NUR 352 Exam 1 Study Outline
Brainstorm all that you can recall about the topics listed on the guide without using your resources. Once you
have recalled all that you are able to, identify the topic you remember the least about and review the content
provided.
Infection………..Review PPTs from class and Giddens Ch./ Concept 24 Infection, ATI E-book Fundamentals
Ch. 11 Infection Control
Objectives: Prevention of infection
Nursing Considerations
oDoes my patient have risk factors? (nurses need to assess their clients for risk of infection)
Recent surgery, indwelling devices, impaired circulation, poor oxygenation,
acute/chronic disease (diabetes, respiratory, hea[tic, kidney, cardiac), caregiver level of
knowledge regarding standard precautions, presence of non-modifiable/ Modifiable risk
factors , recent travel to high risk regions
Differentiate between local and systemic infections, including signs and symptoms
oLocal: limited to specific area
Example of wound infection sign and symptoms: at sitte there is redness, tenderness,
swelling, possible drainage.
oSystemic: affects whole body instead of single organ or part of body.
Signs and symptoms include fever, fatigue, increase pulse and respirations, increased
WBCs
Standard Precautions
oUsed to protect you based on assumption that all blood and body fluids are contaminated
oUse with all persons,
oWash hands
Before patient contact
Before a procedure
Contaminated with blood/ body fluids.
After gloves are removed
Between client contact
oUse alcohol-based products when hands are not visibly soiled or covered in blood/ body fluids
and after removal of gloves.
oUse soap/ water when there is visible contamination, suspected or diagnosis of C. diff
oEnable safety devices/ sharps container.
oUse of disposable or disinfect patient care equipment.
oProper handling of laundry
Precautions and PPE required in each
oStandard
oContact: standard precautions, private room, gloves, gown, disposable BP cuff, thermometer and
stethoscope, and goggles (splashing)
Examples: c. diff, MRSA, RSV, herpes simplex, impetigo
oDroplet: standard precautions, private room, gloves, surgical mask, disposable BP cuff,
thermometer, and stethoscope, and may need contact precautions, visitors need to wear masks
Examples: strep pneumonia, influenza, pertussis, mumps
oAirborne: private room, negative pressure airflow (– draw air out of room through a filter),
N95/HEPA filtration mask (health personnel), face protection with possibility of splashing,
patient to wear surgical mask outside room, disposable BP cuff, thermometer, and stethoscope.
Examples: measles. Varicella, tuberculosis
oProtective: private room, positive air flow (-clean, filtered air in), surgical mask worn by client
outside of room, PPE instructions client dependent. No persons with indection may enter, no
dried or live plants/ flowers, no non-peelable fresh fruits or vegetables
oPrecautions with the following disease processes, C-diff, MRSA, TB
Chain of infection
oCausative agent (bacteira, virus, fungus, prion, parasite)
oReservoir (human, animal, food, water, soil)
oPortal of exit (from the reservoir): respiratory tract, GI tract, genitourinary (GU), skin, mucous
membranes, blood/body fluids, transplacental
oMode of transmission: contact (direct person to person, indirect with inanimate objects , fecal-
oral transmission), droplet (coughing, sneezing, talking), airborne (coughing, sneezing), vector
borne (animals or insects as intermediaries)
oPortal of entry: to the host. Might be the same as portal of exit
oSusceptible host: depends on individuals’ degree of resistance to pathogens (may or may not be
symptomatic), some remain dormant or resurface (shingles). Immunocompromised, breaks in
skin
Communication………. Review PPTs from class, Giddens Chapter/ Concept 43 Communication,
ATI E-Book Fundamentals - Therapeutic Communication
When speaking with a patient in regards to their health, remember you want to gain information from them,
they need to express their needs/ thoughts.
Therapeutic and non-therapeutic communication actions
oTherapeutic communication: face to face process focus is on advancing physical and emotional
well being of a patient. Purposeful use of communication to build and maintain healing
relationships with clients, families, and significant others
Essential components: plan and allow time to communicate, active listening, caring
attitude, honesty (open, direct, sincere), trust, empathy, nonjudgmental attitude.
oNon-therapeutic communication: opposite of therapeutic communication
Actions: requesting explanation (why), probing (personal questions), approval/disproval,
defending (another action), giving advice (not asked), reading questions, asing multiple
questions (give time to answer), false reassurance (don’t worry), belittling (bias),
talkativeness (give time), anxious silence (looking at watch, tapping foot)
Considerations of age, disabilities, culture, factors influencing communication
oChildren: use simple, straightforward lang, be aware of nonverbal messages, be at child’s eye
level, incorporate play in interactions
oOlder adults: amplification of sound, make sure assistive devices like glasses and hearing aides
are available for clients who need them, minimize distractions and face client while speaking,
speak in short and simple sentences, allow time for client to respond, ask for input from
caregivers or family for how to best communicate.
