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Health Assessment > Health Assessment Exam 2 (4-7 > Flashcards

Health Assessment Exam 2 (4-7 Flashcards

1
Q

Factors affecting safety

A

developmental considerations (children hazards increase as motor skills develop), lifestyle (occupation), environment (pollutants), mobility (older adults with unsteady gait), sensory perception (impacted sight/hearing)

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2
Q

Factors affecting safety pt 2

A

knowledge (awareness of safety precautions), ability to communicate (language barriers), physical health state (promote wellness while preventing accidents), psychosocial health state (stress can narrow persons attention)

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3
Q

Nursing assessment (safety)

A

identify patients at risk and unsafe situations

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4
Q

components of nursing assessment for pt risk and safety

A

nursing health history and physical examination

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5
Q

nursing health history analyzes (pt at risk and unsafe conditions)

A

Hx of falls of accidents (#1 indicator of future falls), use of assistive devices (walker), drug/EtOH abuse, family support and home environment (cluttered, lots of stairs, carpets)

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6
Q

physical examination (pt at risk and unsafe conditions)

A

assess mobility, assess communication, assess LOC, assess sensory perception, know signs of abuse/DV/neglect, assess environment

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7
Q

modifiable factors contributing to falls

A

lower body weakness, poor vision, gait/balance issues, feet problems, psychoactive meds, postural dizziness, home hazards

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8
Q

intrinsic factors contributing to falls

A

advanced age (solo is not a risk factor), PREVIOUS FALLS, muscle weakness, gait/balance problems, poor vision, orthostatic hypotension, chronic conditions, fear of falling

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9
Q

extrinsic factors contributing to falls

A

lack of handrails, poor stair design, no bathroom grab bars, dim lighting, tripping hazards, uneven/slippery surfaces, psychoactive meds, improper use of assistive devices

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10
Q

questions to ask patients

A

have you fallen in the past year? do you feel unsteady when standing or walking? do you worry about falling?

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11
Q

Morse fall scale

A

0 = no risk, <25 = low risk, 25-45 = implement standard fall prevention, 46+ = implement high-risk fall prevention

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12
Q

safety considerations for the older adult (characteristics)

A

impaired eyesight, decreased proprioception and balance, slower reflexes, impaired hearing, decreased sensitivity to touch, impaired thermoregulation, decreased flexibility/strength = weakness

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13
Q

fall prevention methods

A

patient teaching, orientation to unit (call bell, bathroom, bed alarm), use side rails, bed lowest position, bed locked, slipper socks, eliminate environmental hazards, indicate fall risk on door and in record

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14
Q

Fire safety

A

RACE

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15
Q

fire safety R

A

rescue anyone in immediate danger of the fire

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16
Q

fire safety A

A

alarm; pull the nearest fire alarm and call fire response

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17
Q

fire safety C

A

contain fire by closing all doors in the fire area

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18
Q

fire safety E

A

extinguish small fires; if not leave the area and close the door

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19
Q

types of restraints

A

physical and chemical

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20
Q

physical restrains can…

A

increase risk of falls,

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21
Q

negative outcomes of restraint use

A

falls, skin breakdown, contractures, incontinence, depression, delirium, anxiety, aspiration/respiratory difficulties, death

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22
Q

safe restraint use

A

hitch knot for quick release, tie to frame of bed or wheelchair, keep call bell within reach, reassess frequently, release every 2 hours for ROM, assess skin integrity, assess mobility, assess tightness/circulation (2 fingers)

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23
Q

can you apply physical restraints without an order?

A

yes in an emergency, but get provider order ASAP; need new order every 24 hours

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24
Q

definition of self-care

A

activities of daily living, instrumental activities of daily living, any neurological impairments that will affect ability to care for self

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25
Q

ADLs

A

BATTED; bathing, ambulating, toileting, transferring, eating, dressing

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26
Q

IADLs

A

grocery shopping, running errands, using the phone

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27
Q

Principles for providing hygiene

A

determine patient preferences, assess ability to assist (maintain highest level of function; encourage independence), assess activity tolerance, respect person space and ways of doing things

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28
Q

factors affecting self care

A

health state, developmental level, socioeconomic status, culture, personal preferences

