PHYSICAL ASSESSMENT

MADE EASY
 VITAL SIGNS

• Temperature
• Apical or Radial Pulse
• Respirations
• Blood Pressure
• Pulse Oximetry
• Pain
 AUSCULTATION

• Remember Skin to Stethy

 PAIN THE 5TH VITAL SIGN

• P- Point of Origin • Where did the pain start

• When did it begin
• What were you doing to
cause the pain
• Does it radiate?
 PAIN THE 5TH VITAL SIGN

• A- Alleviating and • What makes the pain

Aggravating Factors better
• What makes it worse
• Have you had this pain
before
 PAIN THE 5TH VITAL SIGN

• I- Intensity • Rank the pain on a

numerical scale of 1-10
• 1-No Pain
• Wong-Baker Faces Scale • 10-worse pain you’ve
ever experienced
 PAIN THE 5TH VITAL SIGN

• N- Nature of the Pain • Describe the quality of

the pain
– Burning
– Crushing
– Sharp
– Dull
– Constant
– Intermittent
 PHYSICAL ASSESSMENT

• The Sequence • Sequence for the

– I Inspect Abdomen
– P(a) Palpate • I Inspect
– P(e) Percuss
• A Auscultate
– A Auscultate
• P(e) Percuss
• P(a) Palpate
SKIN!!!!!!!!!!!!!!!!!
 SKIN, HAIR, NAILS
Skin Inspection • Color
• Hygiene
• Lesions-size, shape,
location, configuration,
color, blanching,
exudate
• Odors
 SKIN, HAIR, NAILS

• SKIN PALPATION • Moisture

• Temperature
• Texture
• Turgor
• Elasticity
 SKIN, HAIR, NAILS

• HAIR Inspection • Color

• Distribution
• Quantity
 SKIN, HAIR, NAILS

• Nails Inspection • Pigmentation of nail bed

• Ridging, beading,
pitting, pealing
• Schamroth Technique
 SKIN -Abnormal Findings

• Skin-Melanoma • Sores that do not heal

• Nevi-Brown, Black with Red,
White, Blue margins
• Development of a nodule,
especially with erosion or
ulceration
• Bleeding
• Changes in color, size,
thickness
 SKIN -Abnormal Findings

• Kaposi Sarcoma • Malignant tumor of the

endothelium and
epithelial layer of the
skin. Lesions are
characteristically soft,
vascular, bluish-purple
and painless.
• See frequently in
patients with AIDS
 PRESSURE ULCER STAGING

• Stage I • Redness that is not

relieved by stimulation
or removal of pressure.
Skin is intact.

• Stage II
• Abrasion, blisters or
shallow crater due to
partial-thickness loss of
epidermis/dermis
 PRESSURE ULCER STAGING

• Stage III • Full-thickness loss with

damage to
subcutaneous tissue.
Deep crater visible.

• Stage IV
• Full-thickness skin loss,
necrosis, and damage to
fascia, connective
tissue, muscle or bone.
CHEST AND LUNGS
Anatomy
 CHEST AND LUNGS

• INSPECTION • Inspect chest movement

with breathing for
– Symmetry
– Bulging
– Use of Accessory Muscles

Evaluate respirations for

Rate, rhythm, and
Respiratory pattern
 CHEST AND LUNGS

• Auscultate with • Duration

diaphragm of • Intensity
stethscope • Pitch
• Timing (Where in
respiratory cycle does
sound occur)
Where to Auscultate
 CHEST AND LUNGS
Normal Breath Sounds

• Bronchial (Tracheal) • High pitch, Loud,

Inspiration < Expiration,
Harsh/Hollow, Heard
over Trachea

• Bronchvesicular
• Moderate Pitch
Inspiration=Expiration,
Heard over major
bronchus
 CHEST AND LUNGS
Normal Breath Sounds

• Vesicular • Low, soft,

Inspiration>Expiration,
Quality of rustling like
wind in trees, heard
over the peripheral lung
fields
• Most frequently heard
sound
 CHEST AND LUNGS
Adventitious Lung Sounds
• Fine Crackles • High-pitched, heard
during end of
inspiration, not cleared
by coughing

