AY Honor Home Nursing Answer Key
Skill Level
2
Year
1938
Version
10.11.2024
Approval authority
General Conference
1
For tips and instruction see First Aid, Standard.
2
2a
- Creamed or clear soup
- Any drink following the criteria below.
- Pudding
- Jello
For a food to be classified as liquid, it would have to be able to be strained when heated. For example, tapioca pudding would not qualify, but a milkshake without pieces of fruit or other foods would qualify.
2b
A soft diet is recommended in many situations, including some types of dysphagia (difficulty swallowing), surgery involving the jaw, mouth or gastrointestinal tract, and pain from newly adjusted dental braces.
A soft diet can include many foods if they are mashed or pureed, covered or placed with in sauces or gravy, or placed in soups, stews, chili, curries.
A soft diet might include:
- Cooked Hot cereals: oatmeal, porridge, Weetabix/Farina/Cream of Wheat, Cream of Rice.
- Breakfast cereals: Cheerios, Cornflakes, Corn Pops, Corn Chex, Rice Krispies), softened/soggy in milk.
- Macaroni & Cheese (cooked soft, pureed in blender if needed.)
- Mashed potatoes and gravy
- Mashed sweet potatoes
- Pasta cooked soft
- Rice and gravy (cooked soft)
- Risotto
- Couscous
- Quinoa
- Baked potatoes (skinless) with sour cream or cream cheese
- Lasagna, chopped up with extra sauce over top.
- Asian fried rice or noodles with tiny bits of meat and soft veggies.
- Potato Salad, smooshed.
- muffin, pancake, or waffle. (if needed soften with syrup/butter and reheat.)
2c
This diet is culturally diverse, and includes the following:
- Food that is easy to digest.
- Not spicy
2d
A full diet is also sometimes referred to as a general diet. It includes all food items, including drinks.
3
Definition and Symptoms
Fever is most accurately characterized as a temporary elevation in the body's thermoregulatory set-point, usually by about 1–2 °C. Fever differs from hyperthermia. Hyperthermia is an increase in body temperature over the body's thermoregulatory set-point, due to excessive heat production or insufficient thermoregulation, or both. The person who is developing the fever has a cold sensation, and an increase in heart rate, muscle tone and shivering attempt to counteract the perceived hypothermia, thereby reaching the new thermoregulatory set-point. A fever is one of the body's mechanisms to try to neutralize the perceived threat inside the body, be it bacteria or a virus.
Measurement and normal variation
When a patient has or is suspected of having a fever, that person's body temperature is measured using a thermometer.
At a first glance, fever is present if:
- Temperature in the anus (rectum/rectal) or in the ear (otic) is at or over 38.0°C (100.4°F)
- Temperature in the mouth (oral) is at or over 37.5 °C (99.5 °F)
- Temperature under the arm (axillary) is at or over 37.2 °C (99.0 °F)
The common oral measurement of normal human body temperature is 36.8±0.7 °C (98.2±1.3 °F). This means that any oral temperature between 36.1 and 37.5 °C (96.9 and 99.5 °F) is likely to be normal.
However, there are many variations in normal body temperature, and this needs to be considered when measuring for fever. The values given are for an otherwise healthy, non-fasting adult, dressed comfortably, indoors, in a room that is kept at a normal room temperature (22.7 to 24.4°C or 73 to 76 °F ) , during the morning, but not shortly after arising from sleep. Furthermore, for oral temperatures, the subject must not have eaten, drunk, or smoked anything in at least the previous fifteen to twenty minutes.
Body temperature normally fluctuates over the day, with the lowest levels around 4 a.m. and the highest around 6 p.m. (assuming the subject follow the prevalent pattern, i.e., sleeping at nighttime and staying awake during daytime). Therefore, an oral temperature of 37.2 °C (99.0 °F) would strictly be a fever in the morning, but not in the afternoon. An oral body temperature reading up to 37.5 °C (99.5 °F) in the early/late afternoon or early/late evening also wouldn't be a fever. Normal body temperature may differ as much as 1.0 °F between individuals or from day to day. In women, temperature differs at various points in the menstrual cycle. Temperature is increased after eating, and psychological factors also influence body temperature.
