1. Low sodium (NA/salt)
2. Low fat/ fat free
3. Diabetic-counting carbs
1. Surgery- under anesthesia they can have emesis (vomiting) and aspirate (stomach contents end up in the lungs)
2. Certain diagnostic tests- Barium X-rays where they need an empty G.I. tract.
3. Blood work- some blood work requires that you have to fast 8-12 hours. FBS = Fasting Blood Sugar (Fasting blood sugar (FBS) measures blood glucose after you have not eaten for at least 8 hours. It is often the first test done to check for prediabetes and diabetes.)
Think of the tests that are done that require no eating of breakfast/a meal.
1. Fluids are necessary for life
2. We can live several weeks w/o solid food but only a few days w/o water.
3. All activities of a living organism happen in milieu of water.
What to know about hydration.
1. Necessary for metabolism- Metabolism is the sum of all physical and chemical changes that transform food into body energy. Fluids are the transport medium.
2. Circulation- Blood cells need fluids to move them throughout the body.
3. Assist w/ excretion of waste materials thru the renal system.
4. Maintain body temp.- Our bodies are cooled by the evaporation of perspiration.
5. Lubrication- Saliva, Joint fluids and Skin turgor.
What are the functions of fluids?
1. Drinking fluids
3. When output exceeds intake the hypothalamus is activated and we become thirsty.
What are the sources of hydration and what is the function of the hypothalamus when it is activated?
1. Urinary output is the most obvious - 55%
2. Skin thru perspiration, - 25%
3. Lungs thru expired air, - 12%
What are the channels of output?
1. Fluid intake should total about 1500-3500 ml/day
2. If intake is higher than output fluids will be stored in the tissues and edema results.
3. When a person's output exceeds his intake dehydration results.
4. When fluids are imbalanced then the body is also out of balance chemically (electrolyte imbalance)
5. I & O Should be about equal each day.
Facts to know about I & O:
4. Large, draining wounds
5. Profuse diaphoresis
6. Blood loss
What are the causes of Dehydration?
1. Dry, warms skin (body trying to conserve water by decreasing perspiration)
2. Decreased water in subcutaneous tissue. (test turgor if skin does not go back to original shape then dehydration is present.)
3. Dry lips, thick oral membrane dry tongue
4. Scanty, concentrated urine (kidneys are reabsorbing fluids rather than excreting them)
What are the symptoms of Dehydration?
1. Whenever the body in fluid and electrolyte imbalance it can become progressively worse.
2. When this happens it can become incompatible with life.
3. Treatment will include IV fluids containing electrolytes until normal balance can be regained. (good ex of this treatment when i got sick when i was 10 for like 4-5 days in the hospital)
What are things to be aware of when the body is out of balance?
1. Assess for dehydration
2. Record I & O
3. If needed push fluids with a specific plan as noted on the nursing care plan.
4. Usually, you will want the patient to get at least 2000ml/day.
5. H20 is the only nutrient to be absorbed from the large intestine, small intestine is the site of absorption of simple nutrients.
What are your Nursing responsibilities?
1. Find out what liquids the patient prefers.
2. Save liquids from the tray and offer them at frequent intervals.
3. Make sure the patient is swallowing.
4. Position properly-head elevated.
5. If they cannot drink from a glass use a - straw, spoon or syringe.
What to think about when making a schedule for pushing fluids.
1. The study of aging.
2. Geriatrics- The treatment of diseases of old age.
3. We consider the elderly to be older than 65
4. The truth is that some people are elderly at 55 and some not till 75
1. Populations age when the proportion of older persons relative to younger persons increases.
2. The American population has been aging steadily since 1800.
3. The pace of this aging has increased dramatically inthe last several years.
4. Since 1960 the population below 15 has declined by at least 28%
Aging of Society
1. The ranks of the elderly has more than doubled since 1960.
2. The population of frail elderly, those over 85, has quadrupled in this same period.
3. By 2035, 1/4 of all Americans will be over 65
4. Since women, on average, live longer than men the majority of this group will be women.
Our population is still getting older
1. Most of them will: Not have a spouse, live alone, be poorer than elderly men would be.
Problems for these ladies?
