Skills Final

I. SKIN INTEGRITY, HYGIENE, & INFECTION CONTROL

1. Maintaining Skin Integrity

  • Keep skin clean and dry.

  • Encourage frequent repositioning (every 2 hrs).

  • Use barrier creams for incontinence.

  • Inspect bony prominences.

  • Maintain good nutrition & hydration (protein, vitamin C).

2. Hygiene After Bathing

Teach patients to:

  • Pat skin dry (not rub).

  • Pay attention to folds: groin, under breasts, axilla, between toes.

  • Apply moisturizer to prevent cracking.

  • Wear clean clothes, change dirty linens.

3. Proper Hand Hygiene

Most effective way to prevent infection

Steps

  1. Wet hands.

  2. Apply soap.

  3. Rub 20 seconds: palms, backs, between fingers, thumbs, nails.

  4. Rinse downward.

  5. Dry thoroughly.

  6. Use towel to turn off faucet.

When to intervene

If someone:

  • Skips fingertips

  • Doesn’t scrub long enough

  • Touches sink after washing
    → Correct with gentle reminder.

4. Stages of Infection

Stage

Description

S/S

Incubation

Pathogen enters body

No symptoms

Prodromal

Early vague symptoms

Fatigue, malaise, low fever

Illness

Full symptoms

Fever, pain, inflammation

Convalescence

Recovery

Symptoms decrease

5. Inflammatory Response Steps

  1. Vascular response – vasodilation, redness, warmth.

  2. Cellular response – WBCs arrive.

  3. Exudate formation – pus/serous drainage.

  4. Tissue repair – regeneration/scar.

6. Mask Use

  • Apply over nose & mouth, pinch nose piece.

  • Avoid touching mask front.

  • Remove by straps.

  • Dispose in biohazard if soiled.

7. Disinfecting Equipment

  • Clean with approved disinfectant wipes (stethoscope, BP cuff).

  • Prevents HAIs (MRSA, C. diff, CAUTI, VAP).

II. SLEEP & REST

8. Insomnia

  • Difficulty falling or staying asleep.

Symptoms

  • Daytime fatigue

  • Irritability

  • Poor concentration

Patient teaching

  • Consistent sleep schedule

  • No caffeine before bed

  • Cool, dark room

  • Relaxation techniques
    Effectiveness: Pt reports better sleep.

9. Obstructive Sleep Apnea

  • Airway collapses during sleep.

Symptoms

  • Snoring

  • Apneic episodes

  • Daytime sleepiness

Treatment

  • CPAP

  • Weight loss

  • Avoid alcohol/sedatives

10. Melatonin

  • Hormone that regulates sleep-wake cycle.

  • Too much = grogginess, sleep disruption.

11. Sleep Interfering Factors

  • Stress

  • Pain

  • Medications

  • Environment

Tips

  • Limit screen time

  • Bed only for sleep

  • Daily exercise

12. Stages of Sleep

  • N1: Light sleep

  • N2: Most of sleep occurs here

  • N3: Deep sleep, tissue repair

  • REM: Dreaming, memory consolidation

III. PATIENT COMFORT, HYGIENE, NAIL CARE

13. Promoting Comfort

  • Warm blankets

  • Proper positioning

  • Soft lighting

  • Pain control

14. Providing Hygiene Based on Status

  • Dependent pts need full or partial assistance.

  • Prevent skin breakdown & infection.

15. Proper Nail Care

  • Cut straight across.

  • Avoid cutting diabetics’ nails—podiatrist only.

  • Prevent infection and injury.

IV. VITAL SIGNS, SAFETY, PRECAUTIONS

16. Contact & Other Precautions

  • Contact: Gloves & gown (C. diff, MRSA)

  • Droplet: Mask (flu)

  • Airborne: N95 (TB)

Know disease → choose correct PPE.

17. Abnormal Vital Signs

If abnormal:

  • Reassess

  • Report

  • Intervene depending on priority (e.g., low O2 → apply oxygen).

18. Pulse Deficit

  • Apical pulse – radial pulse simultaneously.

  • Difference = deficit → indicates poor perfusion.

19. Orthostatic Hypotension Test

  1. Take BP lying → wait 1 min

  2. Sitting → wait 1 min

  3. Standing
    Positive: Drop ≥20 systolic or ≥10 diastolic + dizziness.

20. Oxygen Therapy — Effectiveness

  • Improved SpO₂

  • Less dyspnea

  • Improved LOC

  • Respiratory rate normalized

21. Too Many Opiates

  • Low RR

  • Low LOC

  • Pinpoint pupils
    → Emergency: give naloxone.

22. HAIs

  • Examples: CAUTI, CLABSI, VAP, MRSA
    Prevention: hand hygiene, PPE, sterile technique, equipment cleaning.

23. Fire Safety (RACE)

  • Rescue

  • Alarm

  • Confine

  • Extinguish

24. Fall Risks

  • Orthostatic hypotension

  • Recent surgery

  • Sedatives

  • Mobility issues

Safety: bed alarms, call light, nonslip socks.

