Acute Illness

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Nerissa21
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111843
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Acute Illness
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2011-10-25 00:57:19
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Acute Illness
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Test # 1
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  1. What are the five princples of primary health care?
    • - Health Promotion activities
    • - Appropriate technology
    • - Accessibility
    • - Public Participation
    • - Interdisciplinary/Intersectoral Collaboration
  2. Health Care Options
    • Family Health teams
    • Community Health Centers
    • NP-Led Clinics
    • Solo physician practices
  3. Who Are You?
    • Healthcare provider
    • Educator
    • Facillitator/Communicator
    • Community developer
    • Social marketer
    • Researcher/Evaluator
    • Resource manager/Planner/Coordinator
  4. The Nursing Process Involves:
    • Assessment
    • Planning
    • Implementing
    • Evaluating
  5. What Does the Assessment involve:
    • Data Collection
    • - History and physical assessment from the client
    • -Documentation
    • -Other people (social worker, family)
    • - Gordon's Functional Review pattern
  6. Nursing Diagnosis
    • Statment of a client's response which is actually or potentially unhealthful
    • -Actual or potential
  7. Planning
    • Set priorities
    • Set goals (short and long term)
    • Identify elements of care
  8. What are the 4 types of IV Solutions
    • Isotonic
    • Hypotonic
    • Hypertonic
    • Additives
  9. Name 3 Vascular Access Devices
    • Angiocath
    • PICC line
    • Central Venous Line
  10. IV Tubing
    • Primary
    • Drip Chamber (macro or micro)
    • Roller Clamp
    • Secondary ports
    • Q72 Hours
  11. Infusion Pumps
    • Continuous analgesia (Requires less drug to maintain pain control, Small, Mobility and independence)
    • Insulin
    • Reservior (preloaded cassette)
  12. What complications are associated with IV therapy?
    • Infiltration
    • Phlebitis
    • Peripheral IV infection with bacteremia and sepsis
    • Air in tubing
    • Piece of Cath. in vein
    • Allergic reaction to cath.
  13. IV Infiltration
    • Arm swollen, cool to touch
    • Fluid leaking from site
    • Tenderness around site
    • Elderly client
    • Site near a joint
  14. Partial Infiltration
    Tip of cannula remains in the vein but vessal wall does not seal around it
  15. Complete infiltration
    Cannula slips out of the veinFluid infuses into surrounding tissue
  16. What are the risk factors associated with Phlebitis
    • Length of time cannula has been in place
    • Harshness of medication
  17. How can we reduce the risk of Phlebitis
    • Dilute medications
    • Slower infusion rate
    • Rotating sites Q48 to 72 hours
    • Using a central line
  18. What is Post infusion phlebitis
    Occurs 2-3 days after discharge
  19. Signs and Symptoms of Phlebitis
    • Vein is hard, skin is red, swollen and warm, but good infusion and blood return
    • Induration (becoming hardend)
    • Red line/ bump above IV site
  20. Thrombophlebitis
    • Infusion is sluggish, looks phlebitic
    • Aspirate before you flush
    • May accompany Phlebitis
    • Inflammation of vein, blood flow has slow and clot is suspected.
    • Remove Cannula and call MD
    • Elevated WBC, fever, chills, and +tive blood cultures
    • Treat with IV antibiotics and vien excision
  21. Nosocomial peripheral IV infection with bacteremia and sepsis
    • Infusion is sluggishIV site is hot, red and painfull, but not hard or swollen
    • Chills, rapid pulse, T 39.4
    • Blood, urine and sputum cultures
    • Heat compress and elevate arm(dialates vessels to allow bld flow)
  22. What is the cause of Nosocomial peripheral IV infection with bacteremia and sepsis
    • Poor aseptic technique
    • Failure to maintain a clean site or closed delivery system
    • Failure to change tubing or cannulas at regular intervals
    • Malnourished, immunocompromised, over 60, or if the client has an infection at another site
  23. Signs and symptoms and interventions of air in tubing
    • Bp drops quickly and pulse increases after tubing change
    • - Air embolism
    • - Place client on left side, lower head of bed.
