Skin
Documentation needed for wounds of any kind
What is size(length, width, depth), color, location, drainage?
True/false: Cane should be placed on the weak side of the body
True/False: Patient may be sitting up when removing a central line.
False. patient should be supine or placed in Trendelenburg. Have patient hold breath or perform a Valsalva maneuver.
Number of witness signatures needed for informed consent.
What is one, unless patient signs with an X or is blind?
Common causes for contact precautions
what is c-diff, MRSA, VRE, lice, scabies
Patients who eat a vegan diet are at risk for what type of anemia
What is pernicious anemia (B12 deficiency)?
Medication that is concerning if patient is receiving negative pressure wound therapy
anticoagulants
Teaching for safe patient transfers
what is stand close to patient, do not grab arms but support at lower back to avoid skin tears, assess for dizziness, ensure both patient and nurse have wide stance for better balance.
Labs that should be checked when patient is receiving TPN or with nutritional concersn
albumin, pre-albumin, cholesterol
Pre-op abnormal labs that must be addressed prior to surgery by calling for orders
what is abnormal potassium?
When should hand hygiene should be done during patient care?
before and after patient care, after touching equipment, immediately after removing gloves. washing with soap and water should be done when hands visibly soiled, sticky, contact with bodily fluids or with infections caused by spores.
most common type of anemia
what is iron deficiency anemia?
Psoriasis is what type of disorder
What is autoimmune? (consider patient teaching regarding treatments)
Medications that place patient at higher risk for falls
Two part question: PICC should be placed in the ________ arm while PIV should be placed in the ________arm
Dominant/non-dominant
Teaching to prevent post-op DVT
True/False: Culture and sensitivity should be collected prior to initiating antibiotics.
True
Patient teaching for sickle cell crisis
increase fluids, encourage mild exercise to improve blood flow, avoid extreme temperatures, avoid elevation
Signs and symptoms of herpes zoster
Pain, itching, vesicles (unilateral on dermatomes typically)
True/False: I should place a pillow directly under bony prominences.
False: heels should be floated, and pillows or wedges used to turn patient but not place directly under bony prominences.
The nurse should do what action if TPN not available
What is Call for order for 10% or 20% dextrose until available?
signs/symptoms of malignant hyperthermia
high fever, tachycardia, dysrhythmias, muscle rigidity. Always check for personal and family history before surgery.
Common causes for droplet precautions
diphtheria, pneumonia, influenza, meningitis, pertussis
Common signs and symptoms of iron deficiency anemia
what is cool skin, pallor, tachycardia, glossitis, fatigue
signs and symptoms of cellulitis
What is red, warm, swollen, painful?
Patient teaching to avoid falls
If s/sx of blood transfusion reaction are suspected the nurse should do what?
STOP the transfusion and call provider immediately.
True/false: Infection puts a patient at risk for dehiscence and eviscerations.
True, impaired skin integrity from infection at the surgical site prevents healing and formation of scar tissue to close wound.
Common causes for airborne precautions
measles, TB, varicella
B12 is responsible for
what is maintain nerve function and synthesis of DNA in RBC