SpecPop Exam 3

Short term feeding tubes

Named for beginning and end of tube

Nasogastric (NG)

Orogastric (OG)

Nasoduodenal (ND)

Oroduodenal (OD)  

Nasojejunal (NJ)

Orojejunal (OJ) 

Long term feeding tubes

Named for procedure to place tube and end of tube

Percutaneous Endoscopic Gastrostomy (PEG)

Percutaneous Endoscopic Jejunostomy (PEJ) 

Percutaneous Radiologic Gastrostomy (PRG)

Percutaneous Radiologic Jejunostomy (PRJ) 

Open or laparoscopic Gastrostomy (G-tube)

Open or laparoscopic jejunostomy (J-tube) 

Gastrojejunostomy (GJ-tube) 

Peripheral Intravenous Line (PIV)

inserted in peripheral vein to introduce fluids, meds, or draw venous blood 

Arterial Line (A-line)

inserted into peripheral artery to draw blood gases and monitor arterial blood pressure – life threatening if dislodged

Central venous catheter (central line)

placed into large vein ending in SVC or right atrium to administer fluids/meds, monitor central venous O2 saturation, central venous pressure

Peripherally Inserted Central Catheter (PICC line)

inserted into cephalic/basilic veins, ends in SVC for long term meds administration 

Pulmonary artery catheter (Swan Ganz line)

nserted into right subclavian vein into SVC through heart to pulmonary artery, anchored by inflatable balloon in pulmonary artery to register pulmonary capillary wedge pressure. Life threatening if dislodged 

Jackson-Pratt drain

small tubes placed into wound bed during surgery left connected to external suction bulbs to drain fluid from surgical site

Intra-aortic balloon pump (IABP)

improves ventricular performance of impaired heart by increasing myocardial O2 supply

Temporary epicardial pacer

wires placed in heart during open heart surgery exiting through mid-sternal incision to regulate “irritable” heart following surgery. Regulates heart until calms down and then removes 

Chest tube

paced directly into pleural space to allow escape of fluid, air, blood

Nasal Cannula

min-mod O2 delivery needs (1-6 L/min)

Simple mask

mod O2 demands, no reservoir bag, holes on side for air mixture/CO2 escape, has nebulizer attachment (6-12 L/min)

Venturi Mask

Mod o2 demands, O2 delivery tube attaches to connecter to precisely control O2 delivery volume (4-12 L/min) 

Trach collar, trach shield, T-piece

collar/shield deliver air around opening of trach tube for “blowby” air.

T-piece attaches directly to tube opening for most precise O2 delivery (4-12L/min) 

Face shield

same O2 delivery principles as trach shield, ideal for those who don’t tolerate nasal cannula or tight mask (4-12L/min) 

Partial rebreather/nonrebreather mask

simple mask with reservoir bag with 100% O2, holes on side for room air mixture (6-10 L/min (partial rebreather) 

High-flow nasal cannula

40-600 L/min of 100% O2, air humidified, temp regulated, good for mouth breathers 

Wall mount O2 delivery system

colored green, O2 turned on, flow controlled by turning valve on side or front of glass cylinder

Ventilator Mode

describes how V assists with inspiration, controls how V functions

Tidal Volume

Volume of air breathed in/out at rest 

Frequency (rate)

respiratory/breathing rate – usually 10-20 breaths/min 

FiO2

Fraction of inspired O2 – concentration of O2 being inhaled by pt 

Inspiratory Flow rate

how fast TV delivered to pt by V (~60L/min up to 120 if needed)

I:E ratio

inspiration to expiration ratio (1:2 to 1:4 normally) 

Sensitivity

determines how much effort (neg pressure) pt must generate to trigger breath from machine 

Positive End Expiratory Pressure (PEEP)

amount of + pressure delivered during expiratory phase, prevents alveoli closure and increases time for gas exchange 

