RESPI AND URINARY PROCEDURES Flashcards
(226 cards)
1
Q
SUCTIONING RECOMMENDED POSITION; Conscious
A
Semi-fowlers
2
Q
SUCTIONING RECOMMENDED POSITION; Unconscious
A
Side lying (prevent aspiration)
3
Q
RECOMMENDED PRESSURE (WALL UNIT) Child
A
90 – 95
4
Q
RECOMMENDED PRESSURE (WALL UNIT) Adult
A
100 – 120
5
Q
RECOMMENDED PRESSURE (WALL UNIT) Infant
A
95 – 100
6
Q
RECOMMENDED PRESSURE (PORTABLE) Adult
A
10 – 15
7
Q
RECOMMENDED PRESSURE (PORTABLE) Adult
A
10 – 15
8
Q
RECOMMENDED PRESSURE (PORTABLE) Infant
A
5 – 10
9
Q
RECOMMENDED PRESSURE (PORTABLE) Child
A
2 – 5
10
Q
APPROPRIATE SIZE OF SUCTION CATHETER; Adult
A
12 – 15
11
Q
APPROPRIATE SIZE OF SUCTION CATHETER; Infant
A
8 – 10
12
Q
APPROPRIATE SIZE OF SUCTION CATHETER; Child
A
5 – 8
13
Q
LENGTH OF CATHETER
A
Measure from the tip of nose to the earlobe or about 13 cm (5-6 in) for adult
14
Q
LUBRICATE CATHETER; Nasopharyngeal suction tip
A
Water soluble
15
Q
LUBRICATE CATHETER; Oropharyngeal suction tip
A
Sterile water or NSS
16
Q
Apply suction during removal to-
A
prevent trauma to mucous membrane
17
Q
Apply suction for
A
5-10 secs, max = 15 secs
18
Q
over suctioning
A
hypoxia and vasovagal stimulation
19
Q
Hyperventilate client with oxygen before and after suctioning to
A
prevent hypoxia
20
Q
Provide _____ and ______ hygiene
A
Provide oral and nasal hygiene
21
Q
How to assess effectiveness of suctioning?
A
Auscultate breath sounds – absence of rales, crackles
22
Q
Removal of fluid or air from the pleural cavity
A
THORACENTESIS
23
Q
THORACENTESIS; Position
A
Sitting upright leaning forward
24
Q
Thoracentesis: Instruct to remain still, avoid __________during insertion of needle
A
coughing
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Normal due to infiltration of local anesthetic agent in thoracentesis
Pressure sensation
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No more than_______ of fluid is removed
1000ml
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Thoracentesis: Apply pressure to:
prevent bleeding
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Thoracentesis: Position: After
Unaffected side (approximately 1 hour)
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After Thoracentesis: Bed rest until VS become stable to?
prevent orthostatic hypotension
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After Thoracentesis: Check for?
Expectoration of blood, Faintness, Vertigo, Tightness in chest, Blood-tinged frothy mucus and Signs of hypoxemia
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Direct inspection and examination of the larynx, trachea, and bronchi
BRONCHOSCOPY
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CARE BEFORE BRONCHOSCOPY: NPO 6 hours for?
clearer visualization
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CARE BEFORE BRONCHOSCOPY: Pre-op med?
Atropine Sulfate (anticholinergic) – depress gag reflex
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depress gag reflex
depress gag reflexAtropine Sulfate (anticholinergic)
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CARE BEFORE BRONCHOSCOPY: Remove dentures and jewelry
prevent aspiration
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CARE BEFORE BRONCHOSCOPY: Sprayed Local anesthesia/topical anesthesia
to numb area
37
a pre- op med to numb area
valium or diazepam – relax pt
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CARE BEFORE BRONCHOSCOPY: Position:
Supine or sitting
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CARE AFTER BRONCHOSCOPY: Position?
Side-lying
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Why pt. to side lie after bronchoscopy?
promote drainage of secretions, prevent aspiration
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CARE AFTER BRONCHOSCOPY: NPO until?
cough and gag reflex return
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CARE AFTER BRONCHOSCOPY: Offer ice chips and fluids when?
cough reflex is demonstrated
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CARE AFTER BRONCHOSCOPY: WOF:
hypoxia, hypotension, tachycardia, dysrhythmias, hemoptysis, and dyspnea
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CARE BEFORE BRONCHOGRAPHY:
o Secure written consent
o Check for allergies
o NPO 6 to 8 hours
o Anticholinergics and Valium
o Have oxygen ready
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CARE AFTER BRONCHOGRAPHY: Position?
