ATI – Nutriton, Feeding and Eating – Flashcards
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Vesicle
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serous fluid-filed, <1 cm ex. Blister
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Pustule
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pus filled ex. Acne
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Wheal
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palpable, irregular borders, edematous ex. Insect bite
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Erosion
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lost epidermis, moist surface, and no bleeding ex. Ruptured vesicle
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Crust
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dried blood, serum, or pus ex. Scab
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Scale
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flakes of skin that exfoliates ex. Dandruff or psoriasis
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Fissure
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linear crack ex. Tinea pedis
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Ulcer
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loss of epidermis & dermis with possible bleeding & scaring ex. Venous statis ulcer or pressure ulcers
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Normal Range of Motion of Joint Movement
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Flexion- decrease the angle Extension- extension/increase the angle Hyperextension- extreme extension Supination- ventral surface is facing up Pronation- ventral surface is facing down Abduction- movement of an extremity away from midline Adduction- movement of an extremity toward midline Dorsiflexion- movement toward dorsum (or top of wrist or foot) Plantar flexion- movement toward plantar surface (or bottom of foot) Eversion- turning body part away from midline Inversion- turning body part toward midline
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a) Kyphosis b) Lordosis c) Scoliosis
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a) -exaggerated curvature of thoracic spine, common in older adults b) -exaggerated curvature of lumbar spine, common during toddler years & pregnancy c) -exaggerated lateral curvature
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Eye Drops
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-use medical aseptic technique when instilling medications in eyes -Have client sit upright or lie supine with head tilted slightly & looking up at ceiling -Rest the dominant hand on clients forehead, hold the dropper above conjunctiva sac about 1 to 2 cm, drop the medication into center of sac & have the client close her eye gently -Apply pressure with finger & clean tissue on nasolacrimal duct for 30 to 60 seconds to prevent systemic absorption of medication
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Ear Drops
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-use medical aseptic technique -Have client sit upright or maintain a side-lying position -Straighten ear canal by pulling auricle upward & outward for adults -*Children- down & back -Hold the dropper 1 cm above ear canal, install medication, & the gently apply pressure with finger to tragus of ear
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Nose Drops
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-use medical aseptic technique when administering medications into nose -Have client supine with head positioned to allow medication to enter appropriate nasal passage -Use dominant hand to instill drops, supporting head with non-dominant hand -Instruct client to breathe through mouth, stay in a supine position, & not to blow nose or 5 min after drop insertion**
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Inhalation- Administrated through metered dose inhalers MDI or dry powder inhalers DP
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MDI- remove cap from inhalers -Shake inhaler 5 or 6 times -Hold inhaler with mouthpiece at bottom -Hold inhaler with thumb near mouthpiece & index & middle fingers at top -Hold inhaler about 2 to 4 cm (1 to 2 in) away from front of mouth -Take deep breath & then exhale -Tilt head back slightly, press the inhaler, & at the same time, begin a slow, deep breath. Continue to breath slowly & deeply for 3 to 5 seconds to facilitate delivery to air passages -Hold breath for 10 seconds to allow medications to deposit for 10 seconds to allow medication to deposit in airways -Take inhaler out of mouth & slowly exhale through pursed lips -Resume normal breathing -A spacer may be used to keep medication in device longer therby increasing amount of medication delivered to lungs & decreasing amount of medication in oropharynx
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If a spacer is used:
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-Remove covers from mouthpiece of inhaler & spacer -Insert MDI into end of spacer -Shake inhalers 5 to 6 times -Exhale completely, & then close mouth around the spacer mouthpiece. Continue as with an MDI
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DPI- Dry Powder Inhaler
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-Do NOT shake device -Take cover off mouthpiece -Follow directions of manufacture for preparing medication, such as turning wheel of inhaler -Exhale completely -Place mouthpiece between lips & take deep breath through mouth -Hold breath for 5 to 10 seconds -Take inhaler out of mouth & slowly exhale through pursed lips -Resume normal breathing -If more than one puff is prescribed, instruct client to wait length of time directed BEFORE administering the 2nd puff -Instruct client to remove canister & rinse inhaler, cap, & spacer once a day with warm running water & dry it completely before using it again
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Nasogastric & gastrostomy tubes
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-Check for proper tube placement -Use syringe & allow medication to flow in by gravity or push it with plunger of syringe General Guidelines: -Liquid forms of medications MUST be used -Sublingual medications should NOT be given -Do NOT crush specially prepare oral medications (extended/time-release, fluid-filled, enteric-coated) -Check compatibility of medications before mixing them -Do NOT mix medications with enteral feedings!!***
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Nasogastric & gastrostomy tubes.... prevent clogging:
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flush tubing before AND after each medication with 15 to 30 mL of water. When administration is complete, flush with 30 to 60 mL of warm water
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Rectal Suppositories
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-Position client in left lateral position** -Insert suppository just beyond internal sphincter -Instruct client to retain medication 20 to 30 min for stimulation of defecation and 60 min for systemic absorption
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Vaginal Suppositories
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-Position client supine with knees bent, her feet flat on bed & close to her hips (modified lithotomy position) -Vaginal suppositories are generally inserted with an applicator -Instruct client to remain in position for the prescribed amount of time
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Parenteral
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-Vastus lateralis site is usually recommended site for infants & children under 2 years of age -After age 2, ventral gluteal site can be used. Both of these sites can accommodate fluid up tot 2 mL. The deltoid site has a smaller muscle mass and only can accommodate up to 1 mL of fluid -Use a needle size & length appropriate for type of injection & clients size. Syringe size should approximate volume of medication.*** -Use a tuberculin syringe for solution volumes <0.5 mL -Rotate injection sites to enhance medication absorption, & document each site used -Do NOT use injection sites that are edematous, inflamed or have moles, birthmarks, or scars -If medication is given intravenously, immediately monitor client for therapeutic side/adverse effects -Discard all sharps (broken ampule bottles, needle) in designated containers. Containers should be leak-and puncture proof)
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Intradermal
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-Used for tuberculin testing or checking for medication/allergy sensitivities -May be used for some cancer immunotherapy -Use small amounts of solution (0.01 to 0.1 mL) in a tuberculin syringe with a fine-gauge needle (26 to 27) in lightly pigmented, thin-skinned, hairless sites (inner surface of mid-forearm or scapular area of back) at a 10 to 15 degree angle
