Nursing Intervention or Treatment Orders



Nursing Intervention or Treatment Orders



Chapter Objectives


On completion of this chapter, you will be able to:


1. Define the terms in the vocabulary list.


2. Write the meaning of the abbreviations in the abbreviations list.


3. Describe what is included in holistic care, and provide an example of a nursing intervention.


4. Describe the function of the central service department with regard to nursing treatment orders.


5. List the types of items stored in the central service stock supply closet (C-locker or cart) on the nursing units and the types of items stored in the central service department.


6. Explain why discontinued reusable equipment should be returned to the central service department as quickly as possible.


7. List four types of enemas.


8. Explain the procedure and purpose of a urine flow test.


9. Explain two types of urinary catheterization procedures and two methods of measuring postvoid residual urine volume.


10. Describe two methods and four purposes of administering intravenous therapy.


11. Explain the major difference between peripheral intravenous therapy and a central line.


12. List four types of central venous catheters.


13. Explain the purpose of a heparin lock, and describe how a heparin lock is kept patent.


14. List three parts of a physician’s order for intravenous therapy.


15. Identify three commercially prepared intravenous solutions, and explain how the health unit coordinator (HUC) would determine how long a bag of intravenous solution would take to empty.


16. List the four blood types and explain the importance of correct labeling of a blood specimen that is being sent for a type and crossmatch.


17. Explain the HUC’s role in obtaining blood from the blood bank and the correct storage of blood.


18. Discuss the purposes of an arterial line and a Swan-Ganz catheter.


19. Identify three types of suction devices inserted during surgery.


20. List at least two heat applications and at least two applications used for cold therapy.


21. Explain why most comfort, safety, and healing orders require a doctor’s order, and identify at least five items or types of equipment these orders may include.


22. List at least four complementary or alternative approaches or therapies that may be recommended or provided to hospitalized patients.



Vocabulary



Ace Wraps


Elastic gauze used for temporary compression to various parts of the body to decrease swelling and reduce skin breakdown.


Adult Disposable Diapers


An absorbent garment worn by patients who are incontinent.


Aquathermia Pad


A waterproof plastic or rubber pad used to apply heat or cold that is connected by hoses to a bedside control unit that contains a temperature regulator, a motor for circulating the water, and a reservoir of distilled water (also called a K-pad or a water flow pad).


Arterial Line (art-line or a-line)


A catheter placed in an artery that is used to measure the patient’s blood pressure continuously and/or to obtain samples for arterial blood gas measurements.


Autologous Blood


The patient’s own blood donated previously for transfusion to be used as needed by the patient (also called autotransfusion).


Binder


A cloth or elastic bandage that is usually used for abdominal or chest support.


Bladder Ultrasound (BUS)


A noninvasive method of assessing bladder volume and other bladder conditions using ultrasonography to determine the amount of urine retention or postvoid residual urine. A portable, ultrasound device called a bladder scanner is used.


Catheterization


Insertion of a catheter into a body cavity or organ to inject or remove fluid.


Central Line


A catheter inserted into the jugular or subclavian vein or a large vein in the arm and threaded to the superior vena cava or the right atrium of the heart.


Chux


A disposable pad placed in areas where patients either lie or sit.


Compression Garments


Tight-fitting, custom-made garments that are used to put constant pressure on healed wounds to reduce scarring.


Donor-Specific or Donor-Directed Blood


Blood donated by relatives or friends of the patient to be used for transfusion as needed.


Egg-Crate Mattress


A foam rubber mattress.


Elevated Toilet Seat (ETS)


An elevated seat that fits over a toilet and has handrails; used for patients who have difficulty sitting on a lower seat.


Enema


The introduction of fluid and/or medication into the rectum and sigmoid colon.


Extravasation


The accidental administration of intravenously infused medicinal drugs into the surrounding tissue, by leakage (as with the brittle veins of elderly patients) or directly (by means of a puncture of the vein).


Foley Catheter


A type of indwelling catheter (tube) that is inserted into the bladder for urine collection and measurement.


Gastric Suction


Used to remove gastric contents.


Harris Flush or Return-Flow Enema


A mild colonic irrigation that helps expel flatus.


Hemovac


A disposable suction device (evacuator unit) connected to a drain that is inserted into or close to a surgical wound.


Heparin Lock


A vascular access device (also called intermittent infusion device, heplock, or saline lock) that is placed on a peripheral intravenous catheter when used intermittently.


Incontinence


Inability of the body to control the elimination of urine and/or feces.


Indwelling or Retention Catheter


A catheter that remains in the bladder for a longer period until a patient is able to void completely and voluntarily, or as long as hourly accurate measurements are needed.


Infiltration


Process by which the tip of an intravenous (IV) catheter comes out of the vein or pokes through the vein and IV solution is released into surrounding tissue. This also can occur if the wall of the vein becomes permeable and leaks fluid.


Intermittent (Straight) Catheter


A single-use catheter that is introduced long enough to drain the bladder (5 to 10 minutes) and is then removed.


Intravenous Infusion


The administration of fluid through a vein.


Irrigation


Washing or flushing out of a body cavity, organ, or wound.


