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Chapter 17

Chapter 17. Treatment Orders. Objectives. Identify two procedures performed to repair obstructed coronary blood vessels. State the purpose of the cardiopulmonary (respiratory care) department. Explain the purpose of hyperbaric oxygen therapy. Identify two basic types of traction.

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Chapter 17

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  1. Chapter 17 Treatment Orders

  2. Objectives • Identify two procedures performed to repair obstructed coronary blood vessels. • State the purpose of the cardiopulmonary (respiratory care) department. • Explain the purpose of hyperbaric oxygen therapy. • Identify two basic types of traction. • Name the traction setup used by patients to assist them to move in bed.

  3. Objectives, continued • Given a list of treatments, identify which department would perform them. • State the purpose of the physical therapy department. • State the purpose of the occupational therapy department. • List the two main types of dialysis.

  4. Lesson 17.1

  5. Cardiovascular Therapies • Cardiovascular treatments are often invasive, and may be performed in the cardiac catheterization lab or in the operating room by an interventional cardiologist • The HUC may have to coordinate and schedule invasive cardiovascular treatments • Consent forms are required and special diets and medications may be necessary

  6. Cardiovascular Therapies, continued • Cardiovascular treatments are often performed directly following invasive cardiovascular diagnostic tests done in the cardiac cath lab (as discussed in Chapter 16) • Angioplasty may follow coronary angiography • Insertion of a pacemaker may follow electrophysiology studies

  7. Cardiovascular Therapies, continued Examples of cardiovascular therapies: • Insertion of a cardiac pacemaker • Insertion of an implantable cardioverter-defibrillator (ICD) • Angioplasty

  8. Cardiac Pacemaker From Thibodeau GA, Patton KT: Anatomy and physiology, ed 6, St. Louis, 2007, Mosby.

  9. Implantable Cardioverter-Defibrillator From Lewis SM, Heitkemper MM, Dirksen SR: Medical-surgical nursing, ed 6, St. Louis, 2004, Mosby.

  10. Coronary Stent From LaFleur Brooks M: Exploring medical language: a student-directed approach, ed 6, St. Louis, 2005, Mosby.

  11. Coronary Artery Bypass Graft (CABG) From Lewis SM, Heitkemper MM, Dirksen SR: Medical-surgical nursing: assessment and management of clinical problems, ed 5, St. Louis, 2000, Mosby.

  12. Cardiopulmonary (Respiratory Care) Downtime Requisition

  13. Cardiovascular Therapies Examples of angioplasty orders: • Percutaneous transluminal coronary angioplasty (PTCA) • Balloon angioplasty • Heart artery dilatation • Stent placement

  14. Cardiovascular Therapies, continued Surgical intervention: • Coronary artery bypass graft (CABG) • Off-pump coronary artery bypass graft (OPCAB) • Minimally invasive direct coronary artery bypass (MIDCAB) • Performed with the aid of a robot (e.g., daVinci)

  15. Cardiopulmonary (Respiratory Care) Department • Respiratory treatments are performed at the patient’s bedside by a respiratory therapist • It is important that the health unit coordinator enter all of the information given in the doctor’s order when ordering a respiratory treatment • The respiratory therapist will read the doctor’s order before performing the treatment

  16. Cardiopulmonary (Respiratory Care) Department, continued Examples of respiratory treatments: • Oxygen (O2) per NP (NC), mask, nasal cath, tent, or ventilator • Intermittent positive pressure breathing (IPPB) • Small volume nebulizer (SVN) • Ultrasonic nebulizer

  17. Wall Outlet for Oxygen

  18. Cardiopulmonary (Respiratory Care) Department • Chest percussion therapy (CPT) • Heated aerosol (HA) • Incentive spirometry (IS) • Biphasic positive airway pressure (BiPAP) • Continuous positive airway pressure (CPAP) • Metered dose inhaler (MDI)

  19. Cardiopulmonary (Respiratory Care)Mechanical Ventilator The ventilator assists or replaces respiration of the patient. Settings: • IMV mode: intermittent mechanical ventilation • TV: tidal volume • FiO2: fraction of inspired oxygen • PEEP: positive end-expiratory pressure • PS: pressure support

