1.

Role of NMC
 Protect health and wellbeing of the public, set standards of education and training for nurses, midwives
and students
2. Reporting of risk
 Report risks in practice (such as not using hoist when moving patient) through writing to the
management or someone in authority (internal). If not resolved, raise to NMC or helpline.
3. Enteral Feeding
 Test the ETF position and patency by auscultation, x-ray, pH testing < 5.
 Elevate the head of bead 30 degrees or more when feeding the patient to prevent aspiration.
4. Dysuria – painful urination; Nocturia – urination at night; Bradycardia – low pulse or heart rate
5. Delegation
 Nurse can delegate a task to someone who is competent to do the task and it is within their job
description that they can do the task
 When delegating medication administration to a final year nursing student, nurse must supervise,
support and countersign.
6. If not competent to do a certain task such as IV cannulation, inform another (colleague or supervisor).
7. Zimmer Frame
 Indicated for patients with poor balance and/or weak legs; mostly used indoors
 Used by lifting and moving it slightly forward then two equal length steps must be taken into the frame’s
center; patients can lean on the frame with their weight on the hand grips; not to be used when getting
up from or sitting down to a chair
8. Crutches – weight should be on both hands, not on the axilla
9. Specimen Handling Protocols
 Collection – do not over fill containers; make sure that the outside of the container is free from body
fluids contamination; label the specimen immediately after collection and place in transport bag with
the request attached.
 Labelling – label the specimen with the correct details
 High Risk – must have a yellow biohazard sticker and place in a transport bag
10. Clostridium Defficile
 foul-smelling watery diarrhea, abdominal pain, colitis; can be transmitted to others through
contaminated objects touched by the patient
 antibiotics are used for treatment; alcohol hand gel is not effective to prevent transmission
11. Needlestick Injury
 Immediately stop what you are doing and attend the injury; encourage bleeding of the wound by
applying gentle pressure – do not suck; wash well under running water; dry and apply a waterproof
dressing as necessary; if blood and body fluids splash into eyes, irrigate with cold water; if blood and
body fluids splash into your mouth, do not swallow and rinse out several times with cold water; report
the incident to your occupational health department – or A&E out of hours – and your manager;
complete an accident form; seek help to initiate an investigation into the cause of the incident and risk
assessment; risk assessment should be carried out with a microbiologist, infection control doctor or
consultant for communicable disease control; consent is required if a patients blood needs to be taken
12. Crohn’s Disease
 Blood and mucus in the stool, diarrhea, abdominal pain, fatigue
 No cure but can go into remission; exact cause is unknown but may be related to genetics, immune
system problem, previous infection, smoking, environmental factors, steroids or immunosuppressants
13. The Code
  Advocate – helping people access relevant health and social care, information and support
 Confidentiality – information must be disclosed if someone may be at risk of harm according to law
 Nurse – makes arrangements to meet people’s language and communication needs; share information
to patients in a way they can understand about their health
 Consent – must be secured before beginning any treatment or care; act on someone’s best interests if
care is provided in an emergency
 Boundaries – gifts, favors, hospitality that may be interpreted as an attempt to gain preferential
treatment must be refused; clear sexual boundaries at all times
 Delegation – must be able to carry out instructions, must confirm that any task delegated meets
required standards; ensure that everyone you are responsible for is supervised and supported
 Risk Management – act without delay if risk is perceived; report concerns in writing
 Record Keeping – records must be completed as soon as possible after an event; include discussions
made, assessments done, treatment and medications given, and its efficiency; each entries must have
signature, date and time
14. Record Keeping
 Improves accountability, shows how decisions on patient care were made, supports service delivery,
supports effective clinical judgments and decisions, supports patient care and communications, makes
continuity of care easier, helps identify risks and enabling early detection of complications
 In the first entry of written records, the person’s name and job title should be printed alongside it; all
other entries must be signed
 All records should have date and time arranged in chronological order and must be as close to the actual
