CHEST TUBE THORACOSTOMY >A chest tube insertion involves the surgical placement of a hollow, flexible drainage tube

into the chest. >Drain blood, fluid, or air and to allow the lungs to fully expand. >Tube is placed between the ribs and into the space between the inner lining and the outer lining of the lung (pleural space). >Chest tubes are used to treat conditions that can cause the lung to collapse, such as: PNEUMOTORAX: Air leaks from the lung into the chest HEMOTHORAX: Bleeding into the chest CHYLOTHORAX: Collection of fat in the chest EMPHYSEMA: Lung abscesses or pus in the chest Risks from any anesthesia are: Problems breathing Reactions to medications Risks from any surgery are: Bleeding Infection Risks from the procedure itself: Accidental movement of the tube Buildup of pus (empyema) Improper placement of the tube--into the tissues, abdomen, or too far in the chest Injury to the lung or heart Injury to the spleen, liver, stomach, or diaphragm local or generalized infection from the procedure One-way chamber: gravity, not suction. 1 bottle for drainage and water seal. Two-way chamber: 1st bottle is drainage, 2nd is water seal; or 1st bottle is drainage and water seal, 2nd is suction control. Three-way chamber: 1st bottle is drainage, 2nd is water seal, 3rd is suction control. Nursing Care: -Do not kink tubing -Do not milk the tube -Maintain drainage system below chest level -Turn client frequently -Observe for fluctuation of fluid in tube (rise on inhalation, fall on exhalation) -Deep breathing and coughing every 2 hours. -Valsalva maneuver or strain when tube is withdrawn. Size of Chest Tube: Male: 28-32 Fr Female: 28 Fr Child: 18Fr Newborn: 12-1 Fr ECG A noninvasive test that is used to reflect underlying heart conditions by measuring the electrical activity of the heart. Measures: 1. Rate and rhythm mechanism of the heart.

2. 3. 4. 5. 6.

The orientation of the heart. Hypertrophy of the heart muscle. Damage to heart muscles. Impaired blood flow to the heart muscle. Abnormal electric activity When is an ECG (EKG) performed? Routine physical examination or screening evaluation. Cardiac exercise stress test. Evaluation of s/s of chest pain, SOB, dizziness or fainting, palpitations. As part of the preoperative workup for surgery in patients who may be at an age where heart disease could potentially be present.

1. 2. 3. 4.

What conditions may be diagnosed with an ECG (EKG)? 1. Abnormally fast or irregular heart rhythms. 2. Abnormally slow heart rhythms. 3. Myocardial infarction 4. Acute heart attack. 5. Acute impairment to blood flow to the heart 6. Systemic diseases (high blood pressure) 7. Lung conditions that affects heart (emphysema, pulmonary embolus) 8. Congenital heart abnormalities. 9. Abnormal blood electrolytes (potassium, calcium, magnesium). 10. Inflammation of the heart or its lining (myocarditis,pericarditis). SUTURING Absorbable-will break down harmlessly in the body over time without intervention. Polyglycolic Acid sutures, Polyglactin 910 , Catgut, Poliglecaprone 25 and Polydioxanone sutures. Nonabsorbable- must be manually removed if they are not left indefinitely. Polypropylene sutures, Nylon (poylamide), Polyester, PVDF, silk and stainless steel sutures. Natural sutures include silk and catgut sutures whereas all other sutures are synthetic in nature. The needle has 3 sections: >Point is the sharpest portion and is used to penetrate the tissue. >Body represents the mid portion of the needle. >Swage is the thickest portion of the needle and the portion to which the suture material is attached.

CATHETERIZATION A urinary catheter is a tube placed in the body to drain and collect urine from the bladder.

Urinary incontinence (leaking urine or being unable to control when you urinate) Urinary retention (being unable to empty your bladder when you need to) Surgery on the prostate or genitals Other medical conditions such as multiple sclerosis, spinal cord injury, or dementia

Catheters come in many sizes, materials (latex, silicone, Teflon), and types (Foley, straight, coude tip). A Foley catheter, for example, is a soft, plastic or rubber tube that is inserted into the bladder to drain the urine. TYPES OF CATHETERS: 1. INDWELLING URETHRAL CATHETERS -An indwelling urinary catheter is one that is left in the bladder attaching to a drainage bag. Use for short time, or a long time. With balloon inflated. 2. CONDOM CATHETER >Used in elderly men with dementia. It must be changed every day. 3. INTERMITTENT (SHORT-TERM) >Remove these catheters after the flow of urine has stopped. DRAINAGE: 1. Leg bag- worn during the day (300-500ml) 2. Down drain- attach to bed. 3. Belly bag- secure around the waist, 24/7. NURSING CARE: Cleansing the urethral area and the catheter itself. Disconnecting drainage bag from catheter only with clean hands Disconnecting drainage bag as seldom as possible. Keeping drainage bag connector as clean as possible and cleansing the drainage bag periodically. Use of a thin catheter where possible to reduce risk of harming the urethra during insertion. Drinking sufficient liquid to produce at least two liters of urine daily Sexual activity is very high risk for urinary infections, especially for catheterized women. LEAKAGE CAUSED BY: Catheter that is blocked or that has a kink in it Catheter that is too small Bladder spasms Constipation The wrong balloon size Urinary tract infections

