Question

Procedure 6 : Tracheostomy Care

Procedure 7 : Pain Assessment

Procedure 8 : 12 Lead ECG recording

Procedure 9 : Chest drains/ underwater seal drainage

Procedure 10 : Assess and respond to acute deterioration in a patient

Procedure 11 : Care of the unconscious client

Procedure 12 : Nasogastric tube insertion and feeding, gastric drainage and gastric tube feeding

Procedure 13 : Intravenous therapy management

Procedure 14 : Central Venous Catheter (CVC) line/ Peripherally Inserted Central Catheter (PICC) management

Procedure 15 : Emergency management of shock

Procedure 16 : Prepare and check emergency equipment

Procedure 17 : Emergency management of Myocardial Infarction

Answer 1

1. Tracheostomy care?

*Gather the supplies.

* wash your hands

* put on clean pair of gloves

* make cleaning solutions

* change inner cannula

* insert clean inner cannula

* clean trach area.

* change teach ties

* change drain sponge

* clean dirty inner canula

* store clean inner cannula

* throw out used supplies.

* clean containers.

* remove gloves and wash hands

2 pain assessment;

* onset mechanisms of injury or etiology of pain if identifiable.

* location and distribution

* duration

* course or temporal pattern.

* character and quality of the pain

* aggravating / provoking factors.

* alleviating factors.

* associated symptoms.

3. 12 lead ECG recording;

V1: 4 the intercostal space at the right sternal edge

V2: 4 the intercoastal space at the left sternal edge

V3: midway between the V2 and V4 electrodes.

V4 : 5 the intercoastal space in the midclavicular line.

V5: left anterior axillary line at the same horizontal levels as V4.

V6: left mid axillary line at the same horizontal level as V4 and V5.

First you have to check the expiry date of electrodes to ensure they are within date. It is important to ensure each electrode has good skin contact, which many involve cleaning or shaving the areas where you need to place electrodes.

1 turn the ECG machine on and ensure ECG paper has been loaded into the machine.

2. Double check all the electrodes are attached in the appropriate locations.

3. Politely ask the patient to remain still and not talk during the recording as muscle activity can interfere with the ECG trace.

4. Press the appropriate button on the ECG machine to record the ECG trace. If the ECG trace is poor , double check the connections to ensure there is good skin contact.

4. Chest drains / underwater seal drainage

Perform hand hygiene.

Use personal protective equipment

Using an aseptic technique, remove the unit from packaging and place adjacent to old chamber

Prepare the new UWSD as per manufacturer direction supplied with drain.

Ensure park drain is clamped to prevent air being sucked back into chest.

Disconnected old chamber

Insert the tubing into the new chamber until you hear it click

Unclamped the chest pain

Check drains is back on suction

Place old chamber into yellow infectious waste bag and tie

Perform hand hygiene

5. Assess and respond to acute deterioration in a patient.

1. Breathing,

Look - observe the rate , rhythm and depth of the patient respiration over a period of one minute.

Lisyern- listern patient breathing

Feel- palpate the patient chest.

Other clues that your patient may be deteriorating include changes in pulse quality ,slow or delayed capillary refill abnormal swelling or edema, dizziness, syncope,nausea, chest pain,and diaphoresis.

* collecting additional information , 2 positioning the patient appropriately.

Getting help,2 talking the blood pressure heart rate and oxygen saturation

Recording vital sign

Getting help.

6. Care of the unconscious patient

Check the person airway, breathing , and circulation.

If you do not think there is a spinal injury, put the person in the recovery position.position the person lying face up . turn the persons face towards you .

Keep the person warm untill emergency medical help arrives.

7. Nasogastric tube insertion and feeding gastric drainage and gastric tube feeding.

Avoid the feed orally

Remove excess oral secretions with suction to avoid aspiration.consider the use of an oral or nasopharyngeal airway, to maintain patency. of the airway and aid removal of secreation.. Monitor and record respiratory function including oxigen saturation, respiratory rate, depth and regularity.

Lubricate the tip of the NG tube.

Gently insert the NG tube in to the nostrils

Advance the NG tube to the desired length.

Inspect patient mouth for evidence of coilling

Secure the NG tube.

Feeding;

Wash your hands

Measure the correct amount of formula and warm it to the desired temperature.

Check tube placement

Clamp the tube

Attach syringe to feeding tube.

Pour the formula into the syringe

Unclamp the tube.

Drainage g tube

Flush g tube once a day

Flush g tube 30 to 60 ml of water

Empty the drainage bag

Wash your hands

Palce the paper towel under the tube

Draw up 30 to 60 ml of water.

Clamp your g tube.

Disconnected your g tube from drainage bag and set the drainage bag to the side.

Insert the syringe into the opening to g tube

Clamp your g tube.

Remove syringe

And reconnect your g tube to the drainage bag

Unclamp your g tube and allow to drain.

8 intravenous therapy

IVs therapy delivers fluids directly into the vein. The intravenous route of administration can be used both for injections, using a syringe at higher pressures as well as for infusion, typically using only the pressure supplied by gravity.

Numbling medicine is injected into the skin to minimize pain , to place the pICC line , a needle is inserted through your skin and into the vein in your arm .ultrasound or an x- ray might be used to confirm the placement. Small incision is made in the vein so that thin, hollow tube (catheter) can be inserted.

9 .emergency management of shock.

Lay the person down, if possible. Elevate the persons feet about 12 inches unless head , neck, or back is injured or you suspect broken hip or leg bones.

Begin CPR , if necessary . if persons is not breathing or breathing seems dangerously week.

Treat obvious injuries

Keep person warm and comfortable.

Follow up.

10. Prepare and check emergency equipment.

Equipment are include a needle holder, forceps, sterile towels, scissors, small bowels , antiseptic solutions, orthopedic equipment,- most emergency room have a generous number of orthopedic devices.

11. Myocardial infarction; although the immediate priority in managing acute myocardial infarction is thrombolysis and reperfusion of the myocardium , a variety of other drug therapies such as heparin, B- adrenoceptor blockers, magnesium and insulin might also be considerd in the early hours.