Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Foundations > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

6 Phases of nursing process

A
  1. Assessment
    - Subjective
    - Objective
    - inspection
    - Palpation
    - Percussion
    - Auscultation
  2. Diagnosis (identifying health needs)
  3. Planning Outcomes
  4. Planning Interventions
  5. implementation
  6. Evaluation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of Baths and who gets them

A
  1. Assist bath ( just assist with areas hard to reach)
  2. Partial Bath ( Bathe only absolutely necessary; needed for individuals in pain or who are really sick)
  3. Bed Bath ( Complete/partial/help) - for paralyzed, unconscious pt.
  • never soak feet of diabetic pts
  • always ask before shaving
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mouth Care

A

Should be done at least once daily, ideally more. Especially for unconscious pt and pt on ventilators.

  • suction for unconscious pt.’s
  • pt on side w/ head of bed lower
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Important things to remember about Hygeine

A
  • keep them covered; maintain privacy
  • be fast
  • be organize
  • wear gloves, change as necessary
  • start with face
  • finish with groin and feet
  • change water

-assess skin integrity!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Chain of 6 Factors of infection

A
  1. Infectious agent
  2. Reservoir
  3. Portal of exit
  4. Mode of transmission
  5. Portal of entry
  6. susceptible host
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Transient flora

A

normal microbes a person picks up from coming in contact with objects and other people

-can be removed by hand washing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Resident Flora

A

live deep in skin layers, where they multiply harmlessly. can’t be removed by hand washing and are generally harmless unless they enter deeper tissues through open wounds or unless pts are vulnerable to disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Reservoir

A

Source of infection, a place where pathogens live and multiply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Portals of exit

A

bodily fluids, coughing, sneezing, seeping wounds, IV lines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Direct v. indirect transmission

A

Direct- touching, kissing, sexual contact

indirect- contact with a fomite, such as droplets from coughing, dirty objects/ linens, airborne: air vents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Four Determining Factors

A
  1. Virulence- power to cause disease
  2. organisms ability to survive the host environment
  3. Number of organisms (the greater the number the more likely to cause disease
  4. Host’s Defenses to prevent infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Classification of infections

A

Local
systemic

acute
chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

exogenous health care- related infections

A

WE DO IT-
Pathogen acquired from healthcare environment (WE DO IT; Uniform, artificial nails, poor hand hygiene, dirty equipment, lack of sterile technique)`

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Endogenous healthcare-related infection

A

Normal flora multiply and cause infection as a result of treatment (THEY DO IT; Overgrowth of normal flora, often broad-spectrum anti-biotics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Primary Defenses Preventing infection

A

Structural barriers of the human body

  • Intact Skin- Helps keep out bacteria, hand washing
  • Mucous Membranes- acts as a barrier
  • Tears- Flush out toxins/Bacteria
  • GI flora-acidity kills bacteria, peristalsis pushes it through
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Secondary Defenses

A

Biochemical processes activated by chemicals released by pathogens

  • Phagocytosis
  • Complement cascade
  • Inflammation
  • Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tertiary Defenses

A

¥ Humoral immunity
¥ B-cell production of antibodies in response to an antigen
¥ Cell-mediated immunity
¥ Direct destruction of infected cells by T cells

18
Q

How to support host defenses

A

Nutrition, hygiene, rest, exercise, stress reduction, immunizations

19
Q

Medical Asepsis

A

“A state of cleanliness that decreases the potential for the spread of infection”
- Hand Hygiene

When:

  • Before and after care
  • When visibly soiled
  • Before and after bathroom
  • Before and after eating
  • After touching Phone

What:

-Alcohol based hand sanitizer (no gel with C-diff or bodily fluids)
Every 3 sanitizers, wash with soap and water
-Soap and Water (warm water, not hot)

How:

  • Friction
  • Paper towels
20
Q

PPE

A

gown, face mask, facesheild/ goggles, hair covers, shoe covers, gloves

21
Q

Types of precautions

A

1.Contact- Gloves, Gown
Example: MRSA

2.Droplet: pathogen spread via moist droplets (coughing, sneezing)
-same as contact precautions (gloves, gown) + (mask and eye protection within 3 ft of client
Examples: RSV, FLU, Pertussis

