Rehab II - Medical Management in the Acute Care Setting

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Invasive, short-term

Basic PIV's are an (noninvasive/invasive) management device that is delivered (short/long) term

PIV

Temporary delivery of medications, fluids, or blood

Cannot

PIV (can/cannot) be used to draw blood

Avoid taking BP on that UE, Avoid kinks/occlusions, Watch for phlebitis/infiltration

PIV clinical implications:

Invasive, long-term

PICC's are an (noninvasive/invasive) management device that is delivered (short/long) term

PICC

Long-term (weeks to months) medications (antibiotics), fluids, and TPN administration

Cephalic, basilic

A PICC should be inserted in the upper arm (________ or ________ vein → SVC)

True

T/F? PICC's allow at home access

Wait for X-ray, Avoid BP on that UE, Avoid axillary crutches

PICC clinical implications:

Non-invasive

EKGs are a (noninvasive/invasive) monitoring device

5, 12

EKGs can be ____ or ____ lead

Stationary, portable

EKGs have a ___________ & ___________ monitor

EKG

Monitors/reads the heart rhythm

Prior to therapy, at rest, with mobility

When should the EKG be observed during therapy?

Artifacts

With an EKG observe for ________ and stability before mobilizing

Non-invasive

Telemetry is a (noninvasive/invasive) monitoring device

BP, HR, O2

Telemetry typically monitors which 3 things:

Portable

With telemetry, transition to ___________ units if possible

True

T/F? With telemetry, there is limited mobility if unable to remove/disconnect

Non-invasive

Supplemental oxygen is a (noninvasive/invasive) management device

Wall connection (stationary), portable tank

Types of supplemental oxygen:

Ensure medical stability

Can you disconnect a patient from O2?

Portable tank

With supplemental oxygen, change to a ____________ for mobility

Nasal cannula, Non-rebreather, Face mask/tent

3 supplemental oxygen devices:

Non-invasive

SCDs are a (noninvasive/invasive) management device

Sequential compression devices

Anti-thrombolytic sleeves that inflate and deflate to prevent DVT by promoting venous return

LE, supine

SCDs are placed on (UE/LE) and are typically worn when ________ or at rest

True

T/F? Reapply SCD when returning the patient to bed

Invasive

Surgical drains are a (noninvasive/invasive) management device for blood/fluid

Jackson-pratt, hemovac

Types of surgical drains:

Active, passive

Surgical drains provide management of blood; Can be ______ [suction] or ________ [gravity or capillary action]

Decrease

For a surgical drain, request that nursing empty it prior to mobility to (increase/decrease) tension

True

T/F? Check with nurse before disconnecting the surgical drain from suction

Non-invasive

Urinals, purwicks are a (noninvasive/invasive) urinary management device

Increased, decrease

The usage of urinals and purwicks result in an (increased/decreased) fall risk and an (increase/decrease) of mobility in the hospital

Invasive

Foley catheter, suprapubic catheter, and nephrostomy tube are all (noninvasive/invasive) urinary management devices

Below

Keep foley bag (ABOVE/BELOW) the level of the bladder

ICU

A hospital facility for provision of intensive nursing and medical care of critically ill patients, characterized by high quality and quantity of continuous nursing and medical supervision and by use of sophisticated monitoring and resuscitative equipment

Invasive

An arterial line (A-LINE) is an (noninvasive/invasive) monitoring device

A-line

Measures arterial BP, obtains blood samples, delivers/administers medications

Measures arterial BP, obtains blood samples, delivers/administers medications

What does an A-line do?

Brachial, radial, femoral

An A-line catheter is placed in either the _______, ________, or _________ artery

Apply direct pressure immediately

If an A-LINE is dislodged, ____________ and call for help

Bedrest, 60-80º

FEMORAL A-lines are on _______ with hip FLEXION limit of _____ degrees.

60-90

After removal of a FEMORAL A-line, bedrest is required for _______ mins

True

T/F? Patients can be mobilized with an UE A-line

Invasive

A PA line or Swan Ganz is an (noninvasive/invasive) monitoring device

PA line (Swan Ganz)

Measures pulmonary artery pressure, R atrial pressure, and cardiac output

Measures pulmonary artery pressure, R atrial pressure, and cardiac output

What does a PA line (Swan Ganz) do?

