OS PO1 - Clinical skills Flashcards
How would you detect a nutritional deficiency?
A blood test.
How is food intake monitored?
With a food diary or nutritional care plan.
These documents include dietary needs, allergies, intolerances and assistive equipment.
Why are fluid intake and output measured?
To prevent dehydration and over hydration.
On average, how much liquid should be outputted during a toilet trip?
240-400ml
What are possible dietary needs?
- Texture
- Preferences
- Cultural needs
- Eating aids
What is the red tray initiative?
A patient who requires feeding support will have their food on a red tray and their drinks on a red cup.
What should you do if you are supporting someone with eating?
Ensure the individual is sat in an upright position and that you are sat at the same height as the patient.
Give them a spoonful of food and then carry out a different task so they don’t feel pressured.
You may need to prompt someone to eat, chew and swallow.
When will a dietary plan be made?
When a nutritional need is identified.
To manage faecal incontinence, constipation, diarrhoea and an overactive bladder.
What condition requires low carb meals?
Diabetes.
What is the barium swallow
An X-ray imaging test that uses barium to create pictures of the upper gastrointestinal (GI) tract.
Used to diagnose problems in the throat, esophagus, stomach, and duodenum. While making the extent of any damage clearer.
What forms can dietary supplements be prescribed in by a dietician?
A drink, shake, tablet or bar.
What dietary changes can be made to improve constipation?
Eating more fibre and drinking more fluids.
What dietary changes can be made to stop diarrhoea?
Eating eggs can slow bowel movements.
What dietary changes can help an overactive bladder?
Avoiding foods with an acidic base, like citrus fruits, pineapple and tomatoes.
What happens to muscles when they aren’t used often?
Muscles can atrophy (waste away) so protein is needed to build muscle mass.
When may a stool sample be taken?
On suspicion of an infection in the bowel and after medication is done to ensure the infection has cleared.
What dipstick test results may cause a GP to diagnose a UTI?
Protein and blood in the urine.
What is a urine culture?
A test which can identify more specifically what bacteria and yeast is present, if a more targeted treatment is needed.
What is the purpose of the prostate gland?
Produces fluid that nourishes and transports sperm.
Where is the prostate gland?
Just above the bladder and surrounds the top of the urethra.
Who gets routine prostate exams?
Men over 60, as they’re at risk of prostate cancer.
What does prostate cancer present as?
An enlarged gland in the rectum, with rectal bleeding, possible stool and urine incontinence and constipation.
Who preforms a prostate exam?
A nurse or a doctor with a gloved finger and lube.
What are haemorrhoids?
Swollen veins, as a result of pressure in the anus.
These become painful and bleed when stool is being passed.
How are haemorrhoids treated?
- Over counter cream
- Suppository containing hydrocortisone
- In more extreme cases a band is laced over it to cut of its blood supply. It will then drop of and clear.
What is a suppository?
A tablet inserted rectally, that melts at body temperature, releasing medication into the blood stream via diffusion through the wall of the bowel.
Who can administer a suppository?
A nurse.
Who may need a suppository?
Those who vomit oral medication
Need constipation treatment (it produces carbon monoxide which stimulates the bowel)
What position does the patient need to be in to be administered a suppository?
Laying on their side with their knees lifted.
Why does a patient need to clench after having a suppository?
To prevent it from coming out.
What is an enema?
A bottle of fluid pushed into the anus using a tube to stimulate the emptying of the rectum.
Done if constipated or to clear the bowel before an endoscopy, colonoscopy and proctoscopy.
Who can administer an enema?
A nurse.
What does good oral hygiene prevent?
- Tooth decay
- Tooth loss
- Gum disease
- Loss of confidence
What would cause someone to require more intensive oral care?
- Ventilated or on O2 therapy as they’re at risk of dry mouth causing discomfort and increasing their risk of oral infection.
- Dementia may make them unaware of their hygiene.
- People with LD’s may need more support.
- Terminally ill, frail, stroke or end of life patients may lack the ability.
- Immunocompromised people are more at risk of oral infections.
What are the signs of an unhealthy mouth?
- Dry
- Sores or ulcers
- Bleeding or swollen gums
- Tooth decay or loss of
- Creamy coatings
- Red patches
- Thrush
- Abscess
- Bad breath
When would a patient have a mouth care assessment?
On admission and then at regular intervals to monitor improvement or deterioration.
How is a mouth care assessment carried out?
With a pen torch to examine the lips, tongue, teeth, gums, cheeks, pallets and under the tongue.
If any problems are identified, record it and put in place a plan of care with patient involvement through an oral care plan.
A dentist may be referred to and involved in their care.
How are dentures cared for?
- Rinse after eating
- Brush with denture cleaning solution
- Soak in cleaning solution over night
- Regular check ups
What may a risk management plan include?
It dictates support that an individual requires like:
- Communication channels
- Medication suitability
- Therapy
- Counselling
What are some signs and symptoms of mental illness?
- Suicide ideation
- Worry and fear
- Low mood
- Cognitive decline
- Irritability
- Low energy
- Difficulty perceiving reality
- Lack of awareness
What is included in a mental healthcare plan?
Clear guidance on signs to be looked for and reported immediately.
What is skin integrity?
Skin health.
Why are underweight people at risk of pressure sores?
They have less flesh over their honey prominences.
Why are underweight people at risk of pressure sores?
They have less flesh over their honey prominences.
What resources are used to monitor skin integrity?
Waterlow, braden and body mapping.
What can cause impaired healing?
- Malnutrition
- Age
- Frailty
- Diabetes
- Steroid use (thins skin)
What vitamins maintain healthy skin?
Zinc and selenium.
