ADLs #2 - Final Flashcards
(111 cards)
1
Q
What does rest and sleep have in common?
A
- essential for physical and emotional health
- contribute to an individual’s ability to carry out activities of daily living
- those deprived of these become fatigued, irritable and less able to perform routine tasks
- body rejuvenates during these
2
Q
Differentiate between rest and sleep.
A
Rest: a state in which an individual feels calm, at ease and free from worry and anxiety, it clears the mind and relaxes the body making it easier for individuals to face demands of everyday living (ex-napping, reading, listen to music, walking, family outing to the zoo), patients may need rest several times a day or if very ill they may need rest during certain activities like bathing and dressing
Sleep: a state of unconsciousness where there is reduced physical activity, decreased perception of surroundings, general reduction in most bodily processes, it eases stress and tension, helps to restore energy, occurs in a regular pattern, part of a person’s biological clock (circadian rhythm)
3
Q
Def: Circadian rhythm
A
Your body’s daily rhythmic activity cycle.
4
Q
How much sleep does someone need on average?
A
- newborn: 12-14 hours of sleep
- adult: 7-8 hours of sleep
- older adults: only a few continuous hours, waking often to void, drink water, eat snacks, listen to the radio or read
- ill or injured: require additional sleep to allow the body to heal
5
Q
Name and describe the two phases of sleep.
A
1) REM (rapid eye movement): permits mental activities that filter, sort and store the day’s activities, individuals may gain insight into problems or issues of concern, dreams occur in this stage, a lack of this sleep can lead to feelings of confusion and suspicion
2) nonREM (non rapid eye movement): most body processes and mechanisms slow down which allows for bone growth, protein production and tissue repair as well as rest
6
Q
Discuss factors that affect sleep: Illness
A
- increases need for sleep
- prostate enlargement causes nocturia
- patients with heart disease may be afraid to sleep for fear of having an attack
7
Q
Discuss factors that affect sleep: Pain
A
- can cause restlessness
- can contribute to anxiety
- can prevent sleep or interfere with continuous sleep
8
Q
Discuss factors that affect sleep: Diet
A
- both hunger and excessive eating before bedtime can disrupt sleep (but small protein snack before bed is sleep-inducing)
- weight gain produces longer sleep periods with fewer wakenings, weight loss produces shorter sleep periods and more frequent wakenings
- milk and cheese induce sleep
- coffee, tea and chocolate prevent sleep
9
Q
Discuss factors that affect sleep: Exercise
A
- moderate activity up to 1 1/2-2 hours before sleep helps a person to relax and fall asleep much easier
- strenuous exercise stimulates the body and keeps one awake
- exhaustion leads to difficulty in falling asleep
10
Q
Discuss factors that affect sleep: Environment
A
- comfortable room temperature and quiet atmosphere facilitate sleep
- distracting noises or light can interfere with sleep
- inadequate ventilation, uncomfortable bed, unfamiliar environment, loss of bed partner, sound of medical equipment, interruptions for treatments can interfere with sleep
11
Q
Discuss factors that affect sleep: Medications
A
- alcohol speeds onset of sleep but disrupts deep sleep
- caffeine and nicotine cause difficulty falling asleep, frequent wakenings and disruption of REM sleep
- antihypertensives and diuretics cause nocturia
- antidepressants and tranquilizer suppress REM sleep
12
Q
Discuss factors that affect sleep: Lifestyle
A
- shift-workers are constantly disrupting their biological clock and may have difficulty sleeping
- people who travel frequently may have to re-adjust their biological clock to accommodate for jet lag
- people who regularly sleep for short periods during the day usually require less sleep at night
13
Q
Discuss factors that affect sleep: Emotions
A
- anxiety interferes with relaxation and may cause frequent wakenings or oversleeping
- depression causes general sluggishness and sleepiness, may cause one to waken often and rise early
- fear of terrorizing dreams may produce insomnia
14
Q
True or false? Patients sleep better if they are free from pain, stress, fear or anxiety.
