Therapeutic Procedures 3853

8/14/2019 Therapeutic Procedures 3853

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THERAPEUTIC

PROCEDURES

SELECTED TOPICS ON

COMMON NURSINGPROCEDURES



UNIVERSAL PRECAUTIONS

HANDWASHING

BARRIER METHOD

STERILIZATION AND DISINFECTION IMMUNIZATION

ENVIRONMENTAL CONTROL AND

SANITATION ISOLATION



THERAPEUTIC EXERCISES

ISOMETRIC

ISOTONIC

ROM



CHEST PHYSIOTHERAPY

BREATHING

COUGHING\POSTURAL DRAINANGE

PERCUSSION AND VIBRATION INCENTIVE SPIROMETER

SUCTIONING

TRACHEOSTOMY CARE

OXYGEN THERAPY



Chest Physiotherapy It is the combination of percussion, vibration, and

postural drainage Percussion is done for 1-2 minutes. If the patient has

tenacious secretions, this can be performed for 3-5minutes

Vibration is done during 5 exhalations Postural drainage is done for 15-20 minutes usually

performed 3-4 times a day. Instruct the client to increase fluid intake to liquefy

secretions This procedure should not be performed in clients

who are pregnant, with chest injuries, dizzy, withpulmonary embolism and abdominal surgery.

This procedure is done before meal or 90 minutesafter a meal



Oxygen Therapy Indicated to clients who needs additional

oxygen, those clients who have reduced lung

diffusion of oxygen through the respiratorymembrane, heart failure leading toinadequate transport of oxygen.

Humidify the oxygen first before you

administer. Check for bubbles in the humidifier topromote adequate flow of oxygen

Check for kinks in the tubing

Position: semi-fowlers/ high fowlers position Place cautionary readings: “NO smoking:

Oxygen is in used” Instruct the client not to use woolen blankets

as this may create static electricity



pulmonary function tests

tidal volume- 500 residual volume- 1200 expiratory reserve volume –1200

inspiratory reserve volume – 3100

Vital Capacity- tidal volume + IRV + ERV =

4800 Total Lung Capacity – Tidal Volume + IRV

+ERV +RV =6000 Forced Residual Capacity – ERV + RV



incentive spirometry – hold 2-6 sec; 4-5

times/H

endotracheal tube- reposition Q8H; cuff 20mm Hg, humidification and aerosol, deflate

cuff occasionaly

visualization – X ray

Lung Scxan – 20-40mins isotopes in body for 8 H

laryngoscopy

Bronchoscopy Thoracentesis- consent, VS and baseline X-ray +

post Procedural



Tracheostomy Care

tie new trache tie before removing theold tie to prevent accidentaldislodgement

use precut gauze and perform care ODat least.

soak iiner cannula in antiseptic soak

with hydrogen peroxide, rinse wellsuction prn, oral care prn



Oxygen Delivery Equipment

cannula – 2-6 LPM – 24-45% Mask – 5-8 LPM – 40-60% parial rebreather – 6-10 LPM – 60-90%

non rebreather – 10-15 LPM – 95-100% tent – 4-8 LPM – 30-50 % Venturi mask –

2-3 LPM – 24-28% 4 LPM – 30% 6 LPM – 35% 8 LPM – 45%

14LPM – 55%



Suctioning PURPOSE: To obtain sputum sample. NURSING ALERT:

Hyperoxygenate the patient before and after the procedure. Apply intermittent suction on withdrawal of the catheter. Do not suction the patient for more than 15 seconds. Thoracentesis PURPOSE: Aspiration of fluid and /or air from the pleural space. NURSING ALERT:

Check the consent. Position: Sitting on the side of the bed with feet on a chair, leaning

over a bedside table. If the patient unable to sit, the patient may lie inhis/her side with hands on the side resting on opposite shoulder.

Instruct the patient not to cough, breath deeply or move duringthe procedure.

After the procedure: Position the patient on the unaffected

side/puncture site up. Check for bleeding at the puncture site and monitor the

respiratory function. Notify the physician if signs of pneumothorax, air embolism and

pulmonary edema occur.



