FINAL EXAM REVIEW
PERIOPERATIVE:
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Preventing complications
o Atelectasis
▪ What can happen?
• Cause pneumonia
▪ Interventions:
• Incentive spirometer
• Coughing and deep breathing
• Chair ambulation
• Elevate HOB
o Thrombosis
▪ What can happen?
• Cause Pulmonary embolism
▪ Interventions:
• SCD’s
• Ambulation
• Blood thinners
o Heparin
• Elevation/positioning
o Wound infection
▪ What can is cause?
• Can lead to sepsis (infection of the blood) and delayed healing
▪ Interventions:
• Hand hygiene, dressing changes, prophylactic antibiotics, Nutrition (DM)
o Ileus
▪ What can happen?
• Prolonged hospitalization, hypoactive bowels
▪ Interventions:
• Ambulation and slow diet progression, constantly listen to bowel
sounds
o Hypovolemia
▪ What can happen?
• Decreased perfusion, renal failure
▪ Interventions:
• Antiemetic (drug that prevents vomiting), IVF, blood, monitor I&Os
o Dehiscence (splitting of the wound) & evisceration (organs are sticking out)
▪ What can happen?
• Return to OR and delayed wound healing
▪ Interventions:
• Abdominal splinting, binder, braces, cover with sterile wet gauze if
evisceration
Managing pain
o PCAs- patient controlled analgesia
▪ Issue can be risk of over sedation
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Continuous oximetry and capnography (monitors concentration or partial
pressure of Co2)
o Hot/cold pads
o Opioids/non-opioids (NSAIDs)
o Pillow support
o Deep breathing exercises
o Coughing exercises
o Guided imagery tapes
o Listening to music
o Anything the patient might use to prevent/stop pain
Dietary restrictions:
o Start with clear liquids then full liquids
o Prevent dried and dehydrated foods, and processed, cheese, diary products, meats and
sweets, to prevent constipation
Goals for discharge
o No infection
o No pain
o Proper education
o Social work and patient have a solid communication
o Post surgery check up meetings set up
o Correct transportation
SLEEP:
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Conditions provoked by sleep:
o Coronary Artery Disease: plaque buildup in the wall of the arteries that supply blood to
the heart
▪ Increased heart rate
▪ Increased angina
• Heart pain, almost feels like a heart attack, its difficult for blood flow to
go through the artery
▪ Increased ECG changes
o Asthma
▪ Increased bronchospasm during REM or aspiration with reflux
o COPD: lung disease that blocks airflow making it harder to breath, emphysema and
chronic bronchitis are conditions that make up COPD
▪ Decreased O2, increased CO2, transient pulmonary hypertension, due to
depressed neuromuscular control
o Diabetes
▪ Blood glucose control varies
o GI issues
▪ Increased gastric acid in REM, increased reflux due to positioning
Conditions that impaired sleep:
o Insomnia: inability to fall or remain asleep or go back to sleep
o Circadian disorder: abnormality in sleep/wake times
▪ Working night shifts, rotating shifts, jet lag
o Restless leg syndrome
▪ CNS disorder
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▪ Overwhelming urge to move legs while resting
▪ Unpleasant creeping, crawling, itching, or tingling sensations
▪ Runs in family
▪ More common in older adults
▪ Avoid stimulants, Rx neuroleptic, heat/cold therapy, vibration, acupressure
Sleep deprivation
▪ Result of prolonged sleep disturbance
▪ Daytime drowsiness, impaired cognitive function, restlessness, perceptual
disorders, slowed reaction time, irritability, somatic complaints
(twitches/tremors), general malaise
▪ If prolongs- delusions, paranoia, psychotic behaviors, change in immune system
▪ Hospitalization can occur