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Subcutaneous
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-Appropriate for small doses of nonirritating, water-soluble medications. Used for insulin & heparin -Use a 3/8 to 5/8 in, 25 to 27-gauge needle or an insulin syringe of 28 to 31 gauge. Inject no more than 1.5 mL solution. For an average size client, pinch up skin & inject at a 45 to 90 degree angle. For an obese client, use a 90-degree angle. -Sites are selected for adequate fat-pad size (abdomen, upper hips, lateral upper arms, thighs)
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Intramuscular
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-Appropriate for irritating medications, solutions in oils, & aqueous suspensions -Most common sites include ventrogluteal, dorsogluteal, deltoid, & vastus lateralis (pediatric) -Use a needle size 18 to 27 (usually 22 to 25 gauge) -1 to 1.5 long, & inject at a 90-degree angle. Volume injected is usually 1 to 3 mL. If a greater amount is required, it should be divided into 2 syringes & 2 different sites should be used
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Z-Track
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-Type of IM injection that prevents medication from leaking back into subcutaneous tissue -It is often used for medications that cause visible and/or permanent skin stains such as certain iron preparations
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Intravenous
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-Appropriate for administration of medications, fluid, & blood products -Vascular access devices can be for short-term use (catheters) or long-term use (infusion ports). Use 16 gauge for trauma clients, 18 gauge for surgical clients, & 22 to 24 gauge for children, older adults, medical clients, and stable postoperative clients -Preffered sites are peripheral veins in arm or hand. Ask client which site he prefers. In neonates, veins of head, lower legs, & feet may be used. After administration, immediately monitor for therapeutic, side/adverse effects
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Epidural
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-Administration of intravenous opioid analgesia (morphine Duramorph or fentanyl Sublimaze) -Catheter is advanced through needle that is inserted into epidural space at level of 4th or 5th vertebrae -Infusion pumps are necessary to administer medication
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Nomenclature: Chemical name- Generic name- Trade name- Prescription medications - Uncontrolled substances- Controlled substances-
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- medication is named by its chemical composition - official or non-proprietary name given by US Adopted Names Council. Each medication has only one generic name - brand or proprietary name given by company that manufacturer the medication. One medication may have multiple trade names - are administered under supervision of providers. These medications may have a habit-forming, have potential harmful effects, and/or require supervision - requires monitoring by provider, but do not pose a risk of abuse and/or addiction. Antibiotics are an example of uncontrolled prescription medications - has potential for abuse & dependence are categorized into schedules. Heroin is medication in Schedule I & has no medical use in US.
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Nurse in ER dept is caring for a patient who has a knee injury. The patient will be discharged & ill be using a pair of axillary crutches for the first time. Which of the following instructions should nurse include when discharging this patient?
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-Hold crutches on the unaffected side when preparing to sit down
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A nurse ambulates an unsteady patient, the patient becomes light headed & begins to fall. Which of the following interventions by nurse is appropriate in this situation? -Wrap both arms around patient's arms & shoulders -Move both feet together when patient begins to fall -Protect patient's extremities while lowering him to the floor -(Correct) Extend one leg & allow the patient to slide down it
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-(Correct) Extend one leg & allow the patient to slide down it
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A nurse stands facing patient to demonstrate active- range of motion exercises. Which of the following should the nurse do when demonstrating hyperextension of hip? -Move the leg behind the body -Move the leg forward & up -Move the leg medially toward the other leg -Turn the foot & leg away from the other leg
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-Move the leg behind the body (correct); this movement demonstrates hypertension of hip -Move the leg forward & up (demonstrates flexion of hip) -Move the leg medially toward the other leg (demonstrates adduction of the hip) -Turn the foot & leg away from the other leg (external rotation of the hip)
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A nurse is observing AP who is using a mechanical lift with a hammock sling to transfer a patient from the bed to a chair. The nurse should intervene if AP: -Places sling under patient from shoulders to knees -Leaves bed in lowest position throughout the procedure -Locks hydraulic valve before attaching the sling to the lift -Raises head of bed to sitting position just before the transfer
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-Leaves bed in lowest position throughout the procedure; bed should be raised to it's highest position in order to prevent injury to prevent injury to nursing staff & to properly position the under the patients bed
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Nurse is caring for a hospitalized patient who is performing active range of motion exercises. Which of the following body movements should indicate to nurse the patient has full range of motion of the shoulder? -Adducting the arm so that it lies next to patient's side -Flexing the shoulder by raising the arm from a side position to a 180 degree angle -Abducting the arm to a 90 angle from side of body -Circumducting the shoulder in a 180 half circle
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-(correct)Flexing the shoulder by raising the arm from side position to a 180 degree angle. This demonstrates full range of motion of the shoulder. The patients fingers would be pointing directly upward -Circumducting the shoulder in a 180 half circle; the patient should be able to circumduct shoulder in full 360 circle -Abducting the arm to a 90 angle from side of body; patient should be able to abduct arm to 180 angle from body --Adducting the arm so that it lies next to patient's side; full range of motion includes being able to adduct the arm all the way across the body to midline
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A nurse is about to transfer to a chair a patient who has a weak left leg. Which of the following actions by nurse demonstrates correct transfer technique? a) Positioning chair slighly behind the nurse so that the seat faces the patient's bed b) Placing the patient's left leg in front of her right leg just prior to transfer c) Aligning nurse's knees with patient's knees just before the transfer d) Grasping the patient under the axilla to assist her to her feet
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a) Positioning chair slighly behind the nurse so that the seat faces the patient's bed. (Chair should be placed at a 45 degree angle to the bed so that patient can safely & easily be pivoted to it) b) Placing the patient's left leg in front of her right leg just prior to transfer. (Stronger right leg should be placed forward so that patient can put majority of her weight on it) c) (Correct)Aligning nurse's knees with patient's knees just before the transfer. This strategy helps nurse safely stabilize patient while moving to a standing position d) Grasping the patient under the axilla to assist her to her feet. (Nurse should place transfer belt around the patient & should avoid holding her directly under axilla)
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Nurse is performing a physical assessment on a paptient & instructs the patient to stand with her feet together and arms at his sides. The purpose of positioning the patient in this manner is to test which of the following? a) Balance b) Muscle Strenght c) Reflexes d) Coordination
