Successfully reported this slideshow.

Therapeutic Procedures

21,225 views

Published on

THERAPEUTIC PROCEDURES - SELECTED TOPICS ON COMMON NURSING PROCEDURES

Published in: Health & Medicine, Technology

Therapeutic Procedures

  1. 1. THERAPEUTIC PROCEDURES SELECTED TOPICS ON COMMON NURSING PROCEDURES
  2. 2. UNIVERSAL PRECAUTIONS <ul><li>HANDWASHING </li></ul><ul><li>BARRIER METHOD </li></ul><ul><li>STERILIZATION AND DISINFECTION </li></ul><ul><li>IMMUNIZATION </li></ul><ul><li>ENVIRONMENTAL CONTROL AND SANITATION </li></ul><ul><li>ISOLATION </li></ul>
  3. 3. SURGICAL ASEPSIS <ul><li>MAINTENANCE OF STERILE FIELD </li></ul><ul><li>MEDICAL AND SURGICAL ASEPTIC TECHNIQUES </li></ul>
  4. 4. THERAPEUTIC EXERCISES <ul><li>ISOMETRIC </li></ul><ul><li>ISOTONIC </li></ul><ul><ul><li>ROM </li></ul></ul>
  5. 5. CHEST PHYSIOTHERAPY <ul><li>BREATHING </li></ul><ul><li>COUGHINGPOSTURAL DRAINANGE </li></ul><ul><li>PERCUSSION AND VIBRATION </li></ul><ul><li>INCENTIVE SPIROMETER </li></ul><ul><li>SUCTIONING </li></ul><ul><li>TRACHEOSTOMY CARE </li></ul><ul><li>OXYGEN THERAPY </li></ul>
  6. 6. <ul><li>Chest Physiotherapy </li></ul><ul><li>It is the combination of percussion, vibration, and postural drainage </li></ul><ul><li>Percussion is done for 1-2 minutes. If the patient has tenacious secretions, this can be performed for 3-5 minutes </li></ul><ul><li>Vibration is done during 5 exhalations </li></ul><ul><li>Postural drainage is done for 15-20 minutes usually performed 3-4 times a day. </li></ul><ul><li>Instruct the client to increase fluid intake to liquefy secretions </li></ul><ul><li>This procedure should not be performed in clients who are pregnant, with chest injuries, dizzy, with pulmonary embolism and abdominal surgery. </li></ul><ul><li>This procedure is done before meal or 90 minutes after a meal </li></ul>
  7. 7. <ul><li>Oxygen Therapy </li></ul><ul><li>Indicated to clients who needs additional oxygen, those clients who have reduced lung diffusion of oxygen through the respiratory membrane, heart failure leading to inadequate transport of oxygen. </li></ul><ul><li>Humidify the oxygen first before you administer. </li></ul><ul><li>Check for bubbles in the humidifier to promote adequate flow of oxygen </li></ul><ul><li>Check for kinks in the tubing </li></ul><ul><li>Position: semi-fowlers/ high fowlers position </li></ul><ul><li>Place cautionary readings: “NO smoking: Oxygen is in used” </li></ul><ul><li>Instruct the client not to use woolen blankets as this may create static electricity </li></ul>
  8. 8. pulmonary function tests <ul><li>tidal volume- 500 </li></ul><ul><li>residual volume- 1200 </li></ul><ul><li>expiratory reserve volume –1200 </li></ul><ul><li>inspiratory reserve volume – 3100 </li></ul><ul><li>Vital Capacity- tidal volume + IRV + ERV = 4800 </li></ul><ul><li>Total Lung Capacity – Tidal Volume + IRV +ERV +RV =6000 </li></ul><ul><li>Forced Residual Capacity – ERV + RV </li></ul>