Hypersomnia
▪ Excessive sleeping (especially during daytime)
▪ Can be related to depression or illness
Narcolepsy
▪ Chronic disorder caused by the brain’s inability to regulate sleep-wake cycles
normally
▪ Uncontrollable episodes of sleep during the day last seconds to minutes
▪ May sleep fine at night
▪ Sleep attacks in short terms
Sleep apnea
▪ Interruptions in breathing seconds to minutes
• Decreased O2, increased CO2, increased heart rate, cardiac
dysrhythmias, cause of fatigue and morning headaches
• Obstructive
o Airway occlusion when muscles of upper airway and tongue
relax
• Central sleep apnea
o Pauses of breathing due to lack of respiratory effort, the
respiratory muscles aren’t being activated basically
o Completes suspension of breathing from dysfunction in central
respiratory control
• Mixed sleep apnea
Pain
Respiratory diseases
SOB
Heart Disease
▪ Coronary artery disease
▪ Chest pain and uncomfortable to feel
▪ Increased heart rate and angina
GI Distress/Gerd
▪ GERD: its gastric reflex
Nocturia
Parasomnias:
o Sleep walking
▪ During stage iii NREM
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Sleep talking
▪ Often NREM sleep
o Bruxism
▪ Teeth clenching and grinding
o Night terrors
▪ Sudden arousal
▪ Including hallucinations and strong emotions
o REM sleep behavior disturbances
▪ Violently acting out a dream
o Enuresis
▪ Peeing in the bed
• Habits to improve sleep
o Schedules routine
o No exercise before sleep
o Avoid bright lights before bedtime
o Don’t eat before bedtime
o Regularly exercise
o Reduce stress
o Reduce fluid intake before bedtime
HYPOVOLEMIA/FVD:
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Causes?
o Loss of extracellular fluid
▪ Water and solutes
• Vomiting and diarrhea
▪ Can include blood
o Includes deficit from 3rd spacing
▪ Spaces between the cells
o Insufficient intake
▪ Nausea
▪ Cognitive disability
▪ Immobility
o Excessive loss
▪ Bleeding
▪ Diabetes mellitus
• Because you constantly going pee because the body is trying to get rid
of the glucose
▪ Diabetes insipidus
• don’t produce enough of the ADH hormone
▪ Excessive sweating
▪ Fever
o Excessive loss cont’
▪ Fistula: is a passage way between two things where it shouldn’t, ex: vagina and
anus tear, causing a passage way (opening)
▪ Nasal gastric tube suctioning
▪ Diuretics & laxatives
▪ Renal failure
• Version that makes you urine a lot
▪ Vomiting &/or diarrhea
▪ Burns
o 3rd spacing (shifting)
▪ Internal bleeding
▪ Fluid shift from burns/injury or surgery
▪ Liver failure-ascites (build up of fluid)
▪ Plural effusion (excess building up between the lungs and the chest cavity) /
heart failure
• Clinical manifestations?
o Lightheaded, dizzy, confused, hallucinations, weakness (low pulse), anxiety, increased
blood pressure, orthostatic hypotension, cool pale skin, weight loss, dark urine
o Lab results: elevated BUN, Na+ normal or increased, low HGB/HCT blood loss, increased
urine specific gravity
o Cellular dehydration: mental status changes, dizziness/weakness, extreme thirst,
elevated temp (no water to help temp regulation), dry skin and mucous membranes
(skin turgor unreliable measure in older adults)
• Interventions?
o Replace fluids- requires same concentration as fluid loss
▪ Oral replacement not sufficient
▪ Lactated ringer or 0.9NS
▪ May be as a rapid bolus
▪ If blood loss, may give blood
o Treat the cause
o May order vasopressor to help maintain BP
o Monitor the patients labs
o If an electrolyte imbalance you could give a non-diabetic Gatorade
o Go through ABCs (airway, breathing, circulation)
HYPERVOLEMIA/FVE:
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Causes?