1. The elderly are by far the heaviest users of the healthcare system.
2. Women, in general, seek medical care earlier and more often than mend do.
3. Per capita expenditures for the elderly are nearly 4x as high as for those under 65.
4. Currently the greatest need for aged health care is the health promotion and illness prevention.
What are the Implications for the health care system?
3. Social Security
4. Public Aid
5. Some have supplemental private insurance. Difficult for the less well-off to meet premium payments.
What are the major issues of funding?
1. Own homes/ apartments
2. With relatives
3. Retirement communities
4. Nursing homes, also called Extended Care Facilities
Where are our elderly?
Most are for profit: Sheltered- assisted living, people care for themselves with reminders, prepared meals, organized outings etc.
Intermediate- Person needs nursing and supportive services
Skilled-person is very dependent and needs the most assistance with skills such as tube feeds, IVs, catheters etc.
What are the types of nursing homes?
2. Day care
3. Council on aging
4. Low cost transportation
5. All you can eat restaurants
6. Store discounts for the elderly
7. Home health
What are some other services?
1. Decrease in height
2. Porous bones
3. Stiffening joints
4. Slowed movements
5. Changes in balance
6. Loss of strength
7. Muscle atrophy
Changes as we age in Musculosketeletal?
1. Atrophy of brain tissue
2. Changes in levels of neurotransmitters
3. Slowed response time
4. Memory changes (these begin after 40)
5. Decreased DTR's (Deep Tendon Refelxes) pupil size, stage 4 sleep, righting reflexes, perception of deep pain and temperature changes.
How people's neurological and cognitive abilities change with aging.
1. Heart valves thicken and become less effective.
2. Aorta and peripheral arterial system becomes stiff resulting in circulatory changes and increased BP.
3. In an effort to compensate the hear pumps more resulting in an increased pulse.
4. Decreased myocardial perfusion orthostatic hypotension.
How does aging affect the heart?
1. Decline in functioning begins after 40
2. Slight decrease in size
3. Becomes flabbier
4. Bronchi harden
5. Mucous glands degenerate
6. 02 saturation drops to 93-94%
7. Decreased tidal volume.
How does aging affect breathing/pulmonary?
1. Primary changes here are related to cardiovascular changes.
2. Elderly become more concerned about their voiding and bowel movements.
3. Decreased bladder capacity, renal blood flow, decreased GFR - glomerular filtration rate is the best test to measure the efficiency of kidney function and determine your stage of kidney disease. Your doctor can calculate it from the results of your blood creatinine test, your age, race, gender and other factors.
The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.
How does aging affect the renal system?
1. Risk for developing Diabetes Mellitus. Increases after age 40.
2. DM is not however, a normal process related to aging.
How does aging affect the Endocrine system?
1. Decreased appetite
4. Difficulty moving
5. Fear of Falling
6. Decreased vision
8. Skin thins
What are the physical concerns of aging?
2. Sensory overload/deprivation
3. Demanding, often difficult behaviors
7. Fear of Death/ wish for death
How are emotions affected by aging?
1. Can they stay safetly in their homes?
2. Do they need institutional care?
3. Elder abuse is a growing problem.
What are some family/ social relationship issues?
1. Cancer- Incidence increases with age (e.g. g-ma), They have been exposed longer to carcinogens, and the immune system functioning declines as we age.
2. TIA's - Transient Ischemic Attacks= Interruption of blood flow to the brain that lasts less than 24 hours.
What are the elderly susceptible to?
1. Cardiovascular- Coronary Inefficiency due to inadequate blood & O2 supply to the heart muscle. Causes Angina-An oppressive pain or pressure in the chest caused by inadequate blood flow and oxygenation to heart muscle. It is usually produced by atherosclerosis of the coronary arteries and in Western cultures is one of the most common emergent complaints bringing adult patients to medical attention.
2. CHF (Congestive Heart Failure) or HF, heart failure. Loss of the ability of the heart to pump sufficient amounts of blood to meet demands of the body. This increases fluid in the lungs(pneumonias). Edema of the feet and legs (poor kidney functioning)
What are other health problems that the elderly face? Know what Angina is. What is CHF and what does it cause?