Ventilator Alarms

High pressure/low pressure 

Low expired volume 

High frequency 

Apnea 

High PEEP/low PEEP 

Elements of PICS

Cognitive, psychiatric (mental health), physical symptoms

Cognitive element of PICS

decreased executive functioning, memory, attention, visuo-spatial skills, mental processing speed 

Psychiatric (mental health) element of PICS

anxiety/acute stress disorder, PTSD, depression 

Physical Impairments element of PICS

pulmonary, neuromuscular, physical function

Rule of 9s for burns

Entire head and neck: 9% (4.5% F/B) 

Arms: 9% each (4.5% F/B) 

Entire trunk: 36% (18% F/B) 

Groin: 1% 

Legs: 18% each (9% F/B) 

Zone of Coagulation

most damage in central portion – destroyed tissue

Zone of stasis/ischemia

decreased perfusion that is potentially salvageable – inflammation, low levels of perfusion 

Zone of hypermia

Outermost region with increased inflammatory vasodilation – unimpaired microvascular perfusion 

Degrees of burn depth

First: superficial, epidermis only 

Second: blisters, superficial to deep partial thickness, very painful 

Third: full thickness 

Fourth: into muscle bone (surgery), almost no pain 

Causes of burns

friction, cold, heat, radiation, chemical, electric sources

Palliative Care

Medical care focused on providing relief from symptoms and stress of a serious illness, aiming to improve quality of life.

Hospice Care

Care given when pt has <6 months prognosis, no curative measures given,

Freud’s cathexis theory of grief

Withdraw emotional energy from deceased (cathexis) to become detached from loved one (decathexis). Done by reviewing thoughts/memories of person (hypercathexis) and expressing emotions 

Bowlby’s phases of grief model

1: shock/numbness

2: yearning/searching

3: disorganization/despair

4: reorganization/recovery

oscillation between 2 and 3 

Worden’s task-based model of grief

Tasks for therapist to help client through

Actualize the loss

Process emotional pain

Support adjusting to world without deceased

Support in finding enduring connection with deceased while embarking on new life 

Rando’s model of grief

anticipatory grieving, supported to prepare for loss, can improve family communication, deal with unfinished business, reinforce reality of anticipated death, allow to say goodby, plan for future without deceased

Stroebe and Schut’s dual process model of grief

copes with loss by oscillating between two coping strategies: loss-orientation (emotion focused) and restoration-orientation (problem focused) 

Social constructivist perspective on bereavement

grieving is process of reconstructing a world of meaning that has been challenged by loss, encourages bereaved to make sense of what has happened, reconstruct meaning and meaningfulness in lives and maintain continuous bond with deceased 

Martin and Doka’s adaptive grieving styles model

Intuitive grievers: process mainly through emotions/sharing feelings with others 

Instrumental: express more physically and cognitively than emotionally – more thinking than feeling 

Blended: express though combo of instrumental and intuitive approaches, understand there’s no single way to grieve, have access to wider variety of coping strategies 

Dissonant: hard time if natural reactions and expressions don’t match own/others expectations of what grief should look like, might feel unseen in grief 

Boss’s Ambiguous Loss model

Ambiguous loss most devastating – remains unclear/indeterminate. Two types of ambiguous loss 

Physical absence of loved one accompanied by psychological presence (divorced parents or missing people) 

Psychological absence accompanied by physical presence (stroke/Alzheimer’s) whose death silently/anxiously anticipated/grieved long before happens – death in slow motion 

Kubler-Ross 5 Stages of Grief

Anticipatory path experienced of people with terminal illness, later adapted for the bereaved/mourning loss of function/reduced quality of life 

Denial: defense mechanism to protect from shock 

Anger: towards self, family, doctors, God, deceased – manifestation of grief 

Bargaining: hopeless/overwhelmed “if only”/”what if” 

Depression: inevitable 

Acceptance: some don’t ever reach stage, no longer deny/struggle against grief, work to focus on celebrating life of loved one, cherish memories, make plans to move forward. Doesn’t mean we forget, can still sometimes travel between stages