Term
| Nursing Practice requires:(3) |
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Definition
1. Cognitive skills
2. Interpersonal skills
3. Psychomotor skills |
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Term
|
Definition
1. Nurse Practice Act of State Board of Nursing of each state
2. Written policies and procedures of employing institutions
3. Federal and state hospital licensing laws
4. Professional organization standards |
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Term
The 5 rights of delegation:
(see p.6; box 1-3) |
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Definition
1. Right task
2. Right circumstances
3. Right person
4. Right direction/communication
5. Right supervision |
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Term
| What separates the professional nurse (R.N.) from the unlicensed health care workers? |
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Definition
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Term
| Clinical Thinking is (powerpoint Definition): |
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Definition
| A reasoning process that requires commitment to grow intellectually; used in making clinical decisions and judgments |
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Term
| Five (5) components of critical thinking (Powerpoint). |
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Definition
| knowledge, experience, attitudes, standards, and the nursing process |
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Term
| Purpose of the nursing process: |
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Definition
| to diagnose and treat human responses to actual or potential health problems |
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Term
| The steps of the nursing process (5): |
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Definition
Assessment
Nursing Diagnosis
Planning
Implementation
Evaluation |
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Term
|
Definition
Use of current best knowledge, clinician's expertise, client’s values and preferences when making clinical decisions
Use of the best scientific information available and apply it to bedside client care. |
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Term
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Definition
| unexpected occurrence involving serious physical or psychological injury |
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Term
| National Patient Safety Goals are set by: |
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Definition
| Joint Commission on Accreditation of Healthcare Organizations (JCAHO) |
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Term
| Four (4 ) Safety Risk Categories: |
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Definition
1. Injury from falls (90% of all reported incidents)
2. Client-inherent events: self-inflicted cuts, burns, ingestion or injection of foreign substances
3. Procedure-related accidents: med & fluid admin errors, improper performance of procedures
4. Equipment –related accidents: electrical malfunction, disrepair, or misuse of equipment |
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Term
| 2006 National Safety Goals for Hospitals (9): |
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Definition
1. Improve accurate client identification
2. Verify telephone or verbal orders
3. Standardize abbreviations, acronyms, symbols
4. Improve timeliness of reporting test results
5. During staff reports, give opportunity to ask questions
6. Improve safety of using medications
7. Reduce risk of health care-associated infections HAI)
8. Accurately reconcile medications given over continuum of care
9. Implement and evaluate a Falls Reduction Program |
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Term
| FALLS PREVENTION GUIDELINES (10): |
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Definition
1. Adjust bed to proper height and lower side rail
2. Orient client to call light and intercom
3. Use of hospital bed and side rails…entrapment with more than two of four rails up at once; check hospital policy
4. Arrange necessary items in logical use sequence (i.e. water pitcher, telephone, reading material, dentures, etc.)
5. Instruct client/family about assistance or activity restriction
6. Explain specific measures that restrict falls (i.e. footwear, dangle first, walk slower, etc.)
7. Clear pathway for ambulatory client
8. Provide adequate lighting
9. Consult with Physical Therapy re: gait or muscle strengthen exercises
10. Confer with MD about reducing or adjusting types/numbers of medications |
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Term
| When should hand washing be used? (6) |
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Definition
1. Hands are visibly dirty or have protein material on them
2. Contact w/ blood or other body fluids
3. Caring for a C-DIFF client (antiseptic hand rub-alcohol does not kill C- Difficile; soap and water does)
4. Exposed to spore forming bacteria (e.g.Clostridium or Anthrax)
5. Before and after eating
After using rest room |
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Term
| When is it appropriate to wash with antiseptic hand rub? |
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Definition
1. IF hands are NOT visibly soiled
Before direct contact with client
2. Before donning sterile gloves
Before performing sterile procedure
3. After contact with client’s intact skin (ie. taking BP or lifting client)
4. When moving from contaminated body site to a clean-body site during care.
5. When in contact w/ medical equipment in client’s vicinity
6. After removing gloves |
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Term
| What is the most prevalent and debilitating occupational health hazard among nurses? |
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Definition
| Musculoskeletal disorders |
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Term
| Guidelines to moving an and positioning the client safely. |
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Definition
1. Use Ergonomics: fitting the task to the worker e.g. elevate the bed to working level, have additional workers, and use assistive devices
3. Use correct body alignment of client
e.g. no excessive strain of joints, tendons, ligaments, or muscles
3. Use the general rule: Reposition q2h if in bed and q20-30 minutes if sitting in chair |
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Term
| Considerations for clients that are in beds.(5) |
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Definition
1. Regularly scheduled program for ROM exercise
2. Protect skin from shearing forces (See p. 96)
3. Use pillows and foam wedges for bony prominences
4. Risk for deep vein thrombosis (DVT)
5. Use of elastic stockings and Sequential Compression Devices (SCDs) (see pp 104-5) |
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Term
| What is the semi-fowlers position? |
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Definition
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Term
| What is the high fowlers position? |
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Definition
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Term
| What is the sims position? |
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Definition
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Term
| What is the prone position |
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Definition
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Term
| What is the supine position |
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Definition
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Term
| Steps to assist client to sit position in bed and Transfer from bed to chair - pp 107-9 |
