Final Exam MDC 1, MDC 1 FINAL QUESTIONS AND ANSWERS |ALL VERIFED

Final Exam MDC 1, MDC 1 FINAL QUESTIONS AND ANSWERS |ALL VERIFED 1. Fall Prevention a. In Homes: i. Remove items that could cause the client to trip(throw rugs and loose carpets) ii. Place electrical cords and extension cords against a wall behind furniture iii. Monitor gait and balance, and provide aids as needed iv. Make sure that steps and sidewalks are in good repair Place grab bars near the toilet and in the tub or shower and install a stool riser Fall Prevention In Hospitals i. Fall bracelets and yellow socks ii. Bed alarm iii. Remove clutter iv. Keep items within reach(call light, personal items) v. Gait Belts vi. "Call, don't fall" 1. Orient them to the call light and educate them to use call light to get help rather than getting up without assistance. Nurses should respond to call light in a timely manner vii. Put them in room close to nurses station viii. Have good lighting (especially at night) ix. BEDS: 1. Put in low position 2. Lock wheels 3. Use side rails appropriately 1. Home Safety a. Preschoolers and School Age Children i. Firearms 1. Keep firearms unloaded, locked up, and out of reach 2. Teach to never touch a gun or stay at a friend's house where a gun is accessible 3. Store bullets in a different locations from guns 1. Home Safety a. Preschoolers and School Age Children i. Poison 1. Teach child about the hazards of alcohol, cigarettes, and prescription, non-prescription, and illicit drugs 2. Keep potentially dangerous substances out of reach Have the poison control hotline number available 1. Home Safety a. Preschoolers and School Age Children i. Motor Vehicles 1. Use booster seats for children who are less than 4ft 9in tall and weigh less than 40lbs(usually 4 to 8 years old) 2. If the care has a passenger air bag, place children under 12 yrs in the back seat 3. Use seatbelts properly after booster seats are no longer necessary 4. Use protective equipment when participating in sports, riding a bike, or riding as passenger on a bike 5. Supervise and teach safe use of equipment 6. Teach the child to play in safe areas and never run after a ball or toy that goes into a road 7. Teach child safety rules of the road. a. Look both ways before crossing road a. Fire Safety i. Elements of Home Safety Plan 1. Where the exit plan in 2. Oxygen safety measures 3. Fire extinguishers and everyone knows there location Smoke detectors need batteries checked every 6 mos 1. Center of Gravity a. should be close to the base of support (below the umbilicus at the top of the pelvis) b. spread feet, wide base of support c. hold objects close to you Bathing a. Bathe clients to cleanse the body, stimulate circulation, provide relaxation, and enhance healing. b. Bathing clients is often delegated to the assistive personnel. However, the nurse is responsible for data collection and client care c. Bathe clients whose health problems have exhausted them or limited their mobility. i. Give a complete bath to clients who can tolerate it and who hygiene needs warrant it ii. Allow rest periods for clients who become tired during bathing iii. Partial baths are useful when clients cannot tolerate a complete bath, need particular, cleansing of odorous or uncomfortable areas, or can perform part of the bath independently. iv. Therapeutic baths are used to promote comfort and provide treatment (soothing itchy skin) Bed Bath: i. Ensure privacy ii. Start with face then arms and chest, then go to legs and feet, and then finally perineal. iii. Encourage patient to participate: 1. Wash their face and perineal area 2. usually set up the washcloth for them and allow them to do what they can and help with what they can't allowing them the independence they still have. "we'll work together" 3. Brush their own teeth Foot Care a. Prevents skin breakdown, pain, and infection b. Is extremely important for clients with diabetes mellitus and a qualified professional must perform it. c. Scrub between toes d. Don't clip nails but file if needed. e. Check for sores, signs of cyanosis, and skin breakdown 1. Pain Assessment a.P:provoking/relieving; what makes it worse and better b. Q: quality; how the pain feels: throbbing, aching, burning c. R: radiate; does the pain radiate anywhere else d. S: severity; on a scale of 1 to 10 how much does it hurt T: timing; onset, duration, and frequency 1. Pain Medication Administration a. Asses before giving pain meds: i. PQRST ii. Possible drug interactions, allergies iii. Correct orders iv. Correct dosage and medications 1. Pain Medication Administration (PT.2) a. Analgesics are the mainstay for relieving pain. The three classes of analgesics are non-opioids, opioids and