What is the goal of acute care physical treatment? prioritized around what the patient needs to
get home safely and independently (or able for a caretaker to take care of them)
What does telemetry do? -view of heart electrical activity
-continuous pulse ox
-intermittent blood pressure
When is telemetry used? pt at high risk for cardiac events
What do telemetry units provide? -data log of heart function
-can alert nurses if a pt is suffering from an acute or dangerous condition
Indications for a peripheral IV -gain access to peripheral circulation
-provide blood transfusion
-infuse fluids and IV meds
-essential for critically ill pts
Intravenous (IV) infusion fluids, meds, blood products, and nutritional substances are
administered into a vein by an IV device with fluid in plastic bag via administration set
Methods to administer IV medication-rapid injection into vein w syringe
-giving meds intermittently over a specific amt of time using an IV secondary line
-give med continuously mixed in main IV solution
4 reasons for an IV to alarm -air in line
-distal line occlusion
-KVO
-line dislodged
What happens when there is air in an IV line -air bubble in line
-needs to be addressed so it doesn't enter circulation
What happens where there is a distal line occlusion in the IV -IV line kinked or
compressed
-find the area, straighten it, and have RN hit reset and start on the infuser
What happens when there is KVO in the IV and what to do -dose of medication complete
-don't unhook it
-IV must be flushed to prevent clotting
What happens when there is a line dislodged in the IV and what to do -will see this
-notify nurse
-put pressure over IV site if it's bleeding
Heplocked IV flushed with saline solution prior to being disconnected from IV to reduce risk
of clot formation and subsequent IV failure
,IV infiltrate if it infiltrates, IV fluid penetrates the surrounding tissue instead of entering the
vein
Peripherally inserted central catheter (PICC) -long, thin, flexible catheter inserted into one of the
large veins of the arm near or above bend of elbow
-then slid into vein until the tip sits in a large vein just above heart in SVC
When is a PICC used?-long term (6-8 weeks) IV therapy
-chemotherapy
-antibiotics
-IV fluids
-feeding
Total Parenteral Nutrition (TPN) -practice of feeding a person intravenously, bypassing the
usual process of eating and digestion
-person receives nutritional formula of salts, glucose, amino acids, lipids, added vitamins
Central venous catheter/central line catheter in large vein in neck, chest or groin via internal
jugular vein, subclavian vein, and/or femoral vein
When would you use a central venous catheter/central line? -pt needs frequent or intensive
cardiovascular monitoring
-drugs that would be irritating to peripheral circulation (chemo)
-assessment of fluid status
-blood draws
-increased viability of IV drugs/fluids
Port a Cath -type of central line
-septum thru which drugs can be injected or samples can be drawn
Which pts will likely have a port a cath? -hematology
-oncology
-renal dialysis
Advantages of port a cath -don't need to find vein every time you receive chemo
-might help women who have some swelling in the arm on the side of surgery
-meds go right into main blood supply to be sent quickly and efficiently to all parts of the body
-avoids discomfort
-decreased times you need a vein stick for blood draw
Pneumatic stockings -inflatable garment usually used on calf or foot
-maintains pulsatile flow in the deep veins of the LEs
-inflated/deflated intermittently and cyclically
What do pneumatic stockings do? helps prevent clot formation in the presence of lack of
movement
,Locations of a PEG tube and why -nasal passageway for short term use
-through abdominal wall directly into stomach for long term use
How to place a PEG tube with aid of endoscope, scope goes down throat to assist in placing
in the wall of the stomach
Where is the PEG tube located? interior of stomach to outside the body through a small
incision a little bigger than the tube itself in the abdominal wall
How do you prevent a PEG tube from coming out? -small wire inside the tube that when it is
placed, you pull the wire from the exterior causing the portion in the stomach to pig tail to
prevent being pulled out
-small balloon at the end of the tube which is inflated in the stomach after insertion
Indications for a PEG tube -difficulty swallowing
-aspiration pneumonia
-neurological deficits
-esophageal atresia
Where is a G tube inserted? stomach
Where is a J tube inserted? jejunum
NG tube -passed thru nose into stomach
-removes contents of the stomach, including air, to decompress the stomach (small bowel
obstruction, intractable vomiting)
-can serve to remove small solid objects and fluid (ex. poison)
Dobhoff tube -nasoenteric tube placed through nose
