chapter 3

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  1. define posture
    relationship of body parts to each other during activity or rest
  2. Describe the harmful effects of prolonged immobility on the body system?
    it can lead to a cascade of physiological changes (eg. bed sores, atelectasis)  that can lead to serious, even permanent harm including death
  3. define body mechanics
    the postures used during activity to minimize physical stress and injury to muscle and joints
  4. what is neutral posture
    posture that minimizes stress on muscles and joints 

    spinal column straight and shoulders aligned with the ankles
  5. what muscle should be used when lifting heavy objects or moving patients
    quadriceps femoris rather then the erector spine
  6. what is the most comfortable breathing position?
    semi upright = semi fowler position30-45
  7. what happens during fowlers positions?
    the position relaxes the abdominal muscles, pulls the abdominal muscles, pulls the abdominal viscera away from the diaphram and allows gravity to aid in diaphragmatic movement
  8. which of the fowlers positions is recomemmended to reduce the incidence of ventilator associated pneumonia (VAP) and to reduce aspiration in patients receiving tube feedings?
    semi fowlers (30-45o)
  9. which of the fowlers position is used to asses jvd?
    semi fowlers ( elevating head PAST 45o)
  10. safe pt movement
    1 Place the bed in a low position and lock its wheels.

    2 Place all equipment (e.g., intravenous [IV] equipment, nasogastric tube, surgical drainage tubes) close to the patient to prevent dislodgment during ambulation.

    3 Move the patient toward the nearest side of bed

    4 Assist the patient to sit up in bed (i.e., arm under nearest shoulder and one under farthest armpit).

    5 Place one hand under the patient's farthest knee, and gradually rotate the patient so that his or her legs are dangling off the bed.

    6 Let the patient remain in this position until dizziness or lightheadedness lessens (encouraging the patient to look forward rather than at the floor may help).

    7 Assist the patient to a standing position.

    8 Encourage the patient to breathe easily and unhurriedly during this initial change to a standing posture.

    9 Walk with the patient using no, minimal, or moderate support (moderate support requires the assistance of two practitioners, one on each side of the patient).

    10 Limit walking to 5 to 10 minutes for the first exercise.
  11. describe the energy conserving ambulation procedures
    this procedures consist of methods that will help the pt breath without having to use additional muscle energy that will only exhoust the pt even more
  12. explain physiological contraindications to pt ambulation
    cardiovascular instability (low blood pressure and cardiac arrhythmias) and pain severe enough to require medication.
  13. what should you monitor during patient ambulation?
    • ams 
    • color (cyanosis)
    • breathing 
    • strength or weakness,
    • and complaints 
  14. define voltage
    the power potential behind electrical (analogous to pressure) this is what determines where current goes current goes from high voltage to low
  15. define ground
    a low resistance connection between the metal case of an electrical device and the earth (ground)
  16. what is the most important factor during electrical injury?
  17. what kind of electrical shock is a medical hazzard
  18. which electrical shock is related with industrial related accident?
    macroshock > mA
  19. describe elements that must be present for a shock to occur
    there has to be a source and ground, the body then becomes part of a circuit where the current flows through the body because the body is "grounded"
  20. list the physiological effects of exposure to different levels of electrical current
    6A- burns and sustained muscle contraction causing respiratory paralysis and ventricular compression, recovery is possible if the current is stopped before the damage is too severe

    2A cardiac standstill (from sustained contraction) and internal organ damage

    100-300mA (on skin) ventricular fibrillation

    10-20A (on skin)sustained muscle contraction (tenaty)

    5mA the maximum "harmless" current if applied externally to dry intact skin

    1mA tingling sensation

    20microA on myocardium can cause ventricular fibrillation
  21. describe relation ship between voltage resistance and current
    • voltage the pressure that moves fluid flow
    • resistance is the is what opposed/ blocks electrical energy
    • current is vol of fluid moved by pressure

    current is directly proportional to voltage and inversely to resistance

    • lC = lV/ ^R
    • ^C= ^V/ lR
  22. AC current?
    • travels back and forth from source to load 
    • from hot prong of the plug to the neutral prong 
  23. direct current 
    flows in one direction from the source to the load and back
  24. explain the function of ground connection in electrical circuits
    the ground connection would lead the circuit back to a zero voltage path "earth"
  25. define electrical leakage and explain its significance in medical equipment?
    a short circuit developed between the hot wire and equipment case, with the ground connection it prevents this leakage to cause a shock i will be directed to a zero voltage pt
  26. fire percentages
    • 23% in hospital 
    •               *15% of those are in pt rooms 
    • 44% in nursing home 
    •               mainly kitchen
    • adding up to 34 million in damage 
  27. what is ambient fio2

