NSG 122 Exam 5 - Questions and Answers

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NSG 122 Exam 5 - Questions and Answers IV insertion steps - open and prepare sterile packages - prepare extension tubing: clean connection port, attach 0.9% NS syringe to tubing and prime tubing, le ... ave syringe attached - prepare IV tubing and solution: place roller clamp 1-2" below drip chamber, close roller clamp, insert tubing spike into solution bag, fill drip chamber 1/3 to 1/2 full, open roller clamp to prime IV tubing, close roller clamp - apply tourniquet - select vein to be used - release tourniquet temporarily - apply clean gloves - clean site - reapply tourniquet - insert needle with bevel up - check for blood return/flashback - advance needle 1/4" and then loosen stylet - using index finger, advance catheter off the needle into the vein - stabilize catheter and release tourniquet - connect extension tubing to catheter - aspirate to assess blood return, then flush line with 0.9% NS - secure catheter with tape/transparent dressing - label dressing with date, time, initials, type and size of catheter used - clean connector sites with alcohol and attach IV tubing - secure IV tubing/extension set - open roller clamp and program EID Peripheral venous IVs - used for short-term access - needs to be flushed frequently - assess every day Peripherally inserted central catheter (PICC) - used for long-term intravenous access - inserted in the basilic or cephalic vein just above or below the antecubital space with the tip of the catheter resting in the superior vena cava - used for chemotherapy, antibiotics, parenteral nutrition How is a new catheter port placement verified? x-ray Infiltration of IV site - solution goes into surrounding tissue because catheter is no longer in the vein - cold skin - pale skin - swelling around the IV site - may or may not have pain in the area Infection of IV site - erythema - edema - fever/chills - malaise Phlebitis - inflammation of a vein - warmth - edema - may be a red streak up the arm Hemolytic reaction destruction of RBCs when a patient receives an incompatible blood transfusion Hemolytic reaction s/s - low back pain - flushing - fever/chills - headache Blood transfusion nursing procedure - 2 adults must verify blood type & Rh factor - verify patient's name & DOB - check blood product's expiration date & donation ID - vitals including lung assessment - verify consent has been signed - patient education for adverse effects - larger size IV catheter - must administer blood within 30 minutes of receiving from lab - remain with patient for first 15 minutes - obtain vitals per facility's policy after blood administration starts - check on patient frequently - transfusion must be complete within 4 hours - if hemolytic reaction occurs, STOP the infusion - all tubing and material must be returned to the lab if a reaction occurs Cultural assimilation process by which an individual or group becomes part of a new culture. Can occur through a variety of means (language acquisition, gaining knowledge of social norms) [Show More]

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