A
True
15
Q
Identify measures which help promote sleep.
A
- encourage client to avoid physical activity before bedtime
- reduce noise
- provide for warmth with a blanket and socks
- darken the room
- give a back massage
- make sure the client is wearing loose-fitting nightwear
- provide a bedtime snack
- ensure a comfortable room temperature
- make sure linens are clean, dry and wrinkle free
16
Q
Common sleep problems: Insomnia
A
A persistent condition in which the person cannot go to sleep or stay asleep throughout the night.
17
Q
Common sleep problems: Hypersomnia
A
Excessive sleep
18
Q
Common sleep problems: Sleep apnea
A
Frequent and prolonged episodes in which the individual stops breathing during sleep.
19
Q
Common sleep problems: Narcolepsy
A
Recurrent, abrupt and uncontrollable onset of sleep attacks during normally alert periods or activity.
20
Q
Common sleep problems: Somnambulism (sleepwalking)
A
People that walk in their sleep without being aware that they are sleepwalking and have no memory of doing so on awakening.
21
Q
Common sleep problems: Sleep deprivation
A
Where the amount and quality of sleep declines.
22
Q
Common sleep problems: Nocturnal enuresis
A
Involuntary bedwetting during sleep, most common in childhood
23
Q
Common sleep problems: Night terrors
A
Partial arousal from stage IV nonREM sleep, most common in children, children will be relatively unaware of the presence of others during the night terror, not be comforted and will usually push other away, usually fall back asleep quickly, have no memory of the night terror upon awakening, have no ill effects from the night terror, will outgrow these attacks
24
Q
Define comfort.
A
- a state of contentment and well-being
- an essential component of an individual’s state of health
- people who are uncomfortable will have difficulty in performing their activities of daily living and when trying to rest
- individuals usually reduce their activity level in an attempt to reduce discomfort and may even withdraw and lose interest in others as they become more and more focused on themselves
25
Define pain.
- an unpleasant physical and/or emotional experience associated with actual or potential tissue damage
- feelings of discomfort, suffering or agony
- a complex human experience felt by people of all ages
- serves as a warning signal that something is wrong in the body
- most persons who seek medical help do so because of the presence of pain
- a personal experience and always subjective
26
Define subjective vs objective
Subjective: it is what the patient says it is and not what others think it ought to be; how the patient experiences pain; observations include information about onset and duration, location, intensity or quantity, quality, and pattern
Objective: behaviours which can be seen by others; observations include vital signs and behavioural/emotional signs
27
Types of pain: Acute pain
- temporary, sudden onset, less than 6 months in duration
- usually has a identifiable cause
- often experienced as a sharp, localized pain
- usually has an identifiable cause (result of tissue trauma or inflammation)
- usually subsides within a short period of time on its own or when treated
- patient experiences increased heart rate and blood pressure, rapid and shallow respirations, dilated pupils, sweating, pallor, increased anxiety and fear
28
Common sleep problems: Chronic pain
- persists or recurs for long periods, greater than 6 months
- not always associated with an identifiable cause
- difficult to manage
- patient may not demonstrate the physical symptoms associated with acute pain
- patient is frequently exhausted, depressed, withdrawn or irritable
29
Common sleep problems: Radiating pain
Pain that is felt not just at the site of tissue damage but extends to nearby areas.
30
Common sleep problems: Phantom pain
Pain felt in a body part that is no longer there, this is due to the disruption of nerve endings in the stump.
