patient care skills ch 10 (exam 3)

special needs patients

-acutely ill and requiring extensive nursing care

-may need life-supporting equipment

-advantages of early application of rehabilitation

considerations for special needs patients

-past and present medical and surgical history and prior level of functioning

-sedation and level of alertness

-cognition and ability to learn

-patients active participation level

-medical stability

-activity tolerance

-adequate muscle strength to participate in active mobility training

Therapy progression of ICU patient

-check vital signs

-asses level of alertness and ability to follow comands

-therapeutic exercise in all planes

-asses bed mobility and supine to sit transfer

-sitting on edge of bed (EOB)

-establish attainable goals

-establish treatment plan
-EOB exercises

-transfer training

-gait training

types of beds

-standard adjustable bed

-air fluidized beds

-post truama mobility beds

-low air loss therapy beds

standard adjustable bed

-most hospital beds can be adjusted using electrical controls

-bed can be raised or lowered, upper and lower components can be adujusted, lower portion can provide knee and hip flexion

-has rails and make sure they are locked when you have them up and in use

-adjust bed to wear you will have the best access to the patient and allow you to use proper body mechanics

-make sure patient is able to contact nursing personnel

air fluidized bed

-rectangular or ovoid bed that contains silicone-coated beads called microspheres

-heated, pressurized air flows through the beads to suspend polyester cover that supports the patient

-patient feels as if they are floating on a warm waterbed

-contact pressure of patients body against polyester sheet is approximately 11-15 mmHg

-less than 32mmHg is beneficial to prevent pressure sores

-indicated for patients that have several infected lesions or requires skin protection and whose position cannot be altered easily (spinal cord injury), requires immobilization.

-temp of air can be controlled, best for preventing pressure sores

-but a sharp object can puncture the bed and it is very expensive

post trauma mobility bed

-designed to maintain a seriously injured patient in a stable position and maintain proper postural alignment through the use of adjustable bolsters

-bed can be turned and repositioned with touch of a button to reduce amount of prolonged pressure

-indicated for patients with reduced respiratory function or advanced pressure injuries, or for patients who require stabilization and alignment after extensive trauma

low air loss therapy bed

-have several segmented and separated air pods that allow the limited escape of air, and the mattress actually channels air toward patients skin

-amount of air pressure can be controlled based on the patient

-indicated for patients with prolonged immobilization, at high risk of developing pressure sores, condition requires elevation of trunk, or who are obese

mechanical ventilators

-currently use positive pressure to move or propel gas or air into patients lungs

-purpose is to maintain adequate air exchange when normal respiration is inhibited

volume cycle ventilator

-primarily used for patients who require long term support, have COPD, patients after thoracic surgery, musculoskeletal disorders, brain injury, etc

-predetermined volume of gas, which is depended on patients needs, is delivered during the inspiratory (inhale) phase of respiration, and expiratory phase remains passive

pressure cycled ventilator

-delivers a predetermined maximum pressure of gas during respiration, and the inspiratory phase ends when that level is reached

-expiratory phase remains passive

-only for short term ventilation

negative pressure ventilator

-mimics natural breathing but lowers pressure inside chest cavity

-this causes lungs to expand and air rush through nose naturally

-when negative pressure is released, there is gentle compression and the chest reconcile and expiration happens

modes of mechanical ventilators

-assist/control (A/C)

-continuous positive airway pressure (CPAP)

-synchronized intermittent mandatory ventilation (SIMV)

-pressure control ventilation (PCV or PC)

-pressure support ventilation (PSV or PS)

-positive end expiratory pressure (PEEP)

airway placement of ETT (endotracheal tube)

-oral pharyngeal

-nasal pharyngeal

-oral esophageal

-nasal endotracheal

-oral endotracheal

-tracheostomy

-laryngostomy

common parameters for monitors

-cardiac and vital signs (main one we need to know)

-ABGs

-intracranial pressure (ICP)

-pulmonary artery pressure (PAP)

-central venous pressure (CVP)

-arterial pressure (A line)

types of monitors

-oximeter

-vital signs monitor

-pulmonary artery catheter

-intracranial pressure monitor

-central venous pressure catheter

-arterial line

-indwelling right arterial catheter

-peripherally inserted central catheter

cardiac enzyme levels

-help determine wether the heart has been damaged

-elevated troponin can indicate heart attack

ABG analysis

oxygenated level of blood (PH, Paco, Hco, Pao)

Blood chemistry

tells you about blood cells and how well they do their jobs

(RBC, WBC, Hgb, Hct)

Precautions of exercise; Hematocrit

-no exercise= less than 25%

-light exercise= greater than 25%

-resistive exercise= greater than 35%

precautions of exercise; hemoglobin

-no exercise= less than 8 g/dl

-light exercise= 8-10 g/dl

-resistive exercise= greater than 10 g/dl

precautions of exercise; platelets

-no exercise= less than 10,000 mcl

-light exercise= 10,000-20,000 mcl

-resistive exercise= greater than 20,000 mcl

precautions of exercise; WBCs

-no exercise= less than 500 mcl

-light exercise= greater than 500 mcl

-resistive exercise= greater than 500 mcl

precautions of exercise; international normalized ration (INR)

-bed rest= greater than 6.0

-no exercise= greater than 5.0

-light exercise= 4.0-5.0

-resistive exercise= less than 4.0

Anticoagulation

-prevents clots

-examples= heparin, warfarin, enoxaparin, fondaparinux sodium (Arixtra), plavix, aspirin

-INR= measures how long it takes for your blood to form a clot— normal range is 0.8-1.2

feeding devices

-nasogastric tube

-gastric tube

-intravenous feeding

-total parenteral nutrition

-hyperalimentation devices

-intravenous infusion lines

complications of IV therapy

-infiltration

-phlebitis

-cellulitis

-thrombosis

-local hematoma

-sepsis

-pulmonary thromboembolus

-air bolus

-catheter fragment embolus

oxygen therapy systems

-oxygen delivery to respiratory system

-modes=

• nasal cannula

• oronasal mask

• nasal catheter

• tent

• tracheostomy mask or catheter

chest drainage systems

-used to remove air, blood, matter, and other undersirable matter from patients chest or plural cavity and maintain pulmonary inflation

-tubes placed in anterior or lateral chest wall to remove air

-tubes placed in posterior and inferior chest wall to remove fluids and blood

-mediastinal tubes drain fluids and blood post surgically

ostomy devices

-opening in abdomen to allow elimination of feces

-enterostomy: types are ileostomy, olostomy, jejunostomy and duodenostomy dependent upon location of the intestine​

purpose of traction

-align fracture segments

-soft tissue stretch

-reduce muscle spasms

-immobilize patient

types of traction

-skin: applied with low weights (bandages, tape)

-skeletal: applied through a pin or wire inserted into the bone (wire, screws)

• balanced suspension traction

• skull

• external fixation

• internal fixation

patient controlled analgesia (PCA)

-self administered, small, predetermined, time limited, doses of pain medication

-follow iv line precautions

objectives of dialysis treatment

-prevent infection

-restore normal levels of fluid and electrolytes

-control acid-base balance

-remove waste and toxins
-assist in or replace kidney function

types of dialysis

-hemodialysis

-peritoneal dialysis

hemodialysis

-blood is taken out of the body by a tube, travels through dialysis machine (filters blood), and then clean blood is returned to the body

peritoneal dialysis

-special cleaning fluid is put into abdomen through a catheter and the fluid fills the abdominal cavity, the lining of abdomen acts as a natural filter, waste and extra fluid move from blood into dialysis fluid, and the used fluid is drained and replaced with fresh fluid