ENEMA

They act by distending the intestines that

increases peristalsis and expulsion of feces

and flatus. Enemas serve the following purpose:

Relief of constipation

Relief of flatulence

Lowers down body temperature

Evacuates feces in preparation for diagnostic

procedures

Administration of medications



ENEMA

Take note of the general principles of Enema: Tube: lubricate and insert 3-4 inches Position: adult- left lateral; infants and

children- dorsal recumbent Administration- administer the enema in a

minimum of 15 minutes duration. Conatainer’s Height- 12 inches above the

rectum Temperature- 42°C or less



types: carminative – expel flatus – 60 –180 ml. retention oil – 1 –3 hours(LUBRICANTS) BULK FORMERS-METAMUCIL-12 HOURS-INC.OFI wetting/stool softeners- Colace(days) Chemical hypertonic irritant-increases peristalsis-

castor oil, Bisacodyl, Cascara)-SUPPOSITORIES-30

MIN Saline- Epson salts, milk of mg(rapid)/mg citrate return flow – haris flushing , colon irrigation fleet – commercial

oil 1-3 H retention others – 5 to 10 mins.

cleansing- irritating( hypertonic osmotic)) high 1000 ml low 500 ml



T = 40-43 ‘ C ( 105 – 110 ‘ F

CHILDREN 37.7 ( 100 ‘ F)

APPROXIMATELY 30 CM ( 12 INCHES) BUTHIGH IN CLEANSING ( 30 – 45 CM. ) 12 TO

18 CM.

INSERT 7 – 10 CM ( 3-4 INCH)-ADULT 5 – 7.5 CM. –CHILD

2.5 – 3.5 – INFANT

IF FEELING OF FULLNESS – CLAMP – 30

SECS



amount

18 mos – 50-200 ml

18 mos – 5 y – 200-300 ml 5 – 12 years – 300 – 500 ml

12 – above – 500 – 1000 ml.

rectal tubes infants-10-12F

toddler – 14 –16F

school age – 16-18F

adult – 22 – 30F



ENEMAS- PRESCRIBED

AMOUNT AND TIME

HYPERTONIC – 5-10MINS – VARIESHYPOTONIC(TAP)-15-20MIN – 500-

1000ML ISOTONIC(SALINE)-15-20MIN- 50MLSOAP SUDS- 10-15MIN- + 3-5 ML.

SOAP

oil( MINERAL/COTTONSEED) – 30-60MIN- 90-120ML.



COLOSTOMY CARE

ostomy – divert and drain fecal material temporary ( trauma / inflammatory

condition)

permanent ( Cancer / congenital or Birthdefects

stoma – red , initial slight bleeding -

normal, no redness or irritation 2 to 5inches sorrounding the areano burningsensation



parts: periostomal seal

adhesive square –solid wafer disk skin barrier

liquid skin sealant

drainable end pouch ( Can be washable)

pouch belt

face plate



ileostomy – no irrigation , wet fecal

material , appliance all the time ,

meticulous skin care,prevent skinbreakdown, constant flow not regulated,

bag emptied half full

colostomy – solid , can irrigate , can bebowel trained , pouch may not be worn

and emptied after every defecation

avoid gas forming foods and nuts , butcan have any food at tolerated after 6

weeks… yogurt recommended



dry skin before applying appliance

karaya – barrier to prevent

contamination with excretaappliance can be up to 2 weeks

broadwell 48 – 72 hours to check for

periostomal skin24-48 hours if eroded / ulcerated

refer to enterostomal therapy nurse

with deodorant ( Charcoal filter Disk)



Catheterization, urinary

PURPOSE: To determine residual urine

and obtain sterile specimen. It can be a

straight catheter, suprapubic, indwelling

catheter, and external device catheter.

NURSING ALERT:

Know the necessary facts:

Principles Male Female



Principles Male Female

Position Supine Dorsal recumbent

Length of tube 40 cm./ 15.75 in. 22cm./ 8.66

in.

French number or Circumference #14- 16 #18

Length of tube to

be inserted 2-3 in. 6-9 in.