31
Common sleep problems: Breakthrough pain
- spontaneous, moderate to severe pain which breaks through previously controlled pain
- frequently associated with chronic cancer pain
32
Discuss factors which affect the pain experience: past pain experience
- the severity of pain, its cause, how long it lasted, and whether relief occurred all affect the client’s current response to pain
- knowing what to expect can help or hinder a client in handling pain
- clients who have never experienced pain may be fearful because they do not know what to expect
33
Discuss factors which affect the pain experience: Emotions
-worry, anxiety and fear can all increase the amount of pain an individual experiences while positive emotions (pleasure, joy and exhilaration) can increase pain threshold and pain tolerance
34
Discuss factors which affect the pain experience: Rest and sleep
- restore energy and help the body to repair itself
- ill and injured clients need more sleep than usual
- lack of rest and sleep affects how a client copes with pain
- pain seems worse when a client is tired or restless
35
Discuss factors which affect the pain experience: Attention
- the more a patient thinks about the pain the worse it can seem
- sometimes pain is so severe that that’s all you can think about
- pain often seems worse at night when there are no distractions
36
Discuss factors which affect the pain experience: Value / Meaning of pain
- pain means different things to different people
- some see it as a sign of serious weakness or of a serious illness
- some clients ignore or deny their pain
- some clients may use their pain to avoid certain people or things
- some use it to get attention
37
Discuss factors which affect the pain experience: Support of others
- presence of others may have either a positive or negative effect on the pain experience
- if their loved ones are supportive then it will be positive
- those who wish to be alone will find the presence of loved ones as an additional stress
38
Discuss factors which affect the pain experience: Culture / Religious beliefs
- can influence the meaning of pain, how it is expressed and dealt with and who is responsible for pain relief
- two beliefs: pain is viewed negatively as a punishment from a higher power and pain is viewed positively as a purification process or a right of passage
39
Discuss factors which affect the pain experience: Age
- newborns do experience pain
- pain response system may be fully developed by three months of age
- as motor control becomes more sophisticated, infants become more adept at physically withdrawing from a source of pain
- young children commonly respond to pain with behaviours such as lethargy, fatigue, anorexia, regression, anger and withdrawal
40
Since an infant cannot talk, what behaviours might suggest the presence of pain?
- crying
- gasping
- grimacing
- groaning
- grunting
- screaming
- being irritable
- being restless
41
Older adults may have alterations in their pain threshold and tolerance if they what?
- believe pain is a natural result of aging
| - have physiologic loss of sensation or circulatory impairment
42
Discuss factors which affect the pain experience: Gender
- men experience more anxiety and depression with pain than women
- women generally demonstrate a lower pain tolerance
43
Discuss factors which affect the pain experience: Environment
-pain threshold and pain tolerance often decrease in unfamiliar environments and environments with excessive sensory stimulation
44
Signs and symptoms of pain, job of the health care aide in recognizing a patient in pain: Location
- ask the client to point to the area of pain
| - ask if the pain is anywhere else and to point to those areas
45
Signs and symptoms of pain, job of the health care aide in recognizing a patient in pain: Onset and duration
When did the pain start? How long has the pain lasted?
46
Signs and symptoms of pain, job of the health care aide in recognizing a patient in pain: Intensity / Severity of the pain
Does the client complain of mil, moderate or severe pain?
47
Signs and symptoms of pain, job of the health care aide in recognizing a patient in pain: Description
Ask the client to describe the pain. Write down what the client says using client’s exact words.
48
Signs and symptoms of pain, job of the health care aide in recognizing a patient in pain: Factors causing pain
- may include moving or turning in bed, coughing or deep breathing, and exercise
- ask what the client was doing before the pain started and when it started
49
What words are used to describe pain?
- aching
- burning
- cramping
- crushing
- dull
- gnawing
- knifelike
- piercing
- pressing
- sharp
- sore
- squeezing
- stabbing
- throbbing
- vicelike
50
Signs and symptoms of pain, job of the health care aide in recognizing a patient in pain: Vital signs
What are the client’s pulse, respirations, and blood pressure? With the occurrence of pain, often there are increases in the readings of these vital signs.
51
Signs and symptoms of pain, job of the health care aide in recognizing a patient in pain: Other signs and symptoms
Does the client have other symptoms like dizziness, nausea, vomiting, weakness, numbness, tingling, screaming, moaning, rubbing, crying?
