Chest Tube and Parenteral Nutrition Quiz
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Questions and Answers

What should be done if the chest tube disconnects from the drainage unit?

  • Instruct the patient to exhale and cough, then immerse the open end in sterile saline. (correct)
  • Clamp the chest tube to prevent air entering.
  • Replace the drainage unit without patient intervention.
  • Notify the healthcare provider immediately.

What is the expected color of drainage from a chest tube within the first three hours post-operatively?

  • Clear and serous.
  • Dark brown.
  • Cloudy and opaque.
  • Bright red. (correct)

How often should the color, amount, and consistency of drainage be assessed post insertion?

  • Every hour for the first 3 hours.
  • Every 15 minutes for the first 2 hours. (correct)
  • Every 30 minutes for the first 6 hours.
  • Every 2 hours after the first assessment.

What is the proper position for a chest drainage unit in relation to the patient's chest?

<p>Upright and below the patient's chest. (A)</p> Signup and view all the answers

What should not be done with a chest tube to prevent complications?

<p>Routine clamping. (B)</p> Signup and view all the answers

What is the most critical reason for using Total Parenteral Nutrition (TPN)?

<p>Patients need to rest their bowel. (B)</p> Signup and view all the answers

Which of the following is NOT a necessary step when administering TPN through a central line?

<p>Change the bag every 48 hours. (A)</p> Signup and view all the answers

What should be done if a 3-in-1 TPN bag shows oil droplets or a creamy layer?

<p>Return the bag to the pharmacy. (B)</p> Signup and view all the answers

For patients receiving Peripheral Parenteral Nutrition (PPN), what is the maximum duration for which it should be administered?

<p>2 weeks (A)</p> Signup and view all the answers

What is the main concern when using TPN regarding potential complications?

<p>High risk of infections. (C)</p> Signup and view all the answers

What is a benefit of brushing teeth at least twice a day?

<p>It helps remove plaque and bacteria. (A)</p> Signup and view all the answers

Which type of exercises involves muscle contraction without shortening?

<p>Isometric exercises (B)</p> Signup and view all the answers

Why should lemon-glycerin sponges be avoided in oral care?

<p>They may irritate the oral mucosa. (A)</p> Signup and view all the answers

What type of exercise significantly improves muscle mass and joint mobility?

<p>Isotonic exercises (B)</p> Signup and view all the answers

What precaution should be taken for unconscious patients regarding oral care?

<p>Turn them on their side to prevent aspiration. (A)</p> Signup and view all the answers

Which oral care product is recommended for critically ill patients to reduce pneumonia risk?

<p>Chlorhexidine gluconate oral spray (A)</p> Signup and view all the answers

Which of the following describes the principle of ergonomics to prevent injury while lifting?

<p>Face the direction of movement and lower your center of gravity. (A)</p> Signup and view all the answers

Flossing helps to address which dental concern?

<p>Tartar removal at the gum line. (B)</p> Signup and view all the answers

What is the primary goal in managing Respiratory Alkalosis?

<p>Raise carbon dioxide levels (D)</p> Signup and view all the answers

What pH value indicates Metabolic Acidosis?

<p>7.35 or lower (C)</p> Signup and view all the answers

Which of the following symptoms is commonly associated with Respiratory Alkalosis?

<p>Tetany (B)</p> Signup and view all the answers

In cases of Metabolic Acidosis, which nursing intervention is crucial?

<p>Administer insulin for DKA (D)</p> Signup and view all the answers

What would be an expected bicarbonate level in metabolic acidosis?

<p>&lt; 22 mEq/L (B)</p> Signup and view all the answers

Which condition can lead to Respiratory Alkalosis due to hyperventilation?

<p>Sepsis (A)</p> Signup and view all the answers

What physiological response is seen in the kidneys during respiratory alkalosis?

<p>Retaining hydrogen and excreting bicarbonate (D)</p> Signup and view all the answers

Which of the following assessments would likely indicate severe metabolic acidosis?

<p>Coma or lethargy (A)</p> Signup and view all the answers

What type of ostomy involves the creation of a stoma in the ileum?

<p>Ileostomy (A)</p> Signup and view all the answers

Which type of ostomy is typically most solid in stool consistency?

<p>Descending colostomy (D)</p> Signup and view all the answers

Which of the following points is not included in the informed consent process?

<p>Names of all surgical team members (D)</p> Signup and view all the answers

Who can administer sedation before the signing of an informed consent form?

<p>No one should administer sedation (A)</p> Signup and view all the answers

A patient must have the right to refuse treatment unless which condition is met?

<p>A court has legally determined incompetency (C)</p> Signup and view all the answers

What is a key characteristic of faecal effluent from an ileostomy?

<p>Frequent and liquid to pasty (C)</p> Signup and view all the answers

Which of the following statements about informed consent is incorrect?

<p>Consent forms can be legal for unconscious patients. (D)</p> Signup and view all the answers

What bowel disorder can lead to the necessity of creating an ostomy?

<p>Inflammatory bowel disease (C)</p> Signup and view all the answers

What is the primary difference between medical and surgical asepsis?