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a) Balance (correct); This maneuver, the Romberg test, assesses balance. The nurse watches for swaying & stands near the patient to protect him for falling b) Muscle strength is tested by having patient resist as nurse attempts to move certain muscle groups c) Reflexes- tested by tapping tendons with a reflex hammer & obeserving the response. The patient should be seated during this procedure d) Coordination- is tested by observing patient perform rhythmic movements of extremeites, such as tapping the foot against nurse's hand
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Nurse is providing teaching to a patient who is receiving intermittent nasogastric feedings. Which of the following should nurse instruct patient to report immediately? a) Feeling of fullness b) Persistent coughing c) Discomfort in naris d) Postfeeding belching
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b) (Correct) Persistent coughing. This could indicate that the distal end of nasogastric tube has moved into respiratory tract. Immediate assessment is needed b/c the patient might be at risk for aspiration. a) Feeling of Fullness- normal finding after intermittent feedings. It is not likely to cause for concern unless the feeling persists or triggers vomiting or if gastric residuals exceed 100 mL c) Friction from presence of tube can be uncomfortable & indicate a need for ongoing assessment; however this does not need to be reported immediately d) This may be normal finding depending on the composition of the formula & patient's usual response to nutrients
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Which of the follwoing formulas is approprat to administorer to a patient who has a dysfunctional gastrointestinal tract? a) Modular b) Elemental c) Polymeric d) Specialty
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b) (correct) Elemental; contain predigested nutrients that are easy for a partially functional gastrointestinal tract to absorb a) Modular formulas are single nutrient formulas & require a functional GI that can absorb whole nutrients c) Polymeric formulas are a whole nutrient formulas & require a functioning GI d) Specialty formulas meet specific needs of patients who have particular disorder (HIV, liver failure), and they are not necessarily formulated for a patient with non functioning GI
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What is the most reliable method for verifying initial placement of a small bore feeding tube is by: a) measuring the pH of gastric aspirate b) auscultating the epigastric area while injecting air c) obtaining an abdominal x-ray d) placing the open end of tube in a cup of water
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c) correct; This is MOST reliable method for verifying initial placement of a small bore feeding tube
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To prevent aspiration during the administration of an enteral tube feeding, nurse should a) flush feeding with 30 mL of water b) add blue food coloring to the enteral formula c) Ensure formula is at room temperature d) place patient in Fowler's position
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d) (correct) Fowlers position is recommended during tube feeding to reduce risk of regurgitation, which can lead to aspiration. If Fowler's is uncomfortable for the patient, an acceptable alternative is elevating head of bed at least 30 degrees a) Flushing tube with water before & after tube feeding helps ensure tube is patent (open) & clear of any formula that could obstruct tube. This is NOT done to prevent aspiration prior to feeding. b) No longer considered safe practice. Stained airway secretions c) Done primarily to prevent stomach cramps
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A patient with gastric ileus postoperative requires nutritional support for approx. 2 weeks. Which of the following types of feeding tube is appropriate for this patient? a) Nasogastric tube b) Nasointestinal tube c) Percutaneous endoscopic gastrostomy tube d) Percutaneous endoscopic jejunostomy tube
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b) (correct) Nasointestinal tube allows post pyloric feeding by depositing enteral formula directly into intestines. This is an appropriate choice for a patient who lacks stomach motility (gastric ileus) & requires short term. (less than 4 weeks) enteral feedings a) Lack of motility in the stomach (gastric ileus) would prevent digestion of enteral formula placed in the stomach c) Lack of motility in the stomach (gastric ileus) would prevent digestion of enteral formula placed in the stomach d) Placing enteral formula into jejunum rather than stomach is approp. for patient who lacks stomach motility (gastric ileus). However, a percutanous tube is indicated for patients who require enteral feedings for more than 4 weeks
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Nasogastric tube feedings are an appropriate choice for a patient who.... a) has a paralytic ileus b) has recently experienced facial trauma c) is postoperative following laryngectomy d) has pancreatitis
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c) correct; Immediately following removal of larynx, patients typically receive IV fluids or parenteral nutrition until GI recovers from anesthesia. Then, a nasogastric tube is inserted & left for about 7 to 10 days to provide enteral feedings until swallowing is safe & adequate a) Patient with paralytic ileus has absence of gastrointestinal motility. Therefore, this is not an appropriate choice for this patient. b) Due to high risk of improper tube placement, patients with recent facial or nasal trauma should not have a nasoenteric tube placed. These patients are better candidates for surgical placement of a gastric or jejunal tube d) Pancreatitis is an inflammation of the pancreas; therefore, food & fluids are withheld to allow pancreas to rest & reduce pancreatic secretion
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To determine how much the length of the nasoenteric tube to insert, nurse should measure the distance from the tip of the patient's nose to earlobe & from the earlobe to the a) umbilicus b) xiphoid process c) manimbrium plus 10 to 20 cm more d) xiphoid process plus 20 to 30 cm more
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d) correct; Measuring from tip of nose to earlobe to xiphoid process approximates the distance from the nose to the stomach for 98% of patients. For duodenal or jejunal placement, an additional 20 to 30 cm is required
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A nurse inserting a nasogastric tube asks patient to flex her head toward her chest after tube passes through the nasopharynx. This action facilitiates proper insertion of the tube by: a) Closing off the glottis b) Preventing curling of the tube in the mouth c) Allowing patient to breathe through her mouth d) Opening lower esophageal sphincter
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a) correct; prohibits the tube from entering the trachea
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An older adult patient in long term care facility is receiving intermittent enteral feedings in his room. His affect is flat, & the nurse suspects that he is feeling isolated. Which of the following interventions is appropriate for this patient? a) Encourage him to go to dining room at meal times to talk with other patients b) Suggest that he watch television while his feedings are being administered c) Remind him that he can have visitors after his feeding administration times d) Ask facility chaplain to speak with patient
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a) correct; By encouraging resident to maintain a normal schedule & social interactions, nurse is helping to rebuild his social network & reverse patterns of isolation
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To prevent a common complication of continuous enteral feedings, nurse should: a) limit time formula hangs to 4 hours b) chill formula prior to administration c) deliver formula at a brisk rate d) allow feeding bad to empty before refilling it
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a) correct; Formula that hangs longer than 4 to 8 hours is at risk for bacterial contamination, typically manifested by patient as diarrhea b) It is recommended that enteral formula be warmed to room temperature. Cold formula can cause abdominal cramping c) Administering enteral feeding too fast (generally, more than 200 to 300 mL over 10 to 20 min) can cause abdominal cramping, nausea, & vomiting. A lower rate of delivery improves tolerance. d) This can result in an excessive infusion of air, which could cause vomiting.