How is inflammation important to skin recovery?
In the inflammatory response, the cause of cell injury, like a foreign body or infection, is expelled from the body.
What can too much inflammation lead to?
Free radicals causing damage.
How can dietary changes reduce inflammation?
Zinc reduces inflammation, healing and soothing the skin.
This may be in supplement form.
What affect does dark nail polish have on an oxygen saturation reading?
It lowers it.
What is the braden scale?
A skin integrity assessment measuring the likelihood of pressure injury.
An evidence based risk assessment tool that prevents further deterioration of the skin.
What is the bristol stool chart?
An assessment of health via 7 stool types
What are the 7 types of stool?
1 - Separate hard lumps
2 - Lumpy and sausage like
3 - Sausage shake with cracks
4 - Smooth and soft sausage like
5 - Soft blobs with clear cut edges
6 - Mushy with ragged edges
7 - Liquid with no solid pieces
What is the malnutrition screening tool?
This is a nutritional risk assessment, done on admission, to assess those who are at risk of malnourishment.
BMI is included.
What is the waterlow scale?
A tool used to assess the risk of developing a pressure injury.
This is measured at regular intervals.
What should be done if an individual scores lower than 10 on the waterlow scale?
- Complete it weekly
- Document
What should be done if an individual scores 10+ on the waterlow scale?
- Follow prevention strategies
- Dietician referral to assess nutritional status and needs
- Waterlow done weekly
- Contact wound care specialist for advice
- Document
What should be done if an individual is found to have a pressure ulcer?
- Enter into ‘incident information management system’
- Contact wound care specialist
- Document on record and wound management chart
- Dietician referral
- Wound management review at each dressing change
- Interventions
What are the 4 stages of wound healing?
Haemostasis phase
Inflammatory phase
Proliferative phase
Remodelling (maturation) phase
Describe the Haemostasis phase of wound healing.
At onset of injury, body initiates its emergency repair system, starting with blood clotting.
Platelets, collagen and the enzyme thrombin in the blood initiates the formation of fibrin mesh (the clot).
This begins tissue repair.
Injured vessels constrict to prevent blood loss, causing the blood loss to collect under the skin, resulting in a haematoma (bruise).
Describe the inflammatory phase of wound healing.
Expels debris and destroys bacteria.
Neutrophil cells peak between 24 to 48 hours after the injury occurs, but they can’t always clear the site of pathogens.
Macrophage cells increase at the cut site and secrete proteins that increase the immune reaction to facilitate tissue repair.
This causes oedema, erythema, pain and heat.
Describe the proliferative phase of wound healing.
Contraction of the wounds skin and tissues edges come together following scab formation, protecting the surface. and preventing contamination.
New blood cells are made or replace the lost ones and granulation tissue fills the wound bed form the bottom up to prevent and abscess.
Describe the remodelling phase of wound healing.
New tissue progressively gain strength and flexibility.
Scarred skin is thicker and less flexible.
What can slow the initial response of wound healing?
- Health
- Nutrition
- Medication
- Conditions
This may cause more blood loss.
How should a wound be treated?
- Clean and disinfect it by washing it and applying antiseptic.
- Use a bandage or waterproof dressing to close the wound and promote healing.
- Antibiotic ointment to prevent infection.
- Hydrocolloid dressing for mild-moderate wounds (change very 3-5 days).
- Compression to increase blood flow and aid recovery.
- Pain management.
Why does a wound need to remain moist?
A moist environment created with exudate promotes healing.
However, excessive exudate can cause maceration (the wound is too soft and fragile).
What can influence healing?
- Age
- Sex
- Stress
- Ischaemia
- Disease
- Obesity
- Medication
- Alcohol
- Smoking
Identify and describe causes of incontinence?
- Stress Incontinence is when urine leaks from the bladder when it’s under pressure, meaning the sphincter muscles can’t cope.
- Pregnancy and vaginal birth damages the pelvic floor and bladder muscles.
- Obesity can result in excess weight in the abdominal area putting pressure on the bladder and pelvic floor.
- Urge incontinence due to inability to get to toilet.
- Overflow incontinence due to an over full bladder.
- Severe and long term constipation or diarrhoea contributes to faecal incontinence.
How would you assess the cause of incontinence?
Find out:
- Type of episode
- Organ affected
- Pain
- Duration
- Physical exam of muscle action and control
- Health history
What are examples of electrolytes?
Salts and minerals like:
- Na
- K
- Chloride
- Bicarbonate
How would you treat and electrolyte imbalance?
Supplements or IV.
(A blood test can identify the exact electrolyte deficiencies to prescribe the correct supplements and IV bag).
What is the role of electrolytes?
Give examples
To maintain bodily functions.
Na and K are responsible for the generation of the electrical impulses in the heart.
Na acts on the kidneys to regulate water loss and retention.
What are the impacts of malnutrition?
- Slower healing
- Reduction in muscle mass (affects strength and bodily functions)
What is the purpose of a pain assessment?
To evaluate pain response and effectiveness of interventions.
What are some pain assessment tools?
- Abbey pain scale (for those with a cognitive disability or communication barriers)
- Numerical
- Visual
- MCGILL pain index (sensory changes like temp, colour and sensitivity)
What is the purpose of a mobility assessment?
To analyse physical abilities so appropriate aids are provided.
This will then date the level of support needed in different circumstances.
What is the elderly mobility scale?
Considers locomotion, balance and position changes.
What is the tinetti balance assessment?
Firstly assess balance when standing up from a. chair and when nudges.
They then assess gait (way you walk).
What equipment needs to be checked daily?
- Oxygen cylinders
- Defibs
- Suction units or lines
- Disposable equipment
