Exit Study Guide:
Chest Tube:
● Must obtain informed consent before insertion
● Place pt in orthopneic position during insertion of chest tube, Benadryl can be
given for pre-procedure
● Obtain chest x-ray to confirm placement
● Place the chest tube collection below the level of the chest and keep the tubing
coiled and free of kinks.
● Chest tube suction should be set to -20
● Drainage to report: cloudy, red, or above 70mL per hour, monitor for s/sx of
infection.
● Document drainage findings Q8hrs
● Keep pt in semi-to-high Fowler's position to allow drainage
● Check on pt Q4hrs and cough and deep breath Q2hrs
● Tracheal deviation may occur from a tension pneumothorax s/sx: absence of
breath sounds, distended neck veins, asymmetry of the chest, and cyanosis.
Collection Chambers:
● Suction Control Chamber: Gentle, steady, or continuous bubbling is good. There
should not be violet or vigorous bubbling.
● Water Seal Chamber: Tidaling occurs during breathing which is good. There
should not be continuous bubbling in this chamber which could indicate an air
leak!
● Drainage Collection Chamber: Monitor drainage color and amount
● Air Leak Chamber: If bubbling may indicate an air leak.
Chest Tube Removal:
● Place an occlusive dressing x3 sides
● Keep two hemostats and a new chest tube at the bedside
● Instruct pt to exhale as much as possible to remove air from the pleural space and
bear down (Valsalva maneuver)
● Give analgesic 30 mins before
● Orthopedic position
THIS CONTENT IS COPYRIGHT OF ANGELINA HEREDIA, GWYNN ROTHHAMMER, AND LEILANI VELA OF UNITEK COLLEGE SJ8 CLASS
OF 2024. YOU MAY NOT DISTRIBUTE OR COMMERCIALLY EXPLOIT THE CONTENT NOR MAY YOU TRANSMIT IT OR STORE IT IN ANY
OTHER FORM OF ELECTRONIC RETRIEVAL
,IV Complications :
● Always stop the IV, however, do not remove the catheter in case the MD orders
diphenhydramine via IV
Phlebitis: heat, redness, tenderness, and streaking up along the vein, stop the infusion and
restart in the opposite extremity
Infiltration: pain, swelling, coolness, numbness no blood return, apply warm/cool
compress and elevate extremity
Extravasation: when fluid flows from the the vessel and flows into the surrounding area
causing swelling, painful blisters
Chart:
● The hospital owns the chart, pt must request their forms
● It must be a cover sheet if you are faxing over the chart
● Have a privacy screen
Priorities:
1. ABC
2. Bleeding
3. New Onset, ex: someone with a new onset of dyspnea takes priority over someone with
COPD with dyspnea
Hip Arthroplasty:
● Place pt supine with head slightly elevated and leg in a neutral position, place abduction
wedge between the client's legs when in bed/chair
● Avoid flexion beyond 90 degrees
● Neurovascular checks hourly for the first 24hrs then Q2-4hrs
● Get a raised toilet seat, grab bars, shower chairs, etc.
● Ambulate ASAP
● Do not turn pt to the operative side
● Do not cross your legs!!!
● Perform calf and leg exercises Q2hrs.
Knee Arthroplasty:
● Place pillow under lower calf and foot, NOT under the knee
● Apply ice within the first 24hrs
● Monitor neurovascular status Q 2-4hrs
THIS CONTENT IS COPYRIGHT OF ANGELINA HEREDIA, GWYNN ROTHHAMMER, AND LEILANI VELA OF UNITEK COLLEGE SJ8 CLASS
OF 2024. YOU MAY NOT DISTRIBUTE OR COMMERCIALLY EXPLOIT THE CONTENT NOR MAY YOU TRANSMIT IT OR STORE IT IN ANY
OTHER FORM OF ELECTRONIC RETRIEVAL
, ● Ambulate ASAP
● Wear elastic stockings
CPM Machine:
● Prescribed to promote motion in the knee, promote circulation, and prevent scar tissue
formation, provide passive ROM
● Pad areas with sheepskin
● Line up with the joints of the CPM machine with the pts operative knee, apply in the
extended position.
