PleurX Drain
How often is PleurX dressing changed
As needed- usually only at time of drainage
T/F
The RN must obtain an order to access the IVAD/port
The RN does not need an order to access the implanted port
Where to place PleurEvac during transport via gurney
Hang on the side of gurney keeping PleurEvac below insertion site
During a code blue, which three items generally need to be obtained from the crash cart immediately.
Defib Pads
Back board
Ambu Bag
Post-op day 0. Does the RN need to wait for PT to walk patient down the hallway?
no. walk the patient if safe as soon as possible.
PleurX drainage at home must be sterile
No. At home the procedure is clean.
What is the frequency of changing the IVAD/port dressing and needle
Every 7 days or more frequently as needed
Taping down to floor
This insulin begins to start working within 10-15 minutes
rapid acting insulin (Lispro)
Reaches peak effect 30-90 minutes and lasts about 2-5 hours
What complications are commonly associated with post-operative pain medications (Opioids)
(name at least 2)
Constipation
Fall risk Related to the following:
dizziness, disorientation, confusion, Lethargy
Is it appropriate to pin the PleurX catheter to clothing
No. it should be coiled and covered with transparent dressing.
Immediately prior to deaccessing the port for the patient to go home the RN will flush/lock with this solution.
Normal Saline
(We no longer lock with Heparinized saline)
This reduces risk of pneumonia and should be done hourly while awake
deep breathing exercises (aka incentive spirometry)
Signs / symptoms of bladder irrigation complications (hint: clot/blockage)
Bladder distention
Pain/discomfort (if able to 'feel')
Lack (or reduction) of output
What is the standard frequency of vital signs post-op as seen in Post Op Care policy.
every 30 minutes x 2, then every hour x 2, then every four (4) hours for 24 hours
What are signs and symptoms that indicate the need to slow or stop PleurX drainage?
Increased Pain/Discomfort
The nurse is unable to determine via palpation or chart note that the port is power capable. Which needle can be used to administer stat meds.
The Miniloc needle (non-power capable non-coring)
When is Milking and Stripping done by the RN?
Never: because it can cause increased intrathoracic pressure
This is considered insulin stacking or "overcorrecting."
Administering repeated correction doses of rapid-acting insulin before the previous correction dose has finished working.
Taken directly from the policy, what are these monitoring parameters required for:
Patient on PCA
Why is a PleurX drain placed
Reoccuring effusion can be managed with PleurX outside of hospital.
The needle is too long when you see this
The clear wings are not in contact with the patient's skin and also there is some visible needle
After disconnecting from suction do you need to cover or clamp the tubing
No, because covering the tubing can cause increased risk of tension pneumothorax
IV dextrose along with IV insulin has been ordered to treat this this condition on the acute medical unit.
HyperKalemia: IV insulin helps pull potassium from the blood and into the cells
The nurse is assessing a new post-op admit and notices increasing temperature, tachycardia, and the patient is having masseter spasms. These signs and symptoms indicate which general anesthesia emergency?
Malignant Hyperthermia