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CCC4 exam 2/70 Questions and answers/100% Accurate
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CCC4 exam 2/70 Questions andanswers/100% Accurate
Infiltration (IV complication) - - area is swollen, tender, and cool to the touch
- Extravasation (IV complication) - - Infiltration of drugs that can damage
the tissues and cause necrosis and sloughing
Pain at the insertion site, tender, cool to touch,
- Phlebitis (IV complication) - - Vein becomes hardened, swollen, and tender
- IV site infection - - Hot, red, and painful. Purulent type drainage around
site.
- How to prevent IV infections - - KEEP EVERYTHING STERILE
-keep airtight dressing over site
-keep tubing free of air
-flush tubing before connecting to IV site
*put patient on I&O
- Normal Urine output - - 30 mL/hr
- Med allergies S/S - - - rash
-hives
-itching
-fever
-swelling
-SOB
-wheezing
-angioedema
-runny nose
- Med allergies treat - - -antihistamines
-corticosteriods
- Priority Intervention for Med allergies - - Airway
- When is mechanical needed? - - Acute respiratory failure
- Mechanical Ventalition complications - - -barotrauma
-oxygen toxicity
, -impaired cardiac output
-infection
-fluid retention
-gastric distention
-GI bleeding
- Prevention of Mech. Ventalition complications - - -manage airway
-endotracheal tube placement
- Nursing Care for Mech. Ventalition - - -keep tubing clear of pooled water
-check oxygenation status
-check for proper settings
- Assess ABCs
*if too much pressure alarm sounds to indicate the correct tidal volume is not
being delivered*
- Thoracentesis - - to remove pleural fluid, instill medication, or obtain fluid
for diagnostic studies
- Indications for thoracentesis - - with ultrasound guidance a large bone
needle is inserted through the chest wall into the pleural space and fluid is
withdrawn
- Thoracentesis positioning - - Sitting, facing the bed, leaning over bed table
with arms crossed.
- After thoracentesis nursing interventions - - -monitior respirations and skin
color
-chest radiograph is ordered after
-monitior vitals every 15 mins for 1 hour or until stable
- Thoracentesis findings to report to provider - - -rapid breathing
-cyanosis
-changes in breath sounds
-tachycardia
- Lumbar puncture procedure - - -to determine whether CSF pressure is
elevated to determine if there is a blockage to the CSF flow
-to inject medications
-to obtain fluid or chemical anaylsis and culture
- Lumbar puncture indications - - sterile procedure into the arachnoid space
between L3-L4 or L4 -L5 opening pressure is obtained and fluid is aspirated
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