A RANDOMLY
STAR-FILLED
COME AT
REVIEWER FROM ME, nle!
A GALAXY FAR
FAR AWAY! Here are some
things I have gathered from
my old notes, which hopefully can help you
pass this Board Exam! Again! Good Luck!
This does not mean that this is an uber
reliable source. If you can, pls. try to check
out Foundations of Nursing Book( The Kozier/
Berman & Synder one) & the Perry, Potter, &
Elkin book!
NURSING TECHNOLOGY TOOLS & STUFF!
-This was taken from the Book; Nursing
Interventions & Clinical Skills by Perry, Potter,
& Elkin 5th edition!
1.CONDOM CATHETER
-Good choice for patients that still has a
functional bladder, but they cant control
the URGE to pee!
-When wrapping the sheath holder around
the condom catheter, it must be placed
spirally around the penis. Dont wrap too
tightly because it might stop blood from
going to penis. Leave 1 to 2 inches of the
condom catheter at the end of the penis.
-NON-invasive. Why? A condom like device
is placed over the penis. Which is why there
is a lesser risk for infection compared to a
foley/straight catheter.
-A tube leads from this device to a drainage
bag.
-Must be changed everyday.
-Urine bag: always ensure that it is lower
than the patient especially when supine so it
flows downward. For safety purposes, it must
be pinned close to bed.
Some *uncircumcised guys, may develop
paraphimosis which occurs when the
retracted foreskin cant be put back in
place because of
swelling. This can also
occur when penis is
erect & during sexual
intercourse.
-The retracted foreskin
swells & tightens
around the penis causing more swelling.
-Thats another reason why boys should be
CIRCUMCIZED! hahaha. & FYI guys. I know
were all proud were nurses & taking up
medicine, med tech, rad tech & what not.
But always remember to protect the dignity
of your patients. Unlike this picture.. which
was even featured in 9gag. (P.S. theyre
cute though, but being cute is not an
excuse to post this relentlessly :O haha)
SPEAKING OF URGE INCONTENCE; lets
review the Urinary incontinence types:
Urge: sudden loss of urine day or night
caused by caffeine intake,
increased fluid intake, infections,
lesions.
Stress: loss of urine associated
with exertion. Coughing,
laughing, sneezing or lifting.
Mixed: symptoms of urge and
stress incontinence.
Reflex: loss of urine without sensory
awareness (spinal cord injuries)
Functional: caused by meds or medical
condition ( stroke)
Overflow: over distended bladder
2. FRENCH SIZES
The French scale or French
gauge system for sizes of a
catheter.
-abbreviated as Fr, but can
also be Fg, Ga, FR or F.
-Each unit is roughly equivalent to 0.33 mm
in diameter ( ex. 18 Fr is 6 mm)
God bless & Good Luck!!
-The smaller the number, the smaller the
catheter.
NOT a Standard, but when it doubt:
Children: 8 Fr & 10 Fr
Female adults: 14 Fr & 16 Fr
Male adults: 20 Fr & 22 Fr
3. URINARY CATHETERIZATION: the
placement of a tube into the bladder to
remove urine
-requires a medical order and strict sterile
technique to prevent transmission of
infection into the urinary system
-prescriber chooses a catheter on the basis
of factors such as latex allergy, history of
catheter encrustation, and susceptibility for
infection
**nurses must always assess clients for latex
allergies
4. FOLEY CATHETER
-For long term catheter use, aka
INDWELLING cath
-Coude Foley is used for men & for getting
around their prostates.
- Pt is at risk for urinary tract infections and
there can be a bio film that gets on it and
decreases urinary excretion so be wary of
that and of being sterile.
- 5 ml for adult, 3 ml for child and 30 ml for
continuous bladder irrigation.
-Most adults have a size of 14-16 French to
minimize trauma and risk for infection.
-Has a bulb attachment to keep it in
bladder (inflated balloon has 3 lumens).
-Connected to a closed gravity drainage
RN JUNE 2016 OR BUST IT BABY! Good Luck! 2
system ( meaning that it
drains urine to a urinary bag,
instead of just free flowing
urine). -Double lumen : for
urinary drainage and to
inflate a baloon.
Triple lumen for continous
bladder irrigation or instill
medicine into bladder. The 3 lumens are to
inflate baloon, to drain bladder and to
irrigate bladder.
-long term use of larger balloons cause
Irritation and trauma to bladder wall and
urine pools below level of catheter.
- indwelling is attached to a urinary
drainage bag to collect continuous flow of
urine.
-coating with silver: sfor antimicrobial to
reduce incidence of CA (catheter
associated) UTI
-This is excellent too for patients who had
anesthesia where they loss the reflex to
urinate after surgery, or for long-term care
patients who absolutely dont have a
working detrusor muscle in their bladder.
-FYI, the more often you change the
cathether, the more it can damage the
lumen (lining) of the urethra.
-Check for signs of infection! (fever, etc.)
-Also, inserting a foley/straight catheter is a
STERILE procedure. So bring out the sterile
gloves, etc. & once the sterile gloves
touches the penile shaft or the patients skin
during insertion, it is already unsterile!
5. STRAIGHT CATHETER
-The catheter of choice recommended for
those who are not straight. Joke.
has single lumen for one-time bladder
emptying. placement of tube into bladder
to remove urine
-relieves urinary obstruction, but excessive
accumulation can caused infections
-Made of rubber or plyvinyl chloride
-May be used when getting a urine sample,
or when urine has to be removed from the
bladder at that moment only ( ex: during
labor & delivery).