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29
Q

early morning pt care

A

assist pt with toileting, provide measures to refresh/prepare pt for day, wash face and hands, provide oral care

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30
Q

partial care

A

patient is able to help with atleast one taks

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31
Q

total care

A

patient is unable to help at all

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32
Q

afternoon care

A
  1. toileting assistance, handwashing, oral care 2. straighten bed linens 3. help patient with mobility to reposition self
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33
Q

hours of sleep care

A

toileting washing oral care, back massage, change soiled bed/linens, position pt comfortably, ensure call light and other required objects in reach

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34
Q

Skin assessment

A

assess daily, use pH balanced no-rinse cleanser, mild soap, avoid hot water, avoid friction/scrubbing, use moisturizers (not between toes of diabetic)

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35
Q

therapeutic affects of bathing

A

removes dirt/bacteria, stimulates circulation, improves joint mobility, provides assessment opportunity, provides opportunity for positive cline-nurse interaction, relaxation and comfort, sense of wellbeing

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36
Q

method to bathe pt

A

clean to dirty; one wipe for each section: 1. face, neck, chest 2. left arm 3. right arm 4. perineum 5. left leg 6. right leg 7. back 8. buttocks

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37
Q

hair care

A

shower cap with dry shampoo in it; soap and water in bed with basin below head (full shower)

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38
Q

oral care (unconscious)

A

face pt toward nurse lying on side; every 2 hours to prevent VAP, dont use toothpaste (dry brush or sponge)

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39
Q

oral care conscious

A

encourage pt to brush own teeth if possible and assist if unable to; remove dentures and brush/clean over sink

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40
Q

nail care

A

file only (no clippers), orange sticks for cuticle care, soaking to soften

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41
Q

ear care

A

cleanse pinna or auricle, no Qtips, debrox for ear irrigation

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42
Q

perineal care

A

female- front to back and cleanest to dirtiest; male- tip from center out and then down the shaft

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43
Q

Type of movement: bend over and touch toes

A

flexion

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44
Q

Type of movement: stretching head back towards butt

A

extension

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45
Q

Type of movement: oblique crunch to one side

A

lateral flexion

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46
Q

Type of movement: turning at the waste to see behind you

A

rotation

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47
Q

Type of movement: moving shoulders forward

A

forward rotation

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48
Q

Type of movement: pulling shoulders back

A

backward rotation

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49
Q

Type of movement: shrugging shoulders

A

elevation

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50
Q

Type of movement: pushing shoulders down

A

depression

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51
Q

Type of movement: arms out in front lifting up in front

A

flexion

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52
Q

Type of movement: pushing arms down (lat pull over)

A

extension

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53
Q

Type of movement: arms out in circular motion (from side to overhead)

A

abduction; moving away from body

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54
Q

Type of movement: crossing arms in front of body

A

adduction

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55
Q

Type of movement: twisting foot away from body

A

external rotation

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56
Q

Type of movement: turning foot toward body

A

internal rotation

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57
Q

Type of movement: curling heel to butt (hamstring curl)

A

flexion

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58
Q

Type of movement: straightening of leg (quad extension)

A

extension

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59
Q

Type of movement: curling toes to shin bone

A

dorsi flexion

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60
Q

Type of movement: pointing toes

A

plantar flexion

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61
Q

Type of movement: rolling foot at ankle inward towards body

A

inversion

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62
Q

Type of movement: rolling foot at ankle away from body

A

eversion

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63
Q

3 types of muscle

A

cardiac, skeletal, smooth/visceral

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64
Q

cardiac muscle

A

branched, uninucleated, involuntary movement

65
Q

skeletal muscle

A

striated, attached to skeleton, voluntary, tubular, multinucleated

66
Q

smooth/visceral

A

non-striated, involuntary, spindle, covers organs, uninucleated

67
Q

articular structures

A

joint capsule, articular cartilage, synovium, synovial fluid, intra-articular ligaments

68
Q

extra-articular structures

A

tendons, bursae, muscle, fascia, bone, nerve, overlying skin

69
Q

ligaments

A

rope like bundles of collagen fibers; connect bone to bone

70
Q

tendons

A

collagen fibers connecting muscle to bone

71
Q

cartilage

A

collagen matrix

72
Q

bursae

A

pouches of synovial fluid; cushion movement

73
Q

muscle health history

A

joint pain, low back pain (OPQRSTI), neck pain, bone pain, mucsle/cramps/weakness