1. CAD- Coronary Artery Disease "hardening of the arteries"
2. Coronary insufficiency which means that there is a lack of sufficient blood supply.
What are more heart problems that the elderly encounter?
1. Cardiac glycosides to strengthen the pumping action of the heart and regulate the heart beat. Digoxin (lanoxin).
2. Diuretics to remove excess fluids (look and asses I & O). Fureosmide (lasix).
3. Antianginals- to dilate coronary blood vessels. Nitroglycerine(patch, paste, tablets).
What kinds of medications can treat the heart?
1. About 50% of those over 65 have hypertension
2. Hypertentsion is currently defined as a bp greater than 120/80.
3. In the elderly this is caused by a thickening of the blood vessel lumen due to the atherosclerosis(The most common form of arteriosclerosis, marked by cholesterol-lipid-calcium deposits in the walls of arteries that may restrict blood flow).
4. Vessels lose their elasticity.
5. Retain fluids as kidney vasculature changes.
What do you need to know about hypertension for the elderly?
1. Antihypertensives: work in a variety of ways to enhance peripheral circulation. e.i. Aldoment. Minipres, capoten etc.
2. Cardiac glycosides (which increases the contracility of the heart which makes heart rate go down. Which is why you have to asses bp before giving any of these meds). These glycosides are used primarily to treat HF.
3. Diuretics - remove excess fluids and decreases circulating blood volume.
What meds are used to do in treat hypertension?
1. CVA= Cerebral Vascular Accidents, also known as stroke.
2. Caused by either Hemorrhage into the brain caused by either a weakening or rupture of the vessel wall or, too much pressure on the wall from hypertension.
3.Caused by blockage or infarction of a cerebral artery either due to an emboli (A mass of undissolved matter present in a blood or lymphatic vessel and brought there by the blood or lymph ) or the gradual build of a thrombus (A blood clot that adheres to the wall of a blood vessel or organ.
In many cases it may obstruct the vessel or organ in which it resides, preventing the flow of blood. Anticoagulants are used to prevent and treat this condition. )
What are CVA's? What is it caused by?
1. These symptoms occur as a direct result of damage to the brain.
2. On the left side: Damage to the left side of the face and the right side of the body.
3.On the right side: Deficits on the right side of the face and the left side of the body.
What are symptoms of CVA?
1. There may be either paralysis or Paresis(weakness).
2. Left side of the brain is dominant in right handed people ans some left handed people and vice versa for the rest of left handed people.
3. For all of us the dominant side contains speech functions, speaking and comprehending.
What are some other effects of CVA's? Talk about the dominant brain for left/right handed people. What does the dominant side contain?
1. The non-dominant side of the brain contains centers for orientation, perception, expression attention, and memory-otherwise known as AFFECT(expression).
2. Decreased perception discrimination and decreased ability to hear.
What does the non-dominant side of the brain contain?
1. When a CVA happens there is initially some cerebral edema (sweeling of the brain) around the area of trauma. (all trauma causes swelling)
2. Some immediate deficits will improve as the edema subsides.
3. The amount of return will be dependent on the size of the damaged area and how quickly treatment begins.
When does cerebral edema occur?
1. Heparin (heparin and coumadin are anticoagulant that reduce clotting but do not get rid of existing clot. The down side to these meds is if you were to get cut you could bleed out a lot more than if you were not on one of these meds.)
3. Aspirin (anticoagulant)
.What meds are used to interfere with clotting mechanism? Know the affects of anticoagulant meds.
1. Bed rest
2. Elevate head of the bed
3. Remember- the initial edema will often make the deficits look greater than they will be after swelling subsides.
What are other treatments besides meds?
1. Aphasia - speech disorder
2. Dysphagia - swallowing dysfunction
3. Apraxia - inability to recall how to place the tongue, lips, and other parts of the speech mechanism.
What does Aphasia, Dysphagia, and Apraxia?
1. The elderly have poor circulation and decreased metabolism.
2.Older patients will be more sensitive to cold and drafts: they will need sweaters and blankets even when you feel warm, they often have cold feet.
