Safety and protection Flashcards
What are medications that affect the brain and increase the risk of falls?
- anxiolytics/sedative-hypnotics
- antipsychotics
- antidepressants
- anticonvulsants/mood stabilizers
- opioid anelgesics
- BP medications/antihypertensives
- blood sugar altering medications
- diuretics
How do antipsychotics increase fall risk?
- syncope
- sedation
- slowed reflexes
- LOB
- impaired psychomotor function
How do antidepressants increase the risk of falling?
can cause hyponatremia (low sodium)
How do anti-hypertensives cause an increase in fall risk?
Can cause or worsen a drop in BP/postural hypotension
How can diuretics increase fall risk?
causes dehydration = orthostatic hypotension
How can urinary catheters cause autonomic dysreflexia?
Bladder distention caused from an overfilled collection bag, a locked/twisted/kinked tube, or a UTI
What is a chest tube used for?
evacuating air, fluid, and/or other material following a pneumothorax, cardiothoracic surgery, pleural effusion, and other conditions
Where must the chest tube be placed once it is secured into the chest wall?
Must remain below the level of the patient’s chest as the water seal is often on the floor
What devices are contraindicated when a chest tube is present?
positive pressure devices
What must you do if a patient’s chest tube becomes disconnected from the patient?
Have the patient fully exhale and place a gloved hand and gauze over the defect at the end of exhalation
– Call for medical help
What is a peripheral IV used for?
Short term infusion of fluids (electrolytes, blood, medications)
(true/false) the UE with a peripheral IV may be raised higher than the level of the IV medication bag.
FALSE - backflow can occur
What can possibly form if an IV solution is low?
Air embolism
What is a central venous catheter (Central line) used for?
Venous access for 6+ days
What are the possible veins that a central line can be administered into?
- SVC
- Jugular
- subclavian
- femoral
What structure does a PICC line give direct access to when administered into the UE?
Peripherally Inserted IV catheter
SVC
What movement is contraindicated when a femoral line is placed?
hip FLX > 45 degrees
What arteries do central arterial catheters use?
- radial
- brachial
- femoral
What are central arterial catheters used for?
Monitoring intra-arterial BP and ABG samples
(true/false) Central arterial catheters are used for medication administration
FALSE
What is a Swan-Ganz Catheter used for?
(Pulmonary artery catheter)
Monitor pulmonary artery pressure, cardiac output, and oxyhemoglobin saturation
What must you do if an arterial line becomes dislodged?
Provide immediate, firm pressure on or above the arterial insertion site to try and control the bleeding
–call for medical assistance
Are tracheal tubes taped or sutured in place?
sutured
Endotracheal and nasotracheal tubes are taped into place
A peaked inspired pressure (PIP) _____ cm H2O can indicate a kinked tube, need for patient suctioning, and/or bronchospasm
> 30 cm H2O
What level of PaO2 is indicative for supplemental oxygen?
< 55 mmHg
During CPR, untrained rescuers can only do what?
Chest compressions
Describe parameters for rescue breathing.
Pulse present but is not breathing
1 breath every 5-6 seconds
OR
10-12 breaths per minute
Check pulse every 2 minutes
What is the optimal number of chest compressions per minute when performing CPR?
120 bpm
no less than 110, no more than 120
Do not lean on chest in between compressions- allows for heart to completely fill before the next compression
How deep should CPR compressions be for an adult?
2+ inches
How deep should CPR compressions be for a child?
approx. 2 inches
1/3 of AP depth
How deep should CPR compressions be for an infant?
approx. 1.5 inches
1/3 of AP depth
(Heat or cold pack) What is most appropriate for strains, sprains, and muscle contusions? Why?
Cold pack because it can decrease hemorrhage, edema, pain, and disability
Heat application is CONTRAINDICATED
If an injured extremity is blue or extremely pale, what can you possibly do to help reduce neurovascular compromise?
Gently straighten the limb
What causes Fat Embolus Syndrome (FES)?
definition: fat globules are released into the bloodstream.
Significant trauma
What are symtoms that may indicate the beginning of FES leading to emergency?
Respiratory distress
Persons with mild concussions have no LOC and symptoms that last how long?
Less than 15 minutes
Persons with moderate concussion have no LOC and symptoms that last how long?
Longer than 15 minutes
What does BE FAST stand for in regards to stroke recognition?
B- balance and coordination
E- eyes
F- Face drooping
A- Arm weakness
S- Speech difficulty
T- Time
Other possible symptoms:
- sudden N/T in the LEs
- sudden confusion or trouble understanding
- dizziness
- sudden severe HA with no known cause
What are immediate signs of possible concussion after injury?
- change in LOC (dazed, stunned,etc)
- anterograde or retrograde amnesia
- confusion
- clumsy
- answers questions slowly
- shows mood change
What are symptoms of concussion
- HA/head pressure
- N/V
- impaired balance, vision, or increased dizziness
- light and noise sensitivity
- feeling sluggish, hazy, foggy, or groggy
- confusion, concentration, or memory problems
What indicates an immediate call to 911 in regards to concussions?