3.Airborne: Pathogen is spread via air currents
-Transmission via ventilation systems, shaking
sheets, sweeping
-Precautions include
-Same as those for contact, with addition of special room, special mask, and mask for patient when transported
Examples: TB, Chicken-Pox, Measles

4.Protective Isolation:
-Protects the client from organisms
-Used in special situations with immune-compromised
patient population
¥ Precautions include
¥ Room with special ventilation and air filters; no carpeting;
daily wet-dusting
¥ Avoiding standing water in the room (e.g., humidifier)
¥ Nurse not assigned to other clients with active infection
¥ Standard and transmission-based precautions, plus mask and other personal protective equipment (PPE) (to protect patient)

22
Q

Surgical Asepsis

A

Includes: Creation of a sterile environment, Use of sterile equipment/supplies, Sterilization of reusable supplies, Surgical hand scrub, Surgical attire, Sterile gloves, Sterile field and Use of sterile technique
• Consider a 1 inch margin/border around the drape unsterile.
• Avoid reaching over a sterile field
• Handle sterile equipment while wearing sterile gloves.
• Limit the amount of time a sterile field remains set up in advance.
• Do no allow sterile field to get wet.
• Only sterile items on sterile field.
• Before adding sterile items assure they are sterile.
• Cuffs of sterile gloves are not sterile (unless using closed method)
• KEEP STERILE FIELD IN VIEW AND ABOVE WAIST

23
Q

NORMAL VITALS

A 
Temp: 97*-100.8*
HR: 60-100
BP:  < 120/80
RR:  14-20
O2 Saturation: 95-100
PAIN: Ideally none
24
Q

Types of temp

A 
Core measurements: 
¥	Tympanic Membrane (EAR)
¥	Rectal 
¥	Pulmonary Artery
¥	Urinary
¥	Temporal Artery (Temple, forehead)
Peripheral 
¥	Oral
¥	Axilla ( Under the arm)
¥	Skin
25
Q

Hypothalamus

A

responsible for thermoregulation

“Set point”

26
Q

Anterior Hypothalamus

A

Coools you down, vasodilation, sweating

27
Q

Posterior Hypothalamus

A

Generating heat, vasoconstirction, shivering

28
Q

Changes in body temp can occur via : (4)

A
  1. Conduction: Transfer of heat from a warm to a cool surface by direct contact
  2. Convection: Transfer of heat through currents of air or water
  3. Radiation: Loss of heat through electromagnetic waves emitting from surfaces that are warmer than the surrounding air
  4. Evaporation: Water is converted to vapor and lost from the skin (as perspiration) or the mucous membranes (through the breath)
29
Q

Pyrexia

A

Fever > 100*

30
Q

Course of a fever

A

Initial—Febrile episode
Second—Course
Third—Defervescence or crisis
Fever is good to a point- above 102 not good- Pt needs be able to eat/drink

31
Q

Apnea

A

Cessation of breathing

32
Q

bradypnea

A

Abnormally slow breathing

33
Q

tachypnea

A

Fast breathing

34
Q

Dyspnea

A

labored breathing

35
Q

orthopnea

A

Inability to breath when horizontal

36
Q

What can cause a high BP

A

too much fluids
smoking
cuff too small
arm lower than heart

37
Q

What can cause a low BP

A 
Medications
 blood loss
dehydration
cuff too big
 arm higher than heart
38
Q

Types of health Histories (5)

A
  1. Comprehensive (health history & assessment)
  2. History of Present illness
  3. Past history
  4. Family history
5. Abuse- CAGE
Cutdown
Annoyed
Guilty
Eye-opener
39
Q

OLDCART

A 
Onset
location
duration
characteristics of symptoms
associated manifestations 
         (anything else?)
Relieving/exacerbating factors
Treatment
40
Q

PQRST

A 
P: Provocative or palliative
Q: Quality or Quantity
R: Region or radiation
S: Severity scale
T: Timing
U: Understanding (Does patient know where pain is from)
41
Q

Subjective

A

What the patient tells you

42
Q

objective

A

What you can observe- PQRST

Foundations (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions