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CP PNUR 2130 POD Quizzes > POD #1 Units 1 - 4 > Flashcards

POD #1 Units 1 - 4 Flashcards

1
Q

What are risk factors/hazards that pose a threat to patient safety?

A

Falling
Tripping
Obstruction

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2
Q

What would you include in a patient and bedside safety check?

A

Ensuring a minimum of 1 safety rail up; maximum of 3

Wheel brakes are on

Call button is accessible

Suction valve is functioning

Oxygen tank is functioning

Emergency kit is located

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3
Q

What is cultural safety?

A

Being Culturally Competent. The redistribution of power and resources in a relationship.

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4
Q

How can you incorporate cultural safety and humility into your clinical practice?

How can you incorporate anti-racism into your clinical practice?

A

Self-Reflective Practice

Building Knowledge Through Education

Anti-Racist Practice

Creating Safe Health Care Experiences

Person-Led Care

Strengths-Based & Trauma-Informed Practice

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5
Q

What are the links in the chain of infection and why is it important for Psychiatric Nurses to understand the infectious process?

A

Portal of Entry -> Susceptible Host -> Pathogen -> Reservoir -> Portals of Exit -> Mode of Transmission

Understanding where we can intervene and break the links in the chain

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6
Q

What is the difference between medical and surgical asepsis?

A

Medical: “Clean technique” Reduces number of pathogens, used in daily procedures

Surgical: “Sterile technique” Eliminates pathogens, used in surgical procedures

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7
Q

What is hand hygiene? What are the five key moments for hand hygiene?

A

Routine handwashing followed by hand sanitizer and prevents transmission of infection

  1. Before touching patient
  2. Before aseptic procedures
  3. After touching patient
  4. After touching patients surrounding
  5. After exposure to bodily fluids
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8
Q

What are the indications for hand washing versus alcohol-based gels/sanitizers?

A

Handwashing is required for heavily soiled hands, C Diff and norovirus, exposure to blood or bodily fluids

Sanitizer is required in between hand washing, kills majority of germs on hands, widely available

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9
Q

How long should hand washing be carried out?

A

15 seconds minimum, 40-60 maximum

Sanitized till absorbed

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10
Q

When should non-sterile clean gloves be utilized?

A

Contact with bodily fluids, Mucous membranes,
Surfaces contaminated with bodily fluids

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11
Q

What are routine practices/standard precautions?

A

Practices used by healthcare professionals to reduce modes of transmission and break chain of infection

Including and hygiene, wearing gloves where appropriate

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12
Q

What are additional/isolation precautions? What is a point of risk assessment?

A

Extra step added to routine practices for patients known or suspected to be infected with certain microorganisms

Ex. Additional PPE for contact, droplet, or airborne precautions: Clearly indicated outside patient door pertaining to specific pathogen and the mode of transmission

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13
Q

How does the psychiatric nurse make an occupied/unoccupied bed ensuring that the principles of medical asepsis and standards precautions are maintained?

A

Wearing gloves when appropriate

Applying gel sanitizer in between steps

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14
Q

After making an unoccupied/occupied bed, what actions would you take to ensure patient safety and comfort?

A

Ensuring top layers are untucked so patient can exit bed as needed

Bedside check (rails, brakes, call button)

Adjusting top fold by feet for patient mobility

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15
Q

What is the normal range of temperature for a healthy adult?

A

36 – 38 Degrees

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16
Q

What factors can affect the patient’s temperature?

A

Fever (Febrile)

Environment

Stress

Foods/Drinks

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17
Q

What are the sites used to assess body temperature?

A

Oral

Rectum

Armpit (Axillary)

Ear (Tympanic)

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18
Q

How does smoking, chewing gum, and ingesting hot/cold liquids or food affect a patient’s temperature? What are the nursing actions for assessing temperature in relation to these activities?

A

They can alter temperature in oral cavity giving an inaccurate reading.

Nursing Actions: Wait 20 mins after hot and cold liquids, 2 mins for smoking, and 5 mins after chewing

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19
Q

What do the following terms mean: core temperature, fever/pyrexia, and afebrile?

A

Core: body’s internal organs

Fever/Pyrexia: Abnormally high temperatures

Afebrile: Patient absent of fever (Normal)

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20
Q

What is the normal range of heart rate for a healthy adult?

A

60 – 100 BPM

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21
Q

What factors can affect the patient’s heart rate?

A

Diet, Exercise, Genetics

22
Q

What do the terms rate, rhythm (irregular/regular), and quality (strength) mean in relation to assessing the pulse?

A

Rate: Time/Frequency

Rhythm: Steady, rapid (regular or irregular)

Quality: weak, strong

23
Q

What do the terms tachycardia and bradycardia mean?

A

Bradycardia = slow heartbeat, lesser than 60 beats per minute
Tachycardia = fast heartbeat, greater than 100 beats per minute

24
Q

What are the two common pulse sites used to assess the heart rate?

A

Neck – Carotid Artery

Wrist – Radial Artery

25
Q

What is the normal respiratory rate range of a healthy adult?

A

12 – 20 Breaths (full inhalation and exhalation) per Minute

26
Q

What factors affect the patient’s respiratory rate?

A

Smoking

Diet/Exercise

COPD

27
Q

How does the psychiatric nurse assess the respiratory rate?

A

Observe Respirations for 30 Seconds x 2 (for 1 min total) OR 1 Full Minute if Irregular

28
Q

What do the terms rate, rhythm, and depth mean in relation to respiration? What characteristics does the psychiatric nurse assess when observing respirations?

