
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Term
| WHat is "neuropathic" pain? |
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Definition
| Neuropathic pain, a chronic pain as a result from an injury to the nervous system. It is SHARP, SHOOTING or burning pain. Ex. shingles or the mumps. |
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Term
| Pain that has been in place for less then 6 months is referred to as _________ pain. What is the goal here? |
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Definition
| acute. goal is to manage effectively & allow the pt to heal. if you don't manage the pain, the catecholamine & glucocorticoid hormones come out. |
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Term
| Pain that has been in place for longer then 6 months is ______ pain. Is there active pathology? Why do we manage pain? |
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Definition
| Chronic Benign Pain is when there is NO active pathology or real reason to be found. We are managing pain to add quality to their life. Examples of chronic benign pain: chronic back pain or migraines. |
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Term
| Pain that is place for longer then 6 mo.'s and there is pathology is called .... |
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Definition
| Chronic Progressive. Ex/ cancer pain. Manage pain here to ad quality to their life. |
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Term
| ________ is a psychological craving for opiods with no physcial need. |
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Definition
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Term
| _______ every patient will build up this for a certain dose of opioid. To maintain you will have to increase. It is a physiological requirement, every patient will need an increase b/c of this. |
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Definition
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Term
| Physical dependence: Is it physiologic (your body requires it) or psychologic (your mind desires it) when your body depends on it when they're on for a week or two? What do you do when stopping these meds? |
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Definition
| It is physiologic, you titrate it down. never take all away immediately. |
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Term
|
Definition
| Pseudotolerance is the need to increase dosage that is not due to tolerance, but due to other factors such as: disease progression, new disease, increased physical activity, lack of compliance, change in medication, drug interaction, addiction, and deviant behavior. |
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Term
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Definition
| Pattern of drug-seeking behaviour of pain patients receiving inadequate pain management that can be mistaken for addiction. The patient is NOT really addicted or being a "drug seeker." |
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Term
| What kind of dependence does an "Addicted" person have? |
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Definition
| Psychological: it is a pattern of compulsive drug use characterised by a continued craving for an opioid and the need to use the opioid for effects other than pain relief. |
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Term
| What kind of dependence does a person with "Tolerance" have? |
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Definition
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Term
| What kind of dependence does a physical dependence person have? |
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Definition
| Physiological. They get this if on for a week or 2 weeks, has to be titrated down or they get cramps, sick, etc... |
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Term
| Explain how the physiology of pain relates to selecting interventions for pain relief... |
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Definition
| We do not want pain to interfere with healing & rest. Use possibly antidepressants, opioid and muscle relaxants. |
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Term
| Describe the components of pain assessment: |
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Definition
| Onset & Duration, Location, Intensity, Quality, Pain Pattern, Relief Measures, Effects on Clients Life (their ADL, their relationships, work and family roles). |
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Term
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Definition
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Term
| Explain the nonpharmacological pain interventions (i.e. cutaneous stimulations of Cold & Hot application.) Lets start with COLD: |
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Definition
| Cold has to be less then 59 degrees F. Cold is more effective then heat. Cold relieves more pain faster and longer.If you can get a pt to stay with the cold it will actually numb nerve endings. Great following tonsillectomies, plastic surgeries and to relieve a headache. |
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Term
| What is the process of cold reaction? |
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Definition
| CBAN is the acronym. C=cold, B=burning/tingling, A=aching, N=Numb. |
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Term
| Explain the non-pharm intervention method of HEAT... |
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Definition
| Heat is temperatures of 104-113 degrees. Heat has either dry or moist. we want to be sure to avoid tissue damage with heat method. Different types of heat: heating pad, hot water bottle. |
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Term
| What penetrates deeper? Moist or dry? |
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Definition
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Term
| When is heat not advised? |
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Definition
| In areas of poor tissue perfusion. Maybe don't use heat with diabetics or patients with peripheral vascular disease. |
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Term
| How long is heat or cold usually used? |
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Definition
| 10-20 minutes on --> off. Remember, we must protect skin at all times! |
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Term
| Other non-pharm interventions to control pain are: |
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Definition
| Vibration, Massage, TENS (transcutaneous electrical nerve stimulation). |
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Term
| Betty said all cutaneous stimulation may work (COLD, HEAT, Vibration, Massage, TENS) acording to the gate control theory. What is the gate control theory? |
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Definition
| the idea that physical pain is not a direct result of activation of pain receptor neurons, but rather its perception is modulated by interaction between different neurons... So, we can use Distraction, Music, Relaxation, Imagery, Positioning/Immobilizing painful areas (splints, casts, assistive devices) |
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Term
| Describe the difference in pain management for the elderly versus pain mgmt in the young adult? |
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Definition
| Elderly have decreased clearance levels. Older pt's experience greater maximum pain relief, the predominant effect is a longer duration of anagesia after a given dose. Therefore, age related increases in pain relief with parenteral drugs appear to be primarily related to increased duration in their system. |
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Term
| What are the characteristics & desired outcomes of acute pain? |
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Definition
| Acute pain: WHEN THE CATECHOLAMINES ARE RELEASED, get change in vital signs with acute pain. The stress response will increase BP, increase HR, feel cool, clammy skin, increase respiratory rate. The goal is to manage the pain effectively and allow the pt. to heal. |
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Term
| what are the characteristics & desired outcome of chronic benign pain? |
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Definition
