Miscellaneous Flashcards
What are some ways to ensure mindful eating habits?
- Listen to body’s hunger and fullness signals
- Eat at the table, with others when possible
- Just eat, don’t multitask.
- Enjoy what you’re eating
- Savor the food
How much weight should a woman gained if pregnant?
o Underweight (BMI < 18.5) = 12.5-18kg (28-40lbs) o Health (BMI 18.5-24.9) = 11.5-16kg (25-35lbs) o Overweight (BMI 25.0-29.9) = 7-11.5kg (15-25lbs) o Obese (BMI > 30) = 5-9kg (11-20lbs)
What are the energy requirement for pregnant women per trimester?
- 1st trimester = + 0 Kcal/day
- 2nd trimester = +340 kcal/day
- 3rd trimester = +450 kcal/day
What are the macronutrient requirement for pregnant women?
- Protein = +25g/day
- Carbohydrates = > 175g/day
- Fat = no change
How many calories per day does a lactating women need in the first 6 months?
500 kcals/day (Advised to eat 330)
How do you prevent weight stigma when talking about weight loss goals?
Focus on:
- Healthy lifestyle behaviours
- Healthy relationship with food
- Health outcomes for chronic disease and QOL
What two questions are asked in the Canadian Nutrition Screening Tool (CNST)?
- Have you lost weight in the past 6 months without trying to?
- Have you been eating less than usual for more than a week?
If patient says yes to both questions on the Canadian Nutrition Screening Tool, what do you do next?
Ensure a Subjective global assessment (SGA) is completed by dietitian
When monitoring food/fluid intake, when do you do a referral to a dietitian?
When intake is below 50% >2 meals/day x 3 days
Name factors used for diagnosing malnutrition. How many are needed? *Which are used for obese patients?
2 factors are needed amongst: o Energy intake* o Weight loss* o Body fat loss o Muscle mass wasting o Fluid (edema) o Handgrip strength
How do you inspect the temple for bilateral muscle wasting?
- Look at patient straight on and have them turn their head from side to side
- Inspect for scooping or hollowing of temporal region
- Such signs = wasting of temporalis muscle
How do you inspect the deltoids for bilateral muscle wasting?
- Inspect straight on with patient’s arms at side
- Squaring of shoulders
- Loss of roundness at junction of shoulder and neck
- Loss of deltoid muscle at junction of shoulder and arm
- Acromion process may protrude
How do you inspect the clavicle for bilateral muscle wasting?
- Inspect for prominence of bone
2. Indicates wasting of pectoral and deltoid muscles
How do you inspect the scapula for bilateral muscle wasting?
- Have patient lift arms and push against hard object
- Inspect for prominent bones or depression between bones
- Such signs indicate loss of trapezius and deltoid muscles
Name all regions known for bilateral muscle wasting.
Upper body: temples, deltoids, clavicles, scapula, interosseous
Lower body: thigh, knee, calf
How do you check for subcutaneous fat loss in malnutrition?
- Orbital fat pads = Loss of bulge under eyes (fat pads), characterized by hollow eye
- Triceps = Palpate (pinch skin) between thumb and forefinger to determine the amount of fat present
- Anterior low ribs = Ribs visible in patients with fat loss
Name other signs of malnutrition (not subcutaneous fat loss nor bilateral muscle wasting)
o Delayed wound healing o Dry, cracked skin o Unintended weight loss o Loose skin o Edema o Dry hair, brittle nails o Eating < 50% of meals and snacks o Pressure injury
Name some nursing responsibilities in terms of oral nutritional supplemental therapy.
o Provide patient (60ml given at time of medications)
o Document consumption/refusal
o Weight patient weekly
enteral feedings are usually given in over a _____ hour period.
