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Nursing Skills > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

Leading Causes of Death

A

Medical errors and “health care-associated infections”

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2
Q

Medical errors and health care-associated infections each kill more Americans than….

A

AIDS, breast cancer or vehicle accidents per year

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3
Q

Probability of dying from a health care associated infection or medical error

A

1 in 760 hospital admissions

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4
Q

The most common way infections are spread

A

Touching a patient or equipment, then touching another patient without washing your hands.

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5
Q

How infections are spread

A
  1. Infectious Agent (germs)
  2. Source of Infection (human/animal/object)
  3. Portal of Exit (cough/blood/diarrhea)
  4. Mode of Transmissions (ex. your hands)
  5. Portal of Entry (skin/lungs/GI/GU)
  6. Susceptible Host- Our Patients
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6
Q

Compliance with handwashing by healthcare staff

A

only 30% to 50%

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7
Q

When to was hands

A

Entering and leaving patient rooms.

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8
Q

The most important way we can reduce infections

A

Frequent handwashing

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9
Q

Always use soap and water if

A

Hands are visibly soiled, presence of infections, before and after eating, after using the restroom, wash hands with friction for at least 20 sec, and after removing gloves and between glove changes.

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10
Q

Bed Safety

A

Bed in low position, bed wheels locked, lift side rails up x2, and call light in reach

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11
Q

Principle-Based Procedures

A
  1. Wash hands before and after care
  2. Gather supplies
  3. Introduce self and others
  4. Identify patient with 2 identifiers
  5. Explain procedure
  6. Provide privacy
  7. Use good body mechanics
  8. Provide patient safety
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12
Q

Temperature

A

measurable heat in the body

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13
Q

Pulse

A

detectable rhythm of the heart contractions

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14
Q

Respirations

A

frequency of breaths

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15
Q

Blood pressure

A

pressure of blood in the arteries

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16
Q

Pulse Oximetry

A

amount of oxygen in the tissues

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17
Q

Vital signs

A

a means of assessing vital or critical physiological functions
One of the most frequent assessments you will make as a nurse

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18
Q

Why are vial signs checked

A

Monitor body systems, detect changes in health statues, evaluate effectiveness of interventions, identify life-threatening warning signs

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19
Q

When are vital signs checked

A

performed no a regular basis
Frequency determined by physician order and/or nursing judgement, client’s condition, facility standards, and location of patient.

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20
Q

Standards for Monitoring Stable patient

A

every 4-8 hours

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21
Q

Standards for Monitoring Postsurgical patient

A

every 15-60 minutes

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22
Q

Standards for Monitoring critical/unstable patient

A

every 5 minutes

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23
Q

Standards for Monitoring home health settings

A

each visit

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24
Q

Standards for Monitoring clinics

A

each visit

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25
Q

Standards for Monitoring skilled nursing facilities

A

weekly to monthly

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26
Q

Interpreting Vital Signs

A

Compare the patient’s values to normal values then compare with previous values

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27
Q

Temp: under tongue

A

Oral; most common site

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28
Q

Temp:Ear

A

Tympanic; adults and children

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29
Q

Temp: Forehead

A

Temporal; infants/small children

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30
Q

Temp: Armpit

A

Axillary; healthy newborns

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31
Q

Temp; rectal

A

Do not use for newborns, patients with low white counts, spinal cord injuries, diarrhea, rectal surgeries, quadriplegics.

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32
Q

Temperature Conversion Fahrenheit to Celsius

A

F temp minus 32, Multiply by 5, divide by 9

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33
Q

Temperature Conversion Celsius to Fahrenheit

A

C temp x 9, divide by 5, add 32

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34
Q

Pulse Locations: Apical Pulse

A

Most accurate site; apex of heart at point of maximal impulse, left midclavicular line, 5th intercostal space, use stethoscope to listen (auscultate), count for 1 minute.

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35
Q

Pulse Locations: Radial Pulse

A

Most common peripheral site, under thumb on wrist.