Balloon size 5-10 ml. (30 ml 5-10 ml

Can be used to

achieve hemostasis

of the prostatic area

following prostatectomy

Place to secure lower abdomen Inner thigh



The procedure is sterile

Maintain a close system

The draining bag must always be

below the bladder

The catheter bag should not be

allowed to lie on the floor

Do not allow the drainage spout to

touch the collection receptacle or on the

toilet bowl when draining it



CATHETER CHANGE

PLASTIC – 1 WEEK

LATEX – 2-3 WEEKS

SILICONE – 2-3 MOS.PVC – 4-6 WEEKS



CLOSED INTERMITTENT

IRRIGATION

ASPIRATE FROM PORT

CBI -3 WAY FOLEY CAHETER

CATHETER IRRIGATION ONLY – 200ML.

BLADDER IRRIGATION – 1000ML

CLAMPS ON BOTH SIDES –ALTERNATELY RELEASED

S O S



URINARY DIVERSIONS-

URINARY STOMA

ILEAL CONDUIT- EXTERNAL POUCH

KOCK POUCH – SMALL DRESSING

OVER STOMA; BLADDER WALLSUTURED TO THE ABDOMEN

SUPRAPUBIC CATHETER –

INTERMITTENT ATHETERIZATION q

3-4 HOURS



NORMAL AMOUNT/ DAY

1-3 / 500-600ML

3-5 / 600-700ML

5-8 / 700-100OML8-14 / 800 – 1400ML

14 – ADULT / 1500 – 2500

CAN HOLD 500 – 750 ML



Bladder training

Q2 hours and 30 mins void(Trigerring, Credesand valsalva)

NEUROGENIC BLADDERIntermitent Catheterization – 2-3 hours if

<150ml ----3-4 H

weaning-intermittent clamping

DTV 1-4 hours after removal

for incontinence – kegels exercises



HEMODIALYSIS

DONE 3-5 HOURS – 2-3 TIMES A WEEK AV FISTULA-NO BP,VENIPUNCTURE OR

CONSTRICTIONS

PALPATE FOR A THRILL AND LISTEN FORBRUIT Q8H

MONITOR FOR HEMORRHAGE DISEQUILIBRIUM

SYNDROME,HEPATITIS,HEMORRHAGE,MUSCLE CRAMPS,AIR EMBOLISM ANDSEPSIS-COMPLICATIONS



PERITONEAL DIALYSIS TENCKOFF,GORE-TEX CATHETER WEIGH BEFORE AND AFTER, WARM DIALYSATE CHON LOSS, INFECTION, -PERITONITIS(CLOUDY

OUTFLOW,BLEEDING) , FEVER , ABDL

TENDERNESS AND N & V PREVENT CONSTIPATION BY INCREASING FIBER IN

DIET,MAINTAIN STERILE PROCEDURE,FORPROBLEMS WITH OUT FLOW –REPOSITION

TYPES: CAPD(4-6H INDWELLING), AUTOMATED 30MINS EXCHANGES, INTERMITTENT- 4X A WEEK – 10H/DAY, CONTINOUS – 1 DAY INDWELLING



DRESSINGS

PROTECT FROM INJURY , BACTERIALCONTAMINATION

PROVIDE HUMIDITY

INSULATION ABSORB DRAINAGE DEBRIDE THE WOUND PREVENT HEMORRHAGE SPLINT / IMMOBILIZE COMFORT

GUAZE, SYNTHETIC , SECURING, TEGADERM



TYPES OF DRESSINGS

DRY TO DRY – TRAP NECROTIC DEBRISAND EXUDATE

WET TO DRY ( SALINE AND ANTI

MICROBIAL SOLUTION – SOFTEN DEBRISAS IT DRIES, DILUTE EXUDATE WET TO DAMP – WOUND DEBRIDED IF

GAUZE REMOVED( VARIATION @

DRYING) WET TO WET – KEEP MOIST – WOUND

BATHED – MOISTURE DILUTES VISCIOUSEXUDATE



WOUND HEALING

HEMOSTASIS---FIBRIN----

PHAGOCYTOSIS----( INFLAMMATION

PHASE 3-4DAYS

FIBROBLAST—COLLAGEN---CAPILLARIES----GRANULATION TISSUE---

ESCHAR---(PROLIFERATIVE 3 – 21 DAYS

MATURATION(PHASE 21 DAYS – 2 YEARS)