There are different locations where temperature can be measured, and these differ in temperature variability. Tympanic membrane thermometers measure radiant heat energy from the tympanic membrane (infrared). These may be very convenient, but may also show more variability.
Children develop higher temperatures with activities like playing, but this is not fever because their set-point is normal. Elderly patients may have a decreased ability to generate body heat during a fever, so even a low-grade fever can have serious underlying causes in geriatrics.
Treatment
Fever should not necessarily be treated. Fever is an important signal that there's something wrong in the body, and it can be used to govern medical treatment and gauge its effectiveness. Moreover, not all fevers are of infectious origin.
Even when treatment is not indicated, however, febrile patients are generally advised to keep themselves adequately hydrated, as the dehydration produced by a mild fever can be more dangerous than the fever itself. Water is generally used for this purpose, but there is always a small risk of hyponatremia if the patient drinks too much water. For this reason, some patients drink sports drinks or electrolyte-replacing products designed specifically for this purpose.
Most people take medication against fever because the symptoms cause discomfort. Fever increases heart rate and metabolism, thus potentially putting an additional strain on elderly patients, patients with heart disease, etc. This may even cause delirium. Therefore, potential benefits must be weighed against risks in these patients. In any case, fever must be brought under control in instances when fever escalates to hyperpyrexia (temperature about 42°C) and tissue damage is imminent.
Treatment of fever is normally done by lowering the set-point, but facilitating heat loss may also be effective. The former is accomplished with antipyretics such as ibuprofen or acetominophen (aspirin can be given to adults, but can cause Reye's Syndrome in children). Heat removal is generally by wet cloth or pads, usually applied to the forehead, but also through bathing the body in tepid water. This is particularly important for babies, where drugs should be avoided. However, using water that is too cold can induce vasoconstriction, and reduce effective heat loss.
Heat loss may also be accomplished by heat conduction, convection, radiation, or evaporation (sweating, perspiration), or a combination of these.
4
Pulse
A normal pulse rate for a healthy adult, while resting, can range from 60 to 100 beats per minute (BPM), although well conditioned athletes may have a healthy pulse rate lower than 60 BPM. Bradycardia occurs when the pulse rate is below 60 per minute, whereas tachycardia occurs when the rate is above 100 BPM. During sleep, this can drop to as low as 40 BPM; during strenuous exercise, it can rise as high as 150–200 BPM. Generally, pulse rates are higher in infants and young children. The resting heart rate for an infant is usually close to an adult's pulse rate during strenuous exercise (average 110 BPM for an infant).
Pulses are manually palpated with fingers. When palpating the carotid artery, the femoral artery or the brachial artery, the thumb may be used. However, the thumb has its own pulse which can interfere with detecting the patient's pulse at other points, where two or three fingers should be used. Fingers or the thumb must be placed near an artery and pressed gently against a firm structure, usually a bone, in order to feel the pulse.
Make sure the person is calm and has been resting for 5 minutes before reading the pulse. Put the index and middle fingers over the pulse count, and count for 30 seconds, and afterwards multiply by 2, to get the pulse rate. If the person's pulse rate is irregular, count for a full minute, and do not multiply. Averaging multiple readings may give a more representative figure.
Home blood pressure measurement devices also typically give a pulse reading.
Respiration Rate
The human respiration rate is usually measured when a person is at rest and simply involves counting the number of breaths for one minute by counting how many times the chest rises. Respiration rates may increase with fever, illness, and with other medical conditions. When checking respiration, it is important to also note whether a person has any difficulty breathing.
Average respiratory rate reported in a healthy adult at rest is usually given as 12 breaths per minute but estimates do vary between sources: e.g. 12–20 breaths per minute, 10–14, and between 16–18, etc. With such a slow rate, more accurate readings are obtained by counting the number of breaths over a full minute.
Temperature
See requirement 3 for this information.
5
Definition
An infectious disease is a clinically evident disease resulting from the presence of pathogenic microbial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa, multicellular parasites, and aberrant proteins known as prions. These pathogens are able to cause disease in animals and/or plants.