-gives fluids, food, medicine to people who can't take them by mouth on a temporary basis
When do you see a Dobhoff tube? short term feeding - usually only for a few weeks
Chest tube - how is it placed and why -places hollow plastic tube between ribs and into
chest
-drains fluid (pleural effusion, blood, chyle), pus (empyema), or air (pneumothorax) from around
the lungs
-often hooked up to suction machine to help with drainage
-usually for a few days
Procedure for placing a chest tube -chest tube thoracostomy
-local anesthesia used
Indications for a chest tube -trauma
-cancer
-infection
-comfort
, Jackson Pratt "JP" drain -post surgical drain
-uses constant suction to pull excess fluid from the body
-removing the plug and squeezing the bulb removes the air, creating a lower air pressure within
the drainage tubing
Hemovac drain -drains blood and fluid from surgical sites
-promotes healing by decreasing drainage around the wound
What should you NOT do over a hemovac drain? do not place a brace on a pt over the
hemovac drain
Lumbar drain -drains fluid surrounding the brain and spinal cord
What are lumbar drains used for? -CSF leaks from nose, ear, or incision site, or around the
brain
-shunt infections
-reducing pressure during craniotomy
-diagnostic aid for NPH
Precautions for lumbar drains -pt should be informed that they need to let nursing staff if they are
to get up or change position so the drain can be properly clamped or re-leveled
-pt should be instructed on purpose of the drain and role of PT
Epidural catheter form of anesthesia where medication is placed directly into the epidural
space
What can result from an epidural catheter? can cause loss of sensation and pain, but typically
doesn't affect motor function
Foley catheter thin sterile tube placed into bladder to drain urine
Texas catheter allows for urinary catheterization in male pts without the use of an internal tube
Colostomy -connects part of colon onto anterior abdominal wall, leaving an opening in the
abdomen called a stoma
-drawn out through incision and sutured to the skin
-feces leave pt body through the stoma
Yankauer hand held suction unit that assists with secretion clearance
Multipodus boot - who is it for? unconscious or immobile acute care pts
Multipodus boot - purpose -places foot and ankle in neutral to prevent contractures
-provides heel and toe clearance for pressure relief and a rotator bar to control hip and leg
rotation in supine
get home safely and independently (or able for a caretaker to take care of them)
What does telemetry do? -view of heart electrical activity
-continuous pulse ox
-intermittent blood pressure
When is telemetry used? pt at high risk for cardiac events
What do telemetry units provide? -data log of heart function
-can alert nurses if a pt is suffering from an acute or dangerous condition
Indications for a peripheral IV -gain access to peripheral circulation
-provide blood transfusion
-infuse fluids and IV meds
-essential for critically ill pts
Intravenous (IV) infusion fluids, meds, blood products, and nutritional substances are
administered into a vein by an IV device with fluid in plastic bag via administration set
Methods to administer IV medication-rapid injection into vein w syringe
-giving meds intermittently over a specific amt of time using an IV secondary line
-give med continuously mixed in main IV solution
4 reasons for an IV to alarm -air in line
-distal line occlusion
-KVO
-line dislodged
What happens when there is air in an IV line -air bubble in line
-needs to be addressed so it doesn't enter circulation
What happens where there is a distal line occlusion in the IV -IV line kinked or
compressed
-find the area, straighten it, and have RN hit reset and start on the infuser
What happens when there is KVO in the IV and what to do -dose of medication complete
-don't unhook it
-IV must be flushed to prevent clotting
What happens when there is a line dislodged in the IV and what to do -will see this
-notify nurse
-put pressure over IV site if it's bleeding
Heplocked IV flushed with saline solution prior to being disconnected from IV to reduce risk
of clot formation and subsequent IV failure
,IV infiltrate if it infiltrates, IV fluid penetrates the surrounding tissue instead of entering the
vein
Peripherally inserted central catheter (PICC) -long, thin, flexible catheter inserted into one of the
large veins of the arm near or above bend of elbow
-then slid into vein until the tip sits in a large vein just above heart in SVC
When is a PICC used?-long term (6-8 weeks) IV therapy
-chemotherapy
-antibiotics
-IV fluids
-feeding
Total Parenteral Nutrition (TPN) -practice of feeding a person intravenously, bypassing the
usual process of eating and digestion
-person receives nutritional formula of salts, glucose, amino acids, lipids, added vitamins