6. CENTRAL LINE
-A central venous catheter, also called
a central line, is a long, thin, flexible tube
used to give medicines, fluids, nutrients, or
blood products over a long period of time,
usually several weeks or more.
-A catheter is often inserted in the arm or
chest through the skin into a large vein.
-This is used also when IV access on the
extremities is poor, or when IV Cutdown,
has failed to make an IV access.
-FYI. This requires a
specialty. If you want
to earn big bucks as a
nurse, you may
specialize on Central
Line insertion or in
assisting in Central Line
insertion!
7. CENTRAL LINE: BROVIAC/HICKMAN
-older type of central line
It can cause clotting so not used anymore,
needs heparin
B & V invented central lines
-A "HICKMAN" catheter or "BROVIAC"
catheter is a long, hollow tube made of soft,
rubber-like material called silicone, with an
opening called a lumen. This catheter is
commonly referred to as
a central venous catheter
because it is inserted into
the large vein leading
directly into the heart.
-FYI again; sometimes
cancer drugs may
destroy the blood vessel on where it is
passing, especially if on the extremities. This
is why central lines are important. Also, Total
parenteral nutrition (TPN) is also
administered using central lines.
8. CENTRAL LINES- GROSHONG
Think iodine. Most commonly used central
line put in subclavian vein less clots, very
sterile, it has one way valve to prevent
blood back flow. Has lumens for
medication like waterless chest pumps,
9. CENTRAL LINE- SWAN-GANTZ
-a catherer
which goes to
heart then
pulmonary
artery
-measures
pressure in left
side of heart for
mean arterial
pressure
Taken from Mosby:
CVP (Central Venous Pressure) Monitoring:
-Provides an indication of pressure in R
atrium
Nursing Alert: To get an accurate
reading, the nurse should place
the zero level of the manometer
at the level of R atrium at the 4th
intercostal space.
-Instruct the client to avoid
coughing and straining as it
increases readings.
-Normal CVP reading is 2-12 mm Hg when
tube is at superior vena cava.
10. CENTRAL LINES-PICC -
peripherally inserted central
catheter nurse can administer
to go to anticubital space .And
arm and has a long line that
goes to heart takes a long time
to administer
-still a central line but inserted
peripherally
-Placement of PICC is through antecubital
fossa into the superior vena cava.
RN JUNE 2016 OR BUST IT BABY! Good Luck! 3

-PICC line; notice how it is in the extremity.
More FYIs about Central lines
-Long-term central
venous access devices
(CVADs) are indicated for
some clients who will
receive intravenous (IV)
therapy or hemodialysis
for longer than 7 days
and up to several years.
-the device is used to
administer IV fluids, medications, blood
products, and parenteral nutrition fluids
-the access devices are also used for
hemodialysis and temporary cardiac
pacing procedures
-chest and neck sites are preferred sites
because they provide a flat, relatively
immobile area and blood flows through the
large jugular veins at a high rate
-risk for infection is higher with internal
jugular veins than with subclavian
-double, triple, or quadruple-lumen
catheters are used when the client requires
several difference infusions
-If total parental nutrition (TPN) is
administered, the port remains designated
for PN only throughout the life of the
catheter
-When IV pushing drugs into a central line,
the nurse must draw back fluid, to see if
theres blood. This would ensure that the
tubing is still in place! DO NOT CONFUSE this
with IM injection where there should be NO
BLOOD when drawing back the syringe!
11. PEG TUBE
-Feeding tube through the abdomen
(Percut Endo
Gastrostomy tube)
Not necessarily Long
term, feeding into
abdomen either
stomach or small
intestine. -Has a stoma
- used if patient has
difficulty drink/eat,
swallow or breathing
-inserted during endoscopic viewing of the
stomach
-tube exits through a puncture wound in the
upper left quadrant of the abdomen, but
held securely in place by virtue of design
12. PEJ TUBE (percutaneous endoscopic
jejunostomy)
-used for clients (for enteral nutrition) who
have a gastric ileus (decreased or absent
peristalsis that affects the stomach but not
the intestines). Delayed gastric emptying,
gastric resections, or neurological
impairment that place them at greater risk
of aspiration
-inserted during surgery (like gastrostomy
tubes)
-after insertion of the large-bore PEG tube,
the PEJ tube is passed through the PEG tube
and advanced into the jejunum
*a Y-connector attached to the jejunostomy
tube caps the PEG tube and closes the
system
*this Y-connector labels the gasrostomy
tube and designates the jejunostomy tube
for feeding
RN JUNE 2016 OR BUST IT BABY! Good Luck! 4
*the nurse must know which tube is gastric
and which is jejunal
13. TUBE FEEDING PUMP
-Connect tubing through infusion pump and
set rate
-continuous feeding delivers prescribed
hourly rate of feeding, thus reducing
abdominal discomfort
Intermittent gavage infusion: gradual
emptying of tube feeding by gravity for
feeding bag reduces risk of abdominal
discomfort, vomiting or diarrhea induced by
rapid infusion of tube feedings.
Continuous drip method: delivers prescribed
hourly rate of feedings, reduces abdominal
discomfort. Residuals must bec checked
every 8-12 hours and tube placement
verified.
IV volume control device:
Releases a measured amount of fluid into a
specific period of time
-delivered thru IV infusion pump or syringe
infusion pump
IV infusion pump: Mechanical pump.
Deliver infusion by exerting positive pressure
on tubing or fluid
Syringe Infusion Pump: syringe is attached
to pump
2ndary IV tubing attached to tip of syringe
and connected to port on primary IV tubing
-admin 10-60 min
Why we need volume control devices?
