Competencies Quiz 1

Front 1

Why is nutrition important?
(3 reasons)

Back 1

Fighting disease
Preventing injury
Strength for performing ADL's (activities of daily living), etc

Front 2

What else can weight gain/ loss mean?

Back 2

Fluid retention/ dehydration

Front 3

Physical signs of malnutrition/ undernutrion

Back 3

Hair, skin, nails- Scaling, poor wound healing, brittle nails may indivate deficiency (findings are non-specific)
Tongue- Look for pale oral mucosa or conjunctiva (may indicate anemia).

Front 4

Prealbumin

Back 4

Prealbumin has 1/2 life of about 2 days, more useful in analyzing recent nutritional status than albumin.

Front 5

Albumin

Back 5

Has 1/2 life of 20-24 days. Reflects nutritional condition as of several weeks ago.

Front 6

Hematocrit (Hct) and Hemoglobin (Hgb)

Back 6

Decreased in amemia

Front 7

Blood urea nitrogen (BUN) and Creatinine

Back 7

Falls below normal with low protein intake. Hydration state and kidney disease also affect levels

Front 8

Therapeutic diets (7)

Back 8

NPO- nothing by mouth

Clear liquid- Liquids that are thin with no particulates AT BODY TEMP. Provides only carbs

Full liquid- All clear liquids and custard, pudding, ice cream, plain soups, juices. Can be nutritionally adequate over time.

Soft/ mechanical soft foods- Easily chewed and swallowed (even w/o teeth). Low fiber, no nuts. Meats & veggies are pureed.

Low sodium- Heart, liver, & kidney patients (Na promotes fluid retention).

Renal- Restricted protein, K, Na

Diabetic- Calories strictly limited.

Front 9

What must the patient be able to do for enteral feeding?

Back 9

Digest and absorb nutrients

Front 10

Types of feeding tubes

Back 10

Large-bore N/g tube- Used for suctioning (large diameter, not ideal for feeding)

Small-bore tube- Inserted through nose into either stomach or intestine.

Front 11

Methods for checking ng tube placement. Which is most definitive? Most used?

Back 11

X-ray (most definitive), pH testing (most commonly used along with visualization), visual exam of stomach contents (aspirated with syringe).

Front 12

Residuals- What is it? Why important? How often? How done?

Back 12

Checking amount of stomach contents before feeding through ng tube.
Excess contents may indicate digestion problems or blockages.
Performed every 4-6 hours
Hook up 50 or 60mL syringe and pull back contents through ng tube.

Front 13

Excessive gastric residuals

Back 13

400mL or greater

Front 14

Questional gastric residual amounts

Back 14

200-400mL.
Evaluate for complaints of fullness, abdominal distension, bowel sounds, presence/absence of nausea/ vomiting

If less than 400, return residual to stomach.

Front 15

Guidelines for adminitering meds through ng tube

Back 15

Flush tube with 15mL water before and after each med.
DO NOT COMBINE MEDS
MAKE SURE MED CAN BE CRUSHED!

Front 16

What do you do when ng tube clogs?

Back 16

Try very warm water first, then carbonated soda and/or cranberry juice. Enzyme-based dissolvers require order

Front 17

Hematemesis
What is it?
What does it look like?
Cause for concern?

Back 17

Partially digested blood in Ng aspirate or vomitus.
Looks like coffee grounds.
Cause for concern

Front 18

Steps in ng tube placement

Back 18

1. Assemble and check equipment
2. Put Pt in high Fowlers (unless contraindicated)
3. Check nostril patency, have Pt blow nose
4. Measure tube length (nares to xyloid process)
5. Lubricate bottom 3/4 of tube
6. Have Pt sip water while tube is passed(or hold breath)
7. Tape tube to nose and secure to gown

Front 19

Activities that have impact on bowel patterns

Back 19

Diet
Exercise
Fluid intake
personal history of bowel habits

Front 20

Meconium

Back 20

First few stools produced by newborns (sticky and black due to digested amniotic fluid swallowed by the neonate). Does NOT indicate blood in stool.

Front 21

Constipation

Back 21

Abnormally hard and dry feces that becomes difficult to expel

Front 22

Impaction

Back 22

Large, constipated mass of stool that becomes so hard that it can't be passed. Frequent passage of small amounts of liquid stool while Pt feels extremely constipated is indication.

