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| You are in a public setting and you see a victim lying on the ground. How do you notify EMS? Should you move the victim? Should you leave the victim to call EMS? What information is given to the operator? Who hangs up first? | You call 911 or have someone else notify EMS. No, you should not move the victim unless leaving them in that position puts them in potential danger. Do not leave victim to call EMS. You give the operator your location, your phone number calling from, what happened how many people, condition of people and what aid has been given. Do not hang up until operator hangs up. |
| Your victim is semi conscious and asking for water. What is your reaction? | Tell him you cannot give him water. |
| Sudden cardiac arrest is when the heart stops.___ ___ will follow cardiac arrest Damage to vital organs will occur in as little as ___ minutes. | Followed by respiratory arrest. Damage to vital organs will occur in as little as 4-6 minutes. |
| The quicker CPR is started the better chance of ___ Do you need to be trained in CPR before performing it on the victim? When do you not perform CPR ( i.e. code status)? | Survival. Yes you need to be trained in CPR before performing it. |
| The most common obstruction in the airway is the ___. | Tougue |
| What position is the victim in to assess respirations? How do you open the air way? When the air way is open, how do you assess respiratory status? | Yes you open air way. |
| Your respiration assessment reveals that your victim is not breathing, what is done next? | Give them 2 breaths, each over 1 second to determine if air is going into the lungs |
| Are respirations given using the mouth to mouth method? | Yes |
| If the chest is not rising and falling and the stomach is enlarging, what is your next action? | Reposition the head and try again. |
| What is your next action after successfully giving to respirations? What side is used to check the pulse? | The side use to check the pulse is the side closets to you. |
| Your victim is without a pulse. What is your next action? Where is your hand placement for chest compressions? How deep is the chest compressed for an adult? | Expose the chest. Place the heel of your dominant hand or the sternum. Compress 1½-2 inches |
| What is the expected rate of compressions and ventilations per minute? | 10-12 breathes/minute, compress at a rate of 100 compressions/minute |
| Ventricular fibrillation is an abnormal heart rhythm like quivering jello, leading to cardiac arrest. Defibrillation delivers a shock to cardiac muscle causing it to stop and then return to normal rhythm. When defibrillation is implemented within 3 minutes of ventricular fibrillation or cardiac arrest the chance of survival is ____. | doubled |
| Identify the compression and ventilation ratio for one man and two man CPR for an adult. | One or two man: 2 ventilations and 30 compressions |
| How are compressions delivered for a child? How far is the chest compressed? What is the ration for one man and two man child CPR? What do you do if the pulse is 60 and below? | Use one hand for small children, two for large children. Compress 1/3 or ½ of the chest depth. 1 man: 2 ventilations to 30 compressions 2 man: 2 ventilations to 15 compressions Give compressions if pulse is below 60 |
| What is the most common air way obstruction with infants? | Tongue |
| After providing the head tilt, chin life maneuver, and attempting to give respirations, the chest does not rise and fall, what do you do? | Reposition |
| What pulse side is used to check circulation in the infant? How are compressions performed with an infant? What is compression/ ventilation ratio for one and tow man CPR of an infant? | Brachial artery is used to check circulation in the infant 1 man- 2 ventilations and 30 compressions 2 man- 2 ventilations and 15 compressions |
| During CPR the victim may vomit. What is the appropriate reaction when this occurs? | Turn their head to the side. |
| The victim has a pulse and breathing on their own, but is not conscious. How do you position the victim to maintain an open airway? | You position the victim in a recovery position in order to maintain an airway. |
| The Heimlich maneuver with adult and children involves asking the victim if they are choking, if they shake their head yes, what other 2 criteria indicate the need to implement the Heimlich maneuver. | The other 2 criteria that indicate the use for the Heimlich are if they are unable to cough, and you hear high pitched sounds on inhalation. |
| The Heimlich maneuver refers to the technique of performing______thrusts | Upward thrusts |
| If the victim is forcefully coughing what do you do? | Don't do the Heimlich |
| You have found the victim lying on the floor unconscious. A bystander states the person was eating a hot dog, started choking, and fell to the floor. Should you perform a finger sweep to locate the obstruction? | Never do the blind finger sweep only if the obstruction is visible. |
| Shock in the body’s reaction to organs and tissues not getting enough blood due to allergic reactions, heart attack, burns, etc. what are the early signs of shock? What is your reaction? | Falling BP, rapid weak pulse, rapid respirations, cold moist pale skin, restlessness confusion and loss of consciousness. Early signs of an allegoric reaction are same as shock but also involve respiratory congestion, swelling of the larynx followed by dyspnea, and respiratory occlusion. |
| The victim experiencing seizure activity has an increased potential of bodily injury. What can you do to prevent injuries? | Stay with the patient and summon help. Use standard precautions for exposure to body fluids. Never restrain movements, move objects out of the way. Put nothing is mouth, loosen clothing, |
