Simulation Activity 1. What is a femoral-popliteal bypass? Describe possible postoperative complications?

? - Femoral popliteal (also called femoropopliteal) bypass surgery is a surgical procedure that may be used to treat femoral artery disease. Femoral popliteal bypass is the surgical opening of the upper leg to directly visualize the femoral artery. It is performed to bypass the blocked portion of the artery using a piece of another blood vessel. Blood vessels, or vein grafts, used for the bypass procedure may be pieces of a vein taken from the legs. One end of the vein graft is attached above the blockage and the other end is attached below the blockage, rerouting blood flow around the blockage through the new graft to reach the muscle. In some situations, a prosthetic (made of artificial material) graft may be used for the bypass graft, rather than a vein graft. Some possible complications that may occur postoperatively with this type of procedure are: Myocardial infarction (heart attack) Cardiac arrhythmias (irregular heart beats) Hemorrhage (bleeding) Wound infection Leg edema (swelling of the leg) Thrombosis (clot in the leg) Pulmonary edema (fluid in the lungs) Bleeding at the catheter insertion site (usually the groin) after PTA procedure Blood clot or damage to the blood vessel at the insertion site (PTA) Restenosis (blockage in the blood vessels after PTA procedure) Nerve injury Graft occlusion (blockage in the graft used in bypass surgery) 2. What is the correct technique for the insertion, care and removal of a urinary catheter? Insertion: Gather equipment. Explain procedure to the patient Assist patient into supine position with legs spread and feet together Open catheterization kit and catheter Prepare sterile field, apply sterile gloves Generously coat the distal portion (2-5 cm) of the catheter with lubricant Apply sterile drape If female, separate labia using non-dominant hand. If male, hold the penis with the non-dominant hand. Maintain hand position until preparing to inflate balloon. Using dominant hand to handle forceps, cleanse peri-urethral mucosa with cleansing solution. Cleanse anterior to posterior, inner to outer, one swipe per swab, discard swab away from sterile field. Pick up catheter with gloved (and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand. In the male, lift the penis to a position perpendicular to patient's body and apply light upward traction (with non-dominant hand) Identify the urinary meatus and gently insert until 1 to 2 inches beyond where urine is

noted Inflate balloon, using correct amount of sterile liquid (usually 10 cc but check actual balloon size) Gently pull catheter until inflation balloon is snug against bladder neck Connect catheter to drainage system Secure catheter to abdomen or thigh, without tension on tubing Place drainage bag below level of bladder Evaluate catheter function and amount, color, odor, and quality of urine Remove gloves, dispose of equipment appropriately, wash hands Document size of catheter inserted, amount of water in balloon, patient's response to procedure, and assessment of urine Care of urinary catheter: Always wash your hands before and after handling your catheter Make sure that urine is flowing out of the catheter into the urine collection bag. Make sure that the catheter tubing does not get twisted or kinked. Keep the urine collection bag below the level of patients bladder. Make sure that the urine collection bag does not drag and pull on the catheter. Check for inflammation or signs of infection in the area around the catheter. Signs of infection include pus or irritated, swollen, red, or tender skin. Clean the area around the catheter twice a day using soap and water. Dry with a clean towel afterward. Do not apply powder or lotion to the skin around the catheter. Do not tug or pull on the catheter. Removal of urinary catheter: - make sure that you unsecure the catheter from the patients body. - You then would hook the syringe to the tubing to deflate all of the water out of the balloon. - Once you have deflated the balloon, tell the patient to bare down and gently pull the catheter out of the body and discard of it. 3. What is the right technique for administering reconstituted intramuscular medication? - you want to identify the 6 rights of administration - make sure you reconstituted the medication correctly and that the medication is mixed properly - you want to identify the correct intramuscular injection site and z track method - clean the location - stick needle, aspirate, inject medication - remove needle - discard in sharps container 4. What is the correct technique for mixing and administering insulin? - you will have 2 nurses verifying the right dosage and insulin, and check blood glucose - you would draw back air in the needle for the correct amount and insert it into the nph insulin first, then you would draw back air for the correct amount and insert into the regular insulin, then you would draw back the correct amount of regular insulin, then you would move back to the nph and draw back the correct amount of insulin from that

container. - identify the 6 rights of administration - clean the sub Q injection site - inject insulin needle and medication - pull out the needle - discard in the sharps container. 5. What are the signs and symptoms of hyperglycemia and hypoglycemia? How would each be treated? Early signs of hyperglycemia: frequent urination, increased thirst, blurred vision, fatigue, and headache. Late signs and symptoms of hyperglycemia: fruity-smelling breath, nausea and vomiting, shortness of breath, dry mouth, weakness, confusion, coma, and abdominal pain. Treatment for hyperglycemia: Fluid replacement. You'll receive fluids either orally or through a vein (intravenously) until you're rehydrated. The fluids replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood. Electrolyte replacement. Electrolytes are minerals in your blood that carry an electric charge. The absence of insulin can lower the level of several electrolytes in your blood. You'll receive electrolytes through your veins to help keep your heart, muscles and nerve cells functioning normally. Insulin therapy. Insulin reverses the processes that cause ketones to build up in your blood. Along with fluids and electrolytes, you'll receive insulin therapy usually through a vein. Signs and symptoms of hypoglycemia: confusion, abnormal behavior or both, such as the inability to complete routine tasks, visual disturbances, such as double vision and blurred vision, seizures (uncommon), loss of consciousness (uncommon), heart palpitations, shakiness, anxiety, sweating, hunger, tingling sensation around the mouth. Treatment for hypoglycemia: The initial treatment depends on your symptoms. Early symptoms can usually be treated by consuming sugar, such as eating candy, drinking fruit juice or taking glucose tablets to raise your blood sugar level. If your symptoms are more severe, impairing your ability to take sugar by mouth, you may need an injection of glucagon or intravenous glucose. 6. What are the principles of sterile technique? - Only Sterile Items Are Used Within the Sterile Field. - Gowns Are Considered Sterile Only from the Wiast to Shoulder Level in Front and the Sleeves. - Tables Are Sterile Only at Table Level. - Persons Who Are Sterile Touch Only Sterile Items or Areas; Persons Who Are Not Sterile Touch Only Unsterile Items or Areas. - Edges of Anything That Encloses Sterile Contents Are Considered Unsterile.

