OSCE PART B Flashcards

(81 cards)

1
Q

What is the normal SG and pH of urine?

A

Specific gravity: 1.016 -1.022

pH: 4.5 -8.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Identify 4 indications for the insertion of a urinary catheter?

A

Surgery
Long term bladder management
Urinary retention
Measurement of output in the acutely ill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are 3 complications associated with catheterisation?

A

UTI’s
Urethral trauma and bleeding
Sphincter erosion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List 6 signs/symptoms of UTI’s

A
Burning sensation, pain or heaviness during voiding
Aching or cramping in lower abdomen
Cloudy, dark brown or milky urine
Leukocytes present in urinalysis
Nausea and vomiting
Tiredness
Delirium or confusion in certain populations
High temperature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List 4 risk factors for urinary incontinence

A
Pathology (eg. spinal cord injury, disease)
Age - over 65
Gender
Mobility levels
Trauma
Pregnancy
Co-morbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How many bladder measurements should you do for a bladder scan?

A

3 within 10% of eachother to ensure accuracy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

You have a patient who is being discharged with a catheter. What discharge planning would you perform to ensure a safe discharge?

A

Follow up appointment with the patient
Make sure the patient has the appropriate equipment for maintenance
Manke sure they are educated on cleaning and maintenance
Commmunity service providers
Care plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 5 symptoms of hypoglycaemia?

A
Tachycardia or increased HR to their normal
Sweating and chills
Hunger
Shakiness/weakness
Lightheadedness/diziness
Irritability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are two reasons for wiping the patients’ hand with a warm cloth?

A

Promotes vasodilation
Cleans away surface bacteria
May help soften skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why do you rotate the sites when taking a BGL?

A

To avoid continued trauma to one area of the hand or finger and give time for it to heal. Also to reduce chance of infection, introducing possible pathogens into an open wound. Portal of entry.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are two strategies they can use to encourage blood flow to the area prior to taking a BGL?

A

Resting the hand below the heart so more blood flow enters the limb
Milking the hand
Warm cloth or compress for vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What part of the finger should they take the blood from? Why?

A

The side of the finger as it’s in usage less. Pain less likely to interfere with their daily activities. Less nerve ending in the side compared to the top and the pad so will be less painful on the whole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

State 4 indications for intravenous infusion therapy.

A

Restore/maintain fluid and electrolyte balance
Nutrition
Administration of medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are 5 potential sources of infection for someone with an intravenous canula (IVC)?

A
Contaminate infusate
Intraluminal spread
Extraluminal spread
Skin flora
Contaminated entry port
Haematogenous spread
Catheter tip contaminated on insertion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Identify 3 risk management strategies a nurse implements to reduce the risk of infection for a patient with an IVC?

A

Change immediately when patient comes into ER, or every 72 hours.
PIVC
5 moments of hand hygiene
Flushing when appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Your buddy nurse asks you to explain how you will’ look, listen and feel’ when caring for a patient with an IVC.

A

LOOK: Observe the PIVC site for discharge, swelling and redness. Observe the dressing, is it intact, clean and dry?
LISTEN: LIsten to the patient, are they in pain, does it hurt on movement or palpation?
FEEL: Feel for heat, hardening of the vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is mechanical phlebitis?

A

Caused by mechanical (movement) irritation of the vein. Usually by rubbing or insertion on a flex point that causes the inner cannula to scrape the inside of the vessel. Inappropriate cannula size.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is chemical phlebitis?

A

Caused by medications, injectable recreational drugs. Often from improper dilution of drugs or overuse of one point. pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is infectious phlebitis?

A

The indroduction of bacteria into the vein, or at the IV site.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Your patient has charted passive range of movements. Explain the difference between active and passive range of movements.

A

Passive is external force

Active movement: patient does themselves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Explain how the respiratory system is impacted in a patient with reduced mobility.

A

Reduced o2 due to Collapse of alveoli, increase risk for pneumonia. Due to pooling secretions
Positional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Explain how the musculoskeletal system is impacted in a patient with reduced mobility.

A

Muscle atrophy
Bone loss
range of movement decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Explain the 2 aspects that a nurse is assessing when completing a neurovascular assessment.

A

Sensory and motor function - Neuro

Peripheral circulation - vascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

List 4 indications for taking a set of neurovascular observations (NVO’s)on a patient.