<p>Medical asepsis reduces the spread of microorganisms. (D)</p> Signup and view all the answers

In which order should personal protective equipment (PPE) be donned?

<p>Gown, mask, goggles, gloves (A)</p> Signup and view all the answers

Which of the following is a key principle of surgical asepsis?

<p>Only sterile objects may touch a sterile field. (C)</p> Signup and view all the answers

What does a red color classification in wound evaluation indicate?

<p>The area is healthy with granulation tissue. (A)</p> Signup and view all the answers

What is the appropriate action for yellow-colored slough in wound care?

<p>Cleanse the area and monitor for infection. (C)</p> Signup and view all the answers

In primary intention healing, what is characteristic of the wound?

<p>Wound edges are well approximated with minimal scarring. (D)</p> Signup and view all the answers

Which moment of hand hygiene should occur after touching patient surroundings?

<p>Moment 5 (C)</p> Signup and view all the answers

What does 'B' in the RYB classification of wounds stand for?

<p>Black eschar requires debridement (A)</p> Signup and view all the answers

Flashcards

Bubbling in suction control chamber

Gentle bubbling in the suction control chamber of the chest tube drainage system indicates proper functioning of the wall suction.

Drainage tubing kinking

Avoid kinking or loops in the drainage tubing to prevent obstruction and ensure proper drainage.

Chest tube drainage assessment

Monitor chest tube drainage color, amount, and consistency regularly to assess for complications.

Reporting chest tube drainage changes

Notify the healthcare provider immediately if there is a sudden or unexpected change in chest tube drainage.

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Chest drainage unit positioning

Keep the chest drainage unit upright and below the level of the patient's chest to ensure proper drainage.

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Total Parenteral Nutrition (TPN)

A solution containing high concentrations of nutrients provided through a central vein.

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Peripheral Parenteral Nutrition (PPN)

A solution with lower nutrient concentration, infused through a peripheral vein.

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Administering Parenteral Nutrition

The process of administering TPN or PPN, always using sterile technique and a pump.

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Medications and Parenteral Nutrition

Never add medications directly to a parenteral nutrition solution.

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Checking for Oil Droplets in TPN

If a parenteral nutrition solution has an oily or creamy layer, it should be discarded.

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Sterile to sterile contact

A sterile object remains sterile when touched by another sterile object.

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Sterile field placement

Only sterile objects can be placed on a sterile field.

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Out of sight, out of mind (sterile)

A sterile object or field out of sight or below the waist is contaminated.

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Air contamination

Prolonged exposure to air contaminates a sterile object or field.

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Wet contamination

A sterile object or field becomes contaminated when it touches a wet, contaminated surface, due to capillary action.

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Red wound tissue

Red granulation tissue indicates healthy wound healing.

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Yellow wound tissue

Yellow slough needs cleansing to promote wound healing.

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Black wound tissue

Black eschar requires debridement to facilitate wound healing.

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Oral Hygiene: Brushing

Brushing teeth at least twice a day removes food particles, plaque, and bacteria, massages gums, and helps prevent bad breath.

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Oral Hygiene: Flossing

Flossing removes plaque and bacteria from between teeth where brushing can't reach, preventing gum disease.

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Oral Hygiene: Rinsing

Rinsing removes any leftover food particles and toothpaste, helping to keep your mouth clean and fresh.

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Isotonic Exercise

Isotonic exercises involve muscle contraction with active movement, like walking or swimming. They help increase muscle mass, strength, and cardiovascular function.

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Isometric Exercise

Isometric exercises involve muscle contraction without movement, like holding a plank. They help improve muscle strength and endurance.

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Isokinetic Exercise

Isokinetic exercises involve muscle contraction with resistance applied at a constant rate, often using specialized equipment.

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Ergonomics for Injury Prevention

Maintaining a wide, stable base, using strong leg muscles, and avoiding twisting are key to preventing injuries during physical activity.

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Diabetes and Oral Health

People with diabetes are at increased risk for periodontal diseases, which can affect their overall health.

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Respiratory Alkalosis

A condition where the lungs lose too much carbon dioxide, leading to a higher than normal pH.

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Hypocapnia

A decrease in PaCO2 (partial pressure of carbon dioxide) in arterial blood, usually below 35 mmHg, due to hyperventilation.

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Kussmaul breathing

Fast, deep respirations often seen in metabolic acidosis, aiming to expel CO2 and compensate for the acidic state.

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Metabolic Acidosis

A condition where the kidneys cannot eliminate excess hydrogen ions, leading to a lower than normal pH.

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Base Deficit

A decrease in bicarbonate levels (HCO3-) in the blood, usually below 22 mEq/L, indicating a lower buffering capacity against acid.

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Excess Acids

A state where the body experiences an excess of acids other than carbon dioxide, leading to a lower pH.

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Hyperkalemia

A condition where the blood has a high potassium level, usually above 5.0 mEq/L, often associated with metabolic acidosis.

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Dialysis

The process of removing waste products from the blood using a machine, often used to treat patients with kidney failure and metabolic acidosis.

