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350 Midterm > Therapeutic Skills > Flashcards

Therapeutic Skills Flashcards

1
Q

What is an HAI?

A

A healthcare associated infection or hospital acquired infection is an infection that a patient has acquired at a healthcare facility. It was not present or incubating at the time of admission.

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2
Q

What factors increase risk of acquiring an HAI?

A

Age
# of HCP
# of invasive procedures
Length of stay in healthcare facility

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3
Q

What are the two categories of HAI?

A

Exogenous - microorganisms foreign to the body (i.e. salmonella)
Endogenous - the altering and overgrowth of a patients normal flora (i.e. yeasts, streptococci)

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4
Q

What are some examples of HAIs?

A

Surgical site infection
Ventilator-associated pneumonia
Antibiotic resistant organisms

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5
Q

What are the six links in the chain of infection/transmission?

A
  1. Infectious agent
  2. Reservoirs
  3. Portal of exit
  4. Mode of transmission
  5. Portal of entry
  6. Susceptible host
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6
Q

Give an example for each link in the chain of infection.

A
  1. Bacteria
  2. Environment
  3. Non-intact skin
  4. Droplet
  5. Mucous membrane
  6. Older persons
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7
Q

Give an example of how to break the chain of infection at each link.

A
  1. Rapid and accurate identification
  2. Environmental sanitization
  3. Practicing hand hygiene
  4. Air flow control
  5. Aseptic wound care
  6. Vaccines
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8
Q

Name and describe the four stages of the infectious process.

A
  1. Incubation period: interval between entrance of pathogen and appearance of first symptoms
  2. Prodromal stage: interval between onset of nonspecific symptoms and specific symptoms
  3. Illness stage: interval where patient manifests infection specific symptoms
  4. Convalescence period: symptoms begin to diminish, body returning to homeostasis
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9
Q

What are routine practices and that is their purpose?

A

Routine practices describe the level of care that should be in place for all patients, regardless of setting, that help prevent the spread of infection from patient to patient, patient to HCP, and HCP to patient.

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10
Q

What are some examples of routine practices?

A
  1. 4 moments of hang hygiene
  2. Using PPE
  3. Practicing the aseptic non-touch technique
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11
Q

Describe the sterility categories of procedures according to ANTT.

A
  1. Sterile - free from all microorganisms
  2. Aseptic - free from all pathogenic organisms in sufficient number to prevent infection
  3. Clean - free from marks or stains
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12
Q

Describe the core components of ANTT.

A
  1. Identify and protect key parts and sites
  2. Ensure that key parts only touch other key parts or key sites
  3. You must use: hand hygiene, non-touch technique, a defined aseptic field, sterile equipment
  4. You should not directly touch key parts or key sites
  5. Sequence practice to ensure efficient, logical, and safe order of tasks
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13
Q

What are the three types of additional precautions and what do they entail?

A
  1. Contact - gloves & gown
  2. Droplet - gloves, gown, mask, face shield
  3. Airborne - N95 respirator, closed door & windows, negative pressure room
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14
Q

When are additional precautions put in place?

A

When a patient is infected or colonized with an infectious agent, has symptoms of an infectious disease, or is part of a high-risk population.

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15
Q

Who can initiate and discontinue additional precautions?

A

Anyone can initiate. Only IPAC can discontinue.

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16
Q

How is the type of additional precaution determined?

A

Based on the mode of transmission of the infectious agent.

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17
Q

Name some examples of symptomology or history that you lead you to initiate additional precautions.

A
  • Unexplained nausea, vomiting or diarrhea
  • Undiagnosed respiratory infection
  • Undiagnosed rash
  • Recent travel and relevant symptoms
  • Hospitalization outside of Canada
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18
Q

What are the four moments of hand hygiene?

A
  1. Before patient
  2. Before aseptic procedure
  3. After body fluid contact
  4. After patient
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19
Q

Why is an alcohol based hand rub the preferred method of hand hygiene?

