Medication
If a resident has chest pain (especially with a known history of acute coronary syndrome), how many times can you give the nitroglycerin spray sublingual and for how long?
Administer 1 spray every 5 minutes for a total of 15 minutes. If the resident still has chest pain after 15 minutes, you may send resident to the hospital.
When do you complete a falls risk assessment screen?
On move in
On return from acute care
Change of status
What are some examples of de-escalation strategies?
Provide time and space
Redirection
Distraction (Get to Know Me)
What is the difference between stage 2 and stage 3 pressure ulcers?
Stage 2:
Partial thickness loss of skin layers involving the epidermis and possible penetrating into but no through the dermis. May present as blisters with erythema or induration. Wound base is moist and pink
Stage 3:
Full-thickness tissue loss extending through dermis and it involves the subcutaneous tissue. May include necrotic tissue, undermining or sinus tract formation.
What is "Independent Double Check" for high alert medications?
Process by which two HCPs work independently to verify accuracy of the medication. The second HCP performs the medication check process without the assistance from the first HCP.
What is under the VCH LTC Falls Risk Screen?
Risk factors (ie: 2 or more falls in the last 6 months, vertigo)
Cognitive Alterations
Mobility Alterations
Sensory/Perceptual Alterations
Elimination Alterations
Taking 5 or more medications or any of the following: sedatives, opiates, anxiolytics, antidepressants, etc.
What is "alert removal"?
Remove all visual alerts (including the purple violence alert icon and delete warning signs on PCC)
Inform resident/family if applicable
Document in PCC
Why is it important to know the peak times of insulin (ie: fast acting and short acting insulins)?
Resident's will be at risk of hypoglycemia or low blood sugar. May provide short acting carbohydrates.
What is the prohibited abbreviation for "both eyes"?
OU - Oculus Uterque
What are signs and symptoms of serious injuries?
Head injury - persistent headaches, decreased LOC/GCS, projectile vomiting
Fracture - shortening of limbs
Spinal injury - numbness/tingling, extreme back pain, paralysis
Open wound
When do we complete the violence and aggression alert form?
- When initial screening indicates a potential for violence or aggression
-Resident becomes violent or aggressive during hospital stay
List the subscales on the Braden Risk Assessment Tool.
Sensory Perception
Moisture
Activity
Mobility
Nutrition
Friction and Shear
What are some of the reasons why we need to complete the "narcotic return form?"
Give 5 reasons.
discontinued, deceased, discharged, drug expired, unsuitable container, illegible label, used narcotic patches or unusable
When do you notify the family if a witnessed fall (with no head impact) happened at 10pm on May 1?
Morning of May 2 - call family in the morning for falls between 2100 - 0800
When do you complete Violence & Aggression Alert Review (after the initiation of the alert)?
Behavioral incidents/change
Quarterly Screening
Care Conference
Describe the process for the application of the silver nitrate swab for hypergranulation?
1. Cleanse the wound and peri wound skin with normal saline
2. Apply skin protectent (ie: petroleum jelly to the peri-wound skin)
3. If there is enough moisture in the wound then use the stick dry; if not, then moisten the tip with only sterile water.
4. Hypergranulation - apply firm pressure on the area, rolling the stick back and forth.
5. Contact time is usually 2 minutes. The newly burnt skin tissue will appear gray- ish colour.
6. Following treatment, gently cleanse the treated area with normal saline damped gauze and apply a dressing which will support a less moist wound environment
What medication can you give to the resident if they are experiencing high ammonia levels due to liver disease?
Lactulose (usually 30mL) - dose is increased to achieve 2-4 loose stools per day as per doctor's order.
What is the minimum hours to initiate the post fall "Care Aide Observation Tool" for unwitnessed fall or head impact?
Minimum of 72 hours - depending on the onset of serious injuries.
When do you call a code white versus calling a police for intervention?
Code White:
- Increased escalation of the behaviour that may threaten safety (aggression to property, person, etc)
- Inability to de-escalate the situation on your own
Call the police:
- Real or perceived threat to life (threat or attempted violence) or significant injury to anyone
- A weapon is involved
- Escalated resident is off the property
- Code White Responders do not have the capacity to safely manage the situation and under the direction of the Code White Leader.
What is serotonin syndrome?
Changes in autonomic function and mental status as well as other neurological findings within 6-8 hours of starting or increasing serotonergic medications.