A-Z Procedures and Keypoints A 1.

Abdominal Paracentesis -have client void first -observe signs of hypovolemic shock (pallor, dyspnea, diaphoresis, drop in BP 2. Antiembolism stocking -apply before getting up of bed -if pt has been walking, ask her to lie down and elevate his legs for 15-30 minutes before applying the stocking Check toes at least every 4 hours 3. Arthroplasty -assess neurovascular status, administer anticoagulant therapy -for total hip replacement-dont flex the hip more than 90 degrees (prosthesis might dislocate) B 4. Bandaging -assess adequacy of circulation -avoid putting strain on ligaments . -bandage from distal to proximal with even pressure 5. Bladder Irrigation -check for inflow and outflow lines for kinks to make sure the solution is running freely -measure the volume of fluid accurately Assess outflow for blood clots 6. Blood transfusion -have two nurses check name and order bank number, expiration date, evidence of contamination, patients identification band and ask name. -infuse only 10-15 ml during 1st minutes to evaluate for any possible transfusion reaction 7. Bone marrow biopsy -direct pressure on site for 5 to 10 minutes after needle is withdrawn to prevent bleeding 8. Bronchoscopy -npo until gag reflex returns 9. Buccal administration -sublingual- under the patients tongue -tell not to smoke before dissolves, caution against chewing the tablet or touching with his tongue C 10. Cardiac catheterization -report any chest pain when dye is injected. -no aspirin 7 days prior to the procedure -report for absent peripheral pulse at leg used 11. Cast -monitor for complications; compartment syndrome, infection, swelling, and skin breakdown. -Handle cast with palms or flats of hands. NO FINGERTIPS -dont use lotions, creams, oil. Use alcohol around the edge of the cast . No powdersand no objects should be inserted inside the cast. Instruct to keep the casted limb above the heart level to minimize swelling 12. Catheter and tubes -saline is NOT used to inflate balloon because it may crystallize and prevent deflation -keep collection bag below the bladder at all times 13. cervical collars

-check neurovascular status before and after application 14. chest physiotherapy -avoid performing postural drainage immediately before or hours after meal -after the procedure instruct the client to cough to expel secretions -Provide oral hygiene 15. Cholecystectomy -ask for allergy to iodine and seafood. 16. cold application -observe for untoward side effect like bluish purple appearance and feeling of numbness. -contraindicated to rheumatoid arthritis, raynaulds phenomenon and buerguers disease. 16. chest tube -never clamp longer than 2 minutes. -if disconnected. Place end of tube in bottle with 2 cm of water or clamp tube close to patient. -wipe end of chest tube and drainage tube with an iodine based disinfectant and reconnect -suction control chamber should bubble vigorously -water seal chamber should not bubble, but water in chamber should fluctuate w/ respiration. 17. circumcision -do not remove the thin, yellow white exudates that forms over the healing area. -dont discharge the neonate until he has voided. 18. colostomy -avoid gas forming foods (cabbage, onions, alcohol, beans, broccoli, asparagus) and high fiber items (nuts, corn, popcorn, celery) that have potential to obstruct the ostomy. -prior to first irrigation, gently insert gloved finger into stoma to note direction of the colon 19. CT scan -check if patient is allergic to iodine or shellfish. -remove jewelry and other metal devices. 20. Credes treatment -1% silver nitrate or 1% tetracycline. Or 0.5% erythromycin -apply from the eyes inner canthus to its outer cantus 21. Cystoscopy and urethroscopy -report clot and blood after procedure D 22. digital removal of fecal impaction -position the client in his left side and flexhis knees to allow easier access to the sigmoid colon and rectum. If patient experiences pain, nausea, rectal bleeding, changes in pulse rate or skin color, diaphoresis, or syncope, stop immediately and notify the doctor. E 23. ear drops -solution should be at room temperature. -contraindicated for rupture of tympanic membrane. 24. ear inspection -below 3 years old- pull auricle downward and backward -above 3years old- pull auricle upward and backward.

