week 1 skills

what are the advantages of IV push?

directly into vasculature, onset of med is within seconds, good for emergency situations, can give multiple doses w/out sticking patient

what are the disadvantages of IV push?

can cause harm if pushed too fast, increases risk of infection, medications can be irritating or harmful to veins, more safety considerations for nurses, need to check for compatibility if running other meds and connecting at Y-site

what is important to know about saline flushes?

they are not approved to be used to dilute meds; need to use actual saline meant to dilute medications

if a patient is c/o pain, redness, swelling during IV push administration, what do you do?

stop pushing med

what size of syringe is used for central lines?

10 mL

what are some indications for a chest tube?

pneumothorax, hemothorax, pleural effusion, thoracic surgery

what is the function of a pleural chest tube?

used to remove air or fluid from the pleural space and to help the lung to re-expand

what is the function of a mediastinal chest tube?

used after cardiac surgery to remove air and fluids from inside the pericardial sac and around the heart; a build up of air or fluids could squeeze the heart and cause cardiac tamponade

what is important to monitor for on wet suction chest tube drainage systems?

the water level as it can evaporate → the height of the water level dictates how much pressure they are using

what are some nursing interventions for patients with chest tubes?

assess respiratory status, assess chest tubes and drainage system with wall suction, daily dressing changes and inspection of the site, palpate for crepitus, assess for pain, using incentive spirometers and splinting for coughing, be ready in case chest tube falls out

what is important to know about water bubbling in the chest tube drainage system?

intermittent bubbling in the water seal chamber for a pneumothorax is expected, especially at the beginning; means that there is still air in the pleural cavity that is escaping which is what we want → common NCLEX question

what does vigorous or continuous bubbling in a chest tube drainage system indicate?

there is an air leak in the system somewhere that needs to be assessed and need to let the provider know about this

do you use wall suction for chest tubes set to water seal or to gravity?

no

where should the chest tube drainage system be located?

below the level of the chest without kinks or loops in tubing

what must always be available near intubated patients?

bag-valve mask, ambu bag, and a flowmeter

when are patients given breaths with an ambu bag?

when they are first intubated, open suctioning, transporting off the ventilator

how to properly use a bag valve mask with ambu bag to breath for a patient?

give breaths every 6 seconds, bag should be squeezed slowly and only to visible chest rise → giving breaths too often or giving large volumes increases intrathoracic pressure

what are some essential nursing assessments for patients with ET tubes?

centimeter markings on tube at teeth or gums match what was documented (don’t measure to lips bc they swell), tube is secured with appropriate device, pilot balloon indicates cuff is inflated (RT manages this), subglottic port is to continuous low suction, assess for pressure sores around mouth and assist RT in moving tube position

what are some assessments for trached patients?

have a backup trach of same size or one smaller at bedside, if speaking valve is used the patient must be breathing on their own, cuff is usually deflated unless pt is being manually ventilated

what is a difference between ET tubes and trached patients?

the cuff is always inflated in ET tubes and usually deflated in trached patients

what are some things to prevent ventilator acquired PNA?

HOB at 30 degrees, utilize subglottic evaluation suction to prevent pooling of secretions, avoid ventilator circuit/tubing changes, perform oral care every 2-4 hours, use chlorhexidine oral rinse if ordered, clear airway secretions only when necessary, daily readiness to wean assessment, peptic ulcer disease prophylaxis, early mobilization