• Coarse Crackles
• Loud, bubbly noise
heard during inspiration,
not cleared by coughing
 CHEST AND LUNGS
Adventitious Lung Sounds
• Rhonci • Loud, low, coarse sounds,
like a snore, most often
heard continuously during
inspiration and expiration

• Musical noise sounding like a

squeak; heard continuously
• Wheeze in inspiration and expiration
 CHEST AND LUNGS
Adventitious Lung Sounds

• www.ymec.com/hp/signal2/lung2.htm
 Rub: Cardiac vs. Pleural

• How do you make a decision regarding

origin???
ABNORMAL RESPIRATORY PATTERNS

• Cheyne-Stokes • Respirations gradually

Respiration wax and wane in a
regular pattern,
increasing in rate and
depth and then
decreasing with periods
of apnea.
• Normal in the very
young and very old
during sleep.
ABNORMAL RESPIRATORY PATTERNS

• Kussmaul • Rapid, Deep, Regular

• Most commonly seen in
patients in Metabolic
Acidosis, usually
associated with Renal
Failure
 PHYSICAL FINDINGS ASSOCIATED WITH
COMMON RESPIRATORY CONDITIONS

• Asthma • Inspection-
– Tachypnea
– Dyspnea
• Auscultation
– Prolonged expiration
– Wheezes
– Diminished lung sounds
PHYSICAL FINDINGS ASSOCIATED WITH
COMMON RESPIRATORY CONDITIONS

• Bronchitis • Inspection
– Secondary to proliferation – Hacking, rasping cough
of mucous glands in the productive of thick
passageways, resulting in sputum
excessive mucus – Dyspnea, fatigue,
secretion. Inflammation cyanosis
of bronchi with partial
obstruction
• Auscultation
– Crackles, Wheeze,
Prolonged expiration
 PHYSICAL FINDINGS ASSOCIATED WITH COMMON
RESPIRATORY CONDITIONS

• Inspection
• Emphysema
– Barrel chest
– Secondary to destruction
of pulmonary connective – Use of Accessory muscles
tissue – Dyspnea on exertion
– Enlargement of air sacs • Auscultation
distal to terminal – Decreased breath sounds
bronchioles
– Prolonged expiration
– Increased airway
resistance, especially on – Muffled heart sounds
expiration secondary to
overdistention of lungs
– Hyperinflated lungs and
lung volume
– Cigarette Smoking
PHYSICAL FINDINGS ASSOCIATED WITH
COMMON RESPIRATORY CONDITIONS

• Atelectasis • Inspection
– Delayed/diminished chest
wall movement
– Tachypnea
• Auscultation
– Diminished/absent breath
sounds
– Wheezes, Rhonci,
Crackles
PHYSICAL FINDINGS ASSOCIATED WITH
COMMON RESPIRATORY CONDITIONS

• Chronic Obstructive • Inspection

Pulmonary Disease – Respiratory Distress
– Audible wheezing
– Cyanosis
– Distended neck veins
– Possibly finger clubbing
(RHF)
• Auscultation
– Rhonci, Wheezing,
Crackles
PHYSICAL FINDINGS ASSOCIATED WITH
COMMON RESPIRATORY CONDITIONS

• Pneumonia • Inspection
– With lobar consolidation – Tachypnea
– Shallow breathing
• Auscultation
– Crackles
– Rhonci
– Bronchial breath sounds
PHYSICAL FINDINGS ASSOCIATED WITH
COMMON RESPIRATORY CONDITIONS

• Pneumothorax • Inspection
– Free air in pleural space – Unequal chest expansion
causes partial or – Tachypnea, Cyanosis,
complete collapse of lung Apprehension
• Auscultation
– Breath sounds decreased
or absent
TRACHEOSTOMY AND TUBES
 Purpose of Tracheostomy

