General Knowledge Flashcards
1
Q
What equipment must you bring for a patient bed bath?
A
Bowl and water
Octenisan
Conti wipes (dry wipes)
towels
clean gown
clean linen
linen basket
deoderant
razor
toothpaste/brush
comb
mouth gel
2
Q
What are the steps of essential care?
A
Introduce yourself
Ask if they would like a wash and if they need assistance
WHO hand washing
Gather equipment needed
Provide dignity
Add octenisan to warm damp cloth and leave on body for one minute before rinsing off and then drying
change gown
change bed linen
dispose of dirty linen
check patient is dry, comfortable and has water and their call bell
WHO hand washing
3
Q
How can you reduce a patient’s temperature?
A
Offer them a fan or to open the window
Change of bed linen/remove blanket
Remove layers of clothing
Encourage them to drink plenty of fluids
4
Q
How do you document a patients credit card?
A
Name of bank and last 4 digits of the card
5
Q
What do you do if a patient refuses any essential care?
A
Document and escalate to nurse if necessary
6
Q
What types of stools are considered constipation and which are diarrhoea?
A
1 and 2.
6 and 7.
7
Q
What do we need to observe in stools?
A
Consistency, smell, colour, blood, frequency
8
Q
What type of stools indicate an infection?
A
Types 5, 6 and 7
9
Q
Normal ranges of: BP, Oxygen Sats, Temp, Pulse, Resps, Urine output
A
100/60-140/90, 95% and above, 36.0-37.5, 60-100, 12-18, more than 30ml/h
10
Q
When would you perform a foot inspection on a patient with diabetes? Then how often?
A
Within 24hrs of admission
Every 24hrs
11
Q
What is the process of a foot inspection and why do we do it?
A
Neuropathy is the loss of sensation in the feet and can lead to diabetic foot ulcers.
Ask patient to close their eyes and then lightly touch their toes in the order 1-6. Ask them to say yes when they feel you touching them.
If you circle more than one N, neuropathy is present
12
Q
Why do a skin inspection?
A
Pressure sores and ulcers are more likely to develop during admission as the patient is not as mobile as normal.
13
Q
How do you complete a skin inspection?
A
Check vulnerable areas and areas that come in contact with medical equipment during washing and manual handling.
Remove stockings everyday and check heels.
14
Q
How do we avoid Pressure Sores/Ulcers?
A
Ensure anti embolism stockings are removed daily
Keep skin clean and dry
Cream on dry areas
Minimal linen, incontinence pads only if necessary
Use of sliding sheets
Increasing repositioning (every 2 hours)
Encourage fluids and food
15
Q
What are the grades of pressure ulcers?
A
Grade 1 - Non-blanchable erythema (redness) of intact skin
Grade 2 - Partial thickness skin loss involving epidermis, dermis or both
Grade 3 - Adipose (fat) and granulation tissue are visible in the ulcer and there may be rolled wound edges present
Grade 4 - Full-thickness skin and tissue loss with exposed fascia, muscle, tendon, ligament, cartilage or bone in the ulcer
16
Q
What causes pressure ulcers?
A
- The occlusion of blood vessels due to external pressure
- Endothelial damage of the arterioles (causing ischaemia) and the tissue microcirculation as a result of shearing forces
17
Q
What is a pressure sore/ulcer?
A
It is localised damage to the skin and/or underlying tissue, usually over a bony prominence
The damage can be present as intact skin or an open ulcer and may be painful
It can take only hours for a pressure ulcer to develop, yet months to years to heal them
18
Q
What is a moisture lesion?
A
Wearing of skin integrity in wet, moist and warm areas
19
Q
Visual Enhanced Observations
A
Observing and maintaining the needs of the patient who is at high risk to themselves or others
20
Q
How do we manage self-harm/violence during EO?
A
Press the emergency call bell. Ideally talk and listen to the patient before it escalates
21
Q
What are the different levels of observations?
A
Level 1 - Routine, all patients, every 2 hrs
Level 2 - Intermittent, those with predictable yet sometimes risky behaviour, every 30mins
Level 3 - Cohort nursing, those with unpredicatable behaviour, always within eyesight
Level 4 - 1:1 or above, frequent and high risk behaviour, must be within arms reach
22
Q
What is Intentional Rounding?
A
The timings of each task the member of staff completes for each patient
23
Q
What are the elements of Pallative Care Rounding?