74
Q

muscle physical exam

A

skeleton: symmetry, contour; gait: steady/unsteady; skin: color, edema

75
Q

joints

A

where 2 bones meet

76
Q

passive range of motion

A

patient has limitations; anchor joint with one hand and use other hand to move joint

77
Q

active range of motion

A

patient can perform independently

78
Q

factors affecting movement and alignment

A

overall physical health, muscular/skeletal/nervous system problems, mental health, respiratory issues, cardiac issues, negative nitrogen balance, lifestyle, environment, attitude/values

79
Q

types of exercise

A

isotonic, isometric, isokinetic

80
Q

isotonic exercise

A

muscle contracts and shortens + active movement ; joint angle changes

81
Q

isometric exercise

A

muscle contraction without shortening; joint angle and muscle length do not change during contraction; no moving or bending of joints (ex:planks)

82
Q

isokinetic exercise

A

muscle shortens with resistance applied; resistance provided at constant rate by external device

83
Q

protective positions

A

fowlers, low/semi fowlers, high fowlers, protective prone, supine, prone, Sims, side lying/latera

84
Q

fowlers position

A

45-60 degree angle; optimal for thoracic lung space; butt bears brunt of weight; heels, sacrum, scapulae are at risk for breakdown

85
Q

low/semi fowlers

A

30 degrees; decreased pressure on lower back

86
Q

high fowlers

A

90 degrees; good for eating

87
Q

how often to reposition patients

A

every 2 hours

88
Q

sims

A

pt lies on side, lower arm behind pt, upper arm flexed at shoulder and elbow out in front; main body weight on humerus, clavicle, ilium

89
Q

side lying/lateral

A

lying on side; main bodyweight on lateral aspect or scapula and ilium; relieves pressure or scapulae, sacrum, heels

90
Q

tredelenburg

A

feet higher then head

91
Q

immobility consequences

A

decreased muscle size/tone/strength, decreased endurance/stability, bone demineralization, decreased joint mobility/flexibility, increased risk for fractures, increased risk of foot drop

92
Q

decreased skin integrity d/t immobility

A

pressure sores (decubitus ulcers)

93
Q

cardiovascular and respiratory consequences of immobility

A

increased cardiac workload, risk of orthostatic hypotension, risk of thrombus formation, decreased lung expansion, decreased rate of respirations, secretion pooling, impaired gas exchange

94
Q

nutrition/metabolic consequences of immobility

A

decreased appetite, decreased metabolic rate

95
Q

GI and urinary consequences of immobility

A

constipation d/t decreased GI peristalsis, increased risk of urinary stasis, increased risk of renal calculi, decreased smooth muscle tone

96
Q

mental status consequences of immobility

A

increased powerlessness, decreased sensory stimulation, decreased social interaction, altered sleep-wake cycle, increased risk for depression

97
Q

why are patients risky

A

cant be held close to body, bulky, no handles, unpredictable

98
Q

why are nurses at risk

A

frequency, force, position, and duration

99
Q

nursing key body mechanics

A

wide base, feet wide knees bent back straight, utilize muscles in legs, work at proper height, face direction of movement, keep pt close to body

100
Q

repositioning methods

A

use draw sheet, friction-reducing sheet, hoyer lift, stand aid machine, air assisted mattress

101
Q

before ambulating pt

A

determine distance prior to standing, assess for weakness/dizziness, non-slip footwear on pt, use gait belt, stand to side and slightly behind (on pt weaker side)

102
Q

ambulation with a walker

A

place walker directly in front of pt, stand to side and slightly behind, pt move walker forward sets it down then step toward (one leg at a time); start with weaker foot first

103
Q

ambulation using cane

A

hold cane on stronger side, nurse on weaker side and slightly behind

104
Q

cane walking steps

A
  1. advance cane, 2. advance weaker side, 3. advance stronger side, 4. advance cane
105
Q

nurse education requirements of medication

A

actions and indications, appropriate dosage, administration guidelines, drug-drug interactions, contraindications and cautions, nursing considerations (teaching), therapeutic effects, adverse drug effects, therapeutic range

