NOCTI Prep - mrsmurraysmedicalcareersclass

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NOCTI Review

Terminology Review

• Can you come up with the medical terms for the following word parts??

• • • • • • A-, an Adeno Adreno -Algia Ang Arth • Auto • Bi • Brady • Bronch • Calc • Carcino • Cardi-

• • • • • • • • • -cele -centesis Cephal-, cerebro Chol Col Cost -cyt Cyano Cyst • derm • Dys • -ectomy • -emesis • Endo • Enter • Eryth • Gastr-

• • • • • • • • Ger Gluc-glyc Hem Hepat Herni Hyper Hyster Ile • Inter • Lapar • Leuko • Lith • Mast • Mamm • Mega-

• • • • • • • • • Melano Mening Meno -natal Necro Neo Neph Neuro Noct • Oculo-, opthalm • Odont • Olig • Ooph • Orchi • Ortho,osteo

• • • • • • • • -oscopy -otomy -paresis -penia -pepsia Per Peri -phagia • -phasia • Phleb • -plasty • -plegia • Pleur-, pneum • Pod • Poly • Pulmon • Noct-

• • • • • • • • • Pyo Pyel Quad Rhin -rraphy -rrhag -rrhea Sangui Salping • -scler • -scope • Sep • Splen • Sub • Sup • Tachy • Thorac-, -thorax

• • • • • • • • Thromb Thyr Trach -tripsy -trophy Ur -uria Vas • Ven • Xantho-

• • • • • • • • • Hemi Bi- , tri-, Quad Hyper-, hypo Tachy-, brady-

High Usage:

Poly-,olig-(scant) Ostomy-, otomy -phagia, -phasia Cyano-, erythro-, leuko-, xantho -paresis, -plegia

• • • • • • Hematuria Glucosuria Oliguria Nocturia Polyuria Anuria

-uria

-pnea

• • • • • • Eupnea – normal! How many/min??

Tachypnea Bradypnea Apnea Hyperpnea Orthopnea

Can you define these?

• • • • • • Pallor Diaphoresis Bariatric Epistaxis Vertigo Syncope

Medical Specialties

• • • • • • • • Geriatrics Hematology Oncology Urology Nephrology Gastroenterology Obstetrics Orthopedics • • • • • • Rheumatology Podiatry Pediatrics Gynecology Endocrinology Neurology

Abbreviations

High Usage Abbreviations

• • • • • • • • Bid Tid Qid HS ADL ac pc prn, ad lib • • • • • • • TPR/ BP BR CBR BR with BRP NPO, PO OOB NKA

• • • • • GI GU Neuro STAT q2H

More Abbreviations

• • • • • • VS RN, LPN, CNA, MA, HA LTC, SNF AD, AS, AU OD, OS, OU

And still more abbreviations

• • • • • • • • • CBC CBC w/Diff CPR CPR DNR EKG, EEG Etoh GB GU • • • • • • FC HIPAA ID,IM,IV,SC LLQ,RLQ,LUQ,RUQ LMP UA

Which Way Is UP??

• • • • • Anterior/Posterior Medial/Lateral Proximal/Distal Superior/Inferior Supine/Prone • Can you put these in a sentence?

Eleven Systems

• • • • • • • • • • • Integumentary system Nervous system Skeletal system Endocrine system Muscular system Cardiovascular system Lymphatic system Urinary system Respiratory system Digestive system Reproductive system

• • • • • • P L A N E S

Body Cavities

• • • • • • • • Law Ethics Criminal laws Civil laws Negligence Malpractice Assault/Battery Fraud

Legal Terms

• • • • • • • • • Defamation Libel/Slander Defamation False imprisonment Invasion of privacy Abuse (types) Informed Consent Scope of practice HIPAA

Patient’s Chart/Medical Records

• • • • • • Record of care Legal doc Record of observations/tx Confidential Errors?

Subjective (description from pt)vs objective( data from HCW)

• • • • • Recording Patient Information: POMR: database, problem list, educ/diagnostics/tx plan, progress notes SBAR SOAP What is required to release pt records to another hospital or provider?

Filing

• • • • • • • • Filed in sequential order - alphabetical Indexing: guidelines of filing practices Each part of a person’s name is a unit Start w/ last name, first, then mid initial Prefix is part of the name (O’Hare)(Mc, Mac, Van, De – ) St. is filed as if it were spelled out Hyphenated name tx as single unit Titles: ignored or are last(4 th ) unit

• Numeric filing – each part of a name is assigned a # and no names appear on outside of file • Color coding: used to distinguish files within a filing sys(ex: green for all new pts) or as part of alphabetical filing sys where each letter is assigned a color • Tickler file: date oriented reminder file – usually organized by month (to do list) • • Retention schedules – how long file kept on site or stored No blank spaces – use n/a

• • • • If an initial is used instead of a name, tx as single unit Identical names: index under names then location Must have written consent to release info Info belongs to pt! File is hospital/office

Insurance

• • • • • • • Ins: if pt and insured are the same person write “same” Insured’s name – who carries the policy? Most policies assoc w/ employment Relationship to insured: spouse or dependent? Primary vs secondary ins Exclusions, pre-certs Deductible, co-pay, co-insurance Payor, subscriber, provider

Employment Skills

• • • • • • What ,when and to whom to report Know legal limits ; HA/PCT reports to RN Act w/in scope of practice Professional appearance Telephone etiquette: id self, unit Incoming emergency call – call 911, get pt name and #, refer to MD/RN immediately • Leaving voice mails – what is acceptable

Employment

• Policy manual- hospital quidelines /rules (dress code, sick days, chain of command) • Procedure manual: instructions for all clinical activities (vs, specimen collection, inf control) • • • • Resume Cover Letter: purpose?