16 hour period (24 in acute settings)
Names signs of dysphagia
o Coughing, clearing throat, choking, shortness of breath while eating
o Long time to chew and eat food
o Gurgling, wet voice
o Drooling, leakage of food and drinks from mouth
o Food pocketing in mouth or stuck in throat
o Weight loss
o Refusal to eat, poor positioning
name some feeding tips
- Same level as patient
- Don’t rush, go at their rhythm
- Head slightly tilted forward
- 90°
- Propped up if needed
- Tell them the food item
- Try to avoid stirring everything together if it is pureed
- Oral hygiene is important
Name the modified texture and consistency from most permissive to most restrictive according to the Quebec: APNED system
Solids: Tender, soft, minced, pureed
Liquids: Clear, nectar, honey, pudding
what is the difference between no added sodium diet and low sodium diet?
no added sodium diet = < 3000 mg of sodium
Low sodium diet = 1500 – 2300 mg of sodium (2/3 – 1 tsp salt)
Name the aspects of nutritional therapy for COPD patients
o Small, frequent meals
o High energy, high protein diet
o May need oral nutritional supplements
Name the aspects of nutritional therapy for CHF
o fluid restriction
o sodium restriction
Name some physical (reproductive related) changes in older men.
o Pubic hair thins and greys
o Penis size decrease
o Scrotum hang lower
o Lower testosterone
If a patient has had unprotected sex 5 days ago and weighs 198lbs which emergency contraception method would you suggest?
Copper IUD
If a patient has had unprotected sex 2 days ago and weighs 175lbs, which emergency contraception method would you suggest?
Ella or Copper IUD
If a patient has had unprotected sex 5 days ago and weighs 120 pounds, which emergency contraception method would you suggest?
Ella or Copper IUD
If a patient has had unprotected sex 5 hours ago and weighs 120 pounds, which emergency contraception method would you suggest
Plan B, Copper IUD
Name 3 associated symptoms of menopause.
Hot flashes, night sweats, numbness and tingling, headache, palpitations, drenching sweats, mood swings, vaginal dryness, itching
Upon inspection of external genitalia, you notice small yellowish nodules that are firm and nontender. Do you alert the doctor?
No. These are sebaceous cysts and are normal
While inspecting the cervix, you notice it has a blueish tint. What is it called? Is this normal?
Chadwick’s sign.
Normal if the patient is pregnant in her 2nd trimester
Can you obtain a pap test if the patient has her menses?
Do not perform a pap test if menses or infection discharge
How often should we screen for cervical cancer in patients between 25-69 y.o.?
q3 years
How often should we screen for cervical cancer in patients over 70?
Cease routine screening only if last 3 pap tests in the last 10 years were negative
What is the name of the questionnaire to assess depression?
Patient health questionnaire (PHQ-9)
Name some communication approach when dealing with a patient in a manic episode.
- Use firm & calm approach
- Call person by their name
- Use short & concise explanation/statements.
- Remain neutral, avoid power struggles
- Be consistent with approach + expectations
- Use simple, concrete terms with consequences
- Firmly redirect energy into appropriate & constructive channels
- Maintain + convey calm + firm approach even in context of hostility
How do you structure the environment of a patient in a manic episode?
- Maintain low levels of stimuli
- Provide structured solitary activities
- Provide frequent high-calorie fluids
- Provide frequent rest periods
- Redirect violent behaviour
- Observe for signs of lithium toxicity
- Prevent person from giving away money or possessions.
Name some physiological needs approaches to maintain when dealing with a patient in a manic episode.
- Offer frequent, high-calorie protein drinks + finger foods
- Frequently remind person to eat.
- Encourage frequent rest periods during the day
- Low stimulation environment + avoid caffeine
- At night, provide warm baths, soothing music, medication prn
- Supervise clothes choice; minimize flamboyant + bizarre dress
- Give simple reminders for hygiene + dress
- Offer fluids + foods high in fiber
What constitutes the Foregut?
Begins: abdominal esophagus
Ends: Duodenum
Blood supply: celiac trunk
Includes: pancreas, spleen, biliary system, liver
What constitutes the Midgut?
Begins: duodenum
Ends: 2/3rds along transverse colon
Blood supply: superior mesenteric artery
What constitutes the Hindgut?
Begins: 2/3rds along the transverse colon
Ends: midway through anal canal
Blood supply: inferior mesenteric artery
Name all special tests in the abdominal assessment and what they test for.
- Murphy’s sign for cholecystitis
- Rebound tenderness (blumberg/rosving) for appendicitis
- Iliopsoas test for appendicitis
- Renal punch for kidney stones
What is a fluid wave and what does it indicate?
o Ask patient to press firmly with edges of both hands down midline of abdomen
o Tap one flank sharply with finger
o Palm of other hand is flat on other flank
o If fluid is present, the wave is transmitted to the other.