Intravenous (IV) Infusion Pump


A device used to regulate the flow or rate of intravenous fluid; more commonly called an IV pump.


Jackson-Pratt (JP)


A disposable suction device (evacuator unit) that is connected to a drain that is inserted into or close to a surgical wound.


Nasogastric (NG) Tube


A tube that is inserted through the mouth or nose into the stomach and is used to feed the patient, or to drain stomach contents to prevent vomiting.


Needleless Heplock or Saline Lock


A safe, sharp device that is placed on a peripheral intravenous catheter when used intermittently.


Patent (Patency)


A term that indicates that there are no clots at the tip of the needle or catheter and that the needle tip or catheter is not against the vein wall (open).


Penrose Drain


A drain that is inserted into or close to a surgical wound; it may lie under a dressing, extend through a dressing, or be connected to a drainage bag or suction device.


Peripheral IV Therapy


An infusion of a liquid prepared solution directly into a vein intermittently or continuously.


Peripherally Inserted Central Catheters (PICC or PICs)


Catheters inserted into the arm and advanced until the tip lies in the superior vena cava; placement is checked with an x-ray examination.


Pneumatic Hose


Stockings that promote circulation by sequentially compressing the legs from ankle upward, promoting venous return (also called sequential compression devices or pneumo boots).


Postvoid Residual Urine Volume


The measurement of urine left in the bladder after urination.


Rectal Tube


A plastic or rubber tube designed for insertion into the rectum; when written as a doctor’s order, rectal tube means the insertion of a rectal tube into the rectum to remove gas and relieve distention.


Restraints


Devices used to control patients who exhibit dangerous behavior or to protect the patient.


Sheepskin


A pad made out of lamb’s wool or synthetic material; used to prevent pressure sores (used frequently in long-term care).


Sitz Bath


Application of warm water to the pelvic area.


Splinting


Holding the incision area to provide support, promote a feeling of security, and reduce pain during coughing after surgery; a folded blanket or pillow is helpful for use as a splint.


Straight Catheter


See Intermittent (Straight) Catheter.


Swan-Ganz Catheterization


Placement in the neck or the chest of a catheter that measures pressures in the patient’s heart and pulmonary artery.


T.E.D. Hose


(Thrombo-embolic-deterrent) A brand name for antiembolism (AE) hose.


Urinary Catheterization


A tube is placed in the body to drain and collect urine from the bladder.


Urine Flow Test


A test that evaluates the speed of urination, or amount voided per second, and the total time of urination.


Urine Residual


Urine that remains in the bladder after urination.


Uroflowmeter


a funnel-shaped device that reads, measures, and computes the rate and amount of urine flow.


Venipuncture


Needle puncture of a vein.


Void (micturate or urinate)


To empty, especially the urinary bladder.



ABBREVIATIONS













































































































































































































Abbreviation Meaning Example of Usage on a Doctor’s Order Sheet
a¯image before Start IV of 1000cc D5LR a¯image surg
@ at Run @ 100 mL/hr
abd abdominal Up C¯image abd binder
ASAP as soon as possible Start IV ASAP
B/L bilateral (both sides) B/L TEDs
cath catheterize Cath q 8 hr prn
CBI continuous bladder irrigation CBI C¯image NS 50 mL/hr
cm centimeter Chest tube 20 cm neg pressure
con’t continue, continuous Foley cath to con’t drainage
CVC central venous catheter Blood draws through CVC
drsg dressing Change drsg q shift & PRN
D/LR dextrose in lactated Ringer’s IV 1000 mL 5% D/LR at 125 mL/hr
D5W 5% dextrose in water 1000 mL D5W @ 125 mL/hr
D10W 10% dextrose in water 1000 mL D10W @ 100 mL/hr
DW or D/W distilled water Irrig cath prn C¯image DW
ETS elevated toilet seat Order ETS for home use
gtt(s) drop(s) IV @ 60 gtts/min
HL or heplock heparin lock
Also called a saline lock		 Convert IV to heplock
H2O2 hydrogen peroxide Irrigate wound C¯image H2O2 & NS equal strength
irrig irrigate Irrig cath C¯image NS prn
IV intravenous Con’t IVs as ordered
IVF intravenous fluids DC IVF at 1000 mL today
KCl potassium chloride Add 20 mEq KCl to IV
KO keep open KO IV C¯image 1000 mL 5% D/W
LIS Low intermittent suction Connect NG to LIS
LR lactated Ringer’s 1000 mL LR 125 mL/hr
min, m minute Run @ 30 gtts/min
mL
Same as cc, which may not be allowed in some institutions, may be confused with “U” or “u” if poorly written		 milliliter 1000 D5W @ 100 mL/hr
MR may repeat SSE now MR × 1
nec necessary SSE now MR if nec
NG nasogastric Insert NG tube
NS normal saline Give NS enema now
N/V nausea and vomiting Notify HO of any N/V
ORE oil-retention enema ORE today
p¯image after Up p¯image breakfast
PICC peripherally inserted central catheter Insert PICC, follow protocol
PVR
or
RV		 postvoid residual urine volume
residual volume		 Obtain PVR this a.m.
Obtain RV this am
SCD sequential compression device Apply SCD when in bed
sol’n solution Irrig cath C¯image NS sol’n
SSE soap suds enema SSE now
st straight retention Cath to st drain
stat
(from Latin word statim, meaning “immediately”		 urgent—rush
may be written in uppercase or lowercase		 Prepare for stat surgery
TCDB turn, cough, and deep breathe TCDB q2h
TKO to keep open 1000 mL D5W TKO
TWE tap water enema Give TWE
VAD vascular access device Use VAD for blood draws
WA or W/A while awake BP q 4 hr W/A
Δ change Δ catheter daily
/ per, by IV @ 150 mL/hr


image




image EXERCISE 1


Write the abbreviation for each term listed.