Interview skills Resignation from job: notice?

Communication

• Therapeutic: listen, observe, silence, open-ended?, leading ?, • • encourage, ask pt to restate, reflect, summarize Poor: approve/disapprove, agree/disagree, advise, defend, minimize, stereotype Use eye contact, touch but be aware of cultural aspects of comm

Defense Mechanisms

• • • • • • Denial – disbelief Withdrawal – physically or thru communic Rationalization – explanation/excuse Projection – blaming another or circumstance Repression – transfer to unconscious mind Suppression – like repression but aware

Infection Control

Aseptic Techniques

• • • • • Asepsis: abs of pathogen Sterile: free from all microorg Contaminated: pathogens present Clean: reduces path • Aseptic Techniq: help prevent contam/spread of inf/break chain of inf Hand hyg, PPE, cleaning equipment/environment

• Antisepsis: inhibit growth of path; not eff against spores/viruses; can be used on skin (alc, bet) • Disinfection: kills path but not always effec for spores/viruses; not on skin; equip • • • Sterilization: kills all microorg inc spores/viruses; equip only What piece of equipment is used to sterilize instruments?

How long are sterile packs from SPD sterile?

Standard/Universal Precautions

• • • • • • • Potentially infectious material All body fluids/all patients: potential sources of inf ALL HCW ALL THE TIME Break chain of inf H/W guidelines PPE: Gloves, gown, mask if risk of exp such as splashing No jewelry, do not reuse gloves

Transmission Based Isolation Precautions

• • • For pt with communicable diseases In addition to SP Type depends on pathogen, how it is spread, whether it is antibiotic resistant • • Use PPE, dedicated equipment, private room Contact, droplet, airborne

Patient Care

• 24 hour clock

Military time

Procedure Skills

• • • Pre-procedure steps: H/W, Assemble equip ID Pt, introd self, explain proc • • Post-procedure steps: Record, report, repeat if needed

Personal Care

• • • • • • • Bathing: Full / complete vs partial Pre-proced steps Wash one body area, rinse, dry, cover, next All pts: start cleanest (face), end dirtiest (anal area). Perineal area: front to back Back Rubs: promote circulation (q8H) CBR pt: turn q 2H Mouth care: q 2H

• • • • Removing a gown when pt has an IV: Slip gown over IV bag if no snaps Never disconnect IV Dressing pt w/ 1 sided weakness/paralysis: remove clothes from good side first then dress weak side first

Vital Signs

• • • • • TPR, B/P Pre-procedure steps?

Temp: ask?

Reason for palpable systolic?

Steps taken when there is an abnormality noted?

Temperature

• • • • • • • Oral: most common Rectal: if pt confused, on O2, under 2 yo, can’t keep mouth closed Rectal vs oral thermom Hold thermometer in place when taking rectal temp; insert < 1” Shake down “mercury” < 96 (or below lowest #) Temperature Ranges: 97-100 Oral temp 98.6 what are rectal, axillary equiv?

Pulse

• • • • • Sites: Radial site most common Apical if irregular, infant, cardiac hx Other sites? Pedal, popliteal, femoral, brachial, carotid Range: 60-90bpm

Respiration

• • • Respirations = 1 inspiration + 1expiration, Pt should be unaware Range: 12-20

Blood Pressure

• • • • • • Systolic- first clear sound Diastolic- sound muffles/last distinct sound Ranges:Systolic 100 – 119/Diastolic 60 – 79 Pre-HTN: Systolic 120–139/Diastolic 80– 89 HTN:>140/90 or above Hypotension: < 100/60

Nutrition

• Diets • • • • • • • • • • Regular Bland Mechanical soft Pureed Na restricted, NAS Low residue Diabetic Cardiac Cl Liq Full Liq

Vitamins

• • • • • A = eyes = night blindness D = bones = rickets/osteomalacia K = blood clotting C= immunity, wound healing= scurvy B= RBC prod = anemia

Other Nutrients

• • • • • • • Carbs = energy Protein = tiss repair Fats = energy K = hrt, nerv, musc function Na = fl balance Iron = hgb formation Ca = musc/cardiac/bones

Feeding Patients

• • • • • • Check diet orders If pt. says diet not correct or if it doesn’t seem right ask nurse Alternate between solids/liquids Encourage patient to finish;don’t force Fill spoon/fork 1/3 Make sure they swallow!

Intake and Output

• • • • Usually measured q 8 w/ 24 H totals Intake = sources?

