Download NSE 221 Study Review: Blood Transfusions and Parenteral Nutrition and more Exams Nursing in PDF only on Docsity!
NSE 22 1 STUDY RE 1 V00%IEW WI VETHRIFIE COMPD!! LETE SOLUTIONS
purpose of blood transfusions - ANSWER 1) increase blood volume
- correct RBC deficiency3) maintain clotting ability
- provide selected blood components as replacement therapy components of blood - ANSWER plasma RBC WBCplatelets
types of transfusions -frozen plasma, cryoprecipitate, and IV immunoglobulins ANSWER whole blood, packed RBCs, platelets, albumin, fresh
When is whole blood given? - ANSWER where major blood loss occurs when are packed RBCs used? -replace RBCs ANSWER most commonly used to improve and/or
When are platelet transfusions indicated? -- pts w/ platelet count of less than 10,000-20,000/mm3 ANSWER - severe microvascular bleeding
- bleeding pts w/ platelet count of less than 50,000/mm when is albumin infusion done? -hypoproteinemia ANSWER - 5% soln used for hypovolemic shock &
- 25% soln for severe burns & low albumin When is fresh frozen plasma used? -expansion is also needed ANSWER replaces coagulation factors when BV
When is cryoprecipitate used? -- to replace factors w/o the hypervolemia risk w/ FFP ANSWER - to increase fibrinogen lvls
What is IVIG used for? -decreased or abolished antibody production capabilities ANSWER a protein replacement therapy for pts who have
antibodies in O blood - ANSWER Anti-A and Anti-B antibodies in A blood - ANSWER anti-B antibodies in B blood - ANSWER Anti-A antibodies in AB blood - ANSWER no antibodies compatible RBC for O blood - ANSWER O Compatible RBC for A blood - ANSWER A,O Compatible RBC for B blood - ANSWER B,O Compatible RBC for AB blood - ANSWER A,B,O,AB Compatible plasma for O blood - ANSWER O,A,B,AB
what causes mild allergic rxn for transfusions? -plasma proteins ANSWER antibodies against donor
what causes anaphylaxis rxn for transfusions? -especially anti-IgA ANSWER antibodies to donor plasma,
what causes febrile non-hemolytic transfusion rxns? -leukocytes & HLA antigens ANSWER antibodies against
what causes febrile hemolytic rxn? -RBCs by host antibodies ANSWER results from rapid destruction of donor's
what causes TRALI rxns? - ANSWER what is the leading cause of death in blood transfusions? - ANSWER TRALI what causes TACO rxn? -accommodate ANSWER blood is administered faster than circulation can
what causes massive blood transfusion rxn? -transfusions (10+ RBC units under 24 hrs) ANSWER when pts receive massive
what causes acute intravascular hemolytic rxns? -attach to transfused RBCs --> RBC destruction ANSWER antibodies in plasma
cause of sepsis rxn during transfusion -transfused blood components ANSWER bacterial contamination of
steps to take when acute transfusion rxn ... - ANSWER 1) STOP transfusion
- maintain patent IV line w/ saline soln
- notify blood bank. & HCP
- recheck identifiers
- monitor VS, & U/O frequently6) treat symptoms as ordered
- save & return blood8) collect samples
pre-transfusion nursing assessments -2) respiratory ANSWER 1) neuro
- cardiac
- active bleeding5) current treatments
- factor deficiencies
- lab values what do you do before starting transfusion? -auscultate the chest ANSWER take baseline vital signs, &
How should you initiate blood transfusion? -(50mL/hr) for 15 mins ANSWER - start transfusion slowly
- check VS, & assess pt q15 min for 1st hr
- document e/c set of VS on the transfusion record if there's no complications after 15 minutes of blood transfusion, nurse may ...? -ANSWER increase rate to infuse as ordered by physician
when must blood be started after leaving blood bank? -started w/in 30 minutes of leaving bank*, and completely used w/in 4 hrs ANSWER blood must be
(desmopressin)
- anti-fibrinolytic
- vit K What is TPN? -provided completely through IV ANSWER form of specialized nutritional support where nutrients are
indications for TPN? -- extended bowel rest ANSWER - nonfunctional GI tract
- postop TPN TPN is made up of 2 components - ANSWER 1) amino acid/dextrose soln
- lipid emulsion soln what is a 3-in-1 admixture? -emulsion ANSWER parenteral nutrition sol'n w/ addition of lipid
fat emulsions are contraindicated in ... -metabolism, pancreatitis, bleeding disorders, liver failure, or resp disease ANSWER - pts w/ a disturbance in fat
what is the vein of choice for TPNs? -there's less risk of thrombophlebitis, & vessel damage ANSWER - central veins are veins of choice b/c
if tube migrates 2cm or more for a PICC line what should you do? -should be stopped & radiography should be repeated for placement verification ANSWER fluids
when is central parenteral nutrition indicated? -necessary or pt has high protein + calorie requirements ANSWER when long term support is
when is peripheral parenteral nutrition indicated? -support, and low protein + calorie requirements ANSWER used for short term
