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Possible INTERVIEW QUESTIONS

Please see below further interview questions and answers, please


remember my answers are not conclusive and to try and think of others
yourselves.

All answers must have lots of detail when possible. Try to

imagine you are in the situation and explain step by step what you would
do. If you are asked about a question where you have never experienced
the situation then just say what you would do if this did happen to you.
Lots of detail in your answers is the key to passing the interview.

How to deliver good standard of nursing care?


In the UK nurses use what we call the NURSING PROCESS. You can use the
steps of the NURSING PROCESS for any nursing problem and it is very
important that you make sure in your interview you use these words:
2. I WILL ASSESS THE NEEDS of the resident/patient
3. I WILL PLAN CARE that I give to my patients (In UK the nurses will
write a care plan listing their actions to take)
4. I WILL MONITOR the care we provide
5. I WILL EVALUATE the care delivered
What will your responsibilities as a nurse in the UK?
- Follow the NMC code of conduct as well as policies of my employer
- I must ASSESS, PLAN, MONITOR & EVALUATE care provided to my
patients
- I will be accountable for all my actions and make sure that I practise
safe nursing

- I must PROTECT my patients from any kind of ABUSE and


KEEP THEM SAFE
- I must keep improving my English so that I communicate with full
confidence with my patients/ staff/ families (THERE ARE MANY COURSE)

If you are giving out the medications and a patient refuses to


take the medicine, what would you do?

I would try to find out why they do not wish to take them and

answer any questions they may have about the medication


I would explain the importance of taking them and what might

happen if they don't (without scaring them!)


I would ask another nurse to try and ask the patient
I would try a little later on to see if they might take them
If they still would not take them, I would consider phoning a family
member who might be able to speak to them over the phone and

persuade them to take them.


Failing everything I would ensure I document it correctly in their

medicine prescription kardex and in the patients notes.


If this continued to happen I would speak to the GP to advise of the
situation and discuss alternatives

What qualities do you think are important for a Nurse in care of


the elderly?

I believe that all nurses regardless of who they look after should be
kind, caring, patient, be trustworthy, motivated, honest, reliable,
punctual, sympathetic and be able to prioritise the care needs of all

their patients.
In relation to caring for elderly I believe you need to have a bit more
patience as the elderly can be very slow at daily tasks eg eating,
washing, dressing ect..but it is part of our job to promote

independence wherever possible and to be patient during each task.


We also need good understanding of dementia and the best ways in
which to deal with its symptoms, this usually entails getting to know

patients on an individual basis and what may be a good

intervention or one patient may not work for the next.


Taking time to get to know my patients is therefore essential to a
good working relationship.

If a patient collapses what would you do?

Assess the situation, is it safe to approach the patient?


Call for help
Assess the patient ABC - commence CPR if necessary, follow the

CPR protocol and get the necessary help.


If not necessary and patient is still conscious ask how they feel now,

how they felt before it happened and when it happened?


Make patient comfortable until able to decide if it is safe to move

them or do you need a medical assessment


Maybe speak with or get the GP on call to assess or emergency

ambulance
Check clinical observations (b/p, pulse, respirations, spo2,) Monitor

as condition dictates
Document incident
Complete an incident form
Inform family if patient allows or if an emergency situation

You have a patient with non insulin diabetes and their BM is


between 3 & 4. What would you do?

Check what the patients normal range is for this time of day
Ask if they have eaten, or are they about to eat?
Ask how they feel?
Review plan in place for patients diabetes treatment and treat as

per plan.
If there is no plan in place and the BM is low for them I will ensure I

give them something to eat (biscuits, glass of milk or coke)


Recheck BM after 30 mins and again if seen necessary
If it continues to be low/lower consider using glucogel
Contact GP if still concerned
Advise patient to call for nurse should they feel in anyway different
(increased heart rate, perspiration, agitated, blurred vision...)

Monitor situation, do they take oral medication for their diabetes,


does it need reviewed

Document situation and ensure other staff members are informed.


Do you understand the term abuse. Explain to me what you the
term abuse means to you?

Abuse is any action that intentionally harms or injures another


person. It also encompasses inappropriate use of any substance,
especially those that alter consciousness (e.g., alcohol, cocaine,

methamphetamines).
There are several major types of abuse: physical abuse, sexual
abuse, substance abuse, elder abuse, and psychological abuse.

If you are the nurse in charge and a nurse called in sick, what
would you do?