Output = urine, bm, emesis, irrigation, suction NPO = No: water, ice, candy, gum, food!

Output

Conversion Table

A cubic centimeter (cc) is a unit of measure equal to one milliliter (ml). 1 ml = 15 gtts 5ml = 1 tsp 15ml = 1 Tbsp **1 oz. = 30 ml 4 oz. = 120 ml **8 oz. = 240 ml = 1 cup

• • 1” = 2.54 cm I kg = 2.2 lb

More Math Matters

Elimination

• • Vocab: voiding, incontinent, anuria, polyuria, nocturia, dysuria, hematuria, oliguria/scant • • • defecation, stool/feces, constipation, impaction, obstruction Bedpan: facture, regular Urine specimens: 1 st AM (common), clean catch/midstream, sterile using cath, 24H • Routine: collect @ 100-120ml

Patient Positioning

• • • • Sims Fowlers Semi fowlers Lithotomy

Five Basic Positions

Ambulation

• Assistive devices: cane, walker, crutches • Canes: use on pt’s STRONG side • HCW stands on weak side of pt

Patient Transfer

• • • • • • Check activity order first! Dangle if first time OOB Dangling: • • sitting up on side of bed Check vitals pre/post Position w/c on pt’s strong side Body mechanics?

Mechanical lift: 2 people operate

Immobility

• • • • • • Can cause: Atrophy-wasting/decrease in size of a body part Contractures- permanent shortening of a muscle or tendon Decubutis Ulcers DVT CBR/immoblie pt: change position q2H

ROM

• • • • • • Flexion, extension Adduct, abduct Plantar and dorsi flexion Supinate, pronate Circumduct Passive ROM, Active ROM

Patient Assessment

• • • • • Hx – patient history H&P: on admission SOAP POMR Subjective vs Objective??

CBC

• • • • • • Phlebotomy RBC, WBC, Platelets, Hgb HCT Correct color tube top for correct test Coag tests: PT, PTT, INR BS, A1C HDL, LDL

Urinalysis

• • • • Volume in 24H @ 1250ml in adult Color: clear- pale yellow,amber, turbid=cloudy Odor: none/malodorous Specific gravity; conc of dissolved substances (kid function)

Skin Care

• • • • Decubutis ulcer: bedsore Risk factors- incontinence, poor nourishment, poor mobility Prevention- nutrition, positioning, turn q2H, skin care Special mattress, egg crate

Care Guidelines for Casts/Immobilizers

• • • • • Elevate to reduce edema Observe for skin discoloration, tightness, swelling, sores, skin temperature, burning, n/t, drainage, bleeding, odor, circulation Protect skin from edges Keep dry Do not insert anything into device

Cultural Influences

• Influence attitudes about health, illness/ reporting of s/s and pain/ cause of illness • Must be sensitive to specific cultural needs

Death and Dying

• • • • • • 5 stages: Denial Anger Bargaining Depression Acceptance • These stages also apply to pt/family when given some dx

9 Rules of Good Body Mechanics

• 1. Wide Base of Support: keep feet 8-10” apart, point in direc of mvmnt • • 2. Bend at knees/hips not from waist 3. Use strongest muscles: shoulders, upper arms, hips, thighs • 4. Use body wt to push, pull or slide. Try not to lift

• • • • • 5. Keep the object being lifted close to your body 6. Avoid twisting 7. Avoid prolonged bending 8. Plan lift, test load 9. If unsure get help!

RACE

• Rescue anyone in immediate danger • Alarm • Contain • Extinguish: if fire is small, contained and does not put you in danger

PASS

• Pull the pin • Aim at base of fire • Squeeze the handle • Sweep side to side; stand back 6-10 feet

Health Care Worker Safety

• • • • • • • Body mechanics Report all injuries H/W!

Use PPE as indicated Standard/isolation based precautions Never recap needles Flush eyes/skin if contaminated

Basic First Aid

CPR

• • • • Check scene safety CAB Check responsiveness and call 911 Check pulse and airway (carotid, brachial in infant)

• • • • • Start compressions: 30 Open airway/pinch nostrils Give 2 breaths 30:2 At least100/min is goal

Choking

• • • • • How do you know?

Heimlich Fist technique Pt becomes unresponsive: Begin CPR, check for object and remove if seen

• • Infant technique? 5 backslaps/5 downward chest thrusts

• • • • • • MI S/S:?

Tx: ?

CVA S/S: ?

Tx:?

First Aid

• • • • • • Bleeding Tx: Direct pressure Elevate part Shock S/S: diaphoresis, pallor, rapid/weak pulse, hypotension, anxiety, n/v • Tx: raise legs, blanket, would you give po fluids?

• • • • • • Poisoning Burns: Tx?

Remove source of heat, cool water, cover, elevate part Heat inj: Tx?

Cool area, cool water cloths, elevate feet Bone inj: immobilize and elevate

• • • • • • Seizure: What would you do?

Nothing in mouth, do not restrain, protect head, recovery position Diabetic emergency: give sugar or not?

Allergic RXN? Abuse signs? Victims of abuse cross all socioeconoomic, gender and cultural groups

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