Clinical Nursing Exam 2

1. Subcutaneous administration usually the slowest because the tissue has decreased vascular perfusion 2. Intravenous administration the quickest because it reaches the systemic circulation immedi- ately 3. Parenteral medication medication that is NOT given via digestive tract (oral/rectal admin- istration) 4. FVRCP right fore limb 5. Rabies right rear limb 6. FELV left rear limb 7. DA2PP right fore limb 8. Bordetella Injectable left rear limb 9. Bordetella Intranasal bilateral nares 10. Bordetella Oral buccal cavity 11. Intramuscular (IM) into the muscle 12. Intraperitoneal (IP) into the peritoneal (body cavity) space 13. Subcutaneous (SQ) under the skin 14. Method of Subcutaneous (SQ) tent skin and insert needle gently 15. Intravenous (IV) into the vein 16. Method of Intravenous (IV) -occlude vessel with tourniquet or digital pressure -remove any air bubbles from sy- ringe -swab hair/skin with alcohol -insert needle, wait for flash of blood -release tourniquet/digital pres- sure -inject drug -apply pressure to prevent bleed- ing 17. Method of Intranasal (IN) -close muzzle and elevate head -dispense medication on the plane of the nose -allow medication to run into both nostrils as patient inhales (mini- mal sneezing) 18. Location of Sciatic Nerve 19. Injection Sites 20. Needle Gauge 18, 20, 22, 25 (diameter) 21. Needle Length 1 inch, 1.5 inch 22. What is the appropriate needle size for IM, SQ, & IV injections in adults? 23. What is the appropriate needle size for SQ injections of fluids in adult dogs & cats? 22-20 gauge 18 gauge 24. What is the appropriate needle size for IM, SQ, & IV injections in juveniles? 25 gauge 25. Standard needle size for adult cats 22 gauge, 1 inch 26. Standard needle size for adult dogs 20-22 gauge, 1-1.5 inch 27. Needle size for Juveniles/fragile veins 25 gauge, 1 inch 28. small animal IP injection site at the level of the umbilicus, to the right/left of the midline 29. Reasons for performing venipuncture -collect blood samples -inject drugs & medications -place IV catheters 30. Stress during venipuncture can ele- vate which lab values? 31. Sampling Techniques -leukogram -cortisol glucose -it is NOT necessary to clip the hair before most types of blood sampling, but swabbing the area with alcohol is recommended to remove superficial skin, and dila- tion of the vessel to improve visu- alization of the vein. 32. Jugular Venipuncture -most common site for drawing large amounts of blood - 6 to 10 cc -sitting restraint w/ control of the head -apply pressure with the thumb over the thoracic inlet -avoid compressing the trachea 33. Cephalic Venipuncture -2nd most common site for draw- ing moderate amount of blood -1st choice for administering IV in- jections -good restraint of the head is re- quired -extend the chosen forelimb by pushing the olecranon forward -sternal/lateral recumbency 34. Lateral Saphenous -alternative access for IV injec- tions in dogs -blood sampling in small volume to avoid risk of vein collapse -minimum of 30 secs of digital pressure to prevent hematoma formation -lateral recumbency -restrainer grasp the upper leg at the stifle with one hand, applying pressure to occlude and distend the vein, while the other hand is controlling the head -tech controls leg at metatarsus level with one hand while perform- ing venipuncture with the other hand 35. RULES TO REMEMBER -vaccines are NEVER given IV -minimum of 30 sec pressure to prevent bleeding/hematomas 36. Serum Separator (Tiger Top) -clot activator & gel separator -used for chemistries 37. Red Top #1 -clot activator -used for chemistries & therapeu- tic drug monitoring 38. Red Top #2 -no clot activator/additive -used to transport separated plas- ma/serum, urinalysis, culture 39. Anticoagulant an agent that is used to prevent the formation of blood clots 40. EDTA-Lavender Top -anticoagulant EDTA -used for CBC 41. EDTA ethylenediaminetetraacetic acid 42. Lithium Heparin- Mint Green Top -gel separator -used for STAT chemistry tests -requires centrifugation -WHOLE BLOOD for special tests 43. Sodium Heparin- Dark Green -no gel separator -used for STAT chemistry tests 44. Sodium Citrate-Blue Top -anticoagulant Sodium citrate -used for clotting profiles 45. Partial Thromboplastin Time (PPT) measures the time that it takes for a fibrin clot to form after calcium and an activator are added to a blood sample 46. Prothrombin Time (PT) measures the amount of time it takes for a fibrin clot to form af- ter calcium and a tissue-activating factor are added to a blood sam- ple 47. Glucose-Grey Top -sodium fluoride (stabilizer) & potassium oxalate (anticoagulant) -used for glucose levels & special chemistries 48. Plasma contains clotting