Transmission
Infectious pathologies are usually qualified as contagious diseases (also called communicable diseases) due to their potentiality of transmission from one person or species to another. Transmission of an infectious disease may occur through one or more of diverse pathways including physical contact with infected individuals. These infecting agents may also be transmitted through liquids, food, body fluids, contaminated objects, airborne inhalation, or through vector-borne spread.
Infection Control
Infection control and health care epidemiology is the discipline concerned with preventing the spread of infections within the health-care setting. As such, it is a practical (rather than an academic) sub-discipline of epidemiology. It is an essential (though often underrecognized and undersupported) part of the infrastructure of health care. Infection control and hospital epidemiology are akin to public health practice, practiced within the confines of a particular health-care delivery system rather than directed at society as a whole.
Infection control concerns itself both with prevention (hand hygiene/hand washing, cleaning/disinfection/sterilization, vaccination, surveillance) and with investigation and management of demonstrated or suspected spread of infection within a particular health-care setting (e.g. outbreak investigation). It is on this basis that the common title being adopted within health care is "Infection Prevention & Control".
Infection control in healthcare facilities
Hand hygiene
Independent studies by Ignaz Semmelweis in 1847 in Vienna and Oliver Wendell Holmes in 1843 in Boston established a link between the hands of health care workers and the spread of hospital-acquired disease. The Centers for Disease Control and Prevention (CDC) has stated that “It is well-documented that the most important measure for preventing the spread of pathogens is effective handwashing.” In the United States, hand washing is mandatory in most health care settings and required by many different state and local regulations as well as good sense.
Cleaning, disinfection and sterilization
Sterilization is a process intended to kill all microorganisms and is the highest level of microbial kill that is possible. Sterilizers may be heat only, steam, or liquid chemical. Effectivness of the sterilizer (often called an autoclave") is determined in three ways. First by the mechanical indicators and gauges on the machine itself, second the heat sensitive indicators or tape on the sterilizing bag turn color, and thirdly and most importantly is the biological test. With the biological test, a highly heat and chemical resistant microorganism (often the bacterial endospore) is selected as the standard challenge. If the process kills this microorganism, the sterilizer is considered to be effective. It should be noted that in order to be effective, instruments must be cleaned, otherwise the debris may form a protective barrier, shielding the microbes from the lethal process. Similarly care must be taken after sterilization to ensure sterile instruments do not become contaminated prior to use.
Disinfection refers to the use of liquid chemicals on surfaces and at room temperature to kill disease causing microorganisms. Disinfection is a less effective process than sterilization because it does not kill bacterial endospores.
Personal protective equipment
Personal protective equipment (PPE) is specialized clothing or equipment worn by a worker for protection against a hazard. The hazard in a health care setting is exposure to blood, saliva, or other bodily fluids or aerosols that may carry infectious materials such as Hepatitis C, HIV, or other blood borne or bodily fluid pathogen. PPE prevents contact with a potentially infectious material by creating a physical barrier between the potential infectious material and the healthcare worker.
In the United States, the Occupational Safety and Health Administration (OSHA) requires the use of PPE by workers to guard against blood borne pathogens if there is a reasonably anticipated exposure to blood or other potentially infectious materials.
Components of PPE include medical gloves, hospital gowns, bonnets, shoe covers, face shields, CPR masks, goggles, surgical masks, and respirators. How many components are used and how the components are used is often determined by regulations or the infection control protocol of the facility in question. Many or most of these items are disposable to avoid carrying infectious materials from one patient to another patient and to avoid difficult or costly disinfection. In the United States, OSHA requires the immediate removal and disinfection or disposal of worker's PPE prior to leaving the work area where exposure to infectious material took place.
Vaccination of health care workers
Health care workers may be exposed to certain infections in the course of their work. Vaccines are available to provide some protection to workers in a healthcare setting. Depending on regulation, recommendation, the specific work function, or personal preference, healthcare workers or first responders may receive vaccinations for hepatitis B; influenza; measles, mumps and rubella; Tetanus, diphtheria, pertussis; N. meningitidis; and varicella. In general, vaccines do not guarantee complete protection from disease, and there is potential for adverse effects from receiving the vaccine.
