PCM Exam 1 Flashcards
(128 cards)
1
Q
When should a pt’s vitals be taken and why is it important?
A
before, during and after the treatment
its important to be able to see the progression of the pt
2
Q
what are the assessments for physiological stability
A
HR
RR
Oxygen saturation
BP
Temp
3
Q
what is HR?
A
indirect measure of contraction in the heart-left ventricle
4
Q
what is the normal HR for newborns
A
100-150 bpm
5
Q
whats the normal HR for children from 1-10 y/o
A
70-130 bpm
6
Q
whats the normal HR for adults?
A
60-100 bpm
7
Q
HR below 60 bpm is indicated as what?
A
bradycardia
8
Q
HR above 60 bpm is indicated as what?
A
tachycardia
9
Q
what are some factors that affect HR?
A
physical activity
health conditions
meds
stress
dehydration
emotional
environmental
10
Q
what are the 7 sites for assessing HR?
A
temporal
carotid
brachial
radial
femoral
popliteal
dorsal pedal
11
Q
whats the normal range for blood oxygen saturation?
A
95-100%
12
Q
what is it called if oxygen saturation is less than 90%?
A
Hypoxemia
13
Q
what are some factors that affect oxygen saturation?
A
emotional state
pulmonary disease
physical activity
age
environment
14
Q
how do we assess O2 satuation?
A
pulse ox
15
Q
how do you manually measure RR
A
one respiration is equal to one inspiration and one expiration
16
Q
what is the normal value of RR in adults?
A
12-18 RR
17
Q
whats the normal value of RR for infants?
A
30-50 RR
18
Q
what are some factors that affect someones RR?
A
age
emotional state
environment
pulmonary disease
19
Q
how do we assess RR?
A
count it
use the monitor
20
Q
what is blood pressure?
A
indirect measurement of the pressure inside an artery caused by the blood flow
21
Q
what is systolic pressure?
A
contraction of the left ventricle (top #)
22
Q
what is diastolic pressure?
A
rest period of the heart (bottom #)
23
Q
what are some factors that may affect BP?
A
meds
diet
physical activity
white coat syndrome
emotional
24
Q
how do we assess BP
A
support pts arm at level of the heart
pt can be sitting, standing or supine or exercising
25
what is normal BP?
120/80
26
what is high normal BP?
130-139/ 85-89 mmHg
27
what is the range for prehypertension?
120-139/85-89
28
what is the range of stage 1 hypertension?
140-159/90-99 mmHg
29
what is the range for stage 2 hypertension?
160-179/100-109 mmHg
30
what is a hypertensive crisis?
above 180/ 110 mmHg
31
what is orthostatic hypertension and the S&S?
form of low blood pressure that happens when you stand up from sitting, sit up from lying down
S&S include dizzy or lightheaded
32
what are the orthostatic hypertension values?
systolic decrease= drop of 20 mmHg
diastolic decrease= drop of 10 mmHg
**within 3 min of positional change**
33
normal range of body temperature?
96.8-99.3 degrees F
average is 98.6
34
how do we objectify pain?
use a pain screen; scales and non-verbals
35
what are the odds of healthcare associated infections?
1 out of 25
4th leading cause of death
36
whats the difference in medical and surgical aseptic teqniques
medical: keeps pathogens confined to a specific area, object or person
surgical: excludes all microorganisms before entering the sterile field
37
whats the difference in medical and surgical aseptic teqniques
medical: keeps pathogens confined to a specific area, object or person
surgical: excludes all microorganisms before entering the sterile field
38
what are standard persuasions for prevention of infection
group of infection prevention practices that apply to all patients regardless of diagnosis
frequent hand washing or rubs
PPE
39
how does transmission based precautions relate to in standard precautions
goes on top of standards
40
what is transmission based precautions
designed to protect caregiver from highly transmissible pathogens
41
what is the hand rubbing method
alcohol based, waterless antiseptic
More effective when hand washing is not required
Less time, more effective, more accessible, less damage to the skin
42
what is the proper hand washing method?
preferred when hands are visibly dirty, solid or considered to be contaminated
Bacteria is removed from the scrubbing and friction
43
when is hand washing required?