Why do the elderly feel chilly a lot of the time?
1. The chance of developing DM increases with every decade of life.
2. It is the result of inadequate production of insulin by the pancreas.
3. We monitor DM by checking blood glucose levels.
4. Urine testing is no longer the testing procedure of choice.
What you should know about diabetes?
1. Meds include oral hypoglycemics and insulin.
2. Diet has to change
3. Usually an increase in activity is necessary
4. Frequent blood testing has to be done
5. Frequent DM evaluation
What will the treatment of DM mean for changes that must be made?
1. Cataracts, glaucoma, blindness
2. Kidney disease
3. Peripheral vascular complications
4. CHF (congestive heart failure- must have tight hyperglycemic control)
6. Poor wound healing
What are diabetics more prone to?
1. More prone to constipation and fecal impaction. This is usually due to decreased fiber in their diets. Decreased metabolism and activity. Decreased muscle tone.
2. More issues with GI bleeds especially if they are on anticoagulants.
How does aging affect the GI tract/ what are the problems that occur in the GI when aging occurs? What meds cause more problems when GI bleeds occur?
2. BPH (A nonmalignant enlargement of the prostate gland caused by excessive growth of prostatic nodules. The enlargement of glands surrounding the urethra causing difficult or painful voiding due to the added pressure of the urethra from the enlarging of the prostate.
3. Chronic real failure - Kidney function deteriorates with age due to vascular changes in the kidneys. May be long term, progressive, or chronic
What urinary problems occur with aging?
1. General changes include: Posture becomes flexed (hunch back)
2. Loss of muscle mass and strength-exercise
3. Shift in the center of gravity due to postural changes: Stance changes, moves more slowly, falls more common.
4. Osteoporosis: bone loss calcium, especially women. Hormonal changes inerfere with CA use. Reduced bone mass, Bones become more fragile and brittle.
5. Fractures occur more easily. Even with a stress that wouldn't normally cause a fracture. Bones vertebrae, wrist and femoral head.
What musculoskeletal Issues occur with aging?
1. Breakdown of bone formation at the joints, especially of the extremities.
2. Becomes more problematic as a person ages.
3. Aggravated by obesity
4. Pain/ stiffness the most common symptoms
5. Treat with total hip replacement e.i. mom
What you need to know about Osteoarthritis.
When considering out body systems remember IF YOU DON'T USE IT. YOU LOSE IT!!!
What is key to understanding the process of aging?
1. Less immunity
2. More prone to infections
3. Less active
4. Decreased fluid and nutritional intake
5. All these factors make the elderly more at risk for developing respiratory infections/ diseases.
What respiratory changes occur during aging?
1. Pneumonia- increased risk of pulmonary edema with this diagnosis.
2. COPD- Chronic obstructive pulmonary diseases. A group of diseases which prevent a person from receiving adequate O2
3. Asthma, emphsema, and chronic bronchitis are examples of COPD.
4. COPD is not reversible.
What are some examples of respiratory problems? Is COPD reversible?
1. Parkinson's is a chronic neurological disease.
2. A progressive disease affecting brain centers which are responsible for control of voluntary movements
3. Caused by depletion of dopamine (a neuotransmitter) in certain ares of the brain.
What is Parkinson's disease?
1. Impaired movement
4. Prone to loss of: balance, postural reflexes, these often lead to falls.
What are the symptoms of Parkinson's disease and what are these people prone to?
1. There is decreased circulation to the skin.
2. Atrophy (shortening) of the skin cells.
3. Prone to changes cell growth , both benign and malignant.
4. Prone to skin infections
5. Skin becomes dryer, needs lubrication
How does the skin change with age what are these elderly prone to when it comes to the aging of skin?
1. The issue is - will the elderly have enough money to live on?
2. Retirement brings 1/2 to 2/3 cut in income.
3. Some elderly become poor when they retire
4. Inflation makes this deficit greater.
5. Social security benefits are often the only income for the elderly.
6. What does this mean? -- Can they afford their meds and food or housing? Will they seek medical care on their limited income? What about utility bills?