A

Rate: rapid, slow

Rhythm: regular or irregular

Depth: Deep? Shallow?

Checking if patient is sputtering, pursed lips or calm

29
Q

What do the following terms mean: tachypnea, bradypnea, dyspnea, apnea, and orthopnea?

A

Tachypnea: Abnormally fast, greater than 20 breaths per minute

Bradypnea: Abnormally slow, less than 12 breaths per minute

Dyspnea: Shortness of breath

Apnea: Sudden stop of breathing

Orthopnea: sensation of breathlessness while laying down

30
Q

What is a pulse oximeter? How does the pulse oximeter measure oxygen saturation?

A

Detects the amount of hemoglobin in arterial blood that is saturated with oxygen. By using cold light source through finger probe

31
Q

How does the psychiatric nurse select an appropriate pulse oximeter site?

A

Finger, Toes, Nose, Earlobe

Choose the above based on factors that can affect reading

Anemia, impaired circulation, activity, jaundice, nail alterations/decorations, dark pigmentation, carbon Monoxide

32
Q

What factors affect oxygen saturation readings?

A

Anemia, impaired circulation, activity, jaundice, nail alterations/decorations, dark pigmentation, carbon Monoxide

33
Q

What is the normal range for oxygen saturation of a healthy adult? A patient experiencing COPD? A patient experiencing co-morbidities or an acute health challenge?

A

Healthy: 95 – 100%

COPD: 88 – 92 %

Co-Morbidity/Acute > greater than 92%

*Below 70% = Life threatening

34
Q

What does blood pressure represent?

A

The force exerted on the walls of an artery by the pulsing blood under pressure from the heart

35
Q

What is the normal range for the blood pressure of a healthy adult?

A

120/80 mmHg

100-139/60-89

36
Q

What do the following terms mean: systolic, diastolic, pulse pressure, hypotension, hypertension, sphygmomanometer, and Korotkoff sounds?

A

Systolic: peak of maximum pressure when blood ejection occurs

Diastolic: minimum pressure exerted against the arterial walls when the ventricles relax

Pulse Pressure: difference between systolic vs diastolic. Used to indicate cardiovascular disease

Hypotension: low blood pressure, lower than 100/60 or 99/59 or below

Hypertension: high blood pressure, greater than 139/89 or 140/90 or above

Sphygmomanometer: blood pressure cuff

Korotkoff: sounds heard through stethoscope when blood pressure cuff is applied (occlusion)

37
Q

What are common mistakes in blood pressure assessment?

A

Incorrect cuff size

Incorrect patient positioning

38
Q

What does orthostatic/postural hypotension mean? How does the psychiatric nurse measure blood pressure to detect postural/orthostatic hypotension?

A

Experiencing low blood pressure/light headedness after standing up from sitting or laying down

Measure blood pressure laying down. Wait (1-3 minutes). Measure again standing up.

39
Q

Why are proper body mechanics important in psychiatric nursing?

A

To ensure patient and nurse safety in clinical settings

40
Q

What are the key principles relevant to body mechanics?

A

Use of correct muscles to complete activities (Client and Nurse)

Prevents unnecessary strain on any muscle or joint

To maintain body alignment, balance, and posture during activity or exercise

Reduces risk of injury to the nurse and the client during routine activities

Reduces fatigue of muscle groups

41
Q

What five bed positions are used when performing activities of daily living?

A

Fowler’s

Semi-Fowler’s

Trendelenburg’s

Reverse Trendelenburg’s

Flat

42
Q

What is the purpose of performing mouth care?

A

To assess condition of teeth, gums, lips, tongue, & buccal mucosa

43
Q

What equipment would the nurse need to provide mouth care to the dependent patient? What equipment would the nurse need to provide mouth care to an independent patient?

A

Can use toothbrush, toothpaste, floss

Can use foam toothette swabs, tongue blade, mouth wash/chlorhexidine solution

44
Q

How do you insert and remove dentures? What are important nursing considerations when caring for dentures?

A

Remove upper dentures followed by lower dentures

Moisten dentures, then insert upper denture followed by lower denture

Clean on a regular basis

Remove at night to give gums a rest and to prevent bacterial buildup

Keep covered in tepid water when not worn

Keep in an enclosed, labelled cup at patient’s bedside stand

DO NOT place on napkins, tissues, or food trays

45
Q

What are important nursing considerations regarding a patient’s personal and cultural preferences related to hygiene/activities of daily living?

A

Social groups influence hygiene preferences/protocols (ex. types of products used, frequency, nature of care)

46
Q

What are the key purposes of bathing?

A

Remove bacteria, increase blood circulation, decrease risk of infection and decrease skin breakdown

47
Q

How does the psychiatric nurse perform a complete bed bath? What is a partial bed bath?

A

Complete: for patients who cannot bathe themselves, full body cleanse

Partial: cleansing areas that are hard to reach or cause discomfort for patients

48
Q

While performing a bed bath, what areas of the skin could you assess on your patient?

A

Excessive dryness, rash, irritation, inflammation, wound status

49
Q

Why does the psychiatric nurse wash extremities from distal to proximal?

A

Stimulates venous blood flow, preventing venous stasis (Use long firm strokes from hand to core)

50
Q

What is meant by the term peri-care or perineal care?

A

Cleaning of genitalia and anal region

51
Q

How does the psychiatric nurse provide perineal care for female and male patients?

A

Female: wash labia majoria from perinium to rectum, separate labia and wipe down in one smooth motion

Male: raise penis, wash tip with circular motion, from meatus outward

CP PNUR 2130 POD Quizzes (3 decks)

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