  28. what is the minimum fioneeded to start a fire?
  29. what should humidity be to prevents sparks?
    high relative humidity >60%
  30. characteristics of an oea 
    • lower ignition point
    • intensifies fire 
    • produces a higher rate of heat output
  31. describe the elements needed for a fire to start and continue to burn
    the "triangle" Hear, O2, Fuel, although O2 is not flammable in the presence of it thing will continue to burn...
  32. fundamental steps in containing a fire..
    a fire can be contained by removing any of the triangle components..
  33. select the appropriate type of extinguisher for each of the fires..
    • type A (ash) fire will used only dry chemical extinguisher
    • type B (boil) fire- ABC / CO2 extinguisher
    • type C (current) fire- ABC / CO2 extinguisher
    • type D fire - only a CO2 extinguisher
  34. characteristic of a dry powder extinguisher?
    • 5-20 lbs 
  35. characteristics of a co2  extinguisher
    • 5-20 lbs 
    • the larger size will have a hard horn at the en of long flexi hose 
  36. what does the acronym PASS stand for in the fire extinguisher training
    Pull the pin—there may be an inspection tag attached

    Aim the nozzle—aim low at the bottom of the fire

    Squeeze the handle—the extinguisher has less than 30 seconds of spray time

    Sweep the nozzle across the base of the fire
  37. what does acronym RACE for core fire plan stand for?
    • rescue pts in immediate area 
    • alert personnel
    • contain fire
    • evacuate other patients
  38. what are rcp responsibilities during a fire 
    • 1.close appropriate zone valves
    • 2. make sure patients in those affected rooms continue receiving necessary tx

    • if evacuating we FIRST supervise movement and care of ventilator pts 
  39. how to store and transport cylinders 
    in appropriate racks or chained containers 

    never store compress gas cylinders with out support 
  40. who regulates AND who monitors medical grade gas storage 
    regulated by National Fire Protection Association 

    monitored by Joint Commission on Accreditation of Healthcare  Organizations 
  41. requirements for storing 300-3000 cubic feet of oor NO
    noncombustible or limited combustible storage rooms with self-closing doors and at least a 1/2 hour fire rating

    20ft from any combustibles
  42. what are pt identifiers used
    • name
    • dob
    • medical record number 
  43. explain the importance of communications skills in a clinical practice?
    in order to provide proper and safe care to pt
  44. list and explain elements of the communication process??
    sender- the person delivering info

    message- info being transmitted it can be verbal or non-verbal

    channel-way it which message is transmitted can be see, hear or feel

    receiver- the person who will be receiving the info..

    feedback- it pretty much restarts the communication process with the receiver as a sender
  45. list the verbal and non verbal elements of active listening
    verbal is written or spoken

    Nonverbal communication includes gestures, facial expressions, eye movements and contact, voice tone, space, and touch

    these two should agree or reinforce each other 
  46. techniques that demostrate empathy to patient
    • asking pt about breathing regularly
    • making good eye contact while talking 
    • using gentle touch (on arm or hand)
  47. describe the major barriers to effective communication in healthcare
    • different meanings to words or symbols 
    • different value system 
    • emphasis on status
    • conflict  of interest
    • lack of acceptance of differences in points of view 
    • feelings of personal insecurities
  48. explain the importance of feedback in the communication process
    feedback is a confirmation that the message was received, wether is was understood or or it allows the sender to know if their is any explaining that should be done.
  49. share info rather than telling 
    sharing creates an atmosphere of cooperarion and trust 
  50. seek to relate to people rather than control them
    explain procedures to patient and ask their permission to proceed is a way to make them feel a part of the decision making regarding their care 
  51. value disagreement as much as agreement 
    be prepared for disagreement and be open to the input of others 
  52. use noonverbal communication techniques
    if you are trying to establish rapport with a patient but do not look him in the eye your communication will not be as effective
  53. attending
    confirming remarks like i see what you mean
  54. paraphrasing 
    repeating the others response in ones own word 
  55. request clarification
    is an attempt and acknowledgement on behalf of the listener that message was not understood 
  56. perception checking eg.
    you dont seem to be sure that you need this treatment. is that correct?
  57. reflecting feeling example
    you seem to be anxious about (this situation)
  58. source of conflict:
    poor comunication
    primary source of conflict in organizations 
  59. other source of conflict in organization?
    • structural problems
    • personal behavior 
    • role conflict
  60. competing 
    power-oriented method of resolving conflict 
  61. accommodating
    unassertive and cooperative , neglecting ones own needs 
  62. Avoiding 
    one or both parties decide not to pursue their concerns 
  63. collaborating 
    parties try to find a mutually satisfying solutions to their conflict 
  64. compromising 
    middle-ground strategy 
  65. admission sheet
    Records pertinent patient information (e.g., name, address, religion, nearest of kin), admitting physician, and admission diagnosis 
  66. pomr: problem-oriented medical record consist of the 
    • database: h&p result  
    • problem: pt 
    • plan: *diagnostic * therapeutic * patient education 
    • progress note: written in SOAP fomat
  67. how do u sign a chart?
    one initial and ur last name and you title(crt, rrt)

    eg. S.Smith, CRT
  68. what happens if you do a mistake?
    a single line should be drawn through the mistake and the word error printed above 

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chapter 3
2014-05-18 17:53:13

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