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Definition
1. Position chair so the move will be toward client's stronger side
2. Lower bed to lowest position; side rail down
3. Raise head of bed to highest position
4. If client bear weight, stand by for safety as needed
5. If client bears partial weight. . .
a. face client with feet shoulder width apart
b. assist client to sit-up
c. apply transfer or gait belt
d. apply nonskid slippers
e. spread client's feet apart , aligning your knees with clients and your foot against client’s
f. rock client up to stand position
g. pivot client toward seat of chair and ease into |
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Term
| What is ORTHOSTATIC (Postural) HYPOTENSION? |
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Definition
a gravity –induced drop in blood pressure (BP)
blood shifted from thorax to pelvis and legs and the redistribution of the blood causes the drop in BP |
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Term
| Signs/Symptoms of orthostatic hypotension |
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Definition
| dizziness, light-headedness, nausea, tachycardia, pallor, fainting |
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Term
| Steps in initiation protocol (11) |
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Definition
1. VERIFY MD’s orders/obtain consent PRN
2. GATHER equipment and supplies
3. PERFORM hand hygiene for 10-15 seconds before each patient contact
4. IDENTIFY client via armband and ask pt to state name
5. INTRODUCE self (name, title, role)
6. EXPLAIN procedure w/ rationale in understandable terms
7. IDENTIFY teaching needed and what to expect
8. ASSESS client to determine if intervention is appropriate
9. ADJUST bed height and lower side rail
10. PROVIDE adequate lighting
11. PROVIDE for patient privacy |
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Term
| Steps in completion protocol.(6) |
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Definition
1. ASSIST CLIENT to position of comfort & organize needed toiletry or personal items within reach
2. BE CERTAIN client has a way to call for help and knows how to use it
3. RAISE the appropriate number of side rails and lower the bed to the lowest position
4. DISPOSE of used supplies and equipment
5. REMOVE AND DISPOSE of gloves, if used. Perform hand hygiene for 10-15 seconds minimum
6. DOCUMENT AND REPORT client’s response and expected or unexpected outcomes |
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Term
| Standard protocol during nursing skills (2) |
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Definition
1. PROMOTE client independence and involvement
2. ASSESS client tolerance and be alert for signs of discomfort and fatigue |
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Term
| Bathing considerations (3) |
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Definition
1. Privacy; draping: expose only areas being washed
2. Assess skin (color, temp, moisture, texture, thickness, edema, turgor, vascularity, lesions)
3. Safety (precautions with tub or shower) |
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Term
|
Definition
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Term
| Signs/Symptoms of dysphagia (8): |
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Definition
1. Choking while eating or drinking
2. Frequent need to clear throat
3. Drooling or leakage of food form mouth
4. Coughing during or after meals
5. Holding pockets of food in the cheeks
6. Unusally intense chewing or repeated attempts to swallow one bite of food
7. Gurgled voice after eating (ask client to as “Ah”)
8. Increased congestion or secretions after eating or drinking |
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Term
| Backrub procedure (10 steps) |
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Definition
1. Use lotion to stimulate circulation
2. Begin in sacral area
3. Massage in circular motions
4. Stroke upward from buttocks to shoulders, upper arms and scapula
5. Use firm, smooth strokes
6. Keep hands on skin in massage pattern for 3-4 minutes
7. Knead skin along sides of spine and neck
8. End with long stroking movements; Tell patient “it’s ending”
9. Observe skin for redness and skin breakdown
1. Remove excess lotion |
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Term
| What are the (5) vital signs? |
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Definition
| Temp, Pulse, Resp., B/P, Pain |
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Term
| Purpose of vital signs (4) |
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Definition
1. Indicate client’s response to physical, environmental,& psychological stressors.
2. Used to assess body systems status
3. Nurse: measures, understands, interprets, and begins interventions based on V.S. findings.
4. Keep client informed of findings to promote active participation in health status |
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Term
|
Definition
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Term
|
Definition
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Term
| Temperature Measurement Sites and relative tempatures. |
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Definition
Oral/Tympanic- 98.6 F; most advantages
Rectal- 1 degree > oral, (R ), red probe
Axillary- 1 degree < than oral, (ax) |
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Term
|
Definition
4+ bounding;
3+ full;
2+ normal;
1+ weak
0= absent |
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Term
|
Definition
radial, apical, carotid,
peripheral pulses (popliteal, posterior-tibial, dorsalis pedis ) |
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Term
| Pulse assessment in infants is typically done at what two sites? |
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Definition
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Term
| What location provides the most accurate measure of heart rate & rhythm? |
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Definition
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Term
|
Definition
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Term
|
Definition
|
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Term
|
Definition
| difference between apical & radial rates |
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Term
| Reasons for large pulse deficit. |
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Definition
1. hardening of arteries (arteriosclerosis)
2. ischemia (insufficient blood flow) 3. ↑ intra cranial pressure. |
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Term
| What are three processes of ventilation? |
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Definition
1. Ventilation
2. Diffusion
3. Perfusion |
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Term
|
Definition
| mechanical movement of air in/out of lungs |
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Term
|
Definition
| resp gas movement. (02 & CO2) between alveoli & RBC’s |
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Term
|
Definition
| distribution of blood thru pulmonary capillaries |
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Term
| Normal rate of respiration: |
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Definition
|
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Term
|
Definition
| respiration ceases for several sec or persistent cessation => results in resp. arrest |
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Term
|
Definition
| inadequate/difficult breathing |
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Term
|
Definition
| abnormally slow (< 12 breaths per min.). |
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Term
|
Definition
| abnormally rapid (> 20 breaths per min.). |
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Term
|
Definition
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Term
|
Definition
| resp. rate is abnorm low, depth ↓. |
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Term
|
Definition
| diff. breathing while lying flat, relieved w/ sitting or standing |
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Term
| Cheyne-Stokes Respirations: |
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Definition
a form of periodic breathing. Typically, in a period of 1 minute:
10-20 second of apnea, then respirations of increasing depth and frequency. Then the cycle repeats itself |
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Term
| Causes of chyene stokes respirations. |
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Definition
| Seen w/ CHF, ↑ cranial pressure, impending death |
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Term
|
Definition
| peak pressure during heart’s contraction |
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Term
|
Definition
| minimal pressure on arterial walls as ventricles relax |
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Term
|
Definition
| diff. between systolic & diastolic pressures, and reflects the stroke volume |
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Term
|
Definition
| width= 2/3 of upper arm length |
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Term
|
Definition
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Term
|
Definition
| BP insufficient for adequate perfusion & oxygenation of tissues |
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Term
| Factors influence BP (9): |
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Definition
| age, gender, body build, race, medications, emotions, physical activity, PAIN, location of cuff. |