Post exposure prophylaxis
In some cases where vaccines do not exist Post Exposure prophylaxis is another method of protecting the health care worker exposed to a life threatening infectious disease. For example, the viral particles for HIV-AIDS can be precipitated out of the blood through the use of an antibody injection if given within 4 hours of a significant exposure.
6
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality. A symptom is subjective, observed by the patient, and not measured. A sign is noticed by the doctor or others. It is not necessarily the nature of the sign or symptom which defines it, but who observes it.
Symptoms include:
|
Pain |
Thirsty |
Paralysis |
7
Care for a Newborn
Newborns must have all of their needs met by others. About the only thing they can do by themselves is poop, pee and breathe (and in the case of premature births, sometimes not even that).
- Feeding
- A healthy newborn must be fed. Breast milk is best, but formula is a common alternative. If you do not know what the baby is drinking, ask the mother.
- Sleep
- Babies need a lot of sleep. Lay an infant on its back, and make sure the temperature is comfortable. If it's chilly, cover the baby's body (not the head!) with a blanket.
- Diaper
- When the baby soils a diaper, it should be changed.
- Holding a baby
- A newborn does not have strong enough muscles in the neck to support the head, so when the baby is held, the head must be supported at all times.
- Medical Care
- Newborns should see a pediatrician frequently. The first pediatrician visit almost invariably occurs in the hospital where the baby was born. A follow-up visit will be scheduled for a week later, and then again as scheduled by the pediatrician.
- Outdoors
- Dress the baby appropriately for the weather. If it's cold, bundle up. If it's hot, you will still need to make sure the baby does not get chilled. Protect the baby from rain, snow, and other forms of precipitation.
- Transporting
- If traveling in a vehicle, securely buckle the baby into a car seat approved for newborns. If carrying the baby, always maintain a firm hold (don't drop the baby!). In a stroller, buckle the baby in and cover with a blanket. Do not leave the stroller unattended, and always keep your hands on it (do not let it roll away).
Care for the Aged
Caring for the aged can be a complicated endeavor. Here are a few tips, but they only scratch the surface. The capabilities of the aged vary greatly, so not all of these tips will apply to all aged persons.
- Help them feel safe and secure.
- Keep a light pitcher of water within easy reach. Keep it full and remind remind them to drink from it. Staying well hydrated will ward off many problems including headaches, loss of appetite, and insomnia.
- Provide a TV remote with large, easy-to-see (and easy to press) buttons. This applies to the telephone as well.
- Regular exercise will improve mobility and help prevent pain caused by arthritis and other ailments. The aged person does not need to run a marathon, but they can often walk or even lift weights. Don't overdo it though.
- Keep them mentally engaged. Board games and hobbies are a must.
- Prepare appetizing meals within the limits of the aged person's diet. Mealtime is oftne the highlight of the day. Make the most of it.
- Keep the temperature comfortable. Seniors are at great risk when the temperature becomes either too hot or too cold.
- Understand the patient's medications. Know whether the medicine should be taken with food or without. Many medicines require that the patient avoid sunlight. Make sure the patient actually takes the medicine you administer, and make sure the dosage is correct. Read all the labels. If the prescription says to continue taking the medicine until it is gone, make sure the patient takes it until it is gone. Watch for allergic reactions and be ready to act.
8
Hands should be washed after contact with any patient, and especially before contact is made with another patient.
The purpose of hand washing in the health care setting is to remove or destroy (disinfect) pathogenic microorganisms ("germs") to avoid transmitting them to a patient. The application of water alone is ineffective for cleaning skin because water is unable to remove fats, oils, and proteins, which are components of organic soil. Therefore, removal of microorganisms from skin requires the addition of soaps or detergents to water. Plain soap does not kill pathogens. However, the addition of antiseptic chemicals to soap ("medicated" or "antimicrobial" soaps) does confer killing action to a hand washing agent. Such killing action may be desired prior to performing surgery or in settings in which antibiotic-resistant organisms are highly prevalent.
The proper washing of hands in a medical setting generally consists of the use of generous amounts of soap and water to lather and rub each part of ones hands systematically for 15 to 20 seconds. Hands should be rubbed together with digits interlocking. If there is debris under fingernails, a bristle brush is often used to remove it. Finally, it is necessary to rinse well and wipe dry with a paper towel. After drying, a dry paper towel should be used to turn off the water (and open any exit door if necessary).