o Excess of isotonic fluid in extracellular
▪ Interstitial or intravascular
▪ Osmolality may stay the same due to both H2O and solutes gained together
o Usually controlled with hormonal response
o If prolonged situation or pre-existing heart condition can result in HF, pulmonary
edema, edema
o Excessive intake
▪ IV’s
▪ High Na or water intake
▪ Blood or plasma transfusion
o Excessive retention
▪ Heart failure, cirrhosis, kidney disease
▪ High Na or Water retention
▪ Steroid therapy, hyperaldosterone (excretes potassium and increased Na
retention which also cause fluid retention, increased blood volume and
cardiapressure), low dietary protein
o Shifting
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▪ Remobilization of fluids after burn therapy
▪ Hypertonic fluids
▪ Use of albumin or other colloids
Clinical manifestations?
o Weight gain
o Elevated and bounding pulse
o Elevated BP and central venous pressure
▪ These drop once in heart failure
o Edema-caused by increased hydrostatic pressure
▪ Initially may be only dependent
▪ Generalized
▪ Pulmonary- specifically increased hydrostatic pressure in pulmonary vessels
o Labs- low h/h (diluted), normal Na or Low, Low K, Low BUN, low serum osmo
Interventions?
o Treatment: treat the cause, if low Na diet, fluid restrict, medications- diuretic (thiazides)
o Nursing interventions: monitor s/s
o Oral & skin care
o Elevate HOB
o Daily weight
▪ Monitor I&O’s
o Monitor edema
o Cramping and muscle weakness, twitching
o Seizures, coma
o Hypertonic solution- only under close monitoring
o Monitor neuro status
o Patient safety
VAD MAINTENANCE (venous access devices):
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Site assessment
o Check for:
▪ Phlebitis: vein inflammation/ thrombophlebitis- clot present
• From poor insertion, pH or osmolality of solution/medication
• Pain, edema, erythema (redness), indurated (hard), increased skin temp
near vein, redness travels along vein, fever, sluggish flow
• Discontinue line, monitor VS, warm compress, notify MD
o Cold compress first if site is warm and tender
• Rotate site to prevent (72-96 hrs)
▪ Infiltration: fluid enters surrounding tissue
• Dislodged catheter
• Swelling, pallor, coolness, leaking, no blood return, sluggish flow
• Pain (some patients don’t feel any )
• Discontinue line
• Elevate extremity
• Restart in different site
▪ Extravasated: medication leak into surrounding tissue
• Dopamine, calcium, chemo
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• Blistering and necrosis result 3-5 day
• Discomfort, burning, pain, blanching, skin is taught, no blood return
• Stop infusion, antidote, notify MD, ice, elevate extremity
• These meds are usually given in the ICU.
Primary and secondary continuous sets changed every 72-96 hours
TPN tubing changed every 24 hours (lipids)
Peripheral IV sites changed every 72-96 hours
IV push/saline flush procedure
Central line dressing change procedure (can be changed weekly-cap changes)
Make sure to flush every 12 hrs
o With saline
o Or heparin (just know a lot of places don’t do that anymore cause it can cause more
issues)
Trouble shooting?
o What to do?
▪ Check for catheter position
▪ Is the line patent? Flushes
▪ Is the catheter up against the vein wall
▪ Does the Client have any other available sites?
▪ Is the tubing kinked?
Arterial line
o Is for intensive care unit
CRYSTALLOIDS:
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Hypotonic (inside of cell is hella salty)
o Shifts the cell
o From extracellular INTO cells
o Cells swell
o 0.45% normal saline
o D5W
▪ Isotonic until dextrose quickly metabolized then hypo
o The treatment hydrates cells (all about the cells)
o Complications
▪ May worsen hypotension (b/c if shifts the cells)
▪ Can increase edema and cause fluid intoxication
▪ May cause low Na
▪ D5W may irritate veins (slow)
Isotonic
o No shift
o No shrink or swell
o 0.9% normal saline
o Lactated ringers
o The treatment is an electrolyte replacement and vascular expansion (coming from
shock, hemorrhage, severe vomiting/diarrhea)
o Complications
▪ May cause fluid overload
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▪ Generalized edema
▪ Dilutes hemoglobin
▪ May cause electrolyte imbalances
Hypertonic (outside is a lot saltier)
o More concentrated
o Shift out of cell
o OUT of cells to extracellular
o Cells shrink
o D5 + 0.45% normal saline
o D5 0.9 normal saline (more concentrated)
o 3% or 5% saline (usually given in ICU)
o Treatment causes vascular expansion, electrolyte replacement (from severe
hyponatremia), cerebral cellular edema
o Complications
▪ Irritating to veins
▪ May cause fluid overload and pulmonary edema
▪ May cause cellular dehydration
▪ May cause elevated Na and Cl
▪ Close monitoring required- high acuity
Colloids:
o Albumin: keeps fluid from leaking out of blood vessels, nourishes tissues, and transports
hormones, vitamins, drugs and substances like calcium throughout the body
o Blood product
o Volume expansion if crystalloid not working, shock, moderate protein replacement
o Vascular fluid
TPN NURSING CONSIDERATIONS:
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What is the purpose of TPN?