    • Clamp IV and check tubbing for disconnection or air leakNotify physician, oxygen, monitor client closely
  24. Signs and symptoms of Allergic reaction to IV fluid or medication
    • IV site turns red,
    • Pt complains of icthing and devlopes rash
    • SOB
  25. Interventions for Allergic reaction to IV fluid or medication
    • Stop the infusion
    • KVO with NS
    • Administer oxygen
    • Notify Physician
    • Document reaction
  26. Allergic Reaction to Catheter and interventions
    • New IV,
    • Red streak over vein,
    • Pain at site
    • Inform physician
    • Use cath. of different material
  27. Client education when going home with IV
    • Alarm
    • Site monitoring
    • Mobility
    • Written instructions
    • S/S of allergic reation
  28. What are some common cardiac conditions
    HTN, CAD, Acute coronary artery syndrome, heart failure, Cardiomyopathy, Arrhythmias, inflammatory and valvular Heart disease, Vascular disorders
  29. How does a client with a Cardiac Condition Present?
    • Chest pain
    • Palpitations Dyspnea
    • Syncope
    • Fatigue
    • Dependant edema
    • Hemoptysis (coughing up blood)
    • Cyanosis
  30. Chest pain - Angina (Cardiac related)
    • Retrosternal,
    • diffuse pressure
    • Left arm, Jaw, Back pain
    • "Aching, dull, pressing, squeezing, Vice-like"
    • Mild to severe
    • Minutes
    • Increases with effort, emotion, eating, cold
    • Relieved with rest and nitroglycerin
  31. Chest pain - Not angina (not cardiac related)
    • Left inframammary localized pain (able to pinpoint)
    • Radiates to right arm
    • "Sharp, shooting, cutting"
    • Excruciating
    • Seconds, hours, days,
    • Increases with respiration, posture, and motion
    • Nonspecific relief measure
  32. Palpitations
    • "Fluttering"
    • "Skipped beats"
    • Several underlying causes, such as thyroid, dehydration
  33. Dyspnea
    • Paroxysmal Nocturnal Dyspnea
    • Orthopnea
    • Dyspnea on exertion
  34. Paroxysmal Noturnal Dyspnea
    • Occurs at night
    • Supine (lying down)
    • Increased intrathoracic blood volume when in supine
    • Runs to window for air
    • Most common with CHF
  35. Orthopnea (Quantify)
    • Pt has to sit up to breath
    • # of pillows can be used to quantify orthopnea
  36. Dyspnea on exertion (Quantify)
    • DOE
    • "How long are you walking before you lose your breath?"
  37. Syncope
    • Fainting
    • Transient loss of cerebral blood flow
    • Hearts inability to pump blood to the brain
    • Affected by position, activity and palpitations
  38. Fatigue (Assessment)
    • How long have you been tired? (new or chronic)
    • Was the onset abrupt? Do you feel tried all day? (in the morning or evening)
    • When do you feel the least tired?
    • Do you feel more tired at home or work? (stress related)
    • Is the fatigue relieved by rest?
    • PEDS: Can they keep up with the other kids?
  39. Dependant Edema
    • Swelling of the legsCHF: Symmetric, worse at the end of
    • the day
    • Bilateral: Systemic cause
    • One foot: Localized, DVT
  40. Cyanosis (assessment)
    • Look around mouth (circumoral)
    • Lips and chest more serious than blue toes and fingers
    • Dark skin: Look under lip and between fingers
  41. Cardiac pain assessment
    • Where is the pain?
    • How long have you had the pain
    • Do you have reacurrent episodes of the pain?
    • How often do you get the pain?
    • What makes the pain worse?