106
Q

know your pt for meds

A

medical history (why giving med), medication history (interactions), allergies, check the MAR, diet and fluid orders, lab values

107
Q

10 pt rights

A

right drug, right dose, right patient, right route, right time, right documentation, right reason, right assessment data, right response, right education, and right to refuse

108
Q

3 checks for med administration

A

when pulling med out, when preparing med for administration, when at the bedside

109
Q

medication pre-administration assessment

A

patient identification (need 2 identifiers), patient assessment (ability to swallow, relevant body system assessment, vitals)

110
Q

medication documentation

A

document as soon as given, document reason not given if indicated, document response to med

111
Q

medication pt education

A

purpose of med, dose of med, time of admin., potential side effects, when to discontinue med, when meds need to weaned down prior to stopping, what adverse effects to report

112
Q

name of drugs

A

generic name (chemical name derived), trade name (advil), chemical name (FDA publication)

113
Q

drug classification

A

pharmaceutical (MOA, chemical structure, physiological effect) and therapeutic (antipyretic, antiemetic)

114
Q

drug schedules

A

schedule I- schedule V; most narcotics are schedule II; based on abuse potential and medical usefulness (marijuana schedule I)

115
Q

components of a drug order

A

pt name and other identifier, date and time order written, medication name, med. dose, route of admin., frequency of admin, signature of provider

116
Q

example of drug order

A

Tylenol 650mg PO q4h prn for john smith

117
Q

types of orders

A

routine/standing, PRN, one time order, STAT, repeat

118
Q

PRN

A

pro re nata; used when med is requested, required, or specifics of order are met (ex: analgesics, anti-emetics, sleep aids); professional judgement calls

119
Q

dose conversions

A

1g = 1000mg; 1000mg = 1,000,000 mcg; 1000mcg = 1mg; 1kg = 2.2lbs; 1mL = 1g; 1000mL = 1L; 1 mL = 15gtts; 5mL = 1tsp; 15mL= 3tsp =1tbl; 30 mL = 1 fl oz; 240mL = 8 fl oz = 1cup; 16oz = 1lb

120
Q

drug calculations

A

dose on hand/ quantity on hand = dose required/X (quantity desired)

121
Q

general administration guidelines

A

hand hygiene before and after, open at bedside and poor into cup, prep. 1 pt at a time, never admin. a med prepared by someone else, do not allow interruptions, double check calculations, dont use unmarked or illegible containers, be aware of changes in liquid clarity and sediment, administer within +/- 1 hour of designated time

122
Q

PO administration

A

oral, sublingual, buccal; tabs, capsules, caplets, spansules, liquids, suspension; make sure pt can swallow; remain with patient while taking meds

123
Q

do not _____ medications because it will alter rate of absorption

A

crush

124
Q

transdermal administration

A

used for hormones, narcotics, cardiac, nicotine; slow onset but maintain consistent serum levels; avoid touching med (wear gloves); not date & time & initials on patch; rotate sites

125
Q

why is it important to rotate sites for transdermal?

A

avoid skin irritation

126
Q

topical skin meds

A

apply with sterile swab, tongue depressor, or gloved fingers (ex: nitroglycerin)

127
Q

opthalmic medications

A

eye drops, ointment, or disks; administer in lower conjunctival sac and apply pressure on inner canthus; do not rub eyes; where gloves and avoid touching eye with dropper

128
Q

otic medications

A

turn head to unaffected side, ensure drops at room temp., pull up and back for adults and down in children (<3); massage tragus after admin., wait 5 minutes before admin. in other ear; wear gloves

129
Q

nasal spray medications

A

wear gloves; have pt sit up and tilted back, agitate bottle gently, close opposite nostril and instruct pt to breath in while you compress bottle gently

130
Q

rectal medications

A

suppositories/enema; wear gloves, place pt on left side, lubricate med; insert past internal rectal sphincter against rectal wall (will feel uptake); have pt remain on side for 5 minutes

131
Q

vaginal medications

A

foams, jellies, liquids, creams, tablets, suppositories; don gloves; pt on back with knees flexed; perform perineal care front to back, change gloves again, insert med using applicator or gloved hand and instruct pt to stay supine for 5-10 minutes

132
Q

parenteral administration routes

A

intramuscular (90 degrees), subcutaneous (45-90 degrees), intradermal (15 degrees)

