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22 Cards in this Set

  • Front
  • Back

How does a nurse help manage chronic disease?

- Promote prevention


- Lifestyle changes/interventions to preventchronic disease


-Once disease occurs, focus shifts to:


◦ Managing symptoms


◦ Avoiding complications


◦ Avoiding acute illness


◦ Promoting health


◦ Maintaining functional status

Define the term 'disability'.

A disability is any condition that restricts aperson's mental, sensory or mobilityfunctions. It could be caused by accident,trauma, genetics or disease. A disability maybe temporary or permanent, total or partial,lifelong or acquired, visible or invisible.




Can be either developmental, acquired or age-related.

Why would you use a nasogastric tube?

- To decompress the GIT


- Nutritional support


- Medication administration


- Less commonly:


Compression


Lavage


Diagnostic studies

What are the different kinds of nasogastric tube?

Nasogastric or Orogastric tubes: Ryles or Sump Tubes for:


- Drainage or Decompression


- Medication Administration


- Short term feeding (1-2 weeks)




Nasointestinal Tubes or PEG:


- Gastrostomy or Jejunostomy


- Percutaneous Endoscopic Gastric Tube

List the steps to nasogastric insertion:

Assessment


- Are they conscious?


- Can they swallow?


- Is their nasal cavity suitable?




Explanation


- Purpose


- Procedure


- Informal consent




Measurement of tube


- Checking placement with x-ray


- Should be half way between xiphoid process and navel

What are the contraindications of using a nasogastric tube?

- Patients diagnosed with liver failure and portal hypertension


- Fracture to the base of skull


- Facial Trauma


- Nasal cavity abnormalities


- Patient with an altered conscious state(should be attended by an experiencedstaff member)

How do you check for the correct placement of a nasogastric tube?

- Chest x-ray


- Aspirate to test pH of gastric contents (NOTE: respiratory aspirate is also acidic).

What are some potential complications of nasogastric tubes?

- Placement errors (lungs/brain/coiled in oesophagus)


- Tube displacement (due to coughing/vomiting)


- Tube blockage


- Pulmonary aspiration

What are the three different fluid types used in IV administration?

Isotonic fluids:


(A solution that has the same salt concentration as cells and blood).


- Glucose 5%*


- Sodium chloride 0.9%


- Compound sodium lactate(Hartman’ Solution)




Hypotonic fluids:


(A solution that contains fewer dissolved particles than is found in normal cells and blood).


- Sodium chloride 0.45%


- 5% dextrose (glucose is rapidlymetabolised, thus hypotonicfluid solution)




Hypertonic fluids:


(A solution where the concentration of solutes is greater outside the cell than inside it).


- 1.8% sodium chloride


- 10% Glucose D5%W + NS


- Mannitol


- Blood and products


- Albumen

What are some complications related to fluid osmolarity?

Isotonic:


- Electrolyte imbalances




Hypotonic:


- Intracellular oedema




Hypertonic:


- Intracellular dehydration



What are some complications or adverse events related to IV therapy?

- Phlebitis (inflammation of a vein. Can be bacterial, chemical or mechanical). - Thrombophlebitis (Irritation of vein stimulates thrombus formation)


- Infection (eg. Cellulitis)


- Extravasation/infiltration (leakage of medication out of vascular space)


- Allergic reaction (can be to fluid, medication or latex).

What are the clinical indications for hypoxia?

- Restlessness


- Confusion


- Tachycardia / Bradycardia


- Dyspnoea / Tachypnoea


- Cyanosis


- PaO2 ↓60 – 90 mmHg


- SaO2 ↓ 90%

What are the different devices used for oxygen administration?

- Nasal prongs (<4L/min)


- Simple face mask (6-8L/min)


- Partial re-breathing mask (8-15L/min)


- Non re-breathing mask (10L/min)


- Air entrainment masks (between 2-14L/min)

Define CPAP.

CPAP: continuous positive airways pressure

Why is humidification sometimes used in conjunction with oxygen administration?

Higher flows of oxygen result in decreasedlevels of humidification by upper airways. This can result in:


- Excessive drying of mucous membranes - Damage to muco-ciliary escalator


- Thickening and drying of secretions


- Increased pt discomfort

What are the clinical indications for administering humidified oxygen?

- Higher flows of O2 > 6lpm


- Pulmonary pathology such as pneumonia

What are some potential complications of oxygen administration?

- CO2 narcosis: when people are given too much oxygen which slows down the oxygen driven drive to breathe and we breathe slower. CO2 can build up and reach levels that can be toxic (eg. hypercapnea).


- Oxygen toxicity: an excess of oxygen in body tissues.

Considerations of drug administration:

Pharmacokinetics (Absorption, Distribution, Metabolism, Excretion)


- First pass effect (drugs acted upon by cytochrome P450 in Liver)


- Increased speed of bioavailability and half life.


- Increased speed of onset of action

What are the needle sizes for various injections?

- 30 gauge (intredermal)


- 25 - 26 gauge (subcutanious)


- 21 gauge (intramuscular)


- 18 - 19 gauge (drug preparation)

Describe the administration of intradermal injections.

- Needle inserted at 15° into forearm or upper arm.


- Mainly used for allergy testing and mantoux testing (for tuberculosis).


- Limited blood supply = slow absorption.


- Small amount of fluid administered.


- Mark the area of bleb / administration.

Describe the administration of subcutaneous injections.

- Needle inserted in adipose tissue at 45-90° (abdomen, outer thigh).


- Mostly used to administer insulin and anticoagulants.


-Dose volume should be <1ml.


- Absorption is slow and sustained due to limited blood supply.

Describe the administration of intramuscular injections.

- Needle inserted at 90° into muscle (eg. deltoid (<1ml) or ventrogluteal (0.5-4ml)).


- Aspirate to check for blood (if blood is present the needle has entered a vein and is now an IV injection - must withdraw and start again).


- Faster medication absorption due to rich blood supply.