entering the ICU or the OR
Decontamination after treating C diff
Exposure to potential contaminants
44
what are contaminants of hand washing
bar soap
water spout
basin
sink rims
towel dispenser
faucet handle
45
what are isolation precautions
linked to the method by which pathogens are transmitted specific PPE depending on type of transmission
46
what are 4 rules of asepsis
1. know which items are sterile
2. know which items are not sterile
3. separate the non sterile from the sterile
4. if sterile items are contaminated, remedy the situation immediately
47
DO NOTS of contaminated garments
DO NOT:
touch any part of the body with PPE
touch the outer surfaces of gloves with the ungloved hand
touch sleeves or front of the gown with the ungloved hands
wear PPE outside of the pt room
48
what is targeted in high levels of disinfectants
everything except high number of bacterial spores
49
whats targeted with intermediate level of disinfectant
viruses, fungi, vegetative bacteria, TB
50
whats targeted with low level of disinfectant
bacteria, some viruses, some fungi
51
what is removed in decontamination
destroyed blood borne pathogens that are no longer capable of transmission of infection partials
52
T/F: disinfectant is stronger than decontamination
False
53
what is the P wave indicating
atrial depolarization
54
what is the QRS wave
ventricular depolarization
55
what is the T wave
ventricular repolarization
56
what is the pathway for cardiac conduction
SA, AV, Bundles of His, bundle branches, purkinje fibers
57
what are we looking for to determine the rhythm
ventricular and atrial depolarization distance between the intervals. and if they are equal, regular, irregular or irregular regular
58
what is sinus rhythm
equal distance between identical waves (60-100)
59
how do you measure the rate values
300, 150, 100, 75, 60, 50
60
what is atrial fibrillation
continual rapid firing of multiple atrial follicles, no single impulse, depolarizes the atria completely
61
what causes A fib
MI
CABG surgery
HTN
Alcoholism
62
what do you see on an ECG for A fib
no P waves
irregular rhythm
atrial spikes
normal QRS
63
what is 3 or more PVC runs indicate
ventricular tachycardia
64
what is ventricular tachycardia
the continuous runs of PVC (150-250 bpm)
65
what are S&S of VT
hypotension
syncope- fainting
66
what causes VT
acute MI or ischemia
electrolyte imbalance
medication toxicity
illicit drugs
67
what are the common lab values (names)
metabolic panels
electrolyte panels
kidney function
liver function
lipid panel
cardiac markers
68
reference value for WBC?
5-10 x 10 ^9 /L
69
whats the up trend for WBC?
>11 x 10^9/L
70
what is the down trend for WBC
<4 x 10^9/ L
71
what are the reference values for platelets
140-400 x k/ul
72
what is the down trend for platelets
<150 k/ul
can cause excessive bleeding
73
what is the uptrend for platelets and what is indicated
>450 k/ul
thrombocytosis
74
PT implications for platelets
100.5 temp= hold therapy, symptoms are based on activity and if pt is at fall risk
75
hemoglobin reference and critical values
men: 14-17.4 g/dl
women: 12-16 g/dl
<5-6 g/dl or >20 g/dl
76
what is the uptrend for hemoglobin
CHF, dehydration, COPD, severe burns, dizziness, chest pain
77
down trend for hemoglobin
anemia, blood loss, lupus, kidney disease, stress ue to bone marrow, tachycardia
78
what is the therapy for hemoglobin
facility dependent symptom based
79
what are the hematocrit reference and critical values
men: 42-52%
women: 37-47%
<15-20% or >60%
80
up trend for hematocrit
COPD, CHF, burns, HA, fever, dizzy, fatigue, weakness
81
uptrend for hematocrit
leukemia, preggo, pale skin, HA, dizzy, arrythmias, dyspnea, monitor SpO2, cirrhosis, myeloma
82
therapy implications for hematocrit
<25%: essential ADLs only
hold out of bed activities
symptoms based approach
83
what is the normal time for blood clotting
11-13 seconds
84
what is the time to clot blood called
prothrombin time
85
what is international normalized ratio (INR)
measurement of how long it takes to clot blood when an oral anticoagulant is used
PT and PTT can differ depending on the lab values
normal value is .8-1.2
increase=risk for bleeding
decrease= risk of clotting
86
what is short term positioning
allowing for treatment of different areas
MT, modalities
87
what is long term positioning
preventing pressure
promoting better breathing positions
preventing ulcers and contractures
88
