# data[].attributes.body
1.
-Abdominal distension
-Pain
-Diaphragmatic dysfunction
-Obesity
-Smoking history
-Prolonged supine position
-Postoperative narcotics
-compromised inspiration and reduced tidal volume
2.
-Position the patient into an upright sitting position in bed or on a chair to promote optimal lung expansion
-instruct patient to exhale, letting all the breath out
-ask patient to close the lips around the mouthpiece of spirometer
-Instruct patient to inhale slowly, breathing in until unable to do so anymore
-Ask the patient to hold the breath for 2-3 seconds then exhale slowly. This helps to maintain maximal inspiration and reduce the riskof progressive collapse of alveoli.
-Repeat 10 times each hour while patient is awake

# data[].attributes.body
1.  The causes of atelectasis are effects of anesthesia, Abdominal distension, Pain, Diaphragmatic dysfunction, Obesity, Smoking history, Prolonged supine position and Postoperative narcotics. This will lead to compromised inspiration and reduced tidal volume.

2. - sit up straight
- instruct patient to exhale letting all the breath out
- ask patient to close their lips around the mouthpiece of the spirometer
- instruct patient to inhale slowly and breathe in until unable to do so anymore
- hold for 5 sec, then exhale slowly (holding breath and slowly exhalation helps to maintain maximal inspiration and reduces the risk of progressive collapse of individual alveoli)

# data[].attributes.body
1.
- Effects of anaesthesia
- Abdominal distension
- Pain
- Diaphragmatic dysfunction
- Obesity
- Smoking history
- Prolonged supine position
- Postoperative narcotics

2.
- Sit up as far as you can in bed, on the edge of your bed
- Hold the incentive spirometer up right with the good-better-best facing you
- Exhale fully before you begin
- Place the mouthpiece in your mouth and seal your lips tightly around it
- Breathe in slowly and deeply as possible
- At the end, hold your breath for 5 sec and breathe out slowly

# data[].attributes.body
Causes of atelectasis:
-  Effects of anaesthesia, Abdominal distension, Pain, Diaphragmatic dysfunction, Obesity, Smoking history, Prolonged supine position
Postoperative narcotics which might cause compromised inspiration plus a reduced tidal volume will cause atelectasis.

Instructions:
1. Place should be sitting up
2. Instruct the patient to breath out letting out all the breath and ask the patient to put their lips around the mouthpiece
3.  Ask them to inhale slowly,
breathing in until they are unable to.
4. Ask the patient to hold the breath for 2-3 seconds then exhale slowly

# data[].attributes.body
1) 3 readings
2) Highest reading. It is considered the patient's peak flow or personal best
3)
- Not breathing in deeply enough to start the test
- Not breathing out forcefully enough to show your true level of dysfunction
- Coughing during test
- Poor seal around the mouthpiece while performing the procedure

# data[].attributes.body
1.Three
2. Highest. This ensures that the patients best is taken to ensure an effective treatment plan
3. Not breathing in deep enough before blowing into the peak flow, stop blowing halfway. No tight seal around the mouth piece

# data[].attributes.body
Q1: 3 readings
Q2: The nurse should record the highest out of the 3. I think that we should take the highest as it is the best reading of the patient.
Q3: - dirty meter (affect reading and make patient sick)
- Not breathing in deeply before the start of the test (not maximum capacity of the lung hence affecting accuracy of the result)

# data[].attributes.body
-IV cannulas may have a chance of producing phlebitis, inflammation of the vein. Signs and symptoms include a warm temperature on the site, pain, swelling and redness.

-several factors should be assessed such as patient-specific factors, relative risk of mechanical complications before insert the cannula and risk of infection.

-Peripheral venous cannula inserted in the upper extremity have lower risk of phlebitis than those on the lower extremity.

-cannula inserted into the veins of the hand have a lower risk of phlebitis than
those inserted on the upper arm or into the veins on the wrist.

-Although steel needles have the same rate of infectious complications as Teflon cannula.

-Select cannulas based on the intended purpose, duration of use, experience at the institution and known complications

-Use a Teflon cannula, a polyurethane cannula or a steel needle.

- Avoid the use of steel needles for the administration of fluids and medications that may cause extravasation. One of the complications of IV therapy

-Wear non-latex or latex gloves when changing the dressings on IV devices

-Replace short, peripheral venous cannulas, and rotate peripheral venous sites every 48 to 72 hours to minimise the risk of phlebitis.

# data[].attributes.body
1. 3
2. Highest, because it is the patient's personal best peak flow
3.

Not breathing in deeply enough to start the test

Not breathing out forcefully enough to show your true level of dysfunction

Coughing during the test

Poor seal around the mouthpiece while performing the procedure

A dirty meter

Blocking the mouthpiece with your tongue

Use of medicines that open the airways (bronchodilators)

Use of a different type or brand of peak flow meter, as measurements may vary among brands and types of meters

# data[].attributes.body
1.three times
2.take the highest of the 3 reading. Bacause the highest number is the peak flow or personal best.
3.
- Not breathing in deeply enough to start the test
-Not breathing out forcefully enough to show your true level of dysfunction
-Coughing during the test
-Poor seal around the mouthpiece while performing the procedure
-A dirty meter
-Blocking the mouthpiece with your tongue
-Use of medicines that open the airways(bronchodilators)
-Use of a different type or brand of peak flow meter, as measurements may vary among brands and types of meters

# data[].attributes.body
Joan and Nicolas.
Q1. We need to take the reading at least 3 times.
Q2. We need to take the highest reading to check if the treatment is effective. (To check for the best condition of the lungs)
Q3. Some of the factors that can affect the reading are not resetting the dial to zero, hands blocking the peak flow meter, patient is not able to understand the procedure and might do it wrongly, patient is coughing a lot and is not able to do the procedure as the reading might not be accurate and the position of the patient.