  9. 9. <ul><li>incentive spirometry – hold 2-6 sec; 4-5 times/H </li></ul><ul><li>endotracheal tube- reposition Q8H; cuff 20 mm Hg, humidification and aerosol, deflate cuff occasionaly </li></ul><ul><li>visualization – </li></ul><ul><ul><li>X ray </li></ul></ul><ul><ul><li>Lung Scxan – 20-40mins isotopes in body for 8 H </li></ul></ul><ul><ul><li>laryngoscopy </li></ul></ul><ul><ul><li>Bronchoscopy </li></ul></ul><ul><ul><li>Thoracentesis- consent, VS and baseline X-ray + post Procedural </li></ul></ul>
  10. 10. Tracheostomy Care <ul><li>tie new trache tie before removing the old tie to prevent accidental dislodgement </li></ul><ul><li>use precut gauze and perform care OD at least. </li></ul><ul><li>soak iiner cannula in antiseptic soak with hydrogen peroxide, rinse well </li></ul><ul><li>suction prn, oral care prn </li></ul>
  11. 11. Oxygen Delivery Equipment <ul><li>cannula – 2-6 LPM – 24-45% </li></ul><ul><li>Mask – 5-8 LPM – 40-60% </li></ul><ul><li>parial rebreather – 6-10 LPM – 60-90% </li></ul><ul><li>non rebreather – 10-15 LPM – 95-100% </li></ul><ul><li>tent – 4-8 LPM – 30-50 % </li></ul><ul><li>Venturi mask – </li></ul><ul><ul><li>2-3 LPM – 24-28% </li></ul></ul><ul><ul><li>4 LPM – 30% </li></ul></ul><ul><ul><li>6 LPM – 35% </li></ul></ul><ul><ul><li>8 LPM – 45% </li></ul></ul><ul><ul><li>14LPM – 55% </li></ul></ul>
  12. 12. <ul><li>Suctioning </li></ul><ul><li>PURPOSE: To obtain sputum sample. </li></ul><ul><li>NURSING ALERT: </li></ul><ul><li>Hyperoxygenate the patient before and after the procedure. </li></ul><ul><li>Apply intermittent suction on withdrawal of the catheter. </li></ul><ul><li>Do not suction the patient for more than 15 seconds. </li></ul><ul><li>Thoracentesis </li></ul><ul><li>PURPOSE: Aspiration of fluid and /or air from the pleural space . </li></ul><ul><li>NURSING ALERT: </li></ul><ul><li>Check the consent. </li></ul><ul><li>Position: Sitting on the side of the bed with feet on a chair, leaning over a bedside table. If the patient unable to sit, the patient may lie in his/her side with hands on the side resting on opposite shoulder. </li></ul><ul><li>Instruct the patient not to cough, breath deeply or move during the procedure. </li></ul><ul><li>After the procedure: Position the patient on the unaffected side/puncture site up. </li></ul><ul><li>Check for bleeding at the puncture site and monitor the respiratory function. </li></ul><ul><li>Notify the physician if signs of pneumothorax, air embolism and pulmonary edema occur. </li></ul>
  13. 13. ENEMA <ul><li>They act by distending the intestines that increases peristalsis and expulsion of feces and flatus. </li></ul><ul><li>Enemas serve the following purpose: </li></ul><ul><ul><li>Relief of constipation </li></ul></ul><ul><ul><li>Relief of flatulence </li></ul></ul><ul><ul><li>Lowers down body temperature </li></ul></ul><ul><ul><li>Evacuates feces in preparation for diagnostic procedures </li></ul></ul><ul><ul><li>Administration of medications </li></ul></ul>