time as possible
 In cases of alterations, registrant must give name and job title and put the signature and date on the
original document
 Information can be released if it is required by law and/or there is wider public interest
 In cases to help prevent, detect, investigate or punish serious crime or if it will prevent abuse or serious
harm to others, registrant can disclose information under Common Law
15. Elderly Care
 People – the nurse who are efficient and able to deliver safe, effective and quality care by being
competent, assertive, reliable and dependable, empathetic, compassionate and kind
 Process – delivering quality care which promotes dignity by nurturing and supporting the older person’s
self-respect and self-worth through communication, assessment, respect for privacy and dignity and
engaging in partnership
 Place – diverse environments in the community or hospital where care is provided for older people
which is committed to equality and diversity, appropriate, resourced adequately and effectively
managed
 Assessment of need – physical, psychological, psychosocial, biological, functional, sexual, spiritual,
cultural
 Privacy and Dignity – must be protected at all times
 Dignified Care – carrying oneself in a professional manner
 Respectful Treatment – ensure patient is pain free and hygiene, continence, nutritional, emotional,
cultural, and spiritual needs are met; acknowledge that partners and family play a vital role in providing
care
 Respect – can be showed by asking for consent or permission before care
 Advocacy – acting on behalf of the older person in a professional capacity
  Diversity – recognizing that people come from different backgrounds
 Equality – making sure that all older people are treated fairly
 Risk Assessment – done in collaboration with the older person, their relatives and other multidisciplinary
team members
 Complaint – must be investigated thoroughly viewing the issues raised from the older person’s
perspective; an opportunity to learn from to improve care
16. Accountability and Delegation
 Registered Nurse – person usually in overall charge of the nursing care if the patient; have the duty of
care and legal liability
 Health Service Providers – accountable both in the criminal and civil courts to ensure that their activities
conform to legal requirements
 To be accountable, one must: have the ability to perform the task, accept responsibility for doing the
task, have authority to perform the task within their job description and the policies and protocols of the
organization
 Appropriate Delegation done: task is necessary and delegation is in the patient’s best interest, support
worker understands the task and how to perform it, support worker has the skills and abilities to
perform the task competently, support worker accepts the responsibility to perform task competently
 Delegation – the process by which the delegator allocate clinical or non-clinical treatment or care to a
competent person
 Vicarious Liability – provided that the employer is working within their sphere of competence and in
connection with their employment, the employer is also accountable for their actions
 NMC Delegator’s Accountability – RN must establish that anyone they delegate to is able to carry out
their instructions, confirm that the outcome of any delegated task meets required standards, make sure
that everyone they are responsible for is supervised and supported
17. Lumbar Laminectomy
 Patient is admitted on the day of the operation or a day before; surgeon and anesthetist will explain
what will happen during operation and give patient the opportunity to ask questions; consent must be
signed before the operation
 Patient position after surgery: bed flat or head of bed elevated slightly with pillow on head and under
the knees
 Patient is turned every two hours using a logrolling technique
18. Lumbar Tap/Puncture
 Contraindicated if patient have elevated Intracranial Pressure; a CT scan of the brain is recommended to
check ICP especially for patients with mass or space occupying lesions since it may lead to herniation or
coning
 Patient is positioned laterally with the back to the edge of bed, head and neck is flexed and knees drawn
up to the chest
 If patient complains of headache, give analgesics as prescribed, ask the patient to lie down and increase
oral fluid intake
 Indicated for the diagnosis of meningitis, subarachnoid hemorrhage, Guillain-Barre’s syndrome
 Complications include:
i. Post-lumbar puncture headache – occur several hours to 2 days after; accompanied by nausea,
vomiting and dizziness
ii. Back Pain – may radiate down to the back of legs
iii. Bleeding
iv. Brainstem Herniation – increased BP, slow irregular pulse, irregular breathing
19. Informed Consent
 An important part of the medical ethics and the international human rights law
