Nursing Research and Evidence-Based Practice

PPE for COVID-19

• Eye protection, gown, gloves, N95 respirator mask

Immediate Nursing Intervention for SOB

• Elevate head of bed and administer oxygen (2L nasal cannula)

Sleep Interference Factors

• Drinking alcohol and caffeine before bed
• Eating spicy foods before bed
• Loud music

Pain Medication Fall

• Wake the client and administer medication

Non-Pharmacological Pain Management

• Massage, distraction, guided imagery, hypnosis

Hygiene Care for Cardiac/Respiratory Issues

• Avoid showers or tub baths

Low Blood Pressure Symptoms

• Dizziness, lightheadedness, weakness

Oral Hygiene for Unconscious Patients

• Avoid pouring water into the mouth
• Use toothed sponges
• Turn patient onto their side

Total Care Definition

• When a patient cannot care for themselves, the nursing team provides all care.

Contractures Definition

• Permanent tightening of muscles, tendons, skin, and tissues causing joint stiffness. This is usually caused by injury, scarring, or nerve damage, or by not using the muscles regularly.

Orthostatic Hypotension Definition

• Low blood pressure that occurs when standing up from a sitting or lying position, because blood vessels do not constrict (tighten) properly when standing

Venous Thrombosis Interventions

• Not listed in the document

Atelectasis (and Prevention)

• Collapse of lung tissue, caused by prolonged immobility;
• Encourage movement, deep breaths, breathing exercises, incentive spirometer, change in body position (supine to upright)

Orthopneic (Tripod) Position

• Leaning forward and supporting the upper body with hands on knees or other surface;
• Used to relieve shortness of breath when lying down due to orthopnea (a type of dyspnea).

Medical Asepsis (Clean Technique)

• Practices to minimize microorganisms in environments and on objects;
• Hand hygiene, disinfection, personal protective equipment (PPE), proper waste disposal, and cleaning of the environment.

Blood Pressure Definition

• Pressure of blood against artery walls
• Blood pressure is not constant and fluctuates throughout the day.

Core vs. Tympanic Temperature

• Core temperature (Tc) reflects internal organ temperature;
• Tympanic temperature reflects heat from the tympanic membrane.

Pulse Oximetry

• Measures the amount of oxygen in blood (oxygen saturation).
• Quickly assesses lung function and oxygen delivery to extremities.

Capillary Refill

• Quick test to asses blood flow in extremities.

Respiratory Rate

• Number of breaths per minute.
• Respiration rate increases with fever, illness, and other conditions.

Stridor

• High-pitched, abnormal breathing sound due to narrowed airways;
• Heard when inhaling or exhaling and can be caused by obstructions.

Healthcare Associated Infections (HAI) Prevention

• Hand hygiene is the most effective way to prevent HAIs.

Fever Purpose/Benefit

• Part of the body's immune response to fight infections
• Makes it harder for bacteria and viruses to survive
• Activates the immune system to fight infection

Medical Asepsis Examples

• Hand hygiene
• Disinfection
• Personal Protective Equipment (PPE)
• Cleaning environments
• Proper waste disposal

Tuberculosis PPE

• Eye protection, gown, gloves, N95 respirator mask

Restraints Use Guidelines

• Restraints should be used as a last resort
• Safety of patient, staff, and others
• Should not be used for convenience or punishment
• Proper techniques

Fire Safety Protocol (RACE)

• Remove: Get people away from the fire
• Alarm: Notify others of the fire (“FIRE” or “CODE RED”)
• Confine: Close doors to contain the fire
• Evacuate/Extinguish: Leave the building following fire safety plan

Nursing Resources for Evidence-Based Research

• Systematic reviews
• Databases like Cochrane Library

Clinical Practice Guidelines

• Developed statements to help healthcare providers make decisions about clinical circumstances.

QI Process (Identifying Step)

• Identifying opportunities for change
• Defining objectives/requirements
• Gathering/sorting data
• Determining root causes
• Ideating/implementing solutions
• Continuously monitoring

LVN Supervision Requirements

• Practice under supervision of a physician, dentist, or registered nurse.

Bed Safety Interventions

• Lock bed wheels
• Keep bed in lowest position

Therapeutic Response Elements

• Supportive, nonjudgmental
• Acknowledge feelings
• Use open-ended questions

Chronic Pain Definition and Associated Conditions

• Long-lasting pain (3+ months), which can be from illness, injury, or other causes;
• Associated conditions include Arthritis, back pain, headaches, muscle strains/sprains, Fibromyalgia, nerve damage and broken bones.

Objective Pain Findings (Nonverbal/Physiological)

• Facial expressions (grimacing, frowning)
• Behavior (restlessness, agitation)
• Sounds (moaning, groaning)
• Physiological markers (changes in vital signs, skin conductance)

Eye Cleaning Infection Prevention

• Wash hands prior to cleaning eyes
• Use a separate part of the washcloth for each eye
• Wipe from inner to outer canthus

Pain Impact on Sleep

• Pain can interfere with getting adequate sleep.

Non-Pharmacological Sleep Interventions

• Massage, soft music/lower noise levels, reduce light, Back rub, milk, and regular exercise in the mornings.