  20. Other Respiratory Orders • Intubation • Insertion of an endotracheal tube • Extubation • Removal of an endotracheal tube • Pre-op teaching

  21. Wound Care Department/Clinic • Hyperbaric oxygen therapy (HBOT) • 100% oxygen under high pressure in a hyperbaric chamber • Improves healing and stimulates growth of blood vessels

  22. Traction Orders • Traction is the mechanical pull applied to part of the body • The pull is achieved by connecting an apparatus attached to a bed to an apparatus attached to the patient • Traction may be applied to the legs, arms, neck, back, or pelvis to treat fractures, dislocations, and long-duration muscle spasms, and to prevent or correct deformities

  23. Traction Orders, continued Two main types of traction: • Skeletal traction • Skin traction

  24. Traction Orders, continued Examples of skin traction orders: • Skin traction 5# to left arm • Skin traction 7# to pelvis • Left unilateral Buck’s traction

  25. Traction Orders, continued Examples of skeletal traction orders: • Cervical traction with Crutchfield tongs • Thomas leg splint with Steinmann pin with 20# of traction • Traction by gravity left arm

  26. Unilateral Buck’s traction

  27. Crutchfield Tongs From Phipps WJ, Monahan FD, Sands JK, et al: Medical-surgical nursing, ed 7, St. Louis, 2003, Mosby.

  28. Traction Orders Other traction-related orders: • Overhead frame and trapeze: used to assist the patient to move about in bed • Braun frame: a cradle for the limb

  29. Lesson 17.2

  30. Physical Medicine and Rehabilitation • Physical therapy: treats patients to improve and restore their functional mobility • Occupational therapy: works toward rehabilitation of patients, in conjunction with other health team members, to return patients to the greatest possible functional independence

  31. Physical Therapy (PT) Types of physical therapy orders: • Hydrotherapy: • Hubbard tank • Whirlpool • Exercises: • Passive, active, resistive, reeducation, coordination, and relaxation

  32. A Hubbard Tank

  33. Physical Therapy (PT) • Walker train: gait train • Crutch train • Transfer train • Wheelchair mobility • Anterior cruciate ligament repair (ACL) protocol • Total hip arthroplasty (THA) protocol

  34. Physical Therapy (PT), continued • Total knee arthroplasty (TKA) protocol • Continuous passive motion (CPM) • Heat and cold application orders: • Ultrasound • Hydrocollator packs • Ice or cold packs

  35. Continuous Passive Motion From Elkin MK, Perry AG, Potter PA: Nursing interventions and clinical skills, ed 2, St. Louis, 2000, Mosby.

  36. Physical Therapy (PT), continued • Pain relief orders: • Transcutaneous electrical nerve stimulation (TENS) • Functional electrical stimulation or electrical stimulation (FES or ES)

  37. Transcutaneous Electric Nerve Stimulation (TENS) From Ignatavicius DD, Workman ML, Mishler MA: Medical-surgical nursing, ed 2, Philadelphia, 1995, Saunders.

  38. Occupational Therapy (OT) • Types of occupational therapy orders: • Activities of daily living (ADL) • Evaluation and treatment • Supply and train in adaptive equipment • Increase mobility • Fabricate cock-up splint for extremity

  39. Dialysis • When the kidneys fail to remove wastes, medical intervention is necessary to sustain life • The kidneys may fail temporarily (acute renal failure) or they may be permanently damaged and become nonfunctional (chronic renal failure and end-stage renal disease [ESRD]) • Two types of dialysis: • Hemodialysis • Peritoneal dialysis

  40. Dialysis, continued • Hemodialysis: • Removal of waste products from the blood by utilization of a machine through which the blood flows • Peritoneal dialysis: • Fluid is introduced into the abdominal cavity that absorbs wastes from the blood through the lining of the abdominal cavity or peritoneum

  41. Radiation Treatments • Performed either in a division of diagnostic imaging or in a separate department • Most patients have radiation therapy on an outpatient basis • The HUC may be asked to set up the patient’s first appointment upon patient discharge

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