25. ear irrigation -recheck temperature of irrigant if you observe for signs of pain or dizziness during irrigation -never use more than 500 ml of irrigant -avoid squirting irrigant if you observe for signs of pain or dizziness during irrigation. 26. EEG -remove all metals, coins, jewelries, free from side rails 27. Electroencephalography (EEG) -no caffeine prior to test -withhold drugs that may interfere with test results For 24-48 hours before test.(anticonvulsants, sedative-hypnotics, antianxiety and anti depressants.) -have suction equipment and diazepam for IV injection available. 28. elimination -bedpan should be warm and dry. Raise head of the bed if possible, provide privacy 29. eye care -gently wipe the patients eye with moistened cotton ball, working from the inner canthus to the outer canthus F 30. Feeding -encourage and allow for independence -upright position to avoid aspiration -do not feed too quickly -if patient is restricted to supine position, feed him liquids carefully and only after he has swallowed any foods in his mouth to reduce risk for aspiration. 31. Fluid I&O monitoring -measure in ml, do not estimate, all liquids coming from tubes, mouth ,IV,GUT, GIT and drainage. 32. Foot boards -use pillow along side each foot to maintain 90 degree alignment 33. foot care for diabetic client -teach how to inspect skin for signs of ulcers, blisters, cuts, swollen areas. -trim nails by cutting straight across G 34. Gastric lavage -never leave patient alone during gastric lavage, observe continuously for any changes in his level of consciousness -keep tracheal suctioning equipment nearby 35. GI series -upper- give laxative after to prevent constipation from barium -lower- have patient breath deeply and slowly to reduce abdominal cramps while barium dye is instilled. 36. Glucose and haemoglobin testing - avoid using ring bearing finger and to ensure adequate blood sample, dont use cold, cyanotic or swollen area as a puncture site. H 37. Handling of chemotherapeutic drugs -wear protective garments, dont eat, drink, smoke or apply cosmetics in the drug preparation area, consider all equipment used as hazardous. -to break ampoules, wrap it with sterile gauze pads.

Label all chemo drugs with a chemotherapeutic hazard -change gloves 30 minutes, when workingsteadily. -provide male patients with a urinal with a tight fitting lid 38. Handwashing -3 elelments-friction, soap and water -remove rings or false nails. Pat dry dont rub 39. Heimlich maneuver -inward and upward thrust 6-10 minutes 40. Hemodialysis -dont use arm with graft/fistula for BP taking. Patency is assessed by hearing bruit over shunt and palpating thrill/ -anticoagulant are added to solution to prevent clotting 41. heparin infusion -no aspirin I 42. Incentive spirometry -evaluate the clients ability to cough effectively and encourage him to cough after each effort. Instruct patient to exhale normally then inhale slowly and as deep as possible, retain entire volume inhaled for 3 seconds. 43. Installation of drugs through a nasogastric tube -before installation- check tube patency -stop procedures if resistance is felt or any sign of discomfort. 44. Instilling nose drops -position: head tilted back into nostrils for at least 5 minutes. -instruct to breathe through mouth 45. insertion of vaginal medication -patient must remain lying down -refrigirate medications if it melt at room temperature 46. intradermal injections -needle at 15 degree angle. -do not massage -circle the site with ball pen. 47. intravenous pyelogram -increase fluids top clear dye and prevent renal failure and reaction Intramuscular injections -use vastus lateralis for IM injection for infants at 90 degree angle -aspirate- if blood appears, withdraw needle. Do not massage L 48. Lumbar puncture -empty bladder and bowels prior to procedure. -lie still and report in lower extremities -lie flat for 4-6 hours after procedure -monitor changes in neurologic status after procedure M 49. MRI -screen for metals inside patient (prosthesis, pacemaker.. etc.., Bulitas in males) 50. Mechanical ventilation -positioning, turning, range of motion, safety,