  14. 14. ENEMA <ul><li>Take note of the general principles of Enema: </li></ul><ul><li>Tube: lubricate and insert 3-4 inches </li></ul><ul><li>Position: adult- left lateral; infants and children- dorsal recumbent </li></ul><ul><li>Administration- administer the enema in a minimum of 15 minutes duration. </li></ul><ul><li>Conatainer’s Height- 12 inches above the rectum </li></ul><ul><li>Temperature- 42°C or less </li></ul>
  15. 15. <ul><li>types: </li></ul><ul><li>carminative – expel flatus – 60 –180 ml. </li></ul><ul><li>retention oil – 1 –3 hours(LUBRICANTS) </li></ul><ul><li>BULK FORMERS-METAMUCIL-12 HOURS-INC.OFI </li></ul><ul><li>wetting/stool softeners- Colace(days) </li></ul><ul><li>Chemical hypertonic irritant-increases peristalsis-castor oil, Bisacodyl, Cascara)-SUPPOSITORIES-30 MIN </li></ul><ul><li>Saline- Epson salts, milk of mg(rapid)/mg citrate </li></ul><ul><li>return flow – haris flushing , colon irrigation </li></ul><ul><li>fleet – commercial </li></ul><ul><ul><li>oil 1-3 H retention </li></ul></ul><ul><ul><li>others – 5 to 10 mins. </li></ul></ul><ul><li>cleansing- irritating( hypertonic osmotic)) </li></ul><ul><ul><li>high 1000 ml </li></ul></ul><ul><ul><li>low 500 ml </li></ul></ul>
  16. 16. <ul><li>T = 40-43 ‘ C ( 105 – 110 ‘ F </li></ul><ul><li>CHILDREN 37.7 ( 100 ‘ F) </li></ul><ul><li>APPROXIMATELY 30 CM ( 12 INCHES) BUT HIGH IN CLEANSING ( 30 – 45 CM. ) 12 TO 18 CM. </li></ul><ul><li>INSERT 7 – 10 CM ( 3-4 INCH)-ADULT </li></ul><ul><li>5 – 7.5 CM. –CHILD </li></ul><ul><li>2.5 – 3.5 – INFANT </li></ul><ul><li>IF FEELING OF FULLNESS – CLAMP – 30 SECS </li></ul>
  17. 17. <ul><li>amount </li></ul><ul><li>18 mos – 50-200 ml </li></ul><ul><li>18 mos – 5 y – 200-300 ml </li></ul><ul><li>5 – 12 years – 300 – 500 ml </li></ul><ul><li>12 – above – 500 – 1000 ml. </li></ul><ul><li>rectal tubes </li></ul><ul><ul><li>infants-10-12F </li></ul></ul><ul><ul><li>toddler – 14 –16F </li></ul></ul><ul><ul><li>school age – 16-18F </li></ul></ul><ul><ul><li>adult – 22 – 30F </li></ul></ul>
  18. 18. ENEMAS- PRESCRIBED AMOUNT AND TIME <ul><li>HYPERTONIC – 5-10MINS – VARIES </li></ul><ul><li>HYPOTONIC(TAP)-15-20MIN – 500-1000ML </li></ul><ul><li>ISOTONIC(SALINE)-15-20MIN- 50ML </li></ul><ul><li>SOAP SUDS- 10-15MIN- + 3-5 ML. SOAP </li></ul><ul><li>oil( MINERAL/COTTONSEED) – 30-60 MIN- 90-120ML. </li></ul>
  19. 19. COLOSTOMY CARE <ul><li>ostomy – divert and drain fecal material </li></ul><ul><ul><li>temporary ( trauma / inflammatory condition) </li></ul></ul><ul><ul><li>permanent ( Cancer / congenital or Birth defects </li></ul></ul><ul><li>stoma – red , initial slight bleeding - normal, no redness or irritation 2 to 5 inches sorrounding the areano burning sensation </li></ul>
  20. 20. <ul><li>parts: </li></ul><ul><ul><li>periostomal seal </li></ul></ul><ul><ul><li>adhesive square – </li></ul></ul><ul><ul><li> solid wafer disk skin barrier </li></ul></ul><ul><ul><li>liquid skin sealant </li></ul></ul><ul><ul><li>drainable end </li></ul></ul><ul><ul><li>pouch ( Can be washable) </li></ul></ul><ul><ul><li>pouch belt </li></ul></ul><ul><ul><li>face plate </li></ul></ul>
