(1) SUCTIONING ○ Suction of an artificial airway
● Performed to promote patent airway Suction Catheters
● To get secretions out of the respiratory system ● Open tipped
● Secretions can be removed through: ○ More effective with thick plugs
○ Coughing ○ Can pull at tissues
○ Suctioning ● Whistle tipped
■ Necessary if client has difficulty handling ○ Less irritating to respiratory tissues
their secretions or when an airway is in ● Most have Thumb port to control suction
place ○ Covered = start suction
● It is usually on mornings that an individual has a lot of ● Suction controlled by a gauge
secretions due to gravity ● SIZES
● ALVEOLI: functional unit of respiratory
● Abnormal increase in respiratory conditions can result from #12 - #18 Adults
a variety of conditions:
○ Lung or bronchial infections #8 - #10 Children
○ Central nervous depression
#5 - #8 Infants
○ Exposure to anesthetic gases
○ Newborns: saliva and amniotic fluid cannot be
expectorated
○ Premature babies may have absent or decreased
cough reflex
Yankauer
SUCTIONING ● A rigid plastic catheter with 1 large and several small
● Is aspirating secretions through a catheter connected either to eyelets through which mucous enters when suction is applied
a suction machine or wall suction outlet ● Used for oral suction (Primarily)
● Primary suctioning techniques are” ● Patients can be taught to use this
○ Oropharyngeal
○ Nasopharyngeal Suction Machine
○ Orotracheal ● Suction to pull out mucus, saliva, blood, secretions, or other
○ Nasotracheal fluids
● Clears the airway for easy breathing
Signs that indicates the need for suctioning
● Restlessness
● Gurgling sounds during respirations
● Adventitious Breathing sounds during auscultation (chest)
● Change in mental status
● Change in skin color
● Change in rate and pattern of respiration
● Change in pulse rate and rhythm
Overview of the procedure
● DO NOT apply suction while insertion (can cause trauma to
mucous membranes)
● Suction attempts should last only 10 -15 SECONDS
Pressure Needed (5-10??)
● Depends on if wall or portable ● With INTERVALS OF 20-30 SECONDS-lubricate
● Depends on AGE ● Flush catheter with sterile or saline water and re-lubricate
EVALUATION
WALL PORTABLE
● Compare client’s respiratory assessments before and after
100-120 Adult 10-15 mmHg suctioning
mmHg ● Ask if breathing is easier or if congestion is decreased
● Client’s technique and compliance
95 -110 Child 5-10 mmHg
mmHg
RECORD AND REPORT
50-95 mmHg Infant 2-5 mmHg ● Respiratory assessments before and after
● Size of catheter used
● route
● Amount
● Consistency and color of secretions obtained
● Frequency
● Client’s response
OROPHARYNGEAL
● Oropharynx
○ Extends behind mouth from the soft palate above the
level of hyoid bone and contains tonsils
NASOPHARYNGEAL
● Nasopharynx
○ Located behind the nose and extends to level of soft
palate
● Used when client is able to cough effectively but unable to
clear secretions by expectorating or swallowing
● Suctioning is done after the patient has coughed
● Done only until able to expectorate
DANGERS OF SUCTIONING
● Hypoxemia
○ Insufficient oxygen in blood (if suction is without
breaks or intervals)
● Vagal nerve stimulation
○ Vagovagal reflex
○ By reflex, larynx and trachea gets irritated resulting
to slowing down of the pulse rate
● Mucosal damage
○ Using suction while insertion
● Micro atelectasis
○ Early manifestation of O2 toxicity
○ Minimal collapse of the lungs
● Aspiration
○ Safety for semi conscious (on their side)
○ Conscious should: semi-fowlers with head turned to
side
● Infection
○ Should follow sterile procedure
(2) NEEDLE STICK
Infections
● Occurs when germs enter the body, increase in number, and
cause a reaction
● When the cells in your body are damaged as a result of the
infection and signs and symptoms of an illness appears
Dynamic of disease transmission
● Source
○ Infectious agent or germs
○ Health care settings: people are one source of germs
■ People can be sick with symptoms of an
infection or colonized with germs (no
symptoms but can infect regardless)
○ Ex: (environmental sources in healthcare)
■ Dry surfaces in patient areas
■ Wet surfaces, moist environments and
biofilms
■ Indwelling medical devices
■ Dust or decaying debris
● Transmission
○ Ways germs are moved to susceptible host
○ General ways germs travel
○ Contact
■ Direct contact
● Occurs direct body contact with the ● Nosocomial infection
tissues or fluids of an infected ○ Health-care associated or hospital-acquired
■ Fomite: infections are a subset of infectious diseases in
● Inanimate objects contaminated by health care facilities
and infected ○ Cannot be present at admission
■ Sharps injuries ○ Must develop at least 48 hours after admission
● A skin puncture by a used needle or ○ Types
sharp instrument ■ Most common
■ Vectors ● Staphylococcus aureus
● Living organisms the can transfer ● Escherichia coli (E.coli)
pathogenic microorganisms ● Enterococci
■ Sprays and splashes ● Candida
● Infected coughs or sneezes, creating ○ Causes
DROPLETS ■ Urinary catheters = urinary tract infections
○ Close range inhalation: ■ Surgical procedures = surgical site infections
droplets are small enough to ■ Central venous catheters = bloodstream
breath in infections
■ Inhalation ■ Mechanical ventilation = pneumonia
● Germs are aerosolized ○ Prevention
○ Airborne transmission ■ Frequent hand hygiene
■ Infected cough, ■ Appropriate PPE use
sneeze, talk ■ Remove indwelling devices ASAP
● Susceptible host ■ Appropriate antimicrobial use
○ Not vaccinates ■ Routine disinfection
○ Immune or weakened immune system
○ Devices and surgical incisions can provide entryway Infection Control
for infection ● Various measures that PREVENT and CONTAIN the spread
○ Factors that increases susceptibility of infectious disease
■ Underlying med conditions
■ Certain medications Infection Prevention
■ Medical treatments and procedures in ● Measures that can LIMIT the spread of microorganisms
healthcare
Types of infection control
● Standard
○ Used for all patient care
○ Based on risk assessment and PPE
● Transmission-based
○ Used in addition to standard
○ For patients who may be infected or colonized with
certain infectious agents
Hand hygiene
● Cleaning your hands by either handwashing, antiseptic hand
wash, antiseptic hand rub or surgical hand antisepsis
● REDUCES:
○ Spread of potentially deadly germs to pxs (3) MEDICATION ADMINISTRATION
○ Risk of health care provider colonization or infection
DRUG
WHO standard precaution ● Any substance used to diagnose, cure, mitigate, prevent, treat
a condition or disease
● Sources:
○ Animals
○ Plants
○ Semi/ Synthetic sources
○ Microbiological
○ Elements??