    • How would you describe it? (dull, presure, sharp?)
    • Does the pain occur at rest, with exertion, after eating, when moving arms or with emotion?
    • Is the pain associated with SOB, palpitations, nausea or vomiting, coughing, fever, coughing up blood or leg pain?
  42. Levine's sign
    Hand over chest
  43. Cardiac-Health perception-Health management (cardio risk factors)
    • Elevated serum lipids
    • HTN
    • Cigarette smoking (Pack years)
    • Sedentary Lifestyle
    • Obesity
    • Stress
    • Diabetes
    • Alcohol or drug abuse (cocaine causes tachycardia)
    • Allergies
    • Family history
  44. Cardiac - nutritional metabolism
    • Weight history (going up and down stresses heart)
    • Diet recall
    • Salt and fat intake
    • Ethnic influences (in terms of intake)
  45. Cardiac - Elimination
    • Diuretic use
    • Constipation (straining can cause CVA)Incontinence
  46. Cardiac - Activity/Exercise
    • Type,
    • Duration and frequency
    • Unwanted effects (of meds. or condition)ADL limitations
  47. Cardiac - Sleep/rest
    • PND
    • Orthopnea
    • Nocturia (fluid is redistrubuted at night),
    • take diuretic in morning
  48. Cardiac - Cognitive/perceptual
    • Pain
    • Language
    • Memory
  49. Cardiac- Self perception/Self concept
    • Body image concerns
    • Effect of illness on client
  50. Cardiac - Role/relationship
    • Marital status
    • Role in household
    • # of children
    • Living environment
    • Significant others
    • Satisfaction with role
  51. Cardiac - Sexuality - reproductive
    • Fear of sudden death
    • Fatigue
    • SOB
    • Impotence (Erectile dysfunction is one of the earliest signs of CAD b/c of decreased bld flow)
    • No viagra if on nitroglyercin
  52. Cardiac - Coping stress tolerance
    • Marital relationships, family ,occupation, church, friends, finances, housing
    • Coping mechanisms
    • Support systems
  53. Cardiac - Values - beliefs
    • "higher power"
    • Crisis
    • Plan of care and conflict with belief system
  54. Functional health patterns
    • Health perception/health management
    • Nutritional/metabolic
    • Elimination
    • Activity/exercise
    • Sleep/rest
    • Cognitive/perceptual
    • Role/relationships
    • Sexuality/reproductive
    • Coping-stress tolerance
    • Values/beliefs
  55. Cardiac -physical examination
    • General appearance
    • Skin
    • Nails
    • Facies
    • Eyes
    • Mouth
    • Neck
    • Chest
    • Extremities
  56. Cardiac-physical findings (HR, pulse)
    • Changes in HR (tachycardia, Bradycardia, Fibrillation)
    • Arrythmia/Dysrhythmia
    • Changes in character of pulse
    • Changes in pulse pressure (diff. b/w systolic and diastolic)
    • Alteration in peripheral pulses
    • Jugular vein distension
  57. Cardiac - physical findings (Bp, Skin)
    • Changes in Bp (HTN, HPTN, Postural hypotension)
    • Changes in skin (pallor, central (more serious) or peripheral cyanosis)Diaphoresis
    • Decreased Cap. refill (less than 2 sec.)Changes in temp. (use back of hand)
  58. Cardiac- physical findings (bleeding)
    • Bleeding
    • - Frank (can see it)
    • - Occult (hidden, in stool)
    • - Bruising/ Ecchymosis
    • - Petechiae (sm. vascular lesions - will disappear when touched)
    • - Decreased cognition (bleeding in brain)
  59. Care of clients with Cardiac conditions
    • Diagnostic testing
    • Medical management (drug therapy, surgical intervention)
    • Interdisciplinary Responsibilities (collaborative care, Independant nursing care - careplans, Discharge planning, community care)
  60. Diagnostics (cardiac) - 24 hr Holter monitor
    • 24-48 hours
    • Diary (to record symptoms)
    • No bath or shower
    • Skin irriatation may occur
  61. Diagnostics (Cardiac) - Echocardiogram
    • Ultrasound waves
    • Blood flow through the heart (structure abnormalities)
    • May be combined with exercise
    • No contraindications