Iv therapy can cause infiltration, phlebitis,
clotting, fluid overload
- heps regulate IV infusion
RN JUNE 2016 OR BUST IT BABY! Good Luck! 5
Used for: kids, at risk for fluid overload,
elderly
Features of a volume control device:
-programmable time
-detectors and alarms
-anti-free flow safeguard
-Nurses can administer fluid and IV
medications.
NURSE ALERT maximum hang time for
formula is 8 hrs. in an open system and 24
hrs. in closed, ready to hang system, which is
supplied by the pharmacy
14. ENDOTRACHEAL TUBE
- short term artificial airways to administer
mechanical ventilation, relieve upper
airway obstruction, protect against
aspiration or clear secretions. Removed
after 14 days.
-allow direct access to lower airways for
suctioning. Used to relieve mechanical
airway obstruction or to protect airway from
aspiration because of impaired cough or
gag reflexes.
-ET has inflated or non inflated cuff:
Cuffed ET are for kids >8 yrs old. It maintains
the ET tube in proper position & prevents
aspiration of GI contents to respiratory tract.
For those <8 y/o; uncuffed ET tubes are used
because the narrow subglottic area
performs the function of a cuff & prevents ET
tube from slipping.
-Suctioning of the lower airway using sterile
technique may be necessary if clients
cannot cough enough forcefully enough to
clear secretions. Endotracheal (ET) and
tracheostomy tubes allow direct access to
the lower airways for suctioning
-physicians or certified personal insert these
airways to create;
- It can also be a route for mechanical
ventilation
Relieve mechanical airway obstruction
Protect the airway for aspiration because of
impaired cough or gag reflexes
SECURING ET TUBE:
- Tape method
Rationale positions tape
to secure ET tube in proper
position
A. pour small amount of
tincture of benzoin on
clean 2X2 gauze and dot on skin above
upper lip (oral ET tube) or across nose (nasal
ET tube) and cheeks to ear. Allow to dry
completely. rationale- protects and makes
skin more receptive to tape
B. on one side of face, secure tape from ear
to nares (nasal ET tube) or edge of mouth
(nasal ET tube). Secure bottom half of tape
across upper lip (oral ET tube) or across top
of nose (nasal ET tube). Wrap top half of
tape around tube and up from
bottom. Tape should encircle tube at least
two ties for security.
C. on other side of face, gently pull tape
firmly t pick up slack and secure to
remaining side of face.
Rationale secures tape to face and
tube. ET tube should be at the same depth
at the lips.
**verify that ET tube is at the established
depth, using the lip or gum line marker as a
guide.
Assessment: check vital signs, breath
sounds,
Observe nasal cavity for nasal or oral
secretions.
Identify pts with increased risk for ineffective
airway clearance.
15. TRACHEOSTOMY TUBE
-LONG TERM USE when continued assistance
from artificial airway.
-may have cuff, inner cannula, pilot balloon
-for people with respiratory issues,
respiration put into stoma
Has double cannula. Take out inner
cannula should be for cleaning, and outer
cannula with insertion device, obturator for
first time, long-term
tracheostomy: surgical opening of trachea,
-curved tube inserted into a tracheostomy
stoma
-Creates a route for mechanical ventilation
-relieve upper airway obstruction
-protect against aspiration
-clears secretion
-metal, plastic, and silicone( light way and
less crusting of secretions)
-double cannula tube: inner cannula is
inserted nadlockedin place after the
obturator is removed, it acts as a removable
liner for more permanent outer tube.
Removed for brief periods to be cleaned.
Main parts are: outer tube (cannula), inner
cannula, and obturator.
Obturator: guides the outer tube during
insertion and is removed immediately after
outer tube is in place. Outer tube can be
secured
Caring: prevents airway injury, infection, skin
breakdown
Tracheostomy suction
apply intermittent
suction by placing and
releasing nondominat
thumb over vent of
catheter. Slowly withdraw
catheter while rotating it
back and forth between
dominant thumb and
forefinger. If catheter grabs mucosa,
remove thumb to release suction. The max.
time catheter may remain in airway is 15
seconds. Encourage client to cough
Rationale intermittent suction and rotation
of catheter prevent injury to tracheal
mucosal lining, Hypoxia related to removal
of oxygen in airway and sections will occur
during suctioning procedure. No more than
two passes with the suction catheter is
recommended during any one suctioning
session.
Normal saline instillation (NSI) used in airway
prior to ET and tracheostomy suctioning is
NOT used anymore. When used with ET
RN JUNE 2016 OR BUST IT BABY! Good Luck! 6
suction it may spread microbes into lower
respiratory tract
Not effective in thinning secretions or
improving removal of secretions
NSI does not may any difference either
whether we use it or not
Dont forget to assess after
suctioning! Are the breath
sounds clear now that you have
suctioned the patients upper
airway?
AIRWAY MANAGEMENT: ET and
Tracheostomy care:
-Correct care to prevent artificial airway
infections
-Elevating BED to prevent ASPIRATIONS
-Change patient position to reduce risk for
atelectasis and pulmonary infections
-Chlorhexidine to dec bacterial
colonization.
-Inc patient mobility to promote pulmonary
function and decrease pooling of
secretions.
-When cleaning the tracheostomy covering,
make sure to clean one side at a time, and
do not unstrap both sides of the snuggly
securing tapes & gauze around the tube!
This would lessen the dislodgment.
- Lets say you were asked to
inflate the balloon securing
the tracheostomy tube in
place. Lets say for example,
the fluid instilled in that
balloon is 10 ml. You must drain a small
amount of fluid, so that the balloon will have
like 9.8ml o ffluid or something to prevent
necrosis of the trachea where the tube was
inserted!
