Exam 1 Concepts: Integumentary System: Know the importance of pressure injury prevention strategies i.e.. Q2 turns (pressure redistribution), moisture barrier cream (reduce moisture), pillows under bony prominences (limits friction/shearing), smooth and wrinkle-free linen (reduce bed irritation), adequate protein intake (improve wound healing) Normal skin findings vs abnormal findings Importance of each skin layer: epidermis (melanin, keratin), dermis (glands, vessels, nerves), hypodermis (fat, anchors skin) How to assess for early signs of pressure injury: redness, blanching, moist vs dry ​Dark skin tones: use palpation to detect tissue consistency Early signs of pressure injury: Q2 turns/repositioning= priority, never massage area, apply heat, or use alcohol Increase protein intake to help wound healing Musculoskeletal System: ROM: active vs passive. Always compare both sides of body for accurate assessment Body mechanics when transferring a patient: bend at knees, not waist, use leg muscles, avoid twisting, stand on patient’s stronger side to optimize support Cane=one point of contact for unilateral weakness; standard walker= four points of contact for bilateral weakness; crutches= three points of contact for non-weight bearing injury (crutches should be 6 inches from sides of feet to ensure stability and prevent tripping) Post-op joint replacement: cold therapy reduces swelling How to prevent contractures (splints, ROM) Osteoarthritis and Rheumatoid arthritis: encourage ROM after pain medication given, use assistive devices as needed to protect joints, apply warm compress before activity to reduce pain/stiffness, take breaks to conserve energy, perform low impact exercises to maintain mobility and strength, quit smoking Function of bone marrow Neurologic System: Correct sequence of a nerve impulse: action potential moves down axon terminal → neurotransmitter released → neurotransmitter binds to receptor → Sodium and potassium ions move to generate new action potential Cranial nerves: CN III = oculomotor, CN VII = facial, CN IX = glossopharyngeal, CNXII = hypoglossal (know what these 4 cranial nerves control) Cerebellum = coordination. Tested with finger-to-nose test Aphasia = difficulty communicating (receptive or expressive). Provide calm, slow speaking/direction, allow extra time, face patient directly, do not rush, do not ask multiple questions at once, do not talk over them Dysphagia = difficulty swallowing. High risk of aspiration. Stop oral intake and notify provider. If able, proceed with thickened liquids, sit patient up 90 degrees, observe for further signs of choking, monitor weight/hydration/nutrition Autonomic nervous system= involuntary (automatic) functions like digestion and heart rate Stroke prevention: adequate blood pressure control = priority Eye/Ear: Eye structures: cornea-bends light; lens-focuses light; retina-photoreceptors; iris-controls light entry PERRLA = pupils equal, round, reactive to light and accommodation Outer ear = pinna, canal; middle ear = ossicles, ET, tympanic membrane, amplifies sound, equalizes pressure, transmits sound; inner ear = cochlea, vestibular apparatus, converts sound to electrical nerve impulse Tympanic membrane: normal = pearly gray, shiny, translucent, visible cone of light Respiratory System: Abnormal lung sounds: Wheezes =high-pitched, often associated with asthma. Crackles = rattling sound, fluid in alveoli/bronchioles, common in pneumonia and heart failure. Ronchi = low pitched, snoring, caused by airway obstruction, common in COPD. Stridor = high pitched sound in the larynx or trachea, medical emergency, common in foreign body obstruction or anaphylaxis Diaphragm = breathing muscle Alveoli = gas exchange Pleura = serous membrane surrounding lungs and chest cavity; reduces friction, allows smooth expansion and contraction of lungs Incentive spirometry: smoking can affect results Chest Xray: patient should inhale fully and hold breath for best view Pulmonary function test (PFTs): avoid caffeine before test Bronchoscopy: post-op encourage coughing and deep breathing exercises Laryngoscopy: NPO for 8 hours prior ETCO2, capnography monitoring = measurement of CO2 being expired. Gas Exchange: Normal pH= 7.35-7.45; < 7.35 = acidosis, > 7.45 = alkalosis Normal CO2= 35-45; <35 = alkalosis, > 45 = acidosis Normal HCO3= 22-26; <22 = acidosis, >26= alkalosis CO2 = respiratory HCO3 = metabolic Dosage Calculation/Miscellaneous: Nursing process: always assess first before intervention There are 5 mL in 1 teaspoon There are 2.2 lbs per kg. ​Pounds to kilograms: divide by 2.2 ​Kilograms to pounds: multiply by 2.2 Know how to read a 24 hour clock (military time…ex. 2000 hours is 8pm) Fahrenheit to Celsius formula: F = (C x 9/5) + 32…….(9/5 = 1.8 in decimal form) ​Example: convert 38.3 C to F ​F = (38.3 x 9/5) + 32 OR (38.3 x 1.8) + 32 ​F = (68.94) + 32 ​F = 100.94 (round to nearest tenth—100

What is the importance of pressure injury prevention strategies?

They help in preventing skin breakdown and promoting healing, such as Q2 turns to redistribute pressure, moisture barrier creams to reduce moisture, pillows to limit friction, etc.