• To bypass a compromised upper airway and

to provide access to the lower airway for basic
air exchange and ventilation
 Advantages (Why)

• No upper airway complications

• Easier to suction
• Easier to stabilize
• Well tolerated by patient
• Improved communication
• Patient can swallow
• Easy to change/reinsert
 Disadvantages

• Immediate complications

• Surgery
• Bleeding
• Pneumothorax/pneumomediastinum
• Air embolism
• Subcutaneous emphysema
 Disadvantages

• Late complications

• Infection
• False passage into subcutaneous tissue
• Hemorrhage (erosion of adjacent structures)
• Formation of granulomatous tissue
• Tracheomalacia or stenosis
• Fistula (TE or TI)
• Occluded with secretions
Tracheostomy Tube
 Types and Sizes of Tracheostomy
Tubes
• Various manufacturers and types
• No standardized sizing
• Variable size, length and shape
• Fenestrated/nonfenestrated
• Cuffed/cuffless
• Single cannula/double cannula
• Disposable/nondisposable
• Specialty tubes
 Fenestrated Trach Tubes

• Fenestrated trachs
– permit use of the
natural airway above
the tracheostomy
tube when inner
cannula is removed
and cuff is deflated
 Shile 6 FEN
• Fenestrated Low Pressure
Cuffed Tracheostomy Tube
• Inner Cannula
– Fenestrated
– Non fenestrated
• Available sizes 4, 6, 8

• 6.4 mm ID
• 10.8 mm OD
• 76 mm Length
Fenestrated Trach Tube
 Passy Muir valve

• One way flap valve

• Allow gas flow through
tracheostomy tube
• Patient exhales via
upper airway
• Use caution with
increased secretions
• CUFF MUST BE
DEFLATED
• Information regarding Tracheostomy Tubes
compliments of Mr. Daniel Chapman, Ast.
Director Respiratory Therapy, Mass. General
Hospital
THE HEART AND BLOOD VESSELS
 Auscultation of Heart
“ALL PUPPIES TAKE MILK”
 Normal Heart Sounds

• S1 • Closure of the AV valves

(Tricuspid, Mitral)
• Indicates the beginning of
Systole
• Best heart at the Apex
• “Lub” sound
 Normal Heart Sounds

• S2 • Closure of semilunar valves

(Aortic, Pulmonic)
• Best heard at the base
• “Dub” sound
 Abnormal Heart Sounds

• S3 • Heard with bell

• Follows S2
• Ventricular filling sound
• Indicates decreased
compliance of the
ventricles
• Frequently seen in
patients with LHF
 Abnormal Heart Sounds

• S4 • Ventricular FILLING
sound
• Occurs in late diastole
when the atria contract.
• Heard with Bell
• Precedes S1
 Abnormal Heart Sounds

• Gallops • Refers to the speed with

which the ventricles are
filling.
• Tachycardia may result
in a summation gallop in
which all 4 sounds are
present
 Abnormal Heart Sounds
MURMURS
• Result from diseased or incompetent VALVES

• Stenosis-Calcification of the valves result in

narrowed lumen and restricts forward flow of
blood

• Regurgitation-Incomplete closure of the

leaflets of the valve, allowing blood to flow
backward
 MURMURS

• Aortic Stenosis • Restricts forward flow of

blood during systole
• LV hypertrophy
develops
• Loud, harsh,
midsystolic, crescendo-
descrescendo
 MURMURS

• Aortic Regurgitation • Blood flows back into LV

during diastole.
• LV dilatation and
hypertrophy
• Murmur starts with S2,
soft, high-pitched
blowing diastolic,
decrescendo
 MURMURS

• Mitral Stenosis • Impedes forward flow of

blood into LV during
diastole
• Enlarged LA
• Murmur-low pitched
diastolic rumble, best
heard at apex
 MURMURS

• Mitral Regurgitation • Blood flows back into LA

during systole
• In Diastole, blood flows
back into LV along with
new flow resulting in LV
hypertrophy
• Murmur-Pansystolic,
blowing, radiates
 GRADING MURMURS
• GRADE • DESCRIPTION
1/6 • Very faint, difficult to hear

