Foundations Weeks 1-3 Flashcards
Thanks Emily S for the deck!
1
Q
Describe the 4 main links of the chain of infection (there were 6 in the book but he only listed 4)
A
Source (wound, water, people, object), portal of entry (sx site, catheter), portal of exit (sputum, emesis, stool, urine, blood, wound drainage, genital secretions), and susceptible host.
2
Q
Name 5 modes of transmission
A
Contact, droplet, airborne, vehicle, vector-borne
3
Q
Define asepsis
A
To make free from disease-producing organisms
4
Q
Define sepsis
A
The poisoning of tissues
5
Q
Name 2 infections that are contact precaution
A
MRSA and c-dif
6
Q
Name 3 infections that are droplet precaution
A
Influenza, pertussis, meningitis
7
Q
Name 3 airborne infections
A
TB, measles, coronavirus
8
Q
Name 2 vehicle-borne infections
A
Salmonella, e. coli
9
Q
Name 3 carriers in vector-born infections
A
Mosquitoes, contaminated needles, ticks
10
Q
What precautions do you take with airborne transmission?
A
N-95, eye protection, negative pressure rooms
Particles last HOURS
11
Q
What precautions do you take with droplet transmission?
A
Level-1 mask (no gown or face shield needed. Particles last only minutes)
12
Q
What are the minimum precautions you take with contact transmission?
A
Gloves and gown
13
Q
Which of these actions are ways to protect yourself from needle stick injuries: SATA :)
- Never recap a needle
- Engage safety lock feature on needles
- Make sure to recap needles in emergencies
- Use puncture-proof sharps containers
A
- Never recap a needle
- Engage safety lock feature on needles
- Use puncture-proof sharps containers
14
Q
Name 4 strategies the CDC says will decrease infection risk
A
- Used of bundled practices for invasive procedure or tx
- Expedient doses and treatment (blood cultures, etc)
- Careful det’d of appropriate antimicrobial therapy
- Following appropriate precautions for specific illnesses
15
Q
Name 3 ways of achieving medical asepsis
A
Hand hygiene, using barriers (gloves, gown, etc), sterilizing
16
Q
When should you use soap and water for hand hygiene?
A
When physically dirty
When around c-dif, spores, etc (vomiting, diarrhea)
When you eat
After using the bathroom
17
Q
When is alcohol-based hand hygiene acceptable?
A
In between rooms
No visible soiling of hands
Between gloves
18
Q
True or false: Using lotion with gloves is bad because it can break them down and make them more permeable
A
True
19
Q
What is the term for the chemical or physical process to remove pathogens?
A
Disinfection
20
Q
What is a process used to destroy everythinggggg, like ….even spores?
A
Sterilization
21
Q
Name a few ways sterilization can be achieved
A
Heat, gas, chemicals
22
Q
When should you always wear gloves (SELECT ALL THAT APPLYYYYYY)?
- When dealing with a pt with broken skin
- While examining mucus membranes for cap refill
- When taking a BP
- When dealing with body fluids
A
- When dealing with a pt with broken skin
- While examining mucus membranes for cap refill
- When dealing with body fluids
23
Q
What PPE should you wear if splash or drainage is anticipated
A
Mask + gown
24
Q
What do you don for protective isolation pts (ex: immunocompromised) ? (also called NEUTROPENIC PRECAUTIONS/REVERSE ISOLATION)
A
Gloves, gown, mask
25
What are some examples of when sterile technique is used (surgical asepsis)?
- Surgery
- Any procedure that involves blood
- When skin is being broken as part of a procedure
- Some dressing changes
- When caring for immunocompromised pts
26
Which historical nurse was the leader of asepsis, the cleaning of wounds, and infection prevention.
Florence Nightingale
27
Which historical nurse was instrumental in the formation of the Army Nurse Corp?
Dorthea Dix
28
Which historical nurse founded the Red Cross?
Clara Barton
29
What does SBAR stand for?
