Axilla | Underarm/armpit |
Bedpan | Device for receiving feces or urine from either male or female patients confined to bed |
Canthus | Corner of eye |
Cerumen | Wax |
Circumorbital | Circular area around they eye |
Dentures | Set of artificial teeth not permanently fixed or implanted |
Febrile | Condition characterized by an elevated body temperature |
Hygiene | Principles of health |
Labia majora/minora | Majora: Larger fold/lip
Minora: Smaller fold/lip |
Medical asepsis | "clean technique"
Inhibits growth and spread of disease producing microorganisms |
Oral hygiene | Care of the oral cavity |
Pathogenic | Disease producing |
Perineal care | Care of the genitalia area |
Personal hygiene | Self-care measures people use to maintain health and prevent disease |
Prone | Lying face down |
Range of Motion (ROM) | Normal movement that any given joint is capable of making |
Sims position | Side lying position |
Supine | Lying face up |
Syncope | Fainting |
Umbilicus | The depressed point in the middle of the abdomen |
Urnial | A device for collecting urine from male patients
Urinals for females are also available |
Vasoconstriction/vasodilation | Constriction: Narrowing of blood vessels, decreased blood flow
Dilation: Dilation of blood vessels, increased blood flow |
Vertigo | Dizziness |
Recommended room temperature | 68F (20C) to 74F (23C) |
Why is good ventilation necessary? | To keep stale air and odors from lingering |
Factors that influence a patient's personal hygiene | Body image
Cultural variables
Knowledge
Personal preference
Physical condition
Social practices
Socioeconomic status |
What are different bed positions used for? | Used to promote lung expansion, postural drainage, and other interventions |
Full side rails are considered to be what? | A form of restraint in a long-term care setting |
Fowlers/High fowlers | Head of bed raised to 45 degree angle up to 90 degrees
Semi sitting to full upright sitting position
Used for eating/drinking to prevent aspiration and to promote full lung expansion |
Semi/Low fowlers | Head of bed raised approx. 30 degrees
Used for patients who cannot tolerate fowler's/high fowler's or position is ordered after lumbar puncture |
Trendelenburg's | Entire bed tilted downward toward head of bed
Facilitates removal of secretions with postural drainage, venous return in patients with poor peripheral circulation, sometimes used to aid in dilation of large vessels for central line placement |
Reverse trendelenburg's | Entire bed frame tilted downward toward foot of bed
Not commonly used; promotes gastric emptying and prevents esophageal reflux, Facilitates arterial circulation to lower extremities |
Flat | Bed is parallel with floor
Used for vertebral injuries, immediately after lumbar puncture, and in cervical traction
Preferred by patients for sleeping |
Explain a cool water tub bath | An option to relieve tension or lower body temp
Water temp is tepid, 98.6F (37C)
Cold water should not be used-causes chilling and shivering |
Explain a warm water tub bath | Used to reduce muscle tension
Water temp. is approx. 110F (43C) |
Explain a hot water tub bath | Relieves muscle soreness and muscle spasms
Not recommended for children
Proper water temp. for adults = 113F (45C) to 115F (46C) |
Explain a sitz bath | Cleanses and aids in reducing inflammation of perineal and anal areas |
Describe skin care data collection | Good turgor (elastic/firm); generally smooth and soft
Intact without abrasions
Localized changes in texture across surface
Skin color variants from body part to body part
Warm/moist |
Good nursing interventions involved with pressure ulcers and pressure injuries can result in what? | Optimal healing of impaired skin without complications
Decrease in patient's discomfort
Decrease in length of stay at facility
Decrease in cost of ongoing care |
Shearing force | Tissue layers of skin slide on each other causing subcutaneous blood vessels to kink or stretch and resulting in an interruption of blood flow to the skin |
Friction | Rubbing of skin against another surface produces friction which may remove layers of tissue |
Stages of pressure injury development | 1. Localized area of skin, typically over a bony prominence, that is intact with non-blanchable redness
2. Partial thickness, loss of dermis, looks like blister
3. Full thickness tissue loss, subcutaneous fat is sometimes visible
-Hardest layer to heal due to lack of capillaries
4. Full thickness tissue loss with exposed bone, tendon, cartilage or muscle |
Suspected deep tissue pressure injury | Wound appears as a localized purple or maroon area of discolored intact skin or a blood filled blister |
What temperatures can the body's thermoreceptors generally adapt well to? | 59F (15C) and 113F (45C) |
Explain what heat and cold applications are used for | Heat: provide comfort and speed healing
Cold: Decrease swelling and reduce pain |
What are warm soaks used for? | Increase circulation to the affected area, reduce edema, aid in the debridement of wounds, relax muscles, and can be used to apply medical solution to large areas
Temp. 105F (40.5C) to 110F (43C) |
What are cold compresses used for? | Used to treat inflammation and prevent edema
Can be either clean or sterile
Apply for 20 min at 59F (15C) |
What can ice packs be used for? | Reduce edema formation, bleeding, provide an anesthetic effect to areas of hemorrhage and hematoma formation, for patients who have undergone dental surgery |
Anticoagulant therapy | Meds that increase the tendency to bleed |