All jewelry should be removed. When rinsing, ensure at all times that you do not allow water to drip from an unwashed area back to the hands. This is why medical professionals hold their hands above their elbows between washing them and drying them. When done, the hands are dried with a sterile cloth.
9
Use a draw sheet or a piece of cloth under the patient if available, so they can be turned and pulled up in bed with more ease, preventing friction on their skin.
Make sure the person is aligned properly, especially when on their back.
Turn the patient every 2 hours during the day and at least 1 to 2 times during the night if possible.
Prop the patient up prior to eating and a half hour afterwards if possible. Otherwise turn the patient on their left side to eat if able.
Using a pillow between the knees while the patient is on his side can help prevent skin break down or creating a twist in the spine.
Have the patient by a window if possible or not contraindicated.
Have the things a patient can use within reach if applicable.
Provide an atmosphere conducive to the patient's and families needs if possible. Example, some people do better being in the middle of the daily activities or they may need a quiet place.
Provide adequate nutrition and fluids if applicable.
Keep the patient clean.
Be respective of the patient's dignity.
10
Eating is a basic function of life, and people who are unable to perform this task may feel they have lost their dignity. Therefore, a patient should only be fed if they are unable to feed themselves. It is never appropriate to feed a patient because it is faster than allowing them to do it themselves.
If possible, a patient should be moved to a dining room for mealtimes. The chair should be comfortable, and positioned so the patient can reach all of his food. If the patient must be fed in bed, the bed should be inclined by about 30° to facilitate swallowing.
Before the meal, wash the patient's face and hands.
Allow time for feeding. Do not rush things. The patient must be given time to taste and enjoy his food. Check that the food is at the proper temperature. Cold foods should be cold, and hot foods should be warm (not so hot as to burn the mouth).
Ask the patient what food they would like first, and if they would like to alternate dishes, or eat each to completion before moving to another. If they patient is not communicative, alternate the foods as you would if you were eating the meal. Feed the patient his next bite when he is ready for it. Do not force the patient to eat anything he does not wish to eat. You may encourage the patient to try the food, but under no circumstances should he be forced to eat anything.
At the end of the meal, clean the patient's face and hands, and if necessary, his clothing as well. Clear away the food and remove any crumbs from the bed. Write down the amount of food that was eaten. Leave the bed inclined for at least 30 minutes after the meal to aid in proper digestion.
11
Administering Medicines
Children do not usually take pills or capsules until they are older. Instead, they should be given liquid medicines. Be careful not to give your child medicine unnecessarily. Just because a child is miserable does not mean that she should be given a drug. Consider this carefully before medicating a child.
Read the warning labels, and understand the proper dosage. A child under the age of two should never be given any medicine (even over-the-counter drugs) without consulting a doctor.
Children who can drink without spilling can use a dosage cup. This is a small cup with markings on the side showing different volumes. Fill the cup to the appropriate line and give it to the child. Watch the child take the medicine so you can be sure it was not poured down the sink, or spilled.
If the child cannot drink liquids without spilling them, you can use a dosing spoon. A dosing spoon looks a bit like a test tube, but the open end is shaped like a spoon. Medicine is poured into the tube which has graduated markings on the side for measuring the dose. The spoon is then inserted into the patient's mouth, and the medicine is poured in. Be sure the patient swallows.
For very small children or for helpless adults, you may need to use a medicine dropper or an oral syringe. Both are marked for measuring the proper dosage. Most syringes have caps covering the tip, and this cap poses a choking hazard. Be sure to remove the cap from the tip of a syringe before using it! Press the plunger so that it is fully engaged in the syringe. Then insert its tip into the liquid medicine and draw the plunger upward until the proper dose has been drawn into the cylinder. Remove the syringe from the medicine and point the tip upwards. Apply slight pressure to the plunger to force the air bubble (if any) out of the tip and recheck the dose level.
