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