TPN complications -electrolyte imbalance, hypercapnia, hypoglycemia, hyperglycemia, re-feeding ANSWER air embolism, catheter occlusion, catheter sepsis, syndrome, pneumothorax, thrombosis of central vein intervention for air embolism -instruct them to perform valsalva manoeuvre ANSWER - turn pt to left lateral decubitus position,
- cap open end of catheter & administer oxygen intervention for catheter occlusion -heparin. try to aspirate clot. ANSWER temp stop infusion & flush w/ saline or
intervention for catheter sepsis -insertion sites for S&S ANSWER - change infusion tubing regularly, & assess
intervention for electrolyte imbalance -toxicity ANSWER - looks for signs of deficiency or
- monitor I/O of electrolytes
- supplemental vitamin K must be given as ordered throughout therapy intervention for hypercapnia -energy requirements ANSWER - monitor parameters, provide 30-60% of
intervention for hypoglycemia -abruptly, but taper rate down ANSWER - to prevent, do not discontinue PN
- test glucose lvls & administer IV bolus of 10% dextrose intervention for hyperglycemia -stable ANSWER - monitor blood glucose lvl daily until it is
hyperventilation - ANSWER ventilation in excess of what is needed to eliminate CO hypoventilation -eliminate CO2 ANSWER ventilation inadequate to meet body's oxygen demand, or
Hypoxia - ANSWER inadequate tissue oxygenation @ the cellular lvl Indications for oxygen therapy -disorders, cardiovascular disorders, CNS disorders ANSWER to treat hypoxemia caused by resp
early manifestations of O2 toxicity -pain, N&V, paresthesia, nasal stuffiness, sore throat & malaise ANSWER reduced VC, cough, substernal chest
late effects of O2 toxicity - ANSWER pulmonary edema, ARDS low-flow devices include: -masks (rebreathing & non-rebreathing) ANSWER nasal cannulas, simple face marks, & reservoir
high-flow devices include: - ANSWER venturi mask flow rate for nasal cannulas - ANSWER flow rate of up to 6 L/minute oxygen face mask is ...? -secured in place w/ strap ANSWER mask shaped to fit snugly over mouth & nose, & is
what's important to know about reservoir masks? -inspect the bag to make sure it is inflated!! If it's deflated, patient may be breathing ANSWER you must frequently large amounts of exhaled CO2. when are partial rebreathing masks useful? - ANSWER in blood oxygen concentrations
that must be raised contraindications for partial rebreathing masks -w/ COPD ANSWER - not recommended for pts
- never use w/ a nebulizer what is use for non-rebreathing mask? -for pts who need large amounts of oxygen ANSWER provides highest [M] of FiO2, so its.
simple face masks are used for - ANSWER short-term oxygen therapy contraindications of simple face masks - ANSWER do not use on pts w/ CO2 retention flow rate for simple face masks -of expired air in the mask ANSWER at least 5L/min flow to prevent accumulation
uses of venturi mask -[M}s ANSWER helpful for pts w/ COPD who require low, constant O
important thing to know for venturi mask -occluded* ANSWER air entrainment ports must *not be
what is the best method for short term therapy? - ANSWER nasal catheter indicators for oxygen-conserving cannula -long-term O2 therapy is used at HOME > during hospitalization ANSWER generally indicated when
contraindications for transtracheal catheter -appropriate for pt w/ excessive mucus production from mucus plugging ANSWER method may not be
what are the types of chest physiotherapy? - ANSWER - chest percussion
- vibration
- postural drainage contraindications of chest percussions -osteoporosis or fractured ribs ANSWER pts w/ bleeding disorders,
what is vibration chest PT? -only during exhalation ANSWER shaking pressure applied to the chest wall,
purpose of vibrations for chest PT? -trapped air, & make shake mucus loose ANSWER vibration increases exhalation of
what is postural drainage? -secretions* from areas of the lungs into the trachea ANSWER use of positioning techniques to *draw
what should CPT be followed up with? - ANSWER productive coughing & suctioning indications for CPT use? - ANSWER for pts who produce greater than 30 mL of sputum types of suctioning? -orotracheal & nasotracheal suctioning + tracheal suctioning ANSWER oropharyngeal & nasopharyngeal suctioning +
when is oropharyngeal & nasopharyngeal suctioning used? -able to cough effectively, but unable to clear secretions ANSWER used when pt is
when is orotracheal & nasotracheal suctioning used? -is unable to cough, & no artificial airway ANSWER when pt w/ secretions
what is open suctioning - ANSWER use of a sterile catheter, that's opened up @ time
of suctioning what is closed suctioning - ANSWER multi-use catheter, in a plastic sheath what are the types of artificial airways? - ANSWER oral, endotracheal & tracheal What is the oral airway? -tongue* into oropharynx ANSWER prevent obstruction of trachea by *displacement of
