To Cath or Not to Cath
Central Access
Managing the artificial airway
What do I do?
?TPN
100
What are some things you should always do BEFORE inserting a catheter?
* check your balloon
* make sure you have orders from the health care provider
* you have all of the necessary materials
* ensure a sterile field
100
This central line is placed percutaneously using sterile technique, and can be left in place for up to one year.
What is a PICC line?
Remember:
1) triple lumen central venous catheters are non-tunneled catheters used for short-term IV therapy
100
What should always be at the bedside of a patient with a trach?
An extra trach tube, obturator, and inner cannula. The ambu bag and mask should be ready to use as well as the suction.
100
What complication of a peripheral IV is pictured below?
phlebitis
What is phlebitis?
100
List 3 of the components of TPN
The components of the PN solution are amino acids, glucose, and lipids as energy sources, with the addition of electrolytes, minerals, trace elements, vitamins, and water
200
Can be used as an alternative to catheterization. It is used for incontinent or comatose men who still have complete and spontaneous bladder emptying.
Condom Catheterization
200
This is how placement of a CVAD is verified prior to initial accessing of the device.
What is checking the chest x-ray?
200
What is a Passey Muir valve and should the cuff be up or down when using the valve?
The Passey Muir valve is a one way valve that allows air to enter through the trach but won't allow it out. This forces the air through the vocal cords and the patient can then speak. The cuff should alway be down when using the valve.
200
You have been asked to remove a PICC line. After obtaining the appropriate supplies, you provide patient education regarding their role within the removal. One critical piece of information to provide is that the patient must ____ while the nurse removes the catheter.
Hold their breath.
Fun Fact: You can ask them to hum their favorite tune. Some patients start to panic at the thought of breath-holding.
200
Explain why hyperglycemia is a common complication of parenteral nutrition
Parenteral nutrition contains increased levels of dextrose that are being infused directly into the blood, because hyperglycemia has also been linked to increased infection rates, monitoring blood glucose levels during a PN infusion is important
300
When a condom catheter is applied, the catheter should be secured on the penile shaft in such manner that the catheter is:
A. Tight and draining well
B. Dependent and draining well
C. Secured with adhesive tape applied in a circular pattern
D. Snug and secure but without causing constriction that impedes blood flow.
D. Snug and secure but without causing constriction that impeded blood flow.
300
During a CVAD dressing change, patients are instructed to do this.
What is wear a mask or turn head away from site?
300
What position should the patient be in while performing trach care?
semi-fowler's unless contraindicated. (30 degrees) This decreases abdominal pressure on the diaphragm and promotes lung expansion.
300
What is the nurse's priority action if a tracheostomy tube is accidentally dislodged?
What is call a rapid response.
300
What if the PN needs to be disconnected and reconnected for any reason?
Interruptions for PN therapy should be avoided. PN should be administered continuously for its ordered duration (i.e., 24 hours or cycled)
400
True or False. A straight single use catheter uses an inflated balloon.
False. It uses a Foley
400
What is the inadvertent administration of a nonvesicant solution into surrounding tissues.
Infiltration
400
What are some ways to maximize patient acceptance of an artificial airway?
Frequently orient pt to time and place. Remind them of the purpose of the airway and the consequences of removal. Minimize tube discomfort. Adequate pain and anxiety management. Provide pt with means of communication (e.g., pen and paper, call light).
400
Suspicion of this is why a nurse places a patient on the left side, with the head lower than the feet after TPN infusing has disconnected the tubing from the central line catheter.
What is an air embolism?
400
Complication with TPN that presents with elevated temperature, confusion, elevated WBC's
What is sepsis
500
An alternative type of catheterization that involves surgical placement of a catheter through the abdominal wall above the symphysis pubis and into the urinary bladder.
Suprapubic Catheterization
500
Describe 4 reasons your patient may have a PICC line placed instead of a peripheral IV.
Long term antibiotics - infusions can be frequent, prevents need for new IV site each session
Frequent lab draws
No peripheral access - some patient have veins that are not easy to access
High osmolarity solutions
TPN
Trauma
500
What type of trach tube is is used when a patient is on the ventilator?
A cuffed trach such as a cuffed Shiley or XLT.
500
outflow, drainage- consistency, color, clots, bladder spasms
What are expected nursing assessments for continuous bladder irrigation (CBIs)
500
Name 3 complications of TPN
What is fluid imbalance?
What is electrolyte imbalance?
What is elevated blood glucose level?