OSCE Flashcards
(25 cards)
Donning and doffing PPE for nasogastric precautions.
Donning: hand hygiene, gown, mask, gloves. Doffing: Removes gloves, hand hygiene, remove gown, hand hygiene, removes goggles, hand hygiene, remove mask, hand hygiene.
Mrs Babylon reports abdominal discomfort and a bloating. She is uncomfortable. She has also developed some atelectasis in her Left lower lobe and is requiring Oxygen at 2L/min via N/specs. She has a PmHy of HT and Hypocholesteremia. She is up to date with her pain relief and has no further pain relief due for 60 mins.
How will you respond? What are your priorities of care?
Complete vital signs, head to toe assessment, fluid intake, positioning, respiratory assessment.
What are you looking for in a respiratory assessment?
Respiratory History, skin colouring, signs of Dyspnoea, Hypoxaemia, Cyanosis, SaO2, FiO2, Resp rate and pattern, work Of Breathing, Auscultation – breath sounds, inspection, Palpation, Percussion, cough characteristics, ? Sputum production.
What is included in an abdominal assessment?
Inspection – what are you looking for here? Palpation – consider technique, auscultation – what are you listening for? Percussion – all 4 quadrants, ensure to note muscle guarding.
What is the pain assessment, PQRST?
Provoking factors, quality of pain, region and radiation, severity, time.
What are the options for pain relief?
Medication Therapy. Non therapeutic – Positioning, hot packs or cold packs, mobilisation, distraction, music/ TV, breathing techniques etc
What are the complications of a RBC transfusion, and what is the patient at risk of?
Anaphylaxis – hemodynamic changes, haemolysis (RBC breakdown), febrile reaction – temp, volume / circulatory overload, transfusion related lung injury (TRALI), rash, respiratory distress.
What should you consider in a blood transfusion?
Types of blood products, Compatibility for transfusion, Indications for Blood transfusions, Consider, PIVC size, Flush PIVC first with Normal Saline, 10mls. Two RNs, vitals signs before commencing transfusion.
How often do you do vital signs once starting a blood transfusion?
Observe the patient carefully for the first 15 minutes. 5 minutely vital signs for the first 15 minutes and stay with the patient.
6 rights of medication?
Patient, medication, dose, time, route, documentation.
What do you do if the patient has a reaction from a blood transfusion?
- Start with checking: Airway – Breathing – Circulation (ABC).
- Know where emergency trolley is. Is a MET call required?
- Do not discard transfusion packs.
- Recheck ID and all details on the blood product pack.
- Do not flush the line of blood into patient.
- Why? You would only be giving them more of the blood they are potentially reacting to.
- Notify the Transfusion service of the transfusion reaction and actions taken.
When should naso tube position be checked?
After insertion, at least once per shift, after episodes of vomiting, retching or coughing, whenever displacement is suspected and in the presence of any new and/or unexplained respiratory symptoms or reduction in oxygen saturation.
Considerations with medication administration through N/G and N/E tube.
Function of enteral tube, aspiration/free drainage, multi-lumen tubes, occlusion Risks, interactions between drugs and/or feeds, crushing - when to and when it is contraindicated e.g., enteric coating.
What are the complications of Enteral Feeding?
Pulmonary aspiration, diarrhoea, constipation, tube occlusion, tube displacement, abdominal cramping, nausea, vomiting, delayed gastric emptying, serum electrolyte imbalance, fluid overload, hyperosmolar dehydration.
Why do you flush N/G and N/E tubes?
To help prevent interactions between the feed and drug administered and to prevent blockages.
What can cause occlusions in an N/G and N/E tube?
Medications. Blockages can occur due to interactions between differing medications and/or interaction with the feed. Drugs such as Proton Pump Inhibitors (PPIs) in a granular form are an issue due to their makeup contra indicating crushing but the size of the granules making administering via a tube difficult.
Do you have to use sterile water for an adult patient with an N/G?
No use tap water for N/G tubes. Although, sterile water for Jejunal tubes, children under 6mths and those in a poor clinical state.
What do you do if the drug is to be taken on an empty stomach?
If drug to be taken on an empty stomach stop feed 30 minutes before dose and resume 30-60minutes after (increase times if gastric emptying poor). Stopping the feed should be in consultation with a dietitian.
Can you mix different medications, and administer them at once?
Only administer one medication at a time and do not mix different medications.
What is Jejunal feeding?
Jejunal feeding is the method of feeding directly into the small bowel. The feeding tube is passed into the stomach, through the pylorus and into the jejunum.
Where do you check to see if the drug can be delivered via N/G?
MIMS online.
Where are drugs absorbed?
Most drugs absorbed in the jejunum. Drug absorption may be reduced due to pH (alkaline environment) or delivery beyond site of absorption.
When should you flush N/G tubes?
Flushing of tubes should occur: Before and after each intermittent feed. Every 4-6 hours during continuous feeding. Before and after each drug administration.
What is an A to E assessment?
Airway, Breathing, Circulation, Disability, Exposure
