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DPT 770: Patient Care > EXAM 1 > Flashcards

EXAM 1 Flashcards

1
Q

when should a pt’s vitals be monitored and why is it important

A

before, during and after treatment
it is an important parameter in progressing the pt

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2
Q

what are the assessments for physiological stability

A

HR
oxygen saturation
respiratory rate
blood pressure
body temp

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3
Q

what is HR

A

indirect measure of contraction of the left ventricle of the heart

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4
Q

what are the normal HR values for adults

A

60-100 bpm

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5
Q

what are the normal HR values for newborns

A

100-150 bpm

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6
Q

what are the normal HR values for children from 1 to 10 yrs old

A

70-130 bpm

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7
Q

what are some factors that can affect HR

A

meds
PA
medical conditions
stress
dehydration

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8
Q

where can we asses HR

A

brachial
radial
carotid
temporal
femoral
popliteal
dorsal pedal

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9
Q

what are the normal ranges for oxygen saturation

A

95-100%

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10
Q

what is hypoxemia

A

SpO2 is less than 90

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11
Q

what are some factors that affect oxygen saturation

A

emotional
medical conditions
PA
age
environment

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12
Q

how do we assess oxygen saturation

A

pulse ox monitor

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13
Q

how do you manually measure respiration

A

one respiration= one inspiration and one expiration

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14
Q

what are the normal respiration values for adults

A

12-20 at rest

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15
Q

what are the normal respiration values for infants

A

30-50 at rest

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16
Q

what are the factors that can affect respiratory rates

A

emotional
PA
age
medical conditions
environment

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17
Q

how do we assess respiratory rate

A

count manually
look at- rate, depth, rhythm, character

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18
Q

what is systolic BP

A

contraction of left ventricle

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19
Q

what is diastolic BP

A

rest period of the heart

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20
Q

what are some factors that may affect BP

A

emotional
PA
age
medical conditions
meds
diet

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21
Q

how do we assess BP

A

support pts arm at level of heart
pt can be standing, sitting, supine or exercising

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22
Q

why take BP in different positions

A

treatment tolerance depending on situation

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23
Q

What are the normal BP values

A

120/80 mmHg

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24
Q

What is the range for BP that is considered high normal

A

130-139/85-89 mmHg

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25
Q

What are the ranges for prehypertension

A

120-139/85-89 mmHg

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26
Q

What is the range for stage 1 BP

A

140-159/90-99 mmHg

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27
Q

What is the range for stage 2 BP

A

160-179/100-109 mmHg

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28
Q

What is the range for hypertensive crisis

A

> 180/>110 mmHg

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29
Q

What is orthostatic hypertension and the S&S

A

Form of low blood pressure that happens when you stand up from sitting, sit up from lying down
S&S- dizziness or lightheaded

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30
Q

What are the orthostatic hypotension values

A

Systolic decrease- drop of 20 mmHg
Diastolic decrease- drop of 10 mmHg
Within 3 minute of positional change

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31
Q

How do we objectify pain

A

Scales and non-verbals

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32
Q

What are the odds of healthcare associated infections

A

1 out of 25
Fourth leading cause of death

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33
Q

What is the difference between medical and surgical aseptic techniques

A

Medical keeps pathogens confined to a specific area, object, or person
Surgical excludes all microorganisms before entering a sterile field

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34
Q

What are standard precautions for prevention of infection

A

Group of infection prevention practices that apply to all patients regardless of diagnosis
Frequent hand washing or rubs
PPE

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35
Q

How does transmission based precautions relate to standard precautions

A

Goes on top of the standard precautions

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36
Q

What is transmission based precautions

A

Designed to protect caregiver from highly transmissible pathogens

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37
Q

What is the hand rubbing method

A

Alcohol based, waterless antiseptic
Most effective when hand washing is not required
Less time, more effective, more accessible, less damaged to skin

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38
Q

What is the hand washing method

A

Preferred method when hands are visibly dirty, soiled, or considered to be contaminated
Bacteria is removed through friction and scrubbing

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39
Q

When is the hand washing method required

A

Entering ICU or operating room
Adding an anti microbial agent makes it antiseptic
Decontamination after treating C diff
Potential contaminants

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40
Q

What is a better decontamination of C diff

A

Hand washing method

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41
Q

What are potential contaminants of hand washing

A

bar soap
sink rims
waterspout
basin
towel dispenser
faucet handle

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42
Q

what are isolation precautions

A

linked to the method by which pathogens are transmitted
specific PPE depending on type of transmission

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43
Q

What are the 4 rules of asepsis

A

Know which items are sterile
Know which items are not sterile
Separate the non sterile from the sterile
If sterile items become contaminated, remedy situation immediately

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44
Q

What are the DO NOTS of contaminated garments

A

DO NOT
touch any area of body with PPE
touch outer surface of gloves with unloved hands
Touch sleeves or front of gown with ungloved hands
wear PPE outside pts room

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45
Q

What do you do with contaminated refutable equipment

A

Place in the appropriate container and return for sterilization

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46
Q

What do you do with contaminated disposable equipment

A

Should be placed in the appropriate containers and discarded according to policies and procedures

