Acute Care: Physiological Monitoring-Lines and Tubes

Question 1

what are the general goals of lines and tubes?

Answer 1

to to measurements and or provide access to internal body systems

Question 2

what are the specific goals of lines and tubes?

Answer 2

rapidly deliver important meds

obtain real-time measurements of physiological fxn

collect bodily fluids

facilitate tissue healing

minimize secondary infections from lines and tubes

Question 3

what is peripheral venous access?

Answer 3

an IV (flexible catheter inserted into a vein) used to deliver meds, fluids, or nutrition

also used to remove blood for sampling/testing

Question 4

what are common problems associated with peripheral venous access?

Answer 4

inflammation/pain due to phlebitus/infection, dislodging IV, infiltration (leaking of fluid under the skin), clotting

Question 5

t/f: we should avoid taking BP on the arm with a peripheral venous access IV

Answer 5

true

Question 6

is taking BP on the arm with peripheral venous access IV in it contraindicated?

Answer 6

no, but we should avoid it if possible

Question 7

can the line with peripheral venous access be disconnected?

Answer 7

sometimes, unless it is a continuous infusion like heparin, ask the nurse

Question 8

what is a peripherally inserted central catheter (PICC)?

Answer 8

IV access for longer time (antibiotics, chemo, total parenteral nutrition (TNP) support)

catheter inserted peripherally and the tip is advanced to the superior vena cava

Question 9

what are the typical peripheral vein insertion points for PICC lines?

Answer 9

basilic, cephalic, or brachial veins

Question 10

should we take BP on the arm with the PICC line?

Answer 10

no

Question 11

t/f: we should wait for an x-ray confirming the location of a PICC line b4 mobilizing a pt

Answer 11

true

Question 12

what are the precautions with a PICC line?

Answer 12

don’t lift more than 10 lbs

no swimming, contact sports, shoveling, vacuuming, etc

Question 13

what is hemodialysis?

Answer 13

a way to artificially perform the normal fxn of the kidneys where blood crosses a semi-permeable membrane (dialyzer), allowing metabolic waste products to diffuse into correction fluid (dialysate)

Question 14

what is the dialyzer in HD?

Answer 14

the semi-permeable membrane

Question 15

what is the dialysate?

Answer 15

the correction fluid in HD

Question 16

what does HD do?

Answer 16

correct fluid or electrolyte abnormalities

remove toxic materials

maintain acid-base balance

Question 17

what does HD do?

Answer 17

filters out byproducts from the blood that gets eliminated through urine and then the rest is filtered back into the blood

Question 18

t/f: HD is accomplished through vascular access that allows high flows and repeated cannulation, while minimizing infection and clot formation

Answer 18

true

Question 19

should you take BP on the arm with HD?

Answer 19

no

Question 20

what are the access sites for HD?

Answer 20

central vein (ie the subclavian vein)

arterio-venous fistula

arterio-venous grafts

Question 21

what is an arterio-venous fistula?

Answer 21

artificially created communication bw an artery in the arm and an adjoining vein

Question 22

what is an arterio-venous graft?

Answer 22

uses an interposed synthetic graft that is less durable than an AV fistula

Question 23

what is continuous renal replacement therapy (CRRT)?

Answer 23

nonstop veno-venous or arterior-venous hemodialysis

extracorporeal blood circulation through a small-volume, low resistance filter to provide continuous removal of solutes and fluid

Question 24

where is the only place you will see CRRT?

Answer 24

in the ICU

Question 25

t/f: CRRT is an absolute contraindication to PT

Answer 25

false, pts just tend to tolerate PT less so we need to coordinate with the team and closely monitor vitals and plan the session to allow sufficient line slack

Question 26

what is peritoneal dialysis (PD)?

Answer 26

uses the peritoneum as the semi-permeable membrane and the diasylate is infused into the abdomen the peritoneum is highly vascularized, allowing waste products and fluids to pass from the blood into the dialysis solution diasylate remains in abdomen for several hours prior to drainage

Question 27

t/f: mobilization with HD is typically contraindicated

Answer 27

true

Question 28

why is mobilization with HD typically contraindicated?

Answer 28

bc of pt fatigue post dialysis

Question 29

what should we assess with HD prior to PT?

Answer 29

labs on fluids and electrolytes status

Question 30

t/f: we should monitor hemodynamics and activity tolerance closely with HD mobilization

Answer 30

true

Question 31

t/f: we should avoid placement of BP cuff over an AV fistula or graft site

Answer 31

true

Question 32

what is the purpose of wound drainage devices?

Answer 32

to collect fluid from internal cavities

Question 33

what is negative pressure wound therapy (wound VAC)?