  21. 21. <ul><li>ileostomy – no irrigation , wet fecal material , appliance all the time , meticulous skin care,prevent skin breakdown, constant flow not regulated, bag emptied half full </li></ul><ul><li>colostomy – solid , can irrigate , can be bowel trained , pouch may not be worn and emptied after every defecation </li></ul><ul><li>avoid gas forming foods and nuts , but can have any food at tolerated after 6 weeks… yogurt recommended </li></ul>
  22. 22. <ul><li>dry skin before applying appliance </li></ul><ul><li>karaya – barrier to prevent contamination with excreta </li></ul><ul><li>appliance can be up to 2 weeks </li></ul><ul><li>broadwell 48 – 72 hours to check for periostomal skin </li></ul><ul><li>24-48 hours if eroded / ulcerated </li></ul><ul><li>refer to enterostomal therapy nurse </li></ul><ul><li>with deodorant ( Charcoal filter Disk) </li></ul>
  23. 23. Catheterization, urinary <ul><li>PURPOSE: To determine residual urine and obtain sterile specimen. It can be a straight catheter, suprapubic, indwelling catheter, and external device catheter. </li></ul><ul><li>NURSING ALERT: </li></ul><ul><li>       Know the necessary facts: </li></ul>
  24. 24. <ul><li>Principles Male Female </li></ul><ul><li>Position Supine Dorsal recumbent </li></ul><ul><li>Length of tube 40 cm./ 15.75 in. 22cm./ 8.66 in. </li></ul><ul><li>French number or </li></ul><ul><li>Circumference #14- 16 #18 </li></ul><ul><li>Length of tube to </li></ul><ul><li>be inserted 2-3 in. 6-9 in. </li></ul><ul><li>Balloon size 5-10 ml. (30 ml 5-10 ml </li></ul><ul><li>Can be used to </li></ul><ul><li>achieve hemostasis </li></ul><ul><li>of the prostatic area </li></ul><ul><li>following prostatectomy </li></ul><ul><li> </li></ul><ul><li>Place to secure lower abdomen Inner thigh </li></ul>
  25. 25. <ul><li>       The procedure is sterile </li></ul><ul><li>       Maintain a close system </li></ul><ul><li>       The draining bag must always be below the bladder </li></ul><ul><li>       The catheter bag should not be allowed to lie on the floor </li></ul><ul><li>       Do not allow the drainage spout to touch the collection receptacle or on the toilet bowl when draining it </li></ul>
  26. 26. CATHETER CHANGE <ul><li>PLASTIC – 1 WEEK </li></ul><ul><li>LATEX – 2-3 WEEKS </li></ul><ul><li>SILICONE – 2-3 MOS. </li></ul><ul><li>PVC – 4-6 WEEKS </li></ul>
  27. 27. CLOSED INTERMITTENT IRRIGATION <ul><li>ASPIRATE FROM PORT </li></ul><ul><li>CBI -3 WAY FOLEY CAHETER </li></ul><ul><li>CATHETER IRRIGATION ONLY – 200 ML. </li></ul><ul><li>BLADDER IRRIGATION – 1000ML </li></ul><ul><li>CLAMPS ON BOTH SIDES – ALTERNATELY RELEASED </li></ul>
  28. 28. URINARY DIVERSIONS-URINARY STOMA <ul><li>ILEAL CONDUIT- EXTERNAL POUCH </li></ul><ul><li>KOCK POUCH – SMALL DRESSING OVER STOMA; BLADDER WALL SUTURED TO THE ABDOMEN </li></ul><ul><li>SUPRAPUBIC CATHETER – INTERMITTENT ATHETERIZATION q 3-4 HOURS </li></ul>
