Download Common occupational disorder in nursing that is preventable with

Test 2
Review Sheet
Common occupational disorder in nursing that is preventable with good Body mechanics?
 Lower Back Strain
What does locking wheels on bed and wheel chair prevent? During Patient Transfers? during Pivot Transfers;
when using Transfer Belts
 Locking wheels on bed and wheel chairs prevent them from rolling away which may cause injury to the
patient or the health care provider. It promotes safety.
Types of Assist to move patient- when do you use each?
 Other nursing staff:
 Mechanical Lift: lift sheet: roller board: similar to conveyor belt. Used when a pt is tranfered from one
bed to antoher
 side boards: Similar to roller board but does not roll. Slippery surface that allows pt. to be moved with a
slip sheet on to another bed or streacher
 gait belt: Used to ambulate or transfer a pt. who is week or unsteady
What types of patient need positioning? What takes priority? How do you prevent patient going to back without
using restraints?•
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Know position& descriptions? Dorsal Lithotomy; Lithotomy, Sims, What can assist you? Trocanter rolls? Hightop Tennis shoes
 Dorsal Lithotomy: 1) a variation of the supine position. 2) patients are on their back with the feel placed
in stirrups and the legs spread apart and abducted. 3) used for examinating the pelvic organs. 4) patients
with joint problems or arthritis may have difficulty assuming this position.
 Lithotomy:
 Sims: 1) a variation of the side-lying position. 2) used for rectal examinations, administering enemas, or
inserting suppositories, or for an unconscious patient. 3) the distribution of weight is different from the
side-lying position because in the Sims position the weight is distributed over the anterior ilium,
humerus, and clavical. When positioning on the left side, place the left arm behind the patient and draw
the right knee and thigh up above the left lower leg. Tilt the chest and abdomen forward so the patient is
resting on them as well. 4) Pressure points common to this position are the clavical, humerus, ilium,
knees, and ankles. 5) support flexed uppermost arm and leg with pillows so that the hand is level with
the shoulder.
What is the purpose of dangling patients? When should it be used? How do you determine if it is effective?
 Purpose: is to gradually accustom the body to the position change.
 When: Before transfering a patient from a horizontal position to a vertical position (bed to wheelchair).
What is the first goal for most nursing dx.? Safety? How is it expressed?
 The first goal is airway, then cardiovascular, then safety. How is it expressed???
What is the purpose of log rolling?
 Log rolling moves the patient in one unit while maintaining straight body alignment. Its used to decrease
muscle spasms and prevent of risk of further injury to those with preexisting injuries or spinal problems.
Does not use lift sheet.
How to prevent flexion contractures?
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Test 2
Review Sheet
Use pillows, hand rolls, bootboards, trochanter tolls, hi-tops, boots and splints.
Passive ROM joints Knee? Hip? Arm? Is active or passive ROM better for a weak patient? When use weights?
How many reps
 Range Of Motion.
 Knee: flex leg by bending at nee.
 Hip: abduct hip joint by keeping leg straight and moving the towards edge of bed.
 internally rotate by keeping leg flat and rolling leg inward, toes pointed toward opposite foot.
 Arm: Flex and extend the shoulder and elbow. Raise straight arm above head then back down.
Internally and externally rotate shoulder
 Active is better then passive because it strengthens muscles as well as increases flexibility.
 Weights should be used when doing physical therapy.
How do you assist the falling patient? How do you place a gait belt? How are your hands positioned?
 If the patient begins to fall, stand with your feet apart slightly behind the patient, and grasp the patient's
body firmly at the waist or under the axilla. As the patient slides, bend your knees to lower your body
while continuing to support the patient.
 Place and buckle the belt around a patient's waist before having the patient stand. It needs to be
tightened just enough to allow space for your hand to grasp it from the rear.
 Insert your hand into the belt from the bottom so that, if the patient falls, you will be able to support the
weight.