52
Describe the objective and subjective indicators of pain.
Subjective: it is what the patient says it is and not what others think it ought to be; how the patient experiences pain; observations include information about onset and duration, location, intensity or quantity, quality, and pattern
Objective: behaviours which can be seen by others; observations include vital signs and behavioural/emotional signs
53
Discuss comfort measures which help prevent and or relieve pain.
- distractions
- relaxation
- guided imagery (creating an image in your mind and focusing on it)
- position client in good body alignment
- keep bed linens tight and wrinkle free
- provide blankets for warmth and to prevent chilling
- give a back massage
- use touch to provide comfort
54
State the purpose of the following procedure: Deep breathing and coughing exercises (DB&C)
- help prevent respiratory problems by expanding lungs, providing oxygen to the body and loosening lung secretions
- commonly performed following surgery and by patients who are confined to bed (inactivity decreases lung expansion and causes mucus secretions to accumulate in the lungs)
- check with nurse before to check how many breaths and coughs the patient should attempt
- some facilities discourage the coughing and encourage only the breathing exercises
55
Demonstrate the following procedure: Coughing and Deep Breathing Exercises
- help the client to a comfortable sitting position, dangling semi-Fowler or Fowler
- have the client place the hands over the rib cage
- ask the client to exhale, explain that the ribs should make as far down as possible
- have the client take a breath as deep as possible, remind the client to inhale through the nose
- ask the client to hold the breath for 3 seconds
- ask the client to exhale slowly through pursed lips, the client should exhale until the ribs move as far down as possible
- repeat
- have the client interlace the fingers over the incision, the client can also hold a pillow or folded towel over the incision
- have the client take in a deep breath
- ask the client to cough strongly twice with the mouth open
56
Deep breathing and coughing exercises are done to prevent what 2 conditions?
1) pneumonia
2) atelectasis (portion of the lung collapses after mucus collects in a section of the airway, preventing air from entering into that part of the lung)
57
State the purpose of the following procedure: Collection of a sputum specimen
- sputum is coughed up from the patient’s lungs or bronchial tubes
- sputum specimens are frequently collected from patients who have respiratory problems
- samples are commonly tested for the presence of blood, microorganisms or abnormal cells
58
Demonstrate the following procedure: collection of a sputum specimen
- put on gloves, put on a mask
- ask the client to rinse the mouth with clear water
- have the client hold the container, only the outside can be touched
- ask the client to cover the mouth and nose with tissues when coughing
- ask the client to take two or three deep breaths and cough up the sputum
- have the client expectorate directly into the specimen container, sputum should not touch the outside
- collect 15 to 30 millilitres of sputum unless you have been told to collect more
- put the lid on the container, do not touch the inside of the lid
- place the container in the bag, attach the requisition to the bag
- remove your gloves, remove your mask, dispose of them in the appropriate container
- practice proper hand hygiene
59
What is considered a sufficient amount of sputum to collect for a specimen?
15 to 30 millilitres of sputum
60
State the purpose of the following procedure: Application of compression stockings (elastic stockings)
- frequently used to help prevent blood clots
- done by putting steady pressure on the veins in the leg, which improves the return of venous blood to the heart
- can be either knee-length or full length
61
Which patients are at risk for blood clots?
- immobilized
- obese
- debilitated
- unconscious
- pregnant
- diabetic
- past and present venous problems
- cardiac problems
- respiratory problems
- orthopaedic problems
62
Compression stockings should be applied before the patient gets out of bed. What is the reason for this?
Otherwise the client’s legs can swell from sitting or standing, making the stockings very difficult to put on
63
Following application, the toes should be checked for edema, bluish colour, warmth and movement. You may see these observations referred to as CWCM (colour, warmth, circulation and movement). The stockings are removed every ______ hours and left off for ________ and then reapplied.