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Ambulation- Crutches: 4 Point Gait
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-Partial weight bearing on both legs -Move right crutch forward (6 to 10 inches), left foot forward, & even with left crutch; then move left foot forward &, move right foot, and even with the right crutch
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Crutch Stance
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6 inches to side of foot & 6 inches in front of her foot; helps maintain balance & wider base of support
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Ambulation- Crutches: 3 Point Gait
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-Prescribed for patients who cannot bare weight on one leg -Move both crutches forward with weight on unaffected leg -***Move unaffected leg forward shifting weight onto the crutches, move both crutches forward, repeat the sequence
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Ambulation- Crutches: 2 Point Gait
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-Prescribed for patients bearing partial weight on both legs & require less support -Move left foot & right crutch forward, move the right foot & left crutch forward; repeat the sequence
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Ambulation- Crutches: Swing to Gait
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-Used on patients who can bare weight on both legs -Maintains stability & requires arm strength -Move BOTH crutches forward, lift BOTH feet & swing forward, place feet next to the crutches; repeat the sequence
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Ambulation- Crutches: Swing through Gait
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-Used on patients who can bare weight on both legs & those who can have both good arm & shoulder strength -Move BOTH crutches forward, lift both feet & swing forward, place feet in FRONT of the crutches; repeat the sequence
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Sitting Down With Crutches
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-Grasp both crutches in one hand, and place other hand on side rail of bed
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Ambulation-Cane
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-Grasp cane on UNAFFECTED side & place other hand on side rail of bed and push up to raise & stand up -Move cane 6 to 12 inches in front of foot -Move AFFECTED leg forward so that it is even with the cane, move UNAFFECTED leg forward & ahead of the cane -Bring cane forward then bring affected leg forward that that it is even with cane -Walk towards patient's unaffected side
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Taking Aspiration Precautions
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Check for swallowing: -Tuck chin at 45 degree angle, have patient swallow twice -Thickened foods work best and NOT liquid foods -Direct food onto unaffected side of patient's mouth -Have patient remain in upright or high-Fowler's position for 30 to 60 min after meal
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Ambulation- Walker
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Belt Restraint
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-At waist level & NOT over chest or abdomen -Ask patient to take deep breath to make sure there is no restriction to his breathing
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Extremity Restraint
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-Foam padding that is applied to wrist or ankle -Wrap around limb with soft part facing skin; use Velcro strap to support device -Make sure you can sleep 2 fingers between restraint and patient's wrist/ankle -Secure to stationary part of bed
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Mitten Restraint
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-Foamless mitten used to restrain the hands -Wrap straps around the wrist and NOT forearm -Make sure 2 fingers slide easily and beneath it
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Elbow Restraint
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-Rigid, padded, fabric splint -Minimizes movement of elbow joint -Helps with patients who pick on IV lines
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A nurse should recognize that which of the following is correct regarding albumin level as a diagnostic marker for nutritional status? a) Albumin level is poor short term indicator of protein status b) Hydration status does not affect patient's albumin level c) An albumin level of 3.2g/dL is within normal reference range d) Albumin level is calculated by keeping a 24 hr record of protein intake
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a) correct; Albumin is NOT sensitive to acute changes in nutritional status. Its long half-life (21 days) makes it a better indicator of chronic illness states than of current protein status at a given point in time b) Hydration does affect albumin level, as do other factors like hemorrhage, wound drainage, age, stress, & surg c) Normal albumin levels range from 3.5 to 5.4g/dL. A level of 3.2g/dL reflects mild protein malnutrition d) Albumin level is determined by a blood test
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A patient has just finished a 16-oz container of OJ. The I sheet documents fluid in mL. Which of the following should nurse document as intake?
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1 oz= 30 mL 16 X 30= 480 mL
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Which of the following dieatry modifications should an adolescent engaging in sports implement? a) Increase fats 30 to 40% of daily kilocalories b) Drink water before & after sports activities c) Keep protein intake at same level d) Decrease carbs to 30 to 40% of daily kilocalories
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a) Fats are NOT increased for adolescents engaging in sports b) correct; an adolescent SHOULD drink water before & after sports activities to prevent dehydration c) Protein should be INCREASED to 1 to 1.5g/kg/day d) The acceptable macronutrient range for carbs is 45 to 65% of total calories
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Which of the following is primary purpose for asking a patient to keep a 3-to-7 day food diary? a) To allow patient to rely on health professionals to identify problem areas b) To determine any changes in patient's appetite c) To evaluate any significant changes in body weight d) To assess the pattern of intake & compare with daily reference intakes
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a) The patient SHOULD be involved in identifying problems areas b) A time period of 3 to 7 days may not be an adequate length of time of assessing appetite changes c) Weight changes may not be reflected accurately in 3 to 7 days d) correct; A time period of 3 to 7 days is an adequate amount of time for assessing dietary habits & patterns & thus the adequacy of the patient's nutritional intake
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When teaching parents of a toddler about feeding & eating, the nurse should include which of the following SAFETY measures? a) Do NOT give child peanut butter b) Have child drink 28 to 32 oz of milk daily c) Give child 8 to 12 oz of fruit juice daily d) Do NOT offer child raw vegetables
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a) This is recommendation for infancy, bc peanuts & peanut butter carry high risk of severe allegic reactions. Once it has been determined that child does not have multiplce food allergies, peanut butter is an attractive source of protein for children b) More than 24 oz of milk daily in lieu of other foods may result in iron deficiency anemia c) Juice should be limited to 4 TO 6 oz per day because it is HIGH in sugar content d) correct: Raw veggies, as well as hot dogs, grapes, nuts, popcorn, & hard candy, have been implicated in chocking deaths & should be avoided at least until child is 3 years old
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Which of the following are an appropriate choices for a patient prescribed a FULL LIQUID diet? (Smooth-textured dairy products) Select all that apply a) Plain yogurt b) Custard c) Pureed veggies d) Mashed potatoes e) Pureed meat f) Gelatin
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-Plain yogurt, custard, pureed vegetables, refined cooked cereals & gelatin & ALL elements of CLEAR liquid diet such as coffee, carbonated beverages, etc