  29. 29. NORMAL AMOUNT/ DAY <ul><li>1-3 / 500-600ML </li></ul><ul><li>3-5 / 600-700ML </li></ul><ul><li>5-8 / 700-100OML </li></ul><ul><li>8-14 / 800 – 1400ML </li></ul><ul><li>14 – ADULT / 1500 – 2500 </li></ul><ul><li>CAN HOLD 500 – 750 ML </li></ul>
  30. 30. Bladder training <ul><li>Q2 hours and 30 mins void(Trigerring, Credes and valsalva) </li></ul><ul><li>NEUROGENIC BLADDER </li></ul><ul><li>Intermitent Catheterization – 2-3 hours if <150ml ----3-4 H </li></ul><ul><li>weaning-intermittent clamping </li></ul><ul><li>DTV 1-4 hours after removal </li></ul><ul><li>for incontinence – kegels exercises </li></ul>
  31. 31. HEMODIALYSIS <ul><li>DONE 3-5 HOURS – 2-3 TIMES A WEEK </li></ul><ul><li>AV FISTULA-NO BP,VENIPUNCTURE OR CONSTRICTIONS </li></ul><ul><li>PALPATE FOR A THRILL AND LISTEN FOR BRUIT Q8H </li></ul><ul><li>MONITOR FOR HEMORRHAGE </li></ul><ul><li>DISEQUILIBRIUM SYNDROME,HEPATITIS,HEMORRHAGE,MUSCLE CRAMPS,AIR EMBOLISM AND SEPSIS-COMPLICATIONS </li></ul>
  32. 32. PERITONEAL DIALYSIS <ul><li>TENCKOFF,GORE-TEX CATHETER </li></ul><ul><li>WEIGH BEFORE AND AFTER, WARM DIALYSATE </li></ul><ul><li>CHON LOSS, INFECTION, -PERITONITIS(CLOUDY OUTFLOW,BLEEDING) , FEVER , ABDL TENDERNESS AND N & V </li></ul><ul><li>PREVENT CONSTIPATION BY INCREASING FIBER IN DIET,MAINTAIN STERILE PROCEDURE,FOR PROBLEMS WITH OUT FLOW –REPOSITION </li></ul><ul><li>TYPES: </li></ul><ul><ul><li>CAPD(4-6H INDWELLING), </li></ul></ul><ul><ul><li>AUTOMATED 30MINS EXCHANGES, </li></ul></ul><ul><ul><li>INTERMITTENT- 4X A WEEK – 10H/DAY, </li></ul></ul><ul><ul><li>CONTINOUS – 1 DAY INDWELLING </li></ul></ul>
  33. 33. DRESSINGS <ul><li>PROTECT FROM INJURY , BACTERIAL CONTAMINATION </li></ul><ul><li>PROVIDE HUMIDITY </li></ul><ul><li>INSULATION </li></ul><ul><li>ABSORB DRAINAGE </li></ul><ul><li>DEBRIDE THE WOUND </li></ul><ul><li>PREVENT HEMORRHAGE </li></ul><ul><li>SPLINT / IMMOBILIZE </li></ul><ul><li>COMFORT </li></ul><ul><ul><li>GUAZE, SYNTHETIC , SECURING, TEGADERM </li></ul></ul>
  34. 34. TYPES OF DRESSINGS <ul><li>DRY TO DRY – TRAP NECROTIC DEBRIS AND EXUDATE </li></ul><ul><li>WET TO DRY ( SALINE AND ANTI MICROBIAL SOLUTION – SOFTEN DEBRIS AS IT DRIES, DILUTE EXUDATE </li></ul><ul><li>WET TO DAMP – WOUND DEBRIDED IF GAUZE REMOVED( VARIATION @ DRYING) </li></ul><ul><li>WET TO WET – KEEP MOIST – WOUND BATHED – MOISTURE DILUTES VISCIOUS EXUDATE </li></ul>
  35. 35. WOUND HEALING <ul><li>HEMOSTASIS---FIBRIN----PHAGOCYTOSIS----( INFLAMMATION PHASE 3-4DAYS </li></ul><ul><li>FIBROBLAST—COLLAGEN---CAPILLARIES----GRANULATION TISSUE---ESCHAR---(PROLIFERATIVE 3 – 21 DAYS </li></ul><ul><li>MATURATION(PHASE 21 DAYS – 2 YEARS) </li></ul>
  36. 36. pressure ulcer dressings <ul><li>dry gauze stage II-IV </li></ul><ul><li>tegaderm film/ hydrocolloid – SI - SII </li></ul><ul><li>Absorptive Dressing III </li></ul><ul><li>Hydrogel – II - III </li></ul>
  37. 37. WOUND CARE <ul><li>PRIMARY </li></ul><ul><li>SECONDARY- INCREASED INFECTION INCREASED TIME INCREASED ESCHAR( PRESSURE SORES) </li></ul><ul><li>TERTIARY- ABD. DRAINAGE </li></ul><ul><ul><li>EXUDATES – SUPPURATION </li></ul></ul><ul><ul><li>PUS – ABCESS( PYOGENIC BACTERIA) </li></ul></ul>