A

Spinal injury
Stroke
Surgery on the area to test for nerve function
Burns patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are two conditions/local factors that may affect a patient’s neurovascular status.
``` Stroke/brain damage Diabetes Paralysis Spinal injury Peripheral vascular disease Epidural ```
26
How would you assess the motor function of the upper limb?
Ulna medial and radial nerves
27
How would you assess motor function of the lower limb?
Peroneal Nerve sensory path | Tibial nerve sensory path
28
How would you assess movement of the upper limb?
Ulna medial and radial nerves
29
How would you assess movement of the lower limb?
Dorsiflexion and plantarflexion
30
Explain Motivation to learn
``` Attentional set Motivation Use of theory to enhance motivation and learning Psychosocial adaptation to illness Active participation ```
31
Ability to learn
Developmental capability Learning in children Learning in adults Physical capability
32
Learning environment
1. Number of people being taught 2. Need for privacy 3. Temperature 4. Lighting 5. Noise 6. Ventilation 7. Furniture
33
Your patient needs a set of NVO’s. Upon entering the room, you note that they are asleep. What is the best course of action in this circumstance – should you let them sleep or wake them up to complete the observations? Explain your reasoning.
You must wake your patient because you’re not able to assess their cognition if they’re unconscious. They can also deteriorate without you realising.
34
Your patient needs some to be taught incentive spirometry. Explain how you will teach your patient to complete incentive spirometry.
``` Assess if it’s the right time, how we can get the most out of the activity. Explain the method and the goal Demonstrate Supervise them completing Adjust if necessary ```
35
Your patient needs some to be taught how to complete deep breathing exercises. Explain how you will teach your patient to complete deep breathing exercises.
Assist client to fowlers or sitting position Ask patient to place hands palms down on lower border of ribs Inhale slowly through the nose and hold breath for 2-3 secs. Exhale slowly through mouth, repeat 3-5 times Supervise exercises every 2-3 hours post op
36
Explain why a patient may prefer nasal prongs as compared to a Hudson mask.
Comfort and convenience
37
A patient requires a non-rebreather mask. Outline three important steps you need to complete in order for the mask to work correctly.
Fully inflate the bag first 15L p/m flow rate Ensure mask is tight
38
EOLC: Why is it important to include pain relief?
Pain interferes with getting legal affairs in order, grieving the loss of his/her life, making amends in strained relationships, and saying goodbye to loved ones
39
What is the goal of end of life care?
The goal of patient care at the End of Life (EOL) is to relieve distressing symptoms including pain, fatigue, nausea, dyspnoea, confusion, restlessness and agitation through the consistent use of comfort measures to enhance quality of life (QOL) and achieve a peaceful death
40
List 4 critical elements of end of life care.
Control of physical symptoms Pastoral care Grief assessment Documents and plans in place
41
Disturbed sleep: Nature of the problem?
Do you have trouble falling asleep? Staying asleep? Long waking periods in the night? Night terrors?
42
Disturbed sleep: Signs and symptoms:
Are you tired during the day? | Have you noticed a loss of concentratio?
43
Disturbed sleep: Onset and duration:
When did you notice this occur? | How long has it lasted?
44
Disturbed sleep: Quality of sleep:
Do you wake feeling rested? | Do you feel as if you enter a deep sleep?
45
Disturbed sleep: Predisposing factors:
``` Routine changes Drugs caffeine Stress Nocturia ```
46
Disturbed sleep: Effect on client:
How has sleep loss affected you? Has your work performance been affected? Have you fallen asleep at inappropriate times?
47
Immediate memory
Ask them to repeat a series of numbers, by gradually increasing the number of digits. Average person can do 5 to 8, so compare to the average in combination with other findings.
48
Recent memory
Ask them to recall verifiable information from earlier in the day or interview, eg. give them a colour, an object and an address to remember. Ask them to recall near the end of the interview.
49
Remote memory
Ask them to recall a surgery from 5 years ago or so. If no surgical history, perhaps a birthday or anniversary that can be verified.
50
How does the nurse complete the following in relation to completing a GCS?
External or internal stimulus that may be interfering with the assessment External: Eg. Alcohol, medications. Internal: Previous stroke, deafness
51
How does the nurse complete the following in relation to completing a GCS? Observe
Eyes of the patient (do they open their eyes when you enter?) Verbal response (Is their response normal and orientated?) Motor (do they move, is it normal if they do?)