A
  • convenient and quick
  • excellent germicidal action, more effective than soap and water
  • helps to keep skin intact, less drying
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20
Q

When should you use soap and water over an alcohol based hand rub?

A

When your hands are visibly soiled

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21
Q

What are the principles of surgical asepsis?

A
  1. All objects used in a sterile field, must be sterile
  2. A sterile object remains sterile, only when touched by another sterile object
  3. A sterile object or field, out of the range of vision or an object held below a person’s waist is contaminated
  4. A sterile object or field becomes contaminated by prolonged exposure to air
  5. When a sterile surface comes in to contact with a wet contaminated surface, it becomes contaminated by capillary action
  6. Fluids flow in the direction of gravity
  7. The edges of a sterile field are considered contaminated
  8. Skin is unsterile and cannot be sterilized
  9. Conscientiousness and honesty are essential in maintaining sterility
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22
Q

Why and when do we measure vital signs?

A
  • Monitoring a patient’s condition, identifying a problem, evaluating interventions
  • Medical order, policy, change in condition, presenting non-specific symptoms, before/after surgery, meds, intervention
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23
Q

How do we evaluate vital signs?

A
  • Norms

- Pt baseline

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24
Q

What is the difference between core and surface temperature?

A
  • Core: tympanic, rectum, arterial, etc. Constant 37

- Surface: skin, axillae, mouth. Fluctuates 36-38

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25
Q

What are factors that influence our body temperature?

A
  • Age
  • Exercise
  • Hormone levels
  • Circadian rhythm
  • Stress
  • Environment
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26
Q

How does fever work as an important defence mechanism?

A
  • increases white blood cell count
  • decreases iron in blood plasma, which reduces space for bacteria to grow
  • stimulates the production of interferons
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27
Q

Discuss the pros and cons to each of the major temperature taking methods.

A 
Oral 
Axillary
Rectal
Tympanic
Temporal Artery
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28
Q

What are the 7 main pulse sites for assessment and what are their locations?

A 
Carotid
Apical
Brachial
Radial
Femoral
Posterior tibial
Dorsalis pedis
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29
Q

What are the HR ranges for an infant and adult?

A

Infant: 120-160
Adults: 60-100

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30
Q

Discuss the factors that affect HR and the circumstances under which each increases and decreases pulse.

A 
Exercise
Temperature
Emotions
Medications
Hemorrhage
Postural Changes
Pulmonary Conditions
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31
Q

What are characteristics are we assessing for HR?

A

Rate
Strength
Rhythm
Equality

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32
Q

What is tachycardia and bradycardia?

A

Tachycardia >100bpm

Bradycardia <60bpm

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33
Q

What is a pulse deficit?

A

Difference between two pulse sites, usually apical and radial pulse

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34
Q

What is sinus arrhythmia?

A

A pulse that is varies with the respiratory cycle.

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35
Q

What are the three actions in respirations?

A

Ventilation - the movement of gases in and out of the lungs
Diffusion - the movement of oxygen and carbon dioxide btwn the alveoli and red blood cells
Perfusion - the distribution of red blood cells to and from pulmonary capillaries

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36
Q

What are the respiration ranges for an infant and an adult?

A

Infant: 30-60
Adult: 12-20

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37
Q

Discuss the factors that affect respirations and whether they increase or decrease rate and depth.

A 
Exercise - increase
Acute pain - decrease
Anxiety - increase
Smoking - increase
Medications - both
Neuro trauma - decreases
Hemoglobin - increase
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38
Q

What characteristics are we assess for respirations?

A

Rate
Rhythm
Depth
Sound

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39
Q

What is bradypnea and tachypnea?

A

Bradypnea <12 breaths/min

Tachypnea >20 breaths/min

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40
Q

What does hyperpnea, apnea, and dyspnea describe?

A

Hyperpnea - laboured breathing
Apnea - pauses in breathing
Dyspnea - shortness of breath

41
Q

What is systolic pressure vs. diastolic pressure?

