Exam 1

What position is this

Sims

What position is this

Low fowlers

What position is this

Semi fowlers

What position is this

High fowlers

What position is this

Trendelenburg

What position is this

Side-lying

What position is this

Prone

What position is this

Supine

How often should you reposition a patient?

At least every 2 hours

Chain of infection

• Pathogen

• Reservoir

• Portal of exit

• Mode of transmission

• Means of entry

• Susceptible host

Donning isolation gear order

1. Gown

2. Mask/respirator

3. Eyewear / face shield

4. Gloves

Doffing isolation gear order

1. Gloves

2. Eyewear / face shield

3. Gown

4. Mask / respirator

Typical temperature range

96.4 - 99.1ºF

Eupnea

Normal breathing, 60-100

Tachypnea

Fast breathing, over 20

Bradypnea

Slow breathing, under 60

Factors that assess respiratory rate

• exercise

• pain

• anxiety

• smoking

• medications

Cardiac output formula

stroke volume x rate

Cardiac output definition

Total volume of blood pumped by the heart into the systemic circulation per minute

Newborn HR

120-160bpm

Toddlers HR

90-140bpm

School aged HR

75-100bpm

Adolescent HR

60-90bpm

Adult HR

60-100bpm

Well trained athlete HR

40-60bpm

BP formula

cardiac output x vascular resistance

Systolic BP

Force of push during ventricular contraction

Diastolic BP

Force of blood at resting phase of contraction

Pulse pressure

Difference between systolic and diastolic BP

Mean Arterial Pressure (MAP)

Average force of blood into the tissues

MAP formula

(systolic BP + (diastolic BP x 2)) / 3

Signs of malnutrition

• Swollen neck glands

• Wounds/pressure sores

• Muscle wasting

• Edema

• Transverse ridges on fingernail beds

How often do restraint orders need to be renewed

24 hours

Standard precautions includes…

• Gloves when touching body fluids

• Mask/eye protecting if splashing possible

• Gown if clothing may be exposed

Contact precautions are used for

Infections spread by direct touch or contaminated surfaces

What PPE used in contact precautions?

• Gloves

• Gown

True or false: contact isolation precautions include a single room and dedicated equipment

True

Examples of contact isolation diseases

• MRSA

• Cdiff

• Scabies

• RSV

Droplet precautions are used for…

infections spread through large respiratory droplets (3-6 ft)

PPE required for droplet precautions

Surgical mask (and gloves)

True or false: Droplet precautions include a single room and dedicated equipment

False- single room only

Examples of droplet precautions diseases

• Flu

• Meningitis

• Pertussis

Airborne precautions are used for…

infections spread through tiny airborne particles that remain suspended in the air

PPE required for airborne precautions

N95 respirator or higher

What type of room is required for airborne precautions

Negative pressure room

Examples of airborne diseases

• Tuberculosis

• Measles

• Chickenpox

• COVID-19

What are reverse isolation precautions?

Precautions that protects immunocompromised patients from infection

PPE required for reverse precautions

• Mask

• Gloves

• Gown

Examples of patients requiring reverse precautions

• Organ transplant

• Chemotherapy patients

• Severe neutropenia

Do you remove mask inside or outside of room?

Outside

Temperature recording methods

• Rectal

• Temporal

• Axillary

• Oral

• Tympanic

Where to feel apical pulse

5th intercostal space at left midclavicular line

Factors that determine BP

• Cardiac output

• Peripheral vascular resistance

• Volume of circulating blood

• Blood viscosity

• Elasticity of vessel walls

Phase 1 of kortokoff sounds

Faint tapping sound

Phase 1 of kortokoff sounds represents…

systolic BP

Phase 2 of kortokoff sounds

Soft swishing sound

Phase 3 of kortokoff sounds

Crisp thumping sound

Phase 4 of kortokoff sounds

Blowing sound

Phase 5 of kortokoff sounds

Silence

Phase 5 of kortokoff sounds represents…

diastolic BP

If a BP cuff is too big, the reading will likely be…

low

If a BP cuff is too small, the reading will likely be…

high

Elevated BP range

120-129 / <80

HTN Stage 1

130-139 / 80-89

HTN Stage 2

140+ / 90+

Hypertensive crisis

180+ / 120+

Culture definition

Thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups

True or false: you can use family/friends as interpretation staff in the hospital

False

True or false: if a police comes to hospital asking for information/medical records, you must provide it

false

SOAP stands for

• Subjective

• Objective

• Assessment

• Plan

SBAR stands for

• Situation

• Background

• Assessment

• Recommendation

4 assessment techniques

1. Inspection

2. Palpation

3. Percussion

4. Auscultation

What is palpation assessment technique

Using sense of touch to assess texture, temperature, moisture, swelling, tenderness, etc

What is percussion assessment technique

Tapping with short “sharp” strokes to produce vibration and sound

5 types of sounds from percussion

• Flatness

• Dullness

• Resonance

• Hyper resonance

• Tympany

Flatness percussion sound

Soft, muddled

Dullness percussion sound

Medium/high pitch, quiet, thud-like sound

Resonance percussion sound

Low pitch

Hyper resonance percussion sound

Exaggerated low pitch sound

Tympany percussion sound

Hollow, high pitch, like a drum

The bell is the concave or flat end of the stethoscope?

Concave

The diaphragm is the concave or flat end of the stethoscope?

Flat

Bell side of stethoscope produces which kind of sounds

Low pitch sound (murmurs, bruits, extra heart sounds)

Diaphragm side of stethoscope produces which kind of sounds

high pitch sound (heart, breath, bowel)

Layers of skin

1. epidermis

2. dermis

3. subcutaneous layer

epidermal appendages

1. hair

2. sebaceous glands

3. sweat glands

4. nails

types of sweat glands

1. eccrine glands

2. apocrine glands

Functions of skin

• Protection

• Temperature regulation

• Wound repair

• Prevents penetration

• Absorption / excretion

Pallor

Pale skin color, may appear white

Erythema

An abnormal redness of the skin or mucous membranes

Cyanosis

Grayish-blue tone- especially earlobes, lips, palms, nail beds

Jaundice

Yellowish color of skin, sclera of eyes, fingernails, palms of hands

Ruddy

chronic, often baseline reddish complexion

Viteligo

loss of pigment in skin, causing distinct white patches

Macule

Flat, confined area that is a change in the color of skin, less than 1 cm in diameter (i.e freckle, flat mole)

Papule

Elevated, firm, confined area less than 1cm in diameter (i.e wart, skin tag)

Patch

Flat, non-palpable irregular shaped macule more than 1 cm in diameter (i.e vitiligo, port-wine stain)

Plaque

Elevated, firm, and rough lesion with a flat top surface greater than 1 cm in diameter (i.e psoriasis)

Nodule

Elevated, firm, confined lesion, deeper in the the dermis than a papule, 1-2 cm in diameter (i.e melanoma, neurofibroma)

Wheal

raised, irregular-shaped area of cutaneous edema; variable diameter (i.e insect bites, allergic reaction)