  38. 38. SURGICAL DRAINS <ul><li>PENROSE – OPEN ENDS </li></ul><ul><li>CLOSED WOUND DRAINAGE ( SUCTION) – DECREASE ENTRY OF MICROBES- HEMOVAC / JACK PRATT TO RESERVOIR </li></ul><ul><li>D/C 3-7 DAYS POST – OP </li></ul><ul><li>PACKAGE – FACILITATE GRANULATION </li></ul><ul><li>IRRIGATION LAVAGE - STERILE </li></ul>
  39. 39. CHEST TUBES AND DRAINAGE SYSTEMS <ul><li>1-DRAINAGE </li></ul><ul><li>2-WATERSEAL </li></ul><ul><li>3-COLLECTION/SUCTION </li></ul><ul><li>SEALED PATENCY-AFTER 3 DAYS REEXPANDED </li></ul><ul><li>FLUCTUATIONS IN WATER SEAL CHAMBER </li></ul><ul><li>RUBBER TIPPED CLAMPS/ FORCEPS; VASELINIZED GAUZE;EXTRA BOTTLE </li></ul>
  40. 40. <ul><ul><li>NUTRITIONAL SUPPORT </li></ul></ul><ul><ul><li>NGT-GAVAGE AND LAVAGE </li></ul></ul><ul><ul><li>TPN </li></ul></ul>
  41. 41. <ul><li>Nasogastric Tube Insertion </li></ul><ul><li>Purposes: </li></ul><ul><ul><li>Gastric Gavage- gastric feeding </li></ul></ul><ul><ul><li>Gastric Lavage- stomach irrigation </li></ul></ul><ul><ul><li>For decompression </li></ul></ul><ul><ul><li>Medication and supplemental fluid administration </li></ul></ul><ul><li>Principles: </li></ul><ul><li>Position: High-Fowler’s position </li></ul><ul><li>Length of tube to be inserted: measured from the tip of the nose to the tip of the earlobe to the xiphoid process (approximately 50cm. </li></ul><ul><li>Lubricate the tip of the tube by a water soluble lubricant before insertion </li></ul><ul><li>Secure the NGT by taping to the bridge of the nose </li></ul>
  42. 42. <ul><li>Gastroenteral Feedings </li></ul><ul><li>This is the administration of formula through a tube placed into the GIT, either by Nasogastric route or surgically created slit on the abdominal wall. </li></ul><ul><li>Remember these principles: </li></ul><ul><li>Position: fowler’s or sitting position </li></ul><ul><li>Prior to feeding, assess the bowel sounds and residual content </li></ul><ul><li>Assess for tube placement and patency: </li></ul><ul><ul><ul><li>Introduce 5-20 ml of air into the NGT and auscultate. Gurgling sounds must be auscultated. </li></ul></ul></ul><ul><ul><ul><li>X-ray most accurate </li></ul></ul></ul><ul><ul><ul><li>Aspirate gastric content </li></ul></ul></ul><ul><ul><ul><li>Immerse the tip of the tube in water, no bubbles must be produced. </li></ul></ul></ul><ul><li>Height of feeding: 12 inches above the patient’s point of insertion </li></ul><ul><li>Instill 60 ml of water into the NGT after feeding to cleanse the lumen of the tube </li></ul>
  43. 43. TOTAL PARENTERAL NUTRITION <ul><li>peripheral< 2 weeks – phlebitis </li></ul><ul><li>PIC – Basilic / cephalic </li></ul><ul><li>PCC – subclavian </li></ul><ul><li>Triple Lumen- infuse and draw blood;TPN;Medications </li></ul><ul><li>Atrial- Hickman/Biovac and Groshong; Huber needle port </li></ul>