what is endotracheal & tracheal airway for? -administer mechanical ventilation, relieve upper airway obstruction, protect against ANSWER short-term artificial airways to aspiration or clear secretions how long as endotracheal & tracheal airways used for? -then removed ANSWER for 14 days, and
how to maintain & promote lung expansion? -- positioning ANSWER - ambulation
- incentive spirometry- breathing exercises
- continuous positive airway pressure (CPAP)
- chest tubes atelectasis - ANSWER collapsed lung ambulation is good for - ANSWER increased lung strength & expansion for pt's w/ cardiopulmonary diseases what is the best position? -degree semi-fowlers* ANSWER *
- if needed, CPT what is recommended for fluid intake to keep mucociliary clearance normal? -ANSWER 1500 to 2000 mL/day, unless contraindicated, also determined by characteristics of secretions. how often should pts who need secretion management cough? -disorders, or pulmonary diseases: q2h while awake ANSWER - if resp tract
- if large amount of sputum, q1h while awake & q2h while asleep types of cough techniques - ANSWER cascade, huff & quad cascade cough - ANSWER slow, deep breath & hold for 2 seconds huff cough - ANSWER while exhaling, pt says "huff" quad cough -inward & upward on abdomen muscles --> cough ANSWER used for pts w/ no abdominal muscle control, nurse pushes
types of breathing techniques - ANSWER 1) deep breathing & coughing exercises
- pursed-lip breathing
- diaphragmatic breathing indications for a tracheostomy - ANSWER (1) bypass upper airway obstruction (2) removal of secretions(3) long term mechanical ventilation (requiring intubation for longer than 7-10 days) (4) permit oral intake & speech in pts w/ long-term mechanical ventilation parts of tracheostomy tube - ANSWER 3 parts: (1) outer cannula w/ flange, (2) inner
cannula, (3) obturator uncuffed tube is suitable for pt that ... -may still require CPT & suctioning ANSWER is in recovery phase of critical illness,
cuffed tube is used to - ANSWER form a seal & facilitate positive pressure ventilation fenestrated tubes are used to - ANSWER help wean pts from temporary trach tube when do trach ties get changed? -Ensure 1-2 fingers can fit beneath ties ANSWER only when wet/soiled or if impeding safety.
what is purpose & length of corking? -on dr's orders ANSWER to help w/ speaking, & length depends
what do you assess in a stoma? -drainage, secretions, bleeding, are sutures in place? ANSWER secretions, stoma skin around trach,
decannulation - ANSWER Process of removing tracheostomy tube laryngeal polyps - ANSWER develops on overused vocal cords electrolarynx - ANSWER handheld device that creates speech w/ use of sound waves voice prosthesis - ANSWER artificial device that produces or amplifies sound contraindications to nasotracheal suctioning - ANSWER BIIGMON
- (nasal) Bleeding, epiglottis, croup- Irritable airway or laryngospasm/bronchospasm
- revise length & frequency of suctioning
- determine need to supplemental oxygen
- notify HCP What to do if there's return of blood secretions when suctioning -frequency & length of suction pressure used ANSWER - evaluate
- rotate cathether
- increase oral hygiene what to do if unable to pass suction catheter through first naris attempted? -- try other nare, or orally ANSWER
- insert nasal airway if suctioning is done frequently
- guide cathether along naris floor to avoid turbinates
- if obstruction is thought to be a blood clot, notify HCP what to do if paroxysms of coughing? - ANSWER - administer supplemental oxygen
- allow pt to rest b/c each suction- consult HCP for bronchodilators or topic anaesthetics
what to do if no secretions obtained during suctioning? -status ANSWER - evaluate fluid
- look for signs of infection
- determine need for CPT- check humidification
length of time for suctioning - ANSWER 10 seconds or less, 1 min b/w each what to do if pt experiences resp distress while suctioning -withdraw catheter & supply O2 ANSWER immediately
pressure of suction for adults - ANSWER 100-150 mmhg pressure of suction for children - ANSWER 50-100 mmhg what to have in room for pt who has tracheostomy? -suctioning tubes (multiple), trach kit, arbitrator, & ambu bag! ANSWER extra inner cannula,
what is peripheral arterial disease? -progressively narrow opening of the arteries in the lower & upper extremities ANSWER thickening of arterial walls -->
what area is most commonly affected by PAD in nondiabetic pts? -popliteal area ANSWER femoral
diabetic patients are most commonly affected by PAD in which areas? -arteries below the knee (anterior tibial, peroneal, posterior tibial) ANSWER
Etiology of PAD - ANSWER 1) atherosclerosis (plaque build up)
- arteries narrowing3) reduced blood flow
- tissue death complications of PAD - ANSWER - atrophy of skin & underlying muscles
- delayed healing
- wound infection- arterial ulcers & gangrene
- amputation symptoms of PAD - ANSWER intermittent claudication, burning pain in feet & toes @