16. WOUND DRAINAGE
- When it accumulates in a wound bed, it
will interfere with healing..
A drain is placed directly through suture line
into wound or through small stab wound
near the surgical site
- Jackson-Pratt and Hemovac are self-
contained suction units that are connected
to a drainage tube within wound and
provides constant low-pressure suction to
remove and collect drainage
17. DRAIN-JACKSON-PRATT
-surgeon places
this drain at the
time of surgery
and connects it
to bulb reservoir
-drain is made of
Teflon and has
multiple drainage
holes
outside of body
drain to drain
leakage after
surgery . needs to be emptied.
-Bulb, when squeezed, applies constant
suction to the drain, pulling excess fluid out
of the wound bed
-is for smaller amount for drainage, causes
fluid to travel with negative pressure -
healing process will have reduced infections
as fluid is drained
-suction by compressing bulb. small amounts
of drainage (100 to 2000 mL / 24 hours)
Usually empited every 4 hours and
emptied if half-full.
18. DRAIN-HEMOVAC (ConstaVac drain)
- for LARGER amount of drainage,
looks like a circular accordion
and placed into body ( > than 500
ml for 24 hours). It is for long term
and you can take it home , a
portable vacuum drain; Should be
emptied if and reset to apply
suction.
Slack tubing: decreases tension
and allows patient to move
-Skill of emptying a closed drainage
container, measuring amount of drainage
and reporting amount on patients intake
and output.
19. PENROSE DRAIN
-In USA, this is super rarely used,
or probably never used
anymore.
-Soft & flexible, without a
collection device.
-Empties into absorptive
dressing material & promotes
drainage passively when
drainage moves from the area of greater
pressure in wound or surgical site to area of
less pressure
RN JUNE 2016 OR BUST IT BABY! Good Luck! 7
- Large pin is attached to outer portion to
prevent drain from slipping back to incised
area. It acts like a straw that pulls fluid out of
wound & release them outside body.
20. CHEST TUBES (ANCIENT)
-In USA, students are taught in Med-Surg that
in the old days, they used jars for chest
tube. But hey! We still use those here in the
Phlippines!
Managing Closed Chest Drainage Systems
Trauma, disease, or surgery can interrupt the
closed negative pressure system of the lungs
- lung collapse
-air (pneumothorax) or fluid (hemothorax)
may leak into the pleural cavity
-chest tube is inserted, and a closed chest
drainage system is attached to promote
drainage or air and fluid from the pleural
space so the lungs can re-expand
-called a thoracostomy tube or thoracic
catheter
-suction may be added to assist gravity in
draining fluid
Placement:
-depends on the type of drainage that is
needed
-apical and anterior chest tube placement
promotes removal of air
-chest tubes are placed low and
posterior or lateral to drain fluid.
This is not the nurses job, but
during insertion, the catheter
must be placed on the superior
portion of the rib. The inferior
portion of ribs has the intercostal
artery, vein & nerve & may be
detrimental for patient if hi.
-mediastinal chest tubes are placed just
below the sternum and drain blood or fluid,
preventing its accumulation around the
heart (e.g. after open heart surgery
21. CHEST TUBE ( WATER SYSTEM)
-3 CHAMBERdevice. To drain chest tube
contents (air, blood, effusions)
1st chamber: collecting chamber
2nd chamber: water seal, one way valve->
air bubbling through water seal chamber is
usual when patient coughs or exhales but
may indicate if continued, a plural system
leak that should be evaluated critically.
3rd camber: suction control chamber.
Height of water is negative pressure
Bubbling should be kept a gentle bubble to
limit evaporating fluid
Increase wall suction does not increase
negative pressure of the system.
22. CHEST TUBE (WATERLESS SYSTEM- single
unit water-seal)
-DRY suctioning control system with
awesome advantages: higher suction
pressure levels can be achieved, set up is
easy, no continuous bubbling, and provides
quiet operation and theres no fluid to
evaporate which would decrease amount
of suction applied to patient
Instead of regulating level of suction with
column of water, they are controlled by a
self-compensating regulator. Disposable
and ambulatory. One way
- If youre a flight nurse, you might see this in
Quatar Airways!
RN JUNE 2016 OR BUST IT BABY! Good Luck! 8

OTHER YADA YADA YODA
ABOUT CHEST TUBES. ITS
boring, like you have to
read the subtitles when
listening to Master Yoda talk, so its up to
you if you wanna check it out:
-Turn off suction source and unclamp
drainage tubing before connecting client to
system. Make a second check to be sure
drainage tubing isnot excessively long
Rationale having client connected to
suction when it is initiated could damage
pleural tissues from sudden increase in
negative pressure. Suction source in turned
on again after client is connected. Tubing
that is coiled or looped become clotted,
impeding drainage, and mat potentially
cause a tension pneumothorax.
*help physician attach drainage
-after tube placement, position client:
Pneumothorax use semi-Fowlers to high-
Fowlers position to evacuate air
Rationale permits optimum drainage of
fluid and/or air. Air rises to highs point in the
chest
Hemothorax use high-Fowlers position to
drain fluid
Rationale - permits optimum drainage of
fluid
-position tubing on mattress next to client
-tubing needs to hang in a straight line from
top of mattress to drainage chamber
Monitoring:
-monitor color, consistency, and amount of
drainage every 15 minutes for the first 2
hours
-indicate fluid, date, and time on chambers
write-on surface
1. Mediastinal tube less than 100 ml/hr is
expected total approx. 500 ml in first 24 hrs.
