Integumentary System
The minimum repositioning schedule to help prevent pressure injuries in bedbound residents
What is repositioning at least every two hours?
The term for respirations greater than 20 breaths per minute in adults.
What is tachypnea?
The heart chamber that receives deoxygenated blood from the body through the superior vena cava.
What is the right atrium?
The most common type of progressive, irreversible brain disease that causes memory loss, confusion, and changes in behavior.
What is Alzheimer’s disease?
An important pressure injury prevention practice that involves controlling moisture.
What is keeping skin clean and dry?
The earliest visible sign of a pressure injury.
What is non-blanchable erythema (Stage 1 pressure injury)?
The best position to help a resident with COPD breathe more easily.
What is the Fowler’s position?
A condition that causes chest pain due to lack of oxygen to the myocardium.
What is angina?
A disease commonly associated with a shuffling gait and increased fall risk.
What is Parkinson’s disease?
The best time of day to apply anti-embolic stockings.
What is in the morning before the resident gets out of bed?
A pressure injury that involves partial-thickness skin loss and may look like a blister or shallow crater.
What is a Stage 2 pressure injury?
The medical term meaning difficulty breathing.
What is dyspnea?
The method used to take nitroglycerin tablets for rapid absorption during chest pain.
What is sublingual administration?
The correct side of the mouth to place food when feeding a resident with left-sided weakness after a stroke.
What is placing food on the unaffected (right/stronger) side?
The structure that acts like a lid to close off the airway during swallowing.
What is the epiglottis?
This painful viral skin condition is caused by the same virus that causes varicella.
What is herpes zoster (Shingles)?
A device used after surgery to help expand the lungs and improve lung capacity.
What is an incentive spirometer?
A resident has swollen ankles, shortness of breath when lying flat, and rapid weight gain over two days. These symptoms indicate this condition is worsening.
What is congestive heart failure (CHF)?
The term describing increased confusion and restlessness in the late afternoon or evening in residents with Alzheimer’s disease.
What is sundowning?
The most common form of anemia.
What is iron-deficiency anemia?
A resident who is incontinent and bedridden begins developing redness on the coccyx. The most important immediate nursing assistant intervention to prevent further skin breakdown involves managing this factor.
What is controlling moisture by keeping the skin clean, dry, and changing briefs promptly?
A resident with suspected tuberculosis is placed on this type of precautions.
What is airborne precautions?
A resident reports crushing chest pain that radiates to the left arm and jaw, along with nausea and sweating.
What is a myocardial infarction?
A resident with Alzheimer’s suddenly becomes combative when staff attempt to redirect him from leaving the unit. The nursing assistant notices the environment is loud and overstimulating. The most appropriate immediate intervention is this.
What is removing environmental triggers and stepping away to maintain safety?
A resident on airborne precautions for suspected tuberculosis must provide a sputum specimen. To obtain the most accurate sample, the nursing assistant should collect it at this time of day.
What is early in the morning (before eating or drinking)?