Check offs 1 - mandatory assignment to pass the class PDF

Preview

Summary

mandatory assignment to pass the class...

Description

Station 1: Oxygen Supply 1 - O2 supply systems: -Sx meets DOT standards for a 3AA (high strength alloy steel) tank. -Hydrostatic testing date stamped w/ inspectors mark (every 5 – 10 yrs) -(+) indicates tank is charged 10%more -E tanks: 0.28 psi factor -PISS- Pin index safety sx -H tanks: 3.14 psi factor -ASSS- American standard safety sx -Administer gas only after verifying color with label markings. -Air: yellow

Oxygen: green

Helium: brown

Carbon dioxide: grey

Nitrous Oxide: blue

-Regulating gas pressure and flow: -Reducing valve & Flow meter = Regulator -Bourdon Gauge and Thorpe tube -DISS- Diameter index safety sx to prevent o2 loss when not in use. *Performance Evaluation: -

Obtain either H (beside) or E (transport) cylinder

-

Make sure safety chain is placed properly. And have safety disk******

-

Crack tank to remove any debris present.

-

Select correct reducing valve for intended use. (Bourdon- transport) (Thorpegravity dependent/ bedside)

-

Secure reducing valve to the cylinder

-

Crack open again to check/ correct any leaks.

-

Calculate amount of time before cylinder must be changed.

-

Push cart correctly to pt area and return all equipment to storage & secure.

2 – Oxygen concentrators: -Use of electricity- always plug into red outlet (backed up by generator) *Performance evaluation: Oxygen concentrators - Place concentrator away from wall/draperies/heat - Plug into red socket - Check gross particle filter and clean as needed - Connect to humidifier if above 4L flow or if pt complains of dryness - Connect o2 delivery device (nasal cannula) - Turn on power switch - Set flow rate as directed - Feel for flow and place on pt - Document procedure in the pts records

Station 2: Infection Control ***** - Hand-washing and Isolation Procedures – Combined -

Contact precautions: Gloves and Gown if permissible

-

Droplet precautions: Glove, Mask (Flu)

-

Airborne precautions: Glove, Gown, N-95 Mask (TB)

*Performance Evalutation - Removes jewelry and watch - Does not contact sink with clothing or body - Adjust water flow and temp - Wets forearms and hands thoroughly - Applies soap liberally - Washes hands with strong friction for 15 sec* - Palm, Wrist, Between fingers, under nails and around cuticles.

- Does not touch the faucet, sides, or bottom of the sink. - Rinse thoroughly from wrists to fingertips - Obtain paper towels without contaminating the hands - Dry hand thoroughly, separate paper towel for each. Wrist to fingertips - Turns off water with clean dry paper towel -- After performing hand hygiene: isolation procedures— - Obtain appropriate apparel - Aseptically applies the gown -Picks up gown at the neck - Hands into sleeves - Fasten ties at neck and then the waist - Apply mask - Apply gloves -- Remove isolation attire before leaving the room— - Remove gloves inside out - Remove mask - Remove gown- untie neck - Pull sleeves off by reaching inside cuff w a finger -Fold the gown inside out and dispose - Perform hand hygiene before leaving the room - Perform hand hygiene outside the room

Station 3: Patient Assessment - Physical assessment including breath sounds and vitals -

Verify physicians orders

-

Review pt chart & prep for precautions accordingly

-

Enter room, introduce yourself,

-

Ensure pt privacy, verify the pt

-

Explain procedure and optimize environment (turning off tv)

-

Perform hand hygiene

-

Record vitals

-

Position the pt sitting up

-

Head: o Nasal flaring- WOB to get air in o Central Cyanosis- Chronic hypoxemia o Pursed lips- COPD pt trying to get air out

-

Neck: o Jugular Vein Distention- Right heart failure (Cor Pulmonale) o Trachea aligned and not deviated 

-

Pneumothorax- trachea will shift to opposing side

Chest: o Check their chest configuration: barrel chest/ bilateral o WOB- Respiratory rate and pattern o Pectus carinatum  Abnormal protrusion of sternum o Pectus excavatum  Depression of part or entire sternum, restricts the lung o Kyphosis  Spinal deformity in which the spine has an abnormal AP curvature o Scoliosis  Spinal deformity in which the spine has a lateral curvature o Kyphoscoliosis  Combination of kyphosis and scoliosis, o Tactile fremitus: “say 99” feel for vibrations going on with both hands 

Increase vibrations with fluid accumulation (pneumonia)



Decrease vibrations with more air (COPD, Emphysema)

o Percussion: Form a dome with your hand and tap on your middle finger 

Dull- consolidation (decrease resonance) pneumonia



Hollow- Air (increase resonance) emphysema



Feel for tenderness/inflammation

o Ask pt to take a deep breath and listen to breath sounds bilaterally

-



Systematically listen to anterior, lateral, and posterior



Normal, Wheezing (constriction), Crackle (fluid in alveoli), Rhonchi ( fluid in large upper airways that’s suctioned out)

Arms: o Digital clubbing: indicates chronic hypoxemia (cystic fibrosis, COPD) o Capillary refill: 2-3 sec which shows circulation and perfusion

-

Legs: o Pedal Edema: Fluid retention in the lower extremities 

-

Pitting or wheeping? 0-4 sec

Vital signs: o Heart rate: radial artery 60-100 o Respiratory Rate: 12-20 o Spo2: 95-100 o Temperature: 98.6 F or 37 C o BP: 120/80

-

Record findings

-

Ensure pt safety and comfort

-

Perform hand hygiene after procedure

-

Relay message to physician: o Situation: Your name/dept/pt name/room# o Background: What factors led up to this event? o Assessment: what is the problem? o Recommendation: what action do you propose?

Station 4: O2 & Humidity

- O2 administration (know all devices, flows, FiO2, etc.) and Aerosol Therapy -

Verify physicians orders in the chart

-

Hand washing and gloves

-

Obtain required equipment: o Nasal cannula: 6 L max at 4L add humidifier 

25-40% fiO2

o Simple oxygen mask: 6-10L 

35-50% fiO2

o Partial rebreather: min 10L 

40-70% fiO2

o Nonrebreather: min 10L 

60-80% fiO2

o Venturi/ Air entrainment mask: for COPD pts hypoxic drive 

-

Fixed fio2

If humidity and aerosol therapy required obtain sterile water o Bubble humidifier: Nasal Cannula o Large volume Jet nebulizer: Bland aerosol therapy 

Large-bore tubing with drainage bag

-

Identify pt by name and dob

-

Explains the procedure to them

-

Adjusts device to the ordered level and confirm its working

-

Ask pt and apply device to them

-

Confirm fiO2

-

Make sure pt is comfortable and leave pt area clean

-

Monitor temperature of gas

-

Wash hands before leaving room

-

Document (equipment, concentration, or flow) in pt chart....