● Check the setting on device Q8hrs
● Place pt supine when applying the CPM device, following placement keep the HOB at 20
degrees
Transcribing Phone Orders:
● Repeat back to the provider
● Asking questions if anything is unclear
● Order must contain dosage, time, route, reason, and frequency
Car Seat Safety:
● Rear-facing until 2 years of age
● If put in the passenger seat, confirm the airbag is off
● 45-degree angle
● Shoulder harnesses are placed in the slots at or below the level of the infant's shoulder
● A retainer clip should be placed at the eel of the infant's armpits
Triage Color Tags:
● BLACK: expectant, not likely to survive to the extent of injuries
● IMMEDIATE: see first!! Ex: shock, pneumothorax
● DELAYED: see second, needs delayed attention, ex: open fractures
● MINOR: see last, non-urgent, ex: minimal fractures, anxiety
Immunizations:
Live vaccines: MMR, Varicella, Rotavirus, & IPV
● Contraindicated with pts taking immunosuppressants, pregnant pts, and pts dx w
HIV/AIDS
DTaP: Administer doses 2,4,6 at 15-18 months & 4-6 years.
THIS CONTENT IS COPYRIGHT OF ANGELINA HEREDIA, GWYNN ROTHHAMMER, AND LEILANI VELA OF UNITEK COLLEGE SJ8 CLASS
OF 2024. YOU MAY NOT DISTRIBUTE OR COMMERCIALLY EXPLOIT THE CONTENT NOR MAY YOU TRANSMIT IT OR STORE IT IN ANY
OTHER FORM OF ELECTRONIC RETRIEVAL
, HPV: Administered at 11-12 years can be given as early as 9, nor recommended after 26 yrs only
if the risks outweigh the benefits
Tdap: admin 1 dose at 11-12yrs, booster Q 10yrs, booster during pregnancy during 26-27 weeks
HIB: 4 doses at 2,4,6 and 12-15 months & 3 doses at 2,4 and 12-15 months
RV: RV-1 at 2 & 4 months & RV-5 at 2,4,6 months (max age 8 months)
IPV: 2,4 and 6-18 months then at 4-6 yrs
MMR: 12-15 months then 4-6 years, Pts ages 19-49 who lack documentation may need 1-2
doses, avoid in pts allergic to gelatin & neomycin
Varicella: 12-15 months and 4-6 years; catch up schedule 2 doses 4 weeks apart 13, avoid in pts
allergic to neomycin & gelatin
Pneumococcal: doses at 2,4,6 and 12-15 months, for adults 65 yrs and older who lack
immunization
HepA: 12-23 months & second dose after 6 months, doses should be spaced 6-12 months or 6-18
months apart
HepB: Given within 12-24 hrs after birth & additional doses at 1-2 months & 6-8 months, 3
doses to pts who lack completion of vaccine course, Wait 2 months between doses 1 & 2 and 2
months between doses 2 & 3
Influenza: One dose is given annually after 6 months of age, Live attenuated for ages 2-4yrs,
Recombinant influenza for ages 18+
Covid-19: For pts 50 years & older, mRNA vaccine, Viral vector vaccine
Meningococcal: Administered at 16 yrs, Administer to high-risk pts every 5 years (MenACWY),
Aged 16-23 & every 2-3 years for high-risk pts (MenB), Zoster: After age 50 a 2-dose series is
administered, Second dose administered 2-6 months after the first
Thrombocytopenia:
● Platelets below 150k
● Usually caused by chemo or radiation therapies
BLEEDING PRECAUTIONS!!
● Use a soft toothbrush and electric razor, do not blow or scratch your nose too
hard, do not bear down, avoid suppositories avoid injections, avoid antiplatelets,
guaiac stools, or emesis, avoid venipuncture
● Hold pressure to venipuncture sites for 3-10 mins or 15-20 mins following an
arterial stick
● S/Sx: petechiae, purpura, gingival bleeding, epistaxis, bruising, and bleeding
THIS CONTENT IS COPYRIGHT OF ANGELINA HEREDIA, GWYNN ROTHHAMMER, AND LEILANI VELA OF UNITEK COLLEGE SJ8 CLASS
OF 2024. YOU MAY NOT DISTRIBUTE OR COMMERCIALLY EXPLOIT THE CONTENT NOR MAY YOU TRANSMIT IT OR STORE IT IN ANY
OTHER FORM OF ELECTRONIC RETRIEVAL
Chest Tube:
● Must obtain informed consent before insertion
● Place pt in orthopneic position during insertion of chest tube, Benadryl can be
given for pre-procedure
● Obtain chest x-ray to confirm placement
● Place the chest tube collection below the level of the chest and keep the tubing
coiled and free of kinks.