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36
Q

Temporal

A

side of head at temple

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37
Q

Carotid

A

side of neck below jaw

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38
Q

Brachial

A

Inner side of elbow

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39
Q

Radial

A

Thumb-side of inner wrist

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40
Q

Femoral

A

Bend of leg at groin

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41
Q

Popliteal

A

Behind knee, inner side

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42
Q

Posterior tibial

A

Below inner ankle

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43
Q

Dorslis pedis

A

Top of Foot

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44
Q

Temperature normal range

A

95.9-99.5 F (35.5-37.5C)

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45
Q

Pulse normal range

A

60-100 beats per minute

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46
Q

Respirations normal range

A

12-20 breaths per minute

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47
Q

Pulse Oximetry normal range

A

> 95% Saturation of peripheral oxygen

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48
Q

Blood pressure normal ranges

A

Systolic 90-120 mm Hg

Diastolic 60-80mm Hg

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49
Q

mm Hg

A

millimeters of mercury

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50
Q

Physiology of Blood pressure

A

Heart beat forces blood against arterial walls, creates a pressure wave as left ventricle contracts and then relaxes, peak phase (highest) Systolic pressure, resting phase (lowest) diastolic pressure.

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51
Q

Stethoscope

A

Used to auscultate the systolic and diastolic pressure, heard as Korotkoff (thumping) sounds

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52
Q

Sphygmomanometer

A

Vinyl or cloth cuff, a pressure bulb with regulating valve, and manometer

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53
Q

Hypotension Systolic

A

Systolic blood pressure <100 mm Hg, some patients normally have low BP, and ask if patient is light-headed or dizzy

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54
Q

Hypotension Orthostatic or postural

A

A sudden drop in BP, a change position from lying to sitting or standing

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55
Q

Hypertension stats

A

BP persistently higher than normal, diagnosed when systolic is >140 mmHg or diastolic is >90 mmHg, tested on two or more separate occasions

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56
Q

Hypertension

A

Primary or Essential Hypertension, diagnosed when there is no known cause for the increase, accounts for about 90% of all hypertension

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57
Q

Hypertension facts

A

A major cause of illness and death in US, increases stress on heart and blood vessels, severity is directly related to the degree of elevation, ntreated may lead to heart attack, heart failure, peripheral vascular disease, kidney damage, or stroke

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58
Q

BP points to remember

A

Measurements on the dial are in 2 mm HG increments, always ask the patient for the arm they prefer BP to be taken. Do not use the side with surgery, IV, or stroke

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59
Q

Responsibility and delegation for vital signs

A

Nurses can delegate the activity of taking vital signs

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60
Q

Nurses are responsible for vital signs

A

Interpretation of vital signs, vital sign trends, decisions based on abnormal findings

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61
Q

Purpose of the Nursing Process

A

To help the nurse provide goal-directed, patient-centered care; a thinking template to make clinical judgement; the art of nursing - based on knowledge, experience and intuition

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62
Q

Why do we use the nursing process?

A

Required by the American Nurse’s Association in the Nursing scope and standards of practice, Required by State Boards of Nursing in US, and Required for facility Accreditation

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63
Q

ADPIE

A

Assessment, Diagnosis, Planning, Implementation, and Evaluation

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64
Q

Assessment

A

Collect facts and data

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65
Q

Objective data

A

Lab test, V/S, someone else comes in and they will get very similar results

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66
Q

Subjective data

A

Patient, family , caregiver, etc. Ex: the patient says they are nauseous

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67
Q

Diagnosis

A

Actual= patient response to an actual problem, risk = for a potential problem (teaching patient about getting screenings), improve health = health promotion and wellness (testing vision and hearing)

68
Q

Planning

A

Prioritize patient diagnoses, goals - reverse or eliminate problems found in nursing diagnoses, set short and long-term goals that are measurable, plan interventions

69
Q

Implementaion

A

Put the plan into action. This is what you do in patient care

70
Q

Evaluation

A

Evaluate the effectiveness of the care provided, evaluate the patient’s response, evaluate whether goals were met, evaluate whether the plan needs to be revised.

71
Q

Nursing Process is Cyclical

A

Use critical thinking skills, reassess the patient, identify new diagnoses, revise the plan and modify goals, implement new actions, re-evaluate outcomes

72
Q

Verbal communication

A

words only 7%

73
Q

Nonverbal communication

A

Body language 55% and voice inflection 38%

74
Q

Types of verbal commmunication

A

Spoken words (privacy), written words (legal), and electronic words (confidential)

75
Q

Why is communication essential for nurses

A

assessing patients, educating patients, advocating for patients, providing patient safety, and collaborating with patient and health team.