Side-lying
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CARE AFTER BRONCHOGRAPHY:
-Side-lying
o NPO
o Cough and deep breath client
o Low grade fever
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CARE AFTER BRONCHOGRAPHY: Cough and deep breath client- to?
promote airway clearance, expansion of lungs, cough of secretions
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CARE AFTER BRONCHOGRAPHY: Low grade fever common
common irritate mucus membrane
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Assess ventilation and Acid-base imbalance
ARTERIAL BLOOD GAS
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ABG: Common site
radial artery, brachial and femoral
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Done before withdrawing blood to determine adequacy of circulation or collateral circulation
Allen’s test
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pinkish color should return within 6 secs, indicates?
good circulation
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Amount of arterial blood obtained:
2mL in a 5-10 mL syringe
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ABG Blood should sent to the lab within?
2 hours
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Before sending ABG blood, place in a container with ice to?
prevent hemolysis – RBC breakdown)
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Apply pressure over arterial site: To?
prevent bleeding
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SPUTUM STUDIES
To identify pathogenic organisms and to determine whether malignant cells are present
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SPUTUM STUDIES: Usual method:
expectoration (early morning)
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Definitive test for TB
Acid Fast Bacilli
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only tell exposure to bacteria but not active TB
Mantoux Test
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Other names of Mantoux Test
Purified Protein Derivative or Tuberculin Skin Test
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Mantoux test: Route?
Intradermal
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Mantoux test: Induration
10 mm - mycobacterium tuberculae
5mm = HIV
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mycobacterium tubercule is resistant to
rifampicin and isoniazid, mycobacterium africanum, mycobacterium bovis
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determine the extent of lesion, parenchyma, determine if it is pulmonary or extrapulmonary
X-ray
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In Sputum studies: Instruct to clear nose and throat and rinse mouth to
decrease contamination of sputum
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In Sputum studies: After taking few deep breaths, patient ________ rather than spits using the __________ and expectorates into sterile container
Cough; Diaphragm
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Deepest specimen from the base of the lungs: obtained in ________ after they have accumulated overnight
morning
69
Specimen delivered to the lab within 2hours: to?
prevents overgrowth of microorganisms
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Offer oral hygiene after collection to?
decrease palatability of sputum
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TB precaution
airborne (use N95) ;
Droplet (within 3 feet);
Contact = use gloves before and remove after
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Detects fluids, tumors, foreign bodies, and other pathologic conditions
CHEST X-RAY
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In Chest X-ray: Usually taken after ____________ or ____________.
full inspiration or deep breath
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In Chest X-ray: Instruct to remove ________, ___________ and other materials that contains metal
jewelries, dentures,
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An airway clearance technique (ACT) to drain the lungs
CHEST PHYSIOTHERAPY
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CPT; Main goal:
remove or drain tracheobronchial secretions
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In CPT it includes:
percussion (clapping), vibration, deep breathing, and huffing or coughing
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In CPT: Not done for patients with
airborne infections
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In CPT: Patient should _________ tight clothing, jewelry, buttons, and zippers around the neck, chest, and waist
remove
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In CPT: Light, soft clothing, such as a T-shirt, may be________.
worn
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Do not do CPT on_______.
bare skin
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Length of CPT:
20-40 mins (ave = 30 mins)
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Best time to perform chest physiotherapy:
a. Upon awakening
b. Before meals
c. 30 mins – 2 hours after meals (prevent possible aspiration)
d. At bedtime
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CPT Classification:
POSTURAL DRAINAGE
PERCUSSION
VIBRATION
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Involves positioning a person with the assistance of gravity to aid the normal airway clearance mechanism
POSTURAL DRAINAGE
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POSTURAL DRAINAGE :Length of time to hold:
3-15 mins
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Put 2 or 3 pillows over stomach for support.
Sitting Positions
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Place a small pillow under head. Put 2 pillows under bent knees.
Trendelenburg Position
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In PD: Breathe in through nose and out through mouth. Remember: always to breathe out for _________than breathe in.
longer- This allows lungs to empty as much as possible
90
Put 2 or 3 pillows under stomach so that chest is lower than hips
Prone
91
Place a small pillow under head and 2 or 3 pillows under hips.
Side-lying Position
92
Also referred to as cupping, clapping, and tapotement
PERCUSSION
93
This is accomplished by rhythmically striking the thorax/chest wall with a cupped hand or mechanical device directly over the lung segment (s) being drained
PERCUSSION
94
PERCUSSION: Length:
2-3 minutes (3-5 minutes)
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Special attention must be taken to not clap over the?
