NHA PCT – Final Review Exam Updated 2022/2023, Exams of Nursing

Download NHA PCT – Final Review Exam Updated 2022/2023 and more Exams Nursing in PDF only on Docsity! Patient Care BODY SYSTEMS Integumentary System- consists of the skin (including glands) Function- protection, temp regulation, water loss and absorption Skeletal System - consists of bone and joints ( including cartilage and ligaments) Function- support, muscle movement, bone store minerals and fats,produce blood cells. Muscular System- consists of voluntary and involuntary muscles. Function- muscle movement Nervous System- consists of the brain, spinal cord, nerves, and sensory receptors. Function- regulate the body's control system to maintain homeostasis Endocrine System- consist of hormone producing glands Cardiovascular system- consists of the heart, blood vessels, blood Function- transport oxygen, nutrients, hormones, water, waste products, and body temp regulation, immune system response. Lymphatic System- consists of lymph nodes, lymphatic vessels, spleen, tonsils, thymus. Function- filter the blood and lymph, remove toxins, serves as a transport system for white blood cells. Respiratory System- consists of the airway Function- taken oxygen and exhale CO2 Digestive System- consists of the mouth, esophagus, stomach, intestines, rectum, anus. Function- break down food for nutrients and eliminates waste Urinary System- consists of the kidneys, bladder, ureter, urethra Function- remove waste from the blood and eliminates excess fluid Reproductive System- produce hormones related to sexual function and procreations DISEASE PROCESSES Infectious- caused by bacteria entering the body. Ex: urinary tract infection Acute- a short recovery time Ex: influenza Chronic- usually last longer than 6 months Ex: atherosclerosis, coronary artery disease, Degenerative- aging process causes tissues in the body to wear down. Ex: arthritis COMMON DISEASES FOUND IN HEALTH CARE Osteoarthritis- inflammation of the joint and can cause wearing of the cartil age which can result in decreased ROM, joint stiffness, mobility change, crepitus. Infections- when pathogens enters the body, grows, and multiplies Phenomena- inflammation of the lungs due to infection in which the air sacs fill with fluid and pus; makes it difficult to breath. Aspiration- inhaling foreign materials such as emesis (vomit) Chronic Obstructive Pulmonary Disease (COPD)- (emphysema and chronic bronchitis) airflow to the lungs is progressively obstructed. Symptoms- coughing, hypoxia, fatigue, dyspnea Hypertension- when systolic is 130/80 or higher Symptoms- sweating, blurred vision, fatigue, vertigo, headache Coronary Artery Disease- results from narrowing of coronary arteries due to plaque build up. Heart Failure- a chronic disorder that results in the heart being unable to continue to pump an adequate amount of blood to meet the needs of the body. Myocardial Infarction ( heart attack) - occurs as a result of a blood clot or atherosclerosis preventing blood in the coronary arteries from reaching the heart. Verbal an non verbal are equally important. Always be attentive to your patients and listen to them by smiling, eye contact, erect posture. Also, show empathy to your patients. EQUIPMENT Oxygen (4L/min)- it can cause the patient’s nasal cavity and mouth to become dry. Notify the nurse if pulse oximetry reading is less than 90%, oxygen tank is almost empty, discrepancy between the prescribed oxygen flow rate and the flow rate on the flow meter and any sudden change in patient condition. Suction- may be required for patients to remove mucus, blood, vomit, secretion, or other substances, from their mouth and throat (oropharyngeal) to keep their airway open. Gather supplies and raise the bed to 45 degrees. Suction the patient's mouth no more than 15 seconds at a time. Monitor and Alarm- a pct needs to be aware if the patients values are outside the expected ranges Cardiac monitor- measures heart activity Ventilator- pumps pressurized air into lungs Capnography- measures the concentration of carbon dioxide in exhaled air Continuous pulse oximetry- measures oxygen level in the lungs Infusion pump- delivers a specific amount of fluids or medication into a patient's circulatory system. Beds Bariatric beds- can accomodate more weight and are wider Alternating pressuring beds- circulate air or water under the patients to prevent pressure ulcers. Airflow beds- support the patient on a fabric layer containing small beads to prevent pressure ulcers and keep skin dry. Pulmonary therapy beds- provide vibration to patients at risk for respiratory complication and can also assist with repositioning. Feeding Tubes- proper position is essential before, during, and