- Pain medications for cancer patients or chronic pain are usually routine and not PRN
Wound care
- Measure wound
- For saline moistened dressing to abd wound:
- Open all materials in sterile manner abd pads, instruments, and cotton swabs – then don
sterile gloves
- Break sterility with left hand and pour normal saline on the gauze
- Clean debris in the wound with cotton swabs → top to bottom inside to out
- Pack the wound with the saline moistened gauze and sterile forceps (not saline
drenched) (using sterile hand)
- Cover the wound with dry gauze
- You can break sterility now to do the abd pad and tape down
- Date and time and initial the bandage
- For necrotic foot ulcers
- Need clean gloves, gauze, chux pad, dermal wound cleanser
- Do hand hygiene and glove, ID patient and review order
- Elevate the leg
- Spray the necrotic tissue with the dermal wound cleanser while shielding any splatter
with the gauze
- Tap dry with gauze and make sure to get in between toes
- Wound irrigation → heel pressure ulcer
- Supplies: sterile normal saline, xeroform, gauze, chux pad, irrigation tray
- Elevate leg
- Pour sterile normal saline into graduated cylinder and measure
- Put on gloves
- Suction up 60ml of the sterile saline with the syringe
- Irrigate the wound with the syringe and holding a basin underneath to catch the liquid
- Pat dry with gauze
- Open xeroform and cut to size (eyeball it); put on the wound and then change gloves
because the gloves are covered with it and its messy
- Put gauze over the xeroform and then put rolled gauze around the wound/ankle to
secure it
- Clean BKA and wrap with ACE wrap
- Elevate leg
- Use 50% tension unless specified otherwise
, - Use figure 8 technique to wrap
NCP
- Everyone gets a plain CT scan to determine type of stroke and to rule out bleed… 4:25
marker
- Stop video at 7:40
- It is about ischemic stroke… do not reference it as stroke
In class notes
- Castile soap is used for soap sud enema → castile soap will promote
peristalsis because it is a mild irritant
- Stoma adhesion should be cut ⅛ of an inch larger than actual stoma
- Pull stoma bag away before cutting because u dont want to puncture the bag
- The black thing on the top of the bag is charcoal to help odor control
- Change inner cannula first, then clean around peristoma and then change trach
ties
- Position patient in high for NG tube insertion because it uses gravity
- Double lumen is salem sump → you can suction
- dobhoff → small bore feeding tube → it has a weighted tip and a
guidewire → You only remove guidewire once placement is confirmed
by xray
- You must know why you are inserting an NG tube
- To measure how much of NG tube we are inserting → tip of nose to
earlobe and then to xiphoid process and add 10 centimeters and mark
it with tape
- Need to know if pt has had recent surgery before NG insertion
- Worst case scenario is NG tube going into brain
- We must have emergency equipment nearby for NG insertion → set up
suction incase pt aspirates
- Patient must put his chin down when NG tube is in the throat → this is
to make sure the NG tube goes to esophagus and not the trachea
- They should also take sips of water or try to swallow after putting their chin down
to help move the tube down by increasing peristalsis
- Tell the patient it will hit the back of their throat and that they will gag and
cough… tell them this is normal and to expect it
- Always have a helper with you incase of choking so someone can call for help
- When you tape NG tube to secure it –?> both pieces of tape go UNDER
- Check back of the throat with pen light, Aspirate and call for xray
Wound care
- Measure wound
- For saline moistened dressing to abd wound:
- Open all materials in sterile manner abd pads, instruments, and cotton swabs – then don
sterile gloves
- Break sterility with left hand and pour normal saline on the gauze
- Clean debris in the wound with cotton swabs → top to bottom inside to out
- Pack the wound with the saline moistened gauze and sterile forceps (not saline
drenched) (using sterile hand)
- Cover the wound with dry gauze
- You can break sterility now to do the abd pad and tape down
- Date and time and initial the bandage
- For necrotic foot ulcers
- Need clean gloves, gauze, chux pad, dermal wound cleanser
- Do hand hygiene and glove, ID patient and review order
- Elevate the leg
- Spray the necrotic tissue with the dermal wound cleanser while shielding any splatter
with the gauze
- Tap dry with gauze and make sure to get in between toes
- Wound irrigation → heel pressure ulcer
- Supplies: sterile normal saline, xeroform, gauze, chux pad, irrigation tray
- Elevate leg
- Pour sterile normal saline into graduated cylinder and measure
- Put on gloves
- Suction up 60ml of the sterile saline with the syringe
- Irrigate the wound with the syringe and holding a basin underneath to catch the liquid
- Pat dry with gauze
- Open xeroform and cut to size (eyeball it); put on the wound and then change gloves
because the gloves are covered with it and its messy
- Put gauze over the xeroform and then put rolled gauze around the wound/ankle to
secure it
- Clean BKA and wrap with ACE wrap
- Elevate leg
- Use 50% tension unless specified otherwise
, - Use figure 8 technique to wrap
NCP
- Everyone gets a plain CT scan to determine type of stroke and to rule out bleed… 4:25
marker
- Stop video at 7:40
- It is about ischemic stroke… do not reference it as stroke
In class notes
- Castile soap is used for soap sud enema → castile soap will promote
peristalsis because it is a mild irritant
- Stoma adhesion should be cut ⅛ of an inch larger than actual stoma
- Pull stoma bag away before cutting because u dont want to puncture the bag
- The black thing on the top of the bag is charcoal to help odor control
- Change inner cannula first, then clean around peristoma and then change trach
ties
- Position patient in high for NG tube insertion because it uses gravity
- Double lumen is salem sump → you can suction
- dobhoff → small bore feeding tube → it has a weighted tip and a
guidewire → You only remove guidewire once placement is confirmed
by xray
- You must know why you are inserting an NG tube
- To measure how much of NG tube we are inserting → tip of nose to
earlobe and then to xiphoid process and add 10 centimeters and mark
it with tape
- Need to know if pt has had recent surgery before NG insertion
- Worst case scenario is NG tube going into brain
- We must have emergency equipment nearby for NG insertion → set up
suction incase pt aspirates
- Patient must put his chin down when NG tube is in the throat → this is
to make sure the NG tube goes to esophagus and not the trachea
- They should also take sips of water or try to swallow after putting their chin down
to help move the tube down by increasing peristalsis
- Tell the patient it will hit the back of their throat and that they will gag and
cough… tell them this is normal and to expect it
- Always have a helper with you incase of choking so someone can call for help
- When you tape NG tube to secure it –?> both pieces of tape go UNDER
- Check back of the throat with pen light, Aspirate and call for xray
