Special Advanced Procedures Unit 51 Adonis K. Lomibao 12/3/11

Objective Have a basic understanding of special procedures and their indications. Identify proper steps in performing procedures.

Introduction Scope and type of assignments given to PCT are influenced by: -Basic operation & experience -advanced training in procedural skills -Facility policy -State laws that specify range of practice

Collecting a Specimen from Closed Urinary Drainage System Keep in mind urine must be fresh. Specimen may not be taken from bag. Procedure to follow depends on kind of foley in place.(p. 908) Proper technique to avoid introducing infectious organisms into system.

Removing an Indwelling Catheter May be removed to reduce risk of infection, if obstructed, or for routine change. Monitor voiding if new catheter isn't inserted by nurse. Notify nurse if pt. Hasn't voided in 4-6 hours, or complaints of abdominal pain. Procedure on p.910

Foley Catheter

Ostomies Ostomy-artificial opening in abdomen for elimination of solid waste and flatus. Colostomy-colon brought to abdominal wall Stoma-the mouth of the opening. Appliance- disposable drainage pouch for stoma. Problems at stoma site may include, leakage, odor control, and irritation of area.

Colostomy

Ostomy

Ostomies Cont. Assist pt. With colostomy by: -Keep area clean and dry. -perform routine stoma care. Initial irrigation done by nurse. If colostomy to be permanent, patients taught to irrigate themselves.

Care of Patient with Ileostomy Permanent artificial opening in the ileum draining through a stoma. Liquid form and contains irritating dig. Enzyme Considerations for care: -Nurse does care for a NEW ileostomy -Routine care given by PCT's -Drainage is irritating to skin -Fit ring so leakage does not occur

Sterile Technique Nursing procedures using sterile technique include: -Invasive procedures -Procedure that breaks skin -Procedures that enter body cavity -Changing surgical dressings -Central IVC Dressing changes -Procedures involving severe destruction of the skin

Sterile Technique

Sterile Technique-Environmental Conditions Environmental conditions: -Clean, dry, flat, stable surface -No airborne contamination -Instruct pt. To avoid touching field & talking, coughing or sneezing over sterile field.

Setting up Field 1-inch border is NOT sterile Only top area of surface is sterile. Sterile supplies can only touch sterile field. Sterile Gloves-allows you to touch sterile items Transfer forceps- used to add supplies to sterile field.

Intro to Advanced Airway Management Advanced airways treat hypoxemia. Advanced health care providers, nurses, and RCP's manage airways and ventilation devices. PCT's need to identify the airways and ventilation devices and understand basic care. PCT's need to identify a patient who is in distress.

Oropharyngeal Airway Curved plastic device inserted in mouth to pharynx. Prevents tongue from obstructing airway. Keeps airway open in unconscious patients. PCT Care: Standard Precautions!, do not stop pt. From pulling out,Check respirations, keep airway open!

Oropharyngeal Airway

Nasopharyngeal Airway Soft rubber device inserted through nostril. May be used in responsive patients. Used for those with recent oral surgery, loose teeth, mouth trauma, and those in need of frequent suctioning. Contraindicated for those with anticoagulant meds, nasal deformities, bleeding disorders, or sepsis.

Endotracheal Intubation Complete airway control! Passed through mouth or nose to patient's lungs. Used for ventilation and suctioning. Used in surgery and CPR situations. Only nurse, RCP, or physician can care for ET tube.

ET Tube

Endotracheal Intubation Care for pt. With ET Tube: -Patient can't sleep. -Being mechanically ventilated. Ventilator-mechanical device that forces air into the patient's lungs. Pt may be restrained--> total nursing care i.e. turning, repositioning, restraint care. Standard precautions & aseptic technique! Bag-Valve Mask- manual ventilation for pt.

BVM

Suction Used to remove fluid, food, and secretions from pt.'s nose, mouth, and airway to reduce risk of aspiration. Can use a flexible plastic suction catheter, or a rigid plastic suction (Yankauer catheter)(For Oral). Sterile procedure done by the nurse, RCP, or advanced provider.

Suction Catheter

Yankaeur Suction