Final I Flashcards
(136 cards)
Clean technique
using appropriate hand hygiene and clean gloves and a clean environment (minimal)
Aseptic Technique
all Sterile supplies, antiseptic skin prep for procedure, a controlled environment.
As sterile as one could get, outside of the operating room (OR)
Sterile techhnique
Complete absence of microorganisms, all instruments and protective clothing are sterile, the environment (field) is sterile. OR setting. (maximum standard required through standard and Universal Precautions recommended by OSHA.
ID
Administered directly under the epidermis at an angle of 10-15°
Used primarily for diagnostic purposes (allergy, TB, Candida) or applying local anesthetics, such as lidocaine 1%
Usually creates a “Wheal” on the skin.
Common sites are the arms and back
Usually uses small syringes and small gauge needles
i.e. 1 cc syringe with a 27 gauge ½” needle
gauge size
Gauge Size = higher the number the smaller the needle width (14-30)
SQ
Administered into the subcutaneous layer at an angle of 45° .
Allows for slow sustained absorption of medications, such as insulin, and opiates, such as morphine, dialudid and demerol
Common sites are the abdomen, lateral and posterior upper arm, anterior thighs, and ventrolateral gluteal region.
IM
Administered into well perfused muscle at a 90° angle and aspiration.
Provides rapid systemic action of relatively large doses of 1-2cc, with least amount of tissue damage.
Includes vaccines such as Hep A/B, MMR,DPT, Pentacel, tetanus, B12, epinephrine, promethazine, hormones
injection Sites are Deltoid, Gluteus Medius, Vastus Lateralis, Rectus Femoris, Gluteus Maximus
joint injxn indications
DIAGNOSTIC
Acute or chronic symptoms present
Diagnosis is unclear or needs confirmation and
consideration of other diagnostic modalities has been made
Septic arthritis has been ruled out
joint absolute CI
Local cellulitis Septic arthritis Acute fracture Bacteremia Joint prosthesis Achilles or patella tendinopathies History of allergy or anaphylaxis to injectable pharmaceuticals or constituents More than 3 previous corticosteroid injections within the past year in a single joint*.
joint relative CI
Minimal relief after 2 previous corticosteroid injections
Underlying coagulopathies
Anticoagulation therapy
Evidence of surrounding joint osteoporosis
Anatomically inaccessible joints
Uncontrolled diabetes mellitus
joint injxn
sterile technique
lidocaine
vasodilator
bupivicaine w/epi
vasoconstrict
dont use on fingers nose penis toes and earlobes
anasthesia
use smallest needle (27-30)
corticosteroids bad news
May accelerate normal, aging related articular cartilage atrophy or periarticular calcification
or tendon rupture
allen test
hold radial and ulnar art to see colatteral aretery supply
Postural Color Change Test
Tests for chronic peripheral arterial disease
With the patient lying on their back, elevate the affected extremity for at least 1 minute
If the color becomes pale, lower the extremity to watch for return of pinkness which should occur within 10 seconds
Acute Arterial Disease
3 P’s-Pain, Pallor, Pulselessness
Pulm Emb
PAD
Chronic inadequate arterial flow
Intermittent claudication while walking, relived by rest
Physical findings: decreased distal pulses, pallor on elevation, ulcers/gangrene
An index of less than 0.9 indicates PAD.
Venous Valve Competency Test
With patient supine, raise one leg as high off the table to 90 degrees and let the venous blood drain from the leg
Occlude the great saphenous vein with one hand in the inner thigh and then lower the leg and ask the patient to stand up
Watch for normal slow venous filling of the leg veins while maintaining pressure on the great saphenous vein from above
If rapid filling occurs during this time there is incompetent valves of the communicating veins.
After 20 seconds release the pressure on the great saphenous vein
If sudden venous distension occurs , it indicates rapid venous filling and incompetent valves of the great saphenous vein.
Homans
dorsiflex ankle if pain in calf then positive for DVT
DVT
Virchow’s triad ingredients for a clot
Stasis
Hypercoagulability
Endothelial injury
pitting edema and painless and not aggrevated by movement
lymohedema
non pitting
LAD benign
Less than 1 cm Tender May be firm but not hard Freely movable Discreet borders