# data[].attributes.body
1. 3 readings
2. Highest. The highest number is called your peak flow or personal best.
3. These factors will lead to an inaccurate result :
- Not breathing in deeply enough to start the test
- Not breathing out forcefully enough to show your true level of dysfunction.          - Coughing during the test

# data[].attributes.body
5.2
Flushing of the cannula, prevent thing like thrombosis , the use of anticoagulant has a role to prevent thrombosis ,however 0.9 saline solution is as effective as heparin to maintain patentcy to reduce phlebitis even so using heparin routinely has been associated with hemorrhagic complication.
5.3
Replace Iv tubing 72 hours interval.replace tubing once blood or blood products has been administered immediately. Replace tubing used to administered lipid emulsion within 24 hours.

# data[].attributes.body
Section 5.1

- Before cannula insertion, cleanse the skin site with an appropriate antiseptic, including 70% alcohol or 10% povidone-iodine. Allow the antiseptic to remain on the insertion site for an appropriate length
of time before inserting the cannula.

- Do not palpate the insertion site after the skin has been cleansed with antiseptic

- Use either a transparent dressing or sterile gauze to cover the cannula site.

-Replace cannula site dressings when they become damp, loose, or soiled, or when the device is removed or replaced. Change dressings more frequently in diaphoretic patients.

- Avoid touch contamination of the cannula insertion site
when the dressing is replaced.

- Do not routinely apply topical anti-microbial ointment to the insertion site of peripheral venous cannulas.

# data[].attributes.body
*handwashing* :
- Most important procedure as many infections are normally due to organisms getting transmitted on the hands of healthcare workers.
- Aseptic technique
- Provides adequate protection against nosocomial infection
- Wash hands before and after palpating, inserting, replacing, or dressing any IV device.
* barrier precautions *
- Wear gloves (latex/ non-latex) when inserting an IV device
- Minimise catheter contamination and subsequent central venous catheter-related infections
- Use clean gloves (sterile/non-sterile) when changing wound dressing

# data[].attributes.body
3-2-1 reflection

3 things i have learned:
- We need to flush the tube in order to prevent clogging and to ensure tube patency
- Total volume of feeds should not exceed 400ml during each bolus feed
- Pre-prepared food reduces the risk of cross-contamination.

2 questions that i have:
- What's the reason behind not exceeding 400ml during each bolus feed?
- Why use warm water to declog feeding tube?

1 connection:
- we need to ensure that we don the necessary equipment before attending to patients with highly infectious diseases in order to reduce cross-contamination.

# data[].attributes.body
3 things I have learnt :
- Feeds should not be decanted in order to avoid diarrhea
-Total volume of feeds should not exceed 400ml during each feed
-Warm water can be used to reclog an obstructed feeding tube

2 questions i have:
- What happens if the total volume of feeds exit 400ml during each feed
-What happens is there is any complications in the feeding tube or the auto pump?

1 connection:
- patient needs to be placed in a lateral position in order for aspiration to be taken

# data[].attributes.body
3 things learnt

There is no need to dilute the formula as  the osmolality of the formula does not cause diarrhoea to patient

Can use sodium bicarbonate or warm water to unclog the obstructed feeding tube

Patient on antibiotics should be monitored for symptoms of diarrhoea because antibiotics reduces the bacteria within the colon that is necessary for the digestion of the enteral feeds.

2 questions

If the patient shows signs of feeding intolerance but does not demonstrate overt regurgitation or aspiration, do you still proceed with feeding?

For continuous feeding, why do you have to start with an initial slow rate of 10 to 40 ml/hour and then advancing it to the goal rate by 10 to 20 ml/hour every 8-12 hours as tolerated, instead of giving it at a constant rate as ordered by dietician from the beginning?

1 connection between something you knew before

Patients should be placed in a semi fowler position or elevated to an angle of at least 30° during and after feeding for at least one hour as this will decrease the risk of aspiration of gastric content.

# data[].attributes.body
3
1.I need to flush the tube with water to prevent clogging and ensure tube patency.
2.Administered sets and containers should be discarded every 24 hours.
3. The total volume of feeds administered should not exceed 400ml each feed.

2.
1.Can patient with nasogastric tube talk?
2.Is it we must only use warm water to declog obstructed feeding tube?

1.
Semi fowler or high fowler positions remained for patient to prevent gastro-esophageal reflux and pulmonary aspiration.