Every 8 hours
| for 30 minutes
64
When doing application of compression stocking, what observations should be reported to the nurse or supervisor?
- unusual skin colour and temperature
- swelling of feet or legs
- signs of skin break down
- patient indicates they have pain, tingling or numbness
- improper fitting of stockings either too tight or too loose
65
Demonstrate the following procedure: Application of compression stockings (elastic stockings)
- lower the bed rail near you if it is up
- place the client in the supine position
- fanfold the top linen toward the client’s thighs, exposing the client’s legs
- turn the stockings inside out down to the heel
- slip the foot of the stocking over the toes, foot and heel
- grasp the stocking top, slip it over the foot and heel, pull it up the leg, it turns right side out as it is pulled up, the stocking must be even and snug
- remove twists, creases and wrinkles
- repeat for the other leg
66
State the purpose of the following procedure: Leg exercises
- help improve circulation and prevent blood clots in postoperative and immobilized patients
- they should be performed at least every 2 hours or as instructed by the nurse or physiotherapist
- exercise the hip, knee, ankle, foot and toes (in unit on range-of-motion exercises
67
Def: Vital signs (VS)
- measurement of body temperature (T), pulse rate (P), respiration rate (R) and blood pressure (BP)
- temperature indicates the amount of heat in the body
- pulse, respiration and blood pressure indicate how the respiratory and circulatory systems are working
- provide information about a patient’s physical and emotional health
- signs of life
- provide objective and concrete data about a person’s health status
68
What is the function of the respiratory system?
- body cells must have oxygen to live so this system provides the route for O2 to get from the air into the lungs where it can be picked up by the blood which carries it to the cells
- when the body cells use the oxygen, carbon dioxide is formed as a waste product, so this system also provides for the removal of the CO2 from the body
69
The process of exchanging gases between the environment and the body is called “respiration.” It consists of what?
1) inhalation: breathing in
2) exhalation: breathing out
* one inspiration and one expiration counts a one respiration
70
What is the most important work of the respiratory system?
- takes place once the air reaches the alveoli, oxygen that is in the air we breathe passes through the alveoli and into the bloodstream for transport to the body cells
- removal of CO2 from the body happens in exactly the same way but in reverse, CO2 is carried by the blood from the body cells to the alveoli and out into the environment through the respiratory tract
- respiratory system provides a route into the body for the many germs that exist in the environment, especially threatening for very young and very old
71
List the common respiratory diseases.
1) influenza: highly contagious infection by virus in airborne droplets
2) pneumonia: infection of the lung tissue
3) asthma: recurring episodes of paroxysmal dyspnea which is wheezing on expiration, inspiration, caused by constriction of the bronchi, coughing and viscous mucous bronchial secretions
4) bronchitis: inflammation of bronchi caused by bacteria or viruses
5) emphysema: walls of the alveoli are damaged and become less elastic than normal
* asthma, chronic bronchitis and emphysema are commonly referred to as Chronic Obstructive Pulmonary Disease - COPD)
72
What is the function of the cardiovascular system?
- the transport system of the body
- carries oxygen and nutrients to the body cells and removes waste products
- a closed system consisting of the heart, blood vessels, and the blood (bleeding occurs if the system is opened)
73
How does the cardiovascular system and the respiratory system work together?
- both systems are connected
- work together to bring O2 to all cells in the body and remove CO2
- brain damage may develop when a person is without oxygen for only 4-6 minutes
74
List the common cardiovascular diseases.
1) arteriosclerosis
2) atherosclerosis
3) hypertension: persistent blood pressure measurements above the normal systolic (140mm Hg) or diastolic (90 mm Hg) pressures
4) cerebral vascular accident (CVA or stroke): sudden loss of brain function because of the disruption of blood supply to the brain
5) transient ischemic attack (TIA): temporary interruption of blood flow in the brain
6) angina pectoris
7) myocardial infarction (MI): death of heart tissue caused by lack of oxygen to the heart
8) congestive heart failure (CHF): an abnormal condition that occurs when the heart cannot pump blood normally, blood backs up and causes an abnormal amount of congestion of fluid in the tissues
75
List situations in which vital signs are commonly taken.