pressure ulcer dressings

dry gauze stage II-IV

tegaderm film/ hydrocolloid – SI - SII

Absorptive Dressing IIIHydrogel – II - III



WOUND CARE

PRIMARY

SECONDARY- INCREASED INFECTION

INCREASED TIME INCREASED ESCHAR(

PRESSURE SORES) TERTIARY- ABD. DRAINAGE

EXUDATES – SUPPURATION PUS – ABCESS( PYOGENIC BACTERIA)



SURGICAL DRAINS

PENROSE – OPEN ENDS

CLOSED WOUND DRAINAGE ( SUCTION) –

DECREASE ENTRY OF MICROBES-

HEMOVAC / JACK PRATT TO RESERVOIR D/C 3-7 DAYS POST – OP

PACKAGE – FACILITATE GRANULATION

IRRIGATION LAVAGE - STERILE

CHEST TUBES AND



CHEST TUBES AND

DRAINAGE SYSTEMS

1-DRAINAGE 2-WATERSEAL 3-COLLECTION/SUCTION

SEALED PATENCY-AFTER 3 DAYSREEXPANDED

FLUCTUATIONS IN WATER SEALCHAMBER

RUBBER TIPPED CLAMPS/ FORCEPS;VASELINIZED GAUZE;EXTRA BOTTLE



NUTRITIONAL

SUPPORT

NGT-GAVAGE AND

LAVAGE

TPN



Nasogastric Tube Insertion Purposes:

Gastric Gavage- gastric feeding Gastric Lavage- stomach irrigation For decompression Medication and supplemental fluid administration

Principles: Position: High-Fowler’s position Length of tube to be inserted: measured from

the tip of the nose to the tip of the earlobe to

the xiphoid process (approximately 50cm. Lubricate the tip of the tube by a water

soluble lubricant before insertion Secure the NGT by taping to the bridge of the

nose



Gastroenteral Feedings This is the administration of formula through a tube

placed into the GIT, either by Nasogastric route or surgically created slit on the abdominal wall.

Remember these principles: Position: fowler’s or sitting position Prior to feeding, assess the bowel sounds and

residual content

Assess for tube placement and patency: Introduce 5-20 ml of air into the NGT and auscultate. Gurgling

sounds must be auscultated. X-ray most accurate Aspirate gastric content Immerse the tip of the tube in water, no bubbles must be

produced. Height of feeding: 12 inches above the patient’s point

of insertion Instill 60 ml of water into the NGT after feeding to

cleanse the lumen of the tube

TOTAL PARENTERAL



TOTAL PARENTERAL

NUTRITION

peripheral< 2 weeks – phlebitis

PIC – Basilic / cephalic

PCC – subclavianTriple Lumen- infuse and draw

blood;TPN;Medications

Atrial- Hickman/Biovac and Groshong;Huber needle port

TOTAL PARENTERAL



TOTAL PARENTERAL

NUTRITION

TPN-IV with bacterial filter(2-3L) TNA – 1 liter/D-no filter If no available solution D10W –ok –initial at

50ml/hr

hyperglycemia- hyperosmolar(HA, N andVomiting,fever, chills, malaise)

Infection ( IV tubing and filter Q24changed,solutions refrigerated and warmed

just prior to administration Pneumothorax

C



Heat and Cold Therapy An intervention the reduces inflammation Principles: Cold application is generally safer than heat

application. Heat application usually requires a doctor’s

order

Cold application is done within 72 hours after an injury, while heat application is done after 72 hours.

The application of heat and cold is done at a

maximun of 30 minutes (an average of 15-20minutes) Check the area applications are done every

15 minutes.