Once the syringe is loaded, place it well within the patient's oral cavity. Then depress the plunger so that the medicine is discharged in the rear of the patient's mouth. This will encourage the patient to swallow rather than spit. If a young child holds the medicine in his mouth, quickly blow air into his face (don't spit!). This will frequently cause him to swallow.
The aged will sometimes also resist taking medications. If you are giving them the medicines and expecting them to take it themselves, watch that the patient actually does swallow the pills. It is not uncommon for an aged person to hide or flush pills he does not think he needs.
Applying Eye Drops
Instruct your patient of the procedure as appropriate. The head of your patient should be tipped back. Gently pull down on the skin below the eye and apply the drop in the pocket formed below the eyeball without touching the dropper on the patient. Then gently apply pressure at the tear duct area with your finger when the patient closes their eye. Instruct the patient not the squeeze their eye shut tight.
12
Fomentations
Fomentations are given by alternating hot and hold. Compressions can be either hot or cold, but no alternation takes place.
- Administration
A thick cotton cloth (such as a diaper or a dish towel) is immersed in 4 liters of hot water (the water may be mixed with a decoction). The cloth is then wrung out, and the temperature tested by applying it to the inside of the therapist's arm. If it is too hot, it can be fanned in the air, but it should not be used if it is scalding hot. It should, however, be as hot as the patient can stand. The hot cloth is applied to the effected area and then wrapped with dry cloths so that the heat is retained. The hot compress is them removed, and the area is quickly sponged down with a cold, wet cloth. Then the heat is reapplied as before. This is continued for up to 60 minutes.
- Conditions for Use
Fomentations can increase circulation, aid in relieving congestion, warm achy joints, and draw abscesses.
Foot baths
- Administration
A small tub (about 8 liters) is filled with hot water. Epsom salt may be dissolved in the water, but this is not strictly necessary. Test the water temperature before taking it to the patient. It should not scald. The basin is placed on the floor at the feet of the seated patient. The patient's bare feet are then placed in the water and allowed to soak for up to an hour. If the water cools, it should be changed. The patient's feet are then towel dried.
- Conditions for use
Foot baths may be given to relieve foot pain. This treatment is good for arthritis. Epsom salt, when used through soaking, can soothe muscle pains and help improve rough patches in the skin.
13
Demonstrate the application of a heating compress
For a strained muscle or ligament, you should use ice or a cold pack immediately and for the next 36 hours. Do not use heat or a heating pad until swelling and bruising has stopped. Cold is used first to reduce swelling and inflammation. Apply cold (ice or an ice pack) for 20 minutes, remove for 20 minutes. Repeat every 4-6 hours. Put a thin towel to protect the skin. Do not put a cold pack or ice directly on the skin or you may get frostbite. After the bruising that comes along with the inflammation stops (1-3 days), use heat to relieve injury pain. Cold reduces inflammation. Heat improves circulation.
Demonstrate the use of heat and cold for the treatment of inflammation and bruises
Many episodes of pain come from muscle exertion or strain, which creates tension in the muscles and soft tissues. This tension can constrict circulation, sending pain signals to the brain. Heat application eases pain by:
- dilating the blood vessels surrounding the painful area. Increased blood flow provides additional oxygen and nutrients to help heal the damaged muscle tissue.
- stimulating sensation in the skin and therefore decreasing the pain signals being transmitted to the brain
- increasing the flexibility (and decreasing painful stiffness) of soft tissues surrounding the injured area, including muscles and connective tissue.
14
14a
That's eating. If you feed your body right, you're off to a good start. Just like you don't put sand into your gas tank, you should put the right fuel into your body.
14b
If you don't use it, you lose it. Or someone said that or should have said that. Exercise improves the health of a body, of the mind, and of the spirit. This should include outdoor exercise.
14c
Our body is 70 percent water. We need to drink enough water to keep hydrated. It also flushes out bad stuff.
14d
The sun is a major source of energy in our world. Sunlight is also important for the body's metabolic balance.
14e
Too much of one thing is bad. We need to practice using good things in moderation.
14f
What can one say. We need air. Find the best air you can breathe. Do not smoke tobacco (or anything else), and avoid second-hand smoke.
14g
Rest allows the body to renew itself. Rest is important for health.
14h
Trust in God to lead you to the right choices.
