Cleaning/Standard Precautions and Vitals

Question 1

What are the different types of transmission-based precautions?

Answer 1

contact, droplet, airborne

Question 2

What are the 2 main categories of isolation precautions?

Answer 2

standard and transmission-based

Question 3

What diseases require airborne precautions?

Answer 3

(MTV)
Measles (Rubeola)
Tuberculosis
Varicella-Zoster
- disseminated herpes zoster (shingles) and chicken pox

Variola - erradicated, but just in case
SARS

Question 4

What are standard precautions?

Answer 4

Basic precautions used for all patients

Question 5

What is asepsis?

Answer 5

absence of disease producing micro organisms

Question 6

When should you wash your hands?

Answer 6

Before and after contact with patient or patient stuff or equipment, after removing gloves too!!
- Some places have policy “Wash in-Gel Out”
Before and after potty break
Before and after eating, smoking or drinking
After sneezing, coughing, blowing or picking nose
Should take at least 30 seconds-some sources say 60 sec
- Jewelry and finger nails can carry germs!

Question 7

What diseases are most likely to affect us?

Answer 7

Hepatitis B (ABCDE)
AIDs (everyone is scared of this one, but the others are more likely)
Tuberculosis
Staphylococcal
Nosocomial
- Many places are calling this HAI-healthcare-associated infection

Question 8

What organizations do we answer to?

Answer 8

CDC: Centers for Disease Control
OSHA: Occupational Safety and Health Administration
State Health Departments
EPA: Environmental Protection Agency
CARF: Commission on Accreditation of Rehabilitation Facilities
The Joint Commission
Others-NIOSH-National Institute of Occupational Safety and Health
Follow policy: the facility is responsible but you’re the one who gets it!

Question 9

List the vital signs

Answer 9

Heart rate (HR) or pulse (P)
Blood pressure (BP)
Respiratory rate (RR)
Oxygen saturation (SpO2)
Temperature (T)

Question 10

What do you look at when checking pulse rate?

Answer 10

Rate (basal and resting)
- basal is taken first thing in the morning
Regularity
Amplitude
- measured on subjective ascending scale
- scale from 0-4; 4 is strongest pulse, 1 is thready

Question 11

Pulse rate

Answer 11

Normal: 60-100bpm
Bradycardia (slow): <60bpm
Tachycardia (fast): >100bpm
Regularity: evenness of pulse rate

Question 12

What are different methods used to check pulse?

Answer 12

Manual palpation with mechanical devices: femoral, dorsalis pedis, popliteal, carotid, radial
- DON’T USE THUMB TO MANUALLY TAKE PULSE
Auscultation
Doppler measurements
Pulse oximeter
- fingernail polish, temperature, and fake nails can throw it off

Question 13

Pulse Methods

Answer 13

Arterial blood gases (PaO2): measured through blood draw
Oxygen saturation (SpO2) levels: measured using pulse ox
Heart rate: beats per minute (bpm)
Maximal heart rate
Target heart rate

Question 14

What is arterial patency?

Answer 14

Presence or absence of blood flow at point of pulse palpation
Increased patency = increased blood flow
Observation
Palpation of pulses
Rate of capillary refill: test for blanching
- lose blood flow –> pressure sore

Question 15

What is blood pressure?

Answer 15

Measure of vascular resistance to blood flow
systolic/diastolic

Question 16

What types of pressure are measure when taking BP?

Answer 16

Systolic: pressure when heart is contracting
Diastolic: pressure when heart is at rest

Question 17

What do we use to measure BP?

Answer 17

Sphygmomanometer

Question 18

Where and how do we measure BP?

Answer 18

Method
- Auscultation of artery using stethoscope while sphygmomanometer applied over artery being auscultated
Site
- Left upper arm

Question 19

What is normal BP?

Answer 19

120/80 but can change due to stress, physical activity, and age

Question 20

Prehypertension

Answer 20

Question 21

Stage 1 hypertension

Answer 21

Question 22

Stage 2 hypertension

Answer 22

Question 23

What is respiration/respiratory rate?

Answer 23

Rate of breathing

Question 24

What methods are used to measure RR?

Answer 24

Auscultation: stethoscope
Observation
Palpation

Question 25

What are the norms for RR?

Answer 25

Newborn: 30-60 bpm Adults: 12–20 bpm

Question 26

What is the purpose of taking temperature?

Answer 26

Basal metabolic state, presence of infection, metabolic response to exercise

Question 27

What methods are used to take temperature?

Answer 27

Thermometers (electronic, heat-sensitive strips) or palpation Rectal is the most accurate

Question 28

What are the norms for temperature?

Answer 28

98.6˚F or 37˚C

Question 29

Pain is (subjective/objective)

Answer 29

subjective

Question 30

What is the purpose of measuring pain?

Answer 30

Diagnosis Prognosis Appropriate interventions Responses to interventions

Question 31

How do we measure pain?

Answer 31

Visual Analog Scale (VAS) Wong-Baker FACES Pain Rating Scale

Question 32

What are the norms when measuring pain?

Answer 32

0 = nonexistent 1–3 = minimal 4–6 = moderate 7–10 = severe pain

Question 33

What are anthropometrics?

Answer 33

Size Weight Proportions of human body Body mass index (BMI)

Question 34

What are isolation precautions?

Answer 34

Isolation precautions are the preventative steps needed to be taken by healthcare workers and staff to prevent the spread or transmission of infections.

Question 35

How do you calculate maximal heart rate?

Answer 35

220 - age

Question 36

How do you measure target heart rate? 60%, 80%?

Answer 36

MHR x 0.6 MHR x 0.8

Question 37

How long does it take for a pressure sore to develop?

Answer 37

15 minutes

Question 38

How do you know when to stop pumping up the BP cuff?

Question 39

When do you not use left arm to take BP?

Answer 39

Stroke - causing flaccidity or spasticity Amputation

Question 40

When is activity contraindicated with BP?

Answer 40

Systolic doesn't rise in proportion with activity A decrease in systolic > 10 Systolic is >240 Increase in diastolic >20 with activity

Question 41

When BP is outside the norms, what questions do you want to ask your patient?

Answer 41

Is it normal? Do you have chest pain? Are you dehydrated? Do you take BP meds? Have you taken your meds yet? What meds are you taking?

Question 42

If a client has high BP and feels like they need to have a BM, what is this a sign of?

Answer 42

heart attack

Question 43

When should you use contact precautions?

Answer 43

ABCDEF - “A” for abscess; you can use standard precautions with minor drainage - “B” for bronchiolitis; the 2 more common viruses that cause bronchiolitis (RSV and parainfluenze) require contact precautions - “C” for cutaneous; any disease involving the skin (herpes zoster, varicella, lice, strep) - “D” for diarrhea; C. diff, norovirus, rotavirus, hepatitis A - “E” for eyes; conjunctivitis (pink eye) - “F” for funky or feisty; MRSA and VRE

Question 44

When doffing PPE what parts are considered clean?

Answer 44

Mask and glasses (behind ears only) Inside of gown