| For the burn victim, what nursing measures can you implement to prevent further damage? | Remove patient from the burn source, put out flames with water, or smother with a sheet, blanket, or towel, do not remove burnt clothing; cover wounds with a satirized, moist cool dressing; cover victim with blanket or coat to avoid heat lose. |
| Strokes occur when the brain is suddenly deprived of blood supply. The victim experiences one sided paralysis, slurred speech, unsteady gait, and at times seizures activity. What care measures do you implement with a stroke victim? | Call EMS, position the victim in a recovery position on the affect side, raise the head and loosen clothing, keep them quiet and warm, given them reassurances, and provide CPR and emergency care for seizures if needed. |
| Orthopedic injuries to joint, muscles bones and ligaments. For this type of injury, what care measures do you implement | Activating EMS notifying the nursing depending on the injury, immobilize the lim do not move the patient. Do not leave the patient and assist with putting them back to bed. Check vital signs, limit mobility and apply ice. |
| Head injuries potentially cause intracranial pressure and bleeding possibly leading to brain damage. | Answer below |
| Symptoms can present right away or as long as___ hours from the times of injury. What are the care measures you will implement? | 72 hours. Care includes staying with the patient, summon help, do not move the victim immediately following the injury. Keep the environment calm and quiet, with dim lighting, maintain NPO, pillow supporting the head, reassure and orient the patient as needed and monitor vital signs. |
| Positing is a concern in long term care where residents often have confusion and dementia> what care measures can you implement in the patients room to prevent accidental poisoning? What is done for the patient accidentally ingested a poisonous substance such as denture tablets? | Remove items that can be ingested in patient's room. Call the nurse if something is ingested |
| Age and diseases of the brain lead to decreased ability to swallow allowing food to enter the trachea and lungs. If your patient is choking coughing develops cyanosis and you suspect they may have aspirated, what nursing measures do you implement? | Stay patient and call for help. Turn patient on side and elevate head of bed. In case of occlusion use Heimlich maneuver |
| In the event of fating episode, if the victim is standing, lye them down and lift their ___to increase blood flow to the brain. If sitting have the victim lean___ and put their ___between their knees. | Lift their legs, have the victim lean forward and put head between knees |
| You are in the cafeteria at work and notice a co worker grabbing his throat. He is unable to speak or forcefully cough. When you as him if he is chocking. He shakes his head yes. You provide the Heimlich maneuver twice and unable to dislodge the obstruction. He is now unconscious and you lower him to the floor. | Answer below |
| What position is he placed in. | Recovery position |
| Is your next action to perform a blind finger sweep to locate the obstruction? | No |
| What is your next action. | Continue the Heimlich |
| After assessing his respiration status, you attempt to ventilate and are not successful. Where will you check for a pulse? | Carotid artery |
| You continue to provide the Heimlich maneuver and eventually you see a food particle in his month. Can you do a finger sweep to remove it? | Yes you can |
| He has a pulse but not breathing. How many respirations will you provide per minute? | 12-14 respirations per-minute |
| His stomach is dis tended and you do not see the chest rise and fall. What is your next action? | Reposition the head |
| The victim has adequate pulse and respirations have resumed, but he remains unconscious. What position will you place him in and why? | Recovery position |
| As a health care provider you will encounter death often. Our job is to approach the dying person as well as the family with caring, respect, and kindness, meeting their needs holistically. Meeting the dying persons needs holistically means you are meeting their___,___, ____and_____needs. | Physical, psychological, social, spiritual |
| The dying person and family often practice attitudes about death based on____ and ____preference. Our role is not to___and accept each individuals unique preferences. | based on religious beliefs and individual preferenceNot to judge |
| Stage one | Denial- the person refuses to believe they are dying. |
| Stage two | Anger- The person blames others. |
| Stage three | Bargaining- They make promises with God in exchange with God |
| Stage four | Depression- Mourn loss of things and future life |
| Stage five | Acceptance- Enters a stage of calm and peace. |
| The CNS’s role is listening, provide touch as appropriate, and provide for their spiritual, cultural needs. Communication can be difficult. Which statement is beneficial? 1. “I understand what you are going through”2. “Would you like to talk. I have time to listen” | “Would you like to talk. I have time to listen” is more helpful. |
| How often are family and friends with the dying patient? Do we limit this time? | Friends and family are with the patient at all times. The time is not limited. |
| Vision | Blurs and gradually fails. Explain what you are doing around the person, provide eye care. |
| Speech | Becomes harder to perform, hard to understand. Ask simple questions that have simple answers. |
| Hearing | The last to go. Explain what you are doing and provide reassurance. |
| As circulation fails, the person may feel____ but the body temperature actually___. Will you need to provide extra coverings? | The person may feel cold but the body temperature actually increases |
| What care measures are needed in regards to oral hygine, skincare, and elimination? | Frequent oral hygiene, careful skin care. Clean up incontinence |
| The focus of hospice is not to provide life___measure, but to improve the ____of the dying person’s life to the fullest extent possible. | Not life saving but to improve the quality |