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Term
| Do not take blood pressure on (4): |
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Definition
1. Injured extremity
2. Extremity w/ IV present
3. Arteriovenous (AV) shunt for renal dialysis
4. Arm on side of previous breast/axilla surgery |
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Term
| Elements in a chain of infection (6): |
|
Definition
1. INFECTIOUS AGENT-
2. MODE OF TRANSMISSION-
3. SUSCEPTIBLE HOST-
4. PORTAL OF ENTRY-
5. RESERVOIR-
6. PORTAL OF EXIT |
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Term
|
Definition
| absence of disease-producing organisms by the purposeful prevention of microorganism transfer |
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Term
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Definition
| clean technique; A clean technique that limits the number of pathogens that could cause infections; application of barrier techniques to break the infectious cycle |
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Term
|
Definition
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Term
| 3 Components of MEDICAL ASEPSIS: |
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Definition
(1) hand washing,
(2) barriers of PPE (gloves, gowns, mask, protective eyewear) &
(3) routine environmental cleaning |
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Term
|
Definition
| one suspected of containing pathogens eg. used bedpan, wet gauze, soiled linen, laboratory specimens, etc |
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Term
|
Definition
| Health-care-associated infections (HAIs) not present or incubating at time of admission |
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Term
|
Definition
| related to a client’s treatment or diagnostic procedure; eg through an IV line or after respiratory suctioning |
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Term
|
Definition
| as a results of the facility or personnel; eg. A URI from contact with a caregiver who has a URI |
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Term
|
Definition
| from clients themselves –or- reactivation of a previous dormant organism such as tuberculosis; eg vaginal yeast in woman receiving antibiotic |
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Term
| STANDARD PRECAUTIONS –Tier 1 (6): |
|
Definition
1. HAND HYGIENE- between client contacts; after contact w/ blood, body fluids, secretions, excretions; equipment or articles contaminated by them; immediately after gloves are removed
2. GLOVES WORN- touching blood, body fluids, secretions, excretions, non-intact skin, mucous membranes or contaminated areas
3. MASKS, EYE PROTECTION OR FACE SHIELDS- if in contact w/ sprays or splashes of body fluids
4. GOWNS- if soiling of your clothing is likely from blood/body fluids
5. CONTAMINATED LINEN- placed in leak-proof bag so no contact with skin or mucous membrane
6. RESPIRATORY HYGIENE/COUGH ETIQUETTE (CDC 2004)- provide client with tissues and containers for disposal ; stand 3 feet (min) away from coughing; use masks prn |
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Term
| STANDARD PRECAUTIONS- Tier 2: |
|
Definition
1. Barriers for AIRBORNE- -negative air-pressure room w/6-12 air changes /hr
-use respiratory protective equipment (mask) during care
2. Barriers for DROPLET-
-use respiratory protective equipment (mask) within 3 feet
3. Barriers for CONTACT-
-use PPE (gown, gloves, mask) when contact with body secretions |
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Term
| Antibiotic –Resistant Strains (6): |
|
Definition
1. Methicillin-resistant Staphylococcus aureus (MRSA)
3. Multi-drug resistant tuberculosis (MDR-TB)
4. Penicillin-resistant Streptococcus pneumoniae (PRSP)
5. Vancomycin-resistant Enterococci (VRE)
6. Extended-spectrum-beta-lactamase organisms (ESBL)
7. Clostridium difficile (C-DIFF) |
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Term
| MRSA causes and treatments: |
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Definition
Now prevalent in the community eg. children in day care and where athletes share equipment
-Colonizes in the nares & skin; transmit by direct contact, not respiratory
-Soft tissue infections manifest as: abscesses, furuncles or cellulitis and may be mistaken for a spider bite
-Drug of choice for Hospital-acquired MRSA: Vancomycin
-Drugs of choice for Community acquired MRSA: tetracycline, doxacycline, clindamycin, sulfamethoxazole-trimethoprim |
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Term
| VRE (Vancomycin Resistent Enterococci)causes and treatments |
|
Definition
-Enterococci are part of normal flora in gastrointestinal and female genital tract
-Vancomycin was drug of choice; now frequent use caused resistance
-Contact Isolation needed
-Spread by direct skin-to-skin contact.. with patient, his environment, bedrails, lunch trays, etc. |
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Term
| C-DIFF (Clostridium Difficile)causes and treatments. |
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Definition
-From frequent use of broad-spectrum antibiotics
-Results in Nosocomial diarrhea
-Contact isolation needed
-Spread by direct skin-to-skin contact.. With patient, his environment, bedrails, lunch trays, etc. |
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Term
|
Definition
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Term
|
Definition
| how drugs move to sites of action |
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Term
|
Definition
| chemical reaction to break down drug to be inactive |
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Term
|
Definition
| elimination of drug from body thru GI tract, kidneys, other body secretions |
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Term
|
Definition
| time from ingestion to first effect |
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Term
|
Definition
| time to reach highest effective concentration |
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Term
|
Definition
| time from ingestion to no further effect |
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Term
| Components of Medication Orders (6): |
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Definition
| Drug Name, dose, route, frequency, reason, signature |
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Term
| Six ”RIGHTS” of Med Administration |
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Definition
1. Right Drug
2. Right Dose
3. Right Client
4. Right Route
5. Right Time
6. Right Documentation |
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Term
| 10 steps for preventing medication errors: |
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Definition
1. Follow the 6 Rights
2. Don’t assume route
3. Read label 3 times
4. Use 2 client identifiers
5. Avoid distractions
6. Double check calculations & Verify with another nurse
7. Don’t guess on written order; call prescriber
8. Question unusually large or small doses
9. Document as soon as given
10. If an error is made, reflect on how to prevent in future |
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Term
| Geriatric Considerations for medications |
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Definition
Polypharmacy- many meds to treat same or many disorders, so incr. drug interactions
Difficulty swallowing lg tabs- sit upright, full glass water, head forward
Slow drug excretion /overuse laxatives- instruct inc. fluid intake, high-fiber foods
Liver detox slows so incr toxicity/sensitivity-monitor for liver dysfunction (labs, jaundice, dark urine)
Drug accumulation alters renal fx- Monitor for renal impairment (decr urine out)
High Risk for Falls/ Confusion
Constipation & GI Upset common.
Self-prescribing- OTC preparation, herbs, folk medicine
Misuse of drugs- under, over, erratic
Noncompliance- misuse of med from unpleasant side effects or financial resources |
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Term
| Advantages of oral medications |
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Definition
Advantages: easy; majority of medications administered; self-administer
Disadvantages: liquids absorbed more quickly than tablets/capsules; slow absorption if with full meals; GI irritation
May have local or systemic effect |
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Term
| Steps for Administration of Oral Medications through Feeding Tube: |
|
Definition
Nasogastric (NG) –or- Nasojejunal tube
Elevate head of bed 60-90 deg.; Verify tube placement; Aspirate for residual; Flush tube w/30 ml water; clamp tube keeping syringe attached; administer medication
Liquids: pour into syringe; allow flow by gravity; flush w/ 30-60 ml water if only one dose; use 15 ml flush between multiple dose and follow last med w/ 30-60 ml
Crushed Tabs> crush and dilute w 15-30 ml warm water; proceed as giving liquid med |
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Term
| Precutions and guidlines for topical meds: |
|
Definition
Apply to skin, mucous membrane, tissue membrane
Used with lotions, patches, pastes, ointments
Sustained, continuous release of med for hours/days
Systemic reaction if skin is thin
Skill: Clean skin first; if patch, do not touch medicated side (wear gloves); avoid previously used site for 1 week |
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Term
| Administration of eye drops: |
|
Definition
O.D.=right eye
O.S.= left eye
O.U.=both eyes
Apply:
Liquids into conjunctival sac; Ointments along inside edge
of lower eyelid on conjunctiva from inner to outer canthus
Technique:
Pt in supine position w/ neck slightly hyper extended (NOT w/ neck injury).
