Tiêu đề NCM 112 RLE MIDTERMS ✅

RD PRS Wound Care: Chest Tube Thoracostomy Study... Chest Tube Thoracostomy: Wound Care Study Guide.pdf Thoracentesis from Clinical Key: Thoracentesis - ClinicalKey for N... WEEK 3 - BASIC NURSING PROCEDURES 12 leading ECG.mp4 - transcript on the table PRS Coronary heart disease remains a leading cause of mortality worldwide. Prompt recognition and treatment of acute coronary syndromes, such as ST-segment elevation myocardial infarction (STEMI) and non-STEMI acute coronary syndrome, can reduce and prevent cardiac arrest. Electrocardiography, one of the most valuable and frequently used diagnostic tools, displays the heart's electrical activity as waveforms. Impulses moving through the heart's conduction system create electrical currents that can be monitored on the body's surface. Electrodes attached to a patient's skin can detect these electrical currents and transmit them to an instrument that produces a record of cardiac activity, known as an electrocardiogram (ECG). An ECG can be used to identify myocardial ischemia and infarction, rhythm and conduction disturbances, chamber enlargement, electrolyte imbalances, and drug toxicity. A standard 12-lead ECG uses a series of electrodes placed on the extremities and chest wall to assess a patient's heart from 12 different views (leads). The 12 leads consist of: - 3 standard bipolar limb leads (designated I, II, III) - 3 unipolar augmented limb leads (aVR, aVL, aVF); - 6 unipolar precordial leads (V1 to V6). The limb leads and augmented leads show the heart from the frontal plane. The precordial leads show the heart from the horizontal plane. UNDERSTANDING ECG LEADS Each of the leads on a 12-lead ECG views the heart from a different angle. These illustrations show the direction of electrical activity (depolarization) monitored by each lead and the 12 views of the heart. Views reflected on a 12- lead ECG Lead View of the heart Standard limb leads (bipolar) I Lateral wall II Inferior wall III Inferior wall Augmented limb leads (unipolar) aVR No specific view aVL Lateral wall aVF Inferior walll Precordial or chest leads (unipolar) V1 Septal wall V2 Septal wall V3 Anterior wall V4 Anterior wall V5 Lateral wall V6 Lateral wall ECG machine measures and averages the differences among the electrical potential of the electrode sites for each lead and graphs them over time. This process creates the standard ECG complex, made up of P-QRS-T. - P wave represents atrial depolarization; - QRS complex, ventricular depolarization; - T wave, ventricular repolarization. REVIEWING ECG WAVEFORMS AND COMPONENTS An ECG waveform has three basic components: the P wave, QRS complex, and T wave. These elements can be further divided into the PR interval, J point, ST segment, U wave, QT interval. P wave and PR interval The P wave represents atrial depolarization. The PR interval represents the time it takes an impulse to travel from the atria through atrioventricular nodes and the bundle of His. The PR interval is measured from beginning of the P wave to the beginning of the QRS complex. QRS complex QRS complex represents ventricular depolarization (the time it takes for the impulse to travel through the bundle branches to the Purkinje fibers). The Q wave, when present, appears as the first negative deflection in the QRS complex; R wave appears as the first positive deflection. The S wave appears as the second negative deflection or first negative deflection after the R wave. J point and ST segment Marking the end of the QRS complex, the J point also indicates the beginning of the ST segment. The ST segment represents part of ventricular repolarization T wave and U wave The T wave usually follows the same deflection pattern as the O wave and represents ventricular repolarization. The U wave follows the T wave but isn't always seen; it is seen most frequently during bradycardia in leads V2 and V3. QT interval The QT interval represents ventricular depolarization and repolarization. It extends from the beginning of the QRS complex to the end of the T wave.