2.Posterior chest tube 100 to 300 ml is
expected during first 2 hours of insertion.
total 500 to 1k ml expected in 1st 24 hrs
3.Anterior chest tube inserted in
pneumothorax little to no output is
expected
23. GLOVES
Of course, gloves are
important. Some
doctors will give you
that WTF look if you
made them wear a
glove that does not fit
them before surgery!
-powder helps put it on but can be irritating
and expensive, cornstarch
Nitrile is a latex free substance
Latex: natural rubber, and non-powder ones
are for surgery , allergic is latex induced
Range for exam gloves: xs, sm, m, l, xl, xxl,
Surgical: 5.5, 6.0, 7.0, 7.5, 8.0, 8.5, 9.0
-washing hands before putting on gloves to
provide protection
-not tight? Gloves might break
loose? Interfere procedures
-good fit reduces accidents so
wear properly
-Maybe, in other aspects of life,
size doesnt matter, except
when wearing gloves in nursing!
24. INCENTIVE SPIROMETER
- Helps measure inspiration of patient to see
their lung abilities. Keep lungs active and
helps prevent pneumonia and inactivity,
helps lower diaphragm. When inhaling: hold
breath 2-3 secs
-Some doctors will prescribe a certain
number at the spirometer that the patient
must reach to ensure that patient is
breathing deeply; it includes the frequency
of how often they should use it per hour.
-Nurses must *teach & encourage use of it
BEFORE surgery because after surgery, the
patient is to groggy for health teachings &
also, so that they can begin using it as soon
as theyre stable after surgery.
- Common mistake of newbie
nurses, they tell patients to
blow into it. But you dont
blow, you take a deep breath
and exhale.
RN JUNE 2016 OR BUST IT BABY! Good Luck! 9
-As for naughty kids, if they dont wanna use
the incentive spirometry because its not
cool & for old people like you, you can
encourage them to deep breath & blow
bubbles! Sound fun right?!
25. IV LOCK (HEPARINE OR SALINE)
-You know how the patient doesnt need an
IV bag with saline & stuff, but just need some
meds like Promethazine to be IV pushed, for
example? Well, they use a saline lock for
that.
-Or like when an IV is disconnected, but
there should still be an open line, well,
theres heparin or saline lock for you!
-prevents phlebitis
- If you dont want any
more fluids dripping then
you would lock out your
IV but keeps it in so you
can administer more
fluids upon need,
-scrub, med, flush- must be flushed
occasionally! This is very important. You
know how that cute nurse you stalk in the
ward carries a saline injection & flushes the
IV line? Well, they do it to the saline lock to
keep it patent & prevent stuff that may
dislodge!
To put it simply, a Saline lock is a vein
peripheral device. Short IV line, for patients
who dont necessary need IV fluids
-tubing is inserted in vein and left there
Heparin lock : same as saline lock, but
prevents clotting around catheter and if
catheter is deep in body
FYI! I just mentioned IV push! In
paper charting here in the
Philippines, some doctors dont make
it clear if they mean through IV ( iv
bag), IV push- like giving a drug
from an injection to a open line! Competent
Nurses already have a common sense for
that, but if you are unsure, always ask.
& SLOW IV PUSH. Some IV push
drugs can be irritating when
given. If you check the drug
book, it tells you how slow the
drug should be pushed. For
example, Candy 50mg / 1ml- IV push it for
1ml/ 30 seconds. Pay attention to that, coz
in the community/ public
hospital setting, its always
just a guesstimation when
it comes to how slow
should an IV push should
be.
-If your patient was Song
Joong Ki, you dont want
him to die right?
So be careful & always remember the 10
rights of Medicine Administration. Those are
too information Overload. If you forget
some, just make sure you remember these 6(
emphasized in Berman & Synder as well as
Perry, Elkin, & Potter)
Right medication:
Patients current meds must be reviewed
and doc wtithpt involved.
Use correct abbreviations to verfy order is
accurately transcribed
-compare the label of
medicine with MAR 3 times.
When getting medicine,
when you put it in cup or
when take it to pts room
-if a patient questions,
recheck
Right Dose: must be the dose ordered.
Compare with the calculation with one
done independently by a 2nd nurse.
Use appropriate measuring devices to
prepare medicine
Right Patient: use 2 identifiers. Check
bracelet or ask to state name.
-compare med on MAR with identification
braclet
-scan bracelet
Right Route: designate a route that the
prescriber ordered. And contact doc if
route is missing. Use injections that are only
prepared for parenteral use.
RN JUNE 2016 OR BUST IT BABY! Good Luck! 10
Right time: routine time schedules for - allows to set-up and prepare for blood
medications at standard intervals transfusion, prime tubing
=med should be given around the clock to -In other countries like USA, blood is mixed
maintain adequate therapeutic levels together with the saline solution as it goes
Right documentation: info on patients MAR down the IV tubing, & it is preferred that an
corresponds with prescribers order and IV pump is used.
label on med container. In the Philippine setting, a blood product to
Verify inaccurate orders before giving be administered can be directly connected
medicine. to the saline lock ( not in the book.. but
-better to give correct medicine at a later seems ideal & had always been done here).
time that to give patient the wrong
medicine. 28. NEEDLE DISPOSAL CONTAINER AND OSHA
-document site of injection (Occupational Safety & Health
Administration)
Medicine Preparation: admin -put needles in the sharps container so you
only medicine you prepare. can usually only use one hand to place
The nurse who gives the sharps into container.
wrong medicine is legally -After administering a drug through an
responsible for that error. injection, it must be
disposed into the
26. IV PIGGYBACK container right away.
HOW IT INFUSES- for pts This is not applicable in
who already have an the Philippine setting,
IV running so it is but in the book, lets just
attached to primary IV respect it.
