HESI Exam Study Guide PDF

**[HESI EXAM STUDY GUIDE ]** **[TRANSMISSION-BASED PRECAUTIONS (TIER TWO) FOR USE WITH SPECIFIC TYPES OF PATIENTS]** Category Disease Barrier Protection +-----------------------+-----------------------+-----------------------+ | Airborne Precautions | Measles, chickenpox | Private room;...

**[HESI EXAM STUDY GUIDE ]** **[TRANSMISSION-BASED PRECAUTIONS (TIER TWO) FOR USE WITH SPECIFIC TYPES OF PATIENTS]** Category Disease Barrier Protection +-----------------------+-----------------------+-----------------------+ | Airborne Precautions | Measles, chickenpox | Private room; | | (Droplets \5 μm; | adenovirus, group A | cohort patients; mask | | being within 3 feet | streptococcus, | or respirator (refer | | of the patient) | Neisseria | to agency policy) | | | meningitides, | | | | pertussis, | | | | rhinovirus, | | | | mycoplasma | | | | pneumoniae, | | | | pertussis, | | | | diphtheria, pneumonic | | | | plague, rubella, | | | | mumps, respiratory | | | | syncytial virus | | +-----------------------+-----------------------+-----------------------+ | Contact Precautions | Colonization or | Private room or | | (Direct patient or | infection with | cohort patients (see | | environmental | multidrug-resistant | agency policy); | | contact) | organisms, such as | gloves, gowns | | | VRE and MRSA, | | | | Clostridium | Protective | | | difficile, shigella | environment | | | and other enteric | Allogeneic | | | pathogens, major | hematopoietic stem | | | wound infections, | cell transplants | | | herpes simplex, | | | | scabies, varicella | Private room; | | | zoster | positive airflow with | | | (disseminated), | ≥12 air exchanges per | | | respiratory syncytial | hour; HEPA filtration | | | virus | for incoming air; | | | | mask, gloves, gowns | +-----------------------+-----------------------+-----------------------+ **[TRICKS TO REMEMBER]** **[ABC S&D---look at what the question is asking for in this order---pick the best answer based on the ABC S&D]** **Airway** **Breathing** **Circulation** **Safety** **Discomfort** **[ADPIE---Remember this order and answer the question based on the template below]** **Assess** **Diagnose** **Planning** **Implementation** **Evaluation** **[REMEMBER, SAFETY OF THE PATIENT IS ALWAYS IMPORTANT]** **[LAB VALUES]** Potassium---(Banana) 3.5 -- 5.0 Magnesium---(Mag Wheels) 1.3 -- 2.1 Calcium---(Boone) 9.0 -- 10.5 Chloride---(Pool temperature) 97 -- 107 Phosphate---(Fossil) 3.0 -- 4.5 Sodium---(Age decrease sodium intake) 135 -- 145 **[Electrolyte Imbalances]** Hypercalcemia---bone pain, muscle weakness, excessive thirst, lethargy, nausea Hypercalcemia---numbness, tingling in digits, muscle cramps, wheezing, fatigue Hyperkalemia---heart arrythmias, numbness and tingling, breathing problems Hypokalemia---Muscle weakness, fatigue, heart arrythmias Hypermagnesemia---diminished deep tendon reflexes, flushing, headache, nausea, drowsiness. Hypomagnesemia---muscle weakness, twitches, tremors, irritability, insomnia, drowsiness Hyperchloremia---diarrhea, vomiting Hypochloremia---diarrhea, vomiting Hyperphosphatemia---Osteoporosis, cardiovascular disease Hypophosphatemia\--changes in mental state, bone pain, fragility, fatigue, weight loss, weakness Hypernatremia---lethargy, myoclonic jerks, confusion, nystagmus, tachycardia Hyponatremia---nausea, vomiting, lethargy, seizure, neurological deficits **[24 hour urine sample]** In the morning, after waking up and emptying your bladder for the first time, urinate into the toilet and note the exact time. This is the start time of your collection.  Collect every drop of urine in a special container for the next 24 hours. This includes urine passed with a bowel movement, but try not to include feces.  On the second day, urinate into the container within 10 minutes before or after the same time as the first morning void on the first day.  Store the container in the refrigerator or a cool place. Label the container with your name, the date, and the time of completion.  Return the container to the lab as soon as possible.  A 24-hour urine test measures the amount of protein or other substances in your urine to check how well your kidneys are working. Your healthcare provider may give you instructions on how and where to take the sample. You should check with your clinician before starting the collection if you have any questions or if you are taking any medications.  **[When to use a facemask vs. respirator mask]** **N95 Respirators** An **N95 respirator** is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. Note that the edges of the respirator are designed to form a seal around the nose and mouth. Surgical N95 Respirators are commonly used in healthcare settings and are a subset of N95 Filtering Facepiece Respirators (FFRs), often referred to as N95s. **Face Masks** A face mask is a product that covers the wearer\'s nose and mouth. Face masks are for use as [source control](https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/face-masks-including-surgical-masks-and-respirators-covid-19#using) by the general public and health care personnel (HCP) in accordance with [CDC recommendations](https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html), and are not personal protective equipment. Face masks may or may not meet any fluid barrier or filtration efficiency levels; therefore, they are not a substitute for N95 respirators or other Filtering Facepiece Respirators (FFRs), which provide respiratory protection to the wearer, or for surgical masks, which provide fluid barrier protection to the wearer. **[Correct order of removing PPE]** The correct order for removing PPE after patient care **Gloves** **Gown** **Goggles** **Mask** Doff (off) the gloves FIRST, followed by the gown, then the face shield or goggles, and lastly, doff the mask or respirator. Types of Wound Drainage **Serous:** Clear, watery plasma wound drainage shows light colored circular spot. **Purulent:** Thick, yellow, green, tan, or brown wound drainage shows thick, yellow, green, tan, or brown stain. **Serosanguineous:** Pale, pink, watery; mixture of clear and red fluid wound drainage shows pale red and pink fluid completely staining the gauze. **Sanguineous**: Bright red; indicates active bleeding wound drainage shows bright red spot surrounded by light red stain. **[WOUND DRESSINGS]** Purposes of dressings. A dressing serves several purposes: Protects a wound from microorganism contamination Aids in hemostasis Promotes healing by maintaining wound moisture Promotes healing by absorbing drainage and debriding a wound Supports or splints a wound site Promotes thermal insulation of a wound surface Dressings by Pressure Injury Stage Pressure Injury Stage Pressure Injury Status Dressing Commentsa Expected Change Adjuvants 1 Intact None Transparent dressing Hydrocolloid Allows visual assessment. Protects from shear. Do not use transparent dressing in presence of excessive moisture. Hydrocolloid does not allow visual assessment. Resolves slowly without epidermal loss over 7--14 days Turning schedule. Support hydration. Nutritional support. Use pressure-redistribution bed or chair cushion. 2 Clean Composite film Hydrocolloid Hydrogel covered with foam or gauze dressing Limits shear. Change when seal of dressing breaks; maximal wear time 7 days. Provides moist environment. Heals through reepithelialization See previous stage. Manage incontinence. 3 Clean Hydrocolloid Hydrogel covered with foam dressing Change when seal of dressing breaks; maximum wear time 7 days. Apply over wound to protect and absorb moisture. Heals through granulation and reepithelialization See previous stages. Evaluate pressure-redistribution needs. Calcium alginate Use when there is significant exudate. Cover with secondary dressing. Gauze Use with normal saline or other prescribed solution. Wring out excess solution; unfold to make contact with wound. Cover with dry dressing tape in place. Growth factors Use with gauze per manufacturer instructions. 4 Clean Hydrogel covered with foam dressing See Stage 3: clean. Heals through granulation, scar tissue development, and reepithelialization Surgical consultation may be necessary for closure. See Stages 1, 2, and 3. Calcium alginate Used with significant exudate; must cover with secondary dressing. Gauze See Stage 3: clean. Unstageable Wound covered with eschar Adherent film Facilitates softening of eschar. Eschar lifts at edges as healing progresses See previous stages. Surgical consultation may be considered for debridement. Gauze plus ordered solution Delivers solution and may soften the eschar. May be considered for slow debridement. Enzymes Breaks down eschar, providing debridement. Eschar loosens over time None If eschar is dry and intact and debridement is not part of the plan of care, no dressing is used, allowing eschar to act as physiological cover. **[Dressings by Pressure Injury Stage]** Pressure Pressure Expected Injury Stage Injury Status. Dressing Comments. 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A patient entering into hospice care is in the terminal phase of illness, and the patient, family, and health care provider agree that no further treatment will reverse the disease process. Hospice care is provided in a setting that best meets the needs of each patient and family, such as in a patient's home or in nursing homes, assisted-living facilities, freestanding hospices, and hospitals. The focus of hospice care is supportive care, not curative treatment (see Chapter 36). Hospice benefits families and patients in the terminal phase of any disease, such as cardiomyopathy, multiple sclerosis, acquired immunodeficiency syndrome (AIDS), and cancer. Hospice team members are available 24 hours a day, 7 days a week to answer questions or visit anytime the need for support arises. Team members collaborate to provide care that ensures death with dignity. Services continue without interruption even if a patient's care setting changes.