NOCTI Review
Jan 12, 2016
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-• Oculo-, opthalm-• Odont-• Olig-• Orchi-• Ortho,osteo
• 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-
High Usage:• Hemi-
• Bi- , tri-, Quad-
• Poly-,olig-(scant)
• Hyper-, hypo-
• Ostomy-, otomy
• -phagia, -phasia
• Cyano-, erythro-, leuko-, xantho-
• -paresis, -plegia
• Tachy-, brady-
-uria
• Hematuria
• Glucosuria
• Oliguria
• Nocturia
• Polyuria
• Anuria
-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
More Abbreviations
• GI
• GU
• Neuro
• STAT
• q2H
• 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
Legal Terms
• Law
• Ethics
• Criminal laws
• Civil laws
• Negligence
• Malpractice
• Assault/Battery
• Fraud
• 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(4th) 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
Military time
• 24 hour clock
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 gtts5ml = 1 tsp15ml = 1 Tbsp
**1 oz. = 30 ml
4 oz. = 120 ml
**8 oz. = 240 ml = 1 cup
More Math Matters
• 1” = 2.54 cm
• I kg = 2.2 lb
Elimination• Vocab:
• voiding, incontinent, anuria, polyuria, nocturia, dysuria, hematuria, oliguria/scant
• defecation, stool/feces, constipation, impaction, obstruction
• Bedpan: facture, regular
• Urine specimens: 1st 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
First Aid
• MI
• S/S:?
• Tx: ?
• CVA
• S/S: ?
• Tx:?
• 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