Stick em
This site is not good because of constant flexion causing kinks to tubing and can impair ROM and use for ADLS. Damage to this site can cause damage to more distal veins in the forearm and hand.
What is using the antecubital for IV insertion? This site should be reserved as a last option
Normal Saline (.9% NS) and Lactated Ringers (LR)
What are examples of isotonic solutions. Solution is isotonic when its effective osmole concentration is the same as that of another solution. This state provides the free movement of water across the membrane without changing the concentration of solutes on either side.
Major complication of tracheostomy tubes with first 72 hours
What is obstruction of tube, mucus plugs? How do you prevent? Frequent assessment, encourage patient to try and cough up, if unable to suction call RT. Good trach care.
Nose to ear to xiphoid process
What is correct way to measure NG tube length?
Left Lateral Position/SIMS
O What is the position for an enema
Hand hygiene, max sterile barriers during insertion, assess daily for necessity, cleaning access port with antiseptic, dressing change every 7 days and or when soiled.
What are bundle elements to prevent CLABSI?
Redness, pain around site, and warmth around vein
What is Phlebitis? Stop the IV infusion, dc the IV and apply warm compress.
Spare trach in current size, and size smaller, trach tray, obturator, ambu bag
What is the emergency equipment needed at the trach bedside?
High Fowlers, then keep HOB 30 degrees
What is correct patient positioning when inserting the NG tube, and while patient has suction or enteral feeding going through the NG tube?
Call light, frequent rounding, commode at bedside, delegate someone to stay at bedside
What are safety considerations to keep patient safe after giving an enema?
change no more than 72-96 hours or longer if clinically inidcated
What is Frequency to change IV sites per CDC
Ensuring no medication from secondary tubing isn't lost by priming that line alone
What is back-filling or back-priming a piggyback line?
When doing trach care or getting ready to suction- instilling normal saline is helpful in loosening secretions
What is no way- old practice! Why? Aspiration=aspiration pneumonia
X-ray and gastric pH
Drain when 1/3-1/2 full and usually 2-4 hours after mealtime.
What is optimal time to empty ostomy pouch?
Surgery, rapid fluid or blood product, pediatric, small fragile veins, medication administration
What are considerations for gauge of needle for IV insertion? 20-22 G usually most suitable, 18 G for trauma, mass transfusions, 22-24 G for children, fragile veins, older adults.
Patient is dehydrated from gastric fluid loss or -give them 0.45% NS the MD says you know this is right because....
What is hypotonic IV solution to expand intracellular volume. Hypertonic is given to replace sodium in hyponatremia. Can also be used to infuse some calories. Irritating to veins think central line. Isotonic fluid for extracellular volume.
Suctioning- how far done, how long, technique of withdrawing the catheter- what do I do right before and in between suction passes
Pass the catheter down until you meet resistance or patients coughs, then start withdrawing slowly apply intermittent suction. No longer than 10-15 s, oxygenate before and in between passes. only suction `1-2 x more at a time.
Three assessments you will perform on patient before insertion of NG tube
Check the nares, assess gag reflex, and bowel sounds. May not have any bowel sounds but this will serve as your baseline.
I will never ever clog my patients feeding tube because as a good RN I will...
Flush, crush, dissolve, flush, liquid form, 15-30 ml of water
Before fluid administration, After catheter placement and before and after medication admin, blood products, blood sampling, or parenteral nutrition and use a push-stop-push-stop method to create turbulence
What is when to flush and the method of flushing for a central line?
infiltration of a vesicant or chemotherapeutic drug
What is extravasation? Which is a type of infiltration that can destroy the tissues and/or cause blistering. Treatment depends on if there is an antidote. Infiltration of other solutions happens when fluid infuses into the tissues. Warm or cold compresses would be applied to site dependent on solution infused and site policy. Warm for isotonic solution. Compare site to opposite side, frequent assessments
Give me key documentation of a patient you did trach care on
Resp assessment before/after, oxygenation status, trach tube size and tube, date/time of change, characteristics of secretions, site assessment
How often should you replace tube feeding bags?
Every 24 hours
What is refeeding syndrome? I never taught you this!
When patients are malnourished and we begin to feed them there can be electrolyte disturbances from using carbs as source of fuel vs. protein stores. Make sure to check electrolyte levels prior to initiation. If there are imbalances make sure to start feeding at slow rate.