  44. 44. TOTAL PARENTERAL NUTRITION <ul><li>TPN-IV with bacterial filter(2-3L) </li></ul><ul><li>TNA – 1 liter/D-no filter </li></ul><ul><li>If no available solution D10W –ok –initial at 50ml/hr </li></ul><ul><li>hyperglycemia- hyperosmolar(HA, N and Vomiting,fever, chills, malaise) </li></ul><ul><li>Infection ( IV tubing and filter Q24 changed,solutions refrigerated and warmed just prior to administration </li></ul><ul><li>Pneumothorax </li></ul>
  45. 45. <ul><li>Heat and Cold Therapy </li></ul><ul><li>An intervention the reduces inflammation </li></ul><ul><li>Principles: </li></ul><ul><li>Cold application is generally safer than heat application. </li></ul><ul><li>Heat application usually requires a doctor’s order </li></ul><ul><li>Cold application is done within 72 hours after an injury, while heat application is done after 72 hours. </li></ul><ul><li>The application of heat and cold is done at a maximun of 30 minutes (an average of 15-20 minutes) </li></ul><ul><li>Check the area applications are done every 15 minutes. </li></ul>
  46. 46. <ul><li>Anti-embolism Stocking </li></ul><ul><li>Helps prevents thrombophlebitis by promoting venous return from the legs </li></ul><ul><li>It usually requires a doctor’s order </li></ul><ul><li>The client’s extremeties must be properly measured to assure therapeutic effect </li></ul><ul><li>Apply stockings before getting out of bed. If the client forgot to wear the stockings, instruct himn or her to assume modified trendelenburg’s position for 15-20 minutes </li></ul><ul><li>The stockings must be removed every 8 hours for 20-30 minutes </li></ul><ul><li>Assess the skin integrity </li></ul>
  47. 47. DOSAGES AND CALCULATION <ul><li>CONVERSIONS </li></ul><ul><li>MEDICATION DOSAGES </li></ul><ul><ul><li>D/A X V = Q </li></ul></ul><ul><li>INFUSIONS </li></ul><ul><ul><li>TOTAL VOLUME X DROP FACTOR </li></ul></ul><ul><ul><li>TIME IN HOUR ( 60 MIN.) </li></ul></ul><ul><li>THERAPEUTIC DOSE </li></ul><ul><li>CLARKS RULE </li></ul><ul><li>BSA COMPUTATION </li></ul><ul><li>IV INFUSION FOR BURNS </li></ul>
  48. 48. <ul><li>MEDICATION ADMINISTRATION </li></ul><ul><li>RIGHT DRUG </li></ul><ul><li>RIGHT DOSAGE </li></ul><ul><li>RIGHT ROUTE </li></ul><ul><li>RIGHT TIME </li></ul><ul><li>RIGHT PATIENT </li></ul><ul><li>RIGHT ATTITUDE </li></ul><ul><li>RIGHT DOCUMENTATION </li></ul>
  49. 49. PARENTERAL ADMINISTRATION <ul><li>IM – G 18-21 ; 1 1/2 INCH, Z-TRACK </li></ul><ul><li>( RETRACT) </li></ul><ul><li>SC/SQ – G 24-26;1/2 – 1 INCH ; 45’ ; DO NOT RETRACT OR MASSAGE ( INSULIN AND HEPARIN) </li></ul><ul><li>INTRADERMAL- 10-15’; G26-27;12 INCH BEVEL UP </li></ul><ul><li>INTRAVENOUS – TOURNIQUET, STERILE PROCEDURE ; 10-25 ; RELEASE TOURNIQUET IF WITH BACKFLOW </li></ul>
  50. 50. IV THERAPY <ul><li>backflow means patent line </li></ul><ul><li>solutions for specific diseases and contraindications of certain solutions </li></ul><ul><li>management and troubleshooting </li></ul><ul><li>check for phlebitis and infiltration </li></ul><ul><li>change line everyday </li></ul><ul><li>keep site sterile </li></ul>
