Midterm

Question 1

medical asepsis

Answer 1

• clean technique
• Procedures that reduce the number of organisms and prevent transfer
• E.g., hand hygiene, barrier techniques, routine environmental cleaning

Question 2

surgical asepsis

Answer 2

• sterile technique
• An area that is free from pathogenic organisms, serves to isolate an operative area from the unsterile environment and maintain a sterile field for surgery and invasive procedures
• Common in operating room (OR) and also at the bedside (e.g., sterile dressing change or insertion of urinary catheter)

Question 3

medical asepsis - safety guidelines

Answer 3

• Hand hygiene with an appropriate alcohol-based hand antiseptic or soap and water is an essential part of patient care and infection prevention and fundamental to patient safety.
• Always know a patient’s susceptibility to infection.
• Recognize the elements of the chain of infection and initiate measures to prevent its onset and spread.
• No artificial nails or nail enhancements or nail polish because of bacterial buildup
• Fingernails should not be longer than ¼ inch in length.
• Consistency incorporate basic principles of asepsis into care
• Ensure that patients cover the mouth and nose when coughing or sneezing; and use and dispose of tissues properly.
• Use clean gloves when you anticipate contact with body fluids, non intact skin, or mucous membranes when there is a risk of drainage.
• Use a gown, mask, and eye protection when there is a splash risk.
• Protect fellow health care workers from exposure to infectious agents through proper use and disposal of equipment.
• Be aware of body sites where HAIs are most likely to develop (e.g., urinary or respiratory tract). This enables you to direct preventive measures.

Question 4

modes of transmission

Answer 4

Contact

• Direct - infectious agent to host
• Indirect - contaminated item

Droplet

• Inhaling or contact with mucous membrane
• Coughing, sneezing, suctioning
• Larger droplet particles

Airborne
- Smaller particles of evaporated - suspended in air for longer

Question 5

hand hygiene

Answer 5

• Hand hygiene is the MOST important technique for infection control and prevention
• Wash hands with plain soap and water or with antibacterial soap and water when hands are visibly dirty or soiled with blood or other body fluids, before eating, and after using the toilet
• Wash hands if exposed to spore-forming organisms
• If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in clinical situations

Question 6

contact precautions

Answer 6

• C. Diff, MRSA
• private room or cohort patients
• gloves and gown

Question 7

droplet precaution

Answer 7

• respiratory tract viruses
• private room
• mask required

Question 8

airborne precaution

Answer 8

• TB
• private room
• negative pressure room
• N95 mask

Question 9

types of pain

Answer 9

Acute (transient)
- Typically lasts hours-month
Chronic (persistent)
- Lasts longer than 3 months or past the time of normal tissue healing

Question 10

types of analgesics

Answer 10

• Nonopioids and nonsteroidal antiinflammatory drugs (NSAIDS)
• Opioids (narcotics)
• Adjuvants or coanalgesics (antidepressants and muscle relaxants)

Question 11

multimodal analgesia

Answer 11

combines drugs with at least 2 different mechanisms of action and non pharmacological strategies so pain control can be optimize

Question 12

pain - safety guidelines

Answer 12

• Monitor patients who receive opioids (by any route) for signs and symptoms of oversedation and respiratory depression.
• Monitor activities such as standing, ambulation, transfer to a chair if patient has received an opioid.
• Monitor for potential side effects of opioid analgesics and recommend or institute supportive measures.
• Epidural analgesia IV infusion lines should be clearly labeled and identified as such to prevent accidental connection with tubing of a different type.
• Patients currently receiving opioids for chronic pain often require higher doses of analgesics to alleviate new or increased pain; this is tolerance, not an early sign of addiction.
• Drug-drug interactions, including enhanced or reduced effects or side effects, often occur with the multiple drug use required by people with chronic pain.
• Know agency policy for frequency of pain assessment and timing for follow-up assessments.

Question 13

non pharmacological pain management

Answer 13

• relaxation and guided imagery (meditation)

- cutaneous stimulation (massage, heat and cold, distraction)

Question 14

cold therapy

Answer 14

recommended for treatment of acute injury to reduce inflammation, pain, spasm and edema
Cold therapy treats localized inflammatory responses that lead to edema, hemorrhage, muscle spasm, or pain
PRICE principle
P: Protect from further injury
R: Restrict/Rest activity
I: Apply Ice
C: Apply Compression
E: Elevate injured area
Electrically controlled continuous cold flow therapy devices simultaneously provide cold and compression. Compression acts with cold to reduce the blood flow and edema formatting while providing support to the soft tissues

Question 15

heat therapy

Answer 15

heat recommended for long standing injuries to increase blood flow and tissue temperature
Promotes healing and relaxation and relieves muscle spasm/joint stiffness
Consists of warm compresses, heat packs, warm baths, soaks, and sitz baths
Check water temperature frequently to prevent burns

Question 16

contrast therapy

Answer 16

(using alternative cold-to-heat ratios of 1:3 or 1:4 minutes) effective for MSK injuries to reduce inflammation, edema and improve joint function

