Nutrition
What is the difference between macronutrients and micronutrients?
Macronutrients include protein, carbohydrates, and fat. They are eaten in large amounts, are the primary building blocks of any diet, and provide the body with energy to function.
Micronutrients are composed of vitamins and minerals and only small amounts are required in a diet.
What are the different types of precautions? When to use them? What PPE is needed for each?
Contact Precautions- wound infections, RSV, scabies, herpes simplex
•PPE – gowns and gloves at minimum by caregivers and visitors
•Private room or cohorting with someone with same infection and 3 feet between clients
•Remove PPE before exiting room
Droplet Precautions- rubella, pertussis, mumps, H. influenza, strep throat
•PPE - Surgical mask for providers and visitors
•Private room or cohorting or at least 3 feet between clients
•Client wear mask when out of room
•Cough etiquette, hand hygiene
•Own equipment
Airborne Precautions – measles, varicella, tuberculosis, COVID
•Private room with door closed, negative pressure room
•PPE – N95 or higher mask, fit testing
•If splashing expected, wear full PPE
Protective Environment:
•Immunocompromised clients
•For a client for first 100 days or longer after hematopoietic stem cell transplant
•No plants
•Positive airflow
•masks for when out of room
What is sleep apnea? Who is at risk? What are the nursing interventions?
•Obstructive sleep apnea (OSA) is related to the recurrent episodes of upper airway collapse and obstruction while sleeping combined with waking from sleep.
•decreased O2 sat during apnea, snoring
•Potential Causes: obesity, sleeping on back, alcohol, Enlarged tonsils
•Effects:
•Interrupted sleep
•Excessive daytime sleepiness
•Low energy
•Lack of motivation
•Treatment:
•CPAP
•Reduce risks: lose weight, reduce alcohol, no sleep aids, stop smoking
•Surgery to reduce- tonsils
What are the newborn reflexes?
Moro - sudden movement/loud noise (startles)
Rooting - stroke cheek or side of mouth (turns to and sucks)
Babinski - stroke sole of foot (toes fan out and foot turns in)
What is the difference between hypoxemia and hypoxia?
⮚Hypoxemia is when there is a limited amount of oxygen in the blood (low O₂ in blood)
⮚Hypoxia is a lack of oxygen at the cellular level (low O₂ in tissues)
Explain the difference between simple and complex carbohydrates
Carbohydrates (sugars and starches) are nutrients that fuel the body, including the central nervous system and brain, while helping protect against disease.
Simple - (sugars) - fructose, sucrose, lactose
Complex – (starches) – wheat, rice, potatoes, pasta
What are prevention strategies for fall risk patients?
•Non-skid footwear
•Bed in low position
•Lock wheels on bed
•Lock brakes on Wheelchairs
•Adequate lighting
•Call light and personal items within reach
•Fall prevention education for clients
•Signage or ID
Define sensory overload in client and what are factors affecting sensory perception?
Sensory Overload is a client receives stimuli at a rate and intensity beyond his/her ability to process.
•Age
•Hearing loss, tinnitus, impacted cerumen
•Vision loss, cataracts , dry eyes, corneas less sensitive, pupils less reactive to light, lens less flexible
•Taste change – decreased with sour, salty, and bitter
•Smell sensitivity decreases
•Touch – affected by peripheral circulation decreases, decrease sensitivity to pressure, pain and temperature
Medications
What are social determinants of health?
•Genetics
•Behavior
•Environmental and physical influences
•Medical care
•Social factors
•CO = amount of blood pumped in 1 min
•HR = heartrate (beats per minute)
•SV = stroke volume
•Amount of blood pumped in 1 beat
•SV affected by :
•Preload – amount of blood in in LV before contraction, Starlings Law – the more stretch (volume) the greater the force of contraction
•Afterload- resistance or force that left ventricle must over come to pump blood forward
•Proportional to blood pressure
•Contractility – strength -- decreased contractility= decreased SV and CO
What BMI is considered underweight, normal and obese?
BMI
< 18.5 is underweight
18.5-24.9 is normal
25-29.9 is overweight
>30 is obese; >40 morbidly obese
What must be considered for blood pressure technique?
•No nicotine or caffeine 30 min prior
•Rest for 5 mins
•Remove bulky clothing
•Choose the right size cuff
•80% of the client's arm
•Cuff too small = False HIGH Reading
•Cuff too large = False LOW Reading
•Client can be lying or seated
•If seated, feet flat on floor
•Assess for extremity restrictions
•Hx breast CA with lymph involvement
•Acute Injury
•Equipment
•Intravenous Lines
•Arm at the level of the heart, supported
•Palm up
•Artery Indicator Arrow on BP Cuff aligned with brachial artery, snug fit, 1 inch above antecubital fossa (elbow crease)
•Can use thigh if needed
•Inflate 30 above expected systolic, release slowly 2mmHg /sec
•Note 1st Korotkoff Sound - Systolic BP (top number)
•When Sounds disappear – Diastolic BP (bottom number)
List effective coping strategies
•Healthy eating –
•Complex carbs
•Vitamin C – can lower stress hormone
•Healthy, crunchy food can decrease tension
•Drink water, avoid alcohol
•Exercise
•Can help with mood, stress, relaxation, increase energy
•Time management
•Reduces stress- everything is not a priority
•Building resilience
•Bouncing back
•Mindfulness - focus on the present
•Rest and relaxation
•Progressive relaxation – tense and release muscle
•Guided imagery – pretend to be at beach
•Sleep hygiene
•Journaling
•Aromatherapy
•Massage
•Meditation
•Music/Dance
•Breathing
What are differences when it comes to modifiable vs nonmodifiable risk factors?