via injection port. -helps prevent needle stick injuries. Waste
Usually placed higher disposal techniques
than IV bag Dont push needles into container coz its a
- it is for antibiotics or risk.
other extra drugs put in OSHA manages employees always having
IV. It is hung higher sharp containers nearbly to facilitate its use.
and normal drugs not infused at same time -Needle disposal units, must be leak proof
with iv. So put IV and needles must only be placed in sharps
system that is a containers
secondary drug. -dont recap after use, contact needle
-We are more disposal unit to ensure it is not too full
accustomed to the
Burette, which is 29. AMPULE
used to administer IV - medication holder
drugs in the where you break off top
pediatric setting. part which has glassy bits
in it. Use a filter needle
27. IV-Y TUBING FOR to get out medication
BLOOD inside but dont use filter
-to administer blood needle to administer drug
with saline solution but - In the Philippine setting, theres rarely ever
not at same time been a filtering needle. What happens
Flush, blood, flush, is after breaking the ampule, you drain
helps dilute RBC so not the fluid using the injection you will be
as thick so no clots. using to administer it to patient. Just
Machine prevents remember that in the book, it says you
blood mixing

RN JUNE 2016 OR BUST IT BABY! Good Luck! 11

have to use a filtering needle first to draw -remove metal/plastic cap from rubber seal
the fluid! and take it out when first preparing vial for
use.
Vial label: specifies solvent/diluents used to
dissolve dry medication & amount needed
As you can see, particle to prepare a desired medicine
contamination may be reduced by concentration.
using an in-line filter and filter Two chambers: has diluents and dry
needle to withdraw drugs from glass medication. Push on upper chamber to
ampoules prior to administration. dislodge the rubber stopper and allow
powder and diluent to mix
Also, imagine if you -vials are closed system.
have to break 100 - inject air before aspirating fluid to create
ampules in like 1 hour. vacuum needed to get medication to flow
You might need an into syringe
ampule breaker so that
your delicate hands will 31. NEDDLE: SIZES GAUGE
still feel soft when you cross hands with your 16-26
boyfriend. gauge is opposite of size
16 gauge is going to be
IN A NUTSHELL: Ampules: single doses of very big, while 26 gauge
injectable medication in liquid form. would be smaller.
Glass with a constricted neck. Snapped off Parts are bevel(slanted
to allow access to medication tip), shaft, and hub (the other end
-medication is easily withdrawn from the connected to injection)
ampule by aspirating fluid with afilter needle Children and thin adults needs smaller
and syring. needle
Filter needles must be used when preparing
medication from a glass ampule to prevent 32. NEEDLELESS CANNULA FOR USE WITH IVS:
glass particles from being drawn into -prevents incidents of sharps, connected to
syringe. IV tubing
30. VIAL -mandated by federal law, its for access
- single dose or multidose plastic glass and value
container with a rubber
seal at top. 33. OSTOMY BAG
If opened, discard it - prevents infection and skin
regardless of amount used. breakdown at site of ostomy
- Several doses and can be -clears out waste from
entered several times. Write intestine.
date when vial is opened on label. Skin must be dry and make
- can have different forms of medication sure skin doesnt leak
inside: liquid, dry and drugs stoma pouching system effluent poop
-closed system: you must inject air into vial -bag should be pointed to patients knees
to permit easy withdrawal of solution while sitting
- for injections: you put air before you draw it Stoma: opening in the abdominal wall for
out fecal or urinary elimination as a result of
diseases like cancer, infalmmatory bowel,
FYI, ampules are cheap to diverticulitis.
produce, so they are still Effluent: output (poop)
manufactured even though they Colostomy: opening in large intestine or
can be placed in vials. colon

Verify with agency how long it can be used.

RN JUNE 2016 OR BUST IT BABY! Good Luck! 12

Fecal effluent vary depending on where
opening in colon is created
- in descending or sigmoid colon which will
have a normal poop
If in ascending or transverse colon: poop is
thick liquid to semiformed stool.
Ileostomy: effluent is watery to thick liquid
and has digestive enzymes
Urostomy (ileal conduit) transplanting
ureters into closed-off portion of intestinal
ileum
They actually call this a Christmas Tree! Ho
Ureters are Implanted through mucosa.
ho ho!
-has pouch to collect effluent
35. PULSE OXIMETER
Irrigation in descendign colostomy: bowel
-measures pulse and oxygen
movement will be regulated so person
saturation of arteries
would be able to wear a small pouch or
- lead light directed to
stoma cap for stoma that would contain
hemoglobin and non-
gas or small amounts of stool.
hemoglobin oxygen and
reflects back onto device.
Patient-Centered Care
For adults: toe, fingers, nose, and ear
-in pouching system, a secure seal is placed
Children: palm and foot; detects hypoxemia
to prevent leakage of effluent and protect
- This can NEVER be 100% because the lungs
skin around stoma to help patient resuem
also need to be supplied with blood that is
normal activites.
outside the O2-CO2 gas exchange. The
Safety: proper stoma placement to reduce
blood drains into the LEFT chamber of the
risk of poor stomal healing, skin irritation and
heart, so it mixes with the oxygenated
impaired skin integrity.
blood. Basically, if the O2 Saturation is 97%,
-filter absorbs odor and does nto allow
the 3% is from the unoxygenated blood form
leakage of liquid effluent through filter.
lungs that mixes with the fresh O2 blood in
-pouch is worn for 3 to seven day
heart.
depending on countours of stoma
37. YANKHAUER SUCTION CATHETER
- suction oral cavity left by bend and even
patients can do it themselves, rigid hollow
34. OXYGEN FLOW-METER:
tube, metal disposable plastic which sucks
-measured in liters/minute. Correct measure
oral cavity
when ball is in middle of the mark
Prevents hypoxemia
Examples are nasal cannula, rebreather
mask, simple mask, non-rebreather mask
-give more than 21% room oxygen
- rates up to 90% plus of oxygen
If patient has COPD, dont give a lot of
oxygen ( check drs order! Because Oxygen
is their drive to breathe!