oCultural considerations: provide an interpreter, address client directly when interpreter is present,
provide educational materials and instructions in the client’s language
Important Communication Skills for health care team/ nurses
oSilence, presenting reality, active listening, asking questions, open-ended questions, clarifying
techniques (restating, reflecting, paraphrasing, exploring), offering general leads, broad opening
statements, showing acceptance and recognition, focusing, giving information, summarizing,
offering self, touch (if appropriate)
General Survey/Vital Signs/Pain……………. Review PPTs from class, ATI E-Book Fundamentals Ch. 26
Data Collection (Components of Health History begins page 129, General Survey Page 133, Ch. 27 Vital Signs
General Survey/ health history – definition and components of each
oHealth history: provides subjective data about health status.
demographic (name, address, birth date, age, gender, advance directives), source of
history (who is giving the information), chief concern (reason for seeking care), history
of present illness (location, quality, quantity, setting), past history and current health
status (childhood illnesses, med/surg diagnoses, treatments, hospitalizations), allergies,
current medications (OTC and prescription), family history (parent, sibling), psychosocial
history (relationships, support systems, living/working situations), health promotion
behaviors (exercise, diet, stress prevention), review of systems (information about the
functioning of all body systems and health problems – integumentary, respiratory,
cardiac, GI, musculoskeletal, mental health)
oGeneral survey: written summary of overall health. It is a snapshot of the first encounter of the
day with a patient. A general sense of how the patient is at the time of meeting
Assess and collect physical appearance (age, gender, race/ ethnicity, level of
consciousness (name, time, place), color of skin, facial features, indication of distress,
possible physical abuse, indications of substance abuse, body structure (build, stature,
height and weight , nutritional status, symmetry of body, posture, gross abnormalities),
mobility (gait, movements, range of motion, motor activity), behavior (facial expressions,
mannerisms, mood and affect, speech, dress, hygiene, grooming, odors), vital signs
Vital Signs
oNormal Adult ranges (see information in vital sign module) of Temperature, pulse, respirations,
blood pressure, O2 saturation.
Temperature: 36 to 38 C or 96.8 to 100.4 F
Pulse: 60 to 100 / min
Respirations: 12 to 20/ min
Blood pressure: less than 120/80
O2 saturation: 95 to 100%
oCauses for alterations in each - Temperature, pulse, respirations, blood pressure, O2 saturation.
Temp alteration: age, hormonal changes, exercise, illness and injury, recent food or fluid
intake and smoking, circadian rhythm, stress, environmental conditions
Pulse alteration: ANS controls heart rate, SNS raises heart rate, PSNS lowers heart rate,
age, tachycardia – greater than 100 (exercise, fever, heat exposure, medication),
bradycardia – lower than 60 (long term physical fitness, hypothermia, medication,
chronic severe pain, relaxation
Respirations alteration: age (newborns are 30-60), sex (males and children use
diaphragmatic breathers and females are chest breathers), pain, anxiety, smoking, body
position, medications (decrease resp rate and depth), illnesses (increase rate), impaired
oxygen carrying capacity of the blood (anemia, high altitudes – increase depth and rate)
Blood pressure: age (infants have low bp that increases with age, adults have slightly
elevated due to decreased elasticity of the blood vessels), stress, circadian rhythms,
ethnicity (black Americans at more risk), sex (men have higher bp than females),
medications (opiates, cocaine, nicotine), exercise (decreases), obesity, family
history/genetics
Steps of assessing vital signs
Developmental considerations - age
Pain - Assessment of pain (PQRSTU); Nonverbal cues; Is it subjective or objective information?
P palliative or provocative factors: What makes your pain worse? What makes it better?
Q quality: How do you describe your pain?
R relief measures: What do you take at home to gain pain relief?
R region (location): Show me where you hurt
S severity: On a scale of 0-10, how bad is your pain now?
What is the worst pain you have had in the past 24 hours
What is the average pain you have had in the past 24 hours
T timing: Is your pain constant, intermittent, or both?
U: Effect of pain: What are you not able to do because of your pain?
With whom do you live, and how do they help you when you have pain?
Nonverbal cues for pain:
oFacial expressions - grimacing, furrowed brow, holding eyes tightly shut, pursed lips
oClenched jaw, grinding teeth
oGrasping or clutching blankets or seat cushions
oRigid body
oUnusual breathing patterns
oMoaning or calling out
oNot responding to voice becoming withdrawn and less social
oFlinching when touched
oGuarding an area of pain, such as clutching it or resisting when someone tries to touch the area
oKicking, restless legs, frequent repositioning. Rocking
oAgitation, irritability, low tolerance for engaging with others