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To assess a patient for adequate swallowing, the nurse should do which of the following? a) Place fingers on patient's throat at level of larynx & ask him to swallow b) Place the tip of tongue depressor on patient's posterior tongue c) With penlight, inspect patient's uvula & soft palate d) Ask patient to raise his tongue upward & move it from side to side
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a) correct; Nurse should be able to palpate the movement of pharynx b) Tongue depressor on posterior tongue is likely to elicit gag reflex. Testing gag reflex helps confirm the function of cranial nerve IX, the glossopharyngeal nerve, but does NOT demonstrate the act of swallowing c) Examining these structures would NOT give nurse any helpful info about patient's ability to swallow without difficulty d) This activity tests the function of cranial nerve XII, the hypoglossal nerve, but it does NOT demonstrate the act of swallowing
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A nurse is performing a nutritional assessment. When obtaining & interpreting anthropometric values, the nurse should recognize which of the following? a) Isolated measurement of height & weight are greater significance than changes over time b) A weight increase of 4 lb in a patient with renal failure indicates retention of 1000 mL of fluid c) The patient should be weighed on same scale at same time each day d) The ratio of height to wrist circumference is most accurate way to identify obesity
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a) Changes in values for an individual over time are of greater significance than isolated measurements bc they show trends that provide info about patient's health status b) A 2 lb weight increase reflects retention of 1000 mL of fluid c) correct; Weighing pt on same scale at same time of day provides MOST CONSISTENT DATA for gauging trends in patient's weight, as shifts in fluid I can alter weight significantly. The patient should also be weighed with same amount of clothing and/or lines each time d) Obesity is identified by multiple factors, particularly body mass index. Height to wrist circumference as an indicator of body frame size
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Which of the following interventions should nurse use at mealtime for patient who has visual deficit? a) Identify food location as though the plate were a clock b) Direct the order in which food items are consumed c) Have patient tilt her head forward while eating d) Avoid talking to patient during mealtime
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a) correct; Telling patient, for example, that chick is at 9 o'clock & broccoli is at 12 o'clock helps orient her to items on the plate & thus facilitates independence in eating b) The PATIENT should direct order of food as well as the speed at which to eat it. Visual deficits should not affect these personal choices c) This intervention is recommended to facilitate swallowing in patient's who have dysphagia, not visual impairment d) Mealtime is social activity. The nurse should converse with patient or invite visitors to join patient for meals
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Nurse is caring for a patient who has impaired swallowing due to cerebrovascular accident. Which of the following interventions should nurse use to assist patient with feeding? a) Provide the patient with a straw b) Offer patient thin fluids c) Elevate the head of bed 45 to 90 degrees d) Place food in the weaker side of mouth
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a) Patients with dysphagia CANNOT always control amount of fluid they take in through straw. Thus, it can increase risk for aspiration b) Thicker fluids are usually easier to swallow than thin fluids c) correct; Patient's head should be sufficiently elevated to prevent aspiration d) For patients who have unilateral weakness, it is best to place food in STRONGER side of mouth
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Which of the following strategies for enhancing the intake of healthful foods is appropriate for an adolescent? a) Encouraging to consume snack foods from grain food group b) Permitting the adolescent to skip breakfast to enhance appetite at later meals c) Making healthful food choices more convenient & available for adolescent d) Allowing the adolescent complete autonomy in making food choices
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a) The dairy, fruits, & vegetables food groups are best choices for snack food for adolescents b) Skipping meals is NOT healthy alternative bc it increases risk of hypoglycemia, which in turn can lead to increased hunger & overeating c) correct; This helps prompt the adolescent to make healthier food choices d) Peer influence could lead adolescent to consume too much fast food & unhealthful snacks. Parents can have a positive influence on an adolescent's diet by using strategies such as restricting amount of unhealthful food choices in the home
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A nurse is caring for a patient who has sustained a head injury & whose level of consciousness fluctuates. The provider prescribes a full liquid diet progressing to a pureed diet as tolerated. Before initiating feedings, it is essential that this patient undergo which of the following? a) Chest X-ray b) Swallowing examination c) Nasogastric tube insertion d) Olfactory nerve evaluation
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a) Unless the patient has had any trauma in chest area, this is NOT mandatory & is unlikely to provide any data confirming or refuting his ability to ingest food safely by mouth b) correct; Patients at high risk for aspiration includes those with decreased level of consciousness. This patient has some periods of decreased alertness, thus a swallowing examination is essential to determine his ability to ingest food safely by mouth c) Unless it has been determined that this patient cannot ingest food safely by mouth, this intervention is unlikely to be prescribed d) Testing cranial nerve I, the olfactory nerve, determines the acuity of patient's sense of smell. Although this sense can be associated with patient's enjoyment of food, testing of this sense would NOT provide any data confirming or refuting his ability to ingest food safely by mouth
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Nursing Interventions: Care of the Body
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-Maintaining privacy -Shaving facial hair if applicable and/or desired by family -Removing all tubes & soiled linens (unless organ are to be donated or this is a medical examiner's case) -Removing all personal belongings to be given to family -Cleansing & aligning body with a pillow under head, arms outside the sheet & blanket, dentures in place, & eyes closed -Applying fresh linens & a gown -Brushing/combing client's hair, replacing any hairpieces -Removing excess equipment & linens from room -Dimming lights & minimizing noise to provide calm environment
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Enemas
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Soapsuds- pure castile soap in tap water or normal saline; acts as an irritant to promote bowel peristalsis *Normal Saline- safest due to equal osmotic pressure; volume stimulates peristalsis *Low Volume Hypertonic- good for clients who cannot tolerate high-volume enemas; Fleet* a commercially prepared hypertonic enema *Oil Retention- lubricates rectum & colon for easier passage of stool *Medicated Enemas- contains medications to be retained
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Enema Procedure
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Perform hand hygiene, prepare enema solution, pour solution into enema bag, allowing it to fill tubing, & then close clamp -explain procedure to client; provide privacy; provide quick access to a commode or bedpan; -place absorbent pads under client to protect bed linens; -position client on left side with right leg flexed forward*; -put on gloves; -lubricate rectal tube or nozzle; slowly insert rectal tube 3 to 4 inches* -for child insert tube 2 to 3 inches; with bag level with clients hip* -open clamp; raise bag 30 to 45 cm above anus, depending on level of cleansing desired; -*slow flow of solution if client reports cramping, or if fluid intake leaks around tube at anus; -if using pre-packed solution, insert lubricated tip into rectum & squeeze container until solution is administered -Ask client to retain solution for prescribed amount of time, or until the client no longer able to retain it; -discard enema bags & tubing; -assist client to appropriate position to defecate*; -remove gloves; perform hand hygiene; -for client who have little or no sphincter control, administer enema on a bedpan*; -document results & clients' tolerance of procedure