after feedings. Patients should be FUNCTIONAL LIMITATIONS Vision loss- explain everything that is taking place and keep them safe by escorting them. Hearing loss- face them and use low pitch voice and rephrase the message. Service animal- do not pet them Physics limitation- offer assistance in and out of chair Mental health- be open to their needs and respect their dignity and right Difficulty communicating- the family can let you know the best way to communicate with them and you can look for clues with their facial expressions. Adaptive Devices Adaptive utensils and built in handheld devices/long handed devices ( toothbrush, comb, brush) - assist patients who have tremors, arthritis, physical disabilities, difficulty grasping, poor fine motor skills. Canes- for patients who can bear weight but have weakness on one side of the body. Crutches- for patients who can not bear full weight on at least one leg Stocking aids- guides the sock onto foot Walker- provide the most stability for patients who can bear weight ROUNDING Opportunity to observe any changes in the patient’s condition and report them to the nurse. It could be shortness of breath, increased signs of pain, incontinence, agitation, emotional changes, difficulty in mobility. Rounding can help you assess which patient needs assistance first. - The Hospital Consumer Assessment Of Healthcare Providers and Systems (HCAHPS) ^^^^ is a national standardized, publicly reported survey of a patient's perspective of hospital care. REMOVING PERIPHERAL IV CATHETERS 1. Make sure the roller clamp on the tube is closed 2. Remove any tape scarring the tube 3. Pull the transparent dressing towards insertion site(avoid injuring vein) 4. Hold dry gauze (sterile) over the site and use slow, steady motion to pull out the catheter. 5. Apply pressure over the insertion site for 2-3 min STERILE AND ASEPTIC DRESSING Sterile - nurses and providers apply and remove sterile dressing and might ask PCT’s to assist. Aseptic Dressing- pct’s will replace dressing that require aseptic or clean technique. If you anticipate pain, check with the nurse about giving the patient an analgesic 30 min prior to dressing change. If dressing adheres to the skin use sterile water or saline solution. 1. Perform hand hygiene 2. Assist patient into a comfortable position 3. Remove old dressing (note for color, amount, drainage) 4. Dispose dressing in biohazard bag 5. Remove gloves, perform hand hygiene 6. Open a package of sterile gauze and saturate with sterile water 7. Cleanse the wound 8. Apply a new dressing 9. Dispose of cleaning gauze and any other materials 10. Remove gloves, perform hand hygiene OSTOMY CARE Needed for patients who are fighting cancer, trauma, or inflammatory bowel disease. PCT’s only clean, empty, cleansing the ostomy and the skin around it 1. Remove belt 2. Hold skin taut and peel off the ostomy appliance from the top 3. Put the appliance in bed pan 4. Wipe away any feces w/ toilet paper and discard in bedpan 5. Place gauze on top of stoma 6. Take the bedpan into the bathroom and dispose of its contents and your gloves. PERFORM HAND HYGIENE 7. Return to the patient with warm water (105-110), gloves. Towel around hand like a mit 8. Remove gauze and wash skin around the stoma with plain water 9. Apply skin adhesive if necessary 10. Place clean ostomy appliance (CHECK if the opening is the right size) 11. Press the wafer against the patient skin for 1- 2 min COMPRESSION DEVICES - Sequential compression device help prevent blood clots from forming in the lower legs - Patient requires this after SURGERY - Check the device every 8 hrs - More so used for patients after surgery - Make sure that the opening is on the back of the knee(popliteal) and the ankle is on the ankle indication. AntiEmbolism Stocking(aka. compression hose or thromboembolic different (TED)) - Prevent blood clots from forming in the deep veins of the leg - Made up of elastic materials that applies firm pressure to the lower legs. - Have the patient lie supine - Turn stocking inside out down to the heel - Place your hand inside the stocking and grasp the tip where the patient toes will go - Place the patient toes into the tip of the stocking, making sure the material is smooth and wrinkle free - Slide the stocking over the rest of the patients foot and heel, making sure the heels fits into the heel portion of the stocking - Slide and put the rest of the stocking up over the calf - DO NOT ROLL STOCKING DOWN AT THE TOp - They have an opening at the top of the toe area to allow for checking circulation RESPIRATORY CARE Turning, coughing, deep breathing AFTER SURGERY… - experience postoperative care - feeling drowsy - make it difficult for the lung to keep