Tell pt to ”look up”,
Apply pressure to lacteal tear duct to avoid systemic reaction!!
Wash away old drainage PRN /or Soak |
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Term
| Technique for administering ear drops. |
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Definition
Straighten ear canal age 3 to adult = pull pinna up and back
under age 3= pull pinna down and back
Technique:
- warm ear drops
- side position/or sitting
- remove cerumen w/ cotton applicator if visible.
- hold ½” above ear canal
- DO NOT touch application chamber to walls of ear canal.
- remain on side for 5-10 mins.
Apply gentle pressure or massage to tragus
- If ordered, place cotton ball (remove after 15 mins.) |
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Term
| technique for administering multi-dose inhaler (MDI) |
|
Definition
measured dose of (spray, mist or fine powder) medication to penetrate lung airway
local effects but also systemic side effects
Technique:
- Shake well; Take deep breath and exhale
- Insert inhaler ½ - 1” , w/ opening toward throat - - Place lips around mouthpiece
- Inhale at same time as depressing canister
- Hold breath for 10 seconds.
- Wait 1-2 minutes between puffs.
- Spacer used for infants/children |
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Term
| Technique for administering Vaginal meds |
|
Definition
Body temp melts med
larger and more oval than rectal suppository
Do inspect condition of external genitalia and vaginal canal prior to insertion.
Insert approx. 2-3 inches
Instruct client on need for disposable panty liners due to meds. melting.
Client may prefer to insert themselves. |
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Term
| Technique for administering anal suppositories |
|
Definition
For fever, pain, bowel elimination
Examine condition of external anus
Don’t use this route after rectal surgery or if active rectal bleeding or diarrhea present.
Left side-lying position for 5-10 min.
Insert 4 inches in adults-past anal sphincter |
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|
Term
| Types of parenteral administration |
|
Definition
Intramuscular = IM, deep in muscle
Subcutaneous = SC or SQ, in fatty layer
Intradermal = ID, just under skin
Intravenous = IV, into the vein |
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|
Term
| What is the Needle stick Safety & Prevention Act (2001) |
|
Definition
Federal Law; Mandates health care facilities to use safe needle devices
Device examples
Safety syringe (plastic guard)
Needleless IV line connections
Sharps disposal in puncture-proof, leak- proof containers |
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Term
|
Definition
|
|
Term
|
Definition
1. 3 ml ….marked in tenths;
2. 1 ml Tuberculin… marked in tenths;
3. Insulin…marked in Units, usually 100 |
|
|
Term
|
Definition
| hub, shaft, bevel (sterile at all times |
|
|
Term
|
Definition
| : ¼ to 3 inches; 18-27 gauge |
|
|
Term
|
Definition
| deltoid, Ventrogluteal, vastus lateralis |
|
|
Term
|
Definition
| greater trochanter & anterosuperior iliac spine |
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|
Term
| Preferred IM site in children less that 1 yr: |
|
Definition
|
|
Term
| Landmarks for vastus lateralis IM site: |
|
Definition
| greater trochanter and patella |
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|
Term
| What shot is only administered in the deltoid? |
|
Definition
| Hepatitis B given only in deltoid |
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|
Term
|
Definition
|
|
Term
| What volumes may be administered IM in detoid? |
|
Definition
| Use for small volume of med :0.5ml-1 ml |
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|
Term
| What length of needle should be used for sub-q injections? |
|
Definition
| ideally, needle length is ½ width of skin fold |
|
|
Term
| Rate of absorption for sub-Q sites. |
|
Definition
| #1-abdomen; #2-arms; #3 thighs; #4-buttocks |
|
|
Term
|
Definition
Sweating, tachycardia,
palpitations, nervousness,
tremors, weakness,
headache, mental confusion,
fatigue |
|
|
Term
| Symptoms of hyperglycemia: |
|
Definition
Thirst, polyuria, blurred vision,
nausea, vomiting, abdominal cramps, weakness, fatigue, headache |
|
|
Term
| Administering cloudy + clear insulin: |
|
Definition
| cloudy, clear, clear, cloudy |
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|
Term
| Precautions when administering heparin: |
|
Definition
RX Action: Clot formation is suppressed, so risk bleeding is increased
S/S : Bleeding gums, hematemesis, hematuria, melena
Lab: PTT (Partial Thromboplastin Time) monitors therapeutic range
Site: abdomen, 2 inches from umbilicus |
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|
Term
| Guidelines for intradermal injections |
|
Definition
Used for local anesthetic or skin testing
Meds are potent…possible analphylaxis
Dermis has DECREASED blood supply so slow absorption
Sites: inner forearm or upper back
Use TB syringe; 3/8 - 5/8 needle, 25-27 gauge, 5-15 degree angle; inject max 0.01-0.1 ml |
|
|
Term
| ASASH Method for IV injections. |
|
Definition
A- ASPIRATE for blood return
S- SALINE FLUSH (10 ml syringe)
A- ADMINISTER (MED) at proper rate
S- SALINE FLUSH (10 ml syringe)
H- HEPARIN (reduce clot formation in catheter) |
|
|
Term
|
Definition
Procedures used to keep objects and areas free from all microorganisms; the highest level of aseptic technique
Used during diagnostic procedures, in OR and Delivery area, procedures that required penetration of the client’s skin eg. Injections, IV insertions, wound (dressings), indwelling tube insertions (foley catheter, chest tubes) |
|
|
Term
|
Definition
| kills all microorganisms incl spores and viruses |
|
|
Term
|
Definition
| use of chemicals on objects to kill or reduce microorganisms |
|
|
Term
| 8 Principles of Surgical Asepsis |
|
Definition
1. All items used within a sterile field must be sterile
2. A sterile barrier that has been permeated by moisture must be considered contaminated
3. Once a sterile package is opened, the edges are considered unsterile
4. Gowns, once put on, are considered sterile in front from chest to waist or table level
5. Tables draped as part of sterile field are considered sterile only at table level
6. If there is any question/doubt of an item’s sterility, the item is considered unsterile !
7. Persons with sterile barriers (gloves) or sterile items make contact only with sterile areas/items
8. Movement around and in the sterile field must not contaminate the sterile field |
|
|
Term
| Procedures for maintaining surgical asepsis |
|
Definition
Educate client / family of need to maintain sterile fields
Check expiration dates/examine stripes changed after sterilization
Avoid delegation of sterile technique procedures to assistive personnel
Label and date bottles/medication once opened (good for ~30 days).