- during a physical examination
- upon admission to a health care facility
- at routine times throughout the day for patients who are in a health facility
- before and after surgery
- before and after complex procedures or diagnostic tests
- after certain care measures such as ambulation
- after a fall or other injury
- when medications that could affect the respiratory or circulatory system are taken
- whenever the client complains of pain, dizziness, light-headedness, shortness of breath, rapid heart rate or not feeling well
- as often as dictated by the client’s condition
- as ordered by the doctor
- as stated on the care plan
- as instructed after the client has been given medication to relieve a fever
76
Define body temperature
The amount of heat in the body, a balance between the amount of heat produced and the amount lost by the body
77
List factors that affect body temperature.
1) age: an infant’s body temperature can be greatly affected by environmental temperature, children’s temperatures are less stable than adult’s, temperature is lower and tends to fluctuate less in older adults
2) time of day: temperatures normally vary by 2 degrees Celsius, with the lowest occurring during sleep and the highest in the late evening
3) exercise: body heat is increased during hard work or strenuous exercise
4) stress: mental stress increases metabolism which increases heat production, physical stress may either increase or decrease body temperature
5) environment: extremes in environmental temperatures can affect an individual’s temperature regulation
78
Identify common sites for measuring body temperature.
- under the tongue (oral temperature) *most common
- in ear (tympanic temperature) *most common
- under arm (axillary temperature) *least accurate
- rectum (rectal temperature) *most accurate
79
Identify the normal range for body temperature.
Average temp. / Normal range
1) oral (mouth): 37 / 36-37.5
2) tympanic (ear): 37.4 / 35.8-38
3) axillary (underarm): 36.5 / 34.7-37.3
4) rectal (rectum): 37.5 / 35.5-38
80
How can temperature be measured?
- using either a glass, electronic or tympanic thermometer
| - disposable oral thermometers and temperature-sensitive tapes
81
Which activities help to reduce a fever?
-having the patient rest in a cool, fresh bed without heavy covers and increasing the patient’s fluid intake to help replace fluid lost through perspiration
82
Define pulse.
The beat of the heart felt an artery as a wave of blood passes through the artery.
Number of heartbeats or pulses felt in 1 minute.
83
Identify the normal pulse range for adults.
60-100 beats per minute
84
List factors that affect the pulse rate.
- age
- gender
- emotions
- body position
- medications
- illness
- fever
- physical activity
- fitness level
85
Which arteries can the pulse be most easily felt?
- temporal
- carotid*
- apical
- brachial
- radial* (most commonly used site)
- femoral
- popliteal
- dorsalis pedis*
* are most commonly used pulses
86
When the nurse takes a pulse, what is important to observe?
1) rate: number of beats per minute, pulses that are over 100 or under 50 BPM are to be reported
2) rhythm: how evenly spaced the beats are, described as regular or irregular
3) force: how strong the pulse is, described as thready when weak and hard to fell or bounding when very strong
87
Define respirations
The act of breathing air into (inhalation) and out of (exhalation) the lungs. During each respiration, the inhalation supplies the cells with oxygen, and the exhalation removes carbon dioxide from the cells. Usually counted right after taking the pulse.
88
Identify the normal respiratory rate of an adult.
12-20 respirations per minute
89
List factors that will affect an individual’s respiratory rate.
- age
- gender
- emotions
- body position
- medications
- illness
- fever
- physical activity
- fitness level
90
When measuring respirations, what is important to observe?
1) rate: number of breaths per minute (one inspiration and one expiration are counted as on respiration)
2) rhythm: how evenly spaced the breaths are, described as regular or irregular
3) character: normal, shallow, deep or laboured
91
Which signs show that a patient is having difficulty breathing and may signal an emergency and must be reported right away?