○ Recombinant DNA technology
● Forms:
○ Tablets
■ compressed
■ Enteric
■ Time-sustained
○ Capsules
○ Troches or lozenges ■ Intravenous
○ Suppositories ● Provides an immediate systemic
○ Solutions response
■ Syrups ● Intradermal
■ Elixirs ● Subcutaneous
■ Tinctures
■ Douche MEDICATION ORDERS
■ Suspensions ● Stat order
○ Emulsions ○ Given IMMEDIATELY and only ONCE
○ Topical ● Single dose
■ Semisolids ○ One time order
■ Topical patches ● Standing order
○ Parenteral products ○ Carried out indefinitely unless specified
■ Ampules ● Prn order
■ Vials ○ AS NEEDED
○ Routes of administration
■ Oral
● Sublingual
● Buccal
● Inhalation
■ Instilling
● Nasal
● Ear
● Eye
● Transdermal
■ Intramuscular
● Placed directly into the synovial
fluid to provide a local effect
● Ex: cortisone injection to the knee
● Intrathecal
○ Absorbed directly into
cerebrospinal fluid
● Right motivation or approach
● Right preparation
■ Insulin
■ Hypodermic
■ Tuberculin
ASSESSMENTS INFORMATION
● Confirm patient’s diagnosis and appropriateness of
medication
● Identify concurrent medications
● Identify potential contraindications or allergies
● Identify client’s knowledge
PARENTERAL ADMINISTRATION
● Administration of medication by INJECTION
● An INVASIVE procedure using aseptic technique
● Requires certain skills
● Effects develop RAPIDLY, depending on the rate of
medication absorption
MATERIALS NEEDED:
● Syringes
○ Types:
● Needles
● ampules/ vials
● Cotton balls with alcohol
● Dry cotton balls
CARE OF SYRINGE AND NEEDLES
● Use a puncture proof, disposal containers
● Never bend or break needles before disposal
● Never recap used needles except under specified
circumstances
SUBCUTANEOUS ADMINISTRATION
● Injecting medications into the loose connective tissue under
the dermis
● Medication absorption is somewhat slower than with IM ● Reminders
injections ○ Patients body weight indicate the depth of the subq-
● Best sites layer
○ For NORMAL SIZE
■ G25, ⅝ inch needle: 45-degree angle
■ ½ inch needle; 90 degree angle
○ For a CHILD
■ ½ inch needle; 45 degree angle
○ OBESE
■ Pinch the tissue and use a needle long
enough to insert through the tissue at the
base of the skinfold
● Reminders:
○ Use a tuberculin or small syringe with a short (¼ to
INTRADERMAL ADMINISTRATION ½ inch) fine gauge (26 or 27) needle
● Usually for skin testing (e.g. tuberculin screening or allergy ○ 10-to-15 angle only
test) ○ Small bleb, resembling a mosquito bite will appear
● Medication absorption occurs slowly on the skin’s surface
● Assess site for changes in color and tissue integrity ○ If a bleb does not appear or the site bleeds after
needle withdrawal = good chance the medication
entered sub-q tissues
INTRAMUSCULAR ADMINISTRATION
● Provides faster medication absorption
● Less danger of causing tissue damage when medication
enters deep muscles
● Reminders
○ Patients body weight and the amount of adipose
tissue influence needle size selection
○ Use a longer and heavier gauge needle to pass
through sub-q tissue and penetrate deep muscle
tissue
○ THIN:
■ Requires a ½ to 1 inch needle
○ OBESE:
■ Requires a needle 3 inches long
○ NORMAL:
■ G-23 NEEDLE; 90 Degree angle
○ CHILDREN, OLDER ADULTS, and THIN
■ Tolerate only 2ml of IM injection
○ SMALL CHILDREN AND INFANTS (under 2 y/o)
■ Recieve no more than 1 ml of medication in
one injection
○ Assess muscle before giving an injection