    • Picks up the chambers of the heart
  62. Diagnostics (cardiac) - Troponin Level
    • Blood test
    • Measures protiens released after MI
    • Rapid bedside test, specifically related to the heart
  63. Diagnostics (cardiac) - Cardiac catherization
    • Written permission required
    • Injection of dye
    • No food or fluids 6-8 hours prior to procedure
    • Post procedure care required (punture site - cath. goes into femoral artery)
  64. Medical interventions (cardiac)
    • antihypertensives
    • Antianginals
    • Cardiotonics
    • Antihyperlipidemics
    • Decreasing the damage to the heart helps the heart work better also prevents any further damage
  65. Ongoing drug therapy (cardiac)
    • Antiplatelet agents (coumadin -need INR)
    • B-adrenergig blockers
    • Nitrates
    • Glycoprotien inhibitors
    • Low molecular weight heparin
    • Direct thrombin inhibitors
    • ADP receptors antagonist
    • Calcium Channel blockers
    • Morphine
    • ACE inhibitors
    • Fibrinolytic therapy
    • Pravex- blood thinner simular to coumadine but you don't need an INR H/E there is no antidote
  66. Surgical interventions (cardiac)
    • Cardiac Catherization
    • Cardiopulmonary Bypass (bloodless feild during open heart surgery)
    • Stent Placement (common-holds artery open)
    • Heart transplant (criteria on heart transplant list)
    • Pacemaker implant
    • CABG(coronay artery bypass graph - go around blocked artery - use saphinous vein in leg)
    • PTCA (Percutaneous transluminal coronary angioplasty)
    • Laser angioplasty (use laser to detroy plaques)
    • AED (automated external defibulator - if heart stops it puts it back on track)
  67. Surgical management (cardiac) pre op
    • History & Physical
    • Pt Fear and knowledge
    • NPO after midnight
    • Admin. sedative as ordered
    • Teach cough and deep breathing
    • explain use of pain meds. after surgery
    • Explain Activity restrictions (6-8 wks after surgery)
  68. Surgical management (cardiac) post op
    • Immediate post op period (3-6 days in ICU)
    • Post cardiac Rehabilitation (cardiac step down unit, telemetry, general medicine, or home)
  69. Post op Complications (cardiac)
    Cardiac, resp., Hemmorage, Neurological, Renal failure, F/E imbalances, Coagulopathies, Poor wound healing, depression, Postpericardiotomy syndrome
  70. Surgical management (Cardiac) post op 2
    • Monitor for complications
    • Analgesics PRN
    • Encouraged increased activity as tolerated
    • Monitor incision
    • Support client and family with recovery and in making required lifesyle modifications
  71. Nursing diagnosis (Cardiac)
    • High risk for cardiovascular disease
    • Decreased cardiac output
    • Activity intolerance
    • Knowledge deficit
  72. Risk factors for primary hypertension
    Age, alcohol, cigarette smoking, Diabetes mellitus, Elevated serum lipids, Excess diatary sodium, Family history, Obesity ethnicity, sedentary lifesyle, Social economic status, Stress, Gender
  73. Complications of HTN
    • Hypertensive heart disease (CAD, left ventricular hypertrophy, which then leads to heart failure)
    • Cerebrovascular disease (stroke)Peripheral vascular disease
    • Nephrosclerosis (hardening of arteries in kidneys)
    • Retinal damage
  74. Lifestyle modifications (HTN)
    • Nutrional therapy
    • Physical activity
    • Medical managment
    • Avoidance of tobacco products
    • Modification in alcohol consumption
    • Stress management
  75. Nutritional Therapy (HTN)
    • Decrease serum cholesterol, obesity and DM
    • <30%fat, <7%saturated fat, <200mg cholesterol
    • 25-30g of soluble fibre (digestable)Fruits, vegetables and whole grains
    • Fewer meats, refined starches and sugars
    • Reduce sodium intake
    • Dietician
  76. Physical Activity (cardiac)
    • Shown to increase HDL
    • Decrease Serum cholesterol, HTN, and obesity
    • 3 to 4 times a week to 5 times 30 min a week.