2/6
• Quiet, but easier to hear
3/6
• Moderately loud
4/6
• Loud, may have thrills
5/6

6/6 • Very loud, +/- thrills, may be

heard without stethoscope

• Can be heard without a

stethoscope
 SOUNDS

• www.med.ucla.edu/wilkes/lungintro.htm
 PULSES for PALPATION
RADIAL, POSTERIOR TIBIAL, PEDAL

• Palpate right and left pulses simultaneously

• Evaluate the pulses for rate, rhythm, elasticity
of vessel wall, and force of amplitude
• Grade the amplitude as
– 4+ Bounding
– 3+ Increased
– 2+ Normal
– 1+ Weak
– 0 Absent
 CAPILLARY REFILL

• An indicator of peripheral perfusion and

cardiac output.

• Depress and blanch the nail bed.

• Release the nail bed and note the time for
color return.
• Normal Capillary Refill is <3 sec.
 ALLEN TEST

• Used to evaluate peripheral circulation prior to

cannulating radial artery (prior to drawing
ABG, or insertion of arterial line)
• Occulde both radial and ulnar arteries.
• Have patient make a fist.
• Have patient open fist and you release ulnar
artery
• Adequate circulation results in return of
normal color in 2-5 seconds
 ASSESSING FOR EDEMA

• Press firmly for 5-10 • 0 No edema

seconds over a bony • +1 Slight pitting, no
surface such as tibia, visible distortion,
fibula, sacrum, sternum. disappears rapidly
• +2 Deeper pit than 1,
disappears in 10-15 sec.
• +3 Pit is deep and may
last more than 1 min.
• +4 Deep pit and lasts
2-5 minutes
PERIPHERAL VASCULAR DISEASE IN
THE LEGS
• Arterial Insufficiency
– 3 P’s- Pain, Pallor,
Pulselessness
– 4th P- Paresthesia (acute
occulsion of major artery)
– 5th P- Paralysis-
completing the
Compartment Syndrome
– Exercise excerberates
pain and rest relieves
– Skin lesion is usually
small, round, dark
• Venous Insufficiency
– Results from impediment
to blood flow
– May be secondary to
Deep Vein Thrombosis
– Treatment is
Heparizination and bed
rest
– Skin lesion is red, has
uneven edges, bleeds
 THE HOMAN’S SIGN

• A positive finding is • Flex the knee with one

suggestive of hand and dosiflex the
Thrombophlebitis or foot.
DVT • A complaint of calf pain
with the procedure is a
positive sign.
ABDOMEN
ABDOMEN
 ABDOMEN
• Inspection • Abnormal findings
– Observe for contour,
symmetry, location of the
umbilicus, skin color
– Jaundice
– Cyanosis
– Glistening, taut
appearance (ascites)
– Bluish discoloration
around umbilicus
(Cullen’s Sign)
– Striae (Cushing Disease-
purple and do not fade)
 ABDOMEN

• Auscultation • Abnormal
– Use Diaphragm of – Hyperactive-loud, high-
stethscope pitched, tinkling
– Begin at RLQ-ileocecal • Stomach growling-
valve area Borborygmus
– Listen in each quadrant – Hypoactive or absent-
for up to 5 minutes postoperatively,
inflammation of
peritoneum
TYPES OF OSTOMIES
 COLOSTOMY

• Descending or Sigmoid -
This type of colostomy may
often produce formed stools.
Irrigation (enema) may be
recommended by the
physician to regulate bowel
movement, in which case
only a special pad or small
security pouch is needed to
be worn over the stoma.
 COLOSTOMY
• Transverse - This type of
colostomy generally does not
result in formed stools, it
being more likely that stools
will be loose. Irrigation may
regulate bowel movement in
some but not in the majority
of cases. Special care must
be taken to protect the skin
from discharge. It is probably
necessary to wear an
appliance at all times.
 ILEOSTOMY