38. NASOGASTRIC TUBE
inserted into stomach to decompress
stomach, to keep it empty until normal
peristalsis returns.
- pliable tube inserted through patients
nasopharynx into stomach.

RN JUNE 2016 OR BUST IT BABY! Good Luck! 13

-tube is hollow ( to allow removal of gastric
secretions and introduction fo solutions into
stomach )
- softer small-bore feeding tube: enteral
feedings
Levin tube: single lumen with holes near tip.
Connected to a drainage bag or suction
device to Get stomach secretions.
Salem sump tube: PREFERABLE for stomach
decompression.
2 lumina: for removeal of gastric contents
and one to provide air vent ( to prevent
suctioning of gastric mucosa into eyelets at
distal tip of tube)
blue pigtaiil in airvent: connects with second
lumen
-when main lumen of sump tube is
connected to suction, air vent permits free,
continous drain of secretions.
-patients may exp burning sensation as tube
passes through sensitive nasal mucosa.
-nose and mucosa may get inflammed and
excoriation.
-keep nose lubricated and clean and
mouth care to minimize dehydration from
mouth breathing.
-insert nasogastric tube with curved end
pointing downward
-aspirate gastric contents and CHECK PH of
gastric contents
-tape must be crossed over around
nasogastric tube.
-Best way to verify and most accurate is
through x-ray
RN JUNE 2016 OR BUST IT BABY! Good Luck! 14
39. SCD: Sequential Compression Devices
Prevents vein and valve problems in legs.
It goes up to legs sequentially every fifteen
seconds
-pump mimics muscle contractions feels
like a massage
Apply sequential compression stockings if
ordered, & must be applied first thing in the
morning!
Rationale sequential compression
stockings promote circulation by
sequentially compressing the legs from the
ankle upward. This will improve venous flow
and reduce swelling.
40. STAPLE REMOVAL SET
- doctors order to remove staples. Stainless
steel, and removed every other one after a
week ( 7-10 days after surgery), scissor style,
tweezer style, sterile and never shared
41. STERI-STRIPS USED ON INCISIONS
-after removal of staples. Holds the skin in
place and offers protection. Falls on their
own. Slim adhesive strips, securely holds
small wounds. Reduces scarring & prevents
macerations
42. SUTURE REMOVAL SET
forceps, scissors, gauze or
staple remover, forceps, scissors,
staple remover for staples. Ordered by
doctornake sure healing took place
-never pull exposed surface out of dermis or
snip both ends of suture
REMOVING SUTURES AND STAPLES
-sutures: used to close a surgical incision
both within tissue layers in deep wounds and
for outer skin layer
Deep sutures: material absorbed or an inert
wire that remains indefinitely
Nonabsorabble sutures: require removal.
Removable skin sutures: interrupted or
continuous
Interrupted sutures: separate stitches, each
with its own knot
Continuous suture: one long thread that
spirals along entire suture line at evenly
spaced Intervals
Blanket continuous suture: spirals along
incision with each turn pulled over to one
side
-looped around thread of previous stitch
before making next turn in spiral
Retention sutures: for obese abdominal
surgery. Has rubber tubing to provide
greater strength
Staples: stainless steel, quick to use, and
provide ample strength. Used for skin
closure of abdominal incisions and
orthopedic surgery when appearance of
incision is not critical
-timing of removal is based on stage of
incisional healing and extent of surgery
-sutures and staples generally are removed
within 7 to 10 days after surgery if healing is
adequate
-Timing removal is important. Always
consider how theyll remain in place to
ensure initial wound closure with enough
strength to support internal organs and
tissues
Separation? Remaining sutures must be left
in place and must be documented and
reported to health care professional.
Steri-strips: applied over incision to provide
support after sutures are removed. It
supports wound by distributing tension
across it.
-NOT removed and are allowed to fall off
gradually.
-staple extractor are placed under the
staple.
-nurse must cut suture as close to skin away
from the knot
43. PYXIS
-new type of system
where nurse will
have to put in med,
id password to get
any medication
seed-capsules
pouch that contains
seeds/medicine
Always consider MAR (Medical
Administration Record) and 10 rights of Med
admin
-purpose is safe medical acess and
accountability with controlled substances
without waiting for pharmacy
-It is like a vending machine, but its purpose
is more of related to billing.
44. IV INFUSION PUMP
-Set to ml/time used often now
instead of gravity iv infusion
Delivers via positive pressure
-Seen in ICUs, & used to deliver
drugs like heparin, where you have
to be very accurate.
-calculates IV drip rates based on
weight, med ordered,
concentration that is put into smart
pump. cardiac in nature, and
double checks whats handled.
-smart pump is only as smart as the
nurse even though it has alert
systems.
PCA PUMP: used for patient controlled
analgesic pump so patient can determine
how much drgus to put into body . there is a
secure part so cant administer too much.
Nurse must monitor it!
-This is for IV pain medication like narcotics (
oxycodone, etc)
-An interactive method of pain
management that permits patient control
over pain through self administration of
analgesics.
-Useful for acute & chronic pain
- Patient depresses button on PCA device to
deliver a regulated dose of analgesisc.