“Lipping” previously opened solutions to remove microorganisms possibly present on edges
Place the top from the solution on table w/ inside of top facing UP. |
|
|
Term
Which procedures require medical aseptic technique and which require surgical aseptic technique?
Urinary catheterization
Tracheal suctioning
Insertion of a rectal suppository
Insertion of a nasogastric feeding tube
Lumbar puncture
Sitz bath |
|
Definition
|
|
Term
| Steps for donning sterile gloves(5): |
|
Definition
Open outer wrapper
Open inner wrapper on a clean , uncluttered surface
Grasp cuff and insert fingers into glove;
Pull cuff down
Using gloved hand, grasp under cuff of glove, lift up, and insert other hand…be careful not to contaminate any portion of the sterile glove surfaces |
|
|
Term
| LEVELS OF LATEX REACTIONS: |
|
Definition
1. Contact dermatitis- nonallergic, skin redness w/ itching.
2. Type IV hypersensitivity- redness, itching, hives, runny nose or coughing (can be delayed 48 hours).
3. Type I hypersensitivity-> LIFE THREATENING
local or systemic reaction:
hives, edema, itching, rash, wheezing, bronchospasms, difficult breathing, laryngeal edema, diarrhea, nausea, hypotension, tachycardia, resp/ cardiac arrest. |
|
|
Term
| Types of Urinary Catheters (3): |
|
Definition
1- Straight Catheter (eg.Red Rubber)
2- Indwelling Urinary Catheter (Foley)
3- Suprapubic Catheter (Thru abd skin into bladder) |
|
|
Term
| Characteristics of a straight catheter |
|
Definition
Used for one-time urine drainage/ residual urine, or specimen collection
A single lumen
Inserted using strict sterile technique
Does NOT have balloon |
|
|
Term
| Characteristics of an Indwelling (foley) urinary catheter |
|
Definition
A retention catheter; used for continuous urine drainage
Inserted using strict sterile technique
Double lumen, (1) for balloon inflation
(2) for urine drainage
Incorporates balloon (5-10cc inflated |
|
|
Term
| Characteristics of a triple lumen catheter. |
|
Definition
Continuous bladder irrigation
Inserted using strict sterile technique
3-way irrigation w/ triple lumen (closed system)
Used post bladder surgery: keeps bladder clear of blood clots/sediment
Dr Orders solution, strength & flow rate. |
|
|
Term
|
Definition
Very small tube lumen
Drains directly from bladder through abdomen wall
Used post gyn or bladder surgery, or spinal cord injuries.
Generally more comfortable then indwelling catheter, Decreases # of UTI’s. |
|
|
Term
| Nursing Assessment of patient with indwelling catheter (5): |
|
Definition
Palpate bladder for distention/ tenderness
Assess if pain/ spasms present
Document urine color, amt, clarity, odor, +/- of mucous, clots or sediment
Strict I & O’s
Client education and knowledge deficits |
|
|
Term
| Central Venous Line (CVL)characteristics: |
|
Definition
Used when client receives IV therapy> 7 days via subclavian, jugular, femoral veins
Administers IV fluids, meds, blood, TPN, or hemodialysis .
Single/ or Multiple Lumen catheter
Serious risk for sepsis, thrombophlebitis, endocarditis, metastatic infection |
|
|
Term
| Central Venous Line PORTS (5): |
|
Definition
Catheter is inserted by MD w/ strict sterile technique
Ports labeled with gauge size & position (eg. 16g distal)
Largest Port = Blood & Colloid Adm.
Most Distal/ Unused Port= TPN ONLY
Middle Port= CVP (central venous pressure) monitoring or IV infusions
Proximal Port= IV infusions
Proximal Lumen= Obtaining blood specimens |
|
|
Term
| Total Parenteral Nutrition characteristics: |
|
Definition
Administration through a central vein of a nutritionally complete formula, including amino acids, 30%dextrose, fat emulsions, vitamins, electrolytes, minerals, and trace elements
Patients receiving have a non-functioning GI tract from illness impairing absorption
Most Distal/ Unused Port= TPN ONLY
Note:
TPN tubing must be changed q 24hrs
TPN bag now good for 24 hrs. |
|
|
Term
| Peripherally Inserted Central Catheter (PICC) Characteristics: |
|
Definition
Long Term Central Venous Access Devices (CVADs) are inserted by PICC Nurse or MD
PICC: Extends from antecubital fossa w/ distal end of catheter resting in central circulation ~heart. See illustration p 787
Other long-term devices: surgically tunneled so portion lies in SQ tissue before exiting body (eg. Hickman)
Other long term devices: surgically implanted & placed in vessel, body cavity, or organ and attached to reservoir placed under the skin (eg. Port-a-Cath) |
|
|
Term
| CVL or PICC Line Sterile Dressing Procedure (15 steps): |
|
Definition
1.Gather equipment (sterile dressing change tray, etc)
2.Apply non sterile (clean ) gloves
3. Don mask.
4.Remove old dressing & tape in direction of insertion. Dispose in biohazard receptacle
5. Inspect catheter, insertions site, suture, & skin
6. REMOVE Non-sterile gloves; then DON sterile gloves.
7.Cleanse w/ ETOH swab x2 (inner→outer motion; “C” technique). No ETOH in incision or on line.
8. After dry, use chlorhexadine swab using a back & forth motion, scrubbing insertion site, surrounding area & tubing for 30 seconds.
9. Allow to dry; apply sterile clear or gauze dsg.
10. Write date, time, & initials on label.
11. Tape dressing -coil extension tubing & secure to arm.
12.Clamp lumens to catheter, one at a time and remove injection caps.