Anti-embolism Stocking

Helps prevents thrombophlebitis by promotingvenous return from the legs It usually requires a doctor’s order The client’s extremeties must be properly

measured to assure therapeutic effect Apply stockings before getting out of bed. If the client forgot to wear the stockings, instructhimn or her to assume modifiedtrendelenburg’s position for 15-20 minutes

The stockings must be removed every 8hours for 20-30 minutes

Assess the skin integrity

DOSAGES AND



DOSAGES AND

CALCULATION

CONVERSIONS MEDICATION DOSAGES

D/A X V = Q

INFUSIONS TOTAL VOLUME X DROP FACTOR

TIME IN HOUR ( 60 MIN.)

THERAPEUTIC DOSE

CLARKS RULE BSA COMPUTATION IV INFUSION FOR BURNS



MEDICATION ADMINISTRATION

RIGHT DRUGRIGHT DOSAGE

RIGHT ROUTE

RIGHT TIMERIGHT PATIENT

RIGHT ATTITUDE

RIGHT DOCUMENTATION



IV THERAPY

backflow means patent line

solutions for specific diseases and

contraindications of certain solutions

management and troubleshooting

check for phlebitis and infiltration

change line everydaykeep site sterile



BLOOD TRANSFUSION

line – PNSS vital signs – baseline then Q15 x 4; Q30 x 2;

then q h

4 –6 hours blood typing and crossmatching watch out for blood transfusion reactions

hemolytic anaphylactic febrile hypervolemic septic



Hygiene and comfortmeasures



BEDMAKING- OD

PERINEAL CARE – FRONT TO BACK

OUTER TO INNER, ONE COTTONBALLPER STROKE

BEDBATHING AND ND SHAMPOO

FOOT, HAIR , SKIN AND NAIL CAREORAL CARE

EYE AND EAR CARE



THERAPEUTIC BATH

SALINE – 4 ML- 500 ML OATMEAL/AVENO – SOOTHES SKIN

IRRITATION, LUBRICATES

CORNSTARCH- IN COLD WATER –SOOTHES IRRITATION

Na CHO3 – 4 ml. – 500 ml H2O cooling / relieves irritation

KMnO4 – tablets dissolved in H2O – clears anddisinfects



Rotating Tourniquet

GET MEAN

APPLY PRESSURE TO 3 LIMBS ONE AT A

TIME RELEASE / ROTATE EVERY 5

MINUTES. PRESSURE IN ONE EXTREMITYFOR ONLY 15 MINUTES

DO NOT RELEASE SIMULTANEOUSLY

PATIENT IN ORTHOPNEIC / FOWLERSPOSITION



CPR and ACPLS Protocols

0-1 MINUTE ; CARDIAC IRRITABILITY

0-4 MINUTES; BRAIN DAMAGE NOT

LIKELY

4-6 MINUTES; BRAIN DAMAGE POSSIBLE 6-10 MINUTES; BRAIN DAMAGE LIKELY

10 MINUTES-IRREVERSIBLE BRAIN

DAMAGE



INFANTS

HTCL MANEUVER, JAW THRUST IFSPINAL INJURY IS SUSPECTED

INITIAL BREATHS – 2 – 1 1/2 SECS

SUBSEQUENT BREATHS 1 B/3 SECS; 20BPM USE 2 OR 3 FINGERS DEPTH:1/2 TO 1 INCH

COMPRESSION AT LEAST 100/MIN RATIO 5:1; CHECK AFTER 20 CYCLES FOREIGN BODY OBSTRUCTIONS:

BACKBLOWS AND CHEST THRUST



CHILDREN

HTCL / JAW THRUST 2 BREATHS INITIAL DURATION OF 1- 1 ½SECS

SUBSEQUENT 1 BREATH EVERY 3

SECONDS 20 BREATHS/ MIN CAROTID ARTERY HEEL OF HAND 1 TO 1 1\2 INCH 100 BPM; CHECK AFTER 12 CYCLES ABDOMINAL THRUST- FOR AIRWAY

OBSTRUCTION



ADULTS

HTCL / JAW THRUST INITIAL 2 BREATHS AT LEAST 2

SECS EACH

DEPRESS 1 ½ - 2 INCHES; RATE 60TO 100

RATIO 5:1

AFTER 4 CYCLES ;RECHECK FOR 10SECS

Therapeutic Procedures 3853

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