| Won't see any change in the vitals with this pain, but will have fatigue, insomnia, depression, hopelessnes, anxiety, decreased mobility and lifestyle changes. We want to manage pain to add quality to their life. |
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Term
| What are the characteristics and the desired outcome of progressive pain (ie cancer)? |
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Definition
| Pain lasting longer then 6 months. classic axample of progressive pain: cancer pain. We want to manage their pain to add quality to their life. |
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Term
| What neurotransmitter is needed to transmit pain impulses from the periphery to higher brain centers? It causes vasodilation + edema. It is found in the pain neurons of the dorsal horn (excitatory peptide). |
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Definition
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Term
| What neurotransmitter is released from the brain stem and dorsal horn to inhibit pain transmission? |
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Definition
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Term
| What neurotransmitter is generated from the breakdown of phosopholipids in cell membranes? This same neurotransmitter is believed to increase sensitivity to pain. What is it? |
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Definition
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Term
| What are the 3 neurotransmitters? |
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Definition
| Substance P, Serotonin & Prostaglandins |
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Term
| What are the Neuromodulators (Inhibitors)? |
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Definition
| Endorphins + Dynorphins & then Bradykinin |
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Term
| What neuromodulator is the body's natural supply of morphine like substances? They're activated by stress and pain. Located in the brain, spinal cord and GI tract. They cause analgesia when they attach to opiate receptors in the brain. |
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Definition
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Term
| These neuromodulators are present in higher levels in people who have less pain than others with a similar injury. |
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Definition
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Term
| _______________________ are released from plasma that leaks from surrounding blood vessels at the tissues site of injury. They bind to receptors in the peripheral nerves, increasing pain stimuli. Also, binds to cells that cause the chain reaction producing prostaglandins (result from breakdown of phospholipids, increase sensitivity to pain). |
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Definition
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Term
| How does pain influence the young? |
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Definition
| They have trouble understanding pain and the procedures nurses administer that cause pain; young children who have not developed full vocabularies have difficulty verbally describing and expressing pain to parents and caregivers. |
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Term
| How does pain influence the elderly? |
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Definition
| Serious impairment of functional status can occur, has the potential to reduce mobility, activities of daily living, social activities outside the home and activity tolerance; requires aggressive treatment, diagnosis & management. |
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Term
| How do infants express pain? |
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Definition
| They cannot verbalize, but express with behavioral cues (facial expressions, crying, body movements) & physiological indicators that are observable. |
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Term
| Older adults are at _____________ risk than younger adults for painful conditions. However, pain is not an inevitable result of aging. |
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Definition
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Term
| True or False? Emotional suffering related to pain may be less in older then younger clients, but there is no scientific basis that there is a decrease in perception of pain occuring with age or that age dulls sensitivity of pain. |
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Definition
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Term
| Do older clients commonly underreport pain? |
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Definition
| Yes, b/c they expect to have it with older age, don't want to alarm loved ones, fear they'll lose their independence, not wanting to bother caregivers, believe caregivers know they have pain & they're doing all they can to relieve it already. Remember, NOT REPORTING PAIN DOES NOT MEAN THE ABSENCE OF PAIN. |
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Term
| Older clients often believe it is ___________ to show pain and have learned to use a a variety of ways to cope w/ it instead. |
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Definition
| unacceptable. Many older clients use distraction successfully for short periods of time. Assumptions about the presence or absence of pain cannot be made solely on the basis of a client's behavior. |
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Term
| Even though older clients experience a higher incidence of painful conditions, such as arthritis, osteoporosis, peripheral vascular disease, and cancer, than younger clients, studies have shown that they _______________ pain. |
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Definition
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Term
| Do cognitively impaired older adults have less pain |
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Definition
| No, it is very probable that pt's with dementia or other deficits of cognition suffer significant unrelieved pain & discomfort. |
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Term
| Does everyone respond to pain the same? |
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Definition
| No, definitely not. Cultures effect pain expression.. some are expressive & some introverted. It is imp for a HC provider to know what extent of particular culture has assimilated to American society. For ex/ if several generations of a Hispanic client's family have lived in the US, the influence of the Spanish culture may be limited, whereas newly immigrated clients still embrace their cultural norms. Nurses should explore the impacts of cultural difference on a clients pain and adjust the plan of care. Work with the client & their family to facilitate communication about the assessment and mgmt of pain. |
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Term
| _________ heightens the perception of pain and decreases coping abilities. |
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Definition
| Fatigue. If fatigue occurs along with sleeplessness, the perception of pain is even greater. Pain is often experienced less after a restful sleep than at the end of the day. |
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Term
| What is the relationship between pain & anxiety.... |
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Definition
| Anxiety often increases the perception of pain, but pain also causes feelings of anxiety. It is difficult to separate the 2 sensations. Critically ill or injured patients who do not have control over their environment or care, have high anxiety levels. This anxiety leads to serious pain mgmt problems. Pharm & nonpharm approaches to manage anxiety are appropriate. |
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Term
| As a HC provider, it is imp to know that clients ways of describing pain will vary. Americans often use hurt & ache to describe pain, and reserve "pain" for severe discomfort. What should you ask to elicity better responses? |
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Definition
| Always use words other then pain to obtain an accurate report. You should say, "Tell me what your discomfort feels like.. " Then they'll describe |
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Term