  51. 51. BLOOD TRANSFUSION <ul><li>line – PNSS </li></ul><ul><li>vital signs – baseline then Q15 x 4; Q30 x 2; then q h </li></ul><ul><li>4 –6 hours </li></ul><ul><li>blood typing and crossmatching </li></ul><ul><li>watch out for blood transfusion reactions </li></ul><ul><ul><li>hemolytic </li></ul></ul><ul><ul><li>anaphylactic </li></ul></ul><ul><ul><li>febrile </li></ul></ul><ul><ul><li>hypervolemic </li></ul></ul><ul><ul><li>septic </li></ul></ul>
  52. 52. <ul><li>Hygiene and comfort measures </li></ul>
  53. 53. <ul><li>BEDMAKING- OD </li></ul><ul><li>PERINEAL CARE – FRONT TO BACK </li></ul><ul><ul><li>OUTER TO INNER, ONE COTTONBALL PER STROKE </li></ul></ul><ul><li>BEDBATHING AND ND SHAMPOO </li></ul><ul><li>FOOT, HAIR , SKIN AND NAIL CARE </li></ul><ul><li>ORAL CARE </li></ul><ul><li>EYE AND EAR CARE </li></ul>
  54. 54. THERAPEUTIC BATH <ul><li>SALINE – 4 ML- 500 ML </li></ul><ul><li>OATMEAL/AVENO – SOOTHES SKIN IRRITATION, LUBRICATES </li></ul><ul><li>CORNSTARCH- IN COLD WATER – SOOTHES IRRITATION </li></ul><ul><li>Na CHO3 – 4 ml. – 500 ml H2O </li></ul><ul><ul><li>cooling / relieves irritation </li></ul></ul><ul><ul><li>KMnO4 – tablets dissolved in H2O – clears and disinfects </li></ul></ul>
  55. 55. Rotating Tourniquet <ul><li>GET MEAN </li></ul><ul><li>APPLY PRESSURE TO 3 LIMBS ONE AT A TIME RELEASE / ROTATE EVERY 5 MINUTES. PRESSURE IN ONE EXTREMITY FOR ONLY 15 MINUTES </li></ul><ul><li>DO NOT RELEASE SIMULTANEOUSLY </li></ul><ul><li>PATIENT IN ORTHOPNEIC / FOWLERS POSITION </li></ul>
  56. 56. CPR and ACPLS Protocols <ul><li>0-1 MINUTE ; CARDIAC IRRITABILITY </li></ul><ul><li>0-4 MINUTES; BRAIN DAMAGE NOT LIKELY </li></ul><ul><li>4-6 MINUTES; BRAIN DAMAGE POSSIBLE </li></ul><ul><li>6-10 MINUTES; BRAIN DAMAGE LIKELY </li></ul><ul><li>10 MINUTES-IRREVERSIBLE BRAIN DAMAGE </li></ul>
  57. 57. INFANTS <ul><li>HTCL MANEUVER, JAW THRUST IF SPINAL INJURY IS SUSPECTED </li></ul><ul><li>INITIAL BREATHS – 2 – 1 1/2 SECS </li></ul><ul><li>SUBSEQUENT BREATHS 1 B/3 SECS; 20 BPM </li></ul><ul><li>USE 2 OR 3 FINGERS </li></ul><ul><li>DEPTH:1/2 TO 1 INCH </li></ul><ul><li>COMPRESSION AT LEAST 100/MIN </li></ul><ul><li>RATIO 5:1; CHECK AFTER 20 CYCLES </li></ul><ul><li>FOREIGN BODY OBSTRUCTIONS: BACKBLOWS AND CHEST THRUST </li></ul>
  58. 58. CHILDREN <ul><li>HTCL / JAW THRUST </li></ul><ul><li>2 BREATHS INITIAL DURATION OF 1- 1 ½ SECS </li></ul><ul><li>SUBSEQUENT 1 BREATH EVERY 3 SECONDS </li></ul><ul><li>20 BREATHS/ MIN </li></ul><ul><li>CAROTID ARTERY </li></ul><ul><li>HEEL OF HAND </li></ul><ul><li>1 TO 1 12 INCH </li></ul><ul><li>100 BPM; CHECK AFTER 12 CYCLES </li></ul><ul><li>ABDOMINAL THRUST- FOR AIRWAY OBSTRUCTION </li></ul>
  59. 59. ADULTS <ul><li>HTCL / JAW THRUST </li></ul><ul><li>INITIAL 2 BREATHS AT LEAST 2 SECS EACH </li></ul><ul><li>DEPRESS 1 ½ - 2 INCHES; RATE 60 TO 100 </li></ul><ul><li>RATIO 5:1 </li></ul><ul><li>AFTER 4 CYCLES ;RECHECK FOR 10 SECS </li></ul>
  60. 60. ERGONOMICS <ul><li>TRANSFER TECHNIQUES </li></ul><ul><li>BODY POSITIONING </li></ul><ul><li>BODY MECHANICS </li></ul>

×