 All information must be given in terms of what the treatment involves, including the benefits and risks,
whether there are reasonable alternative treatments and what will happen if treatment does not go
ahead
 In cases of major medical procedures, consent must be obtained in advance to give planety of time to
examine any information
20. Discharge Planning
 Can reduce patient’s length of stay, emergency readmissions, pressure on hospital beds if made with
clear dates and times
 With elective care, discharge planning should start before admission
 For both elective and emergency care, discharge planning must be done as early as possible
21. Patient Safety
 Means that equipment is used correctly and in good working condition; medications should be given on
time and in correct doses; treatment must be appropriate for their condition; care should be delivered
in a coordinated way by competent professionals who work in an effective team
22. Abdominal Paracentesis
 Done to remove excess fluid in the peritoneal cavity; indicated for patients with liver cirrhosis, tumors,
previous treatment of tumors, pancreatic and liver disease, and congestive heart failure
 Not indicated for patients with abnormal clotting, multiple scars and distended bowel, localized
inflammatory bowel and pregnant patients
 Complications included hypovolemia, hypokalemia, hyponatremia, localized infection on the cannula or
drain insertion site, abdominal wall hematoma, fluid leak, inadvertent bowel perforation, spontaneous
bacterial peritonitis
 Position of the patient during the procedure is semi-recumbent using pillows (supine with head of
patient elevated using pillows)
23. Adduction – movement of limbs toward the midline of the body; Abduction – movement of limb away the
midline of the body
24. Liver Biopsy
 Indicated for hepatitis and cirrhosis; complications include minor pain, severe pain, vasovagal
hypotension, significant hemorrhage, hemobilia, puncture of another organ
 Bleeding may present symptoms of shock: elevated pulse and respiration, decreased blood pressure
25. Chest Drain
 Indicated for patients with pneumothorax, pleural fluid (malignant pleural effusion), traumatic
pneumothorax, peri-operative surgery
 Chest tubes for pneumothorax should not be clamped unless drainage bottle needs to be changed or
when testing the system for air leaks to prevent tension pneumothorax
26. Buttocks IM injection site – upper outer quadrant
27. Professionalism- competence in practice; giving medications on time and right does, performing a procedure
according to approved standards
28. Dignity and Respect – upholding patient’s privacy and confidentiality; involving patient in decision making
29. Service Framework for Older Adults/People
 Safe – care that minimizes risk and harm to service users and staff
 Effective – care that is informed by an evidence base (resulting in improved health and wellbeing
outcomes for individuals and communities)
 Efficient Manner – maximising resource use and avoiding waste
  Accessible – timely, geographically reasonable and provided in a setting where skills and resources are
appropriate to need
 Equitable – does not vary in quality because of personal characteristics such as age, gender, ethnicity,
race, disability, geographical location or socio-economic status
 Person-centered – care that gives due regard to the preferences and aspiration of those who use
services, their family and cares and respect the culture of their communities; Emphasizes the
importance of people being involved in planning a response to their care needs
 Health and Social Wellbeing Improvement – underlines the value of preventive strategies and the
capacity for people to shape their own life chances/health outcomes
 Safeguarding – endorses and promotes the new emphasis on protecting vulnerable adults and older
people against neglect, abuse or exploitation
30. Phases of wound healing
 Inflammatory – 0 to 3 days
 Proliferation – 3 to 24 days
 Maturation – 20 days to 2 years
31. Types of Wound Drain
 Used to prevent accumulation of fluid in a wound bed that may delay healing and predispose wound to
infection
 Vacuum – closed vacuum wound drain system inserted via a stab wound into the wound bed; check
drainage system to ensure maintenance of the vacuum within the bottle and observe and measure any
drainage; do not place on the floor but should be below the level of the wound; lack of flow may mean
all exudates were removed, wound drain is clogged and may require irrigation and aspiration or loss of
vacuum
 Latex Tubing – wide-bore tube made of latex sutured in place and attached to sterile drainage bag;
gravity drainage system; used in major abdominal surgery
 Pauls Tubing – open wound drainage system made of flat corrugated rubber or plastic/latex strip
 Jackson Pratt – self-contained suction system that promotes healing by draining fluid from the wound
