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Adonis K. Lomibao 12/3/11. Special Advanced Procedures Unit 51. Objective. Have a basic understanding of special procedures and their indications. Identify proper steps in performing procedures. Introduction. Scope and type of assignments given to PCT are influenced by:
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Adonis K. Lomibao 12/3/11 Special Advanced Procedures Unit 51
Objective • Have a basic understanding of special procedures and their indications. • Identify proper steps in performing procedures.
Introduction • Scope and type of assignments given to PCT are influenced by: -Basic operation & experience -advanced training in procedural skills -Facility policy -State laws that specify range of practice
Collecting a Specimen from Closed Urinary Drainage System • Keep in mind urine must be fresh. • Specimen may not be taken from bag. • Procedure to follow depends on kind of foley in place.(p. 908) • Proper technique to avoid introducing infectious organisms into system.
Removing an Indwelling Catheter • May be removed to reduce risk of infection, if obstructed, or for routine change. • Monitor voiding if new catheter isn't inserted by nurse. • Notify nurse if pt. Hasn't voided in 4-6 hours, or complaints of abdominal pain. • Procedure on p.910
Ostomies • Ostomy-artificial opening in abdomen for elimination of solid waste and flatus. • Colostomy-colon brought to abdominal wall • Stoma-the mouth of the opening. • Appliance- disposable drainage pouch for stoma. • Problems at stoma site may include, leakage, odor control, and irritation of area.
Ostomies Cont. • Assist pt. With colostomy by: -Keep area clean and dry. -perform routine stoma care. • Initial irrigation done by nurse. • If colostomy to be permanent, patients taught to irrigate themselves.
Care of Patient with Ileostomy • Permanent artificial opening in the ileum draining through a stoma. • Liquid form and contains irritating dig. Enzyme • Considerations for care: -Nurse does care for a NEW ileostomy -Routine care given by PCT's -Drainage is irritating to skin -Fit ring so leakage does not occur
Sterile Technique • Nursing procedures using sterile technique include: -Invasive procedures -Procedure that breaks skin -Procedures that enter body cavity -Changing surgical dressings -Central IVC Dressing changes -Procedures involving severe destruction of the skin
Sterile Technique-Environmental Conditions • Environmental conditions: -Clean, dry, flat, stable surface -No airborne contamination -Instruct pt. To avoid touching field & talking, coughing or sneezing over sterile field.
Setting up Field • 1-inch border is NOT sterile • Only top area of surface is sterile. • Sterile supplies can only touch sterile field. • Sterile Gloves-allows you to touch sterile items • Transfer forceps- used to add supplies to sterile field.
Intro to Advanced Airway Management • Advanced airways treat hypoxemia. • Advanced health care providers, nurses, and RCP's manage airways and ventilation devices. • PCT's need to identify the airways and ventilation devices and understand basic care. • PCT's need to identify a patient who is in distress.
Oropharyngeal Airway • Curved plastic device inserted in mouth to pharynx. • Prevents tongue from obstructing airway. • Keeps airway open in unconscious patients. • PCT Care: Standard Precautions!, do not stop pt. From pulling out,Check respirations, keep airway open!
Nasopharyngeal Airway • Soft rubber device inserted through nostril. • May be used in responsive patients. • Used for those with recent oral surgery, loose teeth, mouth trauma, and those in need of frequent suctioning. • Contraindicated for those with anticoagulant meds, nasal deformities, bleeding disorders, or sepsis.
Endotracheal Intubation • Complete airway control! • Passed through mouth or nose to patient's lungs. • Used for ventilation and suctioning. • Used in surgery and CPR situations. • Only nurse, RCP, or physician can care for ET tube.
Endotracheal Intubation • Care for pt. With ET Tube: -Patient can't sleep. -Being mechanically ventilated. • Ventilator-mechanical device that forces air into the patient's lungs. • Pt may be restrained--> total nursing care i.e. turning, repositioning, restraint care. • Standard precautions & aseptic technique! • Bag-Valve Mask- manual ventilation for pt.
Suction • Used to remove fluid, food, and secretions from pt.'s nose, mouth, and airway to reduce risk of aspiration. • Can use a flexible plastic suction catheter, or a rigid plastic suction (Yankauer catheter)(For Oral). • Sterile procedure done by the nurse, RCP, or advanced provider.
