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PCM > PCM Exam 1 > Flashcards

PCM Exam 1 Flashcards

1
Q

When should a pt’s vitals be taken and why is it important?

A

before, during and after the treatment
its important to be able to see the progression of the pt

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2
Q

what are the assessments for physiological stability

A

HR
RR
Oxygen saturation
BP
Temp

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3
Q

what is HR?

A

indirect measure of contraction in the heart-left ventricle

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4
Q

what is the normal HR for newborns

A

100-150 bpm

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5
Q

whats the normal HR for children from 1-10 y/o

A

70-130 bpm

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6
Q

whats the normal HR for adults?

A

60-100 bpm

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7
Q

HR below 60 bpm is indicated as what?

A

bradycardia

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8
Q

HR above 60 bpm is indicated as what?

A

tachycardia

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9
Q

what are some factors that affect HR?

A

physical activity
health conditions
meds
stress
dehydration
emotional
environmental

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10
Q

what are the 7 sites for assessing HR?

A

temporal
carotid
brachial
radial
femoral
popliteal
dorsal pedal

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11
Q

whats the normal range for blood oxygen saturation?

A

95-100%

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12
Q

what is it called if oxygen saturation is less than 90%?

A

Hypoxemia

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13
Q

what are some factors that affect oxygen saturation?

A

emotional state
pulmonary disease
physical activity
age
environment

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14
Q

how do we assess O2 satuation?

A

pulse ox

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15
Q

how do you manually measure RR

A

one respiration is equal to one inspiration and one expiration

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16
Q

what is the normal value of RR in adults?

A

12-18 RR

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17
Q

whats the normal value of RR for infants?

A

30-50 RR

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18
Q

what are some factors that affect someones RR?

A

age
emotional state
environment
pulmonary disease

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19
Q

how do we assess RR?

A

count it
use the monitor

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20
Q

what is blood pressure?

A

indirect measurement of the pressure inside an artery caused by the blood flow

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21
Q

what is systolic pressure?

A

contraction of the left ventricle (top #)

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22
Q

what is diastolic pressure?

A

rest period of the heart (bottom #)

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23
Q

what are some factors that may affect BP?

A

meds
diet
physical activity
white coat syndrome
emotional

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24
Q

how do we assess BP

A

support pts arm at level of the heart
pt can be sitting, standing or supine or exercising

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25
Q

what is normal BP?

A

120/80

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26
Q

what is high normal BP?

A

130-139/ 85-89 mmHg

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27
Q

what is the range for prehypertension?

A

120-139/85-89

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28
Q

what is the range of stage 1 hypertension?

A

140-159/90-99 mmHg

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29
Q

what is the range for stage 2 hypertension?

A

160-179/100-109 mmHg

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30
Q

what is a hypertensive crisis?

A

above 180/ 110 mmHg

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31
Q

what is orthostatic hypertension and the S&S?

A

form of low blood pressure that happens when you stand up from sitting, sit up from lying down
S&S include dizzy or lightheaded

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32
Q

what are the orthostatic hypertension values?

A

systolic decrease= drop of 20 mmHg
diastolic decrease= drop of 10 mmHg
within 3 min of positional change

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33
Q

normal range of body temperature?

A

96.8-99.3 degrees F
average is 98.6

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34
Q

how do we objectify pain?

A

use a pain screen; scales and non-verbals

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35
Q

what are the odds of healthcare associated infections?

A

1 out of 25
4th leading cause of death

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36
Q

whats the difference in medical and surgical aseptic teqniques

A

medical: keeps pathogens confined to a specific area, object or person
surgical: excludes all microorganisms before entering the sterile field

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37
Q

whats the difference in medical and surgical aseptic teqniques

A

medical: keeps pathogens confined to a specific area, object or person
surgical: excludes all microorganisms before entering the sterile field

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38
Q

what are standard persuasions for prevention of infection

A

group of infection prevention practices that apply to all patients regardless of diagnosis
frequent hand washing or rubs
PPE

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39
Q

how does transmission based precautions relate to in standard precautions

A

goes on top of standards

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40
Q

what is transmission based precautions

A

designed to protect caregiver from highly transmissible pathogens

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41
Q

what is the hand rubbing method

A

alcohol based, waterless antiseptic
More effective when hand washing is not required
Less time, more effective, more accessible, less damage to the skin

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42
Q

what is the proper hand washing method?

A

preferred when hands are visibly dirty, solid or considered to be contaminated
Bacteria is removed from the scrubbing and friction

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43
Q

when is hand washing required?