preventing swelling and pooling of blood
 Vacuum Drain Removal – discontinue suction and stop drainage by clamping the tube then gently but
firmly withdraw the tube while applying counter pressure
32. Thromboembolic/Compression Stockings – improves circulation in the leg veins
33. Ectopic Pregnancy – causes shoulder tip pain when lying down indicative of internal bleeding
34. Phlebitis – IV cannula must be removed immediately and should only be re-sited if the clinical need remains
35. Hypotension and Hypnotics – common causes of falls in older people
36. Intermediate care homes – for patients who need rehabilitation before heading home from hospital
37. Acceptance/Awareness – quality needed in order to not be judgmental when asking about patient’s sexuality
38. Dementia – can be diagnosed if there are changes from previous baseline mental function of patient; patient
may present new confusion
39. Causes of Orthostatic Hypotension
 This is because the baroreflex mechanisms which control heart rate and vascular resistance decline with
age which then displays lability in blood pressure
 Dehydration – blood volume is lost
 Heart Problems – bradycardia, heart valve problems, heart attack and heart failure
 Endocrine Problems – Thyroid condition, adrenal insuffeciency, hypoglycemia
 Nervous System Disorders – Parkinson’s Disease, Multiple system atrophy, Lewy Body Dementia, Pure
Autonomic Failure, Amyloidosis
40. Palliative Care
 Aims to improve the quality of life of patients and their families facing the problems associated with any
life limiting illness
 Provide relief from pain and other distressing symptooms
 Integrates the psychological and spiritual aspects of patient care
 Offers a support system to help patients live as actively as possible until death
 Offers a support system to help the family cope during the patient’s illness and in their own
bereavement
 Uses a team approach to address the needs of patients and their families
 Affirms life and regards dying as a normal process
 Intends neither to hasten nor postpone death
 Is relevant in combination with many other treatment directed at the underlying illness
41. Hypervolemia/Speed Shock
 Signs and symptoms include increased blood pressure, increased pulse, increased respiration, moist
skin, edema, syncope, cardiac arrest
42. Delirium
 Sudden severe confusion and rapid changes in the brain functions that occur with physical or mental
illness; it is currently under-diagnosed and under-treated
 Adverse outcomes: longer hospital stay, increased incidence of dementia, increase in hospital-acquired
complications such as falls and pressure sores, increase rate of admission to long-term care and
increased mortality
43. Re-ablement
 A whole systems approach to embed the concept and practice of preventing loss of independence
where possible and ensuring that services have this goal at the center of their purpose and philosophy
44. Cultural Competence
 Refers to nursing care that is sensitive to issues regarding culture, race, gender, and sexual orientation
 Is a process in which nurse strives to achieve the ability to effectively work within the cultural context of
an individual, family or community from a diverse cultural/ethical background
 Cultural Awareness – the process by which the nurse becomes aware of, appreciates, and becomes
sensitive to the values, beliefs, life ways, practices and problem-solving strategies of other cultures
 Cultural Knowledge – the process by which you seek out and obtain education about various worldviews
of different cultures
 Cultural Skill – involves learning how to do a competent cultural assessment
 Cultural Encounter – may include attending religious services or ceremonies and participating in
important family events
45. Infection Control
 Standard Precaution – formerly known as universal precaution underpin routine safe practice,
protecting both staff and clients from infection; it includes achieving optimum hand hygiene, using
personal protective equipment, safe handling and disposal of sharps, safe handling and disposal of
clinical waste, managing blood and bodily fluids, decontaminating equipment, achieving and maintaining
a clean clinical environment, appropriate use of indwelling devices, managing accidents, good
communication – with other health care workers, patients and visitors, and training/education
 Hand Hygiene – single most important activity for reducing the spread of disease; must be done before
direct contact with patients and after any activity or contact that contaminates the hands, including
 following removal of gloves; any lack of or wrong placement of facilities should be brought to the notice
of the manager
46. Patients’ own medicines
 When patients have their own medicine, the registrant has the responsibility to ask to see the medicinal
