2 main types of ostomies Correct Answer ileostomy- diverts
the ileum to a stoma
colostomy- diverts the colon to a stoma
Airborne Precautions Correct Answer N-95 mask
Negative pressure room
ex. chicken pox, TB, measles, smallpox, COVID 19
Assessing pain Correct Answer Patient is the authority of
their pain.
Use OLDCARTS for pain documentation.
Use numeric rating scale for adults and FACES scale for
pediatric patients
Evaluate the effectiveness of interventions by comparing
assessed pain with baseline pain
Bowel complications Correct Answer Constipation
Diarrhea
Incontinence
Flatulence
Hemorrhoids
Bowel diversions Correct Answer surgery performed to
develop a temporary or permanent artificial opening (stoma) in
the abdominal wall
Care of a Client With Communication Impairment Correct
Answer Expressive aphasia: cannot name object or express
words
,Receptive aphasia: cannot understand written or spoken words
Provide alternate ways of communicating (ex. pen and paper,
white board, sign language)
Pay attention to non-verbal cues
Use close ended questions
Care of a Client With Hearing Impairment Correct Answer
Speak slowly and clearly
Face client when speaking
Proper care of hearing aids
Care of a Client With Restraints Correct Answer Must have
an order
Cannot be used PRN and must be renewed every 24 hours
Two fingers should be able to fit between the device and client
Use quick release knots and tie to the bed (not side rails)
Assess skin integrity every 2 hours
Monitor vital signs
Perform ROM exercises
Pad bony prominences
Never leave patient unattended
Care of a Client With Vision Impairment Correct Answer
Orient patient to environment
Provide assistive devices
Remove clutter
Verbal communication is very important
Cellulitis Correct Answer An acute, spreading infection of
dermal and subcutaneous tissues
-S/S:
, Pain
Warmth
Edema
Induration
Red streaking
Chills
Chain of Infection Correct Answer Infectious agent->
Reservoir-> Portal of Exit-> Mode of Transmission-> Portal of
Entry-> Host
Characteristics of Good Documentation Correct Answer Use
exact measurements
Chart ASAP after completing tasks
Chart in chronological order
Write legibly in black ink
Use correct grammar
Client Education Methods Correct Answer Cognitive
(knowledge, comprehension, application, analysis, synthesis,
evaluation)
Affective (learning through emotion or feeling)
Psychomotor (assess patient's abilities)
complications of immobility Correct Answer muscular
atrophy
increased risk for fractures
decreased appetite
atelectasis
risk for thrombus
increased cardiac workload