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Hazards of bed rest and hospitalization?
- Immobilization
- High bed
- Bed rails
- Decreased plasma volume
- Accelerated bone loss
- Increased closing volume
- Sensory Deprivation
- Isolation
- No glasses or hearing aids
- Barriers
- Rx diet
- Thethers
- Shearing
- Force
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The hazards bed rest and hospitalization can lead to?
- Deconditioning
- Syncope
- Falls
- Fracture
- Decrease pO2
- Physical restraint
- Delirium
- Dehydration
- Malnutrition
- Tube
- Aspiration
- Chemical Restraint
- False Label
- Tardive Dyskinesia
- Pressure Sores
- Infection
- Functional incontinence
- Catheter
- Family rejection
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Hazards of best rest and hospitalization lead to decreased health and well being. These then lead to what?
Dependency and the need to live in a Nursing home.
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Range of motion includes:
- Flexion
- Extension
- Abduction
- Adduction
- Rotation
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How should a cane be used?
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How should a walker be used?
- Wandering Wilma's Always Late
- a i f e
- l t f g
- k h e
- e c
- r t
- e
- d
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IADLs
Instrumental Activities of Daily Living
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Instrumental activities of daily living include:
- Shopping
- Cooking
- Cleaning
- Using the telephone
- Using transportation
- Managing money
- Managing meds
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ADLs
Activities of Daily Living
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Activities of daily living include:
- Bathing
- Ambulation
- Toileting
- Transfers
- Eating
- Dressing
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How should you use crutches on stairs?
- Good leg goes to heaven--up.
- Bad leg goes to hell--down.
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Define medical asepsis.
- Reduces the number of pathogens.
- The "clean technique".
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What is medical asepsis used in?
- The administration of:
- Medications
- Enemas
- Tube feedings
- Daily hygiene
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Define surgical asepsis.
The "sterile technique" that eliminates all pathogens.
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When is sterile technique used?
- Dressing changes
- Catheterizations
- Surgical Procedures
- Ulcers with MRSA infections
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When should you wash your hands?
- After touching:
- blood, body fluids, secretions, excretions, and contaminated items.
- Also after:
- removing gloves and between patient contacts.
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When are gloves appropriate PPE?
- With:
- blood, body fluids, secretions, excretions, contaminated items, mucous membranes, and non intact skin.
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When should gloves be changed?
- When soiled, and between touching high contamination areas and low contamination areas on patients.
- Also, if a rip or hole developes in your glove.
- If sterile technique is being used, change gloves when ever nonsterile items are touched and sterility needs to be maintained.
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When should a mask and eye protection or face shield be worn?
- Possibility of splashes or sprays of blood, body fluids, secretions, or excretions.
- Masks should also been worn in cases of airborne illnesses.
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When is a gown appropriate PPE?
Possibility of splashes or sprays of body fluids, blood, secretions, or excretions.
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Chipped nails, cracked nail polish, nails, cuticles, chapped hands, rings, and jewelry all hide what?
Possible pathogenic microorganisms.
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Name the elements in the chain of infection.
- Causative Agent
- Reservoir
- Portal of Exit
- Means of Transmission
- Portal of Entry
- Susceptible Host
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The easiest way to break the chain of infection is through:
Handwashing.
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Contact Precautions includes the uses of what PPE?
Gown and gloves
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Droplet Precautions include the use of which PPE?
Surgical masks within 3 feet of patient.
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Airborne Infection Isolation requires the use of which PPE?
Particlate Respirator. Negative pressure isolations rooms are also used.
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Occupational Therapy is used to do what?
Help improve the ability to perform ADLs.
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When using a device such as a Hoyer to move a patient, how many caregivers should assist?
Two. Also 2, in transferring patients from bed to stretcher unless patient is over 200 lbs.
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Always use what, when helping a patient to transfer from a bed to a chair or vise versa?
Gait belt.
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The patient has the right to be free of which kind of restraints?
Both physical and chemical restraints that are not required to treat their medical symptoms.
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What are some types of physical restraints?
- Wrist restraints
- Bed rails
- Tightly tucked sheets
- Chairs that prevent the resident from rising
- Chairs or Beds placed so close to the wall that they prevent rising
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What should always come before the use of restraints?
Exhaustively trying to implement other methods to relax the patient and prevent rising and fall risks.
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What are some implementations that nurses could use to avoid the use of restraints?