Question 17

pain - safety guidelines

Answer 17

Know your patient’s risk for injury from heat or cold
Protect damaged skin when applying hot or cold therapy
Know the temperature of the application being used (do not microwave towels)
Check temperature of heating devices or moist compresses prior to applying to skin
Burns/skin injuries are reportable and preventable
Individualize care to meet a patient’s needs and preferences. Patient teaching, safety, comfort and privacy important
Consider factors such as patient age, skin, circulation, vitals, ability to sense temperature and communicate
Use with caution in patients with impaired sensation/perceptions of pain
Do not use cold or contrast therapy if an individual has Raynaud’s or cold urticaria (cold allergy)
Do not apply heat on an area that is bleeding, on an area being treated with products that contain menthol or has decreased sensation, or within 24 hour after acute injury
Be aware of advantages and disadvantages of moist vs dry application with heat
Be aware of which areas have decreased fat/tissue and modify intensity
Check the patient frequently. Observe for excessive redness, maceration or blistering

Question 18

Care of Dentures

Answer 18

Clean dentures as often as natural teeth
Store in an enclosed, labeled cup when not worn
Reinsert as soon as possible
When inserting, ensure a good fit
Loose dentures cause discomfort and make it difficult to chew food and speak clearly

Question 19

lifting and moving patients - safety guidelines

Answer 19

Know how physiological influences on body alignment and mobility affect patients throughout the life span.
Control factors that can indirectly affect body mechanics by making the environment safe.
Determine a patient’s level of sensory perception (vision and hearing) as this affects a patient’s ability to cooperate during transfer and lifting procedures.
Loss of sensation increases vulnerability to the hazards of immobility because of the inability to sense pain or the need for repositioning.
Use assistive equipment and devices to transfer and position patients safely.
Know risk factors for bed entrapment in facility and how to prevent it

Question 20

compression stockings

Answer 20

Used to reduce risk of deep vein thrombosis (DVT)
Reduces blood stasis and venous wall injury
Promotes blood circulation
Requires prescription
** for prevention of DVT not treatment** If signs or symptoms of a DVT are present, do not manipulate the leg to apply stockings

Question 21

Geriatric protocol for improved oral intake

Answer 21

Conduct mealtime rounds to determine amount consumed
Limit staff breaks before or after mealtimes
Assist with mouth care and dentures prior to meal
Encourage family members to visit at mealtimes
Ask family to bring favorite food from home
Suggest small, frequent meals
Provide nutritious snacks

Question 22

nutrition - safety guidelines

Answer 22

Improper handling, preparation, and storage practices in the home environment may result in cases of foodborne illness.
Identify patients at risk for dysphagia and collaborate with other members of the health care team to minimize complications.
Ensure that the patient is receiving the correct therapeutic diet.
Assess level of consciousness before feeding.

Question 23

Nutrition risk screening

Answer 23

predict if a patient is malnourished (or at risk). Involves focussed physical examination and nurse needs to recognize physical signs of nutritional alteration
effects of an illness, disease, or lifestyle on a patient’s nutritional status, such as recent weight loss and decreased oral intake

Question 24

aspiration

Answer 24

• Food, water, vomitus, or oral contents may be aspirated
• Can lead to aspiration pneumonia which can be fatal, especially in older adults
• Tachypnea (respirations above 26/min) is an early sign of aspiration
• Silent or asymptomatic aspiration refers to passage of food or liquid into the trachea and lungs without producing a protective cough or other signs consistent with aspiration
• The subtle signs associated with silent aspiration are easy to miss and include lack of speech, decreased alertness, wet quality to voice, drooling, difficulty controlling secretions, and absence of gag reflex.
• The single most important measure to prevent aspiration is to place the patient on NPO (nothing by mouth) until a dysphagia evaluation by an SLP is performed; then a safe diet can resume

Question 25

urinary output

Answer 25

• Know the average output range for a patient (Adult urinary output averages 1 – 2 L in 24 hours; approximately 0.5 to 1.0 mL/kg/hr. An hourly output of less than 30 mL/hr for 2 consecutive hours shows the need for further assessment)
• Know the signs of dehydration and fluid overload (table 34.1)
• Assess patient’s most recent serum electrolytes
• Weigh a patient to determine fluid status
• 30 cc’s every hour is normal

Question 26

Catheter-associated urinary tract infection (CAUTI) prevention practices

Answer 26

Aseptically inserting urinary catheters (year 2 skill)
Limiting use of indwelling catheters
Using smallest catheter and removing as soon as possible
Secure indwelling catheters
Maintaining closed drainage system
Maintaining free flow of urine
Perform routine perineal care daily, after soiling

Question 27

Bowel Elimination: Principles for Practice

Answer 27

• Chronic constipation is a functional GI disorder
• Opioid-induced constipation occurs frequently in the palliative care population
• Constipation is a complication of acute stroke
• Severe diarrhea may require a fecal management system
• Postoperative ileus and severe abdominal distention is a failure of adequate bowel function

Question 28

Removing Fecal Impaction Digitally

Answer 28

• Fecal impaction: inability to pass a collection of hard stool. Occurs in all age groups
• Digital removal is performed when enemas and suppositories are not successful
• Requires order
• Implementation: help patient to a left side-lying position with the knees flexed and back