- uneven breathing
- rapid breathing or extremely slow respiratory rate
- abnormal noises (snoring or gurgling)
- gasping
- blue skin, around lips, nose, fingernails
92
Define preoperative (preop)
Before surgery period
93
The patient should be ready how long before the scheduled time of surgery?
One hour before
94
Discuss the role of the health care aide when assisting with the care of preoperative patients.
1) diet: patients are usually kept NPO for at least 8 hours prior to surgery, sign of NPO status posted
2) elimination: patients are encouraged to use the bathroom to empty bladder
3) personal care: patients are usually asked to bathe and put on a hospital gown; dentures, eyeglasses, hearing aids, prostheses are removed and stored in a safe place; makeup and nail polish should also be removed; jewellery, wallets and other such valuables are locked up or sent home with family *wedding rings are allowed to stay on but must be taped
4) skin preparation: shaving of the operative site is not usually done by staff on the unit anymore
5) preoperative medication: administered by the nurse to make patient feel sleepy, remind patient not to get out of bed unassisted
6) transport to the operating room (OR): patient taken up to OR by someone who works in that area, health care aide can assist by moving furniture in the patient’s room out of the way and in helping to move the patient from the bed to the stretcher
95
Most patients who are about to have surgery are at least a little nervous and worried. Can you think of what some of their concerns might be? Identify the psychological concerns of preoperative patients.
- complications
- exposure
- disability
- restrictions on lifestyle
- caring for children and other family members
96
Discuss the role of the health care aide in providing preoperative psychological care.
- encouraging the patient to express feelings and worries
- reporting any questions the patient might have to the nurse
- explain to the client the procedures you will perform and the reasons for them
- communicate effectively
- report to your supervisor verbal and nonverbal signs of fear and anxiety that you have observed in the client
- report to your supervisor a client’s request to see a spiritual advisor
97
Define postoperative
After surgery period
98
When do postoperative care begin and what must be done?
- once patients are taken to surgery, postoperative care can begin
- start by making a surgical bed (postop bed)
- gather supplies that will be required by the nurse and or patient like tissues, kidney basin, vital sign record, I&O Sheet, bed pan or urinal, IV pole
- provide extra blankets since patient often feels cold after surgery
- may need extra pillows for positioning
99
After surgery where does the patient go?
Recovery room then will be returned to their unit
100
After surgery, the patient is likely to be drowsy for several hours and need to be observed closely for any symptoms like?
- choking
- bright red bleeding
- fast, slow or irregular pulse
- rise or drop in body temperature
- restlessness
- shallow, slow breathing
- complaints of thirst
- vomiting
- confusion or disorientation
101
Discuss the role of the health care aide when assisting with the care of postoperative patients.
1) positioning: check with the nurse to determine frequency of turning and type of positioning, promotes comfort and prevents complications, reposition every 1-2 hours to prevent respiratory and circulatory complications
2) deep breathing and coughing: help prevent complications, done every 1-2 hours when the client is awake, for comfort the patient should be instructed to splint the incision (hold their hands tightly over the incision)
3) stimulating circulation: after surgery it is important to prevent blood clots and promote blood flow in the legs, do leg exercises or wear elastic stockings
4) early ambulation: prevents postoperative circulatory complications, patient encouraged to ambulate even on day of surgery, does not walk very far just a few feet in the room
5) wound healing: surgical incision needs protection to promote healing and prevent infection, sterile dressing changes are done by a physician or nurse
6) nutrition and fluids: client has an IV infusion upon return from OR
7) elimination: anesthesia, surgery and being NPO can all affect fecal and urinary elimination and medications for pain relief can cause constipation, fluid intake and output are measured during this period, it is important that the client urinates within 8 hours, a catheterization is usually ordered
8) comfort and rest: help promote comfort and rest since patient will probably have pain after surgery
9) personal hygiene:important for patient’s physical and mental well-being, frequent oral hygiene, hair care, complete bed bath the day after surgery help refresh and renew the client’s physical and psychological well being, gown should be changed whenever wet or soiled
102
What is intravenous therapy?