o Restore or maintain nutrition
▪ People who have low albumin levels
▪ Excess nitrogen loss form draining wounds, fistula, or abscess
▪ Renal/hepatic failure
▪ Non functioning GI more than 5-7. Days
o Produce bowel rest
o Promotes tissue and wound healing
Additional assessments?
o This order is often on a day to day basis in hospital
o Provider and registered dietitian collaborate
o Requires daily labs and daily weight to determine nutrition needs
o May order for outpatient use after stable
Nursing considerations?
o Double check order with label
o New tubing with each bag Q24 hr
o Gradual start
o Requires filter
o Do not run with any other fluids or meds
o No labs from this line
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o Central line REQUIRED
o Glucose monitoring Q6
o Taper off when therapy ending
o Frequent oral care
o Strict I&Os
o Central line assessment changes weekly
o Assess for edema
o Lung sounds
o If new bag not available when TPN runs out hang a D10 at same rate
Equipment required?
o Filter
o New tubing with each bag Q24hrs
o Central line
o Infusion pump
Precautions?
o Taper when ending
o Central line assessments
o Assess for edema
o Daily weights and I&O
o Remove solution from refrigerator 30-60min prior to use
o Check order
o Start slow and increase
o Lung sounds
PRCB NURSING CONSIDERATION:
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Assessments?
o Monitor labs, give blood transfusion when HGB lower than 7
Steps?
o Watch for 15 minutes, vitals before, during, and after administer w/in 3-4 hours, watch
for reaction, 2 person sign up
Potential problems?
o Allergy- flushing, wheezing, hives, anaphylaxis
o Bacterial reaction- fever, chills, vomit, diarrhea, HTN
o Febrile- fever, chills, warm slushed skin aches
o Hemolytic (destruction of red blood cells)- fever, chills, dyspnea, chest pain, tachycardia,
hypotension, shock, can be fatal
o Circulatory overload- persistent cough, crackles, hypertension, JVD
Interventions
o STOP THE TRANSFUSION
o REPLACE WITH SALINE (EXCEPT WITH OVERLOAD)
o DO NOT USE SALINE THAT IS ATTACHED TO BLOOD TUBING
o NOTIFY THE PHYSICIAN
o FOLLOW ORDERS FOR MEDS, FURTHER ASSESSMENT
o CALL RAPID RESPONSE AS NEEDED
o NOTIFY BLOOD BANK
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MAY REQUEST BLOOD AND ALL TUBING BE SENT BACK TO THEM FOR TESTING
MAY ALSO REQUIRE LABS DRAWN FROM PATIENT
CIRCULATION & PERFUSION:
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Risk factors (not just heart think peripheral problems too)
o Demographic, socio-cultural, socio-economic
o Health history/ family generic
o CV history specifically
o Lifestyle
▪ Nutrition
▪ Stress management
▪ Activity
▪ Smoking/drugs
Physical examination
o Look, listen, feel
▪ Cardiac
▪ Peripheral circulation
o Pain
o Fatigue
o Dyspnea
What are some changes with aging?
o Cardiac contractile strength is reduced.
o Arteriosclerosis Heart valves become more rigid
o Peripheral vessels lose elasticity
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Diagnostic test
o Blood
▪ Troponin, is the biomarker for myocardial tissue tissues injury
▪ HGB
▪ ABG
▪ Cholesterol & lipid profile
o Stress test
o Cath lab
▪ Angio, cardiac cath, venography
o Radiology
▪ X-ray, US, MRA, VQ, CT
o Cardiac monitoring/ECG/Holter monitor
o Pulse ox & capnography
o ANP-arterial maturate peptide- overstretched arterial
o BNP- Ventricles are overstretched, drops cardiac output
Others?
o What prep before?