| Hospice care is provided for persons with a life expectancy of ____ or less. | 6 months or less |
| What is an advance directive? | Document stating the person's wishes about healthcare in the event they are unable to make a decision themselves. |
| Do all patients have the right to an advanced directive on admission? | Yes |
| What is a durable power of attorney for health care? Who makes health care decisions? | Gives a person a final say over athe patient's care |
| What is a DNR status? Who writes this order? Are there any recitation measures implemented when death occurs? | Do Not Resuscitate. The MD writes the order. No recitation measures are implemented when death occurs |
| The patients self determination act and OBRA gives persons the ___ to accept or refuse medical____. | Right to accept or refuse medical treatment |
| Identify signs that death is occurring. What are the final signs that death has occurred? | Movement, muscle tone, sensation are lost. Gi functions slow down. Body temperature rises but the patient feels cold. Circulation fails, pulse is fast, weak, and irregular. Final signs are no pulse, respirations, BP. |
| The stiffness or rigidity of skeletal muscle that occurs after death is ___. | Rigor motis |
| Who pronounces the patient? When is post mortem care done? When rigor mortis in and what will occurs with rigor mortis? Is the patient’s alignment important? | MD pronounces the patient. post mortem care is done after the MD pronounces the patient. the patient’s alignment is important |
| Care of the person after death is ___ ? | Post mortem care |
| When providing post mortem care do you implement universal precautions? | yes |
| What is done with the denture? Personal belongings? | Dentures are placed in a container. Place belongings in labeled bag. |
| Before and after death the patient's right to ___ and ___ is always upheld. | Right privacy and spirituality |
| Define dementia? Is it acute, chronic, reversible or irreversible? | Loss of cognitive functions. It is the irreversible changes in the brain |
| What is delirum and how do the two differ? Which is AD? | Acute change in mental status, which is reversible. AD is dementia. |
| Define AD. | It is a chronic, progressive, degenerative disease of the brain. |
| What are the pathophysiological changes in the brain of a person with AD? These changes cause death and destruction to brain ___ | Abnormal clumps and tangles in the neuro fibers of the brain. Destruction of brain cells. |
| How does the diagnosis of AD occur? What is the definitive diagnosis? | Several tests are used. When all other causes of dementia are ruled out. |
| Very mild cognitive decline | Person thinks they are having memory lapses. Person misplaces item and forgets names of common items. |
| Mild cognitive decline | Other people notice problems with the person. Social functions decline. |
| Moderate cognitive decline | Memory of recent events declines. Withdraw socially. Unable to shop for things |
| Moderately severe decline | Major memory issue occurring. Confusion of days of week. Chooses inappropriate clothing. Still knows names of self, spouses, and children |
| Severe cognitive decline | Memory is much worse. Personality and behavior changes. Delusions, hallucinations, and repetitive behaviors |
| Very severe decline | The person cannot respond to their environment. Cannot speak or control movements. |
| The best approach for a disoriented patient is to provide a ___ environment | Calm and quiet |
| Identify 2-4 ways to help a disoriented person become better oriented to reality. | Use reality aids such as clocks or calendars. Reduce changes in environment. Orient the person in person, place, and time. |
| The person who is disoriented may benefit from ___ orientation. | Reality orientation |
| Sundowning | Restlessness increases as day ends. Complete activities during the day. Provide calm, quiet environment. Do not attept to reason with them. |
| Hallucinations/Delusions | delusion- false belief not supported by sensory or objective evidence, hallucinations- the perception of sights or sounds that are not present. Do not correct the person. Reassure the the person by telling them you will protect. Check that their glasses and hearing aids are in. Cover mirror if patient finds reflection alarming. |
| Catastrophic reactions | Increased physical activity, talking or mumbling. Explosive behavior with physical violence. Monitor behavior closely. Watch for signs of agitation. Chek for basic needs. |
| Screaming | Person has problems communicating. Are often not understandable. Make sure basic needs are met. |
| Abnormal sexual behaviors | Sexual behavior happens with the wrong person, wrong place, wrong time. The person often mistakes someone else as their sexual partner. Provide privacy and protect other residents |
| Repetitive behaviors | The person repeats the same behaviors over and over again. Words and phrases are repeated. Use distractions such as walks, music, or movie. |
| Caring for the person with AD involves maintaining the person's functional ___as long as possible; maintain a ___ environment, having a personal ___ needs met, and ___ the person's dignity. | person's functional ability as long as possible; maintain a safe environment, having a personal care needs met, and maintain the person's dignity. |
| The environment | Calm and quiet |
| Communication | Simple |
| Safety | Keep environment safe to walk in |
| Poor sleep cycle/habits | Promote proper routine and structure |
| Personal Care | Have same person provide person care that can not be done by the patient |
| At stage of AD should a living will or advanced directives be determined? | Mild to moderate cognitive |
| Your patient is repetitively folding a napkin. Is this harmful behavior? | No |
| If you patient is screaming out, what could this mean? What will you assess? | This could mean a unmet need. Assess if all needs are met. |
