Patient Care II study guide

Five Drug Rights

1. Right patient

2. Right drug

3. Right amount

4. Right route

5. Right time

venipuncture should be preformed in what patient position?

seated, with the arm extended and supported by a surface so it extends in a straight line

Where should the tourniquet be placed?

5-6 inches above the puncture site

Tourniquets are made of what kind of material?

NON-latex

The tourniquet is too tight if what is visualized?

1. blanching of the skin

2. small, reddish discolorations

The tourniquet should be tied in such a way that it can be undone with

1 hand (tuck end under another)

What vein is best for venipuncture?

median cubital vein

Why is the median cubital vein ideal for venipuncture

1. most superficial

2. largest

3. least likely to “roll”

4. least painful

What can the technologist do to prevent/minimize vein rolling

Anchoring the vein below the venipuncture site with fingers

Vein preference in order

1. median cubital

2. cephalic

3. basilic

Why is the basilic vein least preferred?

1. most likely to roll (least anchored)

2. closest to the median nerve (risk of nerve damage)

3. closest to brachial artery

Vein should be _______ rather than seen

felt (palpated)

What finger should never be used for palpation and why?

1. thumb

2. thumb has its own pulse beat

Veins should feel

1. spongy and springy (collapse when palpated)

2. lacking heartbeat

Strategies for vein localization

1. tap antecubital area with index finger

2. hand arm down

3. massage arm from wrist to elbow

4. apply WARM compress

If the median cubital vein cannot be found on the selected arm, where should be looked for next?

the median cubital vein on the other arm

Legs and feet veins require _______ to be utilzed

1. exhaust all other options

2. physician approval

Avoid these vein sites:

1. veins that contain clots

2. veins that have scarred skin over them (burns, tattoos) (can cause infection)

3. veins on the same side of a recent mastectomy (can limit lymph flow)

If you have inserted the needle at too steep an angle and punctured through the vein, what should you do?

slowly withdraw the needle until it’s in the vein

If you have inserted the needle at too shallow an angle and punctured halfway through the lumen of the vein, what should you do?

slowly advance the needle

Angle for venipuncture

15-30

Angle for Sub Q

45 degrees

Angle for IM

90 degrees

One of the most commonly utilized IV needles

winged/butterfly needles

How should you cleanse venipuncture site

circular, inner to outer skin

What is the difference between an ampoule and a vial

1. vials can be used over and over again and have a rubber stopper

2. ampoules are single use and made of glass, filter needle must be used and the ampoule is broken for use

Why are angiocath needles preferred?

the needle retracts after usage to prevent accidental sticks

NG goes from ____ to _____

nasopharynx to stomach/duodenum/jejunum

NE tube goes from _____ to ______

nasopharynx to small intestines (duodenum) via peristalsis

G tube (gastronomy)

stoma from stomach to abdomen

it is the role of the technologist to suction patients: T/F

false

in what area are tissue drains placed?

in areas that tolerate the accumulation of fluid poorly

Purposes of NG tubes

1. diagnostic examinations

2. administration of feedings/medicine

3. treat intestinal obstruction

4. control bleeding

The two most common NG tubes are:

1. Levin

2. Sump

Levin tubes are _____ lumen

single

Sump tubes are ______ lumen

double

The second lumen of the sump tube remains (inside/outside) of the patient, and is called a “______”

1. outside

2. “pigtail”

the pigtail of the sump tube does what?

controls pressure of the tube to prevent tissue damage

the nutriflex tube is used primarily for:

feedings

the nutriflex tube has what attached to its end

a mercury weighted tip

the moss tube has how many lumens (and what are their purposes?)

1. 3

   1. inflatable balloon

   2. aspiration of fluid

   3. duodenal feeding

the S-B tube is ____ lumen and the patient must be continuously monitored if one is in place while a radiographer is taking images

triple lumen

3 purposes of NE tubes

1. decompression

2. diagnosis

3. treatment

Most common NE tubes

1. Cantor

2. Harris

3. Miller-Abbott

Of the three most common NE tubes, which is not single lumen?

Miller-Abbott (double lumen)

What is most important to remind the patient to do while inserting an NG/NE tube?

continuously swallow (often while drinking fluids)

What position is preferred for insertion of an NG/NE tube?

Fowler’s

What methods can be utilized to determine if an NG tube is in the correct placement?