-call light within clients reach -neuromuscular blocking agent (pavulon) and sedatives 51. Mist tent therapy -allow toys for distraction (but not stuffed toys or any battery operated toys. -prohibit smoking near mist tent N 52. Nasal cannula/ nasal prongs -indicated for COPD/hypoxic drive who need low flow oxygen at 2-3 liters per minute. -lubricate nares. Do not use petroleum jelly Place oxygen precaution sign over patients bed. O 53. Over bed trapeze -be sure to hang trapeze within the clients easy reach so he wont need to strain to reach it P 54. pacemaker -teach the signs of pacemaker failure: heart rate less than 60, light-headedness, dizziness or syncope. 55. papanicolau test -no douching for 48 hours -void before test and relax -warm speculum, lubricate with water only -remember to unlock before removal 56. patient transfer (bed to wheel chair) -place wheelchair parallel to the bed, facing the foot of the bed and lock its wheels. 57. perineal and genital care --female- wipe from front to back in a downward motion. -use different corner of the wash cloth or a different cotton ball for each downward stroke, use universal precautions. --male- if not circumcised, retract foreskin carefully to expose the glans penis. 58. peritoneal dialysis -installation time:10 minutes, dwell time 45 minutes, drainage time 15-20 minutes. -Warm dialysate to prevent hypothermia Use aseptique tecnic Weight patient daily 59. post mortem care -fill out identification tag (name, room and bed number, date and time and doctors name) Tie tag on pt hand or foot 60. Postural drainage and chest physiotherapy -lung area to be drained should be lower than the other parts of the chest . with patient lying on the opposite side. 61. pulse oximetry -no false fingernails and nail polish from test finger -for infants, wrap probe around foot -normal SaO2 levels for ear and pulse oximetry are 95-100% R 62. Radiation implant therapy -place lead lined container and long handled forceps in room, safe line on the floor left from the patient, warn visitors to keep clear of the patient to minimize their radiation exposure, use lead shield, place tracheostomy tray if implant will be inserted in the oral cavity or the neck.

3 principles: distance, time, shielding 63. radioactive iodine therapy -for thyroid cancer -no pregnant and minor visitors -sexual intercourse may resume after i week of treatments. 64. rectal examination -allow rectal sphincter to relax prior to insertion of finger. 65. rectal suppositories or ointments -contraiondicated to to pt. With cardiac arythmias (vagal nerve stimulation) -left sims position -inserted 30 minutes before mealtime -instruct that it May discolour the bowel. 66. regular insulin and NPH insulin (RN) -inject clear (regular insulin) into cloudy(NPH) S 67. shaving -to the direction of the hair 68. sigmoidoscopy -liquid diet or small amounts of food for previous 24 hours 69. sonograms -abdominal and pelvic sonograms- needs full bladder. 70.Sputum collection -first sputum in the morning is the best sample. -rinse mouth before obtaining sample. 71. stool specimen -void first before specimen collection. -do not place tissue paper in bed pan. -test for steatorrhea- collect all stool expel. -detecting presence of microbes- small amount ,aseptique technique. -Guaiac test or occult blood- blue color indicates positive result -no meat, raw vegestables, or fruits and vitamin C. 72. suctioning -apply suction no longer than 10 seconds, suction only during withdrawal of catheter. -5-10 seconds is the allowed time. -allow 20 seconds between suctioning passes 73. suture removal -removed after 7-10 days after insertion. -suture on head and neck-3-5 days after insertion -5-7 days on chest and abdomen. T 74. Thoracentesis -not to cough while needle is inserted. (to avoid puncture of the lungs) 75. Total parenteral nutrition -x-ray before induction of solution -check allergy to eggs and fats -never administer meds on TPN line -fats solution need in-line filter for delivery -dont change rate or slow without order 76. tracheostomy -emergency equipment at bedside: extra tracheostomy set. Kelly clamp, suction machine. 77. tube feedings -check placement b4 feeding

-replace aspirated content to prevent metabolic alkalosis. -always elevate head during feedings -dont crush or give enteric coated meds via tube. Look for liquid replacement. U 78. Urine collection -midstream- throw away first 30-50ml 0f urine, then collect. -indwelling catheter- clamp tubing distal to collection port for several minutes. Unclamp after procedure -urine is good only for 2 hours if unrefrigerated. 79. urine collection from catheter -30 minutes before collecting, clamp the drainage, insert the needle to sampling port, never insert the needle into half of catheter, make sure to unclamp drainage tube after procedure. W 80. Wound care and wound colors -red wound- normal healing, cover, keep it moist and keep and protect from trauma -yellow wounds- clean using high pressure irrigation, cover with moist dressing. Black wounds- signal necrosis, debride, apply moist dressing and guard against external contamination -multicolored wounds- classify the wound according to least healthy color present. -reinforce dressing change. -antiseptic should not enter the wound No alcohol for perineal wound.