Test 1 nursing skills

Adverse Events Study (Baker, Norton, Flinton, et al., 2004)

A study indicating that a high number of hospitalized patients can experience preventable adverse events, including death.

Adverse Events

Experiences in hospitalized patients, including death, many of which are deemed preventable.

Patient Safety

A critical aspect of quality health care, as defined by the Canadian Patient Safety Institute (2016).

Factors Affecting Safety

Includes age and development, lifestyle, mobility and health status, sensory-perceptual alterations, cognitive awareness, emotional state, ability to communicate, safety awareness, and environmental factors.

Safe Environment in Healthcare

One in which safety-related skills reduce the risk for illness and injury, contain healthcare costs, improve patient functional status, and increase patient well-being.

Assessing Clients at Risk for Unintentional Injury

Involves nursing history and physical examination, risk assessment tools, home hazard appraisal, and national patient safety goals.

Accreditation Canada Required Organizational Practices (ROPs)

Practices focused on safety culture, communication, safe medication practices, work-life and workforce balance, reducing healthcare-associated infection (HAI) risk, and identifying safety risks.

Evidence-Based Practice (EBP) in Nursing

Its integration into nursing skills and procedures promotes a safer health care environment and improves patient outcomes.

Body Mechanics

The efficient, coordinated, and safe use of the body to move objects and carry out Activities of Daily Living (ADLs).

Purpose of Body Mechanics

To facilitate the safe and efficient use of appropriate muscle groups to maintain balance, reduce energy required, reduce fatigue, and decrease the risk of injury.

Body Balance

Achieved when a wide base of support exists, the center of gravity falls within the base of support, and a vertical line can be drawn from the center of gravity through the base of support.

Proper Body Mechanics Principles (Lifting)

Staying close to the object, enlarging the base of support, lowering the center of gravity, tightening abdominal muscles, tucking the pelvis, bending at the knees, keeping weight close to the body, keeping the trunk erect, and avoiding twisting.

Factors Increasing Risk of Injuries/Falls

Age, mental status, history of falls, medications, special toileting needs, and poor mobility; most falls occur in the home, often on stairs, in bedrooms, or bathrooms.

Mobility

A person's ability to move about freely.

Immobility

A person's inability to move freely, which puts all body systems at risk for impairment.

Effects of Immobility

Altered cardiovascular function, disrupted metabolic functioning, hip & knee contractures, pressure sores, muscle weakness & atrophy, increased risk for pulmonary complications (e.g., pneumonia), constipation, neurovascular impairment, urinary elimination problems, and psychological/psychosocial impacts.

Body Alignment

Means the body is in line with the pull of gravity, reduces strain on musculoskeletal structures, maintains muscle tone, and contributes to balance.

Importance of Correct Body Alignment (Client)

Essential to prevent complications such as pressure sores (which can occur within 24 hours), foot drop, and contractures.

Pressure Injuries (Pressure Sores, Decubitus Ulcer)

Occur when tissues are compressed, leading to decreased blood supply, reduced oxygen to tissue, and cell death.

Clients at Risk for Pressure Injuries

Individuals with alterations in bone formation or joint mobility, impaired muscle development, or Central Nervous System (CNS) damage (cognitive dysfunction or proprioceptive loss).

Benefits of Proper Positioning

Maintains body alignment and comfort, prevents injury to the musculoskeletal system, provides sensory, motor, and cognitive stimulation, prevents strain on muscles, and prevents pressure injuries and joint contractures.

Nursing Process in Mobility/Safety

A systematic approach that includes assessment, nursing diagnosis, planning interventions (like patient transfer and positioning), implementation, and evaluation to maintain a safe environment and improve patient outcomes.

Manual Lifting

One of the leading causes of musculoskeletal injury for nurses.

Maximum Recommended Weight Limit for Client Handling (Manual)

15.9 kg (35 pounds); if a client exceeds this weight, they are considered fully dependent and require an assistive device for transfer.

No Lift Policies

Policies in most healthcare organizations that discourage manual lifting and require the use of safe handling equipment and devices when mobilizing patients.

RANGE OF MOTION (ROM)

The maximum movement possible for a joint, varying based on genetic makeup, developmental patterns, disease presence, and physical activity.

Joint Stiffening

The process by which a joint begins to stiffen within 24 hours if not moved sufficiently, eventually leading to inflexibility.

Contracture

Abnormal flexion and fixation of joints caused by the disuse, shortening, and atrophy of muscle fibers, where flexor muscles contract and pull tight.

Muscle Atrophy

The wasting or diminished size or physiologic function of a part, often due to disuse.

Purposes of ROM Exercises

To maintain joint function and restore joint function.

Contraindications for ROM

Conditions where increased use of energy or increased circulation is hazardous, or when joints are swollen and inflamed.

Isotonic Exercises

Exercises involving muscle contraction and active movement, which change muscle length, maintain joint flexibility and circulation, and increase heart rate and cardiac output (e.g., running, walking, swimming).