| The elastic tissue in the lung tries to contract when? |
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Definition
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Term
| __________ pressure within pleural space exerts a sucking force. |
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Definition
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Term
| What pressure keeps the lungs from collapsing? |
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Definition
| Intrapleural negative pressure |
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Term
| What is atmospheric pressure, intrapulmonary pressure & intrapleural pressure? |
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Definition
| Atmospheric & intrapulmonary pressure is both 760 mm Hg. Intrapleural pressure is 755 mm Hg. |
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Term
| Boyle's Law of Gases says, "Gases from from an area of _________ pressure to an area area of _________ pressure." |
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Definition
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Term
| What happens during inspiration? |
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Definition
| The diaphragm contracts, the chest cavity enlarges (air goes in), with larger lung space - the intrapulmonary pressure drops and air enters the lungs. |
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Term
| What happens during expiration then? (just the opposite) |
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Definition
| The diaphragm recoils, chest cavity shrinks, space within the lungs becomes smaller, pressure within the lungs rises, pressure within the lungs is greater than atmospheric pressure, air leaves the lungs. |
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Term
| Pneumothorax is the collection of ___ in the pleural space. Hemothorax is the collection of _____ in the pleural cavity. They both cause the lungs to collapse, cause pain & dyspnea (SOB). Hemothorax can also cause ______ b/c of blood. |
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Definition
| Air, Blood. Hemothorax can also cause SHOCK. |
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Term
| Will pneumothorax/hemothorax cause increased or decreased breath sounds in apex of affected side? What other symptoms. |
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Definition
| They cause DECREASED breath sounds in apex of affected side. Also, SOB, chest pain or pressure, hypoxia, decreased excursion on affected side. |
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Term
| What is tension pneumothorax? |
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Definition
| This is the WORST pneumothorax of all. The air puts pressure on the other side (which was good) and may cause lung to collapse, then heart & vessels are compromised. The trachea can get diverted to the side. Air fills the pleural space during inspiration, but cannot escape during expiration, the air exerts pressure on the lung on the affected side which may cause the lung to collapse. As the pressure increases-the heart and great vessels compress causing a backup in the venous system, decreased blood return to the heart, and decreased cardiac output. Emergency! |
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Term
| NS skills online said water sealed & waterless, but just remember... |
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Definition
| they are BOTH water sealed drainage for any test question. |
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Term
| What do you always need prior to chest tube insertion? |
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Definition
| Consent form signed by the patient & the doctor needs to explain what's happening. If it is an ER that is an exception. Otherwise, always remember you must have consent form signed by the patient. |
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Term
| What is a heimlich valve? |
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Definition
| a one way valve which may be attached to the chest tube that gets rid of the air. Allows air to escape from the pleural space but keeps atmospheric air from entering. Usually used in situation of chronic air leak, allowing the pt to go home with a chest tube. |
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Term
| A patient needs the following to have a chest tube put in... |
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Definition
| Stable vital signs, should not have respiratory distress or chest pain (but might prior to tube getting in), might have decreased breath sounds (over the lung will be normal until you get the chest tube in- you will hear a difference when ausculating until you get it expanded) Asymmetrical chest movements, don't want to have subcutaneous emphysema (air in the sub-cutaneous tissue. has little crackles. you can get cut/incision and you ca get air into the fat tissue. If you press around the area you will feel it. Normally, not something you want. Hypotension & Tachycardia (symptoms of shock) that might come across in the vitals. |
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Term
| Fluctuation/Bubbling of a water sealed chamber during insertion, intermittently and continuously. Which are ok & which are not? |
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Definition
| fluctuation/bubbling during insertion + intermittently is ok. If you hear it continuously it is not ok. Indicates an airleak. Can be at the site, you don't know-have to find out. Patient is not getting the benefit of the chest tube. You should chart & let the doctor know. You do not want a continuous air leak. Some experienced nurses can check where - watch them do it... |
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Term
| A problem related to chest drainage could be hemorrhage. Though it is rare, for it to be hemorrhage there is more then _____ mL an hour. You should know their vital signs + if they're having pain when you call the doctory. |
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Definition
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Term
| Continous bubbling in chest drainage indicates an |
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Definition
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Term
| Do you always need water in the water sealed chamber? |
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Definition
| YES, will have problems if you do not always have water. Always need to put water in & follow-up with checking that. |
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Term
| If you notice your patient is really struggling for air. Check for an accidental disconnect from the system. What do you do if you find it disconnected? |
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Definition
| When you have chest tubes, you need to have a bottle of water and a dressing (a 4 x 4). You should stick his chest tube in the bottle of water. Have a single system... you have time then to get a new system. If you clamo the sube with a shot of hemostate you can get attn pneumothorax in the course of an emergency if it goes on very long. |
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Term
| Tubing may become kinked or clamped, is that ok? |
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Definition
| No, always make sure you have NO KINKS OR DEPENDENT LOOPS! |
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Term
| 10 steps of chest tube assessment are: |
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Definition
| Check the dressing, check for subcutaneous air, no dependent loops, no stripping, want to check the level of water seal chamber, check tidaling (if patient breathes) & suction, check for bubbles in water seal chamber. Set collection chamber suction on GENTLE BUBBLING. Report type & amount of drainage. Make sure the entire system is "OPEN". You will drain out of a "HOPPER" - big system like a toilet, but it's 2 ft. across... it's for blood. |
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Term
| What do we document for chest tubes? |
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Definition
| In regards to the patient report: about the Dressing, Assessment of site of each dressing, Presence of subcutaneous emphysema. In regards to the system: report amount/type of drainage (mark on space like on the the NG tube. Mark todays date & time. See how much that is & note it) Presence or absence of air leak, Tidaling (want to note if the patient breathes). |
