The vein feels hard and cord-like with a red streak going up the arm.
What is phlebitis?
You are assessing your client's chest tube. The fluid is moving up and down with respirations in the water seal chamber.
What is tidaling?
An important safety precaution to implement when working with epidural analgesia.
What is labeling the epidural catheter?
Your client has a tracheostomy with a non-disposable inner cannula that you remove, clean, and replace.
What is tracheostomy care?
You have a client with a blood transfusion order. The client's temperature is 100 F/37.8 C prior to starting the transfusion.
When should I message the primary care provider?
You have an order to begin IV of D5 0.9%NaCl @ 75/hr.
What is isotonic/maintenance IVF?
Assessment of the client's chest tube includes the amount and type of drainage every shift.
What is an important observation to include in the client's electronic medical record?
The action of checking the client's EMR for an order and any allergies.
What is the first action performed when beginning a PCA?
The assessment of your client for a pneumothorax after having a subclavian catheter inserted.
What is shortness of breath?
The infusion of blood within 30 minutes after leaving the blood bank.
How long does the RN have to begin administering blood?
Using saline to flush the saline lock before and after pushing the IV medication.
What is the correct way to administer IV medication through a saline lock?
Your client's chest tube has continuous bubbling in the water seal chamber during inspiration and expiration.
What is an air leak?
A client that is post-op day 1 after a colon resection.
Which procedure/diagnosis best suits a PCA?
Your first implementation when the client has dyspnea with rales bilaterally after starting IV fluid.
What is decrease the rate of IV fluid and call the primary care provider?
The client has medication going through the IV and also needs a blood transfusion.
What is start a new IV?
You instruct the client to perform this when removing a central vascular access device.
What is bearing down?
The most important intervention to perform when the chest tube is disconnected from the drainage system.
What is submerging the tube in sterile water or saline?
Teaching the family about the maximum amount of medication in a certain period of time delivered via PCA.
What is the set limit of the PCA?
An important implementation with bloody secretions upon suctioning.
What is reduce the suction pressure/suction less often?
Your client has chills, pain, and an increased temperature shortly after starting the blood transfusion.
What is an acute hemolytic transfusion reaction?
During your assessment you find the wrong IV solution being administered to your client.
What is hanging the correct solution and notifying the primary care provider?
A daily intervention after chest tube insertion.
What is a daily portable chest x-ray?
The client has control to self-administer pain medication for improved pain relief and fewer side effects.
What is the primary use of a PCA?
An important implementation with assessment of unequal bilateral breath sounds on an intubated client.
What is notify respiratory therapy and get a chest x-ray?
An important intervention prior to administering blood to prevent a transfusion reaction.
What is check the blood against the client's armband prior to administration?