Med Surg Lab Exam
Preparing a Sterile Field
- only individuals who have performed surgical hand scrub or donned sterile gloves should enter sterile field
- make sure packaging is not contaminated
- open flap of sterile package that is farthest away first, then open the sides one at a time
- keep items away from body and above waste level
- put bottom half of sterile drape on the top half of the sterile surface
- pouring sterile solution:
o verify contents and check expiration date
o can use n0n-sterile hand to pour solution
o don’t splash solution onto sterile field
Surgical Gloving
- unfold top and bottom flabs first when unwrapping sterile gloves
- glove dominant hand first
Indwelling Retention Catheter
- female
o withdraw linens to linen of bed and cover patient with bath blanket
o position client in supine position with knees flexed and ankles up with knees dropped
o put waterproof pad under the patient
o open catheter equipment then apply sterile gloves
o clean outside, outside, inside prior to insertion (1 downward stroke and a cotton ball each time)
o hold catheter with sterile dominant hand
o tell client they will feel pressure and bear down
o insert catheter until you see a flash of urine then advance an additional 2-3in before filling the balloon
o inflate balloon and gently pull catheter, tell client they can relax now
o when securing catheter to the patients thigh, make sure it is at the height of the bladder and that the bag is secured below the bed
o assess skin quality in perineal area
o remove: is there is urine in the tubing make sure it drains before removing the bag, place a drape under the patient. attach syringe to balloon port and remove air from it, slowly and gently remove catheter as patient exhales
- male
o place bath blanket over patient
o same prep steps as female catheter
o clean area in circular motion
- peri care for female with catheter
o wash in skin folds from front to back using different sides of the wash cloth
o do not get soap in urethra
o use new cloth to rinse off soap then pat dry
o clean first 4 inches of the catheter that is closet to the patient
- documentation: date and time of catheterization, type of catheter, size of carheter, amount of fluid used to inflate a balloon, urinary output, catheter patency, urine quality/quantity/odor, clients LOC, abdominal assessment, skin assessment, client and family teaching done
- if resistance is met, stop and reassess the situation
- ask patient if they have had a catheter inserted before and if their were any issues with the procedure
Glucose Monitoring
- insert test strip into monitor and make sure you it turns on
- assess the finger and chose a spot on the lateral side of the finger that has not be pricked a lot (indicated by black dots)
- once you have chosen an area, cleanse with alcohol wipe and let air dry fully prior to stick
- massage the finger to increase circulation in the area
- put gauze/cloth on the patients finger concluding the end of the procedure
Oxygen Therapy
- nasal cannula
o make sure flow meter is connected to oxygen source and connect hose
o set flow rate to prescribed rate for liters per minute
o insert prongs into nose and then put up and around patients ear
o secure around chin with plastic slide
o provide skin care to the naris every 4 hours using water soluble products only
- simple mask
o adding humidification to oxygen the patient does not become dry
o place on face from the nose, downward
- nonrebreather mask
o connect to oxygen source
o flow rate should be high enough to keep the bag 2/3 full
- face tent
o connect pieces of tubing together
o open humidifier and pour in water, then attach to wall
o connect tubing and adjust to prescribed flow rate
o place tent under chin and over mouth and nose
o this device should fit loosely on the patients face
- venturi mask
o connect tubing to color-coded adapter
o connect extension tubing to the flow rate and adjust flow rate to a high flow
o rate is indicated on the adapter or barrel of mask
- KNOW FLOW RATE ON CHART
Nasogastric Tubing
- measure tubing from nose, around ear, to xiphoid process and mark length (for duodenal or jejunal placement add another 20-30 cm)
- give client a cup of water with straw and make sure there is an emesis basin nearby
- coat tip of tube with lube
- ask client to partially flex and head and remind client to breath
- advance tube each times the client swallows
- if you meet resist and there is coughing, gagging, choking or changes in VS then pull back on tube till client recovers
- if tube becomes coiled pull back
- anchor tube to clients nose and avoid pressure on the naris
- mark tube directly below naris
- withdraw gastric acid and test stomach content to verify that it is in the stomach (1-5)
- fasten tup to clients gown
Gastric Decompression
- check for correct positioning
- attach tube to suction and make sure it is the right amount of pressure
- removing an NG tube
o put cloth on patients chest
o to prevent aspiration clear tube from any irrigation and flush with 10mL of water
o remove quickly and inspect tube
- always auscultate lung and bowel sounds when inserting tubing into a patient
Suctioning
- open sterile basin and set on table
- place lube on tubing (gloves are not on yet)
- with dominant hand (keep hand sterile) pick up catheter then connect to suctioning with nondominant hand (now clean, not sterile)
- check suctioning by testing on sterile solution and putting finger over hole
- lubricant catheter
- remove oxygen delivery device and don’t apply suction yet
- nasotrach. suctioning advance 16-20cm or 6-8 inches but for a nasopharyngeal advance 13-16 cm or 5-6.5 in
- slant catheter downward
- if you feel resistance after advancing to proper distance pull back 1-2cm
- then place your non-dom thumb over hole to suction
- do not suction for more than 10-15 seconds at a time
- reapply oxygen and tell silent to cough between
- place in water to clean and wrap tubing around dominant hand
- don’t do more than 2 or 3 hours
- turn off suction at the end and coil tubing in your hand then taking off club with tubing inside of gloves
- perform oral care using suctioning
- document: date/time/frequency of suctioning, breath sounds, heart rate, oxygen saturation before and after suctioning, pre and post suctioning hyperoxygenation, amount/color/consistency/odor of secretions
Eternal Tube Feedings
- give patient water
- breath through mouth
- hyperextend neck
- tape tubing on clients nose
- auscultate breath sounds
- use syringe to with gastric materials and measure pH
- administering nutrients with a syringe:
o obtain 5-10mL of fluid and assess pH
o check residual volume on tube by aspirate all gastric contents of tube, expel into container until you feel resistance from plunger
o removing plunger from syringe then insert food
o flush tube with water after admission of food
- infusion pump:
o inject 30mL of air into the tube to clear it of any secretions
o aspirate to confirm placement
o pull back residual until you feel resistant
o flush tube with 30-50mL of water
o formula should be at room temperature to avoid gastric cramping
o cleanse top of formula container before opening
o label feeding tube with date and time
o place bag about 12inches above patients stomach
Wound Care
- dry dressing change
o measure wound
o cleanse with swabs, new swab on each side
- documentation: onset of wound, chronic condition affecting wound, any associated manifestation, location of wound, wound dimensions, color of wound, any odors, texture of skin, granulating tissue, edema, bleeding
- wound vac is used to apply suction to the wound area and remove damage, reduces bacterial counts, and promotes granulation