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Term
| What do you do if a chest tube patient needs an x-ray? |
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Definition
| If patient is on suction it's okay to turn suction off slowly and just leave the system. Send him to x-ray. Make sure other person knows it should be below the level of the patients chest. Put in a place that you do not kick over. it is safer hanging on the bed, but keep it below the patient too. Always check the tubing & make sure there isn't blood clots or dependent loops. |
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Term
| Why would a clients trachea shift to the side? |
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Definition
| Attention Pneumothorax, the build-up of air in thepleural space compresses the structures in the right chest and creates a mediastinal shift to the unaffected side. |
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Term
| What is the appropriate position of the client for chest tube insertion? If pneumothorax or if hemothorax... |
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Definition
| pneumothorax: lateral side-lying with affected side up; am above the head or semi-Fowler's with arm above head. Hemothorax: fluid in the pleural space, dangle at bedside leaning forward on bedside table. |
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Term
| Where is the tube inserted for pneumothorax? hemothorax? |
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Definition
| pneumothorax = 2-3rd intercostal space, midclavicular line. Hemothorax = 8-9th intercostal space, midaxillary line. |
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Term
| Why do we use negative suction pressure in chest drainage system? |
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Definition
| Under normal conditions, there is always negative pressure in the pleural cavity. This vacuuma effect is necessary for thelungs to stay fully expanded up against the inside of the chest wall. Applying suction pressure will facilitate removal of air and fluid from the pleural space and reestablish normal negativity. |
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Term
| What is the most important connection to keep sterile during set-up of the system? |
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Definition
| Patient drainage tube connection that attaches to the chest tube. |
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Term
| What is the advantage of a dry system? |
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Definition
| It is a more quiet system |
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Term
| What is subcutaneous emphysema? |
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Definition
| Localized accumulation of air in the subcutaneous tissue that is palpated as crackles under the skin. Usually resolves on its own, but may cause problems if it increases and moves towards the trachea. Nursing responsibility is to assess regularly and note any increase. |
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Term
| Are fluctuations in the water seal tubing normal? |
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Definition
| Yes, when pneumothorax is present, the fluid level rises with inspiration and falls with expiration. Absence of fluctuations indicates what? POssible obstruction in system or resolution of the pneumothorax. |
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Term
| Patients water seal chamber intermittently bubbles, what does this mean? |
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Definition
| INtermittent bubbling is normal with expiration or coughing when a client has pneumothrax. It means ther is still air in the pleural space. No action required, document in nurses progress notes. |
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Term
| patients water seal chamber has continuous bubbling, what would you think? |
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Definition
| Means there is an air leak in the system somewhere from collection unit to client. Assess all connections and the tubing for leak. |
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Term
| Patients water seal chamber has an absence of bubbling. What do you think? |
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Definition
| Means there is an obstruction in the system. Could be kinked tubing or blood clot. Or it may indicate that pneumothorax is resolved. Assess for obstruction, gently milk the chest tube to dislodge a clot. |
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Term
| Why is it contraindicated to "strip" a chest tube? |
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Definition
| Stripping a chest tube creates too much negativity in the pleural space and can cause tissue damage. |
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Term
| What is the risk of keeping the Vaseline gauze dressing on the insertion site for any length of time? |
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Definition
| a tension pneumothorax might develop if the client still has an air leak. |
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Term
| What are the signs of tension pneumothorax? |
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Definition
| Dyspnea (SOB), tachypnea (abnormally fast respirations), tachycardia (really high pulse rate above 100), hypotension (low blood pressure), restlessness, diminished breath sounds on the affected side, mediastinal shift on the unaffected side. |
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Term
| What should you do if you suspect a tension pneumothorax is developing? |
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Definition
| Intermittently lift the vaseline gauze dressing to allow air to escape until the physician can re-insert the tube. |
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Term
| Why is it important to not clamp the drainage tubing during transport? |
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Definition
| If the client still has an air leak, a tension pneumothorax might develop. |
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Term
| What are the only times it is ok to clamp the drainage tube? |
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Definition
| To locate a possible leak in the system or briefly when changing the collection unit. |
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Term
| Why is it preferable to obtain a specimen for culture and sensitivity from a dependent loop vs. from the collection chamber? |
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Definition
| It would be a "fresh" specimen and be more appropriate for culture. |
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Term
| Why is tension pneumothorax an emergency? |
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Definition
| it is a complete collapse of the lung. It occurs when air enters, but does not leave, the space around the lung (pleural space). As the amount of trapped air increases, pressure builds up in the chest. The lung collapses on that side and can push the important structures in the center of the chest (such as the heart, major blood vessels, and airways) toward the other side of the chest. The shift can cause the other lung to become compressed, and can affect the flow of blood returning to the heart. So, in the end the biggest ER is: Low/NO BLOOD FLOW FROM HEART! LOW CARDIAC OUTPUT |
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Term
| What is a water sealed suction? |
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Definition
| A prescribed amount of sterile fluid (20 cm of water maybe) is poured into the suction control chamber, which is then attached to a suction a source of tubing. The amount of sterile water added depends on the manufacturer's recommendations. The chamber is filled to the set volume for the prescribed amount of suction. Sterile water may need to be added several times a day because of evaporation. As the fluid level decreases, the amount of suction also declines. |
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Term
| Why are water sealed suctions important to use with chest tubes? |
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Definition