A

Systolic - maximum pressure when ejection occurs from the left ventricle
Diastolic - when the ventricles relax, the remaining blood in the arteries exerts pressure or the minimum pressure exerted against arterial walls at any time

42
Q

What is the range for optimal, normal, hypotensive, and hypertensive pressure in adults?

A

Optimal - 120/80
Normal - 135/85
Hypotension - <90/
Hypertension - >140/90

43
Q

Discuss the factors that affect blood pressure and whether they increase or decrease rate and depth.

A 
Age
Stress
Ethnicity
Gender
Daily variation
Medications
Activity, weight, smoking
44
Q

Discuss the cardiac factors that affect blood pressure.

A 
Cardiac output
Peripheral vascular resistance
Blood volume
Blood viscosity 
Elasticity of vessel walls
45
Q

Describe the five Korotkoff phases.

A
  1. Sharp thump - initial turbulent flow
  2. Swooshing - continuing turbulent flow
  3. Softer thump -
  4. Muffling - less turbulent, returning to normal
  5. Silence - blood flow returned to normal
46
Q

What is the 5th vital sign?

A

Pain -
Subjective, objective
PQRSTAAA

47
Q

Discuss factors that influence hygiene frequency and quality.

A 
Social practices
Personal preferences
Body image
Socioeconomic status
Health beliefs &amp; motivation
Cultural beliefs
Physical condition
48
Q

What factors put a client at risk for skin breakdown in the perineal area?

A
  • In-dwelling catheters
  • Recovering from rectal or genital surgery
  • Recovering from childbirth
  • Uncircumcised males
  • Incontinence
  • Obesity
  • Menstruation
49
Q

Discuss the factors that put a client at risk for general skin breakdown.

A
  • Immobilization
  • Reduced sensation
  • Nutrition and hydration alterations
  • Secretions and excretions
  • Vascular insufficiencies
  • External devices
50
Q

Discuss why oral hygiene is important for unconscious patients.

A
  • susceptible to drying of mucous-thickening salivary secretions
  • cannot swallow salivary secretions; secretions can cause pneumonia if aspirated into lungs
51
Q

Describe: Fowler’s, Trendelenburg, prone, supine, side-lying, and sim’s positions.

A
  • 45 degrees
  • HOB below feet
  • face down
  • on back
  • side-lying
  • prone with shoulder out
52
Q

What are the general objectives of bed rest?

A
  • reduce physical activity and oxygen demands
  • reduce pain
  • promote safety
  • allow for rest
53
Q

Discuss the 8 categories of physiological changes that can occur due to immobility.

A
  • Metabolic
  • Respiratory
  • Cardiovascular
  • Musculoskeletal
  • Urinary Elimination
  • Integumentary
  • Psychological
54
Q

What is a pressure injury?

A

A localized injury to the skin and/or underlying soft tissue as a result of prolonged ischemia

55
Q

What is shearing force vs. friction?

A

Shearing force - gravity and friction causing deep tissue necrosis
Friction - two surfaces moving across one another

56
Q

How can nurses prevent pressure injuries?

A
  • maintain good body alignment
  • position rotation
  • protecting bony prominences
  • keeping joints slightly flexed
  • avoid skin to skin contact
  • keeping bed clean, dry, and wrinkle free
57
Q

Discuss some nursing interventions used to address physiological changes that occur due to immobility.

A
  • maintain optimal nutritional state
  • promote expansion of chest and lungs
  • recent stasis of pulmonary secretions
  • maintain airway
  • reduce orthostatic hypotension
  • reduce cardiac workload
  • prevent thrombus formation
  • maintain muscle strength and joint mobility
  • maintain normal urinary elimination patterns
  • prevent pressure injuries
  • maintain psychological state
58
Q

