Exam 4 Therapeutic Procedures Flashcards Preview

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Flashcards in Exam 4 Therapeutic Procedures Deck (39)
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1
Q

Cerumen Impaction Removal indicated when? (4)

A

Hearing loss
Tinnitus
Vertigo
Otalgia (earache)

2
Q

Cerumen Impaction Removal contraindicated when? (4)

A

Uncooperative
Distorted/abn anatomy
Prior ear surgery
Suspect TM perf

3
Q

Cerumen Impaction Removal complications? (4)

A

TM perf
Otitis externa
Vertigo/NV/Tinnitus
Internal Auditory Canal abrasion

4
Q

Subungual Hematoma is?

Evacuation indicated when?

Contraindicated when? (2)

A

Bleed b/w nail and digit from trauma

Visible/Painful

Crushed/Fractured bed
Involves > 50% of nail

5
Q

Subungual Hematoma Evacuation procedure?

A

Heated paperclip or cautery ->

place on nail

6
Q

Nasogastric Tube Insertion indicated when? (4)

A

Decompress stomach from outlet obstruction or ileus
SBO
Gastric lavage for overdose or bleeding
Enteral feeding

7
Q

Nasogastric Tube Insertion contraindicated when? (4)

A

Basilar skull fxr
Facial trauma
Nasal obstruction
Esophageal dz

8
Q

NG Tube complications? (3)

A

Sinusitis
Gastric irritation
Aspiration PNA (keep head elevated)

9
Q

I&D indicated when?

C/I when?

A

Abscess

Located in nasolabial folds (drain into sphenoid sinus)

10
Q

I&D F/U?

Complications? (4)

A

Wound check 24-48 hrs
Repack daily

Pain
Recurrence
Scar
Worse infection

11
Q

Arthrocentesis indicated when? (2)

C/I when? (5)

A

Eval fluid
Pain relief

Cellulitis or broken skin
Coagulopathy
Infected bursa
Bacteremia
Joint prosthesis (refer)
12
Q

Arthrocentesis needle gauges?

Complications? (5)

A

22-27 for injection
18-21 for aspiration

Bleed
Infection
NN trauma
Cartilage/tendon damage
Drug rxn
13
Q

Thoracentesis indicated when? (3)

A

Remove air/fluid from chest (pleural effusion, empyema, pneumothor)
Fluid analysis
Instill sclerosing meds

14
Q

Thoracentesis C/I when? (2)

A

Coagulopathy

Uncontrolled cough/hiccups

15
Q

Thoracentesis lidocaine injected where?

Aspiration needle inserted where? (3)

Tip of needle pointing up for what?

Down for what?

A

Above rib to avoid neuromuscular bundle that runs below rib

1-2 ICS below level of ↓BS, dull percussion
Above 9th rib to avoid diaphragm puncture
Midway b/w spine and post axillary line

Up for air
Down for fluid
(air will rise above fluid)

16
Q

Thoracentesis complication? (3)

A

Pneumo- hemothorax
Diaphragm puncture
Re-expansion edema (Do not take > 1L, do not perform bilaterally)

17
Q

Paracentesis indicated when?

C/I when? (5)

A

Ascites (dx and therapeutic)

Acute abdomen
Coag
Distended bladder/bowel
Preggo
Infection at site
18
Q

Paracentesis procedure?

Complications? (3)

A

Pt supine w/ raised HOB or L lat decubitus
Insert 1/3 distance b/w umbilicus and ant iliac crest

Rare: perf, infection, hematoma

19
Q

Lumbar Puncture indicated for diagnostics when? (5)

A
CNS infection
MS
SAH
Tumor
Normal Pressure Hydrocephalus
20
Q

Lumbar Puncture indicated for tx when? (2)

A
Admin meds (anesthesia, chemo, ABX)
Remove CSF (pseudotumor cerebri)
21
Q

Lumbar Puncture C/I when? (3)

A

Intracranial lesion (focal deficit, papilledema)
Local skin infect
Coagulopathy or thrombcytopenia

22
Q

Lumbar Puncture insert where?

A

L4-5

20-30° towards umbilicus

23
Q

Opening pressure at lumbar puncture tells us?

Normal pressure values?

A

↑ pressure = tumor, infect, bleeding, MS

N lying pressure = 5-14 mmHg
Sitting = 5-27

24
Q

Lumbar Puncture complications? (4)

A

CSF leak w/ HA
Infection
Nerve impingement
Herniation

25
Q

Central Venous Catheter indicated when? (7)

A
Hemo/CV pressure monitoring
Meds (pressors, chemo, ABX)
TPN
No viable peripheral sites
Emergent vascular access
Hemodialysis
Repetitive blood draws
26
Q

Central Venous Catheter C/I when? (4)

A

Distorted landmarks
Coag
Infection at site
Pneumo- hemothorax on contralat side

27
Q

Central Venous Catheter sites? (4)

A

Internal/External jugular
Subclavian vv
Femoral vv
Brachial vv

28
Q

Central Venous Catheter landmarks for Internal Jugular approach?

A

Apex of triangle formed by sternal and clavicular heads of SCM mm and clavicle

29
Q

Central Venous Catheter: Benefits of subclavian approach? (2)

Drawbacks?

A

Good landmarks
More comfortable for pt

Higher risk of pneumothor

30
Q

Central Venous Catheter complications? (4)

A

Hemorr
Pneumo- hemothorax
Arrhythmia
Infection

31
Q

Immediately post-placement, do what?

A

CXR to verify placement and no hemo- pneumo-

Tip should be in SVC near RA

32
Q

Chest Tube indicated when? (4)

A

Pneumo- hemothorax
Recurrent pleural effusion
Empyema
Penetrating chest truma

33
Q

Chest Tube C/I when (3)

A

Coag
Loculated pleural eff (confined to one or more fixed pockets)
Previous chest tube

34
Q

Chest Tube insertion location?

Procedure? (3 steps)

A

4th/5th ICS, anterior axillary or MCL

2-4 cm incision parallel to ICS
Blunt dissection -> SQ tunnel over top of next rib
F/U CXR

35
Q

Chest Tube complications? (3)

A

Heart/vessel/lung/diaph injury
Pneumo-/Hemo-
Infection

36
Q

Bone Marrow Aspiration/Bx indicated when? (6)

A
Unexplained anemia/leuko or thrombo penias
Abn periph smear
Unexplained splenomegaly
Unexplained fever
Dx/stage leukemia/lymphoma
BM transplant
37
Q

Bone Marrow Aspiration/Bx C/I when? (2)

A

Bleed disorder

Skin infection

38
Q

Bone Marrow Aspiration/Bx site?

A

Iliac crest ->

3 fingers from midline and 2 inferior to iliac crest

39
Q

Bone Marrow Aspiration/Bx complications? (4)

A

Bleed
Infection
Pain
Perf of sternal plate