What are some economic issues that the elderly encounter? What is the only income that elderly have and what does this mean for them?
1. All persons over 65 are eligible for some basic health insurance- Medicare.
2. This can be supplemented with private insurance.
3. The question remains-will these provide enough coverage?
There is some assistance given to the elderly that include what?
1. It's mainly due to losses:
2. Family support system
3. Their role
5. Their body image
6. Life style
7. Multiple losses often lead to depression.
8. They can become sad, feel hopeless without the ability to do anything about their situation.
9. Much will depend on how they coped with loss earlier in their lives and, of course on their support system.
Why are elderly people more lonely?
1. The elderly are often targets of crime.
2. They are frail
3. They may be too trusting
4. Who protects them?
5. Increasing incidences of elder abuse
What are the crime concerns for the elderly?
1. Probably the most common ailment of the aged.
2. This is a common disorder in all age groups but the depth of the depression can increase as we age.
3. Often a response to multiple losses.
4. Elderly are more physically prone to depression: depression is thought to be related to decreased neurotransmitter activity.
Neurotransmitters decrease with age.
What does depression mean for the elderly?
1. C/O of feeling sad, tired, worn out.
3. Poor appetite
4. Somatic complaints (especially bowel)
5. Loss of pleasure in previously enjoyed activities
6. Angry feelings (may not be expressed)
7. Thoughts of suicide
9. Agitated depression-increased motor activity: Pacing, gestures, suspiciousness, obsessive rumination-preoccupation with unlikely problems
10. Depression is NOT a normal part of the aging process!!!
11. What medication are useful: Zoloft, PROZAC and Paxel
What are symptoms of depression? What should you know when it comes to the elderly and depression? What can treat depression?
1. Nursing care measures can be helpful.
2. ECT- electric conductive therapy is sometimes used
3. Family support is helpful.
4. First step as always will be recognizing and seeking treatment for the depression.
What else can be helpeful for the depressed elderly besides meds?
4. Touch/ pain
What are some sensory changes that happens with aging?
1. Largest chronic physical disability on the U.S.
2. Approx. 13% of the aged will suffer a hearing loss sufficient to warrant professional attention.
3. Many hearing problems can be corrected w/ surgery/ hearing aids.
4. Individuals with distorted hearing tend to withdraw and live within themselves. E. I sometimes dad does that at parties b/c he just can't hear anybody. :(
5. Communication Tips: Get their attention before speaking, Articulate distinctly and slowly, allow them time to process the info-we are dependent on all our senses to do this.
What facts to know about hearing loss.
1. All of us will experience some visual changes as we age.
2. Objects look flat, mono colored and blurred.
3. We experience a decrease in depth perception, detail and color.
What are some Visual changes in the elderly?
1. Taste changes-now we will eat spicier foods.
2. the elderly no longer experience touch in the same fashion.
3. This decreased tacitle sensation causes them to be vulnerable to: sores, pain, burns, unknown pressure wounds.
What are some other sensory changes that occur in the elderly?
1. State in which stimulation in one or more of the senses is lacking.
2. This results in impaired sensory perception, and often, depression.
3. 3types: Reduced sensory input (hearing loss), Elimination of order or meaning (confusion), and Restriction of the environment (bed rest).
What is Sensory Deprivation and does this affect the senses ability to sense? What are the 3 different kinds of sensory deprivation?
1. They may: withdraw from social contact.
3. become confused
4. become depressed.
5. In adults these symptoms can cause us to question: is the person psychologically ill? confused? Suffering from a sever electrolyte imbalance? Under the influence of mood altering drugs? (psychotropic ie. Xanax, Ativan)
So what happens to the elderly who experience sensory deprivation? And what might nurses think of the elder person?
1. Provide sensory stimulation
2. Keep date and time posted in their sight line.
3. Get them out of their rooms.
4. Encourage them to join interest groups.
5. Correct sensory problems if possible.
What can we do to help the elderly that have been deprived of senses?
1. Stimulation of 1 or mor of the senses is so excessive the brain disregards or does not respond meaningfully to the stimuli.