Doppler epicardiogram
o What assessment after?
cardiac
OXYGENATION ASSESSMENT:
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Risk factors
o Demographic (age/gender)
o Health history (COPD)
o Respiratory history (asthma/allergies)
o Environmental history (big city with hella pollution or rural)
o Lifestyle
▪ Diet
▪ Activity
▪ Stress
▪ Smoking/drugs
Physical examination
o Upper airway (looking at the throat and back)
Chest (look, listen, feel)- cyanosis, retractions, barreled
o Breathing pattern (tachycardia or bradycardia)
o Secretions (are they coughing sputum)
o Effort (normal, forced, irregular)
Diagnostic test
o Radiology, CT (can detect if they’re having an embolism)
o Pulse oximetry
o Capnography (measures partial pressure of CO2)
o Peak flow
o PFT
o ABG (arterial blood gas)
o Cultures (bacteria, pneumonia)- morning, deep breath and cough, spit
Nursing interventions
o Medications:
▪ Antihistamines
▪ Expectorants (helps thin secretions)
▪ Cough suppressant
▪ Decongestants (clear nasal cavity)
▪ Bronchodilators (open bronchioles)
▪ Vaccinations (flu-shot)
o Deep breathing
▪ Incentive spirometer
o Positioning
▪ Pillow on sides to open up
▪ Tripod position
▪ Sit them up
o Hydration
o Prevent aspiration
o Supplement O2
o Chest physiotherapy
▪ Movie from “5 feet apart”
o Maintain airway
o Suctioning
o Mechanical ventilation
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o Chest tube care
Review procedures for:
o Trach care, chest tubes, oxygenation
PAIN:
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Types of pain
o Acute: it a recent onset it most likely from a result from a tissue injury of some kind
▪ Pain resolves as tissue damage heals
▪ Acute pain triggers a sympathetic nervous system response which can,
• Increase heart rate
• Increased respiratory rate
• Increased blood pressure
• Diaphoresis (sweating, clammy)
• Pallor
• Dry mouth
• Restlessness
• Nausea
• Anxiety
▪ Physiologic processes are also affected,
• Reduced gastric secretion and motility
• Increased blood sugar
• Decreased urine output
• Bronchiolar dilation (to increase oxygen intake)
o Chronic: this is pain that is either constant or intermittent but last longer than 3months
or more
▪ Comes from chronic conditions like cancer or arthritis
▪ Pain interferes with functioning and well being
▪ Vital signs stable during earlier stages so the s/s are more likely to be behavioral
rather than physiological
▪ Some people with chronic pain become suicidal and depressed
o Nociceptive: pain results from physical trauma, like a sports injury, dental, stubbing a
toe, etc.
▪ Somatic- musculoskeletal described as aching, gnawing, throbbing, or
cramping
▪ Visceral –organs
▪ Cutaneous – skin, burning
o Neuropathic
▪ Phantom: the pain patients feel in the area where they previously had a limb
that have been amputated
▪ Referred pain: pain that originates elsewhere but is felt in another location
considerably removed from the pain’s origin
• Ex: a patient with gallbladder disease feels the pain under the right
shoulder blade
Pain assessment
o Verbal
▪ PQRST
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• P: provocative/ palliative (provoking factors)
• Q: quality/quantity
• R: region/radiation
• S: severity
• T: timing/treatment
▪ Face: Wong-baker faces
Non-verbal
▪ Guarding
▪ Facial expression
▪ Behavior, gestors they might be doing
▪ If possible check with family cause they might know how exactly they behave
PHARMACOLOGICAL MANAGEMENT:
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Non-opioid analgesics
o Acetaminophen
o NSAIDS
Opioid analgesic
o PCA
o Pain pumps
o Local/regional injections
Adjuvant analgesics
o are drugs with a primary indication other than pain that have analgesic properties.
o Corticosteroids reducing inflammation.
