Adult Health - Adv. Med-Surg Week 4 notes
Adult Health - Adv. Med-Surg Week 4 notes NU 424
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This 4 page Class Notes was uploaded by Allison Black on Friday February 5, 2016. The Class Notes belongs to NU 424 at Jackson State University taught by in Fall 2015. Since its upload, it has received 16 views. For similar materials see Adult Health in Secondary, Tertiary, and Community Settings in Nursing and Health Sciences at Jackson State University.
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Date Created: 02/05/16
Arterial lines: ▯ ▯ •NOT an IV infusion site. Saline or heparin only.▯ •Discard ﬁrst 5-10cc of blood when drawing from art line. ▯ •Check non-invasive BP to see if it correlates.▯ •Must have good waveform from transducer. poor waveform can either be from too little pressure in pressure bag, or in older art lines, the line attempting to clot off. ▯ ▯ Allen’s test: ▯ ▯ - Done before placing arterial line.▯ ▯ • Compress radial and ulnar arteries. ▯ • Have pt open hand. ▯ • Decompress ulnar artery. ▯ • If color returns within 5-15 seconds, ulnar arterial supply is sufﬁcient for arterial line. ▯ ▯ Monitor for: ▯ ▯ Circulation: ▯ ▯ • Always check for perfusion distal to the site!▯ • Chart color, temperature, capillary reﬁll▯ • Mottled color = decreased perfusion▯ ▯ Motion: can they move their digits?▯ ▯ Sensation: can they feel on the top and bottom of each digit?▯ ▯ ▯eport: ▯ • If arterial line is obstructing perfusion to extremity, it must be d/c’d▯ • ▯ • Must report negative ﬁndings (CMS check) to the prescriber▯ ▯ Removal: ▯ ▯ • Once removed, remember to hold pressure for at least 5 minutes▯ • Hold pressure longer for patients on:▯ - Antiplatelets▯ - Anticoagulants▯ - Those at risk for bleeding (check labs)▯ ▯ Drawing ABGs:▯ ▯ Procedure: Sterile▯ •Gather equipment▯ •Explain procedure to patient▯ •Set up pressure bag & transducer▯ •NS or Heparin for ﬂush▯ •Remove air from bag when spiking▯ •Flush lines / ensure ﬂow / check connections▯ •Change caps▯ •Connect cable to monitor & transducer▯ •Once inserted, connect line to patient & secure▯ •Flush, zero and observe for proper waveform▯ •Troubleshoot ▯ ▯ PEEP: ▯ ▯ •Keeps the airway open during expiration to allow more time for gas exchange▯ ▯ •The epiglottis provides this support in a normal patient. When a patient is intubated the epiglottis is bypassed so it must be provided▯ ▯ PEEP -ay decrease cardiac output▯ - Can increase ICP - be careful in stroke/brain injury pts. ▯n HF pts▯ ▯ Assist control: ▯ ▯ •For pts with NO spontaneous breathing. Set rate, set tidal volume. Pt cannot pull in deeper breaths.▯ •Most pts require sedation to avoid anxiety. ▯ ▯ SIMV: ▯ ▯ •Preset rate and tidal volume. However, pts can pull in spontaneous breaths or deeper breaths at any point. ▯ •Good for pts with spontaneous breaths, pts can take spontaneous breaths but will also be mechanically ventilated if they stop. ▯ ▯ CPAP: ▯ ▯ Pts MUST be breathing spontaneously. ▯ ▯ Alarm Settings:▯ - High pressure alarm- excessive amount of pressure ▯ - Causes: ▯ - Coughing▯ - Mucus/secretions▯ - Biting the tube or a kink in the tubing ▯ Low pressure alarm▯ - Causes: ▯ - Patient may take huge breaths and vent does not have time to respond▯ - Extubation▯ - Disconnection from vent circuit▯ - Cuff leak▯ - Apnea▯ - Causes: ▯ - Cardiac arrest▯ - Respiratory arrest▯ - Loose connection▯ - Too much sedation or narcotics▯ ▯ Complications:▯ ▯ • Barotrauma▯ ▯ ▯ - Push in a great deal of pressure and create a pneumothorax▯ • Right main stem intubation ▯ ▯ ▯ - tube goes past the carina, usually into the right mainstem, since the right one is ▯ ▯ ▯ straighter.▯ • Extubation▯ • O2 toxicity▯ • Aspiration▯ • Acid/Base imbalance▯ • Infection▯ • Dependency▯ • CV Complications▯ • GI Complications - stress ulcers▯ • Endocrine - high blood sugar. Many pts on sliding scale insulin.▯ Psychological Issues▯ ▯ • Factors that affect weaning:▯ • Cardiovascular stability▯ • Lung function▯ • Adequate Hgb/ Hct▯ • Hydration▯ • Metabolic state▯ • Temperature▯ • Obesity▯ ▯ Criteria for weaning:▯ • RR<25▯ • PaO2>60 with FiO2<40▯ • PaCO2<45▯ • normal pH▯ • PEEP<=5▯ ▯ When to stop weaning:▯ • Decreased LOC▯ • decrease or increase in BP>20-30mmHg▯ • increased HR>100 or >20 above baseline▯ • dysrythmia’s (PVC’s >6 min)▯ • decrease in SaO2<90▯ • RR<8 or >30 / Labored breathing▯ • Fatigue▯ • Panic▯ • Cyanosis▯ • Diaphoresis▯ ▯ Evidence based practice (sidenotes):▯ ▯ - Good hand washing▯ - HOB 30-45 degrees▯ - Peptic Ulcer Disease (PUD) Prophylaxis▯ - DVT Prophylaxis▯ - Daily Sedation Vacation▯ - Oral care every 2 hours▯ - Foley catheters with temperature gauges are NOT accurate without a continuous urine output