Isometric Exercises

Exercises where muscle tension occurs without a change in muscle length or joint movement, causing a moderate increase in heart rate and cardiac output (e.g., contracting a muscle and holding).

Mobility

The amount and quality of physical activity.

Immobility

Pertaining to the inability of a body part or limb to be moved.

Flexion

A movement which decreases the angle between two adjoining bones.

Lateral Flexion

Flexion to the side.

Extension

A movement by a joint which increases the angle between two adjoining bones.

Hyperextension

A position of maximum extension, beyond the normal range of extension.

Abduction

Movement of a limb away from the body's midline.

Adduction

Movement of a limb toward the body's midline.

Rotation

Movement of a bone around its central axis.

Circumduction

The circular movement of a limb.

Eversion

Turning the sole of the foot outward by moving the ankle joint.

Inversion

Tursing the sole of the foot inward by moving the ankle joint.

Supination

A movement which allows the palm of the hand to turn up.

Pronation

The rotation of the forearm so that the palm of the hand faces downward or backward.

Plantar Flexion

Flexion of the foot toward the back (pointing toes downward).

Dorsal Flexion

Flexion of the foot upward and inward (pulling toes toward the shin).

Active ROM

Exercises performed by the patient themselves, involving muscle contraction and active movement to maintain or increase muscle strength, length, endurance, and cardiorespiratory function.

Passive ROM

Exercises where another person moves each of the client’s joints through ROM; it is useful in maintaining joint flexibility but does not build muscle strength, performed when the client is unable to move actively.

Active Assisted ROM

Exercises where the client uses a stronger limb to assist in moving a weaker limb, often with nurse assistance, to increase active movement on the strong side and maintain joint flexibility on the weak side (e.g., for hemiplegic clients).

Proper Positioning

Ensures good body alignment, promotes comfort, prevents musculoskeletal injury, prevents complications like contractures and pressure injuries, facilitates procedures, and provides sensory, motor & cognitive stimulation.

Drawsheet

A sheet placed under a client (from shoulders to thighs) used by nurses to fanfold and grasp to move a patient to a desired location in the bed by shifting weight from front to back leg.

Supine Position

Patient is placed on their back with the head of bed flat, with support for the lumbar spine, upper shoulders, neck or head, and ankles to elevate heels; trochanter rolls or sandbags prevent external rotation of hips, and a footboard prevents foot drop.

Prone Position

Patient is positioned on their abdomen, typically with the head turned to one side and supported by a pillow; small pillow under the abdomen below the diaphragm, and arms supported in a flexed position at the shoulders, with pillows supporting lower legs to elevate toes.

Sim's (Semiprone) Position

Patient is in a lateral position, lying partially on the abdomen, with the dependent shoulder lifted out and arm placed at the client's side, and upper arm and upper leg flexed and supported by pillows.

Lateral Position

Patient is rolled onto their side with a pillow under the head & neck, dependent shoulder blade brought forward, both arms in a flexed position, dependent hip slightly forward, a pillow behind the back, and under the semi-flexed upper leg, and feet supported.

Fowler's Position

Head of bed elevated 45-60 degrees, with the head resting against the mattress or a small pillow, and support for arms, hands, lower back, thighs, and ankles with pillows or rolls.

Log Rolling

A technique requiring a minimum of three nurses to keep the spinal column in straight alignment to prevent injury, involving placing a pillow between the client's knees, crossing arms on the chest, and rolling the patient as a unit using a draw sheet.

Pillows (Assistive Device)

Provide support, elevate body parts, splint incisions, reduce post-op pain, and aid with mobility, deep breathing, and coughing exercises. Incorrect sizes can increase cervical flexion or be inadequate for pressure protection.

Wedge (Abductor) Pillow

A triangular-shaped pillow made of heavy foam used following hip surgery to prevent the leg from turning inward, keeping the legs apart or abducted.

Trochanter Roll

A rolled towel or blanket positioned against the hips and upper leg to prevent external rotation of the hips when a patient is lying supine.

Side Rails (Assistive Device)

Increase a patient's mobility/stability in or getting out of bed, prevent unconscious patients from falling, but raised rails not operable by the client are considered a restraint and pose a risk for entrapment.

Footboard

A flat plastic or wooden panel placed at a 45-degree angle to the mattress, parallel to and touching the patient's feet, used to maintain the foot in dorsiflexion and prevent foot drop.

Foot Boots

Used to keep feet in dorsiflexion to prevent foot drop in bedridden patients.

Sandbags

Sand-filled plastic tubes that can be shaped to body contours and used to immobilize an extremity or maintain body alignment.

Hand Rolls

Maintain the thumb in slight adduction, in opposition to the fingers, preventing contractures by maintaining the hand, thumb & fingers in a functional position, typically used for patients with paralyzed arms or unconscious patients.