Hint: SBSL
Spine
Breastbone
Stomach
Lower ribs or back
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Involves the application of a fine tremorous action/ rapid vibratory impulse.
VIBRATION
97
Vibration: Length:
approximately 15 seconds
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Highly infectious chronic disease caused by tubercle bacilli
PULMONARY TUBERCULOSIS
99
tuberculosis among children
Primary Complex
100
PULMONARY TUBERCULOSIS; Causative Agents:
Mycobacterium tuberculae
Mycobacterium africanum
Mycobacterium bovis
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TB: Mode of transmission
Airborne
Droplet
Direct Invasion – rare
Ingestion of unpasteurized milk or dairy products
102
Pasteurized?
63°C = 30 mins;
71.6◦C = 15 secs
103
What is Incubation Period?
s/s not yet specific = from entrance to appearance of s/s
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TB Incubation Period
2-8 weeks
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PERIOD OF COMMUNICABILITY
-While bacillus in the sputum
-Good compliance to regimen – not contagious 2-4 weeks’ after
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Enclosed space (3 months)
Close Contact
107
Closed environment (prison)
High Risk Group
108
with AIDS, HIV, DM, Renal failure
(immunocompromised)
High Risk Clinical Group
109
5 CARDINAL SIGNS OF PTB
C
NS
WL
A
H
LGF-PM
110
DSSM
DIRECT SPUTUM SMEAR MICROSCOPY
111
Early morning sputum collection
Conventional Strategy (Spot)
112
3 times of sputum collection
Spot-Spot
o One Spot – turkak now
o Second Spot – turkak after 1 hour
o Third Specimen – turkak early morning tomorrow
113
SPUTUM ANALYSIS: 2 positive
Positive
114
SPUTUM ANALYSIS: 1 positive and 1 negative
for X-RAY
115
Never been diagnosed and taken anti TB drugs (last 2 months)
NEW
116
Treated but diagnosed again (positive)
RELAPSE PATIENTS
117
Undergone treatment but treatment failure
TREATMENT AFTER FAILURE PATIENTS
118
Loss contact
TREATMENT AFTER LOSS TO FOLLOW-UP PATIENTS
119
o No known treatment
o Return after default
OTHER PREVIOSULY TREATED PATIENTS
120
Does not fit to 5 categories
PATIENTS WITH UNKOWNS PERVIOUS TB TREATMENT HISTORY
121
DOTS
DIRECTLY OBSERVED TREATMENT SHORT COURSE
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DOTS: Intensive phase
2 months
123
DOTS: Maintenance Phase
4 months (C2 = 5 months)
124
MAINTENANCE phase: Meds?
HRZES
125
Extensive parenchyma lesions, (+) smear, newly diagnosed, seriously ill
C1
126
C1 Drug: Intensive Phase
2HRZE
127
C1 Drug: Maintenance Phase
4HR
128
Relapse, treatment failure, return after default, others
C2
129
C2 Drug: Intensive Phase
2 HRZES
130
C2 Drug: Maintenance Phase
5HRE
131
New TB but minimal parenchyma lesions, not seriously ill
C3
132
C3 Drug: Intensive Phase
2HRZ
133
C3 Drug: Maintenance Phase
4HR
134
Chronic PTB, (+) TB and (+) Sputum smear after supervised treatment
C4
135
SECOND LINE DRUGS (INJECTABLES)
AMINOGLYCOSIDES & FLUROQUINALONESS
136
AMINOGLYCOSIDES
Amikacin
Kanamycin
Capreomycin
137
FLUROQUINALONESS
Ciprofloxacin
Moxifloxacin
Levofloxacin
138
SE of Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
Jaundice
139
SE of Ethambutol
Visual Impairment
140
SE of Streptomycin
Tinnitus and hearing impairment
141
SE of Rifampicin, Isoniazid
Oliguria and albuminuria
142
SE of Isoniazid
Psychosis and Convulsion
143
SE of Rifampicin
Thrombocytopenia and anemia
144
DR – TB
Isoniazid
145
MDR – TB
Isoniazid and Rifampicin
146
XDR – TB
Isoniazid, Rifampicin, Fluoroquinalones
147
XXDR – TB
Isoniazid, Rifampicin, Fluoroquinalones
148
TDR - TB
Isoniazid, Rifampicin, Fluoroquinalones
149
Treatment pf choice for renal failure = particularly oliguria or anuria
DIALYSIS
150
Remove the end products of protein from metabolism from the blood
DIALYSIS
151
Maintain safe levels of electrolytes
DIALYSIS
152
DHN: Serum Osmolality?