functioning and remove fluids and mucus TCDB (Turning, coughing, deep breathing) - At LEAST 1-2 HR WHILE AWAKE Turn patients from side to side After abdominal surgery encourage patients to splint the incision area by holding a pillow against it to help reduce pain. SPIROMETRY A breathing exercise that helps prevent respiratory complications after surgery. With this device patients breathe deeply to raise the balls in the chamber by forcefully inhaling through the device. - lso helps to keep lungs clear- with this the patient puts the mouthpiece in his/her mouth and INHALES to move a ball inside the spirometer to a certain level. The patient should hold this for 3 seconds before exhaling. This should be done every 1-2 hours and is ordered by the doctor. TRANSPORT PATIENT VIA BED, STRETCHER, WHEELCHAIR - When you take the wheelchair up the curb, face the curb, face the curb and put the front wheels up onto the curb first, then the larger rear wheels. - When you take the wheelchair down the curb, back the larger wheel off the curb first, then back the front of the wheels off the curb. FIRST AID AND CPR BLEEDING - Apply pressure with gauze to sites that are bleeding, never pick up the gauze to see if the bleeding has stopped. - Nosebleed(epistaxis): patients must sit up and lean forward and apply pressure by pinching the nose for 10-15 min. CHOCKING - Wrap your arms around the patient's waist by grasping your wrist with the thumb against the patient's body, slightly about the naval(belly button) and well below the breastbone. - Do not Repeat thrust until the foreign material has left or the patient is unresponsive SHOCK - Symptom: rapid pulse, increased shallow breathing, blank stare, cold and clammy, pale skin - Insure that the patients has an open airway - If lying down, position head below body - Keep them warm and safe until help arrives FAINTING( SYNCOPE ) - Requires immediate assistance - When patients tell you they're dizzy or about to faint, have them lie down and elevate their legs or sit and place their head in between their knees. CPR The American Heart Association updates the steps often, so you must renew your certification every 2 years. - AED device should be placed near the patient's left ear, and attach the electrodes to the patient's chest. REPORTING INFORMATION Situations that require activating the facilities emergency response team: - no pulse, no breathing Situations that require immediate notification to the nurse: - cyanosis, shortness of breath, difficulty breathing, change in consciousness, choking, fall, uncontrollable bleeding, sudden unbearable bleeding. - PCT’S DO NOT administer medications or perform sterile procedures. Following The Chain Of Command - PCT > LPN > RN > Charge Nurse >Assistant Nurse Manager > Supervisor Of Department > Director Of Nursing ( Chief Nurse) WORKPLACE SAFETY OSHA (1970)(Occupational Safety and Health Administration) - federal agency - Ensures safe and healthful working conditions by setting and enforcing standards and providing training, outreach, education, and assistance for all workers. CDC ( The Centers For Disease Control and Prevention) - federal agency - Help protect workers and patients, focusing primarily on identification, prevention, and control of infectious disease. - Focus on preventing and handling needlestick injuries Biological Hazard- are the result of contact with infectious agent ( bacteria, virus, fungi, other parasite, and bodily fluids) - OSHA Bloodborne pathogens require the implementation of work practices and engineering controls to prevent exposure incidents. Sharps - Dispose of sharps immediately by dropping them in a re biohazard sharps container - NEVER recap, bend, or remove needles from syringes - If removing needle is necessary use a mechanical device - Do not clean up any contaminated glass Hazardous Chemicals - OSHA require chemical manufacturers to supply Safety Data Sheets (SDS) for their chemicals - Each SDS holds a hazardous warning label and lists information about each chemical, including exposure limits and protective measures to take when working with the chemical Radiological Hazards - When working with patient with radioactive implants, consider time, distance, shielding, and safe disposal of patient care items and substances (trash, lenens, specimen, urine,stool) - Healthcare workers who routinely encounter radiation wear a dosimeter that records their total exposure. Electrical Hazards- can result from exposure to high voltage equipment that can cause burns and shock. - Make sure electrical equipment - Do not plug more than two items into an outlet - Dry your hands before touching electrical equipment - Position electrical device away from any water source - Report