adjuvants i. Concerns when taking Opioids: 1. Lower BP and HR a. Orthostatic hypotension (fall risk) 2. Constipation 3. Urinary retention 4. Respiratory depression a. S&S i. Bradypnea, RR less than 8 per min, and are shallow Low O2 saturation Pain Medication Administration (PT.3) a. Before giving more pain medications reassess vitals (look at quality of respirations) and another pain assessment Pain Medication Administration (PT.4) a. After giving medication: i. Reevaluate pain level in: 1. IV: 30 min 2. Oral: 1 hour ii. Check vitals b. The parenteral route is best for immediate, short-term relief of acute pain The oral route is better for chronic, non-fluctuating pain 1. Culture a. Is what people in a group have in common and it changes over time. a. Can be adopted by assimilation b. Effect on healthcare: i. What treatments they accept ii. How they view healthcare iii. How they view illness/disease/health/pain iv. How often or when they access health care v. Death rituals Time Orientation a. some cultures tend to be past, present, or future oriented b. may be late to appointments because their culture (don't wear watches) c. they value traditions and relationships over time and deadlines they might not take medications on time 1. Health Disparities (pg. 302) a. Health Status i. Higher rates of illness and death in minority groups ii. African American: higher maternal death rates Health Disparities (pg. 302 a. Quality of Care Blacks receive worse care compared to white Health Disparities (pg. 302 a. Access to Care Lack of access to preventative healthcare and language barriers can account for differences in the health status of racial and ethnic groups SBAR Communication a. S: situation b. B: background c. A: assessment d. R: recommendations 1. Body Mechanics a. Body Alignment i. Places the spine in a neutral (resting) position. ii. Allows the bones to be aligned, reduces stress and fatigue, & muscles, joints, and ligaments can work efficiently. Body Mechanics When lifting something: i. Keep feet apart ii. Lift with legs, not back iii. Keep it close to you Don't have bed in lower position, stand close to the bed, angle the body toward direction your moving the patient to(avoid twisting Body Mechanics Balance i. Line of gravity should pass through the center of gravity ( imaginary vertical line drawn from the head through the center gravity.) ii. Gravity of center should be close to the base of support (below the umbilicus at the top of the pelvis) iii. Base of support is what holds your body up (feet) iv. The body is balanced when your line of gravity must pass through your center of gravity, and your center of gravity must be close to your base of support Body Mechanics Coordination i. Smooth movements require coordination between nervous system and musculoskeletal system. ii. Voluntary movements are initiated in the cerebral cortex. iii. Damage the motor cortex, cerebellum, or basal ganglia affects coordination of movements. iv. Cerebral Cortex = Voluntary Movement v. Cerebellum = Coordination (proprioception = awareness of posture, movement and position sense). vi. Basal Ganglia = Helps with Coordination 1. Posture a. Tips to maintain posture i. Avoid standing in one position for a lengthy period. If you cannot change position, place one foot on a stool or box and alternate ii. Do not lock knees when standing upright iii. Keep your stomach muscles tight to support your back iv. Do not bend forward at the waist or neck when are working in a low position v. When you are seated, work at a comfortable height vi. Do not wear high-heeled or platform shoes from ling periods of time vii. Do not slump when you sit viii. Sit close to your work ix. Use a chair that supports your back in a slightly arched position x. Sit with your feet flat on the floor and your knees below your hips Sleep on a mattress that is firm but not extremely hard Benefits of Mobility on Respiratory System a. Improves pulmonary circulation b. Improves gas exchange at alveolar capillary membrane c. Dilates bronchioles to increase ventilation Reduces risk of pneumonia 1. Benefits of Regular Exercise a. Cardiovascular System i. Improves pumping action of heart ii. Decreases HR and BP iii. Improves circulation by increasing the number of capillaries Improves venous return to the heart 1. Benefits of Regular Exercise Respiratory System i. Improves pulmonary circulation ii. Improves gas exchange at alveolar capillary membrane iii. Dilates bronchioles to increase ventilation 1. Benefits of Regular a. Musculoskeletal System i. Increase muscles mass, strength, power and endurance ii. Improves flexibility iii. Increases coordination iv. Helps maintain joint structure v. Improves gait