Nutrition
When are patients screened for malnutrition?
Patients are screened at admission and shift change
How often should drains be emptied?
Every 4 to 8 hours or per physician order.
On what post op day can patients shower with a wound vac?
The VAC unit can NOT get wet!
A patient on V.A.C. therapy can shower on “VAC change days” (MON-WED-FRI) before dressing is changed, if okayed by physician.
What are the TWO kinds of Advanced Directives?
Living Will and Durable Power of Attorney
Who can complete the Admission Navigator
RN and LPN.
LPN cannot complete head to toe assessment, but they can ask the questions
What is the gold standard for patient weights?
Standing weight is the gold standard
How often should the chest tube dressing be changed?
Daily or more often if soiled or saturated
When is it ok to send a wound vac home with a patient?
NEVER!!!
Our VAC units NEVER go home or to skilled care with patients
What is the difference between Palliative and Hospice Care?
Palliative:
Best used when it is integrated into a patient’s treatment plan
Follows along with a patient to manage symptoms as they continue to pursue active treatment
Focuses on goals of care, advanced care planning, and expectations of treatments
Hospice:
Patient must have a life expectancy of 6 months or less
Treatment plan is developed to manage symptoms at the end of life
Patients are no longer actively seeking treatment for their illness
Follow with patients families after death, through the grieving process.
When do we document on the "Provider Notification" row within EPIC?
This is where you capture your escalation of critical results, patient condition or concerns.
When is it appropriate to use an estimated or stated weight
NEVER use and estimated weight or stated weight
Suction setting on oasis is set at ____cm H2O unless ordered otherwise
-20 cm H2O
Can the wound vac unit go into the MRI environment?
The therapy unit can NOT go into the MRI environment.
If an ethical issue arises what order should be placed?
Contact Admin Sup-Place Ethics Consult in EPIC
Is secure chat a part of the permanent record?
Secure chat is NOT a part of the permanent record.
You must still capture that communication using the "Provider Notification" section.
How often should the set up and tubing be changed on a closed feeding tube system
Set up and tubing is changed every 24 hours
What is the acronym for trouble shooting a chest tube?
DOPE
Displaced Tube
Obstruction
Pneumothorax
Equipment failure
What action should be taken if the wound vac system fails during off hours?
Place wet to dry dressing if vac fails on off hours
Where in EPIC do you document and Advanced Directive?
Admission Navigator-Advance Directive
What tab under summary can confirm that all admission documentation has been completed
Ad Req Doc
This will be confirmed with a green check mark on the brain
What is the hang time for parenteral nutrition?
5 pm (recently changed from 6pm)
What is the acronym for assessment of chest tubes?
FOCA
F - Fluctuation (Tidaling)
O – Output - Notify Provider if initial output is > 500ml or for 200ml output in a 2 - 4-hour period
C - Color and Consistency
A – Air Leak
What actions should the nurse perform if active bleeding develops suddenly, large amounts develop during therapy, or frank blood is seen in the tubing or in the canister
Immediately stop the V.A.C.
Leave the dressing in place
Call the Wound Care Nurse and the physician
A document that establishes a patient’s health care wishes if they are no longer able to speak for themselves
Advanced Directive
Where do you chart your undress and assess on admission
"Two-person skin check" section-Verifier 1 and Verifier 2