1. soap suds enema


2. keep open


3. may repeat


4. solution


5. necessary


6. centimeter


7. tap water enema


8. nasogastric


9. normal saline


10. nausea and vomiting


11. dextrose in lactated Ringer’s


12. distilled water


13. at


14. oil-retention enema


15. irrigate


16. intravenous


17. catheterize


18. lactated Ringer’s


19. straight


20. sequential compression device


21. immediately


22. after


23. abdominal


24. turn, cough, and deep breathe


25. minute


26. drops


27. change


28. as soon as possible


29. per


30. hydrogen peroxide


31. continue


32. continuous bladder irrigation


33. to keep open


34. milliliter


35. intravenous fluids


36. postvoid residual urine volume or residual volume


37. elevated toilet seat


38. while awake


39. peripherally inserted central catheter


40. vascular access device


41. central venous catheter


42. 5% dextrose in water


43. 10% dextrose in water


44. bilateral


45. heparin lock


46. before


47. dressing


48. low intermittent suction


49. potassium chloride



image EXERCISE 2


Write out each doctor’s order.




Nursing Intervention or Treatment Orders


Background Information


A nursing intervention is any act performed by a nurse that implements the nursing care plan or any specific objective of the clinical plan or pathway, such as turning a comatose patient to avoid the development of decubitus ulcers (bedsores), or teaching insulin injection technique to a diabetic patient before the time of discharge. Interventions may include support measures, activity limitations, administration of medications, or treatments given to relieve the current condition or to prevent the development of further stress. The emphasis is on a holistic approach in nursing care. Holistic nursing or comprehensive care consists of total patient care that considers the physical, emotional, social, economic, and spiritual needs of the patient; the patient’s response to illness; and the effects of the illness on the ability to meet self-care needs. Nursing interventions and treatment orders are discussed in this chapter.



image HIGH PRIORITY


The Evolve website associated with the Health Unit Coordinator Skills Manual includes a simulated hospital electronic medical record program that may be used for practice.


Instruction and paper requisitions (which are seldom used) are also provided for learning purposes and for health unit coordinators who are working in settings without a computerized requisition process or implementation of the electronic medical record.



Communication with the Central Service Department


The central service department (CSD) distributes the supplies that are used for nursing procedures. The supply purchasing department (SPD) is another name for the CSD. Although CSD supplies are frequently used (even when they are not mentioned in a doctor’s orders), obtaining these supplies for the nursing staff may require a separate step in the transcription procedure for nursing treatment orders. For example, for the order footboard to bed, the health unit coordinator (HUC) would order the footboard from the CSD. Other items may include adult disposable diapers or chux for a patient with leakage or incontinence. It is therefore necessary for the HUC to be familiar with frequently used CSD items and to learn the hospital’s system for obtaining them.


The process for obtaining central service supplies may vary among hospitals; thus it is impossible to outline one procedure that would cover all hospital systems. Disposable or frequently used items are stored on each nursing unit (items will vary depending on the specialty of the nursing unit). That storage space is often referred to as the CSD closet, CSD room, or C-locker. When paper charts are used, the charging process is done by removing a bar code label from the item and placing it on the patient’s CSD charge card. Figure 11-1, A, shows a CSD card. The person who removes the supplies is responsible for placing the bar code label on the patient’s CSD card. In hospitals using an electronic medical record (EMR) system, a computer with a scanner is located in the storage area and nurses may scan items with bar code labels directly into the appropriate patient’s EMR. Figure 11-1, B, shows a computer used for this purpose located in a CSD closet.


image
Figure 11-1 A, Central service department (CSD) patient charge card. B, Bar code labels are scanned into the patient’s electronic medical record via a computer located in the CSD closet.

When paper charts are used, a central service technician usually takes a daily inventory of the items stored in the closet or C-locker. Used items are replaced, and the patient’s CSD current charge cards are collected. Some hospitals use a system with an exchange cart that is supplied with frequently used items and is exchanged every 24 hours. The unit receives another completely supplied cart while the CSD replenishes the used cart.


Reusable or infrequently used items are stored in the CSD. Refer to Table 11-1 for a comparison of items commonly stored on nursing units and items often stored in the CSD (items in each category may vary among hospitals).


Related posts:

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  3. Admission, Preoperative, and Postoperative Procedures
  4. Diagnostic Imaging Orders

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Apr 8, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Nursing Intervention or Treatment Orders

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