Communication
"Don't worry, it's going to be okay" this is an example of what non-therapeutic communication
False Reassurance
Most important in Reducing Spread of Infection
"HANDWASHING"
Best method to assess pain
Ask patient (pain scale 0-10)
Only time restraints should be used
When least restrictive alternatives have failed
Stage where most sleep occurs
Stage 2 (10-20)
Communicating with Patients that are Hearing Impaired
Close facing patient, Speak slowly, encourage use of hearing aids, do not cover mouth, written material, sign language
CDiff Precautions
Standard plus, Wash hands with soap and Water, Clean equipment with bleach only.
Apical Pulse Site
Midclavicular, 5th intercoastal space
Correct use of Cane
C.O.A.L, Cane first-affected leg-then good leg.
Pt at risk for sensory deprivation
Isolation, Seclusion
The Acronym "SOLER" stands for?
Sit facing patient, Open posture, Lean towards patient, Eye Contact, Relax
Difference Between Medical and Surgical Asepsis
Medical: "clean technique", Reduce number of microorganisms.
Surgical: "sterile technique", Eliminate number of microorganisms.
Vital Signs, Vomiting, I&O are an example of what type of assessment data
Objective Data
Benefits of Exercise and Activity (3)
Cardiovascular, Respiratory, Musculoskeletal
Basic of Vision Health
Regular vision exams, sunglasses and protective eye wear, Clean hands when in contact with eyes, rest eyes when needed, healthy weight, diet in fruits and vegetables.
"Do's" of Communication (5)
Silence, Presenting reality, Active Listening, Asking questions, Open-ended questions, Clarifying techniques, Offering general leads/broad statements, Showing acceptance and recognition, Focusing, Giving Information, Summarizing, Offering self, Touch, set boundaries/limits when needed
Labs and Diagnostics for Diagnosing Infection (4)
WBC, ESR, C&S, CXR, CT, MRI
Techniques Used During Physical Assessment and description
Inspection, Palpitation, Auscultation, Percussion
Complications of Immobility (4)
Skin breakdown, Contractures, DVT's, PE's, Depression, Constipation, Loss of muscle, Increased risk of infections
Nursing Interventions to Promote Sleep (4)
Bedtime routine, relaxation, light snacks, no exercise 2-3 hrs before bedtime, medication, minimize noise and interruptions.
"ISBAR" Meaning and example of each
Introduce, Situation, Background, Assessment, Recommendation
Chain of Infection (6)
Infectious Agent, Reservoir/Host, Portal of Exit, Means of Transmission, Portals of Entry, Susceptible Host
Normal Values for Temp, Pulse, Resp, B/P, and Sat%
T-(96.8-100.4F), P-(60-100), R(12-20), BP (SBP <120 or DBP <80), Sat (95%-100%)
Fall Prevention Nsg. Interventions (5)
Bed low, assistive devices within reach, call light in reach, yellow non-slip socks, signs, mobility devices, frequent rounds, night lights, reduce clutter in rooms, pt education, bed alarms
Pt education for use of hearing aids
Introduce gradually, clean regularly with dry cloth, keep extra batteries, turn off when not in use