quiz Flashcards Set

Stage 1 Pressure Ulcer - Description

Intact skin with non-blanchable redness, meaning the area doesn't turn white when pressed, and may feel warmer or cooler than surrounding skin.

Stage 1 Pressure Ulcer - Appearance

Red or discolored skin, potentially with changes in temperature, firmness, or sensation.

Stage 1 Pressure Ulcer - Symptoms

Pain, burning, or itching are common.

Stage 1 Pressure Ulcer - Treatment

Focus on removing pressure, keeping the area clean and dry, and addressing any underlying causes.

Stage 2 Pressure Ulcer - Description

Partial-thickness skin loss with exposed dermis, appearing as an open sore, blister, or abrasion.

Stage 2 Pressure Ulcer - Appearance

The wound bed is viable, pink or red, and may be moist.

Stage 2 Pressure Ulcer - Symptoms

Pain, swelling, warmth, and possible drainage or pus.

Stage 2 Pressure Ulcer - Treatment

Clean with a saline solution, protect the area with moisture barriers, and address any underlying causes.

Stage 3 Pressure Ulcer - Description

Full-thickness skin loss with damage to subcutaneous tissue, appearing as a crater-like wound.

Stage 3 Pressure Ulcer - Appearance

The wound extends into the fat tissue and may have a bad odor or signs of infection.

Stage 3 Pressure Ulcer - Symptoms

Pain, swelling, warmth, and possible drainage or pus.

Stage 3 Pressure Ulcer - Treatment

Wound care, addressing any underlying causes, and possibly surgical intervention.

Stage 4 Pressure Ulcer - Description

Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone.

Stage 4 Pressure Ulcer - Appearance

The wound extends deeply into the tissues and may have rolled edges or eschar (hardened dead tissue).

Stage 4 Pressure Ulcer - Symptoms

Extreme pain, drainage, dead tissue, and signs of infection.

Stage 4 Pressure Ulcer - Treatment

Often requires surgical intervention, such as flap reconstruction, and may involve a prolonged recovery period.

Oxygen Administration - Verify the Prescription

Ensure you have a valid prescription for oxygen, including the flow rate and target oxygen saturation.

Oxygen Administration - Gather Supplies

Prepare the necessary equipment, including a pulse oximeter, oxygen delivery device (nasal cannula, simple face mask, reservoir mask, Venturi mask), tubing, and humidifier (if needed).

Oxygen Administration - Perform Hand Hygiene

Wash your hands thoroughly before and after the procedure.

Oxygen Safety - No Smoking

Implement a strict no-smoking policy in the area.

Oxygen Safety - Keep Oxygen Away from Heat Sources

Ensure the oxygen delivery system is at least 5 feet away from heat sources.

Oxygen Safety - Check Oxygen Levels

Verify that portable oxygen tanks are adequately filled before transporting a patient.

Oxygen Safety - Ensure Tubing is Patent

Regularly check for kinks, twists, or blockages in the tubing.

Oxygen Safety - Display Oxygen in Use Signs

Display 'Oxygen in Use' signs in visible areas.

Oxygen Safety - Notify Fire Department

Inform the fire department and electric company that oxygen is being used.

Respiratory Assessment Before Oxygen Administration

Perform a focused respiratory assessment, including airway, respiratory rate, pulse oximetry, and lung sounds.

Oxygen Delivery Devices - Nasal Cannula

Suitable for lower oxygen needs (1-6 L/min).

Oxygen Delivery Devices - Simple Face Mask

Used for moderate oxygen needs (5-10 L/min).

Oxygen Delivery Devices - Reservoir Mask

Delivers higher oxygen concentrations (10-15 L/min).

Oxygen Delivery Devices - Venturi Mask

Provides a precise oxygen concentration (24% or 28%).

Oxygen Administration - Connect and Set Flow Rate

Connect the oxygen tubing to the flow meter and set the oxygen flow rate as prescribed.

Oxygen Administration - Ensure Proper Fit

Ensure that the oxygen delivery device fits snugly and comfortably.

Oxygen Administration - Explain the Procedure

Explain the procedure to the patient and obtain their consent where possible.

Oxygen Administration - Continuous Monitoring

Continuously monitor the patient's response to oxygen therapy, including their oxygen saturation, respiratory rate, effort, and level of consciousness.

Oxygen Administration - Evaluate for Complications

Watch for signs of hypoxia (tachycardia, confusion, dyspnea, restlessness, cyanosis) and other complications.

Oxygen Administration - Adjust Oxygen Therapy

Adjust the oxygen flow rate and/or delivery device as needed to maintain the target oxygen saturation.

Oxygen Administration - Weaning Oxygen

Once the patient is stable, attempt to wean them off oxygen therapy gradually.

Oxygen Administration - Oral Hygiene and Hydration

Encourage oral hygiene and adequate fluid intake to prevent dehydration of the upper respiratory tract.

Oxygen Administration - Skin Care

Observe for pressure or irritation from the mask/nasal prongs and adjust straps or pad if necessary.

Oxygen Administration - Patient Education

Explain the procedure to the patient and their family, and answer any questions they may have.

Oxygen Administration - Safety Precautions

Emphasize the importance of oxygen safety precautions, such as avoiding smoking and keeping heat sources away from the oxygen delivery system.