ac

A

before meals

59
Q

ad lib

A

as desired

60
Q

bid

A

twice a day

61
Q

cap

A

capsule

62
Q

elix

A

elixir

63
Q

gtt

A

drops

64
Q

ID

A

intradermal

65
Q

IM

A

intramuscular

66
Q

IV

A

Intravenous

67
Q

OS

A

left eye

68
Q

OU

A

both eyes

69
Q

pc

A

after meals

70
Q

PO

A

by mouth

71
Q

prn

A

as needed

72
Q

qam

A

every morning

73
Q

qid

A

four times a day

74
Q

subcut

A

subcutaneous

75
Q

supp

A

suppository

76
Q

susp

A

suspension

77
Q

tab

A

tablet

78
Q

tid

A

three times a day

79
Q

1 tbsp

A

15 mL

80
Q

1 tsp

A

5 mL

81
Q

1 kg

A

2.2 lbs

82
Q

What three components are required of nurses for medication administration?

A

Authority
Competence
Safety

83
Q

What information should a nurse gather in an assessment before medication administration?

A

age, vitals, allergies, weight, med history, diagnosis, mobility, diet information, attitudes towards meds, orders, medication specifications.

84
Q

What does a complete order include?

A 
Patients name
Date and time of the order
Medication name
Dose
Route
Time &amp; frequency
Stop date
Signature of prescriber
85
Q

What must a nurse understand in order to safely administer medication?

A
  • drug classification
  • why it is being given
  • normal dosage range
  • usual route of administration
  • usual action
  • expected side effects
  • potential harmful side effects
  • peak action and duration
  • time of onset and action depending on route
  • necessity of pre/post assessment
86
Q

What are the 10 ‘rights’ of medication practice?

A
  1. Patient
  2. Medication
  3. Reason
  4. Dose
  5. Time & frequency
  6. Route
  7. Documentation
  8. To refuse
  9. Patient education
  10. Evaluation
87
Q

Discuss the when, where, and how of ID injections.

A

When: allergy testing
Where: inner arm, upper back
How: 1 mL tuberculin with pre-attached 26-27 G needle 1 cm in length at 5-15 degree angle

88
Q

Discuss the when, where, and how of SC injections.

A

When: insulin, LMWH, some immunizations
Where: loose connective tissue under the dermis (stomach, thighs, upper back)
How: 5/8” 25-30 G needle insert at 45 - 90 degree angle.

89
Q

Discuss the when, where, and how of IM injections.

A

When: influenza, pneumonia, HPV vaccines, irritating medications
Why: Fast absorption, less risk of causing deep tissue damage
Where: ventrogluteal, vastus lateralis, deltoid
How: 5/8” - 1.5” needle 22-25 G depending on weight and size. Insert at 90 degree angle. Max 3 mL for adults in legs, 1 mL for deltoid.

90
Q

What is the preferred IM injection site for adults and children?

A

Ventrogluteal

91
Q

What is the preferred injection site for immunizations?

A

Deltoid

92
Q

What is the preferred injection site for emergencies?

A

Vastus Lateralis

93
Q

What is the preferred IM injection site for infants?

A

Vastus Lateralis

94
Q

What needs to be considered when choosing a needle size and length?

A
  1. Pt weight and size
  2. Type of tissue
  3. Viscosity of the fluid
95
Q

What are the phases of wound healing and what do they entail?

A
  1. Inflammation phase - control bleeding, deliver blood and cells to injured area, epithelial cells form at injured site.
  2. Proliferation phase - filling in the wound with granulation tissue, contraction of the wound, and resurfacing of the wound by epithelialization.
  3. Remodeling phase - collagen fibers continue to gain strength, epidermal layers are re-established.
96
Q

What is a nurse looking for when assessing a wound?

A 
Appearance
Drainage
Drains
Closures
Palpation
Pain
97
Q

What are the nursing interventions to promote wound healing?

A
  • dressings
  • irrigation
  • cultures
  • packing
  • bandaging
98
Q

What are three pressure related factors that contribute to the development of pressure related injuries?

A

Pressure intensity
Pressure duration
Tissue intolerance

350 Midterm (2 decks)

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