Situation
Background
Assessment
Recommendation
30
Name for moving a joint toward the middle of the body?
Adduction
31
Name for moving a joint away from the midline of the body?
Abduction
32
Name for decreasing the angle between two bones?
Flexion
33
Name for straightening a joint?
Extension
34
Name for turning the body or a body part to face upward?
Supination
35
Name for turning the body or a body part to face downward?
Pronation
36
What is paraplegia?
Paralysis of the legs and lower body
37
What is hemiplegia?
Paralysis of one side of the body
38
What is tetraplegia?
Paralysis of all four limbs
39
What does the Nurse Practice Act govern?
What you can do legally; varies by state; developed by Board of Nursing
40
What are some issues coming up with antibiotics concerning drug resistance?
Over-prescribing, using wrong one, not taking as prescribed, not finishing treatment
41
Does sepsis cause hypo- or hypertension?
HYPOtension
42
What would you use for hand hygiene post C. diff client?
Nonantimicrobial soap + h2o
43
What kind of mask do you need for TB?
N95
44
When would you remove a mask in between patients?
Airborne or droplet
| Soiled/wet mask
45
What electrolytes are most important for the musculoskeletal system?
Potassium, vitamin D, phosphorus, vitamin B
46
Define isotonic exercise
Dynamic w/constant tension, movement, contraction (bicep curls); tonic=constant movement
47
Define isometric exercise
Static exercises – tense muscle, hold stationary (holding a yoga pose)
48
What is another word for decreased muscle tone?
Hypotonicity
49
What is another word for increased or rapid muscle tone
Spasticity
50
What is a rhythmic/repetitive motion; can happen at rest?
Tremor
51
What is a spontaneous brief involuntary muscle twitch or limbs or face?
Chorea
52
What is the term for a gait characterized with wide feet and described as duck-like?
Waddling
53
What is the progressive shortening of muscle; loss of joint mobility; fibrous material?
Contracture
54
What is the largest reportable problem related to mobility?
FALLS
55
What are some types of pain that can be caused by immobility?
- Kidney stones (renal calculi – from imbalance between osteoblasts and osteoclasts-->increased blood calcium level)
- Atrophy (“use it or lose it”)
- Contractures
- Joint pain (decreased flexibility)
56
What are some cardiovascular issues that come from decreased mobility?
- Increased cardiac workload: when supine, heart must work harder to perfuse body
- Thrombus formation: due to decreased venous stasis
* immobility does NOT increase blood viscosity, but dehydration impacts this*
- When immobile, baroreceptors not used as much ---> orthostatic hypotension
57
Why does thrombus formation occur with decreased mobility?
Decreased venous stasis*
*immobility does NOT increase blood viscosity, but dehydration impacts this*
58
When immobile, __________ are not used as much so orthostatic hypotension can occur.
Baroreceptors
59
S/s of orthostatic hypotension?
Dizziness, weakness, light headed, hypotension, diaphoresis, SOB
60
What issues can immobility cause with bone?
Imbalance between osteoblasts and osteoclasts (increased blood calcium levels)
61
What is the most frequent site of pressure ulcers?
Sacrum
62
What is atelectasis?
Alveolar collapse
63
What happens to the lungs with immobility?
Decreased lung expansion
64
S/s of decreased lung expansion?
- Immobile client breathes less deeply and w/more effort
- Decreased coughing ability
- Atelectasis (alveolar collapse)
- Pneumonia risk
65
How does immobility affect nitrogen levels in the body?
Negative nitrogen balance:
- Immobility increases rate of protein breakdown (excretion > intake)
- Body doesn’t have enough nitrogen for protein synthesis (impaired wound healing)
- Slow muscle restoration when mobility resumes
66
Why is constipation a possible complication with immobility?
Atrophy of GI muscles, dehydration, rectal filling slow in supine position
67
Examples of activities or programs to recommend (SATA)
```
Tai chi
Group activities
Gymnastics
Membership to local health club
Strength training
PT
```
```
Tai chi
Group activities
Membership to local health club
Strength training
PT
```
68
What is osteoporosis?