Modifiable
•Tobacco
•Diet
•ETOH
•Diabetes
•HTN
•Obesity
•Sunbathing
•Sedentary
NonModifiable
•Age
•Gender
•Ethnicity/ race
•Family history
What is informed consent and the nurses role?
-A client’s full understanding and choice to have a treatment or procedure,
-including the risks involved, benefits, and other alternatives available,
-as well as the benefits and risks in-lieu of having the treatment or procedure.
-The client must be aware of what the treatment or procedure is, who will perform the treatment or procedure, the purpose, and expected outcome.\
-Nurse is a witness to signature/verify signature
List the steps the nurse would utilized for safe enteral feeds
•Check bowel sounds
•Check placement
•Check residual
•Flush
•Feed (Meds)
•Flush
How do you properly use body mechanics
•Stand or move as close to the object as possible
•Keep the abdominal muscles contracted and lower back in normal position
•Maintain the head upright with shoulders raised up
•Bow the hips slightly and squat
•Do not twist the torso. Always pivot or side-step
•Push up from the knees
What is the difference between acute and chronic stress?
Acute stress
⮚The most common and frequent type of stress.
⮚Usually brief and can be positive or negative.
⮚Causes an immediate reaction and triggers the fight-or-flight response.
⮚MVA, death of loved one, victim of crime
⮚Headache, chest tightness, irritability, SOB, GI disturbance
Chronic stress
⮚A disabling condition that occurs when stress levels are heightened, constant, and prolonged.
⮚Anxiety, depression, CA, suicide, CVD
⮚Unrelenting stress- poverty, racism, illness, disease, dysfunctional families
Explain the change theory and different stages
●Precontemplation: There is no intention of taking action.
●Contemplation: There are intentions to take action and a plan to do so in the near future.
●Preparation: There is intention to take action and some steps have been taken.
●Action: Behavior has been changed for a short period of time.
●Maintenance: Behavior has been changed and continues to be maintained for the long-term.
●Termination: There is no desire to return to prior negative behaviors.
●Relapse: Returning to the old behavior, often a learning opportunity
What is involved with postop/post anesthesia care?
•Encourage DB and C Q 2 hr
•Incentive spirometer 10 x per hr
•Early ambulation
•Monitor VS, cap refill, pulses, assess for DVT and bleeding
•Monitor LOC and return to baseline
•Monitor for post op delirium
•Pain management
•Surgical wound care – sterile dressing for 24-48 hrs. Assess draining and signs of infection
•Monitor drains
•Turn and reposition
•Splint incision
•Bowel sounds assessment, laxative or stool softener
•Monitor hydration status and I & O
Name strategies to prevent aspiration in clients
•Thickened liquids – with powder or gel (nectar, honey, or pudding thick)
•Sit patient upright
•Monitor breathing
•Stop feeding if symptoms occur
What are some complications of immobility?
Cardiovascular
•Cardiac deconditioning – less workload on heart
•Orthostatic hypotension
•Deep Vein Thrombosis- DVT-
•Stasis of blood d/t immobility
•Complication
•Pulmonary embolism
•CVA
•MI
Respiratory System
•Decreased air exchange increased risk of infection
•Narrowed bronchioles
•Thicker sputum d/t dehydration
•Atelectasis
•More prone to pneumonia
Gastrointestinal System
•Malnutrition
•d/t anorexia
•Constipation
•Impaction
•GERD
Genitourinary System
•Urinary retention
•Renal calculi
Psychological Integrity
•Loss of mobility can affect self concept and self esteem.
•Increased dependence on others
•Loss of roles and privacy
•Isolation
Integumentary System
•Pressure injury
•Bony prominence areas susceptible
•Shearing and friction
•Moist skin at risk for breakdown
What is the difference between narcolepsy and insomnia?
⮚Insomnia is an ongoing inability to sleep despite having the opportunity to do so.
⮚Narcolepsy – sudden attack of sleep
What are the different levels of prevention?
•Primary prevention is the act of intervening before negative health effects occur. Ex – vaccinations stopping smoking, wear helmet
•Secondary prevention is the detection and treatment of preclinical changes to reduce the impact of disease or injury and limit disability. BO screenings, mammograms, STI screenings, colonoscopies
•Tertiary prevention aims to restore client to optimum functioning – self-care, rehab, Mental Health, Drug & Alcohol
•Quarternary Prevention Protecting from excessive use of medical interventions
What is the difference between venous and arterial wounds?
Venous underlying conditions: varicose veins, previous DVT, obesity, pregnancy, recurrent phlebitis
Venous location: between lower calf and medial malleolus
Venous characteristic: shallow and flat margins, moderate to heavy exudate, slough at base with granulation tissue
Venous condition of leg/foot: Hemosiderin staining, thickening and fibrosis, eczematous and itchy skin, limb edema, normal cap refill
Venous Treatment: compression therapy, leg elevation, surgical management
Arterial underlying condition: Diabetes, hypertension, smoking, previous vascular disease
Arterial ulcer location: Pressure points, toes and feet, lateral malleolus and tibial areas
Arterial characteristic: Punched out and deep, irregular shape, unhealthy wound bed, presence of necrotic tissue, minimal exudate unless infected
Arterial condition of leg or foot: thin, shiny skin, reduced hair growth, cool skin, pallor on leg elevation, absent or weak pulses, delayed capillary refill, gangrene
Arterial treatment: revascularization, antiplatelet medications, management of risk factors