When to administer?
o Scheduled/PRN
Acute pain/chronic pain/terminal pain concerns
Pre-medicate?
o 30 minutes before procedures/activity
ASSESSING PCA PAIN CONTROL:
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Same pain assessment
Also assess knowledge of how to use PCA
Assess actual PCA use:
o Pump records: doses given & frequency of requests
o Assess IV line patency
NON-PHARMOLOGICA PAIN MANAGEMENT:
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Options?
o Distractions
▪ Watching tv, music
o Lighting
o Positioning
o Breathing techniques
ELECTROLYTES:
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Focus on Na, K, Ca, and effects of Mg on K
o Causes of imbalances?
▪ Na: 135-145 (think brain)
• Hyponatremia: for excess H2O gain and Na loss
o Heart failure, cirrhosis, renal failure, low intake, SIADH,
hyperglycemia
o Renal loss, diuretics/antidepressants, GI suction or vomiting,
skin
o s/s nausea, abd cramps, neurological, headache, irritability,
disorientation, change in LOC, can progress to stupor, delirium,
seizures, coma
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Hypernatremia: H2O deficit (seen in older patients)
o Body prevents by increasing ADH and thirst so almost never
seen in alert patients
o H2O loss, DI, watery diarrhea, insensible loss from heat, fever,
pulmonary infection, trach, burns
o Excessive intake, tube feeding, drowning in salty water
o s/s Lethargy, weakness, irritability, twitching, seizure, coma
K 3.5-5 (think heart)
• Hypokalemia: body cannot conserve
o Diarrhea, vomiting, diuretic therapy, excessive sweating, GI
suction, new Ileostomy, inadequate intake, increased glucose
levels cause osmotic diuretics and potassium loss, magnesium
decreased depletion
o s/s
• Hyperkalemia: burns, renal failure, cell injury results in spilling/release
of k into the serum
o Old blood given in transfusion
o Too much intake of salt substitutes
o Meds (k-sparing), acidosis excess H moves K out of cell
Ca:8.9-10.1mg/dl ionized 4.4-5.3 (think neuro/muscular)
• Hypocalcemia: low magnesium due to effect on parathyroid
o Meds/caffeine
o Hypoalbuminemia
▪ Cirrhosis, malnutrition, chronic illness
o Hyperphosphatemia
▪ Excess P binds to Ca creating deposits in tissues
o Alkalosis
▪ More Ca binds to albumin
o Massive blood transfusion
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s/s Neuromuscular & cardiovascular tetany, positive treusseaus
and chvostek’s, anxiety, confusion, irritability, decreased cardiac
output, arrhythmias, muscle cramps, tremors, twitching,
paresthesia of face fingers and toes
Hypercalcemia:
o Hyperparathyrioidism and cancer, Hyperthyroidism, multiple
fractures, Prolonged immobilization, Hypophosphatemia and
acidosis, increased Ca ionization, Excessive vit. D or calcium
supplements, Lithium and thiazides diuretics
o s/s heart skeletal and nervous, confusion, lethargy, depression,
altered mental, muscle weakness, hyperreflexia, HTN, bone
pain, abd pain, constipation, thirst, N/V anorexia
ACID BASE: IMBALANCE CAUSES:
PH 7.35-7.45
HCO3 22-26
PaCo2 45-35
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Respiratory acidosis causes:
o Compromise in ventilation (hypoventilation) , perfusion or diffusion resulting in inability
for body body to get rid of CO2
o Airway obstruction (asthma, COPD), neuo problems, (brain/neck injury, drugs,
diaphragm impair), obesity, post op pain
o Decreased PH
o Too much H too little HCO3
o Liver compensates by excreting H and retaining HCO3
o Cell retain H excreting k causing Hyperk
o Brain stimulate to breath faster to excrete co2
o Increase in co2 = cerebral vasodilation and edema depressing cns
o S/S tachy, tremors, restless, absent diminished lung sounds
