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Fundamentals- BSN1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is the purpose of hygiene?

A 
promotes comfort and relaxation
fosters a positive self-image
promotes healthy skin
prevents infection and disease
opportunity for assessment
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2
Q

Guidelines for bathing (8)

A 
assess patient preferences
gather supplies
provide privacy
maintain safety
maintain warmth
promote indépendance
anticipate needs
work from head to toe
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3
Q

Oral hygiene on patients with special needs

A

use of oxygen therapy

unconscious state

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4
Q

Denture care

A

remove and soak overnight
brush in morning
observe mouth for reddened areas rinse dentures after meals

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5
Q

chain of infection

A

mode of transmission -> portal of entry -> host -> infectious agent -> reservoir -> portal of exit

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6
Q

Type of precaution used when the patient has bacterial meningitis, influenza, and pertussis

A

droplet precautions

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7
Q

Infections that require contact precautions

A

MRSA
VRE
prulent wounds
infectious diarrhea

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8
Q

common diseases that require airborne precautions

A

Tuberculosis
Measles
Chicken Pox

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9
Q

Airborne precaution barriers

A

standard precautions
negative airflow room
special respirators
patient wears surgical mask for transport

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10
Q

Average ranges of temperature

A

96-99, 36.5-37

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11
Q

Average pulse

A

60-100 beats/minute

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12
Q

elevated heart beats above 100/minute

A

tachycardia

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13
Q

pulse below 60 beats/minute

A

bradycardia

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14
Q

normal # of respirations in one minute

A

12-20

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15
Q

average BP

A

120/80

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16
Q

pre-hypertension

A

S: 120-139
D: 80-90

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17
Q

Stage 1 Hypertension

A

S: 140-159
D: 90-99

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18
Q

Stage 2 Hypertension

A

S: 160+

D 100+

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19
Q

loss of skin color, seen in arterial insufficiency , decreased blood supply, and anemia

A

Pallor

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20
Q

makes white skin appear blue-tinged, especially in the peri oral, nail bed, and conjunctival areas

A

cyanosis

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21
Q

characterized by yellow skin tones, particularly in sclera, oral mucosa, palms, and soles

A

jaundice

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22
Q

roughening and darkening of the skin in localized areas, especially posterior neck

A

Acanthosis nigrican

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23
Q

skin redness and warmth is seen in inflammation, allergic reactions or trauma

A

Erythema

24
Q

skins elasticity and how quickly the skin returns to its original shape

A

turgor

25
Q

purpose of capillary refill test

A

if capillaries refill too slowly it could relate to respiratory or cardiovascular diseases that cause hypoxia.

26
Q

location of the preauricular lymph node

A

in front of the ear

27
Q

location of the postauricular lymph node

A

behind the ear

28
Q

location of the tonsillar lymph node

A

angle of mandible on the sternomastoid muscle

29
Q

location of the occipital lymph node

A

at the posterior base of the skull

30
Q

location of the submandibular lymph node

A

on the medial border of the mandible

31
Q

location of the submental lymph node

A

few cm behind the tip of the mandible

32
Q

location of the superficial cervical nodes

A

located in the area superficial to the sternomastoid muscle

33
Q

location of the posterior cervical nodes

A

located in the area posterior to there sternomastoid and anterior to the trapezius in the posterior triangle

34
Q

located deeply within and around the sternomastoid muscle

A

deep cervical chain nodes

35
Q

PERRLA

A 
Pupils
Equal
Round
Reactive to Light
Accommodation
36
Q

EOM’s (Extraocular Muscles)

A

oculomotor (cranial III)
Trochlear (Cranial IV)
Abducens (Cranial V)

37
Q

how to use an otoscope on an adult

A

pull the ear up and back

38
Q

how to use an otoscope on a child

A

pull auricle down and back

39
Q

standing behind patient, whispering letters or numbers, ask patient to repeat, repeat exam on opposite ear

A

Whisper Voice

40
Q

Test used if patient is complaining of loss of hearing in one ear.
Use of tuning fork to vortex of forehead
Normally sound is heard in both ears

A

Weber Test

41
Q

Test that is using bone and air conduction. Ask patient when the sound stops from vibrating fork.

A

Rinne Test

42
Q

Test when patient is standing with arms side to side. Assess swaying of patient in 20 seconds.

A

Rombergs test

43
Q

How to assess the frontal and maxillary sinuses

A

Palpate for tenderness using thumbs going in an upward motion.

44
Q

adherent white patches on mouth

A

thrush

45
Q

Principals of sterile technique

A

The edges of the sterile field or container are considered contaminated.

Sterile object only remains sterile when touched by another sterile object

only sterile objects may be places on a sterile field

A sterile object or field out of the range of vision or an object held below a patients is contaminated

a sterile object or field becomes contaminated by prolonged exposure to air

When a sterile surface come in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action

46
Q

signs and symptoms of an infected wound

A

redness, warmth, swelling, increased drainage, may or may not be purulent.

47
Q

Phases of healing

A

inflammatory phase, proliferation phase, and maturation phase

48
Q

This phase begins with the body initial response to wounding of the skin and lasts about three days

A

inflammatory phase of healing

49
Q

the purpose of this phase are to repair the defect, fill the wound with new tissue, called granulation tissue, and resurface the wound with the skin

A

proliferation phase of healing

50
Q

the last phase of healing that involves “remodeling”, can last up to a year

A

maturation phase

51
Q

fall prevention

A 
side rails up x2
locks on beds and wheel chairs
proper transfers
safety bars on toilets
nonskid footwear
call light within reach
bedside items within reach
52
Q

When are restraints temporarily necessary?

A

reduce the risk of injury to agitated patients

prevent interruption of therapy such as IV, NG, or foley catheter

reduce risk for injury from falling

prevent combative or confused patient from removing life support equipment such as wrist restrains for patient on ventilator

53
Q

Why are seizure precautions necessary?

A

Protect patient from traumatic injury
positioning patient for adequate ventilation and oral secretions
support following a seizure

54
Q

mnemonic used to set priorities in case of fire

A

RACE

55
Q

how to reduce exposure to radiation

A

limit time spent near the source

make the distance from the source as great as possible

use shielding devices such as lead aprons

wear devices that track accumulative exposure.

Fundamentals- BSN1 (3 decks)

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