A
2 hourly, medical and family needs have been met. Mostly making them comfortable
24
Q
Name the symbol:
Yellow falls sign
Green hand
Yellow smiley face
Red hand
Blank O2 Cannister
Blue Flower
Red tray
Crossed out mouth
A
Falls risk
At risk of PU
Fit for discharge
Has a PU
On oxygen
Has dementia
Needs feeding assistance
NBM
25
What do you need to remember to do after your shift, before going home?
Throw your handover sheet in the blue confidential waste bin in the reception area
26
What are some benefits to good manual handling?
Reduce staff risk of injury/absence due to MSK injury
Safety for patient
Reduce liklihood of PU
Reduce risk of injury to patient
27
What are some causes of Back Pain due to poor MH?
Poor posture
repetitive workload
physical and psychological stress
not taking appropriate breaks
poor ergonomics (environment)
28
What does patient capacity and consent mean?
They can understand the information being given
They can retain this
They can weigh this up
They can communicate their decision
29
How should bariatric patients be positioned in bed?
Not flat as this may cause respiratory arrest
30
What is medstrom and what does it supply?
The trust's bariatric suppliers
it provides the beds, air mattresses and types of supportive chairs
31
What are some other health conditions to consider before moving someone?
Depression and Strokes
Resp conditions
Cardiovascular conditions and diabetes
hormonal conditions
lower limb oedema, ulcers and gout,
OA
32
What are some issues for good MH practice?
space
staff numbers
pressure care/repositioning
clothing
bp cuffs
catheters and iv drips
33
Name some aspects of the HCA role
feeding, washing, toileting, observations, enhanced obs, housekeeping, escalating concerns, EoL care, mouthcare, last offices (following death), chaperone
34
Name some areas at risk of developing a PU
Elbow, heel, hip, behind ear, shoulders, back of head, sacrum, spine, ankles, knees, toes, nose, wrist
35
What things must we do before any care procedure?
Introduce yourself, explain what you are going to do, gain consent, wash hands and collect equipment
36
What are the WHO 5 moments of hand hygeine and why is it important?
Before patient contact
after patient contact
after contact with patient environment
after contact with bodily fluids
before aseptic procedures
37
How can we maintain dignity?
Close curtains/doors
Speak in a low tone
Gain consent
Promote independence
Cover areas that aren't being washed
38
What are 2 forms of care to be delivered after the main wash?
haircare and mouthcare
39
What 2 things must you remember before leaving the patient
That their water and call bell are in reach
40
What is the anti-microbial solution called to clean patients?
Octenisan
41
How do you use Octenisan?
Apply it to a warm damp conti dry wipe and wipe onto patient. Leave for one minute and then rinse with different wipe and then dry with towel
42
Name 3 types of catheter bag and why they would be used
Urometer - to monitor hourly urine output
Leg bag - maintains dignity and mobility
Two-litre - immobile patients and overnight drainage
43
What does urinalysis tell us?
Kidney and Liver function
Hydration status
Identifying infections
Detects signs of bleeding
44
When would you not do a urine dip test?
to diagnose UTIs in over 65s due
to older adults having bacteria present in the bladder - it would give a false reading
45
What equipment is needed for a urine sample?
Sterile pot if they struggle to aim
Sample pot to collect sample
Green topped vacutainer
46
How do you collect an MSU?
1. Pass some urine into the toilet then, without stopping flow of urine, catch some urine in the clear pot.
2. Once the pot is about 3/4 full, finish off passing the urine into the toilet and put the lid on yellow pot.
3. As soon as possible, and within 2 hours, transfer urine to the green topped bottle.
4. Remove the label on top of the yellow pot and place the top of the green bottle into the hole in the pot so urine can be transferred without spillage or contamination.
47
How do you test the urine?
Remove stick from container and replace lid to avoid the introduction of excess moisture
Dip stick into urine completely immersing it
Remove strip, hold sideways and run on edge of receptacle to remove excess urine
Lay stick flat for 60 secs before reading results
Label the sample with the patients details
Tell your nurse the findings
Document in the patients notes
48
Name the two types of catheter and how they differ
Intermittent catheters – temporarily inserted into the bladder and removed once the bladder is empty
Indwelling catheters – remain in place for many days or weeks, and are held in position by an inflated balloon in the bladder
Or urethral vs suprapubic
49
What is the procedure before taking an CSU?
1. Wash hands before taking the CSU and put on appropriate PPE
2. If taking a specimen from a sampling port, check first whether there is urine in the catheter tubing.
3. If the tubing is empty apply a clamp below the level of the sampling port. This allows urine to collect above the clamp so
that a sample can be obtained.
4. Clean the sampling port with an alcohol-impregnated swab according to local policy and allow to dry . This reduces the risk
of cross infection or contamination of the specimen.