• This type of ostomy

involves the surgical
construction of a
connection from the
small bowel to the
abdomen, forming a
stoma which allows for
the discharge of body
wastes. Surgery often
involves removal of the
colon and rectum.
 ILEOSTOMY

• The discharge will vary from being quite liquid at first

to semisolid as time goes on. It is necessary to wear
an appliance at all times, and special care must be
given to protecting the skin. It is important for the
ileostomate to take meals at regular hours and to
drink lots of fluid to keep electrolytes in balance. Diet
will have a bearing on the quantity and character of
output.
•
 UROSTOMY

• This type of ostomy

involves the surgical
construction of a
connection from the
ureters to the abdomen,
forming a stoma, which
permits the discharge of
urine after removal or
dysfunction of the
bladder.
 UROSTOMY
• The ureters carry the urine from the kidneys to the
Ileal Conduit (pipeline created from a small section of
the ileum) through which it flows to the outside of the
body. Wearing an appliance is needed at all times and
great care must be taken to protect the skin around
the stoma. After the 15 cm piece of ileum is removed
to create the conduit and stoma, the cut ends of the
ileum are joined and the intestinal tract will soon
function the same as before the surgery.
•
NEUROLOGIC
 CRANIAL NERVES

• CN I-Olfactory (On) • Smell

• CN II-Optic (Old) • Visual acuity
• CN III-Oculomotor • Pupil response
(Olympus)
• CN IV-Trochlear • Downward, inward eye
(Towering) movement
• CN V-Trigeminal (Tops) • Jaw opening, chewing
 CRANIAL NERVES

• CN VI-Abducens (A) • Lateral Eye movement

• CN VII-Facial (Finn) • Facial expression, close
jaw
• CN VIII-Accoustic (And) • Hearing
• CN IX-Glossopharyngeal • Swallowing, gag reflex
(German)
• CN X-Vagus (Viewed) • Speech, swallowing,
parasympathetic
 CRANIAL NERVES

• CN XI-Spinal Accessory • Shrug shoulders

(Some)
• CN XII-Hypoglossal • Tongue movement
(Hops)
 NEUROLOGIC ASSESSMENT

• Level of Consciousness • Person

– Ease of arousal • Place
– State of awareness
• Time
– Orientation

• Squeeze hand, smile,

• Motor Function stick out tongue, raise
eyebrows
 NEUROLOGIC ASSESSMENT

• Pupillary Response • Size

• Shape
• Symmetry of pupils

• Document degree of
constriction to light
– 5/4
 Glasgow Coma Scale

• A quantitative tool that defines the level of

consciousness by giving it a numeric value.
• Divided into 3 parts-Eye Opening, Verbal
Response, Motor Response
 Glasgow Coma Scale

• Best Eye Opening • Spontaneously 4

Response • To Speech 3
• To Pain 2
• No Response 1
 Glasgow Coma Scale

• Best Motor Response • Obeys Verbal Command 6

• Localizes pain 5
• Flexion-withdrawal 4
• Flexion-Decorticate 3
• Extension-Decerebrate 2
• No Response 1
 Glasgow Coma Scale

• Best Verbal Response • Oriented x3 5

• Conversation confused 4
• Speech inappropriate 3
• Sounds
incomprehensible 2
• No response 1
 Glasgow Coma Scale
E+M+V=15
• 90% scores less than or equal to 8 are in a
coma
• Greater than or equal to 9, not in coma
• 8 is the critical score
• Less than or equal to 8 at 6 hrs—50% die
• 9-11----moderate severity
• Greater than or equal to 12----minor injury
 Glasgow Coma Scale

• COMA IS DEFINED AS
• 1 NOT OPENING EYES
• 2 NOT OBEYING COMMANDS
• 3 NOT UTTERING UNDERSTANDABLE
WORDS
 PATHOLOGIC REFLEXES

• Babinski-stroke lateral • Extension of great toe,

aspect and across ball fanning of toes
of foot

• Is indicative of stroke,
brain tumor, head,
neck, back injury.
 PATHOLOGIC REFLEXES