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47
Q

What is targeted in high level disinfectants

A

Everything except high numbers of bacterial spores

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48
Q

What is targeted with an intermediate level of disinfectant

A

Most viruses, fungi, vegetative bacteria, TB

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49
Q

What is targeted with low level of disinfectant

A

Most bacteria, some viruses, some fungi

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50
Q

What is removed in decontamination

A

Destroy blood borne pathogens that are no longer capable of transmitting infectious particles

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51
Q

Which is stronger disinfectant or decontamination

A

Decontamination

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52
Q

what is the P wave

A

atrial depolarization

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53
Q

what is the QRS wave

A

ventricular depolarization

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54
Q

what is the T wave

A

ventricular repolarization

55
Q

what is the pathway for the cardiac conduction

A

SA
AV
Bundle of His
Bundle Branches
Purkinje fibers

56
Q

what do you look for to determine rhythm

A

look for ventricular (R) and atrial (P) depolarizations
distance between intervals are equal
regular, irregular, irregular regular??

57
Q

what is sinus rhythm

A

equal distance between identical waves
60-100

58
Q

how do you measure rate

A

from the start of a bold red line- 300, 150, 100, 75, 60, 50

59
Q

what is atrial fibrillation

A

continuous rapid firing of multiple atrial follicles
no single impulse depolarizes the atria completely

60
Q

what causes A Fib

A

MI
CABG surgery
Valvular disease
HTN
Chronic alcoholism

61
Q

what do you see on an ECG for A Fib

A

no definite P waves
irregular rhythm
continuous chaotic atrial spikes
irregular ventricular rhythm
normal QRS complex

62
Q

what does premature ventricular contraction look like on ECG

A

early QRS complex
wider bizarre QRS
no P wave
compensatory pause

63
Q

what does 3 or more PVC in a run mean

A

ventricular tachycardia

64
Q

what is ventricular tachycardia

A

continuous run of PVC
150-250 bpm

65
Q

whats causes VT

A

acute MI or ischemia
electrolyte imbalance
medication toxicity
idiopathic
illicit drugs

66
Q

what are the S&S of VT

A

hypotension
syncope- fainting

67
Q

what does VT look like on an ECG

A

continuous run of PVC
each QRS is wide

68
Q

what are common lab values

A

electrolyte panels
metabolic panels
kidney function
liver function
cardiac markers
lipid panel

69
Q

what are the reference values for WBC

A

5-10 x 10^9/L

70
Q

what is the up trend for WBC

A

> 11 x 10^9/L
infection, leukemia, obesity, inflammation, stress
weakness, fatigue, fever, dizziness
consider therapy timing around early morning (low level) and late afternoon (high peak)

71
Q

what is the down trend for WBC

A

<4 x 10^9/L leukopenia and neutropenia
viral or bacterial infection, radiation
symptoms based approach to determine appropriateness for PT

72
Q

what are the reference values for platelets

A

140-400 x k/ul

73
Q

what is the down trend for platelets

A

<150 k/ul - excessive bleeding can occur
infection, leukemia, radiation/chemo, liver disease
bruising, petechiae, fatigue, jaundice

74
Q

what is the up trend for platelets

A

> 450 k/ul - thrombocytosis
infection, cancer, stress, inflammation
weakness, headache, dizziness, chest pain

75
Q

what are the PT implications for platelets

A

<10,000 and or 100.5 temp = hold therapy
symptom based when considering activities
is pt a fall risk? = increased risk of hemorrhage

76
Q

what are hemoglobin reference and critical values

A

men = 14-17.4 g/dl
women = 12-16 g/dl
<5-6 g/dl or >20 g/dl

77
Q

what is the up trend for hemoglobin

A

CHF, dehydration, COPD, severe burns
dizziness, arrhythmias, TIA symptoms, chest pain

78
Q

what is the down trend for hemoglobin

A

anemia, blood loss, lupus, kidney disease, stress to bone marrow
decreased endurance, pallor, tachycardia

79
Q

what are the therapy implications for hemoglobin

A

facility dependent
symptom based

80
Q

what are the hematocrit reference and critical values

A

men= 42-52%
women = 37-47%
<15-20% or >60%

81
Q

what is the up trend for hematocrit

A

COPD, burns, CHF, dehydration
fever, HA, dizziness, weakness, fatigue

82
Q

what is the down trend for hematocrit

A

leukemia, multiple myeloma, pregnancy, cirrhosis, RA
pale skin, HA, dizziness, chest pain, arrhythmias, dyspnea
monitor SpO2

83
Q

what are therapy implications for hematocrit

A

<25%= essential ADLs only, hold out of bed activities
symptoms based approach

84
Q

what is prothrombin time

A

evaluates bloods ability to clot
normal 11-13 sec

85
Q

what is partial thromboplastin time

A

used to determine if heparin/warfarin/etc. (blood thinner) therapy is effective
normal 21-35 sec

86
Q

what is international normalized ratio (INR)