50
How do you collect an CSU?
1. Aspirate at least 10ml of urine and withdraw the syringe.
2. Put the urine into a yellow pot, avoiding contact between the
syringe and the pot.
3. Wipe the sampling port with an alcohol-impregnated swab and allow to dry. This reduces the risk of cross infection and
contamination.
4. If a clamp was used, release it to allow urine drainage freely.
5. Insert the syringe tip into the sampling port. Be careful to protect the sterile syringe tip and disinfected sample port from
contamination
51
How do you take a stool sample?
1. Wash your hands and put on appropriate PPE
2. Put a clean pan in the toilet/bedpan/commode to collect the sample
3. Take the sample to the sluice
4. Use the scoop to put the sample into the clean container. Aim to fill a minimum of a third of the container
5. Dispose of the sample in the macerator
52
What are the types of physiological observations?
Pulse, BP, Urine output, Respirations, oxygen saturation, pain, level of conciousness, temperature
53
Why do we do observations?
1. To record a of the patient’s condition when they are admitted or at the start of a shift.
2. To the patient’s condition. This helps us
to assess effectiveness of treatment and identify patients who are deteriorating or at risk of deteriorating.
3. It is a BASELINE MONITOR LEGAL RECORD
54
What can we observe regarding respirations?
* Depth
* Sound
* Patient colour
* Effort level of breathing
55
What can impact respiration rate?
Causes of low respiratory rate
* Rest and relaxation
* Sleep
* Drug-induced
* Airway obstruction
* Muscle fatigue prior to arrest
* Obstructive sleep apnoea
* Head injury
Causes of high respiratory rate:
* Exercise
* Emotional stress
* Agitation
* Anxiety
* Pain
* Sepsis
* Hypoxia
* Bronchospasm
56
What is oxygen saturation?
How much oxygen is in the haemoglobin in the arterial blood. It is displayed as a percentage.
57
What is blood pressure?
The pressure of the blood pushing against the walls of a person’s arteries
58
What are symptoms of hypotension?
Patients may feel dizzy, unsteady, confused,
sweaty/clammy. They may become pale, pulse may increase, respiratory rate may
increase.
59
What are symptoms of hypertension?
headache, vision changes
60
What can we observe other than pulse rate?
Rhythm, regularity, strength (thready, weak, normal, bounding), limb circulation
61
What are causes of bradycardia?
being asleep, fit and young, having
anaesthesia, taking medications
62
What are causes of tachycardia?
Exercise, stress, anxiety, excitement,
smoking, drugs, caffeine, alcohol
63
What are the levels of conciousness?
Alert, confusion, voice, pain, unresponsive
64
What is the normal pain level and what can impact the level of pain?
0.
environment, position, anxiety
65
What is normal vs abnormal urine sample?
clear, straw colour (30ml/hr)
dark,cloudy, noxious odour, blood,
sediment, discharge, pain
Diabetes can cause an increase in urine output
66
What causes inaccuracies in oxygen saturation readings?
Contact/positioning of probe,
acrylics/polish, cold fingers, bright light
or direct sunlight, jaundice or nicotine
stains, dirty probe/finger, recent smoking, excessive movement
67
What methods can be used to take a patient's temperature?
Tympanic 2 hand technique, Axillary, oral, rectal, temporal
68
How do you take a lying standing BP?
1. Lay patient down flat for 10 mins- then take BP reading
2. Stand patient for 1 min whilst looking for signs & symptoms. Repeat BP measurement
3. Keep standing for a further 2 mins (3 mins total) and repeat BP measurement
69
What is the sequence of observations for someone undergoing a blood transfusion?
1. Up to 1 hour before blood transfusion begins.
2. 15 minutes after starting the blood transfusion
3. Hourly throughout the transfusion
4. Within 1 hour after completing the transfusion
5. Repeat for every bag of blood
70
How often do NBM and EoL patients need oral care?
they may need mouth care as frequently as
every 2 hours.
71
What equipment may you need for oral care?
Toothbrush
Toothpaste
Mouthwash tablets
Denture pots
Tweezers
MouthEze oral cleanser
Pen torch
Tray
Lip Moisturiser
Moisturising mouth gel
72
What documentation is needed to be completed after washing?
* Intentional Care Rounding
* Skin Inspection Chart
* Bowel Chart
* Fluid Balance Chart
73
What are you looking for during skin inspection?
* Small blistering to epithelial skin layer
* Discolouration, redness
* Localised heat
* Localised oedema (swelling)
* Purplish / blue localised areas
* Localised heat or coolness
74
Why is the NEWS2 used?