factors 49. Serum blood plasma, but lacks clotting factors 50. Order of the Draw 1. light blue - clotting tests 2. red top - no additive 3. tiger top - serum separator 4. green - heparin 5. lavender - EDTA 6. gray - glucose 51. Purpose of IV catheters -medication, fluids, nutrients, blood products -monitor blood pressure and to collect blood samples 52. Winged Tipped (butterfly) Infusion Catheters -IV medications -pediatric SQ fluids -not for long-term fluid therapy 53. Over the Needle Peripheral Catheters -most common used in vet med -peripheral vein catheterization -constant rate infusions -total parenteral nutrion -drug administration -cephalic & medial/lateral saphe- nous 54. Through the Needle (PICC) -primarily in jugular vein -constant rate infusion -total parenteral nutrition -frequent blood sampling -fluid with osmolality 55. Multi-Lumen Catheter -multiple drug and fluid adminis- tration -total parenteral nutrition -multiple blood sampling 56. IV Catheter Maintenance -dressing should be removed and catheter inspected every 48 hours -monitor for signs -inflammation -infection -swelling -thrombosis -flush with heparinized saline 57. Catheter Complication -line won't flush -blood clot -catheter is out -patient chewed IV line 58. Urinary System -two kidneys -two ureters -urinary bladder -urethra 59. Free Catch -non-sterile -most common -collection of urine as the animal urinates 60. Bladder Expression -non-sterile -least common -avoid in trauma patients due to possibility of ruptured bladder 61. Catheterization -sterile -less common -requires an aseptic technique -insertion of catheter through ure- thra into the bladder (male K9/Fel) -lateral recumbency 62. Cystocentesis -sterile -most common -inserting sterile needle into blad- der through ventral abdominal wall 63. Feline Lower Urinary Tract Disease (FLUTD) -dysuria -pollakiuria -hematuria 64. Normal Urinary Output for Canine & Feline -periuria -stanguria 10-20cc per pound per day OR 1-2cc per kilogram per hour 65. Urinalysis an array of tests performed on urine and is one of the most com- mon form of diagnosing a patient other than blood work 66. 4 part Process of a Urinalysis 1. visual exam 2. biochemical analysis 3. specific gravity analysis 4. sediment examination 67. Visual examination -color, clarity, odor, volume -normal=light amber color, clear, characteristic odor 68. Biochemical Analysis -urine test strips -aka "dip" sticks -test results are read as color changes 69. Biochemical Testing (dip sticks) used to detect substances that may have passed into the urine as a result of damage to the nephron or overproduction of spe- cific analytes (substance under- going analysis) 70. Reagent Test Strips (dip sticks) -test pad change color during re- action -color is compared to the chart on test container 71. Protein -normal in low numbers -proteinuria can occur with fever/strenuous exercise -alkaline/acidic urine can lead to erroneous results -more sensitive to albumin -causes of proteinuria: hemor- rhage, inflammation in UT 72. pH -measure of H concentration -urine pH reflects acidosis/alkalo- sis -NORMAL pH OF DOGS/CATS: 5.0-7.5 73. Glucose -normal urine DON'T contain glu- cose -glucosuria occurs when the tubules can't reasbsorb glucose from the ultra filtrate -blood glucose when exceeds re- nal threshold: K9 180mg/dl FEL 300mg/dl -causes of glucosuria: stress, dia- betes 74. Ketones -ketonuria -metabolic disorder involving in- creased lipids -impaired carbohydrate metabo- lism -starvation -impaired liver function -SENSITIVE, urinalysis must be performed ASAP 75. Bilirubin -brownish-yellow substance found in bile -produced when the lier breaks down old RBC -male dogs have small amount of bilirubin in urine samples -causes of bilirubinuria: hemolyt- ic diseases, hepatic insufficiency, obstruction of bile flow 76. Blood (heme) -bacterial infection -calculi -trauma 77. Urine Specific Gravity Analysis measures the concentration of dissolved materials in urine with the use of a refractometer 78. Sedimentation Analysis -urine is spun in centrifuge -cells/crystals/casts examined -may/may not be stained -requires 5-10mL fresh urine 79. How much urine is required for a sedi- ment analysis? 80. How long should urine be centrifuged and at what speed? 