What are the normal findings of skin compared to abnormal findings?

Normal skin is intact and free of lesions, while abnormal findings include redness, swelling, or open sores.

What are the functions of the epidermis, dermis, and hypodermis?

The epidermis provides barrier through melanin and keratin; the dermis contains glands, vessels, and nerves; the hypodermis anchors skin and contains fat.

How do you assess early signs of pressure injury?

Look for redness, blanching, and differences between moist and dry areas.

What is the significance of palpation in assessing dark skin tones for pressure injury?

Palpation is used to detect tissue consistency, as redness might not be visible.

What are priorities in preventing pressure injuries?

Q2 turns and repositioning, never massaging the area, applying heat, or using alcohol.

What should be increased to improve wound healing?

Protein intake.

What do active and passive ROM stand for in musculoskeletal assessment?

Active ROM is when the patient moves their body; passive ROM is when movement is performed by another person.

What are some body mechanics principles when transferring a patient?

Bend at the knees, use leg muscles, avoid twisting, and stand on the patient’s stronger side.

What is the function of a cane, walker, and crutches?

Cane is for unilateral weakness; walker for bilateral weakness; crutches for non-weight bearing injuries.

What is the role of cold therapy post joint replacement?

It helps to reduce swelling.

How can contractures be prevented?

Using splints and performing range of motion exercises.

What are the recommendations for osteoarthritis and rheumatoid arthritis patients?

Encourage ROM after pain medications, use assistive devices, apply warm compresses, and maintain low-impact exercises.

What is the correct sequence of a nerve impulse?

Action potential moves down axon terminal, neurotransmitter is released, binds to receptor, sodium and potassium ions generate a new action potential.

Which cranial nerves should be known and their functions?

CN III (oculomotor), CN VII (facial), CN IX (glossopharyngeal), CN XII (hypoglossal) and their functions related to eye movement, facial expressions, taste, and tongue movements.

What does the cerebellum control and how is it tested?

It controls coordination, tested with the finger-to-nose test.

What is aphasia?

Aphasia is difficulty communicating. It requires calm direction, extra time, and not rushing the patient.

What is dysphagia, and what precautions should be taken?

Dysphagia is difficulty swallowing, requiring sitting upright and possibly using thickened liquids; stop oral intake if choking is observed.

What does the autonomic nervous system control?

Involuntary functions such as digestion and heart rate.

What is a priority for stroke prevention?

Adequate blood pressure control.

What is the function of the cornea, lens, retina, and iris in the eye?

Cornea bends light, lens focuses light, retina contains photoreceptors, iris controls light entry.

What does PERRLA stand for?

Pupils Equal, Round, Reactive to Light and Accommodation.

What are the functions of the outer, middle, and inner ear?

Outer ear: collects sound; middle ear: amplifies sound and equalizes pressure; inner ear: converts sound into electrical nerve impulses.

What are normal characteristics of the tympanic membrane?

Pearly gray, shiny, translucent, with a visible cone of light.

What are abnormal lung sounds and their implications?

Wheezes (asthma), crackles (fluid), ronchi (obstruction), and stridor (medical emergency) indicating respiratory issues.

What is the main role of the diaphragm?

It is the primary muscle for breathing.

What occurs at the alveoli?

Gas exchange between air and blood.

What is the function of the pleura?

It surrounds the lungs and reduces friction during expansion and contraction.

What notes should be taken regarding incentive spirometry?

Smoking can affect the test results.

How should a patient be positioned for a Chest X-ray?

The patient should inhale fully and hold their breath for the best view.

What should a patient avoid before a pulmonary function test (PFT)?

Caffeine.

What should be encouraged post-bronchoscopy?

Coughing and deep breathing exercises.

What is the NPO requirement for laryngoscopy?

The patient should be NPO for 8 hours prior to the procedure.

What does ETCO2 capnography monitoring measure?

It measures the CO2 being expired.

What is the normal pH range for blood and its significance?

Normal pH is 7.35-7.45; lower than 7.35 indicates acidosis, higher than 7.45 indicates alkalosis.

What are normal levels for CO2 and HCO3?

Normal CO2 is 35-45 mmHg; normal HCO3 is 22-26 mmol/L.

How is acidosis and alkalosis determined using CO2 and HCO3 levels?

CO2 relates to respiratory status and HCO3 relates to metabolic status.

What is the nursing process regarding interventions?

Always assess first before any intervention.

How many mL are in 1 teaspoon?

There are 5 mL in 1 teaspoon.

How many pounds are in a kilogram?

There are 2.2 lbs per kg.

How do you convert pounds to kilograms?

Divide the weight in pounds by 2.2.

How do you convert kilograms to pounds?

Multiply the weight in kilograms by 2.2.

What is the basic military time conversion for 2000 hours?

2000 hours is equivalent to 8 PM.

What is the formula for converting Fahrenheit to Celsius?

F = (C x 9/5) + 32.

If converting 38.3 C to Fahrenheit, what is the final Fahrenheit temperature?

100.9 F after conversion.