Hygiene Purpose

• Prevents infection and skin breakdown;
• Promotes a sense of well-being.

Gingivitis Definition

• Earliest stage of gum disease
• Plaque build-up on teeth leads to infection.
• Red, swollen, bleeding gums.

Flossing Purpose

• Removes plaque and food particles from between teeth and along gum line; Prevents cavities and gum disease, halts plaque from hardening to tartar, and limits odor-causing bacteria buildup.

Patient Pain Assessment Difficulty in Children

• Difficulty describing pain
• Fear of needles/medications

Indirect Transmission of Microorganisms

• Microorganism spread without direct human-to-human contact (e.g., contaminated surfaces, vectors like insects).

Droplet Transmission

• Pathogens transported through droplets from coughing, sneezing, or talking
• Droplets enter mucous membranes of a host or settle on a surface.

Surgical Site Infection (SSI) Symptoms

• Pain/tenderness
• Redness
• Swelling
• Cloudy/pus-like drainage
• Fever
• Nausea/vomiting, Difficulty breathing and/or coughing.

Orthostatic Hypotension

• Drop in blood pressure due to standing;
• Dizziness, Lightheadedness, Blurry vision, Mental confusion, Nausea, Fainting

Pulse

• Series of pressure waves in arteries from left ventricle contractions.
• Measured in beats per minute (bpm).

Korotkoff Sounds

• Sounds heard during blood pressure measurement as the cuff deflates.
• Caused by blood vibrations in the artery wall when blocked.

Bradycardia

• Slow heart rate (less than 60 bpm);
• Fatigue, dizziness, lightheadedness, mental confusion, fainting, shortness of breath, chest pain, and disturbed sleep

Fever Symptoms

• Sweating
• Rapid heartbeat
• Chills
• Headache
• Muscle aches
• Loss of appetite

Eupnea

• Normal, unlabored breathing.

Joint Commission Patient Safety Goals

• Correct patient identification
• Improve staff communication
• Safe medication use
• Safe alarm use
• Prevent infection/surgical site infections
• Identify patient safety risks
• Improve health care equity
• Prevent mistakes in surgery

Chain of Infection

• Pathogen (disease causing organism)
• Reservoir (where organism lives and grows)
• Portal of exit (how organism leaves its host)
• Mode of transmission (how it moves from one host to another)
• Portal of entry (how it enters new host)
• Susceptible host (organism that could be infected)

Medical Asepsis (Clean Technique)

• Practices to minimize the spread of infection.

Standard Precautions

• Hand hygiene
• Respiratory hygiene precautions
• Personal Protective Equipment (PPE)
• Proper/safe waste disposal
• Environmental cleaning

Bed Positioning Interventions to Increase Safety

• Lock bed wheels;
• Keep beds at lowest position.

Nursing Interventions for Confused Patients

• Observe patients every hour; and monitor vital signs.
• Preventing falls (Low bed position with brakes; bed rails, remove items from patient's reach);
• Communicating gently; and limiting extraneous noises.
• Promote sleep hygiene and regular activity schedules.

Complications of Restraints

• Strangulation, ischemia, cardiac stress, immobility, muscle weakness, skin injury, infection, incontinence, dehydration;
• Psychological effects including anger, fear, and frustration.

Cheyne-Stokes Respirations

• Alternating periods of rapid and shallow breathing, with pauses between cycles.

Pressure Injury Prevention Interventions

• Assess risk;
• Use support surfaces (e.g., specialty beds, foam overlays, cushions); Turn/reposition patients regularly
• Maintain skin cleanliness and moisture;
• Provide adequate nutrition and fluids.

Cold Therapy Interventions

• Application of ice packs,
• Ice massage,
• Ice baths to reduce pain and slow blood flow.
• Monitor for shivering (and use assessment tools if needed) and for dehydration.

Non-Pharmacological Sleep Interventions

• Soft music, low noise.
• Reduce light.
• Massage.
• Warm milk/relaxing beverage.
• Regular morning exercise to promote sleep patterns.

Obstructive Sleep Apnea (OSA)

• Episodes of partial/complete upper airway collapse.
• Results in poor quality sleep as the person frequently wakes up (in short periods of time but repeats many times).

Body Temperature Regulation

• Hypothalamus in brain compares body temperature to 37°C (98.5°F) and initiates response to adjust accordingly.
• Afferent sensing (thermoreceptors) relay info from internal organs and skin.
• Efferent response regulates blood flow, sweating, and muscular activity to maintain normal temperature.
• If body temp is too low, blood flow decreases to extremities and muscles to heat-up the core.

Rapid Blood Loss Effects

• Hypovolemic shock
• Tissue ischemia (inadequate oxygen supply to tissues)
• Infarcts (tissue death in organs)
• Sympathetic Nervous System activation.

Back Injury Prevention for Nurses

• Lift with legs, not back;
• Bend at the knees;
• Use mechanical lifts/assistance;
• Adjust work environments;
• Maintaining strong core muscles;
• Getting ample sleep;
• Exercise regularly.

Patient Fall and Injury Prevention in Healthcare

• Use monitors for constant vigilance;
• Lock bed wheels;
• Remove excess items.
• Use bedside alert sensors;
• Communicate gently with patient and family
• Reduce noise and stimulation.