Exam 3 Fundamentals Flashcards
What is PICOT?
format to state a foreground question, the more focused your question, the easier it becomes to search for evidence in the scientific literature.
P: pt population of interest (identify pt age, gender, ethnicity, disease or health problem)
I: intervention or area of interest (which intervention is worthwhile to use in practice.. treatment/diagnostic test/prognostic factor)
C: Comparison intervention or area of interest (what is the usual standard of care or current intervention used now in practice??
O: Outcome
T: Time
what are the levels of research?
Level 1: systematic review or meta-analysis of randomized controlled trials (RCTs). evidence based clinical practice guidelines based on systematic reviews (top of pyramid)
Level 2: a well designed randomized controlled trial (RCT)
Level 3: controlled trial without randomization (quasi experimental study(
Level 4: Single non experimental study (case control, correlational, cohort studies)
Level 5: systematic reviews of descriptive & qualitative studies
Level 6: single descriptive or qualitative study
Level 7: opinion of authorities and/or reports of expert committees (bottom of period)
Which level of research is a systematic review or meta-analysis of randomized controlled trials (RCTs). evidence based clinical practice guidelines based on systematic reviews (top of pyramid)
Level 1
which level research is a well designed randomized controlled trial (RCT)
Level 2
which level of research is a controlled trial without randomization (quasiexperimental study)
Level 3
Which level of research is a single non experimental study (case control, correlational, cohort studies)
Level 4
which level of research is systematic reviews of descriptive & qualitative studies
Level 5
Which level of research is a single descriptive or qualitative study
Level 6
Which level of research is an opinion of authorities and/or reports of expert committees (bottom of period)
Level 7
what can change a pt’s oxygen level?
-anxiety
-hypoventilation
-smoking / COPD
-sleep apnea
-nutrition / low iron (anemic)
-hypovolemia (bleeding out)
what is a s/s of decreased oxygen?
confusion, drowsiness, air hungry aka anxious … so check pulsox!
how to position unconscious vs conscious pt when suctioning?
conscious pt: make sure they are not lying down. Have them sit in upright position.
unconscious: have pt lay on their side
commonly used to promote deep breathing & prevents/treats atelectasis (collapse of alveoli) in a post op pt
incentive spirometer
how to prevent respiratory infection after post op?
use incentive spirometer, get up & moving
collection of air in the pleural space, collapse of lung
pneumothorax
how to prevent alveoli collapse?
teach pursed lip breathing to pts which involves deep inspiration and prolonged expiration (blowing out candle)
what to do if pt has orthopnea?
elevate bed to 45 degree
early signs of hypoxia?
restlessness
signs of hypoxia?
clubbing, cyanosis, O2 stat dropping, increased HR and RR at first then declines as it worsens
modifiable sleep factors?
adjust temperature, decrease lights, no alcohol, no spicy food, reduce noise by closing door in the hospital & cluster pt care
How to promote sleep across all age groups?
maintain a sleep wake cycle (inside & outside of hospital), establish a nightly routine and maintain it.
what to monitor for in a pt w/ narcolepsy?
SAFETY!!!
what causes difficulty sleeping?
alcohol, blue light (computer/phone), exercising before sleep, stress, nicotine
therapeutic communication
never ask the pt “why”… use open ended questions
who will be the best source of info regarding sleep assessment?
the patient! unless it involves snoring, then the partner will be a better source
How can you tell if a pt is resting well?
slow & even RR, pt’s eyes will be closed, pt will be still (not tossing/turning)
major sleep center of body?
hypothalamus (controls body temp)
before sending a pt to get a pyelogram, what should you check?
their allergies, see if they’re allergic to shellfish/iodine because the test test uses iodine dye
what does a pt need to do after a pyelogram test?
drink fluids!!! it will flush the dye out
what is a pyelogram? (IVP = intravenous pyelogram)
x-ray that uses dye to take pics of urinary tract
how to prevent UTIs
-clean front to back
-good hygiene
-stay hydrated 6-8 glasses of water per day
how to care for a urinary indwelling catheter?
-insert using sterile technique & use smallest size
-Peri care once a shift
-keep bag below bladder
-maintain unobstructed flow/no kinks in tubing
how to prevent CAUTIs?
remove foley as soon as it’s no longer needed, use securing device, no kinks in tubing, keep bag below bladder
how to help pt urinate?
give privacy so ease the anxiety so their muscles can relax to urinate
how to insert foley in uncircumcised pt?
retract foreskin for insertion then unretract the foreskin back over
what do you do if a pt is unable to empty bladder within 6 hrs of foley removal?
bladder scan!
what does incontinence put a pt at risk for?
skin breakdown/irritation due to moisture
how to prevent or help stress incontinence?
pelvic muscle exercises AKA Kegels
what info do we need to report for a UA?
-glucose in urina
-ketones in urine
-bacteria in urine
-RBC/WBC in urine
-crystals in urine
-protein (up to 8mg/100mL can be normal) but not usually present in urine
What to do for a pt that needs to use a bed pan?
Change HOB to 30-45 degrees
signs of dehydration?
-thirst
-less frequent urination, -dark-colored urine
-dry skin
-fatigue
-dizziness
-light-headedness
common causes of constipation?
-ignoring the urge to defecate
-chronic illnesses (Parkinson’s, MS, RA, depression, eating disorders, chronic bowel diseases)
-low-fiber diet high in animal fats (meats, carbs)
-low fluid intake
-stress
-physical inactivity
-meds, like opiates
-changes in routine or life (pregnancy, aging, travel)
-neurological conditions that block nerve impulses to colon (stroke, spinal cord injury, tumor)
what causes a pt to be at risk for bowel incontinence?
confused/disoriented pt
stool will be more liquid in which type of ostomy? (colostomy or ileostomy)
ileostomy because of location (right side aka stool doesn’t have enough time to fully form yet due to location)
**this makes it harder for meds to absorb so pts w/ an ileostomy cannot have coated tablets bc there is not enough time for med to absorb
a pt w/ an ileostomy cannot have what?
coated tablets or extended release meds
when to empty an ostomy?
when it’s 1/3 to 1/2 full