Musculoskeletal, Death & Dying

C-spine Education

100

True or false : According to AHS Policy, it is within the scope of practice of a nursing student to take control of the patients head in C-spine precautions when performing a log roll.

False

200

When applying an Aspen collar, the patient should always be in this position:

Supine

300

When caring for a patient with an Aspen collar, how often should skin care be performed and why?

At least twice per day and as necessary, the collar is to be removed for proper skin care to avoid skin breakdown and formation of pressure ulcers. 

400

How many caregivers are required when performing skin care on a patient with an Aspen collar, and what are their roles?

In most cases two people are required to provide skin care and change the lining pads of the collar. 

One caregiver required to provide in-line stabilization of the neck and one to provide the skin care. 

500

As the leader of log-rolling a patient, what are some responsibilities specific to the caregiver in that position?

Leader takes control of the patient's head by placing hands on each side of the head with thumbs along the mandibular edge of the collar and fingers behind the head on the occipital ridge maintaining gentle, yet firm stabilization of the neck. 

Leader completes a brief verbal and motor exam.

Leader gives instruction to patient and staff to lift to the specific edge of the bed and move on the count of 3. 

Musculoskeletal Traction

100

What are the major physical consequences of immobilization?

Loss of muscle strength, endurance and muscle mass; bone demineralization; loss of joint mobility; contractures.

200

What are the primary purposes of MSK traction?

To fatigue involved muscles and reduce muscle spasm; position bone ends in desired alignment; immobilize the fracture site until realignment has been achieved to permit casting or splinting.

300

List 6-8 common complications that children with skin traction may develop.

Impaired skin integrity; impaired circulation; at risk for atelectasis from immobility; impaired sleep patterns; knowledge deficit - teaching needed for family; psychological & emotional distress; GI - constipation, nausea, loss of appetite; MS - pain & loss of mobility; neurovascular complications; blood clots.

400

What neurovascular assessment would need to be performed for a child with a fractured right femur placed on Buck's Extension Skin Traction?

Pain, pallor, bilateral pedal pulses, parasthesia, paralysis. 

500

What are the four safety checks that need to be carried out for a child on Buck's Extension Skin Traction?

Ensuring the weights attached to the end of traction are as ordered; ensuring that the cables are able to move freely along the pulley & that nothing is impeding them; ensuring the cord is assessed daily for fraying, particularly where they pass over the pulley; ensuring traction splint is comfortable and not creating pressure points on the skin. 

Death & Dying: Assessment

100

In the assessment of the dying patient, list 3 signs of impending clinical death related to muscle tone:

Relaxation of the facial muscles; difficulty swallowing & gradual loss of the gag reflex; decreased activity of the GI tract with subsequent nausea, accumulation of flatus, abdominal distention and retention of feces, especially of opioids or tranquilizers are being administered; possible urinary and rectal incontinence because of decreased sphincter control; diminished body movement.

200

In the assessment of the dying patient, list 3 signs of impending clinical death related to slowing of the circulation:

Diminished sensation; mottling and cyanosis of the extremities; cold skin; decelerated and weaker pulse; decreased blood pressure.

300

When assessing the dying patient, how would you anticipate the progression of the loss of body temperature?

First in the feet and later in the hands, ears and nose. 

400

In the assessment of the dying patient, list 2 signs of impending clinical death related to sensory impairment:

Blurred vision; impaired sense of taste and smell.

500

In the assessment of the dying patient, list 3 signs of impending clinical death related to respirations:

Rapid, shallow, irregular or abnormally slow respirations; Cheyne-Stokes respirations (periodic breathing); noisy breathing, referred to as the "death rattle" (caused by the collection of mucus in the throat); mouth breathing which leads to dry oral mucous membranes.

Death & Dying: Nursing Care

100

Name one important intervention for a dying patient who is mouth breathing.

Performing routine mouth care as this leads to dry oral mucous membranes.

200

To assist with ineffective airway clearance in the dying patient, the nurse can perform this intervention (one for each for the conscious and unconscious patient).

30 degrees Fowler's position for conscious patients; lateral & throat suctioning for conscious patients; Sims, 30 degrees lateral, and lateral position for unconscious patients.

300

Related to the impaired physical mobility of the dying patient, what are some important nursing interventions to implement?

Assist patient out of bed periodically (if patient able); regularly change position of bedridden patient; support patients position with pillows, blanket rolls or towels as needed; elevate patients legs when sitting up to prevent pooling of blood.

400

In relation to impaired urinary elimination, what kind of nursing interventions can be implemented to benefit the patient?

Skin care in response to incontinence of urine or feces; Bedpan, urinal or commode chair within easy reach; call light within reach for assistance onto bedpan or commode; absorbent pads placed under incontinent client; linen changed as often as needed; catheterization if necessary; keep rom as clean and odour-free as possible.

500

During post-mortem care the nurse must cap and clamp all IV lines, nasogastric tubes, indwelling drains, etc. After clamping, is the nurse able to remove these lines? Why or why not?

Do not removed these lines unless the hospital policy requires you to do so. Leaving lines and tubes insitu is required for autopsy and any Medical Examiner cases. It can also facilitate the embalming process.

Death & Dying: Documentation

100

Documentation must be accurate. What must you have precise documentation for?

"Time of Death"

200

True or False: The "Death Note: Organ and Tissue Donation" must be completed on all patients.

True

300

Who may pronounce death of a patient? Where is this documented?

Attending physician, Nurse Practitioner, or covering physician. Some physicians and units may have a standing order for a nurse to "declare death."

Document this on the "Notice of Death or Stillborn" form.

400

Why is the "Deceased Patient: Personal Property" form completed? Who completes this form?

To catalogue all the deceased patient’s personal property. Valuables are to be placed in Safekeeping Envelope and are not recorded on this form.

The form is completed by Nursing, Protective Services, Next of Kin.

500

What are 5 of the 7 the communicable diseases listed in Schedule 2 that must be reported to the Bodies of Deceased Persons Regulation? How does the body need to be identified?

AIDS; Hepatitis B; Hepatitis C; HIV; Typhus; Invasive Group A Strep Infection

A Schedule 2 Communicable Disease Tag must be attached to the patient.