1. initial radiograph

2. withdraw gastric fluid

3. use a litmus paper to test pH (3 indicates correct placement)

Patients with gastric tubes may not eat under any circumstance, unless ordered by a physician (T/F)

True

NE feeding tubes are what kind of lumen?

narrow

NE feeding tubes are inserted for the purposes of:

feeding a patient that cannot tolerate eating or taking medications through oral route, and are expected to need to be fed through this method for some time.

NE feedings/medications are given through three methods:

1. gravity drip

2. bolus

3. controlled pump

What tool must be close by when inserting/withdrawing an NG/NE tube?

emesis basin

If removing an NG/NE tube is met with resistance, what should be done?

stop immediately and call for assistance

Three things must be done before transporting a patient with an NG/NE tube in place:

1. Verify physicians order before transport

2. Verify how long suction can be discontinued (time)

3. Verify what pressure is needed for suction

What can be inserted into a double lumen NG tube during transport

a barrel of a piston syringe

What should never be done to a double lumen NG tube during transport?

clamping of the tube (destroys double lumen effect)

Gastronomy tubes can be ______ or _______

permanent or temporary

A newly installed G tube requires what?

sterile gloving when coming into contact (avoid infection)

What is placed for patients that require longterm medical administration, frequent blood transfusions, Hyper-osmolar solutions, or total parenteral nutrition

CV catheters or implanted ports

PPN

partial parenteral nutrition

TPN

Total parenteral nutrition

TPN solutions are _______

hyperosmotic

best location for a CPV line

Brachiocephalic vein at junction of the SVC

Tunnel type CV catheters

1. Hickman

2. Broviac

Other commonly used CV catheters

1. PICC lines (peripherally inserted central catheter)

2. Groshong

What three methods can determine PICC placement?

1. x-ray

2. ultrasound

3. c-arm

What needle is used to access an implanted port

Hubur needle

What two positions are acceptable to place a patient to prevent aspiration when they are vomiting?

1. Semi Fowlers

2. Log roll to side

Suctioning is a _______ procedure

emergency

The radiographer is responsible for what to do with suctioning

Checking if there is suctioning equipment in their department everyday

Suction pressure adults

110-150 mm Hg

Suction pressure infants

50-95 mm Hg

What is a tracheostomy

a tube inserted through the trachea to allow for breathing when the upper airway is obstructed

Are positive pressure or negative pressure ventilators more commonly utilized?

positive pressure (not typically used at home)

Which kind of positive pressure ventilator is most commonly used?

volume-cycle

correct ET tube placement

1-2 inches above the carina (3-5 cm)

placement of the ET tube into the RIGHT main bronchus will cause what?

collapse of the left lung

how many chambers are typically in a chest tube water seal system

2-3

the water seal should remain ______ the patients chest at all times

below

Common tissue drains

1. Hemovac

2. Jackson-Pratt

3. Penrose

Which tissue drains are meant to maintain a constant low pressure by means of a small bulb or evacuation container?

1. Jackson-Pratt

2. Hemovac

Nosocomial infection

An infection acquired in the course of medical care

Iatrogenic infection

An infection acquired during treatment/therapeutic procedures

Exogenous nosocomial infection

An infection within the hospital that comes from flora not native to the patient

Endogenous infection

An infection caused by an imbalance of flora that already dwells naturally inside of the patient

Most common site for a nosocomial infection

Urinary tract (CAUTI)

Protista kingdom

1. Algae

2. Protozoa

3. Fungi

4. Bacteria

Bacteria have simpler internal structures and therefore are called ______

Prokaryotes

Four major disease producing organisms

1. Bacteria

2. Fungi

3. Viruses

4. Parasites

If a microorganism is known to produce disease, it is deemed a _____

Pathogen

Resident flora

Bacterium/microorganisms that typically are housed in an area of the body in a stable level

Example of resident flora:

1. Staphylococci on skin

2. E.coli in the intestinal tract

Transient flora

Flora that is acquired from contact an object (ex: flora that has been picked up on the skin from contact with surfaces)

Bacteria are classified according to _____ and _____

1. Shape

2. Immunological/genetic characteristics

Endospore

A bacteria able to form a protective coating/layer to stay alive in an unfavorable environment (these are difficult to kill)

aerobes survive in _______ environments, whereas anaerobes survive only in ______ environments

1. Oxygenated

2. Non-oxygenated

Diseases caused by bacteria:

1. TB

2. Staph infections

3. Strep

4. Salmonella

5. Lyme disease

6. Gonorrhea

7. Syphilis

8. Tetanus

Fungi are eukaryotic or prokaryotic?

Eukaryotic

Fungi exist in two forms:

1. Yeasts

2. Molds