Indicates ascites
If the ileus is in the first part of the intestine in the LUQ, match the sound to the correct area of the abdomen:
Sounds: hyperactive, normal or absent
Areas: RUQ, LUQ, RLQ, LLQ
- RUQ = Hyperactive sounds
- LUQ = Absent sounds
- RLQ = Normal sounds
- LLQ = Absent sounds
List expected symptoms that you would expect a person experiencing abdominal ileus to report.
- decreased appetite
- constipation
- aching
- intermittent abdominal pain that worsens after eating or with activity.
If the ileus is in the first part of the intestine in the LUQ, in which quadrant would you expect to hear dullness?
- LUQ
- LLQ
List 3 expected symptoms that you would expect a person with liver cirrhosis to report.
- decreased appetite
- weight loss
- nausea especially after eating (unlikely to report abdominal pain)
The Preventive Screening Guidelines are applicable to people who are ___ years of age or older who are not at high risk for colorectal cancer (CRC)
50
What is chloasma?
AKA mask of pregnancy
dark skin hyperpigmentation in the face during pregnancy
What are the 3 phases of the first stage of labour?
- latent
- active
- transition
What is the nitrazine paper test for? What is a positive sign?
Test if the water has broken (in labour). Turns blue if positive.
What are some non-pharmacological means to provide comfort during labour?
- Change positions
- Warm shower/bath
- Massages between contractions
- Breathing techniques
- Ice or fluids for dry mouth
The cervix is fully dilated, what signs should you be looking for that represents that birth is imminent?
bulging perineum and rectum
visible baby parts
increase in bloody show
What stage of labour is the delivery of placenta?
Stage 3
What stage of labour is the delivery of the baby?
Stage 2
What do you look for when monitoring the FHR?
Heart rate (between 110-160)
Variability (minimal < 5, moderate 6-25, marked > 25bpm)
Acceleration (15 beats x 15 seconds)
Decelerations
What could explain sharp variable decelerations?
Umbilical cord compression
What could explain early deceleration? What does it look like on the monitor?
Head compression curved and occurs with contractions
What could explain late deceleration? What does it look like on the monitor?
Placental insufficiency curved and occurs after contractions
What foetal positioning is best?
Left occiput anterior
What are the risks of giving birth with an occiput posterior fetal positioning?
- Shoulder dystocia
- Perineal lacerations / tears
- Instrumental delivery
What is the anatomical landmark for station 0
Ischial spine
What is ideal for contractions?
1 contraction every 2-3 minutes lasting less than 2 minutes
What are the factors to assess during contractions?
o Frequency
o Duration
o Intensity (by palpating the fundus)
Should women do deep or high pitch noises during labour?
Deep pitched noise
In delivery, what is the turtle sign?
Fetal head delivers and retracts back against mother’s perineum (in shoulder dystocia)
What are some complications of delivery? (baby)
Shoulder dystocia Cord prolapse Placental abruption Instrumental delivery C-section
How do we measure baby’s due date?
Nagele’s rule: using first day of LMP, add 7 days and subtract 3 months.
What is included in gestational diabetes patient education?
Blood glucose monitoring (machine, nutrition, s/s of hypoglycemia)
Promote light exercise
Meal preparation and nutritional support
What are some additional precautions used when patient has gestational diabetes
closely monitor the fetus (weight, weekly NST)
When is gestational diabetes screened for?
Approximately 28th week of pregnancy
What are complications of gestational diabetes?
Preeclampsia
Macrosomia
C-section
Hypoglycemia in newborn
What are common symptoms of HELLP syndrome?
General malaise
Epigastric or RUQ pain
Nausea and vomiting
(Hypertension, seizure, fatigue, swelling of face/hands)
What does HELLP stand for?
H = hemolysis EL = elevated liver enzymes LP = low platelets
What medication is given for preeclampsia?
Labetalol for hypertension
MgSO4 if severe preeclampsia to increase seizure threshold
What are risk factors for preeclampsia?
o Chronic renal disease o Chronic hypertension o Family history of preeclampsia o Multifetal gestation o Primigravity o Extremes in maternal age (< 19, > 40) o Diabetes o Obesity o African American ethnicity o Preeclampsia in previous pregnancy
When scoring APGAR, what are the 5 things you look at?
Appearance (skin colour) Pulse (Heart Rate) Grimace (reflexes) Activity (muscle tone) Respiration (rate and effort)
A baby scores 3, 5 on his APGAR test. What does this signify?