-Subcutaneous and IV, but includes epidural
oral and transdermal.
Nurse-controlled analgesia: nurse caring for
patient depresses button after first assessing
patient. PCA by proxy
-May be electronic or noneelctronic
consisting of infusion device, prefilled drug
reservoir and tubing that delivers meds from
infuser thru pt-control module to tubing
connected to pts IV line.
FCA: family-controlled analgesia for kids
RN JUNE 2016 OR BUST IT BABY! Good Luck! 15
-Prevents overdose by having a
preprogrammed delay time or lockout
between pt-initiated doses.
Advantages of PCA: allows a more constant
serum levels of opiod and avoids PEAKS and
THOUGHS of a large bolus
-better pain relief
- reduce complications after surgery
because earlier and easier ambulation
occurs as a result of effective pain relief.
-total no. of opiod use can be reduced. It
allows patient to manage pain with minimal
nursing intervention.
EPIDURAL PUMP: for lose all
feelings abdomen down and
needs an anesthesioloiogist
to put into body. Nurse must
monitor
45. VITAL SIGNS MONITOR
(DYNAMAP): temp, respirations, pulse, bp,
pain, and oxygen saturation
-uses finger
46. VITAL SIGNS: DOPPLER ULTRASOUND:
monitors your vital signs with an ultrasound
so you can monitor blood flow primarily.
Gives a sound of blood flow insid ebody
47. TROCAR: CHEST TUBE INSERTION: pointed
metallic bar to guide chest tube into chest
48. SYRINGE 3 CC: small 3 ML syringe for
inserting medication. Choose smallest
syringe. 3 ML luer lock marked in tenths
49. SYRING TB 1 ML: very small syringe for
inserting very small meds or for inserting TB
dosage to test for TB . all are subcut
because it cant even go that far in. marked
in hundredths or doses of less than 1 ML
1 mm ( TB) tuberculin syringe
50. SYRINGE INSULIN 30, 50, 100 U insulin
administration
-use the smallest syringe possible.
-marked in units for low dose. Holds up to 0.3
to 1 mL
SHOULD I MASSAGE AFTER ADMINISTERING A
SUBCUTANEOUS INJECTION?
You can massage, theres no
contraindication for it for insulin
or for most subcutaneous
medications, since massaging in
the subcutaneous route
increases the absorption.
EXCEPTION: LOVENOX (ENOXAPARIN). The
Low Mol Weight Heparin. DO NOT MASSAGE
in injection site. EVER. And it can only be
administered in the love handle parts of
the body- the abdomen!
INTRAVENOUS
THERAPY
IV device is an
invasive procedure
a nurse can perform
which can put a
patient at risk for
infusion therapy.
Assess a patients a & p of circulatory
system, fluid and electrolyte balance,
patho, etc just to ensure safe delivery of
infusion solutions or
medications
Goal of IV therapy:
maintain and prevent
fluid and electrolyte
balance, administer
continuous or intermittent
med, replenish blood
volume, and assist in pain management.
-Support safe, efficient safe and quality
care when providing IV therapy.
Patient Centered Care
Prepare patient when preparing a
peripheral IV device to help alleviate fears
associated with infusion therapy.
-always appear confident, speak directly to
patient to ensure his privacy, and answer
questions as directly and honestly. Establish
rapport
-have patient breathe in and
out slowly, avoid looking at
catheter during insertion, focus
on pleasant image or past exp.
- providing culturally
competent care
RN JUNE 2016 OR BUST IT BABY! Good Luck! 16
Safety Always verify specific agency policy re:
Insertion of a peripheral shrot IV device, the specific procedural requirements ebfore
potential to incur needlestick injury or be transfusion.
exposed to a bloodborne pathogen is a - orders to transfuse
concern. should always include
Needlestick Safety and Prevention Act: which component to
requires employers to identify and make use transfuse and duration
of effective and safer medical devices. of the transfusion
-all devices should have sharps injury -blood single unit of
protection mechanisms that should be whole blood or
activated before disposal components should be infused within a 4-
-self-sheathing mechanism that covers hour period.
needle tip once catheter is placed or a -order or sequence of transfusion should be
spring action mechanism where needle is specified.
retracted into a protective housing after -Transfusion products match the recipients
catheter is inserted. blood as closely as possible.
-using rigid sharps disposal containers is an Patients blood type and Rh factor must
additional method for sharps injury always be verified to be compatible with
prevention . it should be the donor transfusion
disposed in appropriate - be aware of transmission of infectious
containers. diseases through transfusion of blood
EBP: administering products.
infusion solutions and - blood therapies treat and restore
medications can reduce hemodynamic or provide treatment for
risk of infusion-related diseases related to coagulation
complications deficiencies.
Infusion-related -blood transfusions must be
complications= poor initiated within 30 minutes
infection control after release from
practices laboratory
-serious infectious complications produce -always require 2 witnesses
morbidity because of frequency with which and some form of patient
catheters are used. identification.
Y-Tubing: prevents blood
TRANSFUSION OF product from entering NS bag.
BLOOD Close NS clamp above filter and OPEN
PRODUCTS: clamp above filter to blood product, so
- Transfusion of blood will flow into drip chamber.
blood and its YOU GUYS CAN DO THIS! JUST KEEP YOUR
components is a FAITH STRONG!
major factor in

restoring and maintaining

quality of life.
-caring for patient
receiving blood or blood
components is a nursing
responsibility which is
closely regulated and
monitored.
-collection of donor blood, distribution of
product and standards for transfusion.

RN JUNE 2016 OR BUST IT BABY! Good Luck! 17