Def'n of Pulse
Heart beat
Def'n of Respiration
Inhaling and outhaling. Each in and out is 1
Vital signs are taken with the person in what position?
Sitting up or Laying down
How long is a temperature taken when using a glass thermometer?
2-3 mins
What is the value of each short line between full degrees for a fahrenheit temperature on a glass thermometer.
.2
What do we use to rinse a glass thermometer?
cold water
When measuring temperature for a person experiencing diarrhea, which route cannot be used?
Rectal
Your person has heart disease. When measuring temperature, which route cannot be used?
Rectal
How long do we wait to take an oral temperature after a person has smoked a cigarette?
15-20 minutes
What position do you assist someone to when taking a rectal temperature?
Sims
Where do we assess the apical pulse?
Below the left nipple
What is the current dias
Stethoscoop
Normal Pulse range for adults
60-100 bpm
For how long apical pulse?
1 min
What is the current diastolic B/P range?
60 mmhg/ 80 mmhg
What is the current diastolic B/B range?
90 mmhg/ 120 mmhg
The first sound we hear when taking the blood pressure is?
Systolic reading
What should you do when you cannot hear a person's blood pressure? You have already done troubleshooting.
Tell the nurse
Is the blood pressure cuff applied over clothing?
No
How many mmHg is the cuff inflated above where you last felt the radial pulse in the estimated B/P method?
30 mmHg up
Truth about pain
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Calculation for I & O
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What do you need to know from the nurse and the resident's care plan to check their height?
What scale to use
What is a ketone? When does it occur
-Monosaccharide made from ketone, -C=O in the middle
Define hematuria
presence of blood leaving
Process for specimen collection
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Sputum specimen collection
Performed in the early morning, before eating or drinking; patient produces a deep productive cough.
Midstream urine collection
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What is external rotation?
rotating away from the body
Define flexion
bending a joint
Define plantar flexion
movement that bends the foot downward at the ankle
Why does the physician order bedrest
To promote healing
What are the various possible bedrest orders?
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How do we prevent orthostatic hypotension?
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What time of day is it easier to collect a sputum specimen?
Morning
What are the signs of orthostatic hypotension?
Dizziness, light headedness, sports before your eyes
Which joints are protected from contratures by hand grips?
Fingers, thumbs, and wrists
Who does AAROM?
Resident with another individual
When is the only time we can do ROM to the neck?
If allowed by agency or nurse
What information do you need to know from the nurse and care plan when delegated the task of ROM?
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What ROM exercises can be done for the knee?
Flexion and extension
ROM exercises for the wrist
flexion, extension, hyper extension, radial flexion ulnar flexion
Flexion and extension for the toes
flexion- curl toes, extension-stretch toes
What action will or will not promote comfort while performing range of motion with your resident?
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Important elements of appropriate can usage
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Elements for the appropriate use of the wheeled walker
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Important elements of assisting a person with the use of a brace
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Purpose and benefits of recreational activities
Important for quality of life
Common causes of wounds
Surgery injuries, unrelieved pressure
An open wound on the legs or feet caused by decreased blood flow through veins or arteries is called?
Circulatory ulcer
When a person has an open wound on the lower leg and experiences poor blood return through the veins, this would called what?
Venous ulcer
What are measures to help prevent skin tears when the person in bed cannot reposition self?
Keep sheets are without wrinkles, reposition
circulatory ulcer
An open sore on the lower legs or feet caused by decreased blood flow through the arteries or veins; vascular ulcer
venous ulcers
Monitor observations, avoid tight clothing, etc
Your resident has an arterial ulcer. What are the care measure to promote healing
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An open wound on the foot caused by complications of diabetes is called?
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Facts about diabetes foot ulcers
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What is another name for elastic stockings?
Compressions
We generally apply elastic bandages where?
Arms and legs
How often must limb be checked for color and temperature when an elastic bandage has been applied to it?
Every 1 Hour
List the purposes of wound dressings.
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What can happen to the wound if the dressing is loose or comes off?
Microbes can enter the wound
What are important elements in removing dressings from a wound during a dressing change?
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If safety pins are used to secure a binder, in which direction should they point?
Away
What should you do if a binder is loose or out if position?
Replace it
What is cold application used for?
Causes vasoconstriction and used in instances of injury and the inflammatory response
What are heat applications used for?
Can be dry or moist
Usually requires physician's order
Heat applied to skin provides general comfort and speeds healing process
May be used to:
Relieve pain, reduce congestion, relieve muscle spasm
Reduce inflammation and swelling
Provide comfort, elevate
What happen to blood vessels when heat is applied too long?
They constrict
Considerations before applying moist or dry heat applications
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Why is the aquathermia pad never place under a body part
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