● Chest tube suction should be set to -20
● Drainage to report: cloudy, red, or above 70mL per hour, monitor for s/sx of
infection.
● Document drainage findings Q8hrs
● Keep pt in semi-to-high Fowler's position to allow drainage
● Check on pt Q4hrs and cough and deep breath Q2hrs
● Tracheal deviation may occur from a tension pneumothorax s/sx: absence of
breath sounds, distended neck veins, asymmetry of the chest, and cyanosis.
Collection Chambers:
● Suction Control Chamber: Gentle, steady, or continuous bubbling is good. There
should not be violet or vigorous bubbling.
● Water Seal Chamber: Tidaling occurs during breathing which is good. There
should not be continuous bubbling in this chamber which could indicate an air
leak!
● Drainage Collection Chamber: Monitor drainage color and amount
● Air Leak Chamber: If bubbling may indicate an air leak.
Chest Tube Removal:
● Place an occlusive dressing x3 sides
● Keep two hemostats and a new chest tube at the bedside
● Instruct pt to exhale as much as possible to remove air from the pleural space and
bear down (Valsalva maneuver)
● Give analgesic 30 mins before
● Orthopedic position
THIS CONTENT IS COPYRIGHT OF ANGELINA HEREDIA, GWYNN ROTHHAMMER, AND LEILANI VELA OF UNITEK COLLEGE SJ8 CLASS
OF 2024. YOU MAY NOT DISTRIBUTE OR COMMERCIALLY EXPLOIT THE CONTENT NOR MAY YOU TRANSMIT IT OR STORE IT IN ANY
OTHER FORM OF ELECTRONIC RETRIEVAL
,IV Complications :
● Always stop the IV, however, do not remove the catheter in case the MD orders
diphenhydramine via IV
Phlebitis: heat, redness, tenderness, and streaking up along the vein, stop the infusion and
restart in the opposite extremity
Infiltration: pain, swelling, coolness, numbness no blood return, apply warm/cool
compress and elevate extremity
Extravasation: when fluid flows from the the vessel and flows into the surrounding area
causing swelling, painful blisters
Chart:
● The hospital owns the chart, pt must request their forms
● It must be a cover sheet if you are faxing over the chart
● Have a privacy screen
Priorities:
1. ABC
2. Bleeding
3. New Onset, ex: someone with a new onset of dyspnea takes priority over someone with
COPD with dyspnea
Hip Arthroplasty:
● Place pt supine with head slightly elevated and leg in a neutral position, place abduction
wedge between the client's legs when in bed/chair
● Avoid flexion beyond 90 degrees
● Neurovascular checks hourly for the first 24hrs then Q2-4hrs
● Get a raised toilet seat, grab bars, shower chairs, etc.
● Ambulate ASAP
● Do not turn pt to the operative side
● Do not cross your legs!!!
● Perform calf and leg exercises Q2hrs.
Knee Arthroplasty:
● Place pillow under lower calf and foot, NOT under the knee
● Apply ice within the first 24hrs
● Monitor neurovascular status Q 2-4hrs
THIS CONTENT IS COPYRIGHT OF ANGELINA HEREDIA, GWYNN ROTHHAMMER, AND LEILANI VELA OF UNITEK COLLEGE SJ8 CLASS
OF 2024. YOU MAY NOT DISTRIBUTE OR COMMERCIALLY EXPLOIT THE CONTENT NOR MAY YOU TRANSMIT IT OR STORE IT IN ANY
OTHER FORM OF ELECTRONIC RETRIEVAL
, ● Ambulate ASAP
● Wear elastic stockings
CPM Machine:
● Prescribed to promote motion in the knee, promote circulation, and prevent scar tissue
formation, provide passive ROM
● Pad areas with sheepskin
● Line up with the joints of the CPM machine with the pts operative knee, apply in the
extended position.