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What is a stoma?

An artificial opening in the abdominal wall, created for the elimination of waste products from the body, typically in cases of bowel disorders.

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What is an ileostomy?

A stoma created in the ileum, the last part of the small intestine.

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What is a colostomy?

A stoma created in the colon, the large intestine.

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How does the location of a stoma impact the effluent?

The location of the stoma determines the consistency of the stool output. Ileostomy output is frequent and liquid to pasty, while colostomy output varies depending on the location of the stoma.

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What is reconstructive bowel surgery for a stoma?

A surgical procedure to create a continent pouch, allowing for control of bowel movements with an external opening.

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What is informed consent in the context of stoma surgery?

The patient must be informed of the procedure, alternatives, risks, and expected outcome before giving consent.

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What is the role of the nurse in informed consent for stoma surgery?

The nurse witnesses the patient's signing of the consent form, ensuring the patient understood the surgeon's explanation.

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Under what circumstances is informed consent not valid?

Consent is not valid if the patient is confused, unconscious, sedated, mentally incompetent, or a minor.

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Study Notes

Lab Values

  • Sodium: 136-145 mEq/L (values based on shared email)
  • Calcium: 9-10.5 mg/dL (values based on shared email)
  • BUN: 8-20 mg/dL
  • Magnesium: 1.5-2.4 mEq/L
  • Hematocrit: 36-51%

Hypocalcemia

  • Chvostek and Trousseau signs
  • Muscle cramps
  • Laryngospasm

Hyperkalemia

  • Peak/tall T wave, widened QRS

Important Information from Lab Tests

  • BUN: reveals kidney function
  • Liver produces urea as a waste product
  • Magnesium levels: 1.5 - 2.4

Dehydration

  • Hypernatremia is seen in dehydration
  • Three parameters: (from page 69)
  • ABG and Acid-Base Balance
  • Inverse relationship between calcium and phosphorus

Pain Management

  • PCA (patient-controlled analgesia)
  • Types of masks for oxygen such as non-rebreather
  • Non-rebreather percentage: 90-100%
  • Considerations for bag (non-rebreather): partially inflated, never deflated; O2 saturation should increase; rubberized flap

Critical Thinking/Clinical Reasoning

  • Includes interpretation, analysis, evaluation, inference, and explanation
  • Leads to clinical judgments.
  • Active and orderly reasoning, applies knowledge and experience
  • Problem-solving, logic, reasoning, and decision-making

Patient Safety

  • Neonates/infants: crib rails/monitor constantly, car seat (all 50 states)
  • Toddlers & preschoolers: safety hazards
  • School-aged children: safety during activities
  • Adolescents: issues such as drunk driving
  • Adults: lifestyle habits, violence, medication concerns
  • Older adults: falls, accidents, cognitive changes.
  • Environment: impaired mobility, impaired senses, awareness

ABCs (Airway, Breathing, Circulation)

  • Physiologic needs - Maslow's hierarchy

Infection Control/Asepsis

  • Medical Asepsis: reducing pathogen numbers/transfer; used consistently in and outside health facilities
  • Surgical Asepsis: sterile techniques; procedures to maintain sterility (e.g., IV, catheter insertion)

Transmission Based Precautions

  • Blood, body fluids, secretions, excretions (except sweat, non-intact skin, and mucous membranes)- use universal precautions
  • Hand hygiene - alcohol-based waterless products (recommended/visibly soiled or contaminated)
  • Hand wash with soap and water if contamination with spores is suspected
  • Use soap and water for visibly soiled or contaminated with body fluids

Patient Centered Care

  • Maslow's hierarchy-needs (Physiological; Safety; Belongingness and Love; Esteem; Self-actualization)

Restraints

  • Use only as a last resort.
  • Must be reviewed/approved by physician.
  • Appropriate documentation is required (Include reason, behavior prior to use, and alternatives attempted)

Preventing Falls/Safety

  • Establish a clear strategy to address call lights and alarms
  • Ensure clear pathways, minimize clutter, use nightlights.
  • Keep patient within arms reach
  • Use proper assistive devices and safety features
  • Monitor patients closely and ensure adequate staffing
  • Avoid diuretics at night; Educate patient on proper use of call system

Delegation

  • RN responsible for outcome.
  • RN must assess if the task is transferable.
  • UAP should not perform an independent task; or tasks related to patient assessment or clinical judgment.

Patient Monitoring

  • Signs of injury related to restraints or seclusion
  • Nutrition and hydration
  • Circulation
  • Vital signs
  • Elimination (urine/bowel)
  • Hygiene, and comfort
  • Physical and psychological state
  • Discharge readiness

Restraint Standards

  • Clinical justification for restraint use.
  • Must be time dated.
  • Include type of restraint, reason, intended duration, criteria for removal by the physician.

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Fundamentals Final Exam Review Fall 2022 PDF

Description

This quiz covers essential knowledge regarding chest tubes and total parenteral nutrition (TPN). Questions include management of chest tube complications, drainage assessment, and key protocols for TPN administration. Test your understanding of these critical medical concepts.

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