Essentials exam 2

thank you devi and karina

isotonic

0.9% NS

hypertonic

3% NS

hypotonic

0.45% NS

IV advantages

• rapid drug distribution and onset of action

• no drug loss to tissues

• can establish constant therapeutic levels

IV disadvantages

• circulatory fluid overload

• no room for error

• infection and septicemia

reasons for IV

• physiologically unstable

• mechanical obstruction of GI tract

• high risk of aspiration, nausea

peripheral IV

• short term use

• fluid replacement

• intermittent antibiotics

• arm/hand

central IV

• can tolerate any type of fluid

• long term use

• large volumes of fluid

• medication can irritate vein

• TPN

• 3 types: tunneled, non-tunneled, implanted

non-tunneled central IV uses

percutaneously inserted but reaches central

short-term

non-tunneled central IV advantages

• preserves peripheral veins

• multiple lumens

• all types of IV therapies

• blood sampling

non-tunneled central IV disadvantages

• highest risk for infection

• greater risk of insertion complications (pneumothorax)

• not long term

• easily dislodged

non-tunneled central IV greatest risk infection site

femoral site

tunneled central IV uses

tunneled under skin into vein

cuff anchors catheter

long-term

tunneled central IV examples

dialysis, TPN

tunneled central IV advantages

reduced risk of infection

self care by patient

no dressing needed once healed

tunneled central IV disadvantages

inserted in the OR via fluoroscopy

high cost

provider must remove

implanted central IV uses

long-term, often intermittent use

can be permanent

implanted central IV example

chemotherapy

implanted central IV advantages

internal device, no dressing

unrestricted activity

dec. risk of infection

implanted central IV disadvantages

surgical procedure required for implantation

high cost

requires needle for access (non-coring)

what is important to do after deaccessing implanted central IV

administer heparin

CLABSI stands for

central line-associated bloodstream infection

CLABSI what technique

hand hygiene

maximum sterile barrier precautions

chlorhexidine skin antisepsis

place under controlled conditions

CLABSI uses

EBP bundle used when starting and maintaining central lines

ANTT stands for

aseptic non-touch technique

ANTT uses

used when starting PIV and maintenance

ANTT what technique

standard precautions

protect VAD site & equipment

factors to consider when VAD

• choose VAD with least amount of risk/replacements

• minimize patient discomfort, morbidity, mortality

• decrease health care costs

• minimize impact on ADLs

PIV supplies

IV cath—choose appropriate sixe

IV start kit

• tegaderm

• tourniquet

• chlorhexidine scrub/alcohol

• gauze

• tape

gloves

extension set

normal saline flush

the bigger the gauge

smaller the needle

14G color

orange

14G uses

trauma, rapid infusion

16G color

grey

16G uses

trauma, surgery

18G color

green

18G uses

blood transfusion

20G color

pink

20G uses

IV fluids and medications

22G color

blue

22G uses

IV fluids, small veins

24G color

yellow

24G uses

fragile veins, pediatrics

26G color

purple

26G uses

neonates

over-the-needle catheter

safety device to avoid stabbing yourself

most common site

forearm (most distal first)

avoid which areas

area of infection

area of infiltration

area of phlebitis

arm with dialysis fistula

same side as mastectomy

areas of flexion

hand if possible

infiltration

vein leaks into tissue

phlebitis

inflammation of vein (inc risk of blood clot)

avoid dialysis fistula

dialysis is lifesaving for this patient, leave the site for dialysis

avoid mastectomy

breast removal—less lymphatics, less risk for infection

skill 42.1 read the whole skill and the rationale!! read clinical judgement little boxes

peripheral intravenous catheter

catheter is left in the blood vessel, no needle in patient

replace primary tubing after how many hours

96hours

replace secondary tubing after how many hours

24hours

replace TPN/lipid tubing after how many hours

24hours

replace blood tubing after how many hours

4hours

move IV site every

7 days

KVO

TKO

primary is the

main line that connects IVF to patient

primary administers how much fluid?

larger amounts of fluid

secondary allows

administration of medications that are stable for a limited time

secondary administers how much fluid?

smaller amounts of fluid

where is secondary attached?

at Y-site above the pump

which bag flows determined by

the higher bag will be the one to flow due to gravitational pressure

continuous IV infusion

runs x ml/hr forever until we stop it

intermittent IV infusion

stop after x hours

direct IV drug injection

small amount

administered by syringe push (slowly)

know recommended diluent

add-vantage system

secondary IV

nurse prepares

IV bolus/push IVP what to do?

flush-push-flush

preop assessment

• identify pts normal preop baseline

• identify pt expectation from surgery

  • previous surgery

  • reasons for surgery

• past illness

• allergies vs sensitivity

• medication history

risk factors for surgery

• age

• nutrition

• obesity

• sleep apnea

• immunocompetence

• fluid/electrolyte imbalance

• pregnancy

sleep apnea is a risk why?

difficulty maintaining airway during anesthesia

preop physical examination

• loose or capped teeth (choking hazard)

• dentures, piercings, prosthetics removed prior

• bony prominences

preop implementation

incentive spirometer

SCD

pain relief communicated with patient

preop acute care

normal fluid/electrolyte balance

reduce infection risk=shower to kill normal microbiota off surgery site

prevent bladder/bowel incontinence

what is the surgeon responsible for?

consent signed before sedation

provide detailed surgical information

what is the nurse responsible for?

clarify facts already stated by surgeon

sign that patient is competent

NOT that patient is informed

periop

transport to operating room

holding area:

• IV placement

• anesthesia assessment

• pre-anesthesia med

• skin prep

oxygen saturation is not nurse’s role

periop nursing roles: holding area nurse

take info from floor nurse and take to surgical area

periop nursing roles: circulating nurse

catch-all, NOT sterile, does not scrub in

get supplies, set up OR bed

patient positioning during surgery

OR documentation

periop nursing roles: scrub nurse

set and maintain sterility

drape patient

hand sterile supplies to surgeon

work with circulating

periop nursing roles: specialty nurse

work with surgeon

general anesthesia

full loss of consciousness

regional anesthesia

local anesthesia

loss of sensation at desired site

conscious sedation

maintains their own airway

scrub order

hat and mask before gown

nonscrubbed personnel remain _ from sterile field

3ft radius

assessment every _ during postop?

at least every 15minutes

postop handoff sequence

OR → PACU → acute care

what phase 1 scale prior to discharge?

PARS/Aldrete must achieve 8-10, every 15min

phase 1 is located

not in recovery room

fast track anesthesia

OR → ICU

phase 2 scale

postanesthesia recovery score (PARSAP) every 15min, discharge at 18+

postop airway intervention

CPAP or BiPAP

oropharyngeal airway

oral suctioning is preferred

malignant hyperthermia is triggered by

certain anesthetics, genetics

early malignant hyperthermia

• masseter spasm, general muscle rigidity

• tachycardia, arrythmias, tachypnea

• hypoxia, hypercapnia

• resp acidosis