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*Ostomy Care
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-in an enterostomal therapist (RN) is not available, EDUCATE client about stoma care.* -Hand hygiene; gloves; REMOVE pouch form stoma.* -Inspect stoma. It should appear MOIST, SHINY & PINK. The peristomal area should be INTACT, & skin should appear healthy. -Use mild SOAP & H20 to cleanse the skin, and then dry it gently & complete. Apply PASTE if used. *Measure & draw where to cut skin barrier, allowing only stoma to appear through opening.* -Cut opening in skin barrier; if necessary, apply barrier pastes to creases, apply skin barrier & pouch, fold bottom of pouch & place closure clam on pouch. -Dispose of used pouch. Remove the gloves & perform hand hygiene
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Urinary Diversions: -Urinary Diversion -Ureterostomy -Nephrostomy
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Urinary Diversions- temporary, permanent, a stoma (hole, opening) for drainage of urine; May be created for clients with cancer or injury to bladder Ureterostomy- one or both ureters to abdominal surface Nephrostomy- tube from renal pelvis to abdominal surface Pouched systems for urine diversions are similar those for bowel diversions with similar body image concerns
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Diet:
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-An increase in sodium leads to decreased urinations* -Caffeine & alcohol intake lead to increase urination* - they are diuretics which causes you to expel more urine than amount of water contained in drink and dehydrates you as a result
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Clean-catch midstream CCMS for culture & sensitivity C
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urine sample is "caught" midstream after thorough cleansing of urethral meatus, client voids some urine into a commode, bedpan, or urinal; stops; then; urinates into a sterile cup; Client needs to understand not to place fingers in cup & NOT to touch the lid!*
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Urinalysis
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random non-sterile specimen; explain procedure, ask client to urinate, put on gloves, pour urine into specimen container, label container with client's identifying info, remove gloves, hand hygiene, transport or send specimen to lab
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Catheter Urine Specimen for C&S
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requires sterile specimen form a straight or indwelling catheter obtained using surgical asepsis (sterile technique); drain catheter's tubing of urine; clamp catheter's tubing below the port for 20 min; use surgical asepsis with withdrawing the required amount form port with a syringe; unclamp catheter
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Time Urine Specimens
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usually collected for 24 hours but can be ordered for varying times; discard first voiding*; collect all other voiding's in a container placed on ice*; If client urinated & discards urine, timing of specimen must begin again with next voiding*
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Straight or Indwelling Catheter Insertion
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-Correct size & type of catheter: usually 8 to 10 Fr for children, 14 to 16 Fr for women, & 16 to 18 Fr for men (Use silicon or Teflon products for clients who have latex allergies) -Catheterization kit- with sterile drainage bag for indwelling catheter insertion -Soap & water -Collection container for straight catheterization
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Straight or Indwelling Catheter Insertion: Procedure
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Explain the procedure to client, perform hand hygiene, establish location in room to set up sterile field, provider privacy, lower side rail, raise bed to comfortable height, & establish a good light source for perineal area, position client *Female- supine with knees bent & apart *Male- supine with thighs abducted slightly -Put on gloves & wash perineal area, remove gloves, open sterile package, put on sterile gloves, put antiseptic solution on cotton balls -If manufacturers recommends it for particular indwelling catheter, inflate the balloon with prefilled syringe provided to check its performance & integrity, then deflate it -Lubricate lower portion of catheter -Apply sterile drape, exposing urinary meatus
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*Cleanse Meatus
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*Female- spread labia with non-dominant hand while wiping front-to-back with antiseptic cotton balls held in forceps. The hands on labia is now contaminated & holds this position for rest of the procedure *Male- hold penis with non-dominant hand & wipe in a circular motion starting at the meatus & working down the glans. Repeat 3 more times with clean cotton balls -Insert catheter into meatus using sterile hand! -Advance catheter until urine returns & then continue to advance it another 2.5 to 5 cm** -Release labia/penis & stabilize catheter with non-dominant hand -If using an indwelling catheter, slowly inflate the balloon, release the hand, & pull back gently!!** -Secure catheter to clients leg; place drainage bag below level of client's bladder -If straight catheterization, remove catheter after flow of urine has ceased*** -Dispose of drapes, equipment, & gloves -Replace side rail & lower the bed -Perform hand hygiene
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Closed Intermittent Irrigation
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-Prepare sterile syringe with irrigant. -Clamp catheter between injection port & extension tubing. -Cleanse the injection port with antiseptic swab or wipe. -Insert needle of syringe with irrigant into injection port. -Slowly inject irrigant into catheter. -Withdraw syringe & remove the clamp. -Allow irrigant to drain into drainage bag**
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*Routine Cather Care
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-Soap & water, washcloth, gloves. Procedure: Use soap & water at insertion site; cleanse catheter at least 3 times/day & after defecation.*** -Monitor patency of catheter. -If client reports fullness in bladder area, check kinks in the tubing & check for sediment in tubing. -Make sure the catheter bag/system is at level below the client's bladder to avoid reflux.
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Condom Cather Application
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Equipment: Gloves, condom catheter, elastic tape, leg or standard collection bad. Procedure: Perform hand hygiene, explain procedure to client, adjust height of bed, expose client's perineal area minimally, put on gloves, apply skin prep to skin of penis, hold penis with nondominant hand, & place condom over tip, ALLOWING 2.5 cm of SPACE BETWEEN tip of penis & catheter. -Roll down sides of condom over shaft of penis. -Use elastic tape in spiral manner to secure it if needed. -Attach catheter to leg or standard collection bag. -Observe for presence of urine -Remove gloves & perform hand hygiene. -Lower bed.
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Complications & Nursing Implications
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UTIs- caused by Escherichia coli -Close proximity of urethral meatus in women to the anus -Frequent sexual intercourse -Menopause decreasing estrogen levels & increasing susceptibility to UTIs -Uncircumcised males -Use of indwelling catheters
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Nursing Implications
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-Cleanse female clients from front to back* -Cleanse beneath foreskin in males -Provide regular catheter care
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Log Roll (3 Nurses)
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-Pad knees with pillow before moving patient. -Cross patients arms over chest. -Position 2 nurses on side to which patient will be turned. -Roll patient as a unit on one continuous motion.
