FF - non-systems: PPE, precautions, lines, w/c, AD, ADA accessibility, billing

What is the correct sequences for donning & doffing PPE?

• donning: gown → mask → goggles → gloves

• doffing: gloves → goggles → gown → mask

What PPEs are used for contact precaution?

What are the conditions that require contact precaution?

gown & gloves

• Mrs. WEE:

• M = multidrug resistant organism (MRSA)

• R = respiratory infections

• S = skin infections

• W = wound infections

• E = enteric (C diff)

• E = eye infection (conjunctivitis)

What PPEs are used for droplet precaution?

What are the conditions that require droplet precaution?

gown, gloves, mask

• SPIDERMAN:

• S = sepsis, scarlet fever, strep

• P = parvovirus B19, PNA, pertussis

• I = influenza

• D = diphtheria (pharyngeal)

• E = epiglottis

• R = rubella

• M = mumps, meningitis, mycoplasma, meningeal PNA

• AN = adenovirus

What PPEs are used for airborne precaution?

What are the conditions that require airborne precaution?

everything

• MTV:

• M = measles

• T = TB

• V = varicella

When performing CPR, how far should should the chest be compressed?

• adult: 2 in.

• infant: 1.5 in.

What is a Hickman catheter?

What does it help with?

• central line tunnel under the skin

• provides antibiotics, nutritional solutions, blood samples

What is a Swan-Ganz catheter?

What does it help with?

• balloon flotation device inserted through the internal jugular v. or femoral v. into the pulmonary artery

• monitors blood flow & heart function

What is a colostomy bag?

What does it help with?

• bag that collects stool, where the tube exits the colon to the abdomen when a part of the colon has been removed

• prevents colon cancer

What does a central venous pressure catheter do?

measures BP directly from R atrium & SVC

What does an arterial line do?

What should you do if it gets dislodged?

• monitor ABGs

• if dislodged, apply firm pressure and call nursing staff

What is a chest drainage tube?

What does it help with?

What should you do if it gets dislodged?

• tube inserted through an incision in the chest and may be connected to a mechanical or gravity-based suction system

• removes air, blood, purulent matter from the pt’s chest or pleural cavity

• if dislodged, have the pt exhale, place gauze or a gloved hand over the area and call nursing staff, keep collection bottle below tube

What are the precautions when using IV lines?

• arm should not be held above head for extended periods

• alert staff if fluid is low d/t air bubbles

What are the precautions when using a femoral line?

• no repetitive hip flex

• no hip flex >45°

What are precautions when using a foley catheter?

• hand below the level of bladder

• don’t empty bag if output is being monitored

• empty or alert nursing staff if overfilled

What are the w/c measurements in terms of seat height, depth, width, back height, & armrest height?

• seat height: heel to popliteal fold +2”

• seat depth: posterior buttocks along lateral thigh to popliteal fold -2”

• seat width: widest aspect of buttocks or thighs +2”

• back height: chair seat to axilla -4”

• armrest height: chair seat to olecranon +1”

What is the normal rear wheel axle position in wheelchairs?

For bariatric pts?

For BIL AKA?

• normal: in line w/ the shoulder or slightly posteriorly

• bariatric: COM shifts anteriorly → move the axle forward

• BIL AKA: COM shifts posteriorly → move the axle behind the pt’s shoulders

What is the appropriate standard crutch fitting?

• axilla space 2”

• crutch should be 2” lateral & 4-6” anterior to pt’s toes

What complications are caused by poor crutch fitting?

radial n. or brachial plexus injury

What is the appropriate forearm (Lofstrand) crutch fitting?

• top of forearm cuff is 1-1.5” distal to olecranon process

• crutch should be 2” lateral & 4-6” anterior to pt’s toes

What is the appropriate cane fitting?

What is the sequencing when ascending/descending stairs?

• always held on the stronger side

• handle of cane is at the level of wrist crease w/ 20-25° elbow flex

• cane should be 2” lateral & 4-6” anterior to pt’s toes

• ascending: good foot → bad foot & cane

• descending: bad foot & cane → good foot

According to the ADA, what are the physical accessibility guidelines?

• doorways: 32” wide

• hallways: 36” wide

• standard turning radius: 60”

• ramp: 1”:12”

What are the time-based units in minutes?

• 8-22 min = 1 unit

• 23-37 min = 2 units

• 38-52 min = 3 units

• 53-67 min = 4 units

What are the service-based codes?

billed per service regardless of the time spent

• evals, re-evals, hot/cold packs, unattended e-stim