52
How does the nurse complete the following in relation to completing a GCS? Stimulate
Do they react to sound or pain?
53
How does the nurse complete the following in relation to completing a GCS? Rate
Assign highest response
54
What's PERRLA?
Pupils equal round reactive to light and accommodating
55
Name two tests to assess a patients: | Reflex’s
Babinski | Patella
56
Name two tests to assess a patients: | Sensory function
Proprioception - romberg test | Light touch test
57
Name two tests to assess a patients: | Motor function
Finger to nose | Heel to toe walking
58
5. Your patient is needed a liquid medication. How do you measure a liquid medication in relation to the meniscus?
Eye level to the bottom of the meniscus line.
59
2 counselling notes that you will share with your patient for paracetemol?
Many brands | Can be in many different medications, check for overdoses
60
2 practice points that you need to be aware of as a nurse about paracetemol?
Long term use can lead to liver damage | Can be used for all age groups
61
2 counselling notes that you will share with your patient for Docusate and Senna
Take with plenty of fluid | Cramping nausea vomiting go to GP
62
2 practice points that you need to be aware of as a nurse about Docusate and senna
Onset of action 1-3 days | Short term combo drug. May be used long term in spinal damage,
63
Your buddy nurse asks you to explain the difference between primary and secondary intention.
Primary intention is the healing associated with a closed wound such as a surgical site sealed with stitches. They heal more quickly and are less prone to infection. Secondary intention is the wound healing associated with an open wound such as a pressure sore. Longer healing, epithelialization granulation contraction and scarring different processes for cleaning, more prone to infection.
64
Identify 4 questions you would ask your patient when completing a wound history.
How and when did it happen? How long have you had the wound? Is someone managing already? Medical history
65
List two intrinsic factors that inhibit wound healing
``` Intrinsic: Age Co-morbidities Nutritional status Blood supply ```
66
List two extrinsic factors that inhibit wound healing
Extrinsic: Chemo/radiotherapy Mechanical stress Smoking
67
Explain how you would describe the following attributes of a wound: Depth of loss of tissue
Superficial: Epidermis, upper skin Partial thickness: Skin loss to lower dermis Full thickness: Skin and subcutaneous
68
Explain how you would describe the following attributes of a wound Clinical appearance
``` Necrotic: dead tissue, black appearance Sloughy: Yellow Red: Granulating/hypergranulating Epitheliasing Green/yellow infection ```
69
Explain how you would describe the following attributes of a wound Exudate
Serrous: Straw clear colour Haemoserrous: Slightly blood stained Sanguinous: Blood stain Perulent: Pus
70
Explain how you would describe the following attributes of a wound Peri wound
Surrounding skin. Induration: increase in fibres in tissue. Loss of elasticity Maceration: Softening and breaking down of the tissues due to prolonged exposure to moisture Edemetis: Swelling
71
Explain how you would describe the following attributes of a wound Measurement
Measuring the width of the wound in cms, diameter. | Undermining - depth of the wound
72
Your patient is complaining of urgency and frequency on voiding. Identify 4 areas of question you would explore for this patient no related to pain.
History: Have you had a recent accident that possibly caused trauma? Have you recently had a baby? Do you frequently hold urine? Demographic: What age are they? What is their job and could that be effecting this? Muscular assessment: Make sure the muscles are working appropriately or if there is some weakness in the muscles Neurovascular assessment: See if the brain is talking to the muscles correctly, if not there will be further avenues of assessment.
73
You need to complete an abdominal assessment on you patient. Explain what you would be looking for in relation to Inspection
4 quadrants. Raising, unevenness eg. Hernia. abdominal aorta, discoloration of skin, scars. Bloating, fluid retention. Symmetry
74
You need to complete an abdominal assessment on you patient. Explain what you would be looking for in relation to Auscultation
Active bowel noises in all four quadrants, varying depending on the area. Character and frequency. 5-15 secs.
75
You need to complete an abdominal assessment on you patient. Explain what you would be looking for in relation to Palpation
Distension: drum like tightness. Masses
76
Bilirubin
Jaundice - Blocked bile or pancreatic ducts Hepatitis Liver pathophysiology
77
Blood
``` Trauma Menstruation Surgery Haematuria (kidney pathophysiology) UTI’s ```
78
Glucose
DIabetes High sugar intake Kidney issues
79
Ketones
Poorly controlled diabetes Dehydration starvation
80
Leucocytes
UTIS
81
Protein
Renal disease | Pre-eclampsia