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safetynmeds
NP4 Test 2
| Question | Answer |
|---|---|
| For recconstitution of vials you must | Time and date vial after reconstitiution, Know expiration time, Know what fluid to reconstitute the drug with (read vial) |
| How do Epidurals work on the body? | act on the opiate receptors in the dorsal horn of the spinal cord |
| What are the most common meds used for Epidurals? | perservative free morphine and fentanyl |
| What are some advantages of having an epidural? | more symptomatic effects than intrathecal, can be turned off and on quickly |
| Why is an epidural perferred over an intrathecal catherter? | bc the dura mater provides a barrier for infection |
| Why would an intrathecal catheter be used instead of an epidural? | uses less medication (d/t being in direct contact w cerebrospinal fluid), meds get into the system faster |
| Nursing care for epidural includes | Label tubing, secure all connections with tape, apply tape over injection site, secure catheter with tape, assess site q shift and q use, strict aspect technique |
| Nursing care for patient with epidural includes | assist client with moving and repositioning, teach client not to pull on catheter, assess for s/s of infection, sedation level q1hr for 1st 24 hours, I&O |
| Pro's of using a PCA includes | an interactive method of pain management, decreases roller coaster effects, more constant level of pain relief, basal rate, prevents overdose, programmable lockout, maximum dose, theft |
| Assessment for patient on PCA includes | pain, allergies, knowledge, sedation/respirations, site for infiltration, documentation |
| Common side effects of PCA's include | pruitus, nausea, sedation, respiratory distress, hypotension |
| When would whole blood be used? | emergency and acute trauma |
| Whole blood is effective because it | replenishes both volume and oxygen carrying capacity |
| In order to give whole blood what device must you use? | inline filter |
| Packed red blood cells (PRBC) are used to | increase the oxygen carrying capacity, each unit should increase the hematocrit by about 3% |
| PRBC's consists of | 80% of plasma has been removed |
| How much is an unit of whole blood? | 500 mL |
| When would packed red blood cells be used? | anemias, surgery, disorders with slow bleeding, heart problems (prevents circulatory overload) |
| A unit of packed red blood cells consist's of? How long should it be given over? | 250 mLs over 2-4 hours |
| Washed packed red blood cells are prepared by | being rinsed with a solution that removes white blood cells and plasma proteins |
| Leukocyte-poor Red Blood cells are prepared by | removing 95-99% of the leukocytes |
| Why would leukocyte-poor red blood cells be given instead of regular red blood cells? | to help prevent a febrile reaction |
| When are platelets given? | when platelets are < 20,000 |
| What is the safest way to receive a transfusion? | autologous blood |
| What is autologous blood? | a pre-operative donation of your own blood, must be done atleast 3 days prior to surgery |
| Rh (rhesus) factor is used to | determine the presence or absence of the Rh antigen on the surface of the RBC's |
| If the person is Rh negative they can only recieve | negative blood |
| If the person is Rh positive they can only recieve | positive blood |
| Blood crossmatching consists of | mixing the recpipients serum with the donor's RBC followed by the addition of Coomb's serum |
| Universal blood donor is | O negative |
| Universal blood recipient is | AB+ |
| Steps for blood administration inlcude | *check the orders *check labs *blood bank administration band *patient teaching *Assess vitals *check iv site *iv tubing set up (NS only) *bedside check with a licensed personnel |
| After you have obtained the blood you must start it within how many minutes? | 30 minutes |
| What gauge catheter must the patient have in order to receive blood products? | 18-20 gauge |
| If a patient has had an allergic reaction to a blood product before what would you premedicate them with? | tylenol, benadryl, lasix |
| What must the label on the blood contain? | patients full name, MRN, blood bank armband number, unit number, blood component type, ABO/Rh type compatibility, expiration date, signature by two licensed |
| How many ml's of blood should you administer over the first 15 minutes? | 30 ml |
| Over what period of time (hours) should you administer a unit of blood for? | 2-4 hours |
| How long must you remain with the patient when they recieve the blood product? | the first 15 minutes |
| S/S of an allergic transfusion reaction to blood includes | *flushing *itching *rash *wheezing *hives *laryngeal edema *anaphylaxis |
| An allergic transfusion reaction to blood is caused by | sensitivity to infused plasma proteins/antibody antigen reaction |
| S/S of a febrile transfussion reaction to blood includes | *chills *fever *headache *palpitations *cough *chest tightness *increased heart rate *flank pain |
| A febrile transfusion reaction to blood is caused by | sensitivity of clients blood to WBC's, platelets, or plasma proteins |
| S/S of hemolytic transfusion reaction to blood includes | *chills *fever *chest pain *flushing *diaphoresis *increased heart rate *flank pain *blood oozing from site *acute renal failure *abnormal bleeding |
| A hemolytic transfusion reaction to blood is caused by | incompatibility between clients blood and donors blood |
| S/S of sepsis transfusion reaction to blood includes | *sudden onset chills *very high fever *abdominal cramping *diarrhea *shock *signs of renal failure |
| A sepsis tranfusion reaction to blood is caused by | administration of contaminated blood |
| Blood transfusions must be completed within how many hours of initiation? | 4 hours |
| Blood tubing is changed | every 4-6 units |
| Nursing implementations for transfusion reaction includes | *stop transfusion *take vitals q 5-15 min *notify MD *notify blood bank *collect blood and urine samples *follow MD instructions and facility protocols *monitor patient *watch I&O *do not discard blood or tubing *documentation |
| Why would hyper-alimentaion/TPN be used | prolonged period that the pt. cant eat, GI rest, severe trauma or injury, burns, malnourished, OR |
| What is in hyper-alimentation? (hypertonic fluid) | 10-50% glucose, water, fat, proteins, electrolytes, vitamins, trace elements |
| Nursing implementaions for hyper-alimentation | *daily weights *strict aseptic technique *has to be order everyday so make sure labs are drawn *blood glucose *remove from refrigerator 30 min prior to hanging |
| What type of access must the patient have in order to receive hyper-alimentation? | central line/dedicated port |
| After hanging when does hyper-alimentation expire? | 24 hours |
| What filter must you use for hyper-alimentation? | millipore filter |
| Lipid/Fat emulsions must be given over | 12-24 hours |
| What type of tubing is required for Lipid/Fat emulstions? | vented |
| S/S of an allergic reaction to Lipids/Fat emulsions include | dyspnea, fever, flushing, phlebitis, chest/back pain |
| Labs to follow for Lipids/Fat emulsions inlcude | *pre-albumin (half life of 3-5 days) *BUN *creatinine *glucose *lipids *electrolytes *liver function test *CBC |
Created by:
stilsl
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