Hand-Wrist Splints

Individually molded devices used to maintain proper alignment of the thumb (slight adduction) and wrist (slight extension), designed for specific patients.

Trapeze Bar

A triangular device descending from a securely fastened overhead bar attached to the bed frame, allowing the patient to use upper extremities to raise the trunk, assist in transfers, perform arm exercises, promote independence, and reduce shearing action.

Principles of Moving & Positioning Patients

Includes checking for physician's orders, avoiding overtiring clients, assessing for pain relief needs prior to movement, explaining procedures to clients, and seeking assistance for heavy clients or when unsure to prevent injury.

Dangling Position

A patient sitting at the side of the bed for a period to assess for light-headedness or dizziness (orthostatic hypotension) before further movement.

Transfer Belt

A device used with patients being transferred for the first time and thereafter if deemed necessary, typically grasped around the client's waist by the nurse to assist with standing and pivoting.

Environment (healthcare setting)

The setting for interaction between client and staff, client and family, which should be conducive to healing and communicating.

Nursing assessment of safety

Involves assessing factors such as age and development, lifestyle, mobility and health status, sensory-perceptual alterations, cognitive awareness, emotional state, ability to communicate, safety awareness, and environmental awareness.

Unintentional injuries

A major cause of death among Canadians; nurses must be aware of what constitutes a safe environment for individuals and groups in various settings.

Benefits of a safe environment

Reduces illness and injury, shortens the length of treatment and stay, improves or maintains functional status, increases a client’s sense of well-being, and protects staff allowing them to function optimally.

Characteristics of a safe environment

Basic needs are met, physical hazards are reduced, transmission of pathogens is reduced, cleanliness is maintained, and pollution is controlled.

Environmental factors affecting comfort and communication

Noise, extreme temperatures, distractions, lack of space, and privacy can create confusion, tension, and discomfort for clients.

Florence Nightingale's key environmental factors for health

Fresh air, clean water, efficient drainage, cleanliness, and light (especially direct sunlight); also stressed warming clients, maintaining a noise-free environment, and assessing diet.

Sufficient space in a patient's room

Allows clients, visitors, and healthcare workers to move around freely, which is important for safety and effective care.

Environmental factors controllable by care providers

Temperature, humidity, ventilation, noise, lighting, and cleanliness.

Ideal room temperature for patients

Usually between 20-23 degrees Celsius, though infants, the elderly, and acutely ill (except in specific cases) generally need warmer temperatures.

Humidity

The amount of moisture or water vapor in the air; increased humidity slows evaporation, decreased humidity quickens it.

Effects of low humidity

Causes moisture to evaporate more quickly, leading to dry mucous membranes in the throat and nose, which can increase the risk of respiratory infections, especially in the elderly and very young.

Adequate ventilation

Prevents odors (e.g., from draining wounds, vomit, urine, fecal matter) from lingering in rooms and ensures fresh air circulation.

Odor control in patient rooms

Achieved through prompt emptying of bedpans and urinals, adequate ventilation, use of room deodorizers, and airing rooms when the patient is absent.

Nurse's personal hygiene

Crucial for maintaining a pleasant and safe environment, includes personal cleanliness, wearing underarm deodorant, good mouth hygiene, clean clothing and shoes, and avoiding perfumes or scented products due to patient sensitivities or allergies.

Impact of noise on ill patients

Ill people are sensitive to noise, which interferes with rest, can be particularly distracting to confused patients causing sensory overload, and can lead to physiological responses such as increased heart rate and muscle tension.

Noise reduction strategies in healthcare

Using acoustic tile, drapes, and carpeting; playing calming music; lowering voice levels; performing only essential nursing tasks during sleeping hours, clustering tasks, and making appropriate alarm settings to reduce false alarms.

Importance of adequate lighting

Necessary for assessing clients, performing procedures, and examinations; dimming lights promotes rest and sleep, and sufficient lighting (inside and out) minimizes the potential for injuries.

Chain of Infection

A required process with 6 links for an infectious process to take place.

Infectious Process

Occurs if the links in the chain of events remain intact, leading to the spread of infection.

Reservoir (Infectious Agent)

The environmental home where an infectious agent lives, which can be animate (people, animals) or inanimate (water, soil, medical devices).

Causative Agents

Main types of infectious agents, including bacteria, viruses, fungi, and protozoa.

Bacteria

Much bigger and more complex microorganisms that are fairly easy to grow in a lab, e.g., Staphylococcus.

Viruses

Much smaller microorganisms made of a core of genetic material surrounded by a protein coat; they cannot reproduce by themselves and need to take over another cell.

Normal Flora

Microbes occurring naturally in a body part.

Pathogens

Disease-causing microbes.

Modes of Transmission

Ways pathogens exit the reservoir and are transmitted, including contact (direct or indirect), droplet, airborne, vehicle, and vectorborne.