NSG 1550 Fundamentals of Nursing - Exam 2 Review

Proper Technique for Crutch Walking

• Ascending Stairs:

  • Lead with the strong leg.

  • Bring crutches up after the strong leg.

  • The sequence is: strong leg, then crutches, then weak leg.

• Descending Stairs:

  • Place crutches on the lower step while bearing weight on the strong leg.

  • Move the weak leg to the lower step.

  • Bring the strong leg down to the same step.

  • The sequence is: crutches, then weak leg, then strong leg.

Range of Motion (ROM)

• Definition: The full movement potential of a joint, usually its range of flexion and extension

• Types:

  • Active ROM: Patient performs the exercise independently.

  • Passive ROM: Caregiver or therapist moves the joint, patient does not assist.

• Benefits: Prevents stiffness, contractures, and promotes circulation.

Effects of Immobility on Body Systems

• Musculoskeletal: Muscle atrophy, decreased strength and endurance, joint stiffness, osteoporosis.

• Cardiovascular: Reduced cardiac output, increased cardiac workload, orthostatic hypotension, thrombus formation.

• Respiratory: Decreased lung expansion, pooling of secretions, increased risk of pneumonia.

• Metabolic: Decreased metabolic rate, altered nutrient utilization, electrolyte imbalances.

• Gastrointestinal: Decreased peristalsis, constipation, appetite loss.

• Urinary: Urinary stasis, increased risk of urinary tract infections (UTIs), renal calculi.

• Integumentary: Increased risk of pressure ulcers due to prolonged pressure on bony prominences.

• Psychological: Depression, anxiety, sensory deprivation.

Different Domains of Learning

• Cognitive: Intellectual skills, knowledge acquisition (e.g., understanding medication side effects).

• Affective: Emotions, feelings, values (e.g., expressing feelings about a diagnosis).

• Psychomotor: Motor skills, physical performance (e.g., self-administering insulin).

Home Safety Education

• Older Adults:

  • Remove tripping hazards (rugs, cords).

  • Ensure adequate lighting.

  • Install grab bars in bathrooms.

  • Use assistive devices (walkers, canes).

• Adolescents:

  • Safe driving practices (avoiding distracted driving, seat belt use).

  • Avoiding substance abuse.

  • Mental health awareness and resources.

• Children:

  • Childproof the home (cabinet locks, outlet covers).

  • Teach them about stranger danger.

  • Supervise activities closely.

Safety for Children (Poison Prevention)

• Store medications and cleaning products out of reach and in locked cabinets.

• Use child-resistant packaging.

• Teach children about the dangers of ingesting unknown substances.

• Keep the Poison Control Center number readily available.

Organization for Hospital Accreditation

• The Joint Commission: A non-profit organization that accredits and certifies healthcare organizations in the United States. Accreditation is a sign of quality and commitment to meeting performance standards.

Prevention of Back Injury

• Use proper body mechanics.

• Maintain good posture.

• Strengthen core muscles.

• Avoid prolonged sitting or standing.

• Use assistive devices when lifting heavy objects.

Proper Body Mechanics

• Keep the back straight.

• Bend at the knees and hips, not at the waist.

• Hold objects close to the body.

• Maintain a wide base of support.

• Avoid twisting while lifting.

• Use leg muscles to lift, not back muscles.

Different Types of Pain

• Acute Pain: Sudden onset, short duration, usually associated with tissue damage or injury. Serves as a warning sign.

• Chronic Pain: Persistent pain lasting more than 3 months. May not have a clear cause or may persist after an injury has healed.

• Nociceptive Pain: Caused by damage to somatic or visceral tissue and activation of nociceptors (pain receptors).

  • Subtypes: somatic and visceral.

• Neuropathic Pain: Caused by damage to or dysfunction of the nervous system.

Different Types of Nociceptive Pain

• Somatic Pain: Arises from skin, muscles, bones, and joints. Usually localized and described as sharp, aching, or throbbing.

• Visceral Pain: Originates from internal organs. Often diffuse, poorly localized, and described as cramping, pressure, or deep aching.

Pain Management in Older Adults

• Start with low doses and titrate slowly.

• Consider comorbidities and potential drug interactions.

• Use nonpharmacological interventions as much as possible.

• Monitor for adverse effects (confusion, sedation, constipation).

• Address psychological and social factors.

Pain Assessment

• OLD CART:

  • Onset: When did the pain start?

  • Location: Where is the pain?

  • Duration: How long does the pain last?

  • Characteristics: What does the pain feel like?

  • Aggravating factors: What makes the pain worse?

  • Relieving factors: What makes the pain better?

  • Treatment: What treatments have you tried?

• SOCRATES:

  • Site: Where is the pain?

  • Onset: When did the pain start?

  • Character: What is the pain like?

  • Radiation: Does the pain radiate?

  • Associations: Any other symptoms associated with the pain?

