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1)What are the cause of aletectasis

-effect of anaesthesia
-abdominal distention
-pain
-diaphragmatic dysfunction
-obesity
-smoking history
-prolong supine position
-postoperative narcotics

2) What are the instructions on using an incentive spirometer

Correctly position the patient; this is critical to effective use of incentive spirometry. Help the patient  into an upright sitting position in bed or on a chair to promote optimal lung expan- sion while using the spirometer
Instruct the patient to exhale, letting all the breath out
Ask the patient to close the lips around the mouthpiece of the spirometer;
Instruct the patient to inhale slowly,
breathing in until unable to do so any more (slow breathing prevents or minimises pain from sudden pressure changes in the chest)
Ask the patient to hold the breath for 2-3 seconds then exhale slowly. This is considered a key step while using an incentive spirometer as holding breath and slowing exhalation helps to maintain maximal inspiration and reduces the risk of progressive collapse of individual alveoli. Nurses need to stress the importance of this step to patients and ensure they follow it correctly; if not, patients may assume breathing in through the spirometer is enough to prevent complications

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1. Atelectasis occurs from blocked airway (obstructive) or pressure from outside the lung. General anesthesias is a common cause of atelectasis
Effects of anaesthesia
Abdominal distension
Pain
Diaphragmatic dysfunctio
Obesity
Smoking history
Prolonged supine position Postoperative narcotics
2. Instructions on using an incentive spirometer
- sit up straight
-ensure that mouth wraps around mouthpiece
- inhale slowly and deeply
-hold the breathe from 2 to 3 seconds
- before meal and before sleeping
-let the patient rest when they feel dizziness

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Atelectasis is the term for a collapse of one or more areas in the lung, and often develops after surgery. The most common cause of atelectasis is surgery as the medicine used to keep one asleep (e.g. anesthesia) can affect one’s ability to breathe normally or cough. Other causes include chest pressure, blocked airway and other lung conditions (e.g. lung cancer, pneumonia).

Instructions for using an incentive spirometer:
1. Help the patient into an
upright sitting position in bed or on a chair to promote optimal lung expansion while using the spirometer.
2. Instruct the patient to exhale, letting all the breath out; Ask the patient to close the lips around the mouthpiece of the spirometer.
3. Instruct the patient to inhale slowly, breathing in until unable to do so any more.
4. Ask the patient to hold the breath for 2-3 seconds then exhale slowly.
5. This process should be repeated 10 times each hour while the patient is awake.

yes.

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1. The causes are pneumonia, scarring of lung tissue, tumor and surgery.

2. - Sit up right
- breathe in slowly and deeply
- keep the meter at the eye level
- seal mouth around the mouthpiece tightly
- hold your breath for 5 seconds, let the level drop back to 0, stop if the patient feels giddy and do the breathing 4 times a day and  10 times each session.

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1. 3 Readings

2. The best and highest reading on the peak flow chart.

3. Position of the patient (for lung expansion)
If patient did not blow hard enough (inaccurate reading)
Dirty mouthpiece (inaccurate reading)

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1. 3 readings

2. the highest of the 3 readings as it is considered the patient’s peak flow or personal best .

3. some factors that may interfere & why :

- poor seal around the mouthpiece while performing the procedure will cause air to leak out and result in inaccurate readings

- blocking the mouthpiece with the tongue will not allow all the air to flow through and result in inaccurate readings

- not breathing in deeply enough to start the test will result in inaccurate readings as it is not the peak flow

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1. 3 readings
2. Take the highest reading as it is the value that will be used as a baseline for daily measurements
3. the factors that may interfere are not breathing in deeply enough to start the test, coughing during the test, poor seal around the mouthpiece while performing the procedure.

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Sha and Yifan
1) 3 readings
2) the nurse should document the reading that have the highest score
3) patient who are acutely breathless as the procedure requires physical effort
Patient with severe airflow obstructions as included in the measurement may be air coming from the collapsing airway, yielding an erroneously high result

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1. 3 times
2. The highest reading to measure the maximum capacity of lung expiration
3. Dirty meter - mucus, phlegm or debris in the peak flow meter will affect the reading

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- Take 3 readings
- The highest reading to get the maximum capacity
-  Dirty Flow Meter ,  Position of patient (lung expansion) can affect the reading as it may not be at full capacity.

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To summarise chapter 5.1, antisepsis of the insertion site is regarded as one of the most important measures for preventing cannula-related infection. Before insertion of IV cannulas, the use of tincture of iodine (mixture of iodine + alcohol) is an effective antiseptic for skin preparation, as iodine on its own may cause irritation to the skin, hence it will require cleansing with alcohol.

Dressing cannula insertion sites with transparent semi-permeable polyurethane dressings secures the IV cannula, permits visual observation of the site, allows patients to shower without soaking the dressing, and requires less frequent changes compared to standard gauze & tape dressings. Transparent dressings can be safely left on IV cannulas for the duration of cannula insertion without increasing the risk of thrombophlebitis.

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To summarise chapter 5.2, it appears to be that the prevention of CR-BSI has been effective through the use of anticoagulants agents as thrombi and fibrin deposits on cannulas may serve as a nidus for microbial colonization of the IV devices. It has been revised that the 0.9% saline solution is as competent as heparin to preserve cannula patency and reducing peripheral cannulas. In addition, IV addictive such as hydrocortisone can reduce phlebitis and anti-microbials. For example, the risk of phlebitis is associated with the infusion of certain fluids such as potassium chloride. Thus, flushing the peripheral venous locks with normal saline solution should be done before every use.

To summarise 5.3, it talks about how more frequent replacement of IV tubing could be necessary. This is because although the replacement of administration sets 72h or more after initiation of use is safe and worth the money, but, certain fluids such as blood  and blood products could be contaminated if the environment is favourable for microbial growth. Thus, some suggestions were made so as to reduce the spread of bacterial growth. For example, to replace the tube that was used to administer blood immediately after infusion.

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4.1）Handwashing is an important procedure to prevent the spread of infections by removing pathogens from our hands. Many types of infections are caused by organisms transmitted on the hands of healthcare personnel therefore we should wash our hands before and after palpating, inserting, replacing or dressing any IV device. 5 moments of hand hygiene are very important for preventing cross-contamination and protecting patients against harmful gems from entering their bodies.

4.2) Barrier precautions are crucial especially in hospital settings where many of the patients immunity levels are low. It is all hospital staff's priority to ensure that patients do not get any infections, be it from other patients or from their  surroundings. These procedures can also make patients feel more at ease knowing  that they are well protected. Gloves are critical to prevent the transmission of organisms when hand hygiene alone is not enough in an outbreak or when a patient has a suspected or known pathogen. Glove also protect healthcare worker from cross contaminated and potential blood contact.

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Selection of peripheral cannula insertion have several factors that are taken to determine the site of cannula placement. The factors are risk of medical complications such as bleeding, pneumothorax and also risk of infection. Peripheral Venous Cannula inserted in the upper extremity have a lower risk of phlebitis than those on the lower etremity.

Selection of replacement of IV devices discusses that the material of the IV cannula can also affect the presence of infection to the patient. The type of cannula is chosen by the purpose of the cannula to the patient and also the duration of the IV cannula needed. The steel material IV cannula is not preferable as it may cause tissue necrosis. The change of IV cannula is also required as it also prevent the risk of infection.

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3 things that I have leant:
1. i have learnt how to monitor and manage gastro-intestinal tolerance. Gastric residual volume (GRV) should be checked 4-8 hourly in
continuously fed patients and before each intermittent feeding to monitor residuals more closely during that period.
2. the importance of flushing feeding tube with water before and after bolus or intermittent feeding that helps to to prevent
clogging and restore the patency of partially obstructed tubes.
3. I leant how to manage feeding intolerance. Observe patient during NGT feeding for presence of nausea, vomiting, abdominal pain.

2 questions
1. why do we need to monitor patients on antibiotics  for symptoms of
diarrhoea?
2. why shouldn't we administer sublingual medications via feeding
tube?
1 relation
select the tubes based on patient's condition and replace it according to hospital's policy.

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3 things i learnt :
- Enteric-coated and sustained release medications should not be crushed
- It is important to kink tubing before opening tube to prevent any air flow
- Flush feeding tube with water prior to medication administration to push out any particles blocking the holes

2 Questions:
- What happens when patient has acid reflux with NGT
- How do you know when the machine pump is spoiled

1 Relation:
The things we insert into the tube should be liquid as this will prevent blockage and help a smoother process down.

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The 3 things that I have learnt are how to insert and remove the NGT correctly , the scheduling of enteral nutrition and lastly how to feed the patient via the NGT (we need to kink the tube before opening the spigot)
The 2 things I found interesting was being able to tell that the tube is in a correct position by using the pH strip and also the need to aspirate
1 Question: Will it be uncomfortable if the patient breathes while having the NGT?

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3 things I have learned
1. I learnt how to calculate the scheduling of enteral nutrition.
2. I learnt how to insert and remove nasogastric tube.
3. I learnt bolus feeding and continuous feeding which use machine.

2 things I felt interesting
1. Feeding not only through mouth, also has another ways.
2. When I test the pH value of gastric, if the pH value not more than 5, I need to retest and try to find the reasons before inform staff nurse.

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3 THINGS I HAVE LEARNED
1) I have learned that there is different way to meet the patients nutritional needs when they have difficulty in swallowing or other medical conditions
2) i also have learned to how calculate and schedule the feeding time and amount for the patient that have been ordered by the dietitian
3) i have also learned that there different kind of feeds that the patient is required to take

2 THINGS I FIND INTERESTING
1) that there is different way to insert the tubing as it will help to meet the patients nutritional needs
2) the way of inserting the ngt to the patient

1 QUESTION
1) how does nurses do ngt to patient that is difficult to insert the tubing

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3 things i learned:
- I know how to do nasogastric tube insertion and removal.
- I have learned how to check the formula.This ia important for patient.
- I have learned how to give the patient enteral nutrition via nasogastric tube.
2 interesting things
- I think calculate the date how many  should i give the patient nutrition is interesting.
- When i do insert tube to patient,  every patient has different condition.
1 question:
When i do insert tube to patiwnt,the patient feel uncomfortable, what should i do?

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3 things i’ve learnt :
1. i learnt the difference between bolus, intermittent and continuous feeding
2. i learnt how to determine the amount of gastric residual volume ( GRV )
3. i learnt how to calculate and schedule a feeding chart ( the amount and frequency of feed )
2 things i find interesting :
1. the way the doctors calculate how much of the formula and / or water to prescribe to the patient
2. the fact that we can perform aspiration to check the placement of the tube ( don’t have to physically like take the tube out or something idk pls TT )
1 question i still have :
1. how do nurses tackle patients who require NGT feeding but are afraid of it ?

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3 things l have learnt:
-  I have learnt how to prevent patient from diarrhea during feeding which is ensure the feed   not be decanted before use to prevent growing of microorganisms.
- We need to observe the patients during feeding and make sure they don't have any sign of feeding intolerance. If they show the signs, we can assess for the bowel sound and the abdominal pain.
- I have learnt that smaller syringe has the higher chance to cause the tube to collapse because it exerts higher pressure.

2 questions:
-Why patients on antibiotics need to be monitored for symptoms of diarrhea?
- What we need to do when patient shows the sign of aspiration pneumonia?

1 relation:
- Remain patient in semi fowler position after feeding for at least an hour for better digestion and prevent the formula to enter the lungs.

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Nicholas
3 things i have learnt:

3.Different ways to deliver nutrients to patients who cannot ingest orally
2. I learnt how to schduel bolus feeding for patients
3. I learnt how to deliever nutrients through a nasogastric tube.

2 things i find interesting:
2. how a tube is able to enter a patient through their mouth
1. how different milks are used for different patients

1 question i still have:
1. can patient still vomit if they are on ngt?

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To summarise chapter 5.2, it appears to be that the prevention of CR-BSI has been effective through the use of anticoagulants agents as thrombi and fibrin deposits on cannulas may contaminate IV devices. It has been revised that the 0.9% saline solution is as competent as heparin to preserve cannula patency and reducing peripheral cannulas. In addition, IV addictive such as hydrocortisone can reduce phlebitis and anti-microbials. For example, the risk of phlebitis is associated with the infusion of certain fluids such as potassium chloride. Thus, flushing the peripheral venous locks with normal saline solution should be done before every use.

To summarise 5.3, it talks about how more frequent replacement of IV tubing could be necessary. This is because although the replacement of administration sets 72h or more after initiation of use is safe and worth the money, but, certain fluids such as blood and blood products could be contaminated if the environment is favourable for microbial growth. Thus, some suggestions were made so as to reduce the spread of bacterial growth. For example, to replace the tube that was used to administer blood immediately after infusion.

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3 Things that I learnt:
1. Firstly, I learned that some of the advantages of Nasogastric are, the tube allows bolus/intermittent feeding so the patient is less confined and also it is less expensive

2. Secondly, I learned that it is important to check the CORRECT formula fed. This is because it may affect the patient’s condition. For example, if he/she is a diabetic patient

3. Lastly, I learned how to schedule and calculate the feeding times for patients under NGT feeding.

2 Things that I find interesting
1. I find it interesting that there are many types of feeding formula for NGT feeding.

2. I also find it interesting that we are able to use the Universal Colour Indicator to test the PH level in the stomach. That is if it is acidic or alkali.

1 Question I have
1. What should we do when we are suppose to feed the patient via NGT but he/she totally refuses to comply with us?

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hoo fang wei
3 things i have learnt
- I have learnt the difference between bolus and continuous feeding.
- I can use warm water to declog obstructed feeding tubes. If unsuccessful, pancreatic enzyme with sodium bicarbonate may be used.
- Patient should be in high fowler’s position during feeding and at least 1 hour after feeding.
2 questions i have
- Do antibiotics cause diarrhoea?
- What kind of feeds to use for patient with diarrhoea?
1 connection between something i knew before
- Always flush NGT with water before and after feeding like drinking water during a meal

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3 things I leant
1. One of the advantages of nasogastric is that it’s less expensive and it is easily placed
2. Hold the syringe at the level of patient’s forehead when feeding
3. I learnt how to test for the different pHs using the universal indicator to ensure that we have placed the NGT in the correct position

2 things I find interesting
1. I find it interesting that there are different types of milk formula for different types of patients. We must provide the correct formula as it may affect patient’s condition
2. I found interesting that there are different ways to concentrate the aspirate when you cannot extract anything

1 question I have
1. I have no questions thankyou:)

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3 things i learned:
- jejunostomy and gastrosnomy is costly as the enteral tube is hidden
- i learned to schedule the feeding times for the patient
- to hold the syringe at the patient’s forehead level when feeding the patient

2 things i find interesting:
- i find it interesting that there are different types of feeding formula
- it is interesting to me that only nasogastric can be inserted by the nurse

1 question i have:
- no questions