Baby is having severe distress at 1 minute and moderate difficulty at 5 minutes.
What does an APGAR score of 4 to 6 indicate?
Moderate difficulty at birth
What does an APGAR score higher than 7 indicate?
Minimal to no difficulty at birth
What screening test is used to screen for domestic violence during pregnancy screening?
Abuse assessment screen (A.A.S.)
What screening tool is used to screen for postnatal depression?
Edinburg Postnatal Depression Scale (EPDS)
What time period should the mother consider when filling the Edinburg Postnatal Depression Scale
Past 7 days
What does the Pediatric assessment triangle assess for?
Appearance
Work of breathing
Circulation
In the Pediatric assessment triangle, what does Appearance stand for?
- Abnormal tone
- Decreased interactiveness
- Decreased consolability
- Abnormal look/gaze
- Abnormal speech/cry
In the Pediatric assessment triangle, what does Work of breathing stand for?
- Abnormal sounds
- Abnormal position
- Retractions
- Flaring
- Apnea/gasping
In the Pediatric assessment triangle, what does Circulation stand for?
- Pallor
- Mottling
- Cyanosis
In the Pediatric assessment triangle, what does it mean if signs of Appearance and WOB?
Respiratory failure
In the Pediatric assessment triangle, what does it mean if signs of Appearance and Circulation?
Shock
In the Pediatric assessment triangle, what does it mean if all 3 components are present?
Cardiopulmonary failure
What are signs of adequate hydration in newborns and infants?
o Weight loss within normal range o Straw-coloured urine o Good skin turgor o Moist mucous membranes o Fontanelle not sunken o Normal vital signs o +/- jaundice
In breastfeeding, what are the roles of prolactin and oxytocin?
Prolactin - milk production
Oxytocin - milk ejection reflex
Name some benefits of breastfeeding.
- Decreased postpartum bleeding
- More rapid uterine involution
- Earlier return to pre-pregnant weight
- Delayed resumption of ovulation resulting in increased child spacing
- Higher bone density
- Possible reduction of ovarian and breast cancer
- Psychological and emotional benefits
- Cost savings
- Decreased risk of infections, DBII, Crohns, sudden infant death syndome, obesity, Asthma…
Name some health promotion that can be given to avoid ear infection in infants and toddlers.
o Immunizations
o Breastfeeding
o Preventing exposure to second-hand smoke
o Avoid bottle feeding lying down
Name some health promotion that can be given to avoid yeast infection in infants and toddlers.
o Sterilization of objects in contact with mouth
o Change diaper frequently
o Skin barrier cream (25% zinc oxide)
What are the components of the FLACC behavioural pain assessment
FACE LEGS ACTIVITY CRY CONSOLABILITY
What are the ABCDESSS of diabetes standing for?
A1C BP control Cholesterol Drugs Exercise/eating Self-management Screening Stop smoking
What is the age of sexual consent and how old can the partner be?
12 -13 y.o – partner must be +/- 2 years
14 y.o. – partner must be 12-18 y.o.
16 y.o. – partner may be any age
What is the age for treatment consent?
Treatment necessary for health: 14-17 (inform parents if stay is longer than 12hrs.
Treatment NOT necessary for health: 14-17 (unless serious risk or serious side effects)
What does the acronym HEEADSSSS stand for?
Home Education/employment Eating Activities Drugs Sexuality Suicide and safety Social media Sleep
How do you fill up HEEADSSSS assessment?
Patient must be alone (parent outside)
Questions are non-judgmental, non-direct, open-ended
Follow adolescent lead
When doing the HEEADSSSS assessment, what are some questions that can be used to assess the home?
Where do you live? Who lives with you? Is there anything you would like to change about your family?
When doing the HEEADSSSS assessment, what are some questions that can be used to assess education/employment?
What do you like best / least about school? How many hours a week are you working? How many hours of homework do you do daily?
When doing the HEEADSSSS assessment, what are some questions that can be used to assess eating?
Do you snack out of boredom? Caffeine intake – amount, frequency and time of day? How has your appetite been in the last two weeks?
When doing the HEEADSSSS assessment, what are some questions that can be used to assess activities?
Do you spend a lot of time watching TV? Do you always have a close group of friends you always hang out with? Are there any activities you like to do outside of school or any school-related activities?