High
153
High Serum Osmolality activate?
Thirst Mechanism in Hypothalamus
154
thirsty: Increase?
ADH
155
ADH; High?
Water Reabsorption
156
High h2o reabsorption leads to?
Decrease UO
157
water moves from___________ concentration to____________ concentration
low solute; high solute
158
D5LRS; Shrink cells
Hypertonic
159
0.45 NaCl;
Swell/bursts cells
Hypotonic
160
IV fluid: Do not give to DHN
Hypertonic
161
IV fluid: for DHN
Hypotonic
162
NSS
0.9 NaCl
Isotonic
163
Correct acidosis and replenish the blood bicarbonate system
DIALYSIS
164
Remove excess fluid from the blood
DIALYSIS
165
Purpose of Dialysis
RMCR
166
PERITONEAL DIALYSIS; Site of insertion:
2 inches below umbilicus
167
PERITONEAL DIALYSIS; Area:
avascular
168
PERITONEAL DIALYSIS: Weigh patient before and after the procedure
best indicator of hydration
169
Have patient_______ just before dialysis begins
void- for comfort
170
The dialysate solution should be ______ at body temperature
warm
171
The dialysate solution should be warm at body temperature
for the capillary permeability of peritoneum, prevent abdominal discomfort
172
Cycle of peritoneal dialysis
Infusion time
Dwell time
Drainage time
173
Infusion time
= 10 minutes
174
Dwell time
= 4-6 hours
175
Drainage time
= 30 minutes
176
In peritoneal dialysis: First few bottles of drainage will normally be___________.
pink-tinged
177
In peritoneal dialysis: If drainage stops,
turn client to the sides
178
If drainage stops, turn client to the sides because?
colon may just be occluding the lumen of catheter
179
Peritoneal Dialysis: Observe for_________, ___________, and _____________, _______________.
Observe for fluid leaks, signs of hypovolemia, and hyperglycemia, disequilibrium syndrome
180
disequilibrium syndrome
rapid removal of waste products from the blood than brain
181
S/SX of disequilibrium syndrome
headache, HPN, dec LOC, irritable, confusion
182
Following dialysis, apply__________ and observe site for _________.
dressing; drainage
183
board-like or rigid abdomen
Peritonitis
184
Watch out after Peritoneal Dialysis
Peritonitis and Respiratory Difficulty
185
S/Sx of Peritonitis
board-like or rigid abdomen, fever, ↑WBC, ↑body temp, chills, abdominal pain and tenderness
186
When in Respiratory Difficulty?
Introduce fluid to compress diaphgram
187
Position after Peritoneal Dialysis
Semi-fowlers to promote Lung expansion
188
Requires vascular access
HEMODIALYSIS
189
HEMODIALYSIS; Duration:
2-3 hours per day
190
HEMODIALYSIS; Frequency:
3-4 times a week
191
HEMODIALYSIS; 4 SITES
AV fistula
AV graft
AV shunt
Femoral vein catheterization
192
Before and During Hemodialysis:
-Have client void
-Chart client’s weight
- VS q5mins
-Inform client that headache and nausea may occur
-Ensure bed rest
- Monitor for signs of bleeding
193
Length of time for initial hemodialysis:
30 mins
194
Arm precaution
No BP taking on affected
195
No BP taking on affected because?
disrupt AV fistula patency = pale, arm pain
196
In Hemodialysis : Assess for patency by auscultating _______and palpate for ________.
Bruit; thrill
197
Assess for steal syndrome, this includes:
hand numbness, pain, coldness and weakness
198
In Hemodialysis: Blood transfusion should be administered ________the procedure
during
199
In Hemodialysis: ________________meds are omitted.
Anti-hypertensive (↓BP)
200
o Adherence to well-balanced diet
o Importance of periodic blood chemistries
o Daily weights
CONTINUOUS AMBULATORY PERITONEAL DIALYSIS
201
BENEFITS OF DIALYSIS
Improves the following problems:
Hint: 4E
-Edema
-Elevated BUN, serum creatinine
-Elevated electrolytes
-Elevated blood pressure
202
HEMODIALYSIS MEDS
o Insulin
o Dextrose (glucose)
o Calcium gluconate
o Sodium bicarbonate
o Kayexalate
o Aluminum hydroxide
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