25. Sentinel, Unexpected, Near Miss Events

  • Sentinel: death or serious harm

  • Unexpected: unplanned, adverse

  • Near miss: almost happened but prevented

V. MOBILITY, BODY MECHANICS, ROM

26. Proper Body Mechanics

  • Bend knees

  • Straight back

  • Hold objects close

  • Avoid twisting
    Prevents injuries.

27. Repositioning Patients

  • Use draw sheet

  • Lift, don’t drag

  • Use help or lift equipment

28. Mobility Assessment

  • Use ROM, gait, strength checks.

ROM:

  • Active: patient moves joints

  • Passive: nurse moves them
    Goal: prevent contractures.

VI. MUSCULOSKELETAL

29. Joints, Tendons, Bones

  • Bones: structure/support

  • Joints: movement

  • Tendons: connect muscle to bone

  • Muscles: contract for movement, need oxygen & nutrients.

VII. SAFETY, CONSENT, PERIOPERATIVE

30. Hospital-Acquired Injuries

  • Falls

  • Pressure injuries

  • Med errors
    Prevent through precautions & monitoring.

31. Informed Consent

  • Provider explains procedure.

  • Patient must understand & be competent.

  • Nurse verifies signature and understanding.

32. Postoperative Complications

  • DVT: swelling, pain

  • Infection: redness, fever

  • PE: SOB, chest pain

  • Hemorrhage: low BP, high HR

33. Preparing Skin for Surgery

  • Antimicrobial scrub

  • Remove hair with clippers

  • Maintain sterility

34. Time-Out Procedure

  • Confirm patient, site, procedure
    Prevents wrong-site surgery.

35. Incentive Spirometry

  • Inhale slowly to raise ball

  • Hold 3–5 sec

  • Do 10 times/hour
    Prevents atelectasis.

36. Pre-PACU Assessment

  • Airway

  • Breathing

  • Circulation

  • LOC

  • Dressing sites

VIII. COMMUNICATION & DOCUMENTATION

37. ISBARR

  • Identification

  • Situation

  • Background

  • Assessment

  • Recommendation

  • Readback

38. SOAP Charting

  • S: Subjective

  • O: Objective

  • A: Assessment

  • P: Plan

CBE = charting only abnormal findings

PIE = Problem, Intervention, Evaluation

39. Common Med Abbreviations

  • AC — before meals

  • PC — after meals

  • HS — at bedtime

  • PO — by mouth

  • SQ — subcutaneous

  • SL — sublingual

  • IM — intramuscular

  • IV — intravenous

  • ID — intradermal

IX. RESPIRATORY

40. COPD

  • Barrel chest

  • Chronic cough

  • Low O2
    Teaching: stop smoking, hydration, pursed-lip breathing.

41. Hyperventilation

  • Fast breathing → low CO₂
    Treatment: slow breathing, relaxation.

42. Home Oxygen Safety

  • No smoking

  • Keep away from heat

  • Secure tank upright

43. Pursed-Lip Breathing

  • Inhale through nose 2 sec

  • Exhale through pursed lips 4 sec
    Helps keep airways open.

X. CARDIAC & NEURO

44. Bradycardia

  • HR <60

  • Causes low perfusion: dizziness, fatigue.

45. Heart Disease Risks

Nonmodifiable: age, genetics, gender
Modifiable: smoking, obesity, diet, inactivity

46. Peripheral Neuropathy

  • Numbness, tingling

  • Burning pain

XI. SENSORY & NEURO EXAMS

47. Rinne Test

  • Tuning fork → mastoid → ear

  • Tests air vs. bone conduction.

48. Impaired Speech

  • Use boards, pictures, writing

  • Encourages autonomy & communication.

49. Diabetic Neuropathy

Teach:

  • Daily foot checks

  • No barefoot walking

  • Proper footwear
    Prevents ulcers & amputations.

50. Vision Tests

  • Snellen: acuity

  • Perimetry: peripheral vision

  • Tonometry: intraocular pressure

51. Eye Disorders

  • Glaucoma: peripheral vision loss

  • Cataracts: cloudy lens

  • Macular degeneration: central vision loss

  • Diabetic retinopathy: vessel damage, floaters

XII. PAIN, GI, GU, STRESS

52. Types of Pain

  • Neuropathic: tingling, burning

  • Cancer pain: chronic/progressive

  • Acute: sudden

  • Chronic: >3 months

53. Pain Assessment

  • Verbal scales

  • Nonverbal: grimace, guarding
    Subjective: what patient says
    Objective: what you observe

54. Dehydration S/S

  • Dry mucosa

  • Low urine

  • Tachycardia

  • Poor turgor

55. Constipation

Teaching:

  • Fiber

  • Fluids

  • Physical activity

  • Don’t delay urge

56. Filtering Urine

Checking: clarity, sediment, color
Teach: clean catch.

57. Colonoscopy

Detects: cancer, polyps, bleeding, inflammation.

58. Types of Incontinence

  • Stress: sneeze/cough

  • Urge: strong sudden urge

  • Reflex: neuro issue

  • Overflow: retention → dribbling

59. Stress Types

  • Developmental: expected life stages

  • Situational: unexpected events

  • Adventitious: disasters

  • Cultural: cultural conflicts

60. Acute vs Chronic Stress

  • Acute: short-term (exam)

  • Chronic: long-term (caregiver stress)