NURSING EXAM PORTAL

 Lumber Puncture

• Lumber puncture also known as spinal taping.
• a process where needle are introduce into the subarachnoid space to collect CSF.

Purpose:

• CSF collection and analysis
• Check CSF pressure
• Myelography (iodine dye is injecting through LP for study of structure of spinal cord.)
• Drug administration 
• Spinal anesthesia

Indication

• Lower limb surgery
• LSCS
• Meningitis
• Pott's spine
• Neuro degenerative disorder

Contraindication

Increase ICP

Procedure

1.Collect article:-

• spinal needle:-     adult:-22 G              child:-25 G
• 3 Sample collection vial:- cytological, viral, bacterial, or other examination.
• Manometer:- to check the CSF pressure.
• Betadine
• 2% lidocaine 
• syringe

Position

1. Fetal attitude
2. C shape
3.  Lateral position with head and knee flexed inside.

Site of selection

• Adult:-L3-L4
• Infant:-L4-L5
• Most Common:-L4-L5

Insert needle in subarachnoid space then connect 3 way adaptor. connect manometer and check pressure. mercury rise in manometer and constant a point that is known as CSF pressure.

• Normal CSF pressure:-5-15 mm of Hg 
• after sample collection dressing to the site.
• Position:-Flat position or supine position avoid pillow under back 
• advantage of position :- to prevent headache.
• Most common complication after LP.
• Amount of the sample:-6-10 ml
• sample should be sending in lab in  1-2 hrs.
• Temperature for store the CSF:-
• 0-6 hrs :- Room temperature 22-24 Celsius
• 6-24 hrs:- 4 Celsius 
• Serological Examination:- 20 Celsius. 

 COLOSTOMY AND DIET

Diet Modification is an important part after colostomy generally following diet pattern followed after the procedure:-

1. First 24 hrs:-  IV therapy.

2.24-72 hrs:- Give the liquid and fiber diet (it will help in easy to clean the bowel due to absence of bowel sound after surgery.)

3.After 72 hrs.:-

• Normal diet.
• Before diet modification check the bowel sound of patient.
• if  bowel sound are not present after 72 hrs that is abnormal finding and inform to doctor.
• Bowel should be check in all quadarate.

 COLOSTOMY

Definition:- Artificial opening of the colon (large intestine) through the anterior abdominal wall.

Purpose:- escape the flatus and stool.

Indication:-

1.Intestinal Obstruction.

2.Rectal Tumor and cancer.

3.Intestinal Cancer.

4. Imperforate of anus

Classification:-

According to Placement:-

1.Wet Colostomy 

2.Dry Colostomy

Wet Colostomy:- 

• stool is passed out in liquid form by the client.
• Incision is making in ascending colon.
• ascending wet colostomy is performing for short term/Temporary.
• Time:- 6-8 weeks.
• Opening :-opening of colostomy on the right side of abdomen .

Dry Colostomy.

• Incision is making in sigmoid colon.
• Stool is passing out in normal form.
• sigmoid colostomy is performing for long time or permanent based.
• Opening:- end colostomy or left side of abdominal.

Procedure:-

• nurse role before procedure precaution.
• stop the high fiber diet before 2-3 day from procedure.
• doctor explain procedure.
• doctor collect consent.
• collect investigation and report of patient.
• NBM 8-12 hours before colostomy to prevent risk of aspiration.
• prepare part.
• best time for part preparation(before 30 minute form the surgery)
• Site prepare:- just below the nipple to mid thigh.
• Solution:- 7.5% betadine or 7.5% savlon.

Position:-

• 1.Supine position:-during general anesthesia use in surgery
• 2. Trendelenburg:-when spinal anesthesia use during surgery.

Care of colostomy:-

• Check the vital sign.
• Provide side line or lateral position.
• Clean the outer site of stoma with betadine gauze then use dry gauze.
• Advantage:-prevent the growth of bacteria and microorganism.
• prevent skin irritation due to stool and HCL produce irritation.
• maintain soft dry to the stoma.
• cover to the stoma with a water  patch.

Advantage:-

• to prevent leakage of stool.
• water should be use/cut 1/8 inch more diameter than stoma.
• connect colostomy bag with ring of water.
• provide psychological support due to disturbed body image of client.

observe form stool:-

1. Ascending colon:-Liquid
2. Transverse:- Semi solid
3. Sigmoid:-Normal

Observe the color of stoma:-

• Bright red or pink:-Normal finding.
• Pale Pink:-Normal in anemic patient.
• Black or dusky:-abnormal finding due to compromised of blood circulation.(inform to doctor)
• Malodorous/foul smell form stoma upto  72 hr. after colostomy is normal finding.
• foul smell form stoma after 72 hr. due to infection then nurse inform to doctor.
• colostomy bag empty when fill upto 1/3 lelvel.
• change the water and colostomy bag in 72 hrs in or 3 days.

MASK:-VENTURE MASK

1.Use in severe hypoxia to the client.

2. 8-10 Liter per minute flow rate delivered by mask.

3.avoid less than 5 Liter per minute flow rate by mask Except Venture mask.

Venture Mask:-

1.Use according to color coding.

2.Also known as higher flow mask.

3.Venture mask deliver accurate concentration of oxygen to the patient.

4.Blue:- 2 Liter per minute and 24 %

5.White:- 4 Liter per minute and 28 %

6.Orange:- 6 Liter per minute and 31%

7.Yellow:-8 Liter per minute and 35%

8.Red:-10 Liter per minute and 40%

9.Green:-12-15 Liter per minute and 60%

 NASAL CANNULA

1. 1.5 cm long probe are insert in both nostril.

2.Flow Rate:- 1-4 L/Min.

3.In advance stage:-1-6 L/Min.

4.Concentration:-24-44%

5.Every 2nd hourly replace nasal cannula to prevent dry mucosa and ulcer.

6.Use in COPD use for long time oxygen inhalation.

 NASAL CATHETER

1.The nasal catheter most commonly useful method use in clinical practice.

2.Flow Rate 1-6/Minute.

3.Concentration 22-30% oxygen is delivered by nasal catheter.

4.Procedure:-

Position of Patient:-Rose Position where patient is lying on back with hyper extended of head(1st Priority)

5.High fowler position (2nd Priority)

6.1-2 Liter/ min by nasal cannula in COPD Patient.

7.Measure length of nasal catheter:- tip of nose to ear lobe(10 cm)

8.Replace the nasal catheter of nasal catheter every 8 hourly to prevent stenosis  by mucus.

9.Catherter:-4-6 French.

10.Nasal catheter insert in left nostril and avoid right nostril increase risk of injury.