Subclavian vein, right atrium, pulmonary artery

For a PA line or Swan Ganz a catheter is inserted through a large vein (usually _________) through the _________ into ___________________

Invasive

A CVL (central venous line) is an (noninvasive/invasive) monitoring and management device

Subclavian, basilic, jugular, femoral

For a central venous line (CVL) a catheter is inserted in _________, _________, __________, or ____________ vein to SVC

Central venous line (CVL)

Measures central venous pressure, blood sampling, and medication administration

True

T/F? NO BP on the side of the CVL

Cervical

For patients with jugular CVL, limit _________ ROM

Invasive

A port-a-cath is a surgicaly implanted (noninvasive/invasive) management device

Subclavian, jugular, femoral

The catheter of the port-a-cath is implanted into the _________, ___________, or __________ vein

Clavicle

Port is implanted in subcutaneous pocket in chest wall, below-

Port-a-cath

Long-term administration of chemo, TPN, infusion therapy

True

T/F? Port has reservoir for meds - injected with needle through intact skin

True

T/F? With a port-a-cath, there are NO activity restrictions ONCE HEALED

True

T/F? With a port-a-cath, patients can shower/swim without limitation ONCE HEALED

Invasive

A temporary pacemaker is a (noninvasive/invasive) monitoring and management device

Temporary pacemaker

Provides TEMPORARY cardiac pacing

Epicardial, transvenous

What are the two types of temporary pacemakers?

Epicardial pacemaker

Pacemaker placed on the epicardium (through mediastinal incision) after cardiac surgery.

Transvenous

Pacemaker placed in the right ventricle via central line.

True

T/F? Keep wires & box of temporary pacemaker in sight AT ALL TIMES

30-60

After wires are pulled/discontinued; the patient is on bedrest for _______ minutes

Invasive

A mechanical ventilatpr is a (noninvasive/invasive) monitoring and management device

Mechanical ventilator

Provides positive airway pressure to inflate the lungs

ET tube, Tracheostomy tube

What are the two different types of INTUBATED mechanical ventilator?

ET tube

Which mechanical ventilator is short-term, through the mouth

Tracheostomy tube

Which mechanical ventilator is Long-term, through the trachea

True

T/F? With mechanical ventilation, mobility depends on sedation level.

True

T/F? If vented BUT awake, mobilize within functional abilities

True

T/F? A patient on a mechanical ventilator may need to be switched to portable vent or ambu-bag

High flow O2

High amounts of oxygen without full ventilation; provides LESS pressure and support than vent - patient is breathing on their own

2

A BIPAP machine has how many pressure settings?

1st pressure

BIPAP _____: Assists inhalation; by increasing pressure into the lungs to open airways

2nd pressure

BIPAP______: Assists exhalation; lower to ease exhalation against which patient is breathing

CPAP

Single pressure level, supports inhalation only. **Exhalation is against the same pressure used to push air in for inhalation**

Invasive

A chest tube is a (noninvasive/invasive) management device

Chest tube

Drains excess fluids/air and maintains lung inflation

Pleural, mediastinal

A chest tube is placed in the ________ or __________ space (treat pneumothorax/hemothorax)

True

T/F? A chest tube is typically attached to drainage container with/without suction

BELOW

Keep drainage system (BELOW/ABOVE) the level ofchest tube insertion

Sit the patient in an upright position

If tube becomes dislodged, ___________ and monitor vital signs

True

T/F? WIth a chest tube, avoid kinks in the line and tipping the resevoir

True

T/F? With a chest tube, ask MD/Nurse if patient can be disconnected from suction during mobility activities; if so, do NOT clamp the suction tube

Invasive

An ICP monitor is a (noninvasive/invasive) monitoring and management device

ICP monitor

Catheter in the ANTERIOR HORN of the lateral ventricle

Monitors intracranial pressure, manages CSF, and allows for intermittent/continuous drainage

What does an ICP monitor do?

< 20 mmHg

An ICP monitor monitors intracranial pressure (Normal ICP: _________)

Invasive

An external ventricular drain (EVD) is a (noninvasive/invasive) management device

EVD

Catheter in the anterior horn of the lateral ventricle OR epidural space

EVD

Provides continuous drainage of EXCESSIVE CSF

Jackson-pratt, hemovac

Examples of EVDs:

False

T/F? An EVD does monitoring as well

Intraventricular catheters

The apparatus must align with the external auditory meatus