Central venous catheter/central line catheter in large vein in neck, chest or groin via internal
jugular vein, subclavian vein, and/or femoral vein
When would you use a central venous catheter/central line? -pt needs frequent or intensive
cardiovascular monitoring
-drugs that would be irritating to peripheral circulation (chemo)
-assessment of fluid status
-blood draws
-increased viability of IV drugs/fluids
Port a Cath -type of central line
-septum thru which drugs can be injected or samples can be drawn
Which pts will likely have a port a cath? -hematology
-oncology
-renal dialysis
Advantages of port a cath -don't need to find vein every time you receive chemo
-might help women who have some swelling in the arm on the side of surgery
-meds go right into main blood supply to be sent quickly and efficiently to all parts of the body
-avoids discomfort
-decreased times you need a vein stick for blood draw
Pneumatic stockings -inflatable garment usually used on calf or foot
-maintains pulsatile flow in the deep veins of the LEs
-inflated/deflated intermittently and cyclically
What do pneumatic stockings do? helps prevent clot formation in the presence of lack of
movement
,Locations of a PEG tube and why -nasal passageway for short term use
-through abdominal wall directly into stomach for long term use
How to place a PEG tube with aid of endoscope, scope goes down throat to assist in placing
in the wall of the stomach
Where is the PEG tube located? interior of stomach to outside the body through a small
incision a little bigger than the tube itself in the abdominal wall
How do you prevent a PEG tube from coming out? -small wire inside the tube that when it is
placed, you pull the wire from the exterior causing the portion in the stomach to pig tail to
prevent being pulled out
-small balloon at the end of the tube which is inflated in the stomach after insertion
Indications for a PEG tube -difficulty swallowing
-aspiration pneumonia
-neurological deficits
-esophageal atresia
Where is a G tube inserted? stomach
Where is a J tube inserted? jejunum
NG tube -passed thru nose into stomach
-removes contents of the stomach, including air, to decompress the stomach (small bowel
obstruction, intractable vomiting)
-can serve to remove small solid objects and fluid (ex. poison)
Dobhoff tube -nasoenteric tube placed through nose
-gives fluids, food, medicine to people who can't take them by mouth on a temporary basis
When do you see a Dobhoff tube? short term feeding - usually only for a few weeks
Chest tube - how is it placed and why -places hollow plastic tube between ribs and into
chest
-drains fluid (pleural effusion, blood, chyle), pus (empyema), or air (pneumothorax) from around
the lungs
-often hooked up to suction machine to help with drainage
-usually for a few days
Procedure for placing a chest tube -chest tube thoracostomy
-local anesthesia used
Indications for a chest tube -trauma
-cancer
-infection
-comfort
, Jackson Pratt "JP" drain -post surgical drain
-uses constant suction to pull excess fluid from the body
-removing the plug and squeezing the bulb removes the air, creating a lower air pressure within
the drainage tubing
Hemovac drain -drains blood and fluid from surgical sites
-promotes healing by decreasing drainage around the wound
What should you NOT do over a hemovac drain? do not place a brace on a pt over the
hemovac drain
Lumbar drain -drains fluid surrounding the brain and spinal cord
What are lumbar drains used for? -CSF leaks from nose, ear, or incision site, or around the
brain
-shunt infections
-reducing pressure during craniotomy
-diagnostic aid for NPH
Precautions for lumbar drains -pt should be informed that they need to let nursing staff if they are
to get up or change position so the drain can be properly clamped or re-leveled
-pt should be instructed on purpose of the drain and role of PT
Epidural catheter form of anesthesia where medication is placed directly into the epidural
space
What can result from an epidural catheter? can cause loss of sensation and pain, but typically
doesn't affect motor function
Foley catheter thin sterile tube placed into bladder to drain urine
Texas catheter allows for urinary catheterization in male pts without the use of an internal tube
Colostomy -connects part of colon onto anterior abdominal wall, leaving an opening in the
abdomen called a stoma
-drawn out through incision and sutured to the skin
-feces leave pt body through the stoma
Yankauer hand held suction unit that assists with secretion clearance
Multipodus boot - who is it for? unconscious or immobile acute care pts
Multipodus boot - purpose -places foot and ankle in neutral to prevent contractures
-provides heel and toe clearance for pressure relief and a rotator bar to control hip and leg
rotation in supine