- LOC >30 seconds
- one pupil larger than the other
- Repeat n/v, convulsions, or Sz
- Progressive HA
- slurred speech, numbness, decreased coordination
- confusion, disorientation, amnesia
What are signs and symptoms of Sz?
- altered consciousness
- convulsions, involuntary contractions, rhythmic jerking of extremities
- sensory phenomena
- autonomic phenomena: sudden anxiety, tachycardia, sweating, piloerection, loss of bladder control
- cognitive phenomena: sudden failure to communicate/comprehend, hallucinations, intense feelings
What is status epilepticus?
Seizures that lasts longer than 5 minutes
OR
when seizures occur close together w/o regaining consciousness
What are the classic signs of MI?
- chest pain/discomfort/pressure
- pain in other parts of the body (unilateral Arm, shoulder blades, back, neck, jaw)
- SOB
- nausea
- sweating
- lightheadedness/dizziness
(Men/Women) can present with “silent symptoms” of MI
Women
- chest pressure
- SOB
- sweating
- nausea
- lightheadedness w/o exertion
What is shock?
Failure of the circulatory system to perfuse vital organs
blood is normally shunted from the periphery to maintain vital organs and core temperature
If HR and rhythm are affected due to shock, what can occur?
Can progress to cardiac death and rest
What are s/s of shock?
- pale, grey, or blue skin
- cool skin
- increased and weak pulse
- increased RR
- decreased BP
- drowsiness, diminished LOC, irritability, or restlessness
- N/V
How should you position a person who is in shock if they are responsive and breathing normally?
Supine
–> if no evidence of trauma or injury, person’s LEs can be elevated 6-12 inches (30-60 degrees) to help improve vital signs
DO NOT raise feet if the position and/or movement causes pain
What is vasovagal syncope?
Fainting with sudden drop in HR and BP
What are s/s of vasovagal syncope?
- pale skin
- lightheadedness
- tunnel vision
- nausea
- feeling warm
- cold/clammy sweating
- blurred vision
- slow, weak pulse
- dilated pupils
- jerky abnormal movements
What must you do if a person is experiencing vasovagal syncope?
Lie down with legs elevated until symptoms resolve
OR
Person can sit with their head in between their knees until symptoms resolve
Symptoms resolve typically within 15-30 minutes
getting up too soon puts the person at risk for fainting again.
What medications may prolong clotting?
- NSAIDS (nonsteroidal anti-inflammatory drugs)
- aspirin
Minor bleeds clot within 10 minutes
What do you observe with arterial bleeds?
- Blood is coming from the wound under high pressure
- bright red blood
What do you observe with venous bleeding?
- low pressure bleeding with a steady flow
- dark red/maroon blood
What do you observe with capillary bleeds?
- low pressure bleed
- oozing
- dark red blood
(true/false) When managing bleeding, you should have the part of the body elevated above the heart until bleeding stops
true
What pressure points/arteries should NOT be utilized when trying to manage an arterial bleed?
Femoral and brachial artery
use a torniquet
What is normally the cause of internal bleeding?
blunt trauma rupturing a blood vessel or an organ
What are s/s of internal bleeding?
- ecchymosis/bruises
- swelling (possible rebound tenderness)
- pale, gray, moist, or cold skin
- increased RR and HR
- Weak pulse
- decreased BP
- possible n/v
- possible anxiety/restlessness
- possible decline in Level of consciousness
After administration of an EpiPen, if the person does not respond to the initial dose in ___-___ minutes, a second dose may be administered
10-15 minutes
What are signs of heat stroke?
- nausea
- dizziness
- cramps
- feeling faint
- fatigue
- heavy sweating
- dizziness
- syncope
- confusion
- Sz
Same s/s as heat exhaustion with the addition of CNS s/s
What are s/s of heat exhaustion?
- nausea
- dizziness
- cramps
- feeling faint
- fatigue
- heavy sweating
What is the average length of stay in an acute care hospital?
4-5 days
What does primary care consist of?
Prevention, wellness, and treatment for common pt concerns
Personnel: RN, PCP, PA, NPs
Setting: outpatient
What does secondary care consist of?
Specialized care
Personnel: medical specialists (cardiologists, dermatologist, etc)
Often requires inpatient hospitalization or same-day surgery
(primary, secondary, tertiary) what care environment does PT/OT/SLP commonly work in?
secondary
What is tertiary care?
Highly specialized, technology based medical services (transplants, major surgery)
Personnel: highly specialized physicians in a hospital setting
What is a SNF?
Facility that skilled nursing services, rehab, and other healthcare services are given continuously on a daily basis –> requirement: services needed on a daily basis
- must be certified by medicare
- 24 hour nursing coverage
What is the avg. length of stay in an inpatient rehab hospital?
13 days
3 hrs of PT everyday