# data[].attributes.body
3 things i learnt:

1. pump-assisted delivery of enteral feeds is highly recommended for patients with small-bowel feeding because it helps prevent gastrointestinal complications that are associated with rapid infusion and it reduces gastric intolerance.

2. warm water is the most effective in declogging blocked feeding tubes.

3. we use larger syringes of 50ml to aspirate gastric content from nasogastric tubes to reduce collapse of feeding tube upon aspiration as it exerts a lower pressure per sq inch.

2 questions i have:

1. do we still initiate all formulas at full strength if the person has aspiration pneumonia ?

2. why is warm water the most effective to declog feeding tube, like why not cold or hot water?

1 connection between something i knew before :

-use a mask if handler has a cold, sore throat or upper respiratory tract infection and this is for infection control

# data[].attributes.body
3 things I have learned:
1. The total volume of feeds should not exceed 400ml
2. The difference between nasogastric pneumonia and nosocomial penumonia
3. Measurement of NGT tube

Question
What is 12F?
How can you tell if a patient has nosocomial penumonia or aspiration pneumonia?

I learn why we should sit up patient before feeding

# data[].attributes.body
3 things I learnt:
1) We should use warm water to declog obstructed feeding tubes.
2) The total volume of feeds administered should not exceed 400ml during each bolus feed
3) For prevention of diarrhoea, administration sets and containers should be discarded every 24 hours

2 questions:
1) Do we screen the curtains during feeding ?
2) What if there are complications with the intermittent pump during the process of feeding ?

1 connection:
1) Patient should sit up right and be in the semi-Fowlers/high-Fowlers position during feeding and after

# data[].attributes.body
3 things I learned
1. Total volume of feeds administered should not exceed 400ml during each feed
2. Administration sets and containers should be discarded every 24 hours to prevent diarrhoea
3. We need to monitor for the signs and symptoms of aspiration pneumonia

2 Question
1. Why use warm water rather than hot water  to declog obstructed tube.
2. What is 12F?

1 Connection
1. We need to put patient in a high or semi flower position when feeding.

# data[].attributes.body
3-2-1 Nicolas

3 things I have learnt:
1. I have learnt that the total volume of feeds administered for bolus feeding should not exceed 400ml for each bolus feed.
2.  I learnt that in order to prevent diarrhoea, feeds should not be decanted before use.
3. I learnt that warm water can be used to declog obstructed feeding tubes.

2 questions I have:
1. Is it normal for patients to feel nausea and vomit even if they do not have any complications?
2. Why do patients on antibiotics have to be checked every now and then?

1 connection between something I knew before and after
1. I learnt how to use the machine for intermittent feeding and continuous feeding

# data[].attributes.body
1) I’ve learned that little things matters during NGT feeding, it is important to be meticulous when feeding the patient, this is by checking 5 rights.

Looking for signs of Respiratory distress, nosocomial pneumonias, aspiration, and fluid/milk intake can affect the patient’s overall condition,

thus we need to be careful and observant when doing NGT

2)  what happens when a patient has pneumonia? Do we resume NGT treatment ? Or do we find another alternative?

How do you tell if it’s aspiration pneumonia? Or nosocomial ?

I’ve learned the difference between how aspiration and nosocomial pneumonia occur

# data[].attributes.body
three:
1. Use mask if handler has a cold, sore throat or upper respiratory tract infection as it can reduce the risk of cross infection
2. total volume of feeds administered should not exceed 400 during each bolus feed as it may result in abdominal distension and discomfort
3. we can use warm water to declog obstructed feeding tube

two:
1.what will happen to patient who needs continuous feeding but was not given continuously?
2. what is the temperature range for "warm water" to declog the feeding tube

one:
1. i know that we have to put patient to left lateral position when we are not able to take the aspiration

one:

# data[].attributes.body
1. Pre prepared feeds reduce the risk of cross contamination and cross infection

2. The total volume of feed administer Of bolus feeding should not exceed more then 400ml for each feeding

3. Use warm water to declog obstructed feeding tubes.

2.

1. Can use normal temperature water to flush Down?

2. Can u use a auscultation to listen to the stomach first? Cos there’s sound

1. I know about conform have to do your 7 steps of hand washing before this procedure.

# data[].attributes.body
3.

1. Prep-prepared feeds reduce the risk of cross contamination and cross infection

2. Bolus feeding should not 400 during each feeding

3. Use warm water to deck of obstructed feeding

2.

1. How do pancreatic enzyme and sodium bicarbonate decking the obstructed feeding tubes?

2. If the patient is in vegetative state and unable to demonstrate regurgitation. How do we know when to stop the feeding

1.

Use a mask when the patient has a cold, sore throat or UTI. This is to prevent cross infection

# data[].attributes.body
3 things I have learn:
1. Pre-prepared feeds reduce the risk of cross-contamination and cross infection
2.the total volume of feeds should not exceed 400ml each feeding
3.use warm water to declog obstructed feeding tubes

2 question:
1. What constitutes as inappropriate cessation of feeding?
2. Why cannot exceed 400ml for bolus feed?

1 connection between smtg I knew before:
I knew that to prepare formula feeds and delivery system, we have to start the process by hand washing.