13.Cleanse ports w/ chlorhexadine or alcohol & allow to dry.
14.Apply new caps.
15.Open clamps for infusions to flow |
|
|
Term
| Risk factors for pressure ulcers(3): |
|
Definition
| immobility, decreased sensation, inadequate nutrition |
|
|
Term
|
Definition
| a parallel force that stretches tissue and blood vessels, such as when patient in Semi-Fowlers, starts to slide towards the foot of the bed |
|
|
Term
| Common sites for pressure ulcers (6): |
|
Definition
| sacrum, heels, elbows, lateral malleoli, trochanters, and ischial tuberosities |
|
|
Term
| Three factors leading to formation of pressure ulcers. |
|
Definition
1. Intensity of pressure;
2. duration;
3. tissue tolerance |
|
|
Term
|
Definition
I: nonblanchable erythema; remains red 30 min after pressure relieved; epidermis intact,
II: epidermis broken; lesion superficial; partial thickness dermis loss
III: full thickness dermis loss; SQ fat may be visible
IV: : full thickness dermis loss with exposed bones, muscles, tendons |
|
|
Term
|
Definition
| any fluid that has exuded out of tissue |
|
|
Term
|
Definition
| formation of new epithelial tissue |
|
|
Term
|
Definition
| soft rubber; pulled out in stages as wound heals from inside out |
|
|
Term
|
Definition
|
|
Term
|
Definition
| partial or total separation of wound or incision edges |
|
|
Term
|
Definition
| proliferation stage of wound healing |
|
|
Term
|
Definition
| procedure to loosen necrotic tissue |
|
|
Term
|
Definition
|
|
Term
|
Definition
| thick yellow, green, tan, or brown |
|
|
Term
|
Definition
| total separation of wound layers and protrusion of viscera through the wound opening |
|
|
Term
| Types of wound healing(2): |
|
Definition
| Primary intention, Secondary intention. |
|
|
Term
| PRIMARY Intention wound healing: |
|
Definition
when edges of a clean surgical incision are sutured or stapled together
-tissue loss is minimal or absent;
-wound is not contaminated with microorganisms
-re-establishment of the epidermal layer…
- by post-op day 5, palpate a ”healing ridge” under the dressing |
|
|
Term
| SECONDARY intention wound healing: |
|
Definition
heals from inside out
-accompanies traumatic open wounds w/ tissue loss –or-
wounds w/ high microorganism count
-not sutured at skin level
-a regeneration process using scar tissue to fill in volume of tissue defect
heal from the inside out |
|
|
Term
| Factors that IMPAIR WOUND HEALING(8): |
|
Definition
1. Increasing Age- epidermal & dermal cell atrophy; slows wound contraction
2. Inadequate Nutrition- delay tissue repair and increases risk of infection
3. Obesity- less blood supply in fat tissue to transport nutrients for healing
4. Hematocrit (Hct) < 20% & Hemoglobin (Hgb) < 10 = decreased oxygen delivery ((Smokers ! ))
5. Diabetes – poor circulation from reduced collagen synthesis , decr wound strength, and impaired WBC functions
6. Infected wound- prolongs the inflammatory response;
microorganisms use nutrients and oxygen intended for repair
7. Compromised Immune System- from long term immunosuppressive meds or chemotherapy decreases inflammatory response and reduce healing potential
8. Open wound must be maintained in a moist environment; closed wounds need protection from microorganisms and stress |
|
|
Term
| Wound Closure Materials(4): |
|
Definition
| Sutures, staples, SteriStrips, Dermabond glue |
|
|
Term
|
Definition
| Sterile, thread-like material made of silk, steel, cotton, nylon, linen, Dacron, e,g. 2.0 Chromic; Vicryl). Applied with a needle |
|
|
Term
|
Definition
| Stainless steel wire; applied w/ staple gun |
|
|
Term
|
Definition
| clear,tape-like material; removed by peeling away or allowed to fall off on its own(desired). May be applied post removal of suture/staple, or used instead of suture/staples. |
|
|
Term
|
Definition
| skin glue; edges are aligned and literally “glued” together. |
|
|
Term
| Surgical Wound Care procedure(6) |
|
Definition
1. Remove old dressing using clean gloves; put on sterile gloves to…
2. Cleanse suture line from top to bottom, from suture line outward along each side of incision
3. Use a single sterile antiseptic swab for each stroke
4. If a drain in wound (e.g. Jackson Pratt, Hemovac, Penrose) , cleanse area next to drain, using circular stroke, moving out from the drain.
5. Apply dry sterile dressing (DSD) and secure w/tape
6. Write date, time, and your initials |
|
|
Term
| Methods for dealing with wound drainage(3): |
|
Definition
1. Penrose drains
2. Jackson Pratt p 493 & 495
3. Hemovac p 497 |
|
|
Term
| Surgical Wound Care Documentation(6): |
|
Definition
-Inspect incision for wound approximation; skin integrity around drainage site
-Ask about pain rating (0-10) in quality, location, and factors that relieve or intensify pain.
Nurses Notes:
-Appearance of wound and drainage (amount, color, consistency; any odor)
-Change in wound characteristics or drainage
-Type of dressing applied
-Patient’s subjective response to dressing change/discomfort |
|
|
Term
| Hot therapy indicated for: |
|
Definition
Inflamed body part
New surgical wound
Infected wound
Arthritis
Degenerative joint disease
Localized joint pain
Muscle strain
Low Back Pain
Menstrual Cramps
Hemorrhoid pain |
|
|
Term
|
Definition
Immed after direct
trauma (strains &
sprains) first 48 hrs
Fracture
Muscle spasm
Superficial laceration
Puncture Wound
After injections
Joint Trauma |
|
|
Term
| Physiologic responses to heat therapy(5): |
|
Definition
1. Vasodilation: ↑ blood flow, promotes delivery of nutrients & removal of wastes, lessens venous congestion in injured tissues.