81. Erythrocytes (cell) 82. Leukocytes (cell) 5-10mL rpm for 5 minutes 83. Squamous Epithelial Cells -thin & flat w/ angular borders -largest of 3 epithelial cells 84. Transitional Epithelial Cells -round/oval/caudate (tail) -dense nucleus -may occur in clumps (catheteri- zation) 85. Renal Epithelial Cells -small & round (slightly bigger than WBC) -smallest of 3 epithelial cells 86. Cast Formation -originate in Loop of Henle -tubule shape 87. Hyaline [cast] -acellular -most common type of cast -cylindrical & clear -difficult to visualize due to trans- parency -formed from low urine flow, con- centrated urine, or an acidic envi- ronment 88. Cellular Casts -contains WBC, RBC, Epithelial -erythrocyte cast=hemorrhage -leukocyte casts=inflammation 89. Granular Casts -acellular -course/fine -2nd most common of casts -indicates severe kidney damage 90. Waxy Cast -acellular -wide & smooth w/ blunt ends that may be broken off -results from low urine flow asso- ciated with severe, chronic kidney disease 91. Fatty Cast -formed by the breakdown of lipid-rich epithelial cells -hyaline casts with fat globule in- clusions -yellowish tan color -"Maltese Cross" sign is visible un- der polarized light when choles- terol is present 92. Crystalluria -the presence of crystals in urine -pH & specific gravity of the urine affects the formation of crystals 93. Calcium Oxalate - monohydrate -associated with "ethylene glycol" (antifreeze) toxicity 94. Calcium Oxalate - dihydrate -small squares with 'x' 95. Triple Phosphate (Struvite) -most common crystal in dogs/cats and those with urolithi- asis -formed in alkaline pH -"coffin lids" 96. Uric Acid (Urates) -formed in acidic pH -common in Dalmations and sometimes Bulldogs 97. Cystine -hexagonal, flat, colorless plates -form in acidic pH -associated with defective renal tubular reabsorption of certain amino acids including cystine -affects mostly male dogs -tendency to form uroliths 98. Bilirubin [sediment] -most common in canine urine -no clinical significance -needle-like appearance 99. Ammonium biurate -brown/yellow-brown spherical bodies, sometimes with irregular protrusions -"thorn apples" -neutral to alkaline urine -common in dogs/cats with con- genital portal vascular anomalies 100. Amorphous -acidic/alkaline, depending on type of crystal -aggregates of fine granular mate- rial -can be comprised of urates, phosphates, or xanthine -not clinically significant in small numbers -may be confused with bacteria 101. Bacteria -normal urine has NO bacteria present -contamination mat occur from the distal urethra and/or genital tract -cystocentesis preferred -WBC always present 102. Reasons for initiating fluid therapy -fluid deficits -electrolyte imbalance -acid-base imbalances 103. Fluid in the body either in a cell (intracellular) or out- side of a cell (extracellular) 104. The body is made up of water. 60% Total Body Water 105. TBW Extracellular Fluid Space 16-20% of Body Weight 106. TBW Intracellular Fluid Space 30-40% of Body Weight 107. Blood Plasma pale-yellow protein containing flu- id component of blood that holds the blood cells and platelets in suspension 108. Acid-Base Balance the regulation of hydrogen ion concentration in body fluid 109. Osmosis the tendency of a fluid, to pass through a semi permeable mem- brane into a solution where the solvent concentration is higher, thus equalizing the concentration of materials on either side of the membrane 110. Hypotonic solution -solution with higher concentra- tion of solute -pull water from the cell into the intravascular space -cell shrinks 111. Hypertonic solution -solution with a lower concentra- tion of solute -causes movement of water out of the intravascular space and into the cell -cell swells 112. Isotonic -solution with equal concentra- tions of solute -has no gradient for water move- ment -homeostasis (equilibrium) 113. Blood Volume for Dogs 80-90mL/kg 114. Blood Volume for Cats 40-60mL/kg 115. Blood Volume for Horses 80mL/kg 116. Assessing Dehydration -check patient's perfusion para- meters (HR, MM, CRT, Pulse quality, Extremities, Mentation) -skin tent 117. 3 general fluid types -resuscitation -dehydration replacement -maintenance 118. Categories the fluid types are broken down into -osmolality -maintenance/replacement solu- tions -balanced/unbalanced -purpose -blood products 119. Tonicity -ability of a fluid to change the shape of cells by changing their water content -determine the fluid distribution following infusion 120. Balanced Crystalloids -similar composition as plasma -ISOTONIC -replacement solutions -contains: sodium, chloride, potassium, calcium, lactate -Lactated Ringers Solution (LRS) -Normosol-R (Norm-R) -PlasmaLyte-148 121. Unbalanced Crystalloids -differs from the composition of plasma -not a good replacement/mainte- nance solution -5% Dextrose in water (D5W) -0.9% NaCl (normal saline) 122. Buffers -weak acids that resist change to pH -added to crystalloid solutions to neutralize strong acids b/c ac- etate, gluconate, and lactate are all metabolized to bicarbonate -lactate is found in LRS 123. Fluid Maintenance Rate Cats: 2-3mL/kg/hr (80 x BW) Dogs: 2-6mL/kg/hr (132 x BW)