Skin injury and wounds place the patient at risk for what?
 infection
How do you counsel individuals working outside sweating in warm, sunny environments?
 Make sure to hydrate often
Describe Hygiene interventions related to patient with recent stroke.
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How do you assess Hygiene needs?
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You first ask the patient how they feel about their hygiene. Assessment is best done during their bath
when you can assess the patient's condition and physical appearance. Hygiene practice is affected by
such variables as sociocultural background, economic status, knowledge level, ability to perform self
care, and personal preference so we need to consider all of these when doing our assessment.
Who is more at risk for ulcers? Immobile patient,; mobile but incontinent?
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People who have limited mobility or no mobility, chair or bed bound or temperately bed bound pt.
The pt. who is incontinet would be a more risk because the constant state of wet skin leads to maceration
(softening of tissue that increases the chance of trauma or infection)
Stage Pressure Ulcers? Difference between I, II, III, IV
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Stage I : Intact, nonblanching erythematous (red, irritated, injury or inflammation) area; indicates
potential for ulceration.
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Test 2
Review Sheet
Stage II: Interruption of epidermis, dermis or both, presents as abrasion, blister, or very shallow crater.
Area surrounding the skin may feel warmer.
Stage III: Full thickness crater involving damage and/or necrosis down to, but not penetrating, fascia.
Bacterial infection of ulcer is common and causes drainage from the ulcer. There may be damage to
surrounding tissue.
Stage IV: Full thickness, similar to stage III but penetrating the fascia with involvement of muscle, bone,
and supporting structures, may involve undermining. Infection usually widespread, ulcer may be dry ad
black, with a buildup of tough necrotic tissue (eschar) or appear wet and oozing.
Unstageable: Loss of full thickness of tissue. Base of ulcer covered by eschar in wound bed, base may
contain slough.
Who is more at risk for ulcers?
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Older adults because they have decreased subcutaneous fat, sebaceous gland activity and elasticity in
their skin. So they have less tolerance for pressure, shearing and friction forces. A balanced diet is
necessary to prevent ulcer development, without it the body's cells, capillaries, and tissues are easily
damaged.
Lowered mentally aware patients can be predisposed to pressure ulcers, because they may not realize
they have been in the same position for a prolonged period d/t loss of concept of time. Bed or chair
confinement, inability to move, loss of bowel or bladder control, poor nutrtion, lowered mental
awareness. Also dehydration, obesity, excessive diaphoresis, extreme age causing fragile skin edema
Immobile patient,; If confined to a bed or chair, the same areas of the body sustain pressure. Any patient
that cannot independently change positions, paralyzed, unconscious or with a major orthopedic
procedure.
mobile but incontinent? Incontinence puts the patient at risk for ulcers also. Skin that is frequently wet
will lead to maceration. Diaphoresis (perspiration) or not drying a patient properly after a bath also
places a patient at risk due to moisture
Determine the type of ulcer related to position?
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Side lying? Shoulder, side of head, ilium, perineum, trochanter, anterior knee, malleolus.
Prone? Bony prominences on the front of the body. Head, chest etc.
Who gets ulcers on sacrum? Lying in supine position or sitting.
Heels? Supine position
Ileum? Side lying, prone position.
Scapula? Sitting in the wheelchair.
Describe Reactive hyperemia. How to test? Treatment? Maceration?
 Pressure ulcer is an ulcer that forms from a local interference with circulation and this causes the skin to
blanch. If the pressure is relieved, the skin will become red or a darker color because of vasodilation.
This is called reactive hyperemia – blood rushing to a place where there was a decrease in circulation.
Treatment includes preventing continued injury from pressure or shearing forces, assess frequently and
turn more often. Maceration is the softening of tissue that increases the chance of trauma or infection
and increases patients risk for pressure ulcers.
Describe intervention for dry itchy skin.
 Lotion. Reduce bath water temperature. Mild soap.
Test 2
Review Sheet
Describe the steps in washing the face of an unconscious patient.