2. Reduced blood viscosity: improves delivery of leukocytes and antibiotics to wound site.
3. Reduced muscle tension: promotes muscle relaxation & reduces spasm.
4. Increased tissue metabolism: increased blood flow; provides local warmth.
5. Increased capillary permeability: promotes movement of waste products & nutrients |
|
|
Term
| Physiologic responses to cold therapy (5): |
|
Definition
1. Vasconstriction: reduces blood flow, edema, and inflammation
2. Local Anesthesia: reduces localized pain
3. Reduced Cell Metabolism: reduces O2 needs of tissues
4. Increased Blood Viscosity: promotes blood coagulation at injury site.
5. Decreased Muscle Tension: relieves pain. |
|
|
Term
| Types of specimines that may be collected(6): |
|
Definition
| Urine, Stool, Throat, Sputum, Blood, Wound |
|
|
Term
| Types of urine specimines(5): |
|
Definition
1. Random
2. Midstream (via “Clean Catch” of midstream)
3. Sterile Specimen (via Catheter)
4. 24 hour Timed Urine Specimens
5. Urine dip stick (glucose, ketones, protein, blood and pH) |
|
|
Term
| Equipment needed for urine specimin collection: |
|
Definition
Patient label, Lab request, - Biohazard bag
Sterile urine collection container |
|
|
Term
| Clean Catch (in Mid stream)urine collection: |
|
Definition
| caught midstream by client in sterile container; collect 30-60 ml |
|
|
Term
| 24 hour urine collection: |
|
Definition
Measure elements like protein, creatinine, hormones, glucose
Have client drink 2-4 glasses H20 ~ 30 minutes pre-collection start; Always discard 1st test specimen so client begins test on empty bladder ; Keep specimen on ice during collection period (in labeled bottle with additive) |
|
|
Term
|
Definition
| may need to withdraw specimen with needle if limited quantities of urine are produced and specimen collection is ordered |
|
|
Term
|
Definition
| need deep cough; can be suctioned specimen |
|
|
Term
|
Definition
| swab tonsillar area, or inflamed purulent site |
|
|
Term
|
Definition
occult blood = present but not visible
Hemoccult (Guiac) test: diagnostic tool
specimen tested : stool |
|
|
Term
|
Definition
Gastroccult: for occult blood
specimen tested: emesis and gastric secretions |
|
|
Term
| Blood culture guidelines: |
|
Definition
Collecting Blood Cultures
detect presence bacteria in blood
Venipuncture is 1 deg. method
ALWAYS drawn before antibiotic started
Lab readings at 24, 48, & 72 hrs. |
|
|
Term
|
Definition
| insufficient oxygen to meet metabolic needs of tissues and cells; deficient oxygen in arterial blood |
|
|
Term
| Room Air oxygen concentration: |
|
Definition
| Oxygen concentration of 21% … (also known as Fraction of inspired oxygen: Fio2) |
|
|
Term
| METHODS of oxygen supplementation and FiO2 delivered by each(5): |
|
Definition
nasal cannula 1-6 L/ min; 24-45%
oxymizer 1-15 L/min; 24-100%
venturi mask 4-12 L/min; 60-80%
partial rebreather 8-12 L/min; 40-70%
non-rebreather 10-15 L/min; 60-80% |
|
|
Term
|
Definition
A noninvasive measurement of oxygen saturation in blood
Applied to finger, ear lobe, toe
Normal= 90% (or higher)
Notify MD if < 90 |
|
|
Term
| Normal oxygen saturation: |
|
Definition
| 90% or higher; if less call MD. |
|
|
Term
| Causes of false readings with pulse oximitry: |
|
Definition
False Readings occur with:
nail polish, fake nails, dark pigmentation, sensor not applied properly |
|
|
Term
| Procedure for Incentive Spirometry (7): |
|
Definition
1. Position is sitting position
2. Instruct client to exhale completely, then place mouthpiece so lips completely cover it
3. Inhale slowly maintaining constant flow through unit
4. After maximum inspiration, client should hold breath for 2-3 seconds and then exhale slowly
5. Set marker on spriometer at maximum inspiration point to establish target
6. If client has surgical incision, teach how to splint incisional area to protect and provide support for the area.
7. Promote lung expansion by having client turn, cough, & deep breathe every 2 hrs. while awake. |
|
|
Term
| Fluid intake sources and volumes in adults: |
|
Definition
What goes in
2200-2700 cc fluid IN each day (Average Adult)
from oral fluids (1100-1400 ml) , solid foods (800- 1000 ml), and metabolism (300 ml) |
|
|
Term
| Fluid output volumes and sources: |
|
Definition
What comes out
2200-2700 cc OUT each day (Average Adult)
from kidneys (1200-1500ml), skin (500-600ml), lungs (400ml), gastrointestinal (100-200 ml) |
|
|
Term
| What is counted in fluid intake and output: |
|
Definition
INTAKE
what is measured?
Oral liquids, tube feedings, IV fluids
OUTPUT
what is measured?
Urine, liquid stool, vomitus, nasogastric drainage, wound drainage, chest tube drainage, (pp 177 ff) |
|
|
Term
| Signs/Symptoms of dehydration: |
|
Definition
dry mucous membranes,
thirst,
low B/P, heart rate,
concentrated urine
weight loss |
|
|
Term
|
Definition
| fluid excess or overload. |
|
|
Term
| Signs/symptoms of hypervolemia |
|
Definition
increase in B/P,
decrease in Urine output, coughing, SOB
edema in extremities (1- 4+)
intake > output, weight gain > 2% in 24-48 hrs
low Hematocrit (Hct) |
|
|
Term
| Procedure for Administering an Enema |
|
Definition
-Left Sims position
-750-100 ml warm tap water or prepackaged
-insert tip 2-4 inches (7.5-10 cm)- lubricated
-container at client’s hip level; allow fluid to enter slowly; hold 5-10 min (feeling distended is normal to the bathroom or bedside commode |
|
|
Term
| NASO GASTRIC INTUBATION Purpose: |
|
Definition
to decompress stomach, keeping it empty, until peristalsis returns:
Post surgery when vomiting & gastric distention can occur
When peristalsis is slowed/absent
To administer medications
For irrigation of the stomach
Trauma
During transport |
|
|
Term
| NG tube passes through what to reach stomach: |
|
Definition
Intubation of the
stomach w/ a flexible
tube passed through
nares, nasopharynx,
& esophagus into
stomach. |
|
|
Term
| Technique for NG TUBE Insertion(9): |
|
Definition
1. High Fowlers; Breathe & relax; Occlude one nares, then other, to select one with greater air flow
2. Measure distance to insert tube:
Obtain distance from tip of nose to earlobe to xiphoid process. Marker or tape site.