Respiratory alkalosis causes:
o Increased elimination of CO2, hyperventilation
o Panic attack, hypevent during cpr, acute hypoxia (sepsis, fever)
o Too much hco3 too little H`
o Retain h and excrete HCO3
o H moves out of cell to increase moving k in causing hypok and hypoca
o s/s Tahcy, anxious, restless, lightheaded, weakness, fear, confusion, syncope, tingling of
fingers and toes, signs of low k and low ca
Metabolic acidosis causes:
o Increased in H+ ion production or loss of bicarb
o Excessive GI losses (diarrhea, malabsorption, fistula)
o DKA
o Lactic acidosis
o Potassium sparing diuretic
o Hyperkalemia
o Kussmals res compensation
o Kidneys excrete h and retain na
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o Hyperkalemia
o S/S Confusion to lethargy and coma, Decreased deep tendon reflexes, Dull headache
Metabolic Alkalosis causes:
o Decreased in H+ ion production or gain in bicarbonate
o GI loss (NGT suction, vomiting)
o Sodium bicarb antacids, diuretics (K loss)
▪ Hypokalemia
o Slow breathing to retain co2
o •S/S of underlying condition (HypoK and HypoCl), Neuromuscular excitability, twitching,
weakness, and tetany, hyperactive reflexes, tingling, confusion, seizures, stupor, coma
GENETICS:
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Screening
Affects of genetics on risks of disease/response to diseases & treatments
DEATH & DYING:
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Legal rights
o Advance directive
o Organ donation
Hospice/Palliative care
o Priority care measures
o Provides comfort
´Relaxation techniques
´Energy conservation to reduce fatigue
´Use fans and/or cool, humidified air
´Elevate the head of the bed
´Environment free from smoke and allergens
´Oxygen therapy
´Medications to treat excess secretions and anxiety
´Reminiscence and life review
Signs of impending death
o Withdraw
o Increased sleep
o Difficult digestion
o Decreased appetite
o Dehydrated
o Difficulty swallowing
o Restlessness and agitation
DIAGNOSTIC TESTS:
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What do you know about preventing complications with the following diagnostic test?
o Echocardiogram – dye injection (check allergies)
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MRI- check if there are any metals, phobic? Use anxyolotics (is an anti-anxiety
medication)
▪ The MRI scan is used to investigate or diagnose conditions that affect
soft tissue, such as:
Tumours, including cancer.
Soft tissue injuries such as damaged ligaments.
Joint injury or disease.
Spinal injury or disease.
Injury or disease of internal organs including the brain, heart and digestive organs.
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Angiogram
▪ A coronary angiogram is a procedure that uses X-ray imaging to see your heart's
blood vessels. The test is generally done to see if there's a restriction in blood flow
going to the heart. Coronary angiograms are part of a general group of procedures
known as heart (cardiac) catheterizations.
WHAT ARE SOME EXAMPLES OF INTERPROFESSIONAL COLLABORATION THAT WE HAVE DISCUSSED?
• physical therapy
• Occupational
• Anesthesiologist
• Social work
• nurse
WHAT ARE SOME EXAMPLES OF CULTURAL PREFERENCES THAT NEED TO BE CONSIDERED WHEN
PROVIDING CARE?
• Diet
• Treatments (male or female)
• Blood transfusion
• medications
WHAT ARE SOME WAYS WE MIGHT PRIORITIZE CARE?
• ABCs
• Most life threatening
• Peripheral Catheters
o Angiocath
o Butterfly
o Midline
• Central catheters:
o PICC
o Tunneled & non-tunneled
central lines
o Infusion ports
• Intra Osseous
• Peripheral vs. Central
o Type/Amount of fluid
o Anticipated duration of
therapy
o Patient condition and Venous
condition
• Other
o Dialysis graft or fistula
o Arterial