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Questions and Answers
What is considered objective data during a physical assessment?
Which term describes difficulty breathing while lying down?
What does PERRLA stand for in a neurological assessment?
Which heart sounds are considered abnormal during a cardiovascular assessment?
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What is the maximum acceptable capillary refill time during a cardiovascular assessment?
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What is the first step in the abdominal physical assessment order?
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Which condition indicates an output of less than 50mL in 24 hours?
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Which of the following is an example of non-verbal communication?
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What is typically the last step in the problem solving process?
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What might indicate a communication barrier?
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In Maslow’s Hierarchy, which level comes directly below Self Actualization?
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What does the term MAEW stand for in relation to physical assessment?
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Which of the following is NOT a non-therapeutic communication technique?
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What is the correct position for a patient's bed when not in use?
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Which is a proper method to prevent back strain when lifting?
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What is the primary use of a Class ABC fire extinguisher?
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How should patients be evacuated in case of a fire?
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What should be done with restraints for immobile patients?
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Which is NOT a basic principle of radiation safety?
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When transferring a patient in a wheelchair down an incline, what is the correct procedure?
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In what scenario would restraints be appropriate to use?
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Study Notes
Patient Safety
- Always lower patient beds unless care is being given
- Potential safety hazard: patient spilling water on the floor
Body Mechanics
- Lateral: towards the side of the body (away from the middle)
- Bending at the knees and hips prevents back strain
- Abduction: movement away from the midline (away from the body)
- Adduction: movement toward the midline (towards the body)
- Flexion: bending a limb at the joint
- Extension: straightening a limb
- Back pain is a major work-related injury for healthcare workers
- Trochanter Roll: used to help prevent external hip rotation
Electrical Safety
- Never pull the cord to remove a plug from the socket
- Never use an electrical cord with wires showing
Fire Hazards
- Class A Fire: fabric, wood, paper. Uses a pressurized water fire extinguisher
- Class BC Fire Extinguisher: contains carbon dioxide gas
- Class ABC Fire Extinguisher: contains a dry chemical
- Horizontal Evacuation: moving from East to West
- Vertical Evacuation: moving patients up or down
- Fire needs: oxygen, fuel, and a source of ignition
- Order of Evacuation: ambulatory patients, semi-ambulatory patients, non-ambulatory patients
- NFPA label: Red (Fire Hazard), Blue (Health Hazard), White (Specific Hazard), Yellow (Instability)
Imaging/Radiology Safety
- Basic Radiation safety principles: time, shielding, and distance
Patient Transfers
- Lower the head of the bed to move a patient up in bed with less effort
- Lower the patient back to a sitting position and reassess if they can't maintain a standing position
- Patients should NOT put their hands around your neck during transfers
- When transferring a patient in a wheelchair: back the patient down an incline and lock the brakes on both wheels
Restraints
- Restraints may be used to assist immobile patients, if the patient might hurt themselves, or if the patient needs support
- Restraints must be removed EVERY TWO HOURS
- Ankle boots ordered by an orthopedist are not considered a restraint
- Documentation must include the type of physical restraint used
- When using restraints, attach them to a part of the bed frame that will move with the patient
Miscellaneous
- Adverse Event: unexpected occurrence involving death or serious injury
- Code Pink: missing baby
- Code Blue: patient goes into cardiac arrest
- Code Yellow: mass casualty
- Military Time: 7a: 0700, 7pm: 1900
- High-Fowler’s Position: the head of the bed is raised to almost a 90-degree angle
- Prone Position: lying on the stomach
Physical Assessment
- General: Inspection, Palpation, Percussion, Auscultation
- Objective Data: what you can see and measure
- Subjective Data: what the patient or family says
Neurological System
- Things to assess: pain, orientation, PERRLA (accommodation), Aphasia, Hemiparesis, Pain level
- Orientation: name, place, year (x1, x2, x3)
- Accommodation: pupils constrict when you shift focus from far-sighted to near-sighted
Respiratory System
- Orthopnea: difficulty breathing while lying down
- Wheezing: high pitch sounds on exhalation (Asthma)
- Crackles: sound of fluid filled or collapsed alveoli popping
- Tachypnea: greater than 20 respirations per minute
Cardiovascular System
- Capillary Refill: should be less than 3 seconds
- Pulses: all pulse sites are peripheral, except for apical pulse
- Edema: swelling in the feet and ankles
- Heart Sounds: S1 and S2 are normal (lub dub). S3 and S4 are NOT normal.
Gastrointestinal System
- IAPP: Inspection, Auscultation, then Palpation, then Percussion
- What you might assess: nausea/vomiting
- Palpation: start with light pressure, lift hands between each quadrant, ask patient if they are experiencing any pain
- Absence of bowel sounds: if you don’t hear anything, listen for at least 5 minutes
Genitourinary System
- What you might assess: blood in the urine (hematuria), penile or vaginal discharge
- Nephrostomy: opening into the renal pelvis of the kidney
- Urinary Output: Less than 500mL in 24hrs - Oliguria, Less than 50mL in 24hrs - Anuria
Musculoskeletal System
- MAEW: Moves All Extremities Well
- Plantar Flexion: pointing your toes
- Muscle Atrophy: when a muscle shrinks or wastes away
- Lordosis: exaggeration of the curve of the lumbar spine
Therapeutic Communication
- Verbal Communication can be spoken or written
- Nonverbal Communication (communicating without words): turning your back, rolling your eyes, smiling, eye contact, physical touch, facial expressions, gestures
- You can control prejudices by understanding them and your feelings, and trying to overcome them
- Barriers to communication: talking too fast, labeling others, and sensory impairment
- Good listening skills: showing interest, hearing the message, not interrupting
- In the Communication Model, the patient is usually the “Sender”
- Therapeutic Communication includes active listening, use of self, and no self-disclosure
Non-therapeutic Techniques
- Agreeing or Disagreeing: indicates accord with the patient or opposes their idea
- Requesting an Explanation: implies the patient must defend themselves
- Why: demands a response and requires justification
Empathy
- Relating to the way a person feels (my husband has cancer, your husband died of cancer 2 years ago)
Problem Solving/Critical Thinking/Maslow’s
- Problem Solving: critical for life-saving decisions
- Problem Solving Method:
- Identify the Problem
- Gather Data
- Form a Strategy
- Implement your Plan
- Evaluate the Results: adjustments you could make to improve the plan
- Maslow’s Hierarchy (highest to lowest):
- Self Actualization
- Self Esteem (recognition of achievements, assigned important tasks)
- Social (love, belonging, friendship ...NOT JUSTICE)
- Safety (financial reserves)
- Physiological (food, water, shelter)
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