Definitions
Name a difference in droplet and airborne precautions.
Droplet Precautions:
HH, Mask, Face shield or goggles, private room
Influenza, pertussis, mumps, viruses, diphtheria, meningitis
Airborne Precautions:
HH, Fitted N-95, Negative pressure room, Gown and gloves if contact w/ bodily fluids
TB, Measles, Chickenpox, varicella, SARS, smallpox
What are the 4 stages of a pressure ulcer?
Stage 1: non-blanchable erythema of intact skin
Stage 2: Partial thickness skin loss with exposed dermis
Stage 3: Full thickness loss of skin, visible adipose tissue
Stage 4: Full thickness skin and tissue loss, visible muscle, tendon, or bone
the drive of respirations is controlled by what 2 things? (one answer is a part in the brain)
Control of Respirations:
Controlled by brainstem, driven by CO2 levels
What are the 4 pulse ratings?
0: absent
1: weak
2: expected
3: strong
4: bounding
what is the normal urination volume each hour (mL)?
~30mL/hr
What are the following abbreviations:
HS, AC, IVPB, BID
Hour of Sleep, Before Meals, IV Piggyback, Twice a day
what are the 2 types of sweat glands and where are they located?
Sweat Glands:
Eccrine: everywhere
Apocrine: armpits
how are CPAP and BiPAP similar and different?
Continuous Positive Airway Pressure (CPAP): prevents apnea episodes
Can cause abd bloating or eye irritation
Bilevel Positive Airway Pressure (BiPAP): 2 airflow levels (for inhalation & exhalation)
Shiny skin, reduced hair growth, and muscle atrophy are characteristics of which type of peripheral vascular disease?
Arterial
what are urination levels for clients with Oliguria and Anuria?
Oliguria: <400mL/day
Anuria: <50mL/day
What assessment tool is used for pain, and what does the abbreviation stand for?
Pain Assessment: (PQRST)
Pain, quality, radiates, severity, time
Caucasians and AA's are at risk for developing which skin risks?
Skin Risks:
Whites: higher risk for melanoma
Blacks: development of keloids (big scar tissue around wound)
A Venturi Mask is best indicated for a client with which disorder?
COPD, due to precise FiO2 delivery
explain what Chronotropes and Inotropes are.
Chronotropes: meds that change heart rate
Inotropes: meds that help heart contractility
Clear Liquid Diet: water, broth, gelatin, popsicles
Full Liquid Diet: milk, pudding, soup, yogurt
Describe the 4 types of drainages, their characteristics, and what contents they consist of.
Serous: blood plasma, clear
Purulent: bacteria, WBC’s, dead tissue, yellow
Serosanguineous: Plasma and blood, clear red
Sanguineous: blood, red
Describe each: wound regeneration by primary, secondary, and tertiary intent.
Wound Regeneration:
Labile: Primary (edges join), Secondary (too far apart), Tertiary (left open and sutured later)
describe the sounds of crackles, wheezing, stridor, ronchi, and pleural friction rub.
Abnormal Sounds:
Crackles: popping
Wheezing: high pitched due to narrow airways
Ronchi: low pitched rumbling, snoring, often clear with couching
Stridor: high pitched crowing, upper airway obstruction
Pleural Friction Rub: walking on snow, inflamed pleura rubbing together
Where are the catheters located after insertion? Peripheral IV, Peripheral Midline, Central Line
Peripheral IV: AC region
Peripheral Midline: cephalic vein for 10-14 days
Central Line: vena cava through femoral artery or internal jugular vein or subclavian
what is a normal urine specific gravity range?
0.015-0.025
what type of IV fluids would be Hypotonic, Isotonic, and Hypertonic?
HYPOtonic: indicated for fluid overload
0.45% Saline, water goes into cells to expand them
ISOtonic:
0.9% LR, water transfers equally in and out of cell
HYPERtonic:
3% Saline, water leaves cells to dehydrate them
what are the 5 wound healing stages?
Wound Healing Stages:
1– Hemostasis: blood clots
2– Inflammation: wbc infiltration, scabbing
3- Epithelialization: migration, skin
4- Fibroplasia: strengthens wounds
5- Maturation: wound gets more support
what is the range of O2 available through a nasal cannula, simple face mask, and a non-rebreather mask? (in L)
Nasal Cannula: 1-6L/min, FiO2 24-44%
Watch for skin breakdown around ears/nares
Simple Face Mask: 5-8L/min, FiO2 35-55%
Snug fit, remove for meals
Non-Rebreather: 10-15L/min, Fio2 50-80%
Highest concentration of O2 w/out intubation
Ensure reservoir bag is ⅔ inflated
One-way valve prevents rebreathing CO2
what are the ECG waves (PQRST) indicating?
ECG:
HR– R wave to R wave
P wave- atrial depolarization
QRS complex- ventricular depolarization
T wave- ventricular repolarization
what are 3 abnormal urine findings?
Abnormal Findings: dark, cloudy, musty, acidic or alkaline, blood, albumin, glucose, ketones, bile