2. In the hospital provide info in manageable amounts to prevent this.
What is Sensory Overload?
1. Irregular radial rhythm (I Had Poops)
2. History of cardiac disease
3. Prior to administration of certain medications
Why would you check apical pulse?
An abnormally rapid heart rate, greater than 100 beats per minute (bpm) in adults.
A heart rate under 60 bpm
Abnormal, disordered, or disturbed rhythm.
Irregularity or loss of rhythm, esp. of the heart.
Very normal as a person inhales pulse increases and slows down on exhalation.
Doubling of a heart beat.
Extra sound when blood is going to a place it shouldn't. Always abnormal, but if someone is not feeling devastating symptoms then do not operate.
Result of AV valves (mitral and tricuspid) closing at beginning of systole.
Dull, low pitched
best heard at 4th ICS, left of sternal border
Closing of aortic and pulmonic valves and end of systole.
Higher pitched, shorter
best heard at 2nd ICS, left and right of sternum.
a 3rd sound that immediately follows s2. Result of heart failure, ventricular volume overload
a 4th sound that immediately precedes s1 result of increased ventricular filling.
You count for full minute when you asses abnormal radial pulse readings, person has heart disease etc.
When do you count for a full minute?
def: the measure of the pressure exerted by blood as it pulsates through the arteries.
What is the definition of blood pressure?
There are two systolic and diastolic.
How many pressures are there? and what are they called?
Result of contraction of the ventricles
When ventricles are at rest.
Who are the three players?
The hypothalamus directs the body to conserve heat by constricting blood vessels in the skin.
What happens when the blood flow is cooler than hypothalamus set point?
Until the temp. of blood is higher than set point of hypothalamus.
How long does heat production go on for?
What is temperature controlled by?
Heat is produced by by bodies chemical reactions concerned with metabolism and energy release.
What is heat produced by?
It takes place through regulation of blood flow through skin, sweating and shivering.
Where does the adjustment of body heat take place?
The hypothalamus directs blood vessels to dilate.
What does the the hypothalamus do when the bodies temp is higher than the set point?
warm blood to body surface so that its heat can be lost to environment.
This brings a large flow of .....
The hypothalamus also stimulates sweat glands to produce sweat. When sweat evaporates it cools the skin.
What else does the hypothalamus stimulate? And why does stimulating these ____ _____ help with making the body cooler?
36.5C-37.4C, 97F-99F. It takes 3-5 minutes to take oral temp.
What is the normal oral temp range? Howl long does it take to take oral temp.
37.5C 99.5 F It takes 3 minutes to take a rectal temp
What is the normal Rectal temp? How long does it take to take a rectal temp.
36.5C 97.6F It takes 5-10 minutes to take an axillary temp.
What is the normal axillary temp? How long does it take to take a axillary temp?
You shake it down below 95F.
What do you do before taking a temperature with a mercury thermometer?
Red=Rectal and Blue= oral/ axillary
What does red and blue mean on thermometers?
You should asses for weather or not they ate, drank, or chewed gum or smoke in the last 15 minutes. Any of these things could raise temp.
Before taking an oral temp what should you asses for and why?
1. Skin warm, dry and pale
6. Dry mucous membranes and skin
8. Flushed face
9. Decreased urine output.
What are the signs of rising temp?
1. Vasodilation skin less pale
What are the signs of lowering temp?
Difficulty breathing in a horizontal position
(end of life breaths) irregular periods of apnea alternating with rapid breathing.
Hyperventilation increase in rate and depth.
Increased temp will usually result in increased pulse and respiratory rate.
What is the relationship between temperature and pulse and respiratory rate?
1. Always at beginning of shift.
2. As ordered by physician.
3. Before and after certain diagnostic procedures.
4. According to unit policy.
5. When your assessment indicates need. Ex abnormal rate of respiration/ change in VS.
When to take vital signs
1. Patient confused
2. Patient unconscious
3. Oral surgical procedures
4. Nasogastric tube in place
When should you not take oral temp?
Measures the number of times the left ventricle contracts to eject blood in the aorta.
What is the definition of pulse?