    • Progressive increase in activity
  77. Why don't some people take their medication?
    • Cost
    • Instruction unclear or not given in writting
    • Inadequate or no client teaching
    • Lack of involvement of the client in the treatment plan
    • Side effects
    • Dementia (forgetful)
    • Inconveinient dosing
    • illiterate
  78. Avoidance of tabacco Products
    • Encourage smoking cessation
    • Refer to smoking cessation program
    • Change routine associated with smoking
    • Ask for family member support
    • substitute with other activities
  79. Modification in alcohol consumption
    • When assesing if they admit to 12 it is probably more
    • GDT- Liver funtion test
    • If they stop abruptly they can die
  80. Stress management
    • Identify stress levels and possible strategies for reduction
    • eg. imagery, education, relaxation exercises
  81. Discharge planning
    • Collaborative effort
    • Begins on admission
    • Must include client and family
  82. Homecare Instructions Post Surgery
    • Continue with progressive activity as tolerated
    • Cough and deep breathing exercises
    • Avoid lifting (4-6 wks)
    • 2-4wks until sexual activity
    • Monitor incision for S/S of infection or occulsion
    • Perform necessary incisional care
    • Comply with lab monitoring
    • Arm bracelet (if on coumadin)
    • take meds. as prescribed
    • Follow dietary restrictions (2g of na)
  83. Common respiratory conditions
    Pneumonia, asthma, COPD, Cystic fibrosis, Lung cancer, Tuberculosis, ARDS, ARF(acute resp. failure), Atelectasis, bronchiectasis, pleural effusion, Pneumothorax, Pulmonary embolism (bld flow dosn't get to lungs)
  84. How will this client present? (Resp.)
    • SOB
    • Wheezing
    • Pleuritic chest pain (b/w ribs)
    • cough
    • Sputum production
    • Hemoptysis (coughing up blood)
    • Voice change
    • Fatigue
  85. Early S/S of inadequate oxygenation
    • Unexplained apprehension, restlessness, irritability confusion and/or lethargy
    • Tachypnea/Tachycardia
    • DOE
    • Mild hypertension
    • Arrhythmias
    • Diaphoresis, decreased urinary output, unexplained fatigue
  86. Late S/S of inadequate oxygenation
    • Unexplained confusion or lethargy
    • Combativness, coma
    • Use of accessory muscles,
    • ICS retraction (inspiration), pause for breath inbetween sentences/words
    • Arrhythmias, hypotension, cyanosis, cool, clammy skin
    • Diaphoresis, decreased urinary output, unexplained fatigue
  87. Resp. Health perception - health managment
    • percieved change in health status
    • Course of illness
    • Degree of dypnea
    • Characteristics of cough
    • Family history
    • Living arrangments and recent travel
    • Current and past smoking
    • Use of equipment (nebulizer, O2)
    • Immunizations (flu/pneumonia vacc.)