Used to identify and respond to patients at risk of deteriorating
75
What are the 6 parameters of the NEWS2?
1. Respirations
2. Oxygen Saturations
3. Blood Pressure
4. Pulse
5. Level of Consciousness
6. Temperature
76
How do you chart oxygen device on the NEWS2?
V28
H28
77
After completion of the NEWS2, when would you escalate to the nurse?
1. NEWS2 total of 1 or above
2. If any parameter is outside the normal range
3. Urine output is less than 30 mLs/hr
4. Pain Score of 1 or above
5. If you have ANY worries
78
When must a patient be started on a fluid balance chart?
Any patient scoring over 3 in one parameter or a total score of 5 and over
79
How do you know how much oxygen a patient is on?
read from the middle of the ball
80
Which type of oxygen mask uses different coloured attachments?
Venturi
81
What are the different types of oxygen devices?
A = Breathing Air
N = Nasal cannula
SM = Simple mask
RM = Reservoir Mask
TM = Tracheostomy Mask
V = Venturi Mask Eg. V24 or V28
H = Humidified Eg. H28 or H35
82
What is different about tracheostomy masks?
Humidified oxygen is always delivered through tracheostomy masks. They are going past the mouth and straight into the trachea
83
What is different about Venturi masks?
*Venturi masks deliver a fixed amount of O2 in increments 24, 28, 35, 40, 60% O2
*Colour coded with the individual flow rate (L/min) written on each of the barrels
*Always check that the flow meter matches what is on the colour attachment
84
Why used humidified oxygen?
* Humidified O2 is used for high flow over prolonged periods
* Prevents drying out of secretions and mucosa
* Always check that the L/min on the humidified air bottle matches the flow meter on the wall
85
What is documentation?
Material that provides official information or
evidence.
Documentation serves as a record and can
be on paper, online or digital.
86
Why is documentation important?
* Essential part of Care planning
* Communication
‒ Nursing staff
‒ MDT
‒ Patient
‒ Other departments
* Legal requirement
* Evidence of care given
87
What is information governance?
how to manage and
share information appropriately.
It covers personal information, relating to patients/service users and employees and corporate
information such as financial and accounting records.
88
What are the 4 types Information?
personal
confidential
anonymised
pseudo-anonymised
89
What are the modes of transmission?
Direct contact - touch
indirect contact - contaminated surface
droplet - Microorganisms from the airway
airborne - Pathogens usually spread by droplet
90
What are the impacts of an HCAI?
* Major cause of death.
* Can lead to disabling conditions.
* Emotional stress for patients.
* Risk to staff.
* Affect on resources.
* Longer hospital stay.
* Cost to the Trust.
91
What are the strengths and weaknesses of washing hands with soap and water?
* Effective for decades.
* Effective against spore forming
organisms (C-diff).
* Great for removing visible dirt.
* Costly infrastructure.
* Sinks can increase risk of infection – only use sinks for hand washing.
* Contact dermatitis.
92
Strengths and weaknesses of hand sanitiser
* Effective against most micro
organisms.
* Quick to use.
* Cheap to supply.
* Minimises contact dermatitis
* Does not remove visible dirt.
* Not effective against organisms like C.diff and Norovirus.
* Potential patient safety issues.
93
What is PPE used for?
to protect you and patients from
contamination and transmission of infections.
94
Which bin would used masks go in?
Clinical waste
95
When would you wear gloves?
if there is potential risk of exposure to blood and/or other body fluids, non-intact skin or mucous membranes is anticipated or likely.
96
Difference between detergent and disinfectant
Detergent - removing dirt
Disinfectant - decrease presence of bacteria, fungi and viruses
97
How to stop someone from choking
* If not coughing effectively
* Call for help
* Deliver 5 back blows
* Heel of hand between the shoulder blades
* Assess to see if object cleared
* Stand behind the patient
* Place a fist and place onto abdomen
* Grasp this hand with your other hand
* Pull sharply inwards and upwards
* Repeat up to 5 times
98
What is the crash call?
2222 "adult cardiac arrest" and give the ward name
99
How to give CPR
push down 5-6cms twice per second
100
What can the HCA do during cpr?
Look after other patients
support relatives
running blood samples to pathology
101
Role of HCA during sepsis
retrieve the sepsis 6 red bag from resus trolley
to support fluid balance monitoring using a fluid balance chart and in ensuring familiarity with the equipment that is needed by other members of the team, to deliver the Sepsis 6 within a 1-hour window
102
What is the take 3, give 3 procedure?