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A nurse is caring for a patient who sustained trauma to his head & neck & will require LONG-TERM airway support. Which of the following devices will be required for home health care for this patient? a) Nasopharngeal airway. b) Oropharyngeal airway. c) Endotracheal tube. d) Tracheostomy tube.
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a) This type of airway management device keeps upper airway patent when it is at risk for becoming obstructed by the tongue or secretions, typically in a patient who is unconscious. This is not a suitable device for LONG TERM mgt of airway obstruction. b) This type of airway keeps upper airway patent when it is at risk for becoming obstructed. Because it does NOT stimulate the gag reflex, it can be used for patients who are ALERT. However, this is not suitable device for long term mgt of airway obstruction. c) Although this patient probably had an ET tube inserted initially, ET tubes are NOT usually left in place for more than 14 days. Doing so places patient at risk for infection & airway injury. d) Tracheostomy tubes are used for LONG-TERM airway support. They are suitable devices for long-term management of airway obstruction.
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A nurse is suctioning a patient's airway using IN-LINE suctioning. When using this method, it is appropriate for the nurse to a) Hyperoxygenate the patient before disconnecting the ventilator. b) Apply suction pressure while advancing the catheter. c) Wear a face shield during the procedure. d) Reuse the catheter repeatedly.
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a) With in-line suctioning, it is NOT necessary to disconnect the patient from ventilator. b) For any method of ET or tracheostomy suctioning, applying suction when inserting the catheter is inappropriate as it could cause trauma and oxygen depletion. c) With in-line suctioning, the nurse is NOT exposed to airway secretions bc the catheter is enclosed in plastic sheath. Therefore, a face shield is NOT necessary. d) correct; With in-line suctioning, the catheter attaches to the ventilator tubing & DOES NOT ave to be replaces until system is replaced. IT can be used repeatedly.
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A nurse is caring for a patient who has cuffed ET tube in place. Which of the following is an appropriate component of ET tube care for this patient? a) Repositioning the ET tube in patient's mouth every 8 hours. b) Providing oral & nasal care every 12 hours. c) Applying the securing tape over patient's ears. d) Maintaining a cuff pressure of 30 mm Hg.
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a) correct; Moving the ET tube to the other side of patient's mouth every 8 hr (or according to facility policy) helps prevent irritation to the oral mucous membranes. b) Oral & nasal care should be performed EVERY 2 to 4 hours! c) Applying tape over patients ears can result in pressure ulcers. d) The recommended cuff pressure is 20 to 25 mm Hg to minimize the risk of injury to the tracheal mucosa.
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A nurse is preparing to suction from the mouth of a patient who has dysphagia. Which of the following is appropriate suction device or method for the nurse to use? a) In line suctioning. b) Yankauer catheter. c) Bulb syringe. d) Open suctioning.
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a) With in-line suctioning, also called CLOSED suctioning, the suction catheter is attached to ventilator tubing. It is designed to remove secretion from trachea, NOT from the mouth. b) correct; A Yankauer (tonsil tip) suction catheter helps clear secretions from the mouth. This is the appropriate device to use for patients who can cough effectively but cannot swallow or expectorate secretions. c) Bulb syringes are generally used for suctioning secretions from a newborn's mouth & nose. Because of the low level of suction provided, they are generally inadequate for suctioning an adult patient's secretions. d) The open method is traditional means of suctioning an ET or tracheostomy, using the catheter one time only. It is NOT appropriate to use this method for suctioning a patient's mouth.
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In LINE SUCTIONING
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also called CLOSED SUCTIONING
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A nurse is caring for a patient who has a tracheostomy tube in place. During tracheostomy care, which of the following should nurse place underneath the flanges of the outer cannula? a) Commercially prepared transparent dressing. b) Cotton-filled gauze square. c) Commercially prepared fenestrated dressing. d) Twill tape.
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a) Tracheostomy dressing must be removed often, & the adhesive backing of a transparent dressing would be too irritating to the patient's skin if removed frequently. b) Lint or fibers from cotton-filled gauze squares put the patient at risk for aspiration. It is NOT appropriate tracheosotmy dressing. c) correct; A commercially prepared tracheostomy dressing is made of material that does NOT unravel & has a fenestration/slit designated to fit around the tracheostomy tube under the flanges. d) Twill tape is attached to the "eyes" at the edges of the flanges. It is NOT looped or wrapped under flanges.
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A nurse is performing chest physiotherapy for a patient who needs help mobilizing & expectorating thick pulmonary secretions. To increase the turbulence of the air patient exhales, the nurse should use which of the following techniques? a) Vibration. b) Percussion. c) Nebulization. d) Postural drainage.
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a) correct; Vibration is used during or after percussion to increase the turbulence of exhaled air and loosen secretions. b) Percussion involves striking the skin over congested lung fields to dislodge secretions from bronchial walls. It does NOT increase air turbulence. c) Nebulizer therapy is often given before postural drainage to help loosen secretions, not to increase air turbulence. d) Postural drainage allows secretions to drain by gravity from different areas of the lungs. It does NOT increase air turbulence.
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A nurse is preparing to perform ET tube care and plans to use tape to secure the tube. Which of the following is an appropriate preparatory action for this procedure? a) Cut a piece of tape that reaches posteriorly from naris to naris. b) Have tincture of benzoin ready to apply to the patient's face. c) Prepare an astringent solution for cleaning the patients face. d) Open a package of sterile gloves so they are ready to use.
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a) Tape should be 6 inches longer than distance from naris to naris posteriorly. b) correct; Tincture of benzoin or a liquid adhesive not only protects the patient's skin, but also prepares the skin around the nose or mouth and on face for better adherence of the tape. c) The patient's face & neck should be cleaned with soapy washcloth, then rinsed and dried. An astringent solution is inappropriate. d) Sterile gloves are NOT required when securing an ET tube.
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Urinary/Stool Incontinence
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the involuntary excretion of bowel contents; loss of bladder control
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Apply pressure to skin at the client's ankle
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Appropriate way to check for edema
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Palpating for dorsalis pedis pulse
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determines circulation
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Pinching & pulling up the skin at the top of foot
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Check for skin turgor
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Press on the nail bed of client's big toe
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Check for capillary refill; expected range less than 2 seconds.