Low bone mass, deterioration of bone tissue
69
Risk factors of osteoporosis? SELECT EM ALL FRENS
- premenopausal
- family history
- history of fractures
- alcohol
- cigarette smoking
- prolonged immobility
- premenopausal (No, it's POSTmenopausal)
- family history
- history of fractures
- alcohol
- cigarette smoking
- prolonged immobility
70
Trendelenberg position is:
Head 30-40° lower than feet
71
Semi-fowlers position is:
30-45° sitting
72
Fowlers position is:
80-90° sitting
73
Prone position is:
Face down (great for oxygenation)
74
Lithotomy position is:
Supine with hips flexed; examinations
75
When a hand roll is used as a positioning aid, what does it help prevent?
Contracture
76
Cane basics:
- Maintain ___ points of support ALWAYS
- Cane on __________ side
- Move cane forward _______
- Move weak leg _____ distance as cane
- Move strong leg forward and ____ cane/weaker leg
- maintain 2 points of support
- cane on stronger side
- move cane forward first
- move weak leg same distance as cane
- move strong leg forward and past cane and weaker leg
= 1st cane, 2nd weak leg, 3rd strong leg
77
What is an EHR?
Electronic Health Record
78
Disadvantages of EHR?
Expensive and difficult to implement
79
Advantages of EHR?
Legible, standardization of info, graphs for trends, access off-site
80
What are the main elements of documentation?
Privacy: HIPAA, accurate (only observations YOU observed), concise and complete, objective, organized and timely (document as you go along!)
81
There are 8 million types of documentation records. Which two of these do NOT belong?
- Admission Entry or Admission Assessment
- Flow Sheet
- Plan of Care Assessment
- Clinical Pathway
- Draw Sheet
- Atelectasis Notation
- Narrative Progress Notes
- Nursing Discharge Notes
Atelectasis Notation and Draw Sheet
LOLZ
82
What is the Admission Entry or Admission Assessment?
* Extensive background questionnaire
| * ie Any cultural beliefs that affect care?
83
What do you find on a Flow Sheet? What is a benefit of a Flow Sheet?
* Vital signs
* Assessment
* Lab data
These allow trends to be easily seen
84
What do you find in a Plan of Care Assessment?
* Care plan
| * Concept map
85
What is a Clinical Pathway?
Used for clients with specific and generally predictable conditions, it guides care, identifies progression of client. Is different from a care plan in that’s its more related to a specific medical procedure.
86
What is included in the Nursing Discharge Summary?
* Expectations after discharge
* Follow-up appointments
* When to reach out for assistance
THIS BEGINS AT INTAKE!
87
What are Narrative Progress Notes?
Relevant client and nursing activities throughout shift in a narrative format; easiest to learn; allows for detail; takes time; difficult to pick out important details
88
What are 3 acronyms for types of taking Narrative Progress notes?
* SOAP
* PIE
* FOCUS
89
What is a SOAP note?
```
Subjective
- What patient expresses
Objective
- Vital signs, lab data
Assessment
- A “conclusion” based on the S and O
Plan
- What nursing interventions are used to address the
conclusion
```
90
Disadvantage of SOAP notes?
Unable to be used for general charting
91
What is a PIE note?
- Problem
- Intervention
- Evaluation
Good way to focus on nursing problem; problem is that it’s NOT interdisciplinary
92
What is a FOCUS (DAR) note?
- Data
- Action
- Response
Great for teaching pt something at discharge. Pt education. Disadvantage: Not used by other health professionals.
93
What is it called when nurses document only what is abnormal? This is the exception to "if you didn't chart it, you didn't do it."
Charting by exception
94
What documentation occurs when there is an error?
Incident report
95
T/F: Always put in your notes when you made an incident report
False. Never note this. It should not be a part of the patient's chart.
(SO SKETCH.)