| They help to stop the problem of air moving back into the chest, and it also provides greater capacity for the collection of blood or body fluids without any clogging of the suction outlet/connection. |
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Term
| What is a Heimlich Valve? |
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Definition
| a One-Way valve attached to a chest tube. They allow air out, but no air in. Used for chronic airleaks and allows patient to go home with them. |
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Term
| Why do you irrigate N/G tubes? |
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Definition
|
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Term
| How often do you irrigate a N/G tube to suction? |
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Definition
| as ordered by the physician. Also, as much as the facility policy indicates. Or when the tube is occluded. |
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Term
| What do you irrigate with? |
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Definition
|
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Term
| Under what circumstances do you not irrigate an N/G tube? |
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Definition
| Fresh post-op or without an order/policy |
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Term
| What types of suction do you have for nasogastric suction? |
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Definition
| Intermittent (starts & stops) - there is Low (LIS) that is less pressure & High (HIS) Greater pressure. Then there is continuous. |
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Term
| WHen you are removing a N/G tube to suction - what should you assess? |
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Definition
|
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Term
| What are some observations to observe related to oxygenation? |
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Definition
| ANXIETY/RESTLESSNESS & BEING CONFUSED (#1 SIGN OF BEING HYPOXIC) also look at their facial expression, chest movements & retraction of chest wall, flaring nostrils, grunting, respirations (rate, rhythm & depth), respiratory patterns |
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|
Term
| How long should you apply suction to airways? |
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Definition
| Apply intermittent suction for up to 10-15 seconds in adults |
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|
Term
| How would you know if suctioning was effective? |
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Definition
| a decrease in adventitious lung sounds. Clearing of the breath sounds. |
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Term
| How would you position the conscious vs. the unconscious patient when suctioning? |
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Definition
| Conscious: with head to one side with oral suctioning and neck hyper-extended with nasal suctioning. Unconscious: with patient in side-lying position facing nurse. |
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Term
| What are the complications related to suctioning? How can they be prevented? |
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Definition
| Complications you can encounter suctioning are hypoxemia and de-saturation: arrythmias, hypotension. Prevent these by: applying suction for 15 second maximum, allow client to rest between catheter passes, give supplemental oxygen during rest periods,re-oxygenate before suctioning. |
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Term
| When would sterile technique be indicated vs. clean technique? |
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Definition
| Sterile is used for oropharynx & trachea. Clean is for the mouth. |
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Term
| when is oropharyngeal or nasopharyngeal suctioning indicated? |
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Definition
| Oropharyngeal or nasopharyngeal: used when the client is able to cough effectively but unable to clear secretions by expectorating or swallowing. |
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Term
| when is orotracheal or nasotracheal suctioning indicated? |
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Definition
| orotracheal or nasotrachaeal suctioning is used when the client with pulmonary secretions is unable to cough & does not have an artificial airway present. |
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|
Term
| What is the purpose of suctioning? |
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Definition
| to clear the respiratory tract of secretions when the client is unable to clear them by themselves. It helps to maintain airway patency and promotes gas exchange. |
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|
Term
| Is vaseline safe to use on an irritated nose when oxygen is being administered? who or why not? |
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Definition
| No! a spark can occur b/c Vaseline is a petroleum based product. Sparks with oxygen can cause fire. A water soluble lubrican should be used. |
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|
Term
| Describe the liter flow capacity for each oxygen delivery mode: |
|
Definition
• nasal cannula – 1-6 L/min provides 24-44% oxygen
• simple mask – 5-8 L/min provides 40-60% oxygen
• non-rebreather - > 10L/min provides > 90% oxygen
• venturi mask – 4-10 L/min provides 24-55% oxygen |
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Term
| Contrast the disadvantages of oxygen via nasal cannula |
|
Definition
Nasal cannula:
Flow rates beyond 6L/min of no benefit.
FiO2 (fraction of inspired oxygen) varies with patient respiratory rate/pattern.
Pressure points (ears & nose).
Drying of nasal mucosa; humidification for flow rates of > 4L/min. |
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Term
| Contrast the disadvantages of oxygen via Simple Mask |
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Definition
• Simple Mask:
o FiO2 generally not accurate
o Must remove for eating, cough, etc
o More uncomfortable than cannula |
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Term
| Contrast the disadvantages of oxygen via Non-rebreather: |
|
Definition
Non-rebreather:
o Must remove for eating
o Uncomfortable
o Risk of suffocation if oxygen source inadvertently disconnected |
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|
Term
| What are two advantages of nasal cannula and mask (any type)? |
|
Definition
• Nasal cannula:
o Most comfortable to wear
o Don’t have to remove to eat
• Mask:
o Provides slightly higher FiO2 than cannula
o Suitable alternative for patients with nasal trauma |
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|
Term
| With what patients is the venturi mask especially helpful? |
|
Definition
| It is used in patients with COPD; they have CO2 retention so accurate flow of oxygen is required |
|
|
Term
| How is the venturi mask set? |
|
Definition
| With a dial (different colors) |
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|
Term
| If you find a patient on O2 using a hair dryer or electric razor, what should you do? |
|
Definition
| Turn off immediately. Explain that a spark from one of these could combine with oxygen and cause a fire. |
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|
Term
| What does a pulse oximeter measure? |
|
Definition
| It is used for continuous or intermittent measurement of arterial oxygen saturation. Most of the oxygen transported by the blood is bound to hemoglobin. The degree of binding or saturation is determined by the percentage of hemoglobin that is loaded with oxygen. It measures only the percentage of hemoglobin that is carrying oxygen. It provides no specific information about the patient’s overall hemoglobin level or how well oxygenated blood is being delivered to the tissues. |
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Term
| What patients are recommended for use of pulse oximetry? |
|
Definition
Those at risk for hypoxemia:
o patients undergoing anesthesia;
o post anesthetic patients; critical care and emergency room patients;
o patients undergoing invasive procedures, oxygen titration, and/or weaning from mechanical ventilation |
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|
Term
What do the following values indicate for pulse oximetry?