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Fluid Volume Deficits
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hypovolemia-isotonic (loss of water & electrolytes from ECF) & dehydration-osmolar (loss of water with no loss of electrolytes)
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Hemoconcentration
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occurs with dehydration, resulting in increases in Hct, serum electrolytes, & urine specific gravity
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Causes of Hypovolemia
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-Abnormal GI losses- vomiting, nasogastric suctioning, diarrhea. -Abnormal skin losses: diaphoresis (sweating). -Abnormal renal losses: diuretic therapy, diabetes insipidus, renal disease, adrenal insufficiency, osmotic diuresis. -Third spacing: peritonitis, intestinal obstruction, ascites, burns. -Hemorrhage. -Altered intake such as NPO.
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Causes of Dehydration
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-Hyperventilation (increased breathing). -Diabetic ketoacidosis. -Enteral feeding without sufficient water intake.
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Monitor I. Alert provider if urine output is
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less than 30 mL/hr
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Fluid Volume Excesses
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hypervolemia isotonic (water & sodium retained in abnormally high proportions) & overhydration-osmolar (more water gained than electrolytes.
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Severe hypervolemia can lead to
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pulmonary edema & heart failure
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Hemodilation occurs with
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overhydration, resulting in decreases in Hct, serum, electrolytes
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Causes of Hypervolemia
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-Chronic stimuls to the kidney to conserve sodium & water (heart failure, cirrhosis, increased glucocorticosteroids). -Abnormal renal function with reduced excretion of sodium and water (renal failure). -Interstitial to plasma fluid shifts (hypertonic fluids, burns) -Age related changes in cardiovascular and renal function. -Excessive sodium intake.
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Sodium Imbalances
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-Expected serum sodium levels are between 136 and 145 mEq/L.
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Why must patients who have diabetes limit their caloric intake?
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Limiting the number of calories consumed provides better control of blood glucose and of the amount of insulin required.
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Why must some patients restrict protein intake?
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A protein-restricted diet is prescribed for patients who have renal impairment (uremia) or liver disease (cirrhosis or hepatic coma) to control the end products of protein metabolism (nitrogen wastes).
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What is a restricted fat diet?
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A fat-restricted diet focuses on avoiding saturated (hydrogenated) fats, trans fats, and cholesterol to treat dyslipidemia, diabetes mellitus, and cardiovascular disease.
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What other sources of calcium are available for patients who are lactose-intolerant?
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some non-liquid milk products, broccoli, collard greens, canned sardines and salmon, molasses, rhubarb, soy flour, spinach, and tofu
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What are the two types of fiber?
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insoluble and soluble
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True/False: Patients don't need to wash their hands if they are unable to perform most of their activities of daily living (ADLs) because they don't touch anything dirty.
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The insoluble type (in the cell walls of plants) speeds elimination of waste products and soluble fiber (such as oat bran) decreases intestinal speed, blood cholesterol levels, and absorption of glucose.
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Why must some patients increase fiber intake?
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A low-fiber diet is prescribed for patients during certain phases of intestinal disease or abnormalities, but it should not be used long-term.
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Which patient populations are especially at risk for eating disorders?
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Adolescence is the stage at which anorexia nervosa typically begins, with women more commonly affected than men.
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If a person's weight is less than 85% of normal, they may have:
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anorexia nervosa
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Signs to look for when suspecting bulimia nervosa are:
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lacerations of the palate with callouses on the fingers or the dorsum of the hand, oligomenorrhea or amenorrhea, and stomatitis.
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Bulimia nervosa is characterized by:
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recurring episodes of binge eating followed by purging in the form of fasting, excessive exercise, use of laxatives or diuretics, and self-induced vomiting.
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What can we do to help noncomplint patients with major lifestyle changes?
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It is best to approach the patient with a nonjudgmental attitude and try to elicit the patient's feelings about the prescribed change. Educate the patient on the change and offer suggestions for alternate methods of handling the change.
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Homonymous hemianopsia is:
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blindness of the same visual field of both eyes.
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What can we suggest to help patients with Homonymous hemianopsia?
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suggest the scanning technique: Have the patient move their head laterally 180 degrees (starting with the chin above the right shoulder to where the chin is above the left shoulder) so that he can see the entire visual field.
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Anthropometric measures include:
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height, weight, body mass index, height to wrist circumference, mid-upper arm circumference, triceps skinfold thickness, and ideal body weight
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Anthropometric measures should be taken at what time of the day?
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the same time every day
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Evaluation of dietary intake and output are import for evaluating:
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Nutritional status
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What should be done before meal time for a patient with dysphagia?
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A swallowing examination
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Liquids should be thickened if:
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the patient has dysphagia.
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Anthropometry is:
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measurement system of the size and makeup of the body.
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True/False: Patients don't need to wash their hands if they are unable to perform most of their activities of daily living (ADLs) because they don't touch anything dirty.
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False
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If a patient's nails are soft and moon shaped, their eyes' conjunctivae (mucous membranes of the eyelids) are pale, their tongue is smooth or has sores, and they are suffering from weakness or fatigue from anemia, the most likely have _______ deficiency.
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iron
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If a patient's reflexes are decreased and they have an enlarged heart, they may be suffering from ________ deficiency.
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thiamin
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Decreased cardiac output, hypotension, and dysrhythmias are all signs of _________ deficiency.
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vitamin C
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Potassium, sodium, magnesium, and phosphate deficiencies all cause weakness of the _________.
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muscles
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Acute respiratory failure can be caused by ________ deficiency.
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phosphate
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A patient is admitted to your floor with abdominal cramping, diarrhea, and hypotension. You notice upon examination that the patient's legs are slightly bowed and they have several bruises. You ask the pt if they remember how they got the bruises and they say no. What might you conclude from this information?
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The patient has vitamin C deficiency.
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What are the fat soluble vitamins?
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A, D, E, K
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The end products of protein metabolism are:
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nitrogenous wastes.
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True/False: Healthcare workers should only document a patient's therapeutic responses because this accentuates the positive and progressive aspects of care instead of the negative, thus improving the attitude of the healthcare workers as well as the patient.
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False
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True/False: Any written material students prepare and share, submit, or distribute must exclude the patient's name, room number, date of birth, medical record number, and any other identifiable demographic information.
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True
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True/False: The date and time period you spent with a patient are not standard items to document on.
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False