A

entering the ICU or the OR
Decontamination after treating C diff
Exposure to potential contaminants

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44
Q

what are contaminants of hand washing

A

bar soap
water spout
basin
sink rims
towel dispenser
faucet handle

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45
Q

what are isolation precautions

A

linked to the method by which pathogens are transmitted specific PPE depending on type of transmission

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46
Q

what are 4 rules of asepsis

A
  1. know which items are sterile
  2. know which items are not sterile
  3. separate the non sterile from the sterile
  4. if sterile items are contaminated, remedy the situation immediately
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47
Q

DO NOTS of contaminated garments

A

DO NOT:
touch any part of the body with PPE
touch the outer surfaces of gloves with the ungloved hand
touch sleeves or front of the gown with the ungloved hands
wear PPE outside of the pt room

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48
Q

what is targeted in high levels of disinfectants

A

everything except high number of bacterial spores

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49
Q

whats targeted with intermediate level of disinfectant

A

viruses, fungi, vegetative bacteria, TB

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50
Q

whats targeted with low level of disinfectant

A

bacteria, some viruses, some fungi

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51
Q

what is removed in decontamination

A

destroyed blood borne pathogens that are no longer capable of transmission of infection partials

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52
Q

T/F: disinfectant is stronger than decontamination

A

False

53
Q

what is the P wave indicating

A

atrial depolarization

54
Q

what is the QRS wave

A

ventricular depolarization

55
Q

what is the T wave

A

ventricular repolarization

56
Q

what is the pathway for cardiac conduction

A

SA, AV, Bundles of His, bundle branches, purkinje fibers

57
Q

what are we looking for to determine the rhythm

A

ventricular and atrial depolarization distance between the intervals. and if they are equal, regular, irregular or irregular regular

58
Q

what is sinus rhythm

A

equal distance between identical waves (60-100)

59
Q

how do you measure the rate values

A

300, 150, 100, 75, 60, 50

60
Q

what is atrial fibrillation

A

continual rapid firing of multiple atrial follicles, no single impulse, depolarizes the atria completely

61
Q

what causes A fib

A

MI
CABG surgery
HTN
Alcoholism

62
Q

what do you see on an ECG for A fib

A

no P waves
irregular rhythm
atrial spikes
normal QRS

63
Q

what is 3 or more PVC runs indicate

A

ventricular tachycardia

64
Q

what is ventricular tachycardia

A

the continuous runs of PVC (150-250 bpm)

65
Q

what are S&S of VT

A

hypotension
syncope- fainting

66
Q

what causes VT

A

acute MI or ischemia
electrolyte imbalance
medication toxicity
illicit drugs

67
Q

what are the common lab values (names)

A

metabolic panels
electrolyte panels
kidney function
liver function
lipid panel
cardiac markers

68
Q

reference value for WBC?

A

5-10 x 10 ^9 /L

69
Q

whats the up trend for WBC?

A

> 11 x 10^9/L

70
Q

what is the down trend for WBC

A

<4 x 10^9/ L

71
Q

what are the reference values for platelets

A

140-400 x k/ul

72
Q

what is the down trend for platelets

A

<150 k/ul
can cause excessive bleeding

73
Q

what is the uptrend for platelets and what is indicated

A

> 450 k/ul
thrombocytosis

74
Q

PT implications for platelets

A

100.5 temp= hold therapy, symptoms are based on activity and if pt is at fall risk

75
Q

hemoglobin reference and critical values

A

men: 14-17.4 g/dl
women: 12-16 g/dl
<5-6 g/dl or >20 g/dl

76
Q

what is the uptrend for hemoglobin

A

CHF, dehydration, COPD, severe burns, dizziness, chest pain

77
Q

down trend for hemoglobin

A

anemia, blood loss, lupus, kidney disease, stress ue to bone marrow, tachycardia

78
Q

what is the therapy for hemoglobin

A

facility dependent symptom based

79
Q

what are the hematocrit reference and critical values

A

men: 42-52%
women: 37-47%
<15-20% or >60%

80
Q

up trend for hematocrit

A

COPD, CHF, burns, HA, fever, dizzy, fatigue, weakness

81
Q

uptrend for hematocrit

A

leukemia, preggo, pale skin, HA, dizzy, arrythmias, dyspnea, monitor SpO2, cirrhosis, myeloma

82
Q

therapy implications for hematocrit

A

<25%: essential ADLs only
hold out of bed activities
symptoms based approach

83
Q

what is the normal time for blood clotting

A

11-13 seconds

84
Q

what is the time to clot blood called

A

prothrombin time

85
Q

what is international normalized ratio (INR)

A

measurement of how long it takes to clot blood when an oral anticoagulant is used
PT and PTT can differ depending on the lab values
normal value is .8-1.2
increase=risk for bleeding
decrease= risk of clotting