▪ Take blood cultures
▪ Measure serial lactates
▪ Measure urine output – hourly
▪ Give broad-spectrum antibiotics –within an 60 mins
▪ Give intravenous fluids – bolus
▪ Administer high flow oxygen
103
Important to consider with mental health
clear communication
relationship building
active listening
clear line of support
104
Section 2 of the Mental Health Act
should be placed on level 4 EO (1:1)
offer time off walk
no right to leave hospital grounds
treatment can't be enforced
105
Section 3
level 4 (1:1)
treatment can be enforced
106
Barriers to success around treating mental health issues
hospital staff lack confidence
stigma
complexity of some MH patients
language we use stops us looking at other reasons - confirmation bias
107
What to do with someone who SHs
take it seriously
acknowledge their actions
highlight you are there to help
ask what helps
don't judge
give time
don't trivialise their situations
don't assume they are suicidal
don't assume they are seeking assistance
108
What are some communication difficulties?
* Understanding what people say
* Structuring sentences and finding the right words
* Unclear speech e.g. slurred speech
* Don’t pretend to understand when you haven’t.
* Use the communication chart on their bedside if they have one
* Encourage the person to point to what they want.
* Encourage the person to write or draw the message.
* Ask the patient to repeat themselves and to talk more slowly
109
How to make a patient understand?
* Show/point to what you are talking about
* Don’t shout - it’s often not that they can’t hear you
* Use gesture
* Keep sentences short and simple
* Give the person extra time to respond
* Don’t talk over the patient as if they weren’t there
* Try saying it in a different way if the person does not understand
110
Step 1 of cleaning patient's mouth
– Ensure you have the relevant equipment
– Adhere to appropriate PPE and hand decontamination
– Tell the patient what you are going to do
– Position your patient as upright as possible
– If you are not able to reposition upright, continue to provide mouth care with qualified staff help, use suction to reduce aspiration risk.
– Begin by applying lip balm to the patients lips – this will prevent the lips from cracking (oralieve lip balm is safe for O2 users)
– Ask patient to open their mouth
– Use a pen torch to help - look at the top of the patients mouth
111
Step 2 of oral care
– Apply Oralieve Dry Mouth Gel to cover silicone head of MouthEze cleanser (instead of pink sponges) – massage into cheeks/tongue/gums/roof of mouth. Remove any secretions or debris. Tweezers can be used to remove any loose debris from the mouth but please seek support with this.
– Dry mouth gel may need to be reapplied frequently at first if secretions dry. Repeat as needed. This will keep mouth moist for 2-5 hours.
– MouthEze cleansers are to be replaced each shift (12hr shift) – rinsed with running water and left on tray to air dry.
– Add a small amount (pea sized) low foaming fluoride tooth paste to a small soft toothbrush.
– Clean the patients teeth in the same way you would clean your own
– Clean the tongue using a toothbrush
112
Step 3 of oral car
– Do not rinse the mouth with water – encourage the patient to spit out residue – or use gentle suctioning if required. Seek advice from qualified staff if suctioning is required. Be cautious with patients who have dysphagia and those that are Nil By Mouth – seek support from qualified staff.
– Continue until mouth is clean
– Stryker suction toothbrushes and sponges can be used after demonstration of product on
ward.
– Dispose of used items
– Remove appropriate PPE and adhere to appropriate hand decontamination
– Ensure patient comfort
113
How to clean and store dentures
* Remove dentures and clean 2 x daily
* Brush dentures with soap and water or denture cleaner, not toothpaste. Rinse well.
* Advise the patient to leave the denture out at night in a named denture pot with a lid
* Remove denture if broken/unsafe
* Dentures should also be taken out if the patient is very drowsy and medically unwell
114
What is the aim of oral care?
To reduce the risk of aspiration, leading to chest infection
115
Difficulties completing mouth care
* If for any reason you cannot complete mouth care on your patient - inform your staff nurse and record why on the assessment tool
* If you notice any changes to your patients mouth, e.g. bleeding, oral thrush please let the staff nurse know
* Your staff nurse should document any difficulties and inform medical team if necessary
116
When would you stop giving food/drink?
* Coughing with food and drink
* Wet sounding voice
* Change in breathing
* Patient tiring
* No attempts to swallow
* Refusing food or drink
117
Modified Diet
* IDDSI Level 4: Pureed Diet
* IDDSI Level 5: Minced and moist
* IDDSI Level 6: Soft and bite size
recorded on food and fluid charts
118
Thickened Fluids
stops aspiration as it is travelling slower
needs to be added to all liquids including soup
Level 1 - 1 scoop slightly thick (200ml)