RD PRS Preparation of Equipment Inspect all equipment and supplies; if a product is expired, its integrity is compromised, or it’s defective, remove it from patient use, label it as expired or defective, and report the expiration or defect as directed by your facility. Implementation ● Verify the practitioner's order. ● Assess patient to make sure that an indwelling urinary catheter is indicated; assess for alternatives to indwelling urinary catheter use. If needed, use bladder ultrasonography to measure the volume of urine in the patient's bladder to avoid unnecessary catheterization. ● Check medical record for allergies (latex and iodine) ● Gather necessary equipment. Use the smallest-bore catheter possible that will support adequate urine drainage (unless otherwise clinically indicated) to minimize bladder neck and urethral trauma. ● Obtain assistance of a coworker, as needed, to help with patient positioning and ensure sterile technique ● Ensure adequate lighting. ● Use insertion checklist to guide the insertion process. ● Perform hand hygiene. ● Confirm patient's identity using at least 2 identifiers. ● Provide privacy. ● Explain procedure to increase their understanding, allay their fears, and enhance cooperation. Inform them of the reason for catheterization and what to expect in terms of discomfort. Discuss the risks associated with indwelling urinary catheter use and necessary measures to reduce risk of CAUTI. Advise patient and her family to remind staff to perform hand hygiene before and after handling catheter, if not done. ● Raise patient's bed to waist level before providing care to prevent caregiver back strain. ● Perform hand hygiene. ● Put on gloves and, as needed, other PPE to comply with standard precautions. ● Place patient in a supine or lithotomy position with her knees bent and legs abducted to allow visualization of urinary meatus. Alternatively, position the patient on her side in knee chest position if she's unable to tolerate supine or lithotomy positioning ● Place fluid impermeable pad on bed between patient's legs and under her hips to avoid soiling the Linens ● Open outer packaging of the pre-packaged insertion kit and place it between the patient's legs. ● Using sterile no-touch technique, open the insertion kit wrap. ● Put on sterile gloves, place a sterile underpad drape beneath the patient. ● Shield gloves by cuffing the drape material over your gloved hands to prevent contamination. ● Place sterile fenestrated drape over perineal area to create a sterile field, take care not to contaminate your sterile gloves ● Tear open packet of presaturated antiseptic swabs, or saturate sterile swabs or cotton balls with antiseptic solution, sterile water, or sterile saline as directed by your facility. Be careful not to spill the solution on the equipment. ● Open container of water-soluble lubricant and deposit the lubricant into the insertion kit tray. ● Open catheter and place it in the tray with lubricant. If drainage bag is not preconnected, attach it to other end of the catheter ● Attach syringe filled with sterile water to balloon inflation port, don't inflate the balloon before insertion unless directed by the manufacturer because doing so can cause micro tears which increases the risk of infection. ● Separate labia majora and labia minora as widely as possible with thumb middle and index fingers of your non-dominant hand so that you have a full view of the urinary meatus. ● Keep labia separated throughout the procedure. So that they don't obscure urinary meatus or contaminate area when it's cleaned. ● With dominant hand use antiseptic swab or using plastic forceps, pick up a cotton ball soaked with sterile antiseptic, sterile water, or sterile saline to clean labium minus farthest from you. ● Using downward stroke then discard the swab or cotton ball repeat for the labia minora closest to you. ● Use another antiseptic swab or solution soaked cotton ball to clean the area between the labia minora. ● Maintaining sterile technique, pick up catheter with your dominant hand and ensure that the catheter tip is lubricated with water-soluble lubricant. ● Hold catheter 2- 3" (5-7.6 cm) from the tip and slowly insert the lubricated catheter tip into the urinary meatus. Expect to be able to advance the catheter without meeting resistance. ● Continue to hold labia apart until urine begins to flow. Then advance catheter about 2" to 3" (5 to 7.6 cm) further to make sure that the balloon is in the bladder and not in the urethra. If urine doesn't begin to flow, ask your coworker to apply gentle pressure to the suprapubic region, which may initiate urine flow. If you inadvertently insert the catheter into the vagina, leave it there as a landmark and then begin the procedure over again using new supplies. ● Inflate balloon using the water filled syringe instilling recommended amount of sterile water specified on catheter to secure the catheter inside the bladder. ● Gently pull catheter until inflated balloon is snug against bladder neck, secure catheter to patient's thigh using a securement device or tape to prevent possible tension on the urogenital trigone. ● Keep catheter and drainage tube free from kinking and avoid dependent loops to prevent the obstruction of urinary flow. ● Position drainage bag below the level of patient's bladder to prevent backflow of urine into bladder which increases the risk of CAUTI. ● Don't place the drainage bag on the floor to reduce the risk of contamination and subsequent CAUTI ● Return bed to the lowest position to prevent falls and maintain patient safety. ● Discard used supplies in appropriate receptacles. ● Remove and discard gloves and other personal protective equipment, if worn. Perform hand hygiene. ● Document the procedure. Special Considerations ● Patients at high risk for latex hypersensitivity: spina bifida, spinal cord injury, atopy, certain food allergies, and occupational exposure. Provide a latex-free environment by avoiding all products containing latex proteins, including gloves, catheters, condoms, drains, and injection ports. ● Latex urethral catheters have been associated with an increased risk of cytotoxicity, urethritis, stricture, UTI, and encrustation. Selection of alternative material, such as 100% silicone, reduces these risks, particularly when long-term catheterization is likely. ● Empty the drainage bag at least once per shift using a separate, clean collection container for each patient. Avoid splashing and prevent contact of drainage spigot with the collection container. ● If you need a small urine sample for laboratory examination (for culture or urinalysis), thoroughly disinfect needleless sampling port with disinfectant pad and let it dry. Aspirate urine from sampling port using a sterile adapter or syringe. 3