76
Q

Types of nonverbal communication; body language

A

Posture, stance, gait, facial expressions, eye contact, touch and hand gestures

77
Q

Phases of the Nurse/Patient Relationship

A

Stage 1: Pre interaction phase, Stage 2: Orientation phase, Stage 3: Working phase, stage 4; Termination phase

78
Q

Preinteraction phase

A

Gather information prior to meeting patient

79
Q

Orientation phase

A

Meet the patient- introduce self, sit down, ask, observe, assess, interview, identify patient’s needs

80
Q

Working phase

A

Use therapeutic communication, develop and implement care plan, collaborate with others on the team

81
Q

Termination phase

A

Evaluate outcomes, and tronsition patient to next step

82
Q

What is therapeutic communication

A

Patient-centered (it’s about the patient), goal-directed it’s about the Patient’s goals), it’s ALL about the Patient.

83
Q

Empathetic

A

Put yourself in another’s place

84
Q

Respectful

A

Use proper name, provide privacy

85
Q

Genuine

A

Honest and truthful

86
Q

Collaborative

A

be flexible, partner with the patient

87
Q

Advocacy

A

speak up for patient’s rights

88
Q

Techniques of Therapeutic communication (10)

A

Call the patient by their proper name, use open-ended questions (what or how), Actively listen (sit down, make eye contact), and share observations (you look sad, afraid, concerned), convey acceptance (everyone has a story), offer assistance (how can I help you?), use humor appropriately (puppies and kittens), paraphrase patient comments, seek clarification (be on the same page), provide information in living room language, and summarize the conversations (the BIG points)

89
Q

What is non-therapeutic communication

A

Social conversations, self-absorbed, can be hurtful, and damages professional relationships

90
Q

Nontherapeutic communication

A

Asking “why didn’t you”, using closed-ended questions, changing the subject, gibing false assurances (everything is going to be just fine), giving advice, and giving stereotyped responses (don’t worry we’ve done this a million times), showing disapproval or disagreement, failing to listen, excessive self-disclosure, comparing patient experiences, being defensive, using personal terms of endearment

91
Q

Legal, Ethical and Safety issues

A

Legal- Confidentiality and Social Media, Ethical- professional boundaries (sharing personal info, inappropriate touch), Patient Safety- $200 billion in added costs (70-80% of medical errors are due to poor communication

92
Q

Sentinel events

A

death of serious injury

93
Q

Collaborative communication

A

Important information for the team, coordination of care, communication hand-off (SBAR)

94
Q

SBAR

A

Situation, background, assessment, and recommendation

95
Q

Vision Impaired

A

make sure patient has glasses on, provide good lighting in room, use clock face numbers for location of items, provide large-print, and/or audio material, and use a light touch to arm or shoulder to alert patient of you presence.

96
Q

Hearing impaired

A

Assist with hearing aids/check batteries, always face patient when speaking, decrease background noise, speak clearly 3-6 ft from patient, use white board for written communication, always check for understanding, use sign language interpreter as needed

97
Q

Physical Impairments

A

Dyspenea, pain
Use nonverbal cues (hand squeeze/head nod), watch for facial expressions, white boards/erasable markers for nonverbal patients

98
Q

Cognitive impairments

A

Dementia, brain injury

Consult with family for helpful ideas, avoid confrontation, and accept their reality

99
Q

Language/Culture/Literacy

A

Use facility interpreter service (do not use family members for important information), ask patient about cultural practices to provide best care (ask about personal space), speak to all patients using living room language and shame-free environment, only teach 2-3 key points at a time, and use tech-back/show-me for understanding

100
Q

Family/caregiver communication

A

Get patient’s permission, educate family/caregivers about care issues, listen and observe family dynamics, provide written and/or audio materials, allow time for hands-on demonstrations, check for other supportive networks

101
Q

Employers top 5 skills/qualities

A

Communication skills, strong work ethic, teamwork skills, analytical skills, initiative

102
Q

General concepts of hygiene essential to patient care

A

cleans skin to decrease infection, provides comfort, promotes health, and improves self-image

103
Q

Activities of Daily Living

A

Bathing, Dressing, Grooming, Eating, Oral Care, and Toileting

104
Q

Physical factors that influence hygiene and self-care

A

Pain-Limits mobility and energy
Mobility deficits: decreased range of motion, weakness, balance
Sensory deficits: Safety concerns and decreased independence (sight and numb touch)
Fatigue: loss of strength due to physiologic changes in the body

105
Q

Cognitive impairments

A

Cannot problem-solve ADL processes, and forgets when hygiene was performed

106
Q

Emotional Disturbances on Hygiene

A

Profound lack of energy for ADLs, and altered reality does not include hygiene

107
Q

Factors that influence hygiene and self-care

A

Personal preference (time of day and how often), culture and religion, Economic status, and knowledge level.