Answer 33

application of localized negative pressure by controlled suction to the wound surface noninvasive therapy to promote healing in difficult wounds that fail to respond to established Rx modalities

Question 34

t/f: wound VAC provides a closed, moist wound healing environment

Answer 34

true

Question 35

what are the benefits of wound VAC/negative pressure wound therapy?

Answer 35

assists granulation helps remove interstitial fluid helps remove infectious materials

Question 36

what is a major precaution with wound VAC/negative pressure wound therapy?

Answer 36

don't break the seal!

Question 37

what is a foley catheter (indwelling catheter)

Answer 37

a urinary drainage tube thin, sterile inserted into the bladder to drain urine with a balloon at the end filled with sterile water to hold it in place

Question 38

t/f: foley catheter may be placed for urinary retention

Answer 38

true

Question 39

what lines and tubes need to be kept below the level of the waist?

Answer 39

chest tubes and foley catheters

Question 40

what are the considerations for PT with urinary drainage tubes?

Answer 40

need to maintain the foley catheter below the level of the bladder drain any urine in the tubing b4 mobilizing for prevention of backflow make recommendations to the team when the catheter bag needs to be emptied or a pt is mobile enough to use the commode

Question 41

what is the purpose of feeding tubes?

Answer 41

to deliver nutrition when GI is obstructed, aspiration, or calorie supplementation is needed

Question 42

what is a Dobhoff tube?

Answer 42

short term nutritional needs while intubated or if the pt is at risk for aspiration

Question 43

what is a gastrostomy (G) tube/percutaneous endoscopic gastrostomy (PEG) tube?

Answer 43

a small, flexible, hollow tube w/a balloon or flared tip surgically inserted and secured into the stomach for nutrition

Question 44

what are the considerations for NG tubes?

Answer 44

determine if the tube is to suction or gravity drainage and whether the tube can be disconnected for out of bed mobility determine if the tube can be disconnected prior to and/or during therapy session

Question 45

t/f: NG tube and feeding tubes are the same thing

Answer 45

false

Question 46

what are the CV consequences of bed rest and immobility?

Answer 46

decreased exercise tolerance/VO2max decreased CO decreased resting HR decreased resting and max SV increased venous compliance decreased orthostatic tolerance venous pooling

Question 47

t/f: anytime there is blood pooling, there is an increased risk for clotting

Answer 47

true

Question 48

what are the hematologic consequences of bed rest and immobility?

Answer 48

decreased blood volume decreased RBCs increased DVT risk

Question 49

what are the MSK consequences of bed rest and immobility?

Answer 49

muscles atrophy (can happen very quickly) decreased mitochondria density and aerobic enzymes bone demineralization, osteopenia, osteoporosis

Question 50

what are the psychiatric consequences of bed rest and immobility?

Answer 50

increased anxiety increased agitation increased delirium increased depression

Question 51

what are the pulmonary consequences of bed rest and immobility?

Answer 51

decreased lung volumes and capacities decreased respiratory muscles strength increased risk for pneumonia/PE

Question 52

what are the metabolic/endocrine/electrolyteconsequences of bed rest and immobility?

Answer 52

increased insulin resistance increased urinary excretion of sodium, potassium, calcium, and phosphorus hypercalcemia/renal stone formation

Question 53

what are the nutritional consequences of bed rest and immobility?

Answer 53

cachexia/malnutrition obesity

Question 54

why is there a loss of respiratory strength and endurance with bed rest and immobility?

Answer 54

bc the pts are not taking deep breaths

Question 55

t/f: pts can lose their sense of upright with bed rest and immobility

Answer 55

true

Question 56

why is the digestive system influenced by bed rest and immobility?

Answer 56

bc the body cant mechanically break down food or absorb nutrients well in supine

Question 57

what is sitting upright good for?

Answer 57

prevention of aspiration, breathing, and orientation

Question 58

in pts who are highly mobile b4 admission, what % are disabled at d/c?

Answer 58

13%

Question 59

in pts who are moderately mobile b4 admission, what % are disabled at d/c?

Answer 59

35%

Question 60

in pts who are of low mobility b4 admission, what % are disabled at d/c?

Answer 60

71%

Question 61

what % of pts over 90 y/o lose their ability to do their daily activities following hospitalization?

Answer 61

65%

Question 62

what can we do for a pt if they CAN walk?

Answer 62

walk the pt to the bathroom instead of using the bedside commode encourage family/friends to walk with the pt take a walk down the hallway b4/after each meal; walk to and from the door brush teeth in the bathroom

Question 63

what can we do if a pt CAN'T walk?

Answer 63

help the pt uses the bedside commode instead of the bed pan increased total amount of time spent outside of bed help the pt sit in a chair for all meals

Question 64

why is bed rest so bad?

Answer 64

bc it can cause thromboembolic disease, jt contractures, atelectasis, skeletal muscle atrophy/weakness, and pressure ulcers