133
Q

when combining from vial and ampule…

A

draw from vial first

134
Q

when drawing from single dose vial and multi-dose vial…

A

draw from multi-dose vial first

135
Q

limited compatibility

A

can be given 15 minutes after the next one

136
Q

injection guidelines

A

let patient control which side, position to reduce muscle tension, divert clients attention

137
Q

leg site injections

A

pt should sit or lie down

138
Q

gluteal site injections

A

lie on abdomen or side

139
Q

rounding guidelines

A

dosage less than 1.0, round to nearest 100th; dosage is more than 1.0, round to nearest 10th

140
Q

preventing needle stick injuries

A

never leave syringe at bedside, never place syringe in pocket, never cap bend or break, cannot recap contaminated needles

141
Q

needle selection

A

use shortest length and smallest gauge; length depends on muscle mass/adipose tissue (1/4in -3in); diameter (gauge) lower number = larger diameter, gauge choice depends on viscosity of fluid

142
Q

tuberculin syringes

A

maximum 1mL; calibrated by 1/100; 25-27 gauge and 1/4-1/2 inch needle

143
Q

standard syringes

A

3mL or 5mL; calibrated by 0.1 and 0.2 respectively

144
Q

insulin syringe

A

marked in units; small does use U30 and U50; U100 is most common and equates to 1 mL; non-detachable needle 28-30 gauge and 1/2-5/8 needle

145
Q

intradermal injection

A

used for PPD or allergy testing; use tuberculin syringe; give into dermis (forearm, upper back, under scapula); 25-27 gauge, 1/4 or 1/2 inch, 5-15 degree angle; 1 mL syringe

146
Q

intradermal technique

A

bevel up, insert at 5-15 degree, inject to form wheal or bleb, remove needle after brief delay; DO NOT MASSAGE

147
Q

subcutaneous injection

A

45-90 degrees; small doses (max 1mL), absorbs slower than IM; use 25-30 gauge and 3/8 or 5/8 needle

148
Q

subcutaneous technique

A

abdomen (fast and 2’’ from umbilicus), upper arms, anterior thighs, gluteal (slowest); hold pinch skin and release after needle inserted

149
Q

needle length based on subcutaneous tissue

A

if you can grasp 1in choose longer needle and insert at 45 degrees; if you can grasp 2+in use shorter needle and insert at 90 degrees

150
Q

insulin injection

A

only use insulin syringes, agitate syringe by rolling in hand (never shake); observe sites for lipodystrophy; abdomen best for absorption

151
Q

when mixing insulin

A
  1. inject air into longer acting (opaque) without allowing needle to touch insulin 2. inject air into fast acting (clear) without allowing to touch insulin 3. draw up clear insulin 4. draw up opaque insulin
152
Q

administering heparin

A

SC injection at 90 degree, use small gauge needle (25-28), use 5/8 -7/8 needle length, measured in 10000 U/mL, preferred site is abdomen; DO NOT RUB; pinch gently during injection

153
Q

intramuscular injection

A

muscle layer is more vascular = absorbed faster than SC/ID, used for irritating/viscous/oily preps, use 3mL syringe, 18-25 gauge, 5/8-3in; do not give mor than 3mL in one injection; inject at 70-90 degrees; inject slowly

154
Q

z tracking

A

recommended for all IM injections to prevent back flow; pull skin to one side, insert needle, inject med, release displaced tissue, withdraw needle

155
Q

deltoid

A

recommended adult site (>3), vaccine admin., rapid absorption; max of 1mL; use 5/8-1.5in needle

156
Q

deltoid landmarks

A

palpate lower edge of acromion process, 2 fingers below, upside down triangle, inject in the center

157
Q

vastus lateralis

A

safe for everyone (toddler/infant preferred); divide anterior thigh into 3 equal parts and inject into outer middle third; use 5/8-1in; ~3mL injection

158
Q

ventrogluteal

A

recommended site for adults; free of major blood vessels and nerves; preferred for viscous irritating fluids; use 1.5in needle; ~3mL injection

159
Q

ventrogluteal landmark

A

palm on greater trochanter, index finger on anterior superior iliac spine, middle finger on iliac crest, inject in between middle and index fingers

Health Assessment (5 decks)

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