speed, stability and balance vi. Reduces risk of falls and helps older adults maintain independent lifestyle vii. Improves bone mass and density viii. Improves skeletal development in children 1. Benefits of Regular a. Nervous System i. Speeds nerve impulse transmission ii. Reduces sympathetic response to exercise iii. Improves reaction time 1. Benefits of Regular a. Endocrine System i. Increases sensitivity to insulin at the receptor site ii. Increases efficiency of metabolic process Improves temperature regulation 1. Benefits of Regular a. GI System i. Improves appetite ii. Improves abdominal muscle tone iii. Decreases risk of colon cancer iv. Walking increases peristalsis 1. Benefits of Regular a. Urinary System i. Increases efficiency of kidney function 1. Benefits of Regular a. Integumentary System Improves skin tone as a result of improved circulation 1. Benefits of Regular Immune system i. Reduces susceptibility to minor viral illnesses ii. Reduces systemic inflammation 1. Benefits of Regular a. Mental Health i. Boosts energy level ii. Release endorphins, which assist with pain control and stress management iii. Improves self-esteem and body image iv. Promotes clearer thinking and improved memory in older adults v. Provides nonpharmacological management to symptoms of anxiety and depression 1. Benefits of Regular a. Overall Health i. Burns calories to achieve and maintain healthy body weight ii. Leads to reduced abdominal obesity iii. Improves overall stamina iv. Reduces fatigue Increases sleep time and improves sleep quality. Fowler's i. Semi sitting position in which the head of the bed is elevated 45 to 60 degrees. ii. This position promotes respiratory function by lowering the diaphragm and allowing the greatest chest expansion. iii. Semi-Fowler's: head is raised 30-45 degrees iv. High-Fowler's: the head is raised 60-90 degrees (recommended for patient who have trouble breathing) Lateral i. Side-lying position with the top hip and knee flexed and placed in front of the rest of the body. ii. Creates pressure on the lower scapula, ilium, and trochanter but relieves pressure from heels and sacrum Sims i. Semi-prone position ii. The lower arm is positioned behind the patient, and the upper arm is flexed. iii. This position facilitates drainage from the mouth and limits pressure on the trochanter and sacrum Supine i. Also known as the dorsal recumbent position ii. The patient lies on their back with head and shoulders elevated on a small pillow. iii. Used for those with Hypotension a. Prone i. The patient lies on their abdomen with their head turned to one side. This is the only position that allows full extension of the hips and knees. It also allows secretions to drain from the mouth a. Tri-pod (orthopneic) Used for patients with COP Trendelenburg i. Head down, feet up ii. Helps with venous return iii. Used for those with Hypotension How to move patient up in bed: i. use another person's help ii. use draw sheet(can cause shearing), it is even better to use plastic device iii. patient should have hands across their chest, so they don't have shearing on the arms, with the patient supine, and head lifted towards chest(reduces risk of hyperextension). 1. Range of Motion Terms Extension movement that increases the angle between two adjacent bones Circumduction a conical movement of a body part. (rolling your neck, head in a circle) Adduction movement of an extremity toward the midline of the body Abduction movement of an extremity away from the midline of the body Internal rotation rotating a joint inward External rotation rotating a joint outward Flexion movement that decreases the angle between two adjacent bones Active ROM i. Patient does not need assistance with ROM Passive ROM Anytime someone is assisting someone with ROM Interventions to Prevent Risk for Contractures a. Passive ROM i. Flexion and extension 1. DVT Signs and Symptoms i. Unilateral pain ii. Swelling iii. Warmth iv. Redness v. Assessment: Measure the calf!!! 1. DVT a. Prevention i. Calf pump exercises ii. If appropriate: get patient walking once an hour iii. SCD: sequential compression devices iv. Changing their position 1. DVT a. Risk Factors i. Immobility (venous stasis) ii. Obesity iii. Cancer or chemo iv. Diabetes v. History of smoking or current smoker vi. Oral contraceptives vii. Older adults (especially with hip fractures) viii. Heart disease ix. Surgical procedure longer than 30 minutes 1. Adaptive Devices We use them to promote client independence as much as possible Interventions to Promote Respiratory Function a. Positioning (High-Fowler's for meals to reduce risk of aspiration) b. Incentive spirometer (take deep breaths) c. Deep breathing techniques d. Coughing