POSSIBLE COMPLICATIONS Allergy or sensitivity to latex Bladder stones Blood infections (septicemia) Blood in the urine (hematuria) Kidney damage (usually only with long-term, indwelling catheter use) Urethral injury Urinary tract or kidney infections Call your health care provider if you have: Bladder spasms that do not go away Bleeding into or around the catheter Fever or chills Large amounts of urine leaking around the catheter Skin sores around a suprapubic catheter Stones or sediment in the urinary catheter or drainage bag Swelling of the urethra around the catheter Urine with a strong smell, or that is thick or cloudy Very little or no urine draining from the catheter and you are drinking enough fluids. COMPLICATIONS: 1. Tissue trauma and infection 2. Bacteruria 3. Renal inflammation, nephro-cysto-lithiasis, pyelonephritis if left prolonged. ABDOMINAL LAYERS: 1. Skin 2. Subcutaneous tissue 3. Fascia 4. Muscle 5. Peritoneum FOUR STAGES OF ANESTHESIA: 1. ONSET -administration >>> LOC. -drowsy/dizzy, auditory & visual hallucination. -close OR doors, keep room quite, standby. 2. EXCITEMENT -LOC >>> loss of eyelid reflexes -increase autonomic activity, irregular breathing, may struggle. -remain quite at clients side. 3. SURGICAL ANESTHESIA -loss of eyelid reflexes >>> loss of most reflexes and depression of vital fxn. -unconsciousness, muscle relaxation, decrease gag and blink reflex. -begin preparation in this stage. 4. DANGER -depression of vital fxn >>> respiratory & circulatory failure. -client not breathing, +/- heartbeat -if arrest occurs, assist in establishing airway, provide cardiac arrest tray, syringes, assist sugeon.

Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. PURPOSE: 1.Restore blood volume after hemorrhage 2.Maintain hemoglobin levels in severe anemia 3.Replace specific blood component. TYPES: 1. Homologous/ Allogeneic transfusions''=transfusions using the stored blood of others. 2. ''Autologous transfusions'' = using the patient's own stored blood. 500ml= 4 hours *Acetaminophen and/or an antihistamine such as diphenhydramine=prevent other types of transfusion reactions. *In patients at risk of congestive heart failure, many doctors administer a diuretic to prevent fluid overload, a condition called Transfusion Associated Circulatory Overload or TACO. REACTION: 1. hemolytic, 2. febrile, 3. circulatory over load 4. allergic Sign of an acute reaction: sudden chills or fever, low back pain, hypotension, nausea, flushing agitation or respiratory disorders. Sign of less severe allergic reaction: hives and itching but no fever. NSG MGT FOR TRANSFUSION REACTION: 1. Stop the transfusion. (maintain IV line by NSS, new tubing, at slow rate). 2. Assess patient, take v/s. 3. Notify physician. 4. Notify blood bank, send blood back for repeat typing. Equipment 1.Unit of whole blood 2.Blood administration set either a straight line or a Y set ( Y set is preferred) 3.Normal saline solution 4.IV dressing 5.Vena puncture set containing a 18 needle or catheter, or if blood is to be administered quickly no 16 needle or a larger. 6.Alcohol swab 7.Tape 8.Disposable gloves (Sterile) PROCEDURE: Before BT: 1. Get baseline data of TPR,BP, rxn to previous BT 2. Obtain correct blood component -check pts identity, doctors sign, expiration date, color, blood type, ID #, Rh group

*If the patients Clinical status permits, delay transfusion if baseline temperature is greater than 38.50 C DURING: 1. Wash hands 2. Give any pre-medications 3. Prepare & identify pt. 4. Equipments 5. Gloves 6. Position the client 7. Prime tubing with saline solution. 8. If no tubing, do venipuncture. If client has IV solution, needle should be 18 gauge or larger. No dextrose or ringers cause it lysis RBC. 9. Establish BT. 2ml/minute. 10. Remain at bed side for 5-30 minutes. If no circulatory overload, increase rate. 11. Observe patient. *If any reaction: close clamp & run normal saline, report to doctor, save urine and observe. POST PROCEDURE: 1. V/S 2. Document 3. Terminate transfusion 4. Discard administration set WOUND DRAINAGE: 1. Serous = clear or straw colored. Arises from protein and fluid in the tissue. With platelet & fibrin for clotting, supports healing. 2. Serosanguinous = pink due to a small number of blood cells mixing with serous drainage. 3. Sanguinous = red drainage from trauma to a blood vessel. 4. Hemorrhaging = leaking blood vessel putting out blood. 5. Purulent = yellow, gray or green drainage that comes out of a wound when infection invades the area. ********************************************* Newborn Care: 1. After delivery, suction mouth first the nose. 2. APGAR (1st min and 5th minute). 3. Proper identification 4. Cord care 5. Bath baby 6. Anthropometric measurement Weight: 5.5-9.5 lbs Length: 45-55am HC: 33-35.5cm CC: 30-33cm 7. Credes prophylaxis 8. Vitamin K 9. Foot printing 10. V/S 11.Dressing/wrapping