A

measure how long it takes the blood to clot when an oral anticoagulant is used
PT and PTT can differ depending on lab
normal .8-1.2
increase = risk for bleeding, decrease = risk of clot

87
Q

What is the rate of the sinus rhythm and diagnosis

A

between 100-150
trachycardia

88
Q

what is the rate of the sinus rhythm and diagnosis

A

less than 50 bpm
bradycardia

89
Q

what is the rate of this sinus rhythm

A

75 bpm

90
Q

what is the diagnosis of the following ECG

A

VT

91
Q

what is the diagnosis of the following ECG

A

PVC

92
Q

what is the rate for the following sinus rhythm

A

60 bpm

93
Q

what is the rate for the following rhythm

A

between 100-75 bpm

94
Q

what is the rate for the following rhythm

A

less than 50 bpm

95
Q

what is the diagnosis of the ECG

A

A Fib

96
Q

what is short term positioning

A

allowing for treatment of different areas
MT, modalities

97
Q

what is long term positioning preventing and promoting

A

preventing pressure ulcers and contractures
promoting better breathing positions

98
Q

for long term positioning how often do you reposition a pt

A

every 2 hours to maintain integrity of all 4 movement systems

99
Q

for short term positioning how often do you need to reposition a pt

A

every 15 minutes

100
Q

why would you need to reposition a pt

A

poor circulation, fragile skin, decreased sensation, difficulty breathing

101
Q

what is wrong if a pt has prolonged redness of bony prominences

A

tissue damage

102
Q

what are the general positioning guidelines

A

explain procedure to pt
maintain neutral spine
always provide a way for pt to have communication

103
Q

what are the areas of greatest pressure in supine

A

head
sp
inferior angle scapula
elbows
PSIS
sacrum
heels

104
Q

what are the greatest areas of pressure in prone

A

forehead/lateral ear
acromial process
anterior humeral head
sternum
ASIS
patella
dorsum of foot

105
Q

what are the areas of greatest pressure in sidelying

A

lateral ear
lateral ribs
lateral acromial process
lateral humeral head
medial or lateral humerus
greater trochanter
medial or lateral knees
medial or lateral ankles

106
Q

what are the greatest areas of pressure in sitting

A

ischial tuberosity
posterior thighs
sacrum
sp
elbow

107
Q

what can make pts more susceptible to pressure injuries

A

decreased mobility
fragile skin
incontinence
impaired sensation/circulation
muscle atrophy
friction or shear

108
Q

what is the skin blanching test

A

when pressed, healthy lighter skin will blanche and quickly return to healthy pink

109
Q

who is more at risk for skin breakdown

A

people with increased pigmentation

110
Q

if skin does not blanche, what does it indicate

A

compromised/damaged tissue

111
Q

what do we NOT do with a pt that has a negative skin blanche test

A

position them on compromised area

112
Q

what increases load

A

a decrease in surface area
decrease in cushioning

113
Q

how does load relate to time with pressure injuries

A

increase load + decrease time = injury
decrease load + increase time = injury

114
Q

how do we prevent pressure injuries

A

limit direct contact with bony landmarks
increase surface area
increase cushioning
decrease load
decrease time

115
Q

what are the most common contractures

A

flexion contractures

116
Q

who has a increased risk of cervical flexion contractures

A

pts with swallowing restrictions or breathing dysfunctions, cardiac condition, lung condition

117
Q

what can cause hip/knee flexion contractures

A

gathched bed
certain neurological conditions

118
Q

who has an increased risk for wrist flexion contractures

A

neurological diseases, injury, disuse

also accompanied by finger and thumb flexion

119
Q

how do you position a pt with edma

A

extremities above heart

120
Q

how are positioning devices beneficial

A

reduce or eliminate load on the tissue
help pt maintain static positioning

121
Q

what pts would we do prone positioning

A

pulmonary issues
amputees

122
Q

when should we reposition a sitting position

A

every 10-15 minutes

123
Q

what should we avoid in sitting

A

sacral sitting

124
Q

what is the risk in high fowlers position

A

sacral shearing

125
Q

what reason could we use trendelenburg

A

BP management
pregnancy

126
Q

what reason could we do reverse trendelenberg

A

spinal cord

127
Q

what are the safety and comfort concerns for supine position

A

support under knees/lower legs and head

128
Q

what are safety and comfort concerns for prone

A

support under abdomen/hips- decrease lordosis
pressure off toes

129
Q

what are the safety and comfort concerns for sidelying

A

support under head
distribute pressure over greater trochanter
support top arm

130
Q

what are the safety and comfort concerns for sitting

A

back supported

131
Q

what safety and concern should be in all positioning

A

normal spinal curves
proper airway

132
Q

what are the principles of draping

A

clean linens
expose areas only being worked on
remove folds/wrinkles
instruct pt
ensure comfort
protect pts clothing

133
Q

what are cultural sensitvities

A

same gender
hospital gown exposure
can’t remove certain clothing items

134
Q

what should we implement for pts with trauma

A

good communication
informed consent
respect boundaries
active pt involvement
monitoring signs of discomfort

DPT 770: Patient Care (1 decks)

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