- Sterile Field Is Created as Close as Possible to Time of Use. - Sterile Areas Are Continuously Kept in View. - Sterile Persons keep well within the Sterile Area. - Sterile Persons Keep Contact with Sterile Areas to a Minimum. - Destruction of Integrity of Microbial Barriers Results in Contamination. 7. What is the procedure for performing a wet to dry dressing change? Removing old dressing: Wash your hands befor and after each wound dressing change. Put on a pair of non-sterile gloves. Carefully remove the tape. Remove the old dressing. If it is sticking to your skin, wet it with warm water to loosen it. Remove the gauze pads or packing tape from inside your wound. Put the old dressing, packing material, and your gloves in a plastic bag. Set the bag aside. Cleaning the wound: Put on a new pair of non-sterile gloves. Use a soft washcloth to gently clean your wound with warm water and soap. Your wound should not bleed much when you are cleaning it, but a small amount of blood is okay. Rinse your wound with water, and gently pat it dry with a clean towel. Do not rub it dry. In some cases, you can even rinse the wound while showering. Check the wound for Increased redness or swelling A bad odor Drainage that is darker or thicker Color of the drainage and amount After cleaning your wound, remove your gloves and put them in the plastic bag with the old dressing and gloves. Wash your hands again. Changing the dressing: Put on a new pair of non-sterile gloves. Pour saline into a clean bowl. Place gauze pads and any packing tape you will use in the bowl. Squeeze the saline from the gauze pads or packing tape until it is no longer dripping. Place the gauze pads or packing tape in your wound. Carefully fill in the wound and any spaces under the skin. Do not let the wet gauze or packing tape touch any healed skin. Cover the wet gauze or packing tape with a large dry dressing pad. Use tape or rolled gauze to hold this dressing in place. Put all used supplies in the plastic bag. Close it securely, then put it in a second plastic bag, and close that bag securely. Put it in the trash.

Wash your hands again when you are finished. 8. What is the correct technique for applying an elastic bandage using the figure-eight bandage? Hold the bandage so that the roll is facing up. This way, bandages containing Velcro face the right way and stick to the bandage when you finish wrapping.

Start the loose end of the bandage on the top of the foot. Hold the loose end of the bandage in place with one hand. With the other hand, wrap the bandage in a circle twice around the foot. Always wrap the bandage in the direction of outside (little toe side of foot) to inside (big toe side of foot). Overlap the elastic bandage by one-half to one-third of its width each time you go around. After the foot has been wrapped twice, move your hand to the heel. Wrap the bandage moving up toward the ankle. The bandage should be wrapped in a spiral way, like making a "figure 8". Leave the heel uncovered. Cross the bandage over the foot, moving upward, and pass it behind the ankle. Move the bandage down and cross it over the top of the foot.

Wrap the bandage under the foot to complete the "figure 8". Repeat this one more time.
Pass the bandage around your calf and start wrapping it in upward circles toward your knee. Stop wrapping below the knee. You do not need to wrap the bandage down the calf again. Fasten the end to the rest of the bandage with tape, metal clips, or Velcro. Do not fasten metal clips on a bandage where there is a skin fold or crease, such as under the knee.

9. What would be the appropriate teaching strategies for an elderly Hispanic patient in regards to diabetic foot care? When dealing with a patient of a different culture you need to be culturally sensitive. Learn about his culture and his daily living activities and how he does certain things then you should teach and talk to him about the basic/most important things dealing with foot care and also in the instance and elderly Hispanic man you need to assess if he can even understand English and possibly get a translator and also you would probably need to teach these things also to someone other than just him, possibly his children or whoever helps take care of him on a regular basis. Look at your feet on a daily basis and check for cuts, blisters, redness and nail problems. Wash your feet in lukewarm (not hot) water in order to keep them clean. Be gentle when bathing your feet. Wash with a sponge and dry by blotting, especially between the toes. Moisturize your feet daily to keep dry skin from itching or cracking. Do not moisturize between the toes, though; this could encourage fungal infections. Cut nails carefully and straight across. File the edges. Do not cut nails too short; this could lead to ingrown toenails. Never trim corns or calluses. Let the podiatrist do the job. Wear clean, dry socks. Change them daily. Avoid the wrong type of socks. Tight elastic bands can reduce circulation. Bulky socks can fit poorly and irritate the skin. Wear socks to bed if you have cold feet at night. Shake your shoes and inspect the insides before wearing them. You might not feel a pebble in your shoe, but it can cause a sore or blister on your foot. Keep your feet warm and dry. Do not wet your feet in the snow or rain. Wear warm socks and shoes in the winter. Never walk barefoot - not even at home! You could step on an object and get a cut. Take care of your diabetes. Always monitor your blood sugar and keep sugar levels under control. Do not smoke. Smoking restricts blood vessels in your feet. This may be difficult to convince someone that is a smoker but just inform them of the importance of avoiding it and what damage it can do. Get periodic foot exams. Visit your podiatrist on a regular basis for an examination in order to prevent diabetic foot complications. If this is not realistic then you could stress the importance of having someone aside from yourself to help you inspect.