any potentially unsafe equipment to the biomedical engineering department after you tag it and remove it from patients room Fire or Explosive hazards- include open flames, oxygen, and flammable chemicals. - Can cause burns and injuries - Oxygen if common in healthcare facilities and oxygen are highly flammable - If anyone is smoking instruct to extinguish it right away Other safety Hazard- wet floors - Make sure there are safety signs or cones warning of the hazard Report Work Injuries - Report accidents to the charge nurse for assessment of the injured individual and fill out necessary forms - Report the facts as you observed them - An incident or occurrence report is necessary - If the patient is injured the nurse fills out the form - The form provides a record for the incident to be investigated and prevented in the future - Incident report is also needed for medication error - If you are injured report it and contact the facility human resources department PATIENT SAFETY Operational Standards- government agencies, health care regulatory organizations, and professional organizations have rigorous standards for ensuring safe and proficient patient care delivery in health care facilities. The Joint Commision - Has operational standards that focus on continual improvement of patient safety and quality of care - It updates standards regularly to reflect advances in healthcare and medicine - It addresses areas such as the patients right, patient education, operational movement - The National Patient Safety Goals help increase patients safety by setting requirements for issues such as accurate identification, communication of test results, and necessary training of healthcare professionals. The Clinical And Laboratory Standards Institute - Has operational standards specifically for laboratory testing - Committed in providing high quality care for patients by developing standards and guidelines to help laboratories achieve accreditation - This agency works with the industry and health care professionals to ensure that they have the most up to date info and use the safest method when performing blood test CDC And OSHA - Established operational standards for many standards of patient care such PPE, Infection control, exposure protocols, and medical examinations. Facility Policy And Procedure Manuals - A manual is accessible online or hard copy, they allow quick access to protocols for most situations you will encounter. The Hospital Consumer Assessment Of Healthcare Providers And Systems - A national, standardized, publicly reported survey of patient perspectives of Hospital care Patient Safety Guidelines - Include identifying patients correctly, improving staff communication, using alarms safely, preventing infection, and identifying patient safety risks. - Inadequate lighting, obstacles, medication, health problems, aging, vision loss, cognitive impairment, and incontinence are causes of falls - Admitting nurses asses each patients risk of falls and takes precaution such as wristband that alerts staff General Safety Precautions Preventing Falls - Make sure patient is wearing non skid slippers or shoes - You may share PHI to patients providers, medical specialists, nurses ,billing, accountant, and healthcare insurance employees. - When using a computer or laptop secure your password, never leave it logged on unauthorized, always fully log off. - When printing patients info always shred it after Patient Identification - The Joint commission mandates using 2 identifiers to verify each patients identity before care or procedure - Patient must state the identifiers while you compare it to the medical record, identification, requisition form. Identifiers - Name - Date of birth - Social security number ( only for requisition form) - Phone Number - Home address - Photo identification - Do not use patient bed or room number If patient cant identify themselves and there is so no reliabel person who can ( nurse, guardian, immediate family member). Also, don't proceed if there are any discrepancies. COMMUNICATION Electronic Medical Record ( EMR) - where you record info about patient and ONLY other members in the healthcare facility can see it - it is easy to access, different location, legibility, consistency , accuracy Electronic Health Record - The same as EMR, but more than one facility can access it @ = \ranomission \nfecti cus Agent Susceptible, ‘ | sage peservoir | Portal of Portal of exit entr Mode of transmission Fathogen = there must be first be a pathogen or infechous agent present. X72 Virus, bacteria, fungi Or preroz Om Reservoir- An envicroament conauehve +0 perhogen survivalis Known OS & resevoir: tx. 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