96
List a few examples of things that would lead to an incidence report?
- Falls
- Medication errors
- Equipment malfunction
- Injury to client/visitor/employee
97
What does SBAR stand for?
- Situation
- Background
- Assessment
- Recommendation
98
When do you use a verbal order?
Emergencies only! Use call-out and call-back
| technique.
99
If a verbal order is not an emergency, what should you do?
Request that provider put in the order, nicely :)
100
What is a handoff?
Report given whenever another person is assuming care for the patient.
101
When should you do a handoff?
Traveling to get a test, going for a procedure, changing hospitals, shift change.
102
How should report be given to the next shift?
- Given at client’s bedside
| - Concise + accurate
103
What is another word for the ability to perform primary functions (feeding, toileting, bathing, dressing)?
Self care
104
What are the physical benefits of bathing (SATA)?
```
Remove bacteria
Allows skin assessment
Promotes circulation
Hydration
Maintain muscle tone
Maintain joint mobility
```
```
Remove bacteria
Allows skin assessment
Promotes circulation
Maintain muscle tone
Maintain joint mobility
```
105
What are the psychosocial benefits of bathing?
Mo SATA
- Client relaxation
- Rapport with nurse
- Promotes well-being
- Promotes circulation
- Client comfort
- Client relaxation
- Rapport with nurse
- Promotes well-being
- Client comfort
(Circulation is a physical benefit)
106
What is a sitz bath? What/who/when does it benefit?
Used to cleanse, soothe, reduce inflammation of perineal or vaginal area (post childbirth, rectal surgery, hemorrhoids/fissures)
107
Benefit of a hot water bath?
Relieve muscle spasms and soreness
108
What kind of bathing is considered general bathing?
Warm water bath.
109
When would you use a cool water bath?
Relieve muscle tension, decrease body temp when febrile
110
Why would you use a soak bath?
To soften or loosen secretions, reduce pain and swelling in inflamed skin
111
Best temp to keep general bath water?
Between 110°-115°F
112
Name some factors that affect self care.
- Environment (homelessness, safety, accessibility, wheelchair ramp)
- Motivation (mental health, cognitive abilities: confusion, delusion, doing everything for them)
- Energy (meds, disease states that impact o2 and energy levels)
- Illness, surgery
- Pain
- Neuromuscular fxn/sensory deficits (tremors)
113
Concerning levels of self care rating 0-4, the ______ the level, the more dependent the patient is rated
Higher
0: completely independent
1: use equipment or devices to perform self-care activities INDEPENDENTLY
2: requires assistance or supervision from another to complete activities
3: requires assistance or supervision AND uses equipment/devices (DEPENDENT)
4: completely depends on another person to perform self-care activities
114
What do feet with poor perfusion look like?
Cold and dusky
115
What do feet with poor perfusion possibly indicate?
Decreased healing
Increased fall risk
Decreased sensation
Increased risk of infection
116
SELECT ALL THAT APPLY as important for diabetic foot care:
```
Inspect daily
Clean with cold water + soap
Dry carefully, esp between toes
Cut toenails straight across
No lotion between toes
```
```
Inspect daily
NOT Clean with cold water + soap -- w/WARM water
Dry carefully, esp between toes
Cut toenails straight across
No lotion between toes
```
117
What is a flat, thickening of skin; usually bony prominence?
Callus
118
What is a cone shaped lesion; usually 4th or 5th toe over joint?
Corn
119
What are round, irregular, flat warts; often painful?
Plantar warts
120
What are inflammation/thickening of bursa of great toe joint?
Bunions
121
What is red, scaly, cracking skin esp in between toes
Tinea pedis (athlete’s foot)
122
What is the treatment for lice (hair and clothes)?
Hair: pyrethrin and permethrin every 9-10 days
Clothing: extreme temps for 5 minutes (hot h2o + hot air)
123
What are two things you might call in a speech therapist for?
Swallow evals; appropriate diet
124
What does an OT focus on?
ADLs
