Unit VII
This is done immediately after evisceration of a wound
What is cover the wound with a sterile gauze or sterile towel
What is aspirate stomach contents and test ph for acidity
Difference between a Jackson Pratt (JP) and Hemovac drain
What is difference in size and JP needs to be manually compressed to establish suction.
This is done when performing oropharyngeal suctioning for a client
What is rotate the suction catheter while withdrawing for 10 to 15 seconds
Decreased oxygen levels in the blood
What is hypoxemia
Thick yellow or green drainage is considered this.
What is purulent drainage.
Signs of Hypovolemic Shock
What is decreased blood pressure and urinary output
Phase that takes place after induction of anesthesia and before the first surgical incision
What is Time-Out
How to remove staples from a surgical wound
What is place the prongs under the staple and depress to remove staple and place steri-strip
What is compress (or recollapse) after empyting it.
Initial Risk assessment for pressure injury is performed on the patient
What is when patient is admitted to the hospital
Purpose of pouring water into an NGT after feeding or medication administration
What is so the tube doesn't get clogged.
Partial thickness loss of skin with red tissue in wound bed
What is Stage 2 pressure injury
This causes a impaired oxygen transport from the lungs to the tissues
What is low hemoglobin or severe anemia
Improves lung function and strengthens abdominal muscles
What are breathing exercises
Best time to collect Sputum culture.
What is early in the morning after the patient wakes up
This is done for continuous enteral feedings to ensure safe effective care
What is refrigerate unused portion and discard after 24 hours
How to maintain adequate nutrition intake for a patient with a venturi Mask
What is request an order for a nasal canula during meals.
This is done when witnessing an informed consent with a patient who only speaks Spanish
What is request a medical interpreter.
Nursing action done to confirm paralytic ileus
What is auscultate for absence of bowels sounds in all 4 quadrants for 3 - 5 mins.
Deep crater without visible bone, tendon or muscle
What is stage 3 pressure injury
Teaching for use of an Incentive Spirometer
What is inhale through the I/S 10 times with each use.
Most effective position to reduce skin damage and pressure injury to a patient.
Elevate the HOB no more than 30 degrees
This is documented as difficulty breathing when laying flat.
What is orthopnea
This is given to adult clients at risk for skin breakdown to maintain skin integrity.
What is provide the patient with foods high in protein.