• Kernig-Raise leg straight • Resistance to

or flex thigh on straightening, pain
abdomen, then extend down posterior thigh,
knee indicates meningeal
irritation
• Brudzinski-Flex chin on
chest • Resistance and pain in
neck, indicates
meningeal irritation
• ELECTROLYTES AND PHYSICAL ASSESSMENT
FINDINGS
 Sodium
135-145 mEq/l

• Hyponatremia <135 Confusion, poor skin tugor,

lethargy, muscle
excitability, cold, clammy
skin, abdominal cramps,
N/V/D, Tachycardia,
Headache, Seizures
 Sodium
135-145 mEq/l

• Hypernatremia >145 • Confusion, hot, flushed

skin, dry mucous
• May be secondary to membranes, furrowed
tongue, fever,
dehydration
temperature,
hypotension, extreme
thirst, decrease urine
output, seizures,
increase in muscle tone
and deep tendon
reflexes
 Potassium
3.5-5.0 mEq/L
• Hypokalemia <3.5 • Muscle cramps and
weakness, nausea,
vomiting,
hypoactive/absent
bowel sounds,
weak/irregular pulse,
difficulty breathing,
hypotension,
disorientation
 Potassium
3.5-5.0 mEq/L
• Hyperkalemia >5.0 • Muscle weakness,
paraesthesia, nausea,
slow/irregular pulse,
cardiac dysrhythmias,
respiratory difficulty,
decreased urine output
 Calcium
8-10.0 mEq/l

• Hypocalcemia • Numbness, tingling of

<8.0 mEq/l fingers, hyperactive
reflexes, positive
Trousseau’s (carpal
spasm)

Chvostek-twitching of
facial muscles when
tapped in front of ear
 Calcium
8.0-10.0 mEq/L

• Hypercalemia- • Loss of muscle

>10.0 mEq/l coordination
• Anorexia
• N/V
• Decreased LOC
• Personality changes
• Cardiac Arrest
 Magnesium
1.5-2.5 mg/dl
• Hypomagnesium <1.5 • Muscular tremors
• Hyperactive DTR
• Confusion/Disorientation
• Dysrhythmias
 Magnesium
1.5-2.5 mg/dl
• Hypermagnesium >2.5 • Hypoactive DTR
• Decreased respirations
• Hypotension
 Acid Base

• R-espiratory • pH 7.35-7.45
• 0-pposite • pCo2 35-45
• M-etabolic • HCO3 22-26
• E-equal
Intravenous Solutions
 ISOTONIC FLUIDS

• Most resemble normal plasma

• Do not cause RBC to either swell or shrink
• Used to treat dehydration, and in fluid
resuscitation

– Dehydration caused by running, fever, labor, Burns

 ISOTONIC FLUIDS

• Normal Saline 0.9% NS

• Lactated Ringer’s (contains a balance of
electrolytes)
• D5W –Dextrose in Water
 HYPOTONIC FLUIDS

• Causes fluid to move from the ECF (circulating

volume) to ICF (inside the cells)

• Indicated for cellular dehydration

 HYPOTONIC FLUIDS

• Half strength Normal Saline- 0.45% NS or

• ½ Normal Saline (1/2 NS)
• Quarter Strength Normal Saline-0.25% NS or
• ¼ Normal Saline (1/4 NS)

• Assists with renal function. Provides free

water, Na, and Cl.
• Does not assist with electrolyte replacement
or provision of calories
 HYPERTONIC FLUIDS

• Draws water out of the cells and into the

extracellular compartment to restore
equilibrium. The cells will shrink.