- Frequently checking in on patient
- Provide frequent tolietry opportunities
- Place call light in reach of patient
- Place all needed items in reach of patient
- Talk and explain to patient the need to use their call bell
- Place bed alarms on the patient's bed
- Put the bed in its lowest position
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How often should patients in restraints be checked on?
Every 15 minutes.
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A full range of motion and skin assessment should be done every?
2 hours.
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A physician assessment of restraint needs to be completed every?
24 hours
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A nurse may initiate restraints to limit the patient's harm to them selves but,
They need to obtain an order from a physician for the restraint within 12 hours.
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Before a patient is restrained, there should be documentation of what?
Every method tried before the use of restraints.
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A patient who is put into retraints needs to be seen by a physician within what time period?
In 1hour a face to face assessment from a physician needs to be done.
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Restraint orders must be renewed or discontinued in what time period?
24 hours.
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The Physical Therapist must do what with new patients?
They must do the inital assessment of new patients. The PTA cannot do this.
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What is the most important thing to remember when transferring a patient?
Always use supportive equipment when available, such as a Hoyer.
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What is the proper fitting for walkers, rollers, canes and crutches?
The handle of the device should be at the level of the patient's styloid process in their wrist, with slight elbow flexion when held.
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How do foley catheter sizes work?
The larger the #, the larger is the diameter of the catheter. Avg=16.
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How do needle sizes work?
The higher the #, the smaller the size, and the greater pressure that is released. 18-20 is good for fluid collection.
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If a sterile drape becomes wet, is it still sterile?
NO, it is now unsterile.
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During home self cathereizations, does the patient need to follow special precautions and to used a new catheter every time?
NO, the patient does need to follow special precautions, but a new catheter is not needed for every use.
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Is less than 30 mL/hour of urine a normal level of output with the insertion of a catheter?
NO, this is a very low urine output level and the physician should be consulted about removing the present catheter.
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How many liters of oxygen should a COPD patient receive?
1-2.5 L of oxygen.
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What should you do is a patient's O2 level is at 85%?
Place the patient on a nasal cannula, contact their physician, and check their lung sounds for any abnormalties.
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When does a patient qualify for the need to have oxygen?
When their levels of oxygen are at 88% or below.
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What is the max flow rate for a nasal cannula device?
The max flow rate is 6L/min at 25-45% FIO2
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What is the increase in percent of oxygen compared to the flow of liters per minute?
- at 0 L/min 21%
- at 1 L/min 24%
- and a 4% increase with each additional liter after.
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Flow rates greater than what, will irritate the nasopharynx?
Greater than 4 liters is irritating.
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What do oxygen delivery devices NOT do?
They don't provide humidified oxygen.
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Which oxygen delivery device should be used on children?
The Soft Vinyl Pediatric Mask.
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The Soft Vinyl Pediatric Mask is poorly tolerated in which age group of patients?
Infants and toddlers.
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What is the flow rate for the Soft Vinyl Pediatric Mask?
35-60% at 6-10L/min.
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What can cause oxygen concentration to be reduced when using oxygen masks?
- High spontaneous inspiratory flow.
- Loose fitted mask.
- Low oxygen flow into mask.
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Which devices are for Moderate flow of oxygen delivery?
The Partial Rebreathing Mask with reservoir and the Venturi Mask.
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What is the flow rate of oxygen in a Partial Rebreathing Mask?
35-60% at a 6-10 L/min rate with the first third of exhaled gases mixing with the reservoir. These gases are oxygen rich.
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What is the flow rate for a Venturi Mask?
24-50% oxygen. Valve and flow rate can be controlled to dial in oxygen concentration.
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Which device is used for high oxygen delivery?
A Non-rebreathing Mask is used.
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What is the flow rate for a Non-rebreathing Mask?
95% oxygenat 10-12 L/min.
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Why are two valves added to the rebreathing mask?
It prevents entrainment of room air during inspiration and retention of exhaled gases during expiration.
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What is the percentage of oxygen in room air?
20%
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What is an elevate BUN?
Anthing over 20
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What is an elevated Creatinine level?
Anything over 2
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Why are fluid overload patients given an isotonic saline solution?
The fluid is equal and will not give or take.
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What are the two most important things to measure in fluid management?
I&O and weight.
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What are some safety precautions to remember with oxygen safety?
- Moisten the nose with chapstick
- No smoking
- Wear 100% cotton clothing to reduce static
- Know devices and their flow rates
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