86
Q

what is short term positioning

A

allowing for treatment of different areas
MT, modalities

87
Q

what is long term positioning

A

preventing pressure
promoting better breathing positions
preventing ulcers and contractures

88
Q

how often do you reposition a pt for long term positioning

A

every 2 hours to be able to maintain integrity of all 4 movement systems

89
Q

how often do you reposition a pt in short term positioning

A

every 15 mins

90
Q

why do you need to reposition a pt

A

to prevent ulcers (poor circulation), fragile skin, decreased sensation, or if they have difficulty breathing

91
Q

what is indicated if the pt has prolonged redness of bony prominences

A

tissue damage

92
Q

guidelines for positioning

A

explain the procedure to the pt, keep them in a neutral spine, provide a way for the pt to have communication with a healthcare worker

93
Q

what are the areas of greatest pressure while pt is in supine (bony prominence’s)

A

sp
head
inferior angle of scapula
elbows
PSIS
sacrum
heels

94
Q

what are the areas of greatest pressure while pt is in prone (bony prominence’s)

A

forehead/ lateral ear
acromial process
anterior humeral head
sacrum
ASIS
patella
dorsal aspect of the foot

95
Q

areas of greatest pressure when sidelying

A

lateral ribs
lateral ear
lateral acromial process
lateral humeral head
medial or lateral humerus
greater trochanter
medial/lateral knees and ankles

96
Q

areas of greatest pressure when sitting

A

ischial tuberosity
posterior thighs
sacrum
sp
elbow

97
Q

what is the skin blanching test

A

when pressing pts skin, healthy skin will blanche and turn pink quickly

98
Q

who is at a higher risk for skin breakdown

A

people with increased pigmentation

99
Q

what increases load

A

a decrease in surface area
decrease in cushioning

100
Q

how do we relate load and time with pressure patients

A

increase load + decreased time= injury
decreased load+ increase time= injury

101
Q

how would we prevent pressure injuries on our pt

A

limit the direct contact of bony landmarks
increase surface area
increase cushioning
decrease load
decrease time in position

102
Q

what are the most common contractures

A

flexion contractions

103
Q

if a pt has swallowing restrictions or breathing dysfunctions, cardiac condition or lung condition, what do they have a higher risk of

A

cervical flexion contractures

104
Q

what can cause hip or knee contractures

A

neurological conditions

105
Q

who would have an increase risk of wrist contractions

A

neurological disease, injury disuse pts

106
Q

how does a PT position someone with edema

A

keep the extremities above the heart

107
Q

what do positioning devices do

A

reduce/ eliminate load on the tissue while pt is in static position

108
Q

what pts would we put in prone positioning most often

A

amputees and pulmonary pts

109
Q

how often do you reposition for seated

A

every 10-15 mins

110
Q

what do we try to avoid in sitting

A

sacral sitting

111
Q

what can high fowlers position cause there to be

A

sacral shearing

112
Q

what circumstance would we need to use trendelenburg position

A

pregnancy
BP management

113
Q

why would we use reverse trendelenberg

A

spinal cord

114
Q

what do we always want to do for comfort and safety in supine

A

support knees, lower legs, and the head

115
Q

safety and comfort concerns for sidelying

A

support head, arm and distribute pressure evenly

116
Q

safety and comfort concerns for prone

A

support hips/abdomen
keep pressure off of the toes

117
Q

safety and comfort concerns for sitting

A

support back
*if needed support side so they dont slump

118
Q

what is the general rule when positioning a pt

A

maintain normal and neutral spine
proper airway

119
Q

principles of draping

A

clean linen
only expose areas youre working on
no wrinkles or folds
be sure pt is comfortable
protect their clothing

120
Q

culture sensitivities

A

cant remove clothing
gender
hospital gown exposure

121
Q

what do we always want to do with a pt that was involved with trauma

A

informed consent
good communication
respect boundaries
watch for signs of discomfort
active involvement
apply firm pressure, dont be soft

122
Q

what are the 2 types of exercise

A

active
passive

123
Q

levels of assist are based off of what scale

A

GG

124
Q

what does level 6 indicate on GG scale

A

independent

125
Q

what does level 5 indicate on GG scale

A

set up/ clean up
helper will help set up while the pt is able to complete the activity

126
Q

what is level 4 on the GG scale

A

supervision or touching assistance
- helper provides verbal ques/ touching to help assist pt with activity

127
Q

what is level 3 on the GG scale

A

partial/ moderate assistance
- Helper does less than half the effort. helper helps lift, hold or support limbs (but providing less than half)

128
Q

what is level 2 on the GG scale

A

substantial/maximal assistance
- Helper does MORE THAN HALF the effort. pt can help very little

PCM (1 decks)

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