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NRSG 202 > Hi-Flo 02 > Flashcards

Hi-Flo 02 Flashcards

1
Q

How is Hi-flow measured

A

% not L

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2
Q

What applications can be used for Hi-Flo O2

A

Aerosol/Star Wars/Venturi/Trach Masks, Face Tent, T-piece Airvo/Optiflow

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3
Q

Can Lo or Hi flow be on for longer periods of time?

A

High flo oxygen can be applied for longer periods of time due to humidification

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4
Q

What is the purpose of humidification?

A

To moisten mucous membranes

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5
Q

When do you change a Aquapak?

A

When it runs out but change tubing Q7Days

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6
Q

What is the nursing care for hi-flow?

A

Label equipment with patient name and date
Clean face masks/prongs
Assess straps (change when soiled)
Observe for pressure sores
Complete respiratory/cardio assessment as per, doctors orders, as per protocol and PRN
Ensure adequate sterile water and assess the setting levels
Assess tubing for excess water & empty as needed

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7
Q

How do you transfer hi flow patient?

A

You can’t always depending on mask but
Transporting patients
-Consult RT
-Non Rebreather Mask may be necessary

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8
Q

How does a pt eat with hi flow

A

-Nasal prongs at 6L may be necessary
-Have mask available for in-between bites
Use portable O2 tank at bedside if needed

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9
Q

Benefits of optiflow?

A

NOT an AGMP
More comfortable
Clients can eat & drink
Precise oxygen concentration
Decreased WOB
Promotes ciliary movement & secretion clearance

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10
Q

Why do you not need airborne precautions with an optiflow?

A

NOT an AGMP

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11
Q

What mode should the optiflow be on?

A

Invasive unless pt has a trach

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12
Q

How often does the nurse have to assess the optiflow?

A

Monitor FiO2 setting, flow rate, temperature, and sterile water bag at least every 4 hours

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13
Q

HOw often does an optiflow pt need to be assessed in the first 24hrs and then following?

A

Respiratory/cardiovascular assessment/VS required by the nurse q4h and PRN for the first 24 hours
After 24 hours; monitor as determined by team

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14
Q

Who initiates optiflow?

A

Resp Therapist (RT) or Critical Care Nurse (CCN) with a doctors order

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15
Q

Who titrates optiflow?

A

CCN or RTT

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16
Q

Who discontinues optiflow?

A

RTT or CNN w doctors orders

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17
Q

How do you calculate how much air is left in the cylinder?

A

psi x 0.28
L/min

1) psi (what is left in the tank)
2) Multiply by the conversion factor (E-class is 0.28)
3) Divide by the L/min client requires

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18
Q

What is the most common conversion factor you will see?

A

0.28

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19
Q

Is nebulizer best practice?

A

Nebulizer no longer best practice, MDI w Spacer is best way to administer medication
Nebulizer = AGMP

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20
Q

Why do you not use oropharyngeal airway on conscious pt?

A

Can stimulate the gag reflex! Only use on patients with altered level of consciousness

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21
Q

How often do you perform mouth care on a pt w oropharyngeal airway?

A

Mouth care every 2 hours or as per protocol
May be suctioned prn
Remove and assess the mouth every 8 hours

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22
Q

Can you tape an oropharyngeal airway?

A

No! choose right size

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23
Q

How do you measure the right size for oral airway?

A

Measurethe oral airway from the center of the mouth to the angle of the jaw, or from the corner of the mouth to the earlobe.

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24
Q

How do you insert oral airway?

A

With the airway distal tip pointing up, open the mouth and insert the airway along the tongue
When the distal end reaches the soft palate rotate the airway 180 degrees