When doing the HEEADSSSS assessment, what are some questions that can be used to assess drugs?
When you go out with your friends or to party, do most of the people that you hang out with drink or smoke? Drugs: Do you? How much and how often? Do you or your friends drive when you have been drinking? Have you or your friends ever tried any other drugs? Specifically what?
When doing the HEEADSSSS assessment, what are some questions that can be used to assess sexuality?
Have your ever had any discharge or lesions you were concerned about? Have you had sex (type)? Did you use contraception? What type and how often? Do you like boys / girls / unsure [do not assume heterosexuality]? Have you been in a romantic relationship? Tell me about the people that you’ve dated. Are your sexual activities enjoyable? What does the term “safer sex” mean to you?
When doing the HEEADSSSS assessment, what are some questions that can be used to assess suicide and safety?
Do you feel sad or down more than usual? Do you find yourself crying more than usual? Are you bored all the time? Are you having trouble getting to sleep? Have you thought about hurting yourself or someone else? Do you find yourself spending less and less time with friends?
When doing the HEEADSSSS assessment, what are some questions that can be used to assess social media?
Do you post a lot of personal information on these sites? Which ones do you use? How many hours a day do you spend on social media sites?
When doing the HEEADSSSS assessment, what are some questions that can be used to assess sleep?
How many hours of sleep do you get a night? Do you look at a screen when you’re in bed? Do you have trouble falling asleep or wake up during the night?
What are some general approaches to have when doing children assessment?
- Establish a child-friendly environment
- Make sure there are chairs for everyone
- Speak to families in non-medical terms
- Ask the child what name they want to be called
- Provide privacy and warmth
What are some traditional framework known about toddlers (18m to 3y)?
Curious/egocentric.
Concrete thinking - take things literally,
Striving for independence (say no a lot).
Imitate health behaviors of caregivers.
Fear of bodily harm
What are some traditional framework known about Preschoolers (3 to 5y)?
Egocentric. Independent - ask questions. Take words literally. Magical/illogical thinkers. Require lot of reassurance. Fear bodily harm, dark, death, left alone. Health concepts as tasks to master
What are some traditional framework known about School aged children (6 to 10/11y)?
Adequate grasps of language for simple instructions/explanation.
Have general understanding of healthcare and providers.
Major cognitive development
What can nuchal rigidity be a sign for?
Meningitis
In adolescents, what are differences in neurodevelopment?
Limbic system development occurs earlier than prefrontal cortex.
Structural change of corpus callosum.
Concrete to abstract thinking as adolescent matures.
Shift from influence by family to peers
What does ISBAR stand for?
Identity Situation Background Assessment Recommendation/Responsability/Readback
In ISBAR, what does I stand for and what do you do.
I = identity
Say your name, professional position and location – the person you are speaking to may be responsible for several locations.
Confirm who you are speaking to. This helps save time and ensures you can document the conversation.
Identify the patient both by name and with their unique ID number to avoid medical errors.
In ISBAR what does the S stand for and what do you do?
S = situation
Start with why you are calling. This will focus the listener.
In ISBAR what does the B stand for and what do you do?
B = background
Provide relevant information only from the history, assessment, tests and management. Know your context and audience – does the listener know the patient well or not?
In ISBAR what does the A stand for and what do you do?
A = Assessment
State what you think is going on and give your interpretation of the situation and your degree of certainty. State the obvious (the listener may be just waking up).
In ISBAR what does R stand for and what do you do?
R = recommendation, responsibility and readback.
State what you want from the listener and ask questions.
Responsibility and Readback are not always included in explanations of ISBAR, however it is important for patient safety to know who will be carrying out the actions (ex., I will be doing the blood tests and you will be putting the orders in the system).
Closing the communication loop to clarify plan and especially if any verbal orders are taken to confirm accuracy.
What does CUS stand for?
Concern,
Uncomfortable,
Safety and Stop
How do you use CUS?
Saying the words Concern, Uncomfortable, Safety and Stop during a situation to make others aware of your discomfort.
What does PACE stand for?
Probe
Alert
Challenge
Emergency/Escalate
What is CUS and PACE used for?
Graded assertiveness to challenge any situation one might feel uncomfortable with regardless of hierarchy.
How do we use CUS and PACE
By going up in intensity when lower words or probes are being ignored.