# of heartbeats per minute
Rhythm and (force)fulness e.g. bounding, strong, thready and weak.
body area were a large artery runs close to the surface and can be pressed to bone. e.g. radial/ brachial
indication of how evenly the heart is beating-regular or irregular.
Arterial pulse slower than apical pulse due to ineffective contraction of heart.
1. Diarrhea present
2. Rectal surgery
When should you not take a rectal temperature?
1. Blood Pressure
What does taking vital signs include?
in the 4 quadrants surrounding the belly button.
Where do you listen for the bowel sounds?
You asses weather or not they are absent, hypoactive or hyperactive. Normal range =5-35
What do you asses for in the bowel sounds?
What is the most basic technique in preventing and controlling the transmission of pathogens?
1. Before and after contact with a client
2. After touching organic material
3. Before invasive procedures
4. Before dressings
5. Before preparing meds
6. After touching contaminated materials
How often does the CDC suggest a nurse to wash her hands.
You must use soap if client has Clostridum dificale. infection, commerical products are ineffective
When do you have to wash your hands with soap & water?
1- 2 sheets, both flat or 1 fitted and 1 flat
2 - pillow case or as many as needed
3 - Draw sheet
4 - Bath blanket
5 - Thermal blanket
6 - spread
What is the equipment for bed making?
The spread and thermal are reusable.
What may be reusable if not soiled?
Entire bed frame tilted downward with head of bed down.
Entire bed frame tilted up with foot of bed down
Client facing down, watch face arms and feet
Body weight rests on hip and shoulder
Side laying (laterl)
Body weight rests on ileum, humerus, and clavicle
Sims (semi- prone)
This position is for pelvic exams and tests i.e. pap smears
Client flat facing up
What type of diet is easy to chew?
What type of diet is soft and low in residue, that is low in roughage and spices?
What type of diet consist of liquids that you can see thru. ex. jello.
What type of diet consists of anything that is liquid at room temp. such as ice cream, custard.
It is usually filled out for the next day in the am/morning.
When is the menu filled out?
Only if the patient needs some extra assistence when filling out the menu.
Do you assist the patient to fill out the menu?
You only call if necessary.
When do you call the dietitian?
You should check for tray delivery times and make sure your patient has the right meal.
What should you check/ review?
Check if patient on NPO/ Nothing by mouth.
What is an important thing to check for?
You monitor intake
what do you monitor?
Make food accessible for the patient.
What should a nurse do when setting up the place to eat?
Position patient raise head of bed to comfortable eating height. Turn to side if unable to raise the bed
up in chair if possible
How should the patient be positioned?
Room should be free of odors
No unemptied bedpans
No filled urinals
How should the atmosphere be in the room when the patient is about to eat?
What to you do to convey an unhurried atmosphere when feeding the patient?
Let them know what is on the tray and check for preferences
What should you let the patient know and what should you check for?
Allow them to do as much for themselves as possible
How much do you allow the patient to do for him/her self?
Offer liquids frequently, it is easier to take solids and liquids together.
What should you offer frequently and why?
Prepare the food
What should you do when getting food for the patient with limited motion?(i.e. a stroke patient)?
When we prepare the food it can also be called a ___ ___.
No, but you should encourage them to do as much as possible for themselves.
Should the patient with limited motion be made to do everything for him/her self?
When feeding the patients you don't want them to _____. But feed if needed.
You should offer smaller portions more frequently.
What do you want to do for your patients that are poor eaters?
You should have them eat the more nutritious foods first. I.e. milk before coffee.
What should you have them eat first?
Make sure you order their favorite foods if possible
If you are able to, what should you do for the patient when ordering their food?
What should you talk to them about while they eat?
Use a clock as a reference guide to tell them where on the tray different foods are located.
What should you do for eaters who can feed themselves but are blind?
If they cannot feed themselves tell them what you are feeding them so they know what to expect.
What should you do if the blind patient cannot feed themselves?
Always encourage them to do as much for themselves as they can.
What should you always do for the patient when feeding/ giving them their meals?
You have to document how well they ate.
What do you as a nurse have to do after they ate?