Medically Complex Exam 1 Questions and Answers Graded A 2024

What are the 3 goals of critical care? - 1. Preservation of life 2. Reduction of complications for overall morbidity 3. Restoration of function What are the 3 goals of rehab services in acute management? - 1. Prevention of secondary complications 2. Restoration of function 3. Reduction in LOS (length of stay) What is the difference between enteral and parenteral feeding? - - Enteral: within, or by way of, the intestine or GI tract (think en = in = INtestine) - Parenteral: by other means (IV, sub q, intramuscular or intramedullary injections) What is a nasogastric tube (NG tube)? - - AKA Dobhoff tube - Nose to stomach in patients who have gag reflex - Come out easily; usually short term and only in hospital (may be attached to wall suction) What is a gastrostomy tube (G tube)? PEG tube? - - Surgically placed in stomach or duodenum for swallowing dysfunction - Short term; stitched in place - PEG tube = percutaneous What is a Jejunostomy tube (J tube)? - - Surgically placed in jejunum for impaired gastric emptying - Usually longer term needs - Skin excoriation because of gastric fluid leakage How long before you begin intervention should enteral feedings be turned off? Why? What else can you do to further prevent injury to the patient? - - 30 minutes before to prevent aspiration - HOB (head of bed) lifted 30° to also prevent aspiration What is the main risk when using drains (such as a rectal or urinary catheter)? - INFECTION What is a Jackson-Pratt or Hemovac drain? - - Incisional drain located in the surgical incision to facilitate drainage of blood and edema - Attached to a vacuum or collection system What is a Penrose drain? - - Incisional drain into bandages - Relies on gravity What are the indications for tracheal tubes? In the short term what kind of tracheal tube should be used? - - Upper airway obstruction present - Easier, safer suctioning - Facilitates mechanical ventilation - Short term = Endotracheal What are the 2 types of tracheostomy tubes? - - Fenestrated: has holes = allows exhaled air to pass over your vocal cords so you can speak - Non-fenestrated: no holes = unable to speak What is the name of the procedure that is used to place chest tubes? What is the goal of these? - Thoracotomy: placed in the pleural or mediastinal cavity to remove excess fluid, blood, or air in order to restore normal negative intrapleural pressure Where would a chest tube be placed to remove air? To remove fluid? How is the position confirmed? - - Air: 2nd, 3rd, 4th intercostal space - Fluid: 6th, 7th, 8th intercostal space - Position confirmed radiographically and sutured in place THINK: air is lighter = would be up higher If a CT scan reveals that your patient's chest tube is on water seal what does that mean for PT? What if they are on wall suction? - - On water: can mobilize - On wall: do NOT disconnect What are some complications that may arise from having a chest tube placed? - - Pain, bleeding, atelectasis (lung collapse), subcutaneous emphysema, tracheal or mediastinal shift