3. Curve tube end; lubricate; extend neck back
4. Insert tube along floor of nasal passage aiming down toward ear. Do not force past resistance.
5. Stop just above oropharynx and explain next step requires swallowing
6. Flex head forward and swallow small sips. Advance 1-inches w/each sip
7. STOP if cough, gag, choke. Withdraw and let pt. rest.
8. If not, continue- watch for coiling in back of throat
9. Advance until tape mark is reached. Anchor to cheek with tape until placement is checked |
|
|
Term
| Procedure for verifying placement of NG tube: |
|
Definition
a. ask client to speak
b. inspect posterior pharynx for coiled tube
c. flush 30 cc air then aspirate to obtain gastric contents
d .measure pH with color-coded pH paper [Gastric ph: 4 or less; Intestinal: >4 ]
e. x-ray …indisputable placement verifier |
|
|
Term
| TECHNIQUE for IRRIGATING a NG TUBE(5): |
|
Definition
1. Verify tube placement; Draw up 30 ml NSS (or tap water if agency protocol); Clamp tube
2. Insert syringe w/ 30 ml slowly (or tube may collapse)w/ syringe-tip pointed at floor
3. After instilling, immediately aspirate fluid. (Calculate difference between instillant & aspirant)
4. Reconnect to intermittent suction
5. DOCUMENT |
|
|
Term
|
Definition
| surgical incision to place tube in LUQ; use w/ normal gastric emptying & no excess residual volume |
|
|
Term
| Percutaneous Gastrostomy Tube (PEG): |
|
Definition
| endoscopic insertion to place tube through puncture wound in LUQ (See p. 714) |
|
|
Term
| Percutaneous or Jejunostomy Tube (PEJ or J –Tube): |
|
Definition
| use of a PEG tube advanced into the jejunum; use when delayed gastric emptying or gastric ileus; Y-connector caps PEG tube to make a closed system |
|
|
Term
| TECHNIQUE to ADMINISTER TUBES FEEDINGS(3): |
|
Definition
1. Check for gastric residual before each feeding *
2. Aspirate contents; * if >100 ml, hold feedings (or per agency policy)
3. Return (instill) aspirated contents through tube; Irrigate tube w/30 ml water
Now, you may Initiate feeding |
|
|
Term
| Tube feeding technique via Bolus: |
|
Definition
If administering via bolus or syringe, pinch tube; remove plunger from syringe & attach syringe barrel to tube.
Fill syringe w/ measured amt formula & elevate syringe to ~18 inches (max) above tube insertion site; Allow gravity drainage of feeding through tube |
|
|
Term
| Time to administer feeding tube via infusion pump. |
|
Definition
| allow bag to empty over 30-60 minutes |
|
|
Term
| Technique for administering meds via intermittent enteral feeding: |
|
Definition
Verify meds to be administered are NOT sublingual, enteric-coated, or sustained-release (look up in drug book); crush!
DO NOT MIX meds & tube feedings: give separate intervals to avoid potential drug-food interaction |
|
|
Term
| Guidlines for insertion of a Insertion of a Peripheral Intravenous Device: |
|
Definition
Purpose- to maintain fluid & electrolyte balance, continuously or intermittently
Delivery success- client prep, vein selection, appropriate catheter selection, and skilled catheter insertion
Dangers- exposure to blood-borne pathogens… so strict asepsis and standard precautions |
|
|
Term
| IV needle types and durations: |
|
Definition
Winged infusion butterfly needle- one time infusion; IV push
Short, over the needle, catheter (< 3 in)- continuous/intermittent or short term infusion(< 7 days)
Midline peripheral catheter ( 3-8 in)- continuous/intermittent infusion (7-14 days) |
|
|
Term
| VENIPUNCTURE PROCEDURE(20): |
|
Definition
1. Apply tourniquet
2. Locate sites: inner arm & dorsal surface of hand
3. Palpate vein for resistance
4. Cleanse site chosen for insertion
5. Stabilize vein below insertion site with skin taut
6. Puncture skin with catheter at 10-30 deg. angle
7. As catheter enters skin, look for blood return in flashback chamber
8. Then lower catheter flush with skin
9. Advance catheter into vein
10. Apply pressure above insertion site with index finger/dominant hand
11. Retract stylet by pushing safety tab
12. Release tourniquet
13. Flush injection cap slowly
14. Connect IV tubing to catheter tubing; Secure connector
15. Place tape under catheter hub
16. Criss-cross ends of tape over hub
17. Apply transparent dressing
18. Place tape over transparent dressing
19. Apply chevron over tape
20. Fold 2x2 gauze in half, under catheter hub
Apply 2x2 gauze over site…and Label dressing ! |
|
|
Term
| UNEXPECTED OUTCOMES FOR IV's(4): |
|
Definition
Phlebitis- pain/tenderness at IV site with erythema at site or path of vein; insertion site is warm to touch
Infiltration- rate of infusion slows; site of insertion becomes swollen; cool to touch, pale, and painful
Positional IV Infusion- client’s flow rate is altered and changes with position of extremity
Infection- client complains of chills, fever, malaise; IV site may show purulent drainage |
|
|
Term
| WHAT ALTERS INTRAVENOUS FLOW RATES: |
|
Definition
1. Changes in client’s positions –
(height of parenteral container should be > 36 in. above heart)
2. Flexion of involved extremity- (positional access )
3. Partial/complete occlusion of IV device (viscosity or temp of IV soln; occluded air vent)
4. Venous spasm - (occluded in-line filter)
5. Vein trauma (phlebitis)- (improperly placed restraints)
6. Manipulated by client or visitor –
(crimped admin set tubing; tubing dangling below bed; low battery of an electronic device) |
|
|
Term
| Support surface Overlay or Mattress: |
|
Definition
| a pressure –reducing device especially for head, trunk, feet. e.g. Egg crate; Air mattress overlay; air-integrated replacement mattress |
|
|
Term
|
Definition
| promote skin integrity in the immobile or bedridden by reducing effects of shear ,friction, maceration, and pressure. i.e. Air-filled cushions mounted on a bed frame |
|
|
Term
|
Definition
| distributes weight evenly over the support surface reduces shear force and friction through fluidization, i.e. (temp controlled air flow throughout) |
|
|
Term
|
Definition
| Maintains skeletal alignment while providing constant rotation; Rotates side-to-side at 60-90 deg. q7min |
|
|
Term
|
Definition
| Allows upright /sitting position; transport; in-bed scales for the morbidly obese (up to 850 lbs) |
|
|