108
Q

Bathing Guidelines

A

Wash from distal to proximal to improve venous return
Wash from clean to dirty areas
Control temp of water; allow patient to check water temp
Change water often
Wash, rinse and dry before moving to next area

109
Q

Bathing a patient

A

Face and neck (water only), hands and arms, chest, abdomen, feet and legs, perineal area, back, and rectal area

110
Q

Common types of bath

A

Assisted shower (bathe hard to reach area), Partial bath (bathe necessary areas; face, hands, underarms, perineum) Bed bath (complete, partial, and assisted)

111
Q

Recommendations Physical Intimate Touch

A

Project a professional appearance
Speak clearly
ask if patient can complete own care
ask if patient would like a second assistant to be present
Ask if nurse gender preferred
Ensure Privacy
Get permission first before making contact
Use touch that is firm, not rough; unhurried not lingering
Look for verbal/nonverbal cues of discomfort, stop, ask for feedback

112
Q

Oral Care

A

Provide oral care every 2 Hours if NPO (nothing by mouth), removes bacterial, reduces risk of tooth decay, reduces risk of respiratory and cardiac infections, and improves appetite

113
Q

Oral care for unconscious patient

A

Provide oral care every 2 hours, position patient on side, head lower than body, use minimal water, have suction available

114
Q

Care for dentures

A

Place wash cloth in bottom of sink before brushing, and store in labeled denture cup in water

115
Q

Care of Eyes

A

Clean inner to outer, no soap
Special care for contact lenses
Special care for artificial eyes

116
Q

Care of Ears

A

Special care for hearing aids

117
Q

Care of feet

A

Special care with diabetes and peripheral nephropathy
Check facility policy about trimming nails
wash and dry feet completely
No lotion between toes or bottom of feet

118
Q

Label and properly store all personal items including

A

Dentures, eye glasses, contact lens, hearing aids, and jewelry

119
Q

Safety actions before leaving patient’s room

A

Leave patient in a comfortable safe position
Return bed to low position, lock wheels, raise side rails x 2, and call light in reach
Wash hands before leaving the room

120
Q

Hygeine Procedures

A

Complete Bed bath, perineal care, making an occupied bed, brushing and flossing teeth, denture care, oral care for unconscious patient, shaving a patient, and caring for hearing aid.

121
Q

Principles of Body Mechanics

A 
Keep spine in natural alignment
Elevate work surface to center of body
bend from knees, not waist, when lifting
Feet apart for wide base, avoid twisting
Keep patients or objects close to body
Use lifting devices when appropriate
Request help when needed
122
Q

Activity Intolerance

A

Decreased capacity for exercise and ADLs

123
Q

Risk factors for activity intolerance

A

Heart failure, Peripheral Vascular Disease, Chronic Obstructive Pulmonary Disease, and Prolonged Bedrest (shortness of breath, dyspnea, profound fatigue)

124
Q

Immobility

A

Physical Impairment
Osteoporosis, limited joint mobility, cerebrovascular accident, spinal cord injury, brain injury, and balance/equilibrium problems.

125
Q

Effect of Activity intolerance and immobility on body systems: Cardiovascular System

A

Increased heart rate, venous stasis, orthostatic hypotension, Deep Vein Thrombosis (DVT)

126
Q

Effect of Activity intolerance and immobility on body systems: Pulmonary System

A

Pulmonary edema, pneumonia, and atelectasis

127
Q

Effect of Activity intolerance and immobility on body systems: Integumentary system

A

Tissue ischemia, and pressure ulcers

128
Q

Effect of Activity intolerance and immobility on body systems: Musculoskeletal System

A

Muscle atrophy, joint contractures (everything curls up), foot drop, and bone loss/osteoporosis

129
Q

Effect of Activity intolerance and immobility on body systems: Gastrointestinal system

A

Decreased peristalsis, constipation, bowel obstruction/paralytic ileus

130
Q

Effect of Activity intolerance and immobility on body systems: Genitourinary System

A

Urinary stasis, Urinary tract infections, renal calculi (kidney stones)