  • Time course: Does the pain follow any pattern?

  • Exacerbating/Relieving factors: What makes the pain worse or better?

  • Severity: How severe is the pain?

• PQRST:

  • Provokes: What provokes the pain?

  • Quality: What is the quality of the pain?

  • Radiates: Does the pain radiate?

  • Severity: How severe is the pain?

  • Timing: When did the pain start and how often does it occur?

Pain Assessment Tool for Various Age Groups

• Infants: FLACC scale (Face, Legs, Activity, Cry, Consolability).

• Young Children: Wong-Baker FACES Pain Rating Scale.

• Older Children and Adults: Numeric Pain Scale (0-10).

• Nonverbal Patients: CPOT (Critical-Care Pain Observation Tool).

Nonpharmacological Treatment for Pain

• Physical:

  • Heat or Cold Application.

  • Massage.

  • Exercise.

  • Transcutaneous Electrical Nerve Stimulation (TENS).

• Cognitive/Behavioral:

  • Relaxation techniques.

  • Distraction.

  • Guided imagery.

  • Meditation.

Pharmacological Treatment for Different Types of Pain

• Nociceptive Pain:

  • Non-opioid analgesics (acetaminophen, NSAIDs).

  • Opioid analgesics (morphine, codeine).

• Neuropathic Pain:

  • Antidepressants (tricyclic antidepressants, SNRIs).

  • Anticonvulsants (gabapentin, pregabalin).

PCA (Patient-Controlled Analgesia)

• A method of pain control that allows patients to self-administer pain medication (usually opioids) intravenously.

• Requires patient education and monitoring for respiratory depression.

• Benefits: patient feels more in control and better suited for pain management.

Spiritual Health

• Involves finding meaning and purpose in life, connecting with something greater than oneself, and practicing values. Can be supported by nurses through active listening, presence, and facilitating religious practices.

Sleep Disorders

• Insomnia: Difficulty falling asleep or staying asleep.

• Sleep Apnea: Pauses in breathing during sleep.

• Narcolepsy: Excessive daytime sleepiness and sudden sleep attacks.

• Restless Legs Syndrome: Uncomfortable sensations in the legs and an irresistible urge to move them, especially at night.

Sleep Hygiene Practices

• Maintain a regular sleep schedule.

• Create a relaxing bedtime routine.

• Avoid caffeine and alcohol before bed.

• Create a comfortable sleep environment (dark, quiet, cool).

• Exercise regularly, but not close to bedtime.

Recommended Hours of Sleep for Different Age Groups

• Infants: 14-17 hours.

• Toddlers: 11-14 hours.

• Preschoolers: 10-13 hours.

• School-age Children: 9-11 hours.

• Adolescents: 8-10 hours.

• Adults: 7-9 hours.

• Older Adults: 7-8 hours.

Chain of Infection

• Infectious Agent: Pathogen (bacteria, virus, fungi).

• Reservoir: Where the pathogen lives (human, animal, environment).

• Portal of Exit: How the pathogen leaves the reservoir (respiratory tract, blood, urine).

• Mode of Transmission: How the pathogen spreads (contact, droplet, airborne).

• Portal of Entry: How the pathogen enters a new host (respiratory tract, skin, mucous membranes).

• Susceptible Host: A person at risk for infection (immunocompromised, elderly, young children).

Infection Control Precautions

• Standard Precautions: Used for all patients, regardless of suspected or confirmed infection status. Includes hand hygiene, use of personal protective equipment (PPE), and safe injection practices.

• Transmission-Based Precautions: Used in addition to standard precautions for patients with known or suspected infections. Includes:

  • Contact Precautions: For infections spread by direct or indirect contact (e.g., MRSA, C. difficile). Requires gown and gloves.

  • Droplet Precautions: For infections spread by large droplets (e.g., influenza, pertussis). Requires mask.

  • Airborne Precautions: For infections spread by small airborne particles (e.g., tuberculosis, measles, varicella). Requires N95 respirator and negative pressure room.

• Reverse (Protective) Isolation: To protect immunocompromised patients - mask, gloves, gown required; positive pressure room preferred.

HAIs and MDRO Pathogens

• Healthcare-Associated Infections (HAIs): Infections acquired in a healthcare setting.

• Multi-Drug Resistant Organisms (MDROs): Microorganisms that are resistant to multiple antibiotics (e.g., MRSA, VRE, CRE).

Medical Asepsis vs. Surgical Asepsis

• Medical Asepsis (Clean Technique): Reduces the number and spread of microorganisms (e.g., hand hygiene, wearing gloves).

• Surgical Asepsis (Sterile Technique): Eliminates all microorganisms (e.g., sterilizing instruments, using sterile gloves).

Providing Hygiene Care

• Bathing

• Oral Care

• Hair Care

• Nail Care

• Perineal care

• Providing privacy, maintaining warmth, and promoting independence. Observe skin condition for breakdown.