- administration of fluids through a needle which has been inserted directly into a vein and then taped in place
- needle is connected to several feet of tubing which attaches to an IV bag which contains the solution being administered to the patient
103
Important things to remember when caring for a patient with an IV
- that the tubing is free and unkinked at all times
- when turning and positioning a patient, and when changing the gown, take care not to pull the needle out of the vein
- when ambulating the patient, remember to take the IV pole along with you
- maintenance of the IV is done by the nurse but you can notify the nurse when the IV solution bag is almost empty or when the system does not seem to be running
- report any problems with the IV site (the place where the needle enters the skin): bleeding, puffiness or swelling, pale or reddened skin, complaints of pain at the site, hot or cold skin near the site
104
How is wound drainage done?
- drainage from a wound must be removed in order for proper healing to take place
- process is facilitated by the insertion of a wound drainage tube which consists of several feet of tubing attached to a collection device
- it is important that these drainage tubes do not become dislodged when turning, positioning and ambulating the patient
- emptying the drainage collection device will be the nurse’s job
- health care aide can tell the nurse when the device is about half-full
105
What is oxygen therapy?
- supplemental oxygen for patients who have less than the normal required amount of oxygen in their bloodstream
- oxygen can be supplied through wall outlets, portable oxygen tanks and oxygen concentrations
- patient receives the oxygen through a special device which is placed over their nose and or mouth
106
Which kinds of devices are used in oxygen therapy?
1) nasal cannula (nasal prongs): a plastic tube that fits behind the ears and a set of two prongs that are placed in the nares of the nose and oxygen flows through the prongs, deliver less oxygen compared with face masks
2) simple face mask: a mask that covers the client’s nose and mouth with a plastic tube at the bottom that delivers the oxygen, mask also has holes on with side to allow for the exhaled carbon dioxide to escape, deliver more oxygen than nasal cannulas
3) partial rebreather mask: bag is added to the simple face mask to collect exhaled air, when breathing in the client inhaled oxygen as well as some exhaled air and some room air, the bag should not totally deflate during inhalation
4) Venturi mask: allows precise amounts of oxygen to be given, special colour coded plastic adaptors that fit into the mask are connected to the source of oxygen, each colour is coded to show what amount of oxygen the mask delivers
* sometimes the oxygen is humidified before it gets to the patient (cold pot)
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Define flow rate
The amount of oxygen the patient is to receive and ordered by the physician, only the nurse or respiratory therapist should set to adjust the flow rate
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What special care is needed when the patient is receiving oxygen therapy?
- never remove the oxygen administration device without first consulting with the nurse, masks are usually removed for eating but nasal prongs can be left in place
- when ambulating a patient who is receiving continuous oxygen from a wall outlet, switch over to a portable oxygen tank while the patient is up
- always check the product identification tag on a portable tank before using to ensure the tank contains oxygen
- always check the regulator on the oxygen tank to ensure the oxygen tank contains sufficient oxygen for the planned usage
- make sure the oxygen administration device is secure but not right
- check for signs of irritation from the device, particularly in spots where the device rests on the skin
- remove any excess moisture that builds up under an oxygen mask, keep the patient’s face dry and clean
- never remove the device
- report to your supervisor if client removed the device
- make sure the device is secure but not right
- keep the client’s face clean and dry when a mask is used
- secure connecting tubing in place
- make sure there are no kinks in tubing
- make sure the device is clean and free of mucus
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Define hypoxia
A deficiency of oxygen in the cells
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What are the signs and symptoms of hypoxia?
- restlessness
- dizziness
- fatigue
- agitation
- increased pulse rate
- anxiety
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What should you do if you observe hypoxia or altered respiratory function?
Tell supervisor immediately