● Check the setting on device Q8hrs
● Place pt supine when applying the CPM device, following placement keep the HOB at 20
degrees
Transcribing Phone Orders:
● Repeat back to the provider
● Asking questions if anything is unclear
● Order must contain dosage, time, route, reason, and frequency
Car Seat Safety:
● Rear-facing until 2 years of age
● If put in the passenger seat, confirm the airbag is off
● 45-degree angle
● Shoulder harnesses are placed in the slots at or below the level of the infant's shoulder
● A retainer clip should be placed at the eel of the infant's armpits
Triage Color Tags:
● BLACK: expectant, not likely to survive to the extent of injuries
● IMMEDIATE: see first!! Ex: shock, pneumothorax
● DELAYED: see second, needs delayed attention, ex: open fractures
● MINOR: see last, non-urgent, ex: minimal fractures, anxiety
Immunizations:
Live vaccines: MMR, Varicella, Rotavirus, & IPV
● Contraindicated with pts taking immunosuppressants, pregnant pts, and pts dx w
HIV/AIDS
DTaP: Administer doses 2,4,6 at 15-18 months & 4-6 years.
THIS CONTENT IS COPYRIGHT OF ANGELINA HEREDIA, GWYNN ROTHHAMMER, AND LEILANI VELA OF UNITEK COLLEGE SJ8 CLASS
OF 2024. YOU MAY NOT DISTRIBUTE OR COMMERCIALLY EXPLOIT THE CONTENT NOR MAY YOU TRANSMIT IT OR STORE IT IN ANY
OTHER FORM OF ELECTRONIC RETRIEVAL
, HPV: Administered at 11-12 years can be given as early as 9, nor recommended after 26 yrs only
if the risks outweigh the benefits
Tdap: admin 1 dose at 11-12yrs, booster Q 10yrs, booster during pregnancy during 26-27 weeks
HIB: 4 doses at 2,4,6 and 12-15 months & 3 doses at 2,4 and 12-15 months
RV: RV-1 at 2 & 4 months & RV-5 at 2,4,6 months (max age 8 months)
IPV: 2,4 and 6-18 months then at 4-6 yrs
MMR: 12-15 months then 4-6 years, Pts ages 19-49 who lack documentation may need 1-2
doses, avoid in pts allergic to gelatin & neomycin
Varicella: 12-15 months and 4-6 years; catch up schedule 2 doses 4 weeks apart 13, avoid in pts
allergic to neomycin & gelatin
Pneumococcal: doses at 2,4,6 and 12-15 months, for adults 65 yrs and older who lack
immunization
HepA: 12-23 months & second dose after 6 months, doses should be spaced 6-12 months or 6-18
months apart
HepB: Given within 12-24 hrs after birth & additional doses at 1-2 months & 6-8 months, 3
doses to pts who lack completion of vaccine course, Wait 2 months between doses 1 & 2 and 2
months between doses 2 & 3
Influenza: One dose is given annually after 6 months of age, Live attenuated for ages 2-4yrs,
Recombinant influenza for ages 18+
Covid-19: For pts 50 years & older, mRNA vaccine, Viral vector vaccine
Meningococcal: Administered at 16 yrs, Administer to high-risk pts every 5 years (MenACWY),
Aged 16-23 & every 2-3 years for high-risk pts (MenB), Zoster: After age 50 a 2-dose series is
administered, Second dose administered 2-6 months after the first
Thrombocytopenia:
● Platelets below 150k
● Usually caused by chemo or radiation therapies
BLEEDING PRECAUTIONS!!
● Use a soft toothbrush and electric razor, do not blow or scratch your nose too
hard, do not bear down, avoid suppositories avoid injections, avoid antiplatelets,
guaiac stools, or emesis, avoid venipuncture
● Hold pressure to venipuncture sites for 3-10 mins or 15-20 mins following an
arterial stick
● S/Sx: petechiae, purpura, gingival bleeding, epistaxis, bruising, and bleeding
THIS CONTENT IS COPYRIGHT OF ANGELINA HEREDIA, GWYNN ROTHHAMMER, AND LEILANI VELA OF UNITEK COLLEGE SJ8 CLASS
OF 2024. YOU MAY NOT DISTRIBUTE OR COMMERCIALLY EXPLOIT THE CONTENT NOR MAY YOU TRANSMIT IT OR STORE IT IN ANY
OTHER FORM OF ELECTRONIC RETRIEVAL