  88. Resp. Nutritional/metabolic
    • Weight loss (planned/unplanned)
    • rapid weight change (fluid retension)Dehydration
    • Obesity (to tired)
  89. Resp. Elimination
    Activity intolerance (ability to get to the washroom in time, long enough cord)
  90. Resp. Activity/exercise
    • Dyspnea
    • ADL's
    • Self care strategies
  91. Resp. Sleep/rest
    • Night walking
    • # of pillows
    • Sweating (TB)
  92. Resp. Cognitive/Perceptual
    • Anxiousness (b/c can't breath, which increases HR, therefore more dyspnea)
    • Ability to learn and retain
    • Cooperation with treatment
    • Discomfort
  93. resp. Self perception/ self concept
    • Development of role functions
    • Self esteem
    • Personal body image
    • Support groups or rehab programs come in to play (kingston is closest)
  94. Resp. Role/Relationship
    • Performance at work
    • Impact of meds. O2, and special routines
    • Environmental exposure
  95. Resp. Sexuality/ Reproduction
    Teaching position strategies for sexual fulfillment
  96. Resp. Coping/ Stress
    • Cycle of dyspnea and anxiety
    • Physical and social isolation
    • Coping strategies
  97. Resp. Value - beliefs
    • Adherence to management regimen
    • Conflict with cultural beliefs, financial constraints, failure to note benefit, or other reasons
  98. Physical examination (Resp.)
    VS, Nose, Mouth and Pharynx, Neck, Thorax and lungs, skin colour
  99. Physical findings (Resp. nose, mouth)
    Nose - Patency (plug one nostrol (breath in out) then plug other), inflammation, deformities, symmetry and discharge, polyps

    Mouth and pharynx - Colour, leisions, masses, gum retractions, poor dentition, bleedin, obvious dental caries, and pursed lip bleeding
  100. Physical findings (Resp. Neck and other)
    • Neck - Symmetry, tender or swollen areas (trachea should be midline), Lymph nodes
    • Cough, sputum, clubbing of digits
  101. Physical findings Thorax and lungs
    • Inspection
    • Palpation
    • Percussion
    • Ausculation
  102. Thorax and lungs inspection
    • Alterations in rhythm and depth (apnea, tachypnea, bradypnea, hyperpnea, hyperventilation, arrthythmic resp.
    • Colour (cyanosis, Cherry pink, Reddish blue)
    • Dyspnea
    • Use of accessory muscles, indrawing, retraction
    • Splinting, guarding
    • Prolonged expiratory phase
  103. Thorax and lungs palpation
    • Tracheal position (should be midline)
    • Chest symmetry
    • Fremitis
  104. Thorax and Lungs Percussion
    • Resonance
    • Tell the size of the lung (have them exhale and percuss up, have them inhale and percuss up)
  105. Thorax and Lungs Auscultation
    • Decreased or absent air entry
    • Wheeze
    • Crackles (fine, coarse)
    • Friction rubs (Hold breath to tell if its cardiac or lungs)
    • Stridor (obstruction) - High pitched
    • Grunts, snores, hoarseness
  106. Emergency Management (Resp.) Chest trauma
    • Blunt or penetrating
    • <20% of both lung: rest and limit activity it will go away on it's own
    • 20-30% pt needs thoracentesis (needle though chest wall to draw fluids out)
    • > 30% chest tube attached to underwater seal and suction (need to wait for lungs to re expand)
  107. Nursing responsiblities (Resp.)
    • Ensure patent airway
    • Administer high flow O2 with non-rebreather mask
    • Establish IV, begin fluids as appropriate
    • Remove clothing to assess wounds
    • Cover sucking wound with non-pourous dressing taped on 3 sides (don't want air in, need air to get out)
    • Stablize impaled objects
    • Assess for other signs of injurys
    • Stablize flail rib segments (by hand or horizonal tape)
    • Semi-fowlers, or on injured side after cervical spine injury has beed ruled out (allows for good expansion of lung)
  108. Chest Tubes
    Purpose is to remove air of fluid from the pleural space in order to reestablish subatmosphere intrapleural pressure which will reexpand the affected lung
  109. Drug therapy (Resp.)
    • Bronchodilators
    • Anticholinergics
    • Anti-inflammatories
    • Glucocorticoids
    • Leukotriene receptor antagonsists
    • Antibiotics
    • Antituberculosis
    • Expectorants
    • Antitussives
    • Opiates
  110. oxygen Therapy
    • Used to prevent or relieve hypoxemia by increasing the amount of oxygen in the air
    • Wall piped system, oxygen tanks, concentrators
    • Equipment: Flow meter, humidifier, tubing, delivery device
  111. Nasal Cannula
    • Comfortable, inexpensive, can eat with it on.