• 95% and above=
• Below 90% = |
|
Definition
95% and above= normal
Below 90% = desaturation, report to physician |
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|
Term
| Your patient asks “When should I use the incentive spirometry?” Your response is: |
|
Definition
| Every 1-2 hours while awake, 5-10 repetitions. |
|
|
Term
| When is incentive spirometry indicated? |
|
Definition
| Indicated for surgical patients, pneumonia, those patients at risk for atelectasis |
|
|
Term
| Why is incentive spirometry encouraged? |
|
Definition
| Because it encourages the patient to take deep breaths thereby preventing atelectasis (collapse of a lung). It also gives visual feedback to clients about inspiratory volume. |
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|
Term
| A postoperative inspiratory capacity should be what percentage of the preoperative volume? |
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Definition
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Term
| How should the patient be instructed to use the incentive spirometer? |
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Definition
| Tell the client to inhale slowly and with an even flow to elevate the balls and to keep them floating as long as possible to ensure a maximally sustained inhalation. |
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Term
| What is a Thorpe tube? What is a bourdon gauge? What is each used for? |
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Definition
| A Thorpe tube is a scale & ball or plunger float that attaches to a wall oxygen outlet. A bourdon gauge is a round face with a needle adjustment usually seen on oxygen tanks. |
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Term
| How many psig (pounds per square inch, gauge) should there be for an oxygen tank to be full? |
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Definition
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Term
| At what psig would an oxygen tank be considered empty? |
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Definition
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Term
| How should an oxygen tank be stored when not in use? |
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Definition
| It should be stored in its proper carrier (upright) |
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Term
| At what angle can a bourdon gauge be read accurately? |
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Definition
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Term
| What are the advantages of using humidification with oxygen? |
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Definition
o Less drying of membranes, increases patient comfort level.
o May be heated |
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Term
| When should humidification be used? |
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Definition
| Flow rate 4 L/minute or above |
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Term
| What are important nursing/RT implications when humidity is used? |
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Definition
| Must use sterile saline for humidification – solution should be changed according to agency policy; humidification can be a source of nosocomial infection. |
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Term
| Why do we use nebulization? |
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Definition
| It improves clearance of pulmonary secretions. It is also used to administer bronchodilators and mucolytic agents |
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Term
| Definition of Chronic Illness is: |
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Definition
Impairment or deviation from normal functioning that has one or more of the following characteristics:
• It is permanent
• It leaves a permanent disability
• It is cause by nonreversible pathologic alterations
• It requires special training of the client for rehabilitation
• It may require a long period of care.
• Taken from National Commission on Chronic Illness
• Usually lasts longer than 6 months |
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Term
| The # of chronic conditions is increasing. Due to what? |
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Definition
| ever growing # of elderly people, increasing # of people surviving major ilnesses that in the past would have died, illnesses previously viewed as acute (such as heart attack, stroke or HIV) are now recognized to be episodes of chronic conditions, lifestyle diseases account for a significant # of chronic disorders (such as diabetes, cancer and emphysema), ACCIDENTS also contribute to the # of chronic and disabling conditions (such as traumatic brain injuries, spinal cord injuries, amputations) |
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Term
| What are the most common "costly" chronic illnesses? |
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Definition
| diabetes, arthritis, asthma and other chronic lung problems, osteoporosis, mental disorders, Alzheimer’s disease, neurologic disorders such as strokes and spinal cord injuries, and hypertension. |
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Term
| There are 4 stages of a chronic condition or a typical pattern of chronic illness. This is called a _________. |
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Definition
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Term
| What are the 4 stages of the chronic condition or typical pattern of chronic illness? |
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Definition
• Prediagnostic
• Diagnostic
• Chronic
• Terminal |
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Term
| Why is it so imp that the individual & their family understand this pattern (trajectory)? |
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Definition
| because clients and their families largely carry out the management of the chronic condition in the home environment. |
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Term
| In the prediagnostic stage, what are the manifestations and risk factors that are present? |
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Definition
The MANIFESTATIONS of chronic conditions MAY BE VAGUE OR ABSENT. There may be risk factors present, which may or may not be plainly visible such as:
• Heart disease – smoking, high fat diet
• Breast cancer – family tendency
• Hypertension – smoking, high cholesterol, stress, age, high salt intake
• Colon cancer – high fat diet. |
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Term
| Some Risk Factors are modifiable and others are not modifiable... give ex's of each: |
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Definition
| Smoking, obesity, stress are modifiable. Heredity, gender, age are not modifiable. |
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Term
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Definition
•The client is definitely aware that something is amiss.
•Some seek medical attention and may receive a diagnosis in all stages of this phase.
•The chronic condition that can follow the acute illness or trauma is more readily apparent.
•Clinical manifestations range from vague to severe to life threatening.
•Hypertension is labeled the "silent killer" because there are no symptoms until harm is done to vital organs (brain, heart, and kidney) and the individual may have no idea that he has high blood pressure. |
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Term
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Definition
•This stage is often referred to as "the long haul".
•The individual must learn to live with the condition for a prolonged period of time – more often the rest of their life.
•This is a period of remissions and exacerbations and later a progressive decline (which may be rapid or slow).
•If the condition has an acute onset (stroke, heart attack, and spinal cord injury) the greatest return of function frequently occurs within the first six months.