products, check suitability of use, explain how and why they will or won’t be used, establish if they are
prescribed, ascertain if they meet the criteria for use; they should not be removed from the patient
without their permission including controlled drugs and must only be used for that named individual
47. Controlled Drugs
 All controlled drugs must be stored in a locked receptacle which can only be opened by a person who
can lawfully be in possession, such as the pharmacist or registrant in charge; cup boards must be kept
locked when not in use, the lock must not be common to any other lock in hospital, keys must only be
available to authorised members of staff, cupboard must only be dedicated for the storage of controlled
drugs
48. Administering Medicine using patient’s own supply in the hospital or care home setting
 Registrant must check the medicines in the locked cabinet or locker (only for care homes and not for
hospital setting since lockers are not labeled for a specific patient) with the prescription chart and use
only those medicines belonging to that named patient; if supply is not available, medicines belonging to
another patient must not be used
49. Controlled Drugs Discrepancy
 A running balance of stock should be calculated and recorded after each transaction and balances
should be check with the physical amount of stick at regular intervals
 Two members of the staff should check all stock received and removed and both individuals should
initial the entry in the Controlled Drugs Register
 When discrepancy is found, it should be reported immediately to the registered manager/ registrant in
charge who should investigate promptly; if discrepancy is not resolved, local pharmacist advice should
be sought and the CQC local office informed
50. Nutrition support in adults
 Malnutrition – a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals
cause measurable adverse effects on body composition, function or clinical outcome; both a cause and a
consequence of ill health
 Nutrition Support – methods to improve or maintain nutritional intake
i. Oral Nutrition Support – examples are fortified food, additional snacks and/or sip feeds
ii. Enteral Tube Feeding – the delivery of a nutritionally complete feed directly into the gut via a
tube
iii. Parenteral Nutrition – intravenous delivery of nutrition
 Malnourished people: BMI of less than 18.5 kg/m2; unintentional weight loss greater than 10% within
the last 3-6 months; a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within
 At risk for malnutrition: eaten little or nothing for more than 5 days and/or are likely to eat little or
nothing for 5 days or longer; a poor absorptive capacity and/or high nutrient losses and/or increased
nutritional needs for causes such as catabolism
51. Yellow Card Scheme – an important method by which potential adverse drug reactions can be detected
52. When patient with Cerebrovascular Accident present with symptoms of unequal pupils and decreasing level of
consciousness, alert specialist team because this is an emergency case.
53. When outside the hospital setting, nurses are should act professionally and competently as expected of them.
54. When a patient is seen unconscious, nurse must first assess the surroundings for danger, then assess patient’s
responsiveness and consciousness then apply first aid if necessary and call for help.
55. Elderly Infection
 The hallmark sign of fever is absent because their immune system (thymus producing T-cells or T-
lymphocites) is unable to mount a response to infection due to the effects of aging
 Signs and symptoms include: confusion or delirium like state, agitation, hallucinations, behavioral
changes, dizziness, falling
56. Dehydration
 Signs and symptoms include: tiredness, dizziness or light-headedness, headache, muscular cramps,
sunken eyes, passing little urine, dry mouth and tongue, weakness, irritability,
 Severe Dehydration: weakness, confusion, rapid heart rate, coma, very little urine
57. Meconium Aspiration Syndrome
 Signs and symptoms: obvious presence of meconium or dark green staining of the amniotic fluid, green
or blue staining of the skin at birth, baby appears limp, low Apgar score, breathing is rapid, laboured or
absent, signs of postmaturity is present, fetal monitor may show bradycardia
58. When caring for patients with dysphagia, water and thin liquids are not allowed because it can cause aspiration.
It is better to give soft food and thick liquids.
59. Intravenous Morphine Care and Administration – giving water to drink is not a priority.
60. The best site to check for edema in elderly people is the feet.
61. Overhydration
 Signs and Symptoms: headache, vomiting, confusion, agitation, swelling of hands and feet, seizures,
collapse
62. Digoxin – if patient has a heart rate of 52 bpm, it should be withheld and proper documentation must be done.