skills exam 2 (parenteral, bed/nutrition, IV)

parts of syringe

parts of needle

mixing medications

must be compatible!

intradermal injections

skin testing

use tuberculin or small hypodermic syringe

5-15 degree insertion with bevel up

creates bleb

SQ injection

usually 1-2mL syringe; unless insulin syringe

25 gauge 5/8 needle

IM

very obese- 3 inches

thin- ½ to 1 inch

adults- 2 to 5 ml

children, thin, older- up to 2 ml

smaller children and older infants- up to 1 ml

smaller infants- up to 0.5ml

IM injection sites

ventrogluteal site

vastus lateralis

deltoid

choosing IV site

basilic, cephalic, medial cubital

central lines

subclavian, jugular, femoral

sterile procedure

PICCs- long term use

critical assess use; accessed only by physician

infusaports

long-term fluid or replacement needs

chemo, radiation, poor vascular access, frequent vascular access, surgery

irritating infusions

potassium, vasoactive medications

parts of IV needle

IV gauges

IV site care

assess every 8 hours

dressing change 24-72 hours

tubing 48-72 hours

IV bags every 24 hours

documentation- date/time, size/type of cath, number of attempts, dressing/stabilzation, patient tolerated

infiltration

IV dislodges from vein

swelling, coolness, pallor, pain, feel “tight”

no blood return

needs to be removed immediately; place warm compress to site and avoid

phelbitis

check site every 8 hours- redness, warmth, swelling, burning

inflammation due to- too big cath size, irritating solution, infection at site

extravasation

caused by irritating fluids

burning, stinging, redness cause necrosis/ulceration

factors affecting hygiene

culture, socioeconomic, spiritual practices, developmental level, health state, personal preference

skin assessment

incorporate with other assessment of other body systems

look for rashes, lumps, itching, dry, lesions

teaching skin care

more expensive does not mean better

deodorants and antiperspirants not recommended for some procedures

cosmetic- harmful additives, bacteria growth, throw out 2-4 months, dont share

sunscreen- sun exposure increases risk for cancer; certain medications increase sun sensitivity

check for ticks

gingivitis

inflamed gingiva

periodontitis

inflamed gums leads to degeneration of tissues/bone

tartar

hard deposits on gum lines from plaque/bacteria build up

halitosis

strong mouth odor

could be first sign of periodontal disease

stomatitis

inflamed oral mucosa

glossitis

inflamed tongue

cheilosis

ulcer/dry lips w fissures at angle of mouth

could be strep bacteria/lack iron/B vitamin or skin irritation

feet/nails

edema

special shoes

cleanliness and intactness

cap refill and contour of nail bed

swelling, inflammation, lesions of the feet

perineum

swelling, inflammation, itching

special hygiene during menstruation

note- color lesion, excoriation, tenderness, discharge, anal cracks, nodules, distended veins, masses, or polyps

odor

hair

texture, cleanliness, oiliness

scaling, lesions, inflammation, infection

dandruff, alopecia, pediculosis

early morning care

toileting

refresh patient for day

wash face and hands

mouth care

AM care

after breakfast

toileting, oral care, back massage, special skin measure, hair care and cosmetics, dressing, position for comfort, refresh and change linen, tidying up bedside

partial and complete bathing

PM care

ensure comfort after lunch

offer assistance with toileting, handwashing, oral care

straighten bed linens

help with repositioning

hour of sleep (HS care)

toileting, washing, oral care

back massage

change any soiled bed linens or clothing

position comfortably

call light and other objects needed are in reach

PRN care

offer individual hygiene measures as needed

change clothing and bed linens of diaphoretic patients

oral care every 2 hours

bathing

removes oil, perspiration, dead skin, some bacteria

stimulate circulation

produce sense of well-being

excessive bathing and elderly may experience dry skin

musculoskeletal exercise

vaginal

plain soap and water

pubic to anus

male

tip, circular motion from meatus outward; downward strokes