Ask the sick nurse to keep us up to date of when she will return
Look at the staff roster and try to make changes by asking other

staff to swap shifts or do extra


Cover any immediate shift myself if I an unable to get cover
Follow the policy in place for emergency cover eg: phone nursing

agency if possible
Advise the manager of the situation when they return

How will you manage a new admission?

I will admit the patient as per the policy/procedure in place.


I will assess what needs addressing and prioritise
I will assess the patients 'Activities of daily living' Maintaining a safe
environment,
Elimination,

Communication,
Washing

and

Breathing,

dressing,

Eating

Controlling

and

drinking,

temperature,

Mobilisation, Working and playing, Expressing sexuality, Sleeping,

Death and dying and prepare care plans accordingly.


I will orientate the patient to the new environment and show them
how to call for assistance.

I will explain the day to day routine and ask about their likes, dislike,
preferences eg; do they like to eat in the dining room with others or

alone in their room.


Ask them what they consider to be of most importance to them
whilst staying with us and advise others of these things to try and

make them feel as comfortable as possible.


This list is endless.......

A resident has a history of chronic heart failure, with a low bp,


poor oral intake over 24 hours also taking diuretic, what action
would you take?

I appreciate the resident has heart failure however I would hold the

diuretic until I had the patient assessed by a doctor.


I would ask the resident to remain on bed rest with their legs raised

to try and increase the b/p


I would ask why they have not been drinking and treat any problems

in relation to this and advise the importance of drinking


I would assist with drinking needs
I would carry out anything ordered by the doctor e.g.; IV Fluids,
monitoring of input and output, regular monitoring of clinical

observations (bp, pulse, resp ect)


Ensure the patient is comfortable and has the nurse call bell to

hand.
Advise patient not to mobilise alone until we get the bp at

satisfactory level, in case they should feel light headed and faint.
Advise all staff on shift of the situation
Document everything

What action would you take if you find a resident on the floor
complaining of leg pain?

Get help
Assess the situation and approach if safe to do so
Ensure the patient is as comfortable as possible whilst you assess
them

Assess the patient -how did it happen, did the fall, where is the pain,

what type of pain is it, is the pain constant


Check the clinical observations - temp, pulse, bp ect...
Look at the leg for signs of a break, did they hear a crack
Speak with the doctor or phone for an ambulance dependent on the

assessment
Only mobilise if certain there is no break otherwise await the doctor
or ambulance and make patient as comfortable as possible

You find a resident who is non responsive, what action would you
take?

call for help


immediately instigate CPR protocol - ABCD....
(At this point in your interview, (please explain each step of
CPR and what you will do and why)

If you are the nurse on day shift and two residents develop
vomiting and diarrhoea, what action would you take?

Immediately instigate the protocol for possible infection prevention


spread eg: wearing appropriate clothing when entering the rooms,
putting up signs on doors if appropriate, wash clothing and bedding

as per policy for infected linen.


Inform patient of possible infection status and allow time for

questions and relieve anxieties.


Obtain samples of faeces for testing (send for O and S and CDIF if
seen necessary) (organism and sensitivity and clostridium dificile)
( to send for cdif the sample must be water like and if this is
suspected

then

alcohol

gel

must

not

be

used

for

hand

decontamination and soap and water washing is essential)


Isolate the patients to their room
Inform all staff of possible infection status including domestic staff

(cleaners) and kitchen staff


Ensure nurse in charge is aware
Speak with the doctor and carry out anything they request

monitor the patient for signs of dehydration, commence on an input

and output chart


monitor dietary intake
administer anti-emetics, anti-diarrhoea medications as the doctor

has prescribe
Limit visitors to the residents and ensure they are aware of hygiene

procedures.
Inform kitchen staff and discuss the last 24 hours menu, ???could it

be food poisoning???
Possibly stop visitors entering home if more residents develop
symptoms

What is the reverse barrier technique?


Protective Isolation, otherwise known as reverse barrier nursing, is the
separation of a patient who is at high risk from diseases and organisms
that are carried by others. The policy that is put into place helps to
prevent

patient

from

infection

from

another

patient.

An example of a patient who would require protective isolation is


somebody who has a damaged immune system, which would make them
more susceptible to catching diseases from other patients. The patient
would need to be moved to a single room or ward, which contains a hand
washbasin and a toilet. The door to the isolation room should be kept
closed at all times, and only opened for entrances and exits that were vital
for the care of the patient. The number of staff accessing the room would
be kept to a bare minimum so as to limit the risk of further infection