131
Q

Effect of Activity intolerance and immobility on body systems: Nervous System

A

Altered proprioception, and altered balace

132
Q

Effect of Activity intolerance and immobility on body systems: Psychosocial Impact

A

depression/hopelessness, loneliness/isolation, altered sleep patters, and disorientation

133
Q

Lung expansion

A

raise head of bed, turn/cough/deep breath every 2 hours, use incentive spirometer every one hour while awake

134
Q

Prevent blood clots

A

Active and passive ROM, sequential compression devices, anti-embolism stockings, keep hydrated, encourage self-care of ADLs

135
Q

Prevent orthostatic hypotension

A

Raise head of bed, dangle at side of bed, check v/s

136
Q

Prevent atrophy

A

Active and passive ROM, overhead trapeze bar, and footboard

137
Q

Prevent skin breakdown

A

Turn/reposition every 2 hours or more often if needed, proper alignment in bed, use pillows/wedges/trochanter rolls, and keep skin clean and dry

138
Q

Prevent shear

A

by using draw sheet to prevent drag when repositioning

139
Q

Supine

A

Laying on back

140
Q

High Fowler’s

A

90 degrees

141
Q

Semi-Fowler’s

A

45 Degrees

142
Q

Sim’s

A

Side-lying with hip and knee flexion

143
Q

Prone

A

lying on abdomen

144
Q

Prevent altered digestion

A

healthy diet, increase protein and fiber intake, adequate fluids, promote regular toileting

145
Q

Prevent infection and risk of renal calculi

A

encourage adequate fluid intake and emptying bladder

146
Q

Prevent depression/loneliness

A

Encourage visits from family/friends, include patient and planning care, offer spiritual/chaplain care as needed, prevent sleep disruption, engage in conversation, and orient to reality

147
Q

Fall risk factors

A

Over age 65, history of falls and fear of falling, balance or gait problems, muscle weakness, visual impairment, neurological impairment, cognitive impairment, bowel or bladder incontinence, cardiovascular issues, and multiple medications

148
Q

Fall Precautions

A

Assess every patient for risk of falls
Frequently observe patients (every 2 hours during day and every 1 hour at night)
Bed safety
Answer call light quickly
Good lighting in room, nightlight at night
Keep patient’s belongings within easy reach
Use gait belt and nonskid socks/shoes
Keep walkways clear, clean and dry
Use proper fitting clothing
Familiarize patient with environment
Patient return-demo call light
Patient to use handrails in bathroom and hallways
Keep wheelchair wheels locked when stationary
Communicate and document fall risk to health care team (armband, sign on door)

149
Q

Interventions for Safe Mobility

A

Gait belt, walker, wheelchair, crutches, cane
Dangle patient first, raise head of bed, turn patient and lower legs to floor, sit patient on side of bed for several minutes, and have patient move legs before standing
Use transfer board and mechanical lift as necessary

150
Q

Active ROM

A

Patient can do it themselves

151
Q

Passive ROM

A

We have to move the joint for them.

152
Q

Flexion

A

Bending at a joint in the natural direction of movement

153
Q

Extension

A

moving from the flexed position to a neutral or straight position

154
Q

Hyperextension

A

moving beyond a straight or neutral position

155
Q

Rotation

A

Pivoting a body part on its axis

156
Q

Abduction

A

movement of a limb in a direction away from the midline of the body

157
Q

Adduction

A

Movement of a limb in a direction toward the midline of the body

158
Q

Circumduction

A

A combination of movements that causes a body part to move in a circle

159
Q

External rotation

A

rotation from a joint in the direction away from the midline of the body

160
Q

Internal Rotation

A

Rotation from a joint in the direction toward from the midline of the body

161
Q

Supination

A

Rotation of the palm of the hand upward or in the anterior direction

162
Q

Pronation

A

Rotation of the palm of the hand downward or in the posterior direction

163
Q

Opposition

A

The relationship of the thumb and fingers for the purpose of grasping objects

164
Q

Eversion

A

movement of the ankle to turn the sole of the foot laterally(away from the midline)

165
Q

Inversion

A

movement of the ankle to turn the sole of the food medially (toward the midline)

166
Q

Dorsal flexion

A

Flexion of the ankle in the direction of the dorsal surface

167
Q

Plantar Flexion

A

Flexion of the ankle in the direction of the plantar surface

Nursing Skills (2 decks)

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