Front 23

Diarrhea

Back 23

Rapid movement of feces through GI tract resulting in poor absorption of water and nutrients producing frequent, watery stools (often accompanied by cramping)

Front 24

Steatorrhea

Back 24

Grayish stool with visible fat. Results from poor fat digestion.

Front 25

Melena

Back 25

Large amounts of digested blood in the GI tract that makes stools look black and tarry.

Front 26

Hematochezia

Back 26

Large amounts of undigested bright red blood in the stool.

Front 27

Occult blood

Back 27

Hidden blood. Blood mixed in throughout stool in quantities too small to be seen by naked eye

Front 28

Test that checks for blood in stool

Back 28

Fecal Occult Blood Test (FOBT)

Front 29

Steps in administering an enema

Back 29

1. Place Pt in Sims Left Lateral Position
2. Administer fluid at lukewarm temp
3. Lube the tip and insert 3-4 inches into rectum (adult)
4. Start with bag 18in above rectum (higher the bag, faster the flow). Take at least 10-15 mins for 500-750mL
5. If soap suds ordered, only use soap in enema kit
6. Enemas until clear- specify. Can cause electrolyte imbalance (text states no more then 3)

Front 30

Why are hospitalized Pts at high risk for infection?

Back 30

Lowered resistance due to disease
Invasive procedures that breach normal skin defenses/ barries (cath, IV)
Large number of pathogens in hospital

Front 31

Major mode of transmission of pathogens in hospitals?

Back 31

Hands of health care workers

Front 32

Steps to wash hands

Back 32

Wet hands
Use warm water (opens skin pores)
Lather up and vigorously rub for 15-30 seconds.
Use if hands are visibly soiled, otherwise use alcohol rub

Front 33

Alcohol rubs

Back 33

Rub vigorously for 15-30 seconds. Before and after patient contact

Front 34

When should hands be washed?

Back 34

-When visibly soiled
-Before and after Pt contact
-After contact with blood, body fluid, mucous membranes, non-intact skin.
-When moving from contaminated to clean site
-After signigicant contact with pt's environment (side rails, over bed table, etc)
-After eating
-After removing gloves

Front 35

When should nurses wear gloves?

Back 35

-Scrates or breaks in skin
-Inserting needles into patients
-High risk of contacting pt's bodily fluids

Front 36

Serous

Back 36

Clear and watery

Front 37

Serosanguinous

Back 37

Pale red and watery type of drainage (some RBCs in it)

Front 38

Sanguinous

Back 38

Frank blood (a thick type of drainage)

Front 39

Purulent

Back 39

Pus- liquified necrotic tissue, usually indicative of infection

Front 40

Second most common type of nosocomial infection

Back 40

wound infection

Front 41

Dehiscence

Back 41

Partial separation of wound layers at the surface of the wound (mostly in abdominal wounds)

Front 42

Evisceration

Back 42

Total separation of all layers of a wound with protrusion of abdominal organs.

Front 43

Fistula

Back 43

Abnormal passageway connecting epithelial surface with another epithelial surface.

Front 44

Enterocutaneous fistula

Back 44

Abnormal passageway connecting an epithelial surface with an organ. Usually are infected.

Front 45

Process of emptying the bladder

Back 45

micturition/ urination/ voiding

Front 46

Difficult or painful urination

Back 46

dysuria

Front 47

Diminished flow of urine

Back 47

Oliguria

Front 48

Absence of urine

Back 48

Anuria

Front 49

Production of larger than normal amount of urine

Back 49

polyuria

Front 50

Red blood cells in urine

Back 50

hematuria

Front 51

Involuntary urination (other than incontinence)

Back 51

enuresis

Front 52

Involunary passage of urine (temporary or permanent)

Back 52

incontinence

Front 53

Interventions for urinary retention

Back 53

Fluid management
Enhancing stimulus by:
Providing privacy and don't rush
Position in normal voiding position
Sound of running water
Spray warm water over perinium
Place hand in warm water
Crede maneuver

Front 54

Reasons for urinary catheter

Back 54

urinary retention or obstruction.
Empty bladder prior to, during, and after certain surgeries
Preceise I/Os
Sterile urine specimens
Keep bladder decompressed after urinary tract surgery
Prevent incontinence

Front 55

When should patients void after indwelling catherter removal?

Back 55

6-8 hours, usually sooner. If not, check for distension and call provider.