•Some individuals who are in the chronic and terminal stages of an illness must seek nursing care from a long-term care facility either in a hospital or a nursing home. |
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Term
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Definition
•The changes in body systems become irreversible
•When the loss of those functions is incompatible with life.
•Some chronic conditions (arthritis) do not have a terminal stage.
•Death is due to other conditions – treatment with steroids.
•Technological advances have eliminated the terminal stage for some chronic conditions (renal failure – kidney transplant). |
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Term
| Trajectory is defined as the course of something, indicating the predictable direction & movement. In healthcare, the illness trajectory begins & ends when? |
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Definition
| the illness trajectory begins with the pathological event (however subtle) and ends with either the resolution of the problem or the development of another problem or complications. |
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Term
| With medicine’s advanced technology, is there is the opportunity to change the trajectories from past ages? |
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Definition
| Yes, but there must be compliance on the client’s part. |
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Term
| However, the trajectory seldom takes into account the _____________ aspects of a chronic condition. |
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Definition
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Term
| THe adaptation theory can be applied to chronic illness. What is the definition of adaptation? |
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Definition
| The process and outcome whereby the thinking and feeling person uses conscious awareness and choice to create human and environmental integration |
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Term
| Explain the 5 stages of adaptation (usually in HC to finding out about a condition) |
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Definition
•DISBELIEF is the first phase. Denial may stay with the client for awhile. This is a protective mechanism to allow the client time to adjust.
•DEVELOPING AWARENESS is the second phase. It may be referred to as a stage of anger. The client can be outright angry, cry, withdraw, become depressed, may feel guilt – if they had just been a better person, or followed the physician’s directions to a "T".
•INTEGRATION is the third phase and is the rational acceptance of the chronic condition.
•COPING behavior is the fourth stage and are highly individualized. Some are effective and constructive while others are ineffective and can do damage. The nurse needs to support the client’s better coping behaviors.
•SUCCUMBING behavior may develop if the stages listed above are not passed through successfully. |
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Term
| In what stage does a person have rational acceptance of their chronic condition? |
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Definition
| Integration (the 3rd phase) |
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Term
| What stage can develop if the client does not pass through the previous phases normally undergone? ie. disbelief, then developing awareness where they are angry & cry, the integration (rational acceptance), then coping (everyone does this their own way... some ways are effective & others do damage). |
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Definition
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Term
| To live with a chronic illness, food family support is very important. The patient & their families must learn how to be involved in what tasks? |
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Definition
| Prevention of medical crises. Following prescribed medical therapy, Management of medical crises that do occur (what protocol to follow), Performance of prescribed regimens (very necessary), Prevention of social isolation (work to keep these people in contact with others), The longer the patient lives with a chronic illness the more body systems that will be involved, As with all patients, they should always have all prescriptions filled at the same pharmacy so each drug can be evaluated for drug to drug interaction. |
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Term
| Definition of Rehabilitation: |
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Definition
| Process of learning to live with a chronic or disabling condition. Goal is to return client to fullest possible physical, mental, social, vocational, and economic capacity. |
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Term
| Two basic goals of the rehabilitation team? |
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Definition
| Maximize abilities and minimize disabilities. |
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Term
| Acute care vs. rehab following effects? |
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Definition
| With acute care there is no residual impairement, but with rehab there is residual impairment. |
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Term
| What is the difference between chronic illness and a disabling condition. |
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Definition
| A chronic illness lasts at least 3 months and a disabling condition is a physical, mental or behavioral health condition that can cause a disability. |
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Term
| Participation in rehab is done for what reasons? |
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Definition
1) prevent disability,
2) maintain function,
3) restore as much function as possible |
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Term
| Drug & Alcohol Rehab involves both... |
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Definition
o Physical Dependency and
o Psychological Dependency |
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Term
| Abnormality in body structure(s) or function resulting from any cause. May be temporary or permanent. This is the definition of _____________. |
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Definition
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Term
| Consequence of an impairment and usually described in relation to functional ability. This is the definition of ____________. |
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Definition
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Term
| The disadvantage person feels as a result of an impairment or disability at societal level. A lot of impairments are made worse by how society looks at them or deals with them. This is the definition of _____________. |
