Flashcards for Multiple Skills

1
Q

What are Active ROM Exercises?

A

When the patient can perform them

These exercises are designed to enhance the patient’s range of motion through voluntary movement.

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2
Q

What are Passive ROM Exercises?

A

When you perform them for the patient

These exercises are conducted by a caregiver to help maintain the patient’s range of motion.

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3
Q

How often should ROM exercises be performed?

A

At least twice daily

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4
Q

How many times should each sequence of ROM exercises be repeated for each joint?

A

5 times on each side of the body (except for the neck)

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5
Q

Where does skin breakdown usually occur?

A

Bony areas (sacrum, heels, elbows, hips, back of the head, perineal area)

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6
Q

What is the first stage of skin breakdown?

A

Redness that doesn’t blanch

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7
Q

What does the second stage of skin breakdown resemble?

A

Looks like a blister, with surface skin that peels or cracks open

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8
Q

Describe the third stage of skin breakdown.

A

Lost skin layers and underlying fat and tissue are visible

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9
Q

What characterizes the fourth stage of skin breakdown?

A

Resembles a crater, with damage all the way through to muscle and bone

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10
Q

What does ‘unstageable’ mean in terms of skin breakdown?

A

Crater is full of dead tissue

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11
Q

What are the signs and symptoms of infection in wounds?

A
  • Redness
  • Swelling
  • Fever
  • Increasing pain and discomfort
  • Warmth around the wound
  • Foul odor
  • Drainage
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12
Q

What type of drainage is a clear indication of infection?

A

Purulent drainage (contains pus)

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13
Q

How do you know that a wound dressing needs replacement?

A
  • Moisture or drainage soaking the dressing
  • Looseness of the dressing
  • Nonadherence of the adhesive portion of the dressing or tape securing it
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14
Q

What should be checked if significant pain is anticipated during dressing change?

A

Consult with the nurse about the patient getting an analgesic 30 minutes prior to the dressing change

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15
Q

What should you do if the dressing adheres to the skin?

A

Moisten it with sterile water or sterile normal saline solution

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16
Q

What is required for oxygen therapy to be initiated?

A

It must be prescribed by a licensed provider

17
Q

What are the types of oxygen equipment?

A
  • Nasal cannula
  • Face mask
  • Nonrebreather
18
Q

What should be done if the patient has symptoms of dryness or the flow rate is greater than 4L/min?

A

Attach the flow meter to a humidifier

19
Q

What are the signs and symptoms of hypoxia?

A
  • Anxiety
  • Lack of concentration or focus
  • Fatigue
  • Hypertension
  • Cyanosis
  • Dyspnea
  • Increase/decrease in HR or RR
20
Q

What is the purpose of suction equipment?

A

To remove mucus, blood, vomit, and secretions from the patient’s mouth and throat

21
Q

What should you inform the patient before suctioning?

A

Suctioning can cause coughing, gagging, and sneezing

22
Q

What position should the patient be in during suctioning?

A

Raise the head of the bed to 45 degrees; if unconscious, place the patient on their side

23
Q

How long should you suction at a time?

A

No more than 15 seconds

24
Q

What should the patient do between suctioning?

A

Cough and breathe deeply

25
What equipment is used for tracheostomy suctioning?
A sterile suction catheter kit
26
What should be done before suctioning a patient with a tracheostomy?
Preoxygenate the patient
27
How should the suction catheter be advanced?
Advance until you feel resistance and then pull back about 1 cm
28
What is the maximum suction duration when using a catheter?
No longer than 10 seconds
29
What does TCDB stand for?
Turning, coughing, deep breathing
30
What does TCDB help prevent?
Respiratory complications
31
How often should patients be encouraged to cough and take deep breaths?
Every 1-2 hours while awake
32
What is the purpose of an incentive spirometer?
Breathing exercise to help prevent respiratory complications after surgery
33
What is the correct technique for using an incentive spirometer?
Inhale, hold for 3 seconds, then exhale
34
How often should patients be encouraged to use the incentive spirometer?
Every 1-2 hours