NUR 150 Final Exam Hondros

What do we want to do with chain of infection? - break it, wash hands How does HAI spread - not hand washing, equipment What PPE is worn for what isolation - Contact - gloves, gown Droplet - mask, gloves, gown standard precautions - gloves What infections do we put in Contact isolation - VRE, MRSA, C-Diff (with hand washing) What kind of precautions for Airborne - N-95, Hood What are the rules for restraints - check circulation every 30min release every 2 hours must have doctors order first new Doctors order every 24 hours What is best way to help with anxiety - sit with patient, listen, use therapeutic communication What is HIPPA, how is it broken - -protects patients information broken - posting on social media, looking up someone not your patient, keeping computer open What problems come from being immobile - weight loss, pressure sores, pneumonia Who is at risk for HAI - elderly, immune compromised, low economical, children What are the important rules for peri-care - privacy, explain procedure, only expose what you need to Collaborative between nurses and doctors - decrease risk for injury, to avoid an event where patient has died or sustained serious injury What is the nurse practice act - guide lines , its our scope of practice How do we check a tympanic temp - up, back for an adult What is ethics - compassion, empathy What pulse do we check most often - radial What is first thing we do after a fall - vital signs, assessment What do we do if we find a patient unresponsive - check cardioid pulse Ways to prevent CAUTI"S - out ASAP, empty bag regularly, keep bag lower than bladder, change every 30 days, peri-care Prone position - laying face down Sims position - laying on right side, knee-thigh drawn up to chest Dorsal recumbent - laying on back with knees bent with feet still flat on ground Lithotomy - laying supine with hips knees flexed and thigh externally rotated Supine position - laying flat on back face up Trendelenburg position - head of bed pointed downward, feet in air Orthopnic - sitting on side of bed with arms rested on over bed table. this is used for people with breathing problems Where is apical pulse - mid-clavicular 5th intercostal space What are examples of portals of entry for infection - mouth, break in skin, mucous membrane How do we prevent falls - falls assessment on admission, keep room clutter free, toilet schedule, keep things in arms reach What is therapeutic communication - ones that leave it open for patient to communicate to or discuss something, ask them to give you an example of something about what they mean What kind of meds can't be given by G-tube - enteric coded, capsules, extended release What are the 6 rights of Medications - medication, patient, dose, route, time, documentation What is term when one drug mixes with another drug - drug interaction What is drug compatibility - when different drugs can be given together What is drug tolerance - when your body builds up What are drug adverse effects - undesirable effects ex: HA, nauesa What tools are for measure functional status - Lawton (IADL) Katz (ADL) What tools do we measure cognition - Montreal, Mini-cog How do we reduce pressure sores - reposition, high-fiber diet, change incont as often as possible What are signs and symptoms of dehydration - slurred speech, skin tint, low urine output, dry mucus membranes, BP low while Pulse High What do we do when a patient refuse a med - educate, document What are parts to drug order - drug name, dose, frequency, route, amount What is healthy people 2020 - website that promotes healthy living and decreasing disease What are signs/symptoms of dysphagia - choking, drooling, pocketing food What are the dysphagia precautions - no straws, fowlers position after food/drink , have them put chin to chest when swallowing What happens if the precautions are not put in place - aspiration pneumonia How can we assess LOC - ask name, place, date, situation