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25
Why would you use a nasal airway?
Better tolerated by alert patients
26
How do you measure a nasal airway?
Measure the nasal airway from the clients earlobe to the tip of the nostril Ensure the diameter of the airway is not larger than the nostril
27
How do you insert nasal airway?
Lubricate the airway with water-soluble jelly Insert along the floor of the nostril with a slight twisting action, aim towards the back of the opposite eyeball
28
Tracheostomy
An opening made for a tube via a surgical incision in the trachea just below the larynx (Procedure is called Tracheotomy)
29
Cuffed tracheostomy
Cuffed Tracheostomy tubes have an inflatable cuff that produces an airtight seal between the tube and trachea.
30
Assessment of a tracheostomy
Focused respiratory assessment Note the character of the secretions from the trach Presence of drainage on tracheostomy dressing or ties Note the appearance of the incision/new stoma: Redness? Swelling? Purulent discharge? Odour?
31
Bedside safety equipment for a trach:
- Suction equipment - Oxygen equipment with humidification Two replacement tracheostomy tubes (one of the same size, and one a smaller size than the current tube) - Obturator and spare inner cannula 10 ml syringe Tracheal tube exchanger Tracheal dilators or forceps Sterile gloves
32
When is a chest tube needed?
When pressure placed on the lung interferes with expansion When negative pressure needs to be restored When air or fluid needs to be drained May be used for chronic conditions
33
Assess chest tube insertion site
Lift up gown and look at site q4h Is dressing dry & secure? No air leaks? Palpate/listen for subcutaneous emphysema
34
Chest tube assessment overall
Prioritize chest tubes during QPA Advanced Resp Assessment Advanced Cardio Assessment PAIN: give prn analgesic DB&C q2 hours (may be contraindicated in lobectomy) Assist with range of motion/mobilizing as needed
35
DB&C
DB&C = Deep breathing and coughing
36
Closed system=
Maintain a closed system - Ensure connections are taped and secured according to agency policy - Tubing is free from kinks or compression - No dependent loops
37
Where does the drainage system have to be in regards to the pt
Drainage system below level of chest Secured to the ground or bed so doesnt tip
38
What are you looking for w drainage system?
Check for “tidaling” with respirations Ensure suction control dial is set to ordered level (usually 20 cm) Check for bubbling in air leak monitor Record date/time/amount of drainage on the outside of the chamber Record amount and characteristics of the drainage on the fluid balance sheet and patient chart Replace drainage chamber when full
39
Safety for bedside chest tubes
Two guarded clamps Sterile water Vaseline gauze (Jelonet) or other product per agency 4 x 4 sterile dressing Waterproof tape
40
When do you clamp chest tubes?
Do NOT clamp a chest tube unless: ordered by MRP, changing chamber, checking for leaks, dislodged
41
Where should you put chest tube clamps when moving patient?
TAKE GUARDED CLAMPS WITH PATIENT EVERYWHERE THEY GO
42
What happens if chest tube becomes disconnected from drainage system?!
Emergency! Clamp and submerge the end in 2cm of sterile water Clean ends with alcohol and reconnect immediately Unclamp
43
What happens if chest tube is pulled out?!
Emergency! Cover the insertion site with a gloved hand, call for help! Cover site with a sterile gauze and tape ONLY tape top and both sides- leave the bottom open Call MRP
44
What happens if The drainage is suddenly bright red?!
This may indicate an active bleed Monitor amount of drainage and vital signs Notify the MRP
45
What happens if A clot blocks the tubing?!
Do not strip or “milk” tubing May need to change drainage system Notify MRP if needed
46
What happens if The Chest tube has an air leak?!
Begin at dressing and clamp momentarily, working towards drainage chamber at 20-30 cm intervals Each time you clamp, check the water-seal/air leak meter chamber for bubbling When the clamp is between the source of air leak and the drainage chamber, the bubbling will stop. If bubbling stops the first time you clamp, the air leak must be at the chest tube insertion site or the lung
47
When do you recap a needle?
NEVER recap a used needle! Use needle safety device to cover
48
When do you need to empty the sharps bin?
2/3 full
49
Where are you putting an intradermal injection and why?
Injection into the dermis: between the epidermis and the subcutaneous tissue Low blood supply, slow absorption
50
How much liquid can be inserted via intradermal injection?
Can only administer a very small amount of liquid, usually 0.1 ml
51
Label your intradermal syringe with:
Label your syringe with: 2 client identifiers Name of the medication (ex. Tuberculin PPD) Dose and the amount (5TU/0.1ml)
52
What is the most common intradermal injection site:
inner forearm 5-10cm from elbow
53
What are you trying to avoid when choosing intradermal site?
Avoid areas with: abrasions or lesions, swelling, visible veins, edema, burns, rashes
54
Where do you inject if the intradermal site you chose is now wrong?
If you mess up, go 2-4cm away from last spot
55
Which direction should the bevel face?
UP
56
How deep do you insert the needle of intradermal injection?
3mm into the skin
57
When do you repeat intradermal injection?
Repeat test if: No wheal or bleb forms Solution leaks out
58
What do you do after intradermal injection?
Do not cover the injection site Do not massage injection site May be some blood at injection site (wipe away) Inform client that a wheal or bleb is expected, it will eventually be absorbed Document: For TB include date, dose, route, lot#, site location, and the measurement of the wheal/bleb
59
how long do you have to read TB test?
A TB skin test must be read by a designated HCP 48 – 72 hours from the administration of the test
60
What is a positive result of a TB test?
A skin test of 0-4 mm is considered negative A skin test of 5-10mm is considered positive in high risk populations, children <5yrs, or recent contacts A skin test of 10mm is positive in anyone else
61
Who deals with TB?
Public health nurse
62
TB treatment
Combination of oral antibiotics for 6 months or longer Isolation until no longer contagious Patients are closely followed by public health “DOT” Directly Observed Therapy
63
What are must do's for sputum collection?
Has to be brought up from lungs/ chest 15ml = tbl sp do not use mouth wash better before breakfast get patient to DB&C x3

NRSG 202 (4 decks)

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