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Definition
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Term
| The Principles of rehab are: |
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Definition
1. Rehabilitation should begin ASAP.
2. Pathology precipitating a disability may be irreversible and non-treatable.
3. An individual's capabilities should be maximized and their disabilities minimized.
4. New and modified behavior patterns must be developed to cope with current and anticipated situations.
5. A meaningful life must be made possible that preserves the dignity and worth on an individual.
6. The psychological reaction to a physical impairment is similar to grieving.
7. The individual and his/her significant others are participants in decision-making.
8. Rehabilitation requires the collaborative efforts of the health care team.
9. Rehabilitation is a process that never ends. |
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Term
| Are disabilities always negative? |
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Definition
| No, disabilities do not have to affect your life negatively |
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Term
| What was the poem "welcome to Holland" about? |
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Definition
| family who has a child with special needs. Imp to make parents see it isn’t terrible, it is just a different place. You’ll get to same goals in a little bit different way. |
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Term
| What is the point of voactional rehab? |
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Definition
| Individuals are assessed for need for job modification or vocational rehab. the Goal is: Meaningful training, education & the end goal is employment. Many productive years left. |
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Term
| How should a blind person be treated? |
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Definition
| same as you would anyone else. They do the same things, but use different techniques. |
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Term
| What lubricant do you use with nasopharynx & nasotrachea? |
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Definition
| water soluble jelly. no petroleum based products like Vaseline. |
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Term
| Peak flow meters measure the: |
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Definition
| maximum volume of air expelled forcibly in expiration |
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Term
| What position do most breathe best in? pregnant people? |
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Definition
| Ask the patient, but most is High Fowlers. Pregnant wommen low Fowlers b/c otherwise it can put pressure on their diaphragm. We want to use gravity to help facilitate breathing. Keep these patients mobile too... helps decrease fluids. |
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Term
| Nursing interventions to maintain and promote lung expansion biggest purpose is: |
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Definition
| to maintain the AIRWAY! (breathing is always #1 in test questions, she said) |
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Term
| Your pt. is pursed lip breathing. Can you give him some oxygen quick, then tell the doctor? |
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Definition
| No, oxygen is a medication & requires a physicians order. If pt. is coding then you do it, but otherwise oxygen is considered a med & you don't just apply if you feel like it. |
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Term
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Definition
| causes restlessness! irritability, anxiety, confusion, disorientation, patients will faint. Vitals in hypoxia: increases pulse rate (tachycardia), increases respiratory rate (tachypnea), elevates BP, cardiac dysrhythmias, pallor, complains of dyspnea (uncomfortable breathing), and finally cyanosis. This is a late sign... need to worry! |
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Term
| What are the advantages of nasal cannulas? |
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Definition
| Can leave on ALL THE TIME, do NOT HAVE TO TAKE OFF TO EAT, it is comfortable. We need to look at: any type of skin breakdown in nose or ears. Check skin every 6 hours. Can humidify & you should if you can... |
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Term
| What are the advantages & disadvantages of the simple mask? |
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Definition
| Advantages: can provide a higher level of oxygen. Alternative for pt who has had any nose trauma. Disadvantage: pt has to remove if eating or coughing so oxygen is going up and down. It is not comfy. Can switch simple mask with nasal cannula to give nose a break. |
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Term
| Non rebreather masks have reservoir bags. There is a partial rebreather & a non rebreather. Only difference is: |
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Definition
| the nonrebreather has 2 flaps over exhalation port. The danger this can be is the pt can suffocate & rebreath all of the oxygen.... really need to watch. Partial rebreather: those ports are open so don't need to worry about that. |
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Term
| Advantage of non rebreather mask: |
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Definition
| you can deliver HIGH amount of oxygen. |
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Term
| Advantage of the venturi mask? |
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Definition
| It is the most acccurate oxygen delivery system with color coded adapters. |
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Term
| Never take a patient anywhere if there is less then ___ psig (pounds per square inch). |
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Definition
| 500. A full tank is 2000. Make sure it is turned on when you read it :) turn off when not in use. |
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Term
| Oral airways & nasal airways are used on what patients? |
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Definition
| oral is UNCONSCIOUS (put it in sideways and twist it to hold the tongue down. Nasal airways are used on UNCONSCIOUS & SEMI-CONSCIOUS, use for frequent NT. |
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Term
| If pt needs to be intubated and has loss of arway, burns or they're unable to breathe on their own we need to deliver air for them. These can be put in temporarily under sedation at the pt's bedside. Client cannot talk, eat or drink. Has a cuff that prevents aspiration (stomach contents can't come up & go into the lungs). ALso prevents excape of oxygen for mechanical ventilation. These are.... |
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Definition
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Term
| _________ are used when trached for 10-14 days. They're inserted nasally or orally. They are temporary & are inserted at the bedside. A persons pinky is about the size of their trachea. |
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Definition
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Term
| Nursing care of Endotracheal tubes requires: |
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Definition
| Secure ET tube, restrain client if necessary, use alternative forms of commuication, suction when indicated, absolutely need to do FREQUENT ORAL CARE, routinely assess oral membranes, reposition ET tube every 24 hours (move tube to opposite side), document position (keeps from slipping in or out) and monitor for potential complications. |
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Term
| Are endotracheal tubes temporary or permanent? |
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Definition
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Term
| If behavior is unassertive, it is ______. If it is overassertive, it is _________. |
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Definition
| unassertive (passive), overassertive (aggressive) |
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Term
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Definition
| It's a personality trait characterised by covert obstructionism, procrastination, stubbornness, and inefficiency. This behaviour is often a manifestation of passively expressed underlying aggression, and sometimes benefits from therapy |
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Term
| One may exhibit assertiveness by: |
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Definition
| behaving, within the parameters of a situation, in an effective fashion, honestly expressing one's feelings, while respecting the right and feelings others involved. |
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Term
| Develop assertive behavior skills. Talk about EDIA: |
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Definition
| E=Empathy statement. D=non-blameful description of another's behavior, I=an "I" message, A=an action statement, what it is you want to happen. |
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Term
| How do we learn assertive behavior skills? |
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Definition
| By instruction, behavior modeling, and by PRACTICE (main way!) and feedback. |
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Term
| Would you say, "That person is passive" or "I am passive?" |
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Definition
| No you don't speak about someone who is passive as being passive. Say their behavior tends to be passive. Assertiveness is a characteristic of behavior. It is person & situation specific, not universal. |
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Term
| What should the nurse do if she notices the chest tube has been pulled back or dislodged? |
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Definition
| That's when the 4 x 4 dressing comes in handy. Keep a 4 x 4 on to stop the air from coming in. We put it on at the height of EXPIRATION. have the patient cough & slap it on. We used to tape it on, but now we just tape 3 sides of gauze dressing. It sucks in, but they can breathe out & don't get attention pneumothorax. |
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