    • Drying to nasal mucosa, can lead to nasal ulceration
  112. Simple mask
    • May or may not by humidified
    • Holes on the side of the mask allow for entry of room air
    • Permits higher O2 concentrations, inexpensive,
    • Must be removed prior to eating, requires flow rate >5L/min. May cause facial irratation, not practical for long term
  113. Partial rebreather mask with reservior
    • Similar to simple mask, but has reservior bag
    • Oxygen conserved, rebreath from resevoir.May lead to oxygen toxicity
  114. Non rebreather mask with Reservoir
    • One way valve to prevent rebreathing of expired air
    • 100%
  115. Ventri mask
    • Connector or dial to deliver a specific amount of oxygen
    • Set for each liter to be delivered with fixed amount of room air
  116. Tracheostomy bag
    • Over trach
    • Must be humidified
  117. Face tent
    • Fits under chin and loosely over face
    • Oxygen and humidification for pt who cannot or will not keep a mask on
  118. Complications of Oxygen Therapy
    • Oxygen induced hypoventilation
    • Atelectesis
    • Oxygen toxicity
  119. Oxygen indused hypoventilation
    • pt loses stimulis to breath
    • Do not admin > 3L/min w/o Doc order
  120. Atelectasis
    • The collapes of alveoli.
    • Occurs b/c O2 damages surfactant
    • High concentrations should be limited to brief periods if possible.
    • Encourage deep slow breaths
  121. Oxygen Toxcity
    • greater concentration of21% - Potential for damage to aveolocapillary membrane increases
    • >50% over 24 hours - sharp cheat pain, dry cough, decreased pulmonary function (ARDS).
    • Avoid high concentrations for a long period of time.
    • Use lowest setting possible to maintain oxygenation
  122. Safety concerns (Oxygen)
    • Combustion
    • Infection transmission (ideal for growth (exhaled air and moisture) wash equipment, date equipment, change equipment)
  123. Chest tube (assessment)
    • VS Q4H
    • Bilateral chest expansion
    • Palpate for SubQ emphysemia
    • Auscultate for medastinal shift and breath sounds
    • Colour and amount of drainage in chest tube
    • Fluctuation of fluid in the drainage apparatus with each breath
  124. Chest tube (no fluctuation)
    • Check patency
    • Check connection (sealed with water)Have client cough and change positions
    • If not corrected, call physician (they will milk the tube)
  125. Chest tube care
    • Keep above level of apparatisCoil tubes on bed and and pin to sheet using a tape tab
    • No dependant loops
    • Keep 2 rubber tipped Kelly forcepts at the bedside at all times to clamp a disconnected or broken tube
    • Sterile vasoline gauze
    • Never lift drainage apparatus above the level of insertion site
  126. Asthma Lifestyle modifications
    • Remove pets form home
    • Remove carpeting from home
    • Clean the house
    • Ensure mattresses and pillows in allergen proof covers
    • HEPA air cleaner
    • Smoking cessation
    • Air conditioner
    • Avoid going outside on hot windy days (5-10am)
    • Check pollen count
    • Change clothing
    • Remove plants that may be triggers
    • Do not hang laundry out to dry
  127. Physical Activity "(Asthma)
    • Establish activity with HCP
    • Take medication prior to exercise
    • Start slowly
    • Warm up and cool down
    • Stop and rest with symptoms and take relieve RX
    • Monitor temperature and pollution
  128. Self monitoring (asthma)
    • Asthma action plan
    • Peak Flow meter

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