how often do you reposition a pt for long term positioning
every 2 hours to be able to maintain integrity of all 4 movement systems
89
how often do you reposition a pt in short term positioning
every 15 mins
90
why do you need to reposition a pt
to prevent ulcers (poor circulation), fragile skin, decreased sensation, or if they have difficulty breathing
91
what is indicated if the pt has prolonged redness of bony prominences
tissue damage
92
guidelines for positioning
explain the procedure to the pt, keep them in a neutral spine, provide a way for the pt to have communication with a healthcare worker
93
what are the areas of greatest pressure while pt is in supine (bony prominence's)
sp
head
inferior angle of scapula
elbows
PSIS
sacrum
heels
94
what are the areas of greatest pressure while pt is in prone (bony prominence's)
forehead/ lateral ear
acromial process
anterior humeral head
sacrum
ASIS
patella
dorsal aspect of the foot
95
areas of greatest pressure when sidelying
lateral ribs
lateral ear
lateral acromial process
lateral humeral head
medial or lateral humerus
greater trochanter
medial/lateral knees and ankles
96
areas of greatest pressure when sitting
ischial tuberosity
posterior thighs
sacrum
sp
elbow
97
what is the skin blanching test
when pressing pts skin, healthy skin will blanche and turn pink quickly
98
who is at a higher risk for skin breakdown
people with increased pigmentation
99
what increases load
a decrease in surface area
decrease in cushioning
100
how do we relate load and time with pressure patients
increase load + decreased time= injury
decreased load+ increase time= injury
101
how would we prevent pressure injuries on our pt
limit the direct contact of bony landmarks
increase surface area
increase cushioning
decrease load
decrease time in position
102
what are the most common contractures
flexion contractions
103
if a pt has swallowing restrictions or breathing dysfunctions, cardiac condition or lung condition, what do they have a higher risk of
cervical flexion contractures
104
what can cause hip or knee contractures
neurological conditions
105
who would have an increase risk of wrist contractions
neurological disease, injury disuse pts
106
how does a PT position someone with edema
keep the extremities above the heart
107
what do positioning devices do
reduce/ eliminate load on the tissue while pt is in static position
108
what pts would we put in prone positioning most often
amputees and pulmonary pts
109
how often do you reposition for seated
every 10-15 mins
110
what do we try to avoid in sitting
sacral sitting
111
what can high fowlers position cause there to be
sacral shearing
112
what circumstance would we need to use trendelenburg position
pregnancy
BP management
113
why would we use reverse trendelenberg
spinal cord
114
what do we always want to do for comfort and safety in supine
support knees, lower legs, and the head
115
safety and comfort concerns for sidelying
support head, arm and distribute pressure evenly
116
safety and comfort concerns for prone
support hips/abdomen
keep pressure off of the toes
117
safety and comfort concerns for sitting
support back
*if needed support side so they dont slump
118
what is the general rule when positioning a pt
maintain normal and neutral spine
proper airway
119
principles of draping
clean linen
only expose areas youre working on
no wrinkles or folds
be sure pt is comfortable
protect their clothing
120
culture sensitivities
cant remove clothing
gender
hospital gown exposure
121
what do we always want to do with a pt that was involved with trauma
informed consent
good communication
respect boundaries
watch for signs of discomfort
active involvement
apply firm pressure, dont be soft
122
what are the 2 types of exercise
active
passive
123
levels of assist are based off of what scale
GG
124
what does level 6 indicate on GG scale
independent
125
what does level 5 indicate on GG scale
set up/ clean up
helper will help set up while the pt is able to complete the activity
126
what is level 4 on the GG scale
supervision or touching assistance
- helper provides verbal ques/ touching to help assist pt with activity
127
what is level 3 on the GG scale
partial/ moderate assistance
- Helper does less than half the effort. helper helps lift, hold or support limbs (but providing less than half)
128
what is level 2 on the GG scale
substantial/maximal assistance
- Helper does MORE THAN HALF the effort. pt can help very little