• Used to increase circulating volume without

requiring large infusions of IV fluids.
 HYPERTONIC FLUIDS

• D5RL • D5 and 0.45%NS

• D10RL

• 3%NS
 ACCESS DEVICES

• PICC TLC VAD

 VENOUS ACCESS
Indications for Use
Chemotherapy
Total Parenteral Nutrition (TPN)
Antibiotics (Long Term)
Blood transfusions
Rehydration 
Multiple / frequent blood tests
 Central Venous Access
Why is it useful?
Reduces damage to small peripheral veins
from toxic solutions
Long-term placement of these devices
allows for reduced number of venous
punctures
 CENTRAL VENOUS ACCESS
DEVICES
Port-a-Cath
Usually implanted under skin under the clavicle. A
tubing connects the “port” to a central vein.
“Port” refers to the lumens that are available to receive
medications or for blood draws. “Ports” are usually
either single or double lumens.
 Huber Needle

• A special right angled needle utilized to

“access” the lumen of the Port-a-Cath.
• IV tubing is attached to one end of the Huber
utilizing sterile technique
• The tubing and the needle are flushed with a
normal saline solution. The needle is inserted
into the lumen of the port and the infusion
started
HUBER NEEDLE
 Venous Access Port
Port-a-Cath
• How is it cared for?
• Dressing worn for 1 week
• Steri-strips
• Sterile transparent non-occlusive dressing
• Post-procedure instructions Avoid use for 48 –
72 hours to minimize the risk of an infected
blood clot Keep site clean and dry for 7 – 10
days Remove suture in 7 – 10 days Flush
monthly and after each use using saline and
heparin
 PICC LINE

Peripherally inserted central catheter It’s

a non-tunneled external catheter
• Small flexible catheter inserted into a
peripheral vein then threaded so that its
tip is positioned in a central location
• Mid-line catheter stops midway up the
arm
 PICC LINES

• Best suited for treatments lasting from

several weeks to 6 months requiring frequent
access to veins
 Care of the PICC LINE

Dressing:
• The dressing should be changed frequently:
– every 72 hrs 
– whenever they lose adhesion 
– whenever they become wet
• Swimming and rigorous arm work is
discouraged
– a waterproof barrier such as plastic kitchen wrap
should be applied before showering
 PICC LINE Care (cont)

• How is it cared for?

• Flushing: The PICC line should be flushed
(rinsed) with 10 cc’s (1 cc = 1 milliliter) of
saline solution and then 5 cc’s heparin (an
agent that prevents clotting) daily and after
each use
PICC LINE
Triple Lumen Catheter
 TLC
Triple Lumen Catheters
• Placed in either right or left subclavian vein
• Utilized for administration of up to three
infusions
• Infusions may be maintenance fluid, drips,
blood
• Any of the 3 “Ports” may be utilized for
medication administration or blood draws
• “Ports” not being utilized must be flushed with
a heparin or normal saline solution every shift
 LABORATORY TEST

Basic Metabolic Panel (BMP)

– Creatinine Potassium
– CO2 Sodium
– Chloride BUN
– Glucose Calcium
 COMPLETE METABOLIC PANEL
(CMP)
• Albumin Chloride
• Alkaline Phos Creatinine
• ALT Glucose
• AST Potassium
• Total Bilirubin Sodium
• Calcium Total Protein
• CO2 BUN
 COMPLETE BLOOD COUNT
(CBC)
• WBC
• WBC with Differential-specific patterns of WBC
• RBC
• Hct/Hgb
 COMPLETE BLOOD COUNT
(CBC)
• RBC indices-calculated values of size and Hgb
content of RBC’s. Important in anemia
evaluations
Components of the RBC indices are:
MCV-Mean Corpuscular volume
MCHC-Mean Corpuscular hemoglobin concentration
MCH-Mean Corpuscular hemoglobin
 COMPLETE BLOOD COUNT
(CBC)
• Platelet count
• RDW-Red Cell Distribution width. Indicates
abnormal variation in size of RBCs.
• MPV-Mean Platelet Volume-indicates
uniformity of size of the platelet population
 COAGULATION STUDIES

• PT-Prothrombin time-used to measure

warfarin therapy
• INR-International Normalized Ratio
• PTT/APTT-test for the same functions and is
used to monitor heparin therapy