 Talk and explain what you are doing. Use warm water and a clean, soft cloth. DO NOT use soap.
Describe perineal care for females, circumcised males vs. uncircumcised males.
 Provide privacy and use a new washcloth and new warm water. Offer patient the chance to do it
themselves. If they can't place an underpad beneath the perineum. Always wash, rinse well, and pat dry.
Clean rectum last. If they have a catheter, carefully wash around it with soap and water, then rinse.
 For females: Wash from front to back. Cleanse in between all skin folds of labia.
 For uncircumcised male: Retract foreskin and clean head of penis, rinse, and reposition foreskin.
 For ALL males: Lift and clean scrotum.
Oral care with dentures includes? The NPO pt requires what in the way of oral care?
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If you need to remove the dentures, remove the top one first. Place washcloth in sink and fill with tepid
water 1 inch in depth. Brush all surfaces with water and paste or powder. Rinse well with tepid water
and palce in a labeled denture cup or emesis basin that is half-filled with cool water. Clean the patients
mouth with a soft brush and toothpaste. When reinserting dentures use dental adhesive if needed and
place top denture in first. NPO patient: explain what you are doing. Place emesis basin under their
mouth and chin. Turn on the suction and keep it nearby. Use a toothbrush and toothpaste and toothettes
to cleanse the mouth. Use half-strength hydrogen peroxide and mouthwash or water to clean every
surface in the mouth. Floss. Rinse mouth when needed by squirting in water with syringe and then
suctioning. Wipe patients mouth, lubricate lips and corners with water soluble lubricant.
Describe the way to remove tangles and dirt from matted hair.
 Alcohol, astringetns, or water may be used to loosen hair strands that are tangled and matted.
Know when to use a safety razor? When is it more appropriate for an electric razor?
 Safety razors are used by health personel and electric razors are given to patients to use when they shave
themselves. The patient must be capable of shving without harming themselves otherwise the nurse must
do it.
Describe a routine for nail care? For diabetics?
 Nail care includes regular trimming, cleaning under the nails, and cuticle care. You should soak the nails
in warm soapy water for 5-10 minutes, use an orangewood stick to clean under the nails, and gently push
cuticles back. Cut nails straight across to prevent them from growing into the skin on the sides. Monitor
the color of the nail bed to check circulation. For diabetics you most likely need a physicians order to cut
their nails, but it depends on your agency's policy.
When do you use a lens suction cup? When do you remove contact lens?
 Use lens suction cup on hard lenses and only when the patient is unable to perform the task themselves..
When do you use suction for oral care? What does the suction do?
 When the pt. can’t swallow
How can you regulate temperature in patient rooms? Who requires higher environmental temperature?
 Regulate temperature in patient rooms by asking them what they prefered and what their status is. The
Elderly and children require higher temp.
Describe appropriate environmental intervention for respiratory congestion.
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Test 2
Review Sheet
increase humidity of the environment: use of a humidifier.
How does safety bars ensure safety in surgical patients?
 Enhance patient mobility, provide patient safety, and supposts trunk and buttocks, strengthen upper
extremities.
What does the RACER acronym mean?
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Rescue any patients in immediate danger by removing them from the area
Activate the fire alarm system.
Contain the fire by closing doors and any open windows.
Extinguish the flames with an appropriate extinguisher.
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What does ALARA Mean in terms of radiation?
 As Low As Reasonably Achievable
Who do you call if you suspect a home care pt. poisoning with Fuel ?
 Call poison control with the following information: what was ingested, the age of person who ingested,
how much was ingested, any symptoms or complaints you observe.
When using restraints what should do first? Principle of using protective devise?
 Access why pt. is acting out and explain any misconceptions that they may have.
MSDS? What is your responsibility? Where stored? OSHA? Who is this?
 Material Safety Data Sheet. As a nurse, you are responsible to know where to find and use the
information. Stored at a central location in the workplace. Occupational Safety and Health
Administration: Regulates chemicals in the workplace.