Hesi Practice

Throughout the placement of a chest tube, the patient should be assessed for complications of chest tube drainage and for re-expansion of the lung. A nurse should assess the lungs and the thorax for tracheal deviation, nonsymmetrical movement of the chest, emphysema, changes in the pattern of breathing, adventitious lung sounds, and presence of a pneumothorax (tympany).

The majority of nurses are still auscultating air insufflation over the abdomen to check the placement of nasogastric tubes, since it was the method that was taught for many years. It is an easy and less expensive way to check the placement, but research has shown that it is not reliable. Research showed that sounds can be transmitted to the epigastrium no matter where the nasogastric tube is placed. It does not matter if it is in the lungs, esophagus, or stomach, it can still be heard through the stethoscope (De Boer, J., Smit, B., Mainous, R., 2009).

2. The nurse is doing preconception counseling with a 28-year old woman with no prior pregnancies. Which of the following statements made by the client indicates to

3) A nurse takes care of a patient with cardiac dysrhythmia. Which of the following laboratory values is a priority for the nurse to monitor?

The patient will require surgery to repair the hole in the intestines, and subsequently will have a drainage tube, NG tube, and feeding tube. All drains will need to monitored for placement/movement, and drainage. Input and output will be closely monitored and recorded. The patient will remain on NPO, or nothing by mouth, to rest the bowels along with frequent assessments to monitor for infection and bleeding. The nurse will need to monitor for bowel sounds, vital sign changes, temperature changes, pain, abdomen girth, and wound/incision inspections. The following labs will require monitoring: CBC, H&H, albumin, BUN & creatinine, glucose, and ABG’s and lactic acid if sepsis is suspected. Careful and frequent monitoring of labs will alert the nurse if the patient develops sepsis, or hypovolemia due to excessive bleeding (Belinhof, et al., 2012). In addition to vital signs and labs, the nurse will also include patient assessment into consideration before drawing conclusions by means of critical thinking. After the full assessment has been made, the nurse will report any findings to the health care provider that require further investigation or

The nurse attempts to help an unmarried teenager deal with her feelings following a spontaneous abortion at 8-weeks gestation. What type of emotional response should the nurse anticipate?

The only intervention identified within the scope of nursing practice is to use sterile technique. Central line insertion, intubation, and prescription are functions of the physician.

X Safe and Effective Care Environment X Management of Care X Safety and Infection Control X Health Promotion and Maintenance X Psychosocial Integrity X Physiological Integrity X Basic Care and Comfort X Pharmacological and Parental Therapies X Reduction of Risk Potential X Physiological Adaptations

The nurse recognizes that what information in the client's history supports a diagnosis of gestational diabetes?

Going forward we will keep our tape to secure our PEDS patients in our PEDS vent in the heart center. Remember if the baby is not born in our SCN it is now considered a pediatic patient. We can use the vent in the heart station to ventilate them. I have enclosed a picture and a link to demonstrate the correct way to tape an Peditric ET tube. Also see my self or John if you need a one on one.

I work in Interventional Radiology (IR) we took care of a patient who needed a new percutaneous nephrostomy tube. The procedure was considered urgent, the patient had a mass blocking the right ureter, the consulting physicians felt the patient was becoming septic. Placement of a nephrostomy tube requires the patient be positioned prone on the IR exam table for approximately an hour, and the patient is anesthetized using MAC sedation when a patient is getting a new nephrostomy tube. After the nephrostomy tube is placed the patient recovers in IR and then returns to his room until he is ready for discharge. Once the patient is discharged from the hospital the patient must have a visiting nurse, or the patient must be discharged to a nursing facility so a professional health care provider will be monitoring the nephrostomy tube post discharge. Patients are required to follow up with IR for routine nephrostomy tube exchange every 3 months after the nephrostomy tube is placed until the tube is no longer needed.

Only when it is absolutely necessary should a catheter be inserted into a patient. Every patient is assessed for the need for a Foley catheter. If the Foley is inserted, assessments are also then done daily to see if the need is still valid. If the reason is not justifiable the catheter must be removed from the patient (Joint Commission releases new NPSG for CAUTI, 2011). Nurses must follow guidelines while inserting indwelling catheters as well. Aseptic technique is critical to maintain during this process. The use of sterile equipment and a sterile procedure helps to reduce the risk of CAUTI. If in any way the catheter becomes contaminated during the process of insertion, the nurse should discard of the entire catheter and start with a new, sterile kit. Proper hand hygiene is very important before and after contact with indwelling catheters to decrease risk of infection. Maintenance of a close drainage is system is also important that way bacteria are not able to get in and cause infection (Revello & Gallo, 2013). Decreasing the number of times Foleys are inserted and how long they stay in for can help reduce the risk of CAUTI since the longer a Foley stays in, the higher the risk of infection becomes. Nurses must keep the catheter line patent, with no kinks to allow urine to flow freely through into the collection bag. When a urine sample must be obtained it must be done in a sterile

The nurse would want to ensure adequate nutrition for the baby and preventing aspiration or infection

For how long medicine has been around, one would well assume that health care professionals have reached expertise by now on common practices. An example of such common practice would be insertion of a nasogastric tube and unfortunatly expertise of this procedure is not the case. The use of nasogastric tubes can be dated back to the seventh centry and since then an accumulating body of evidence based research has suggested new methods in regards to how to confirm the placement of the feeding tube. (Esther, Tan, & Ang, 2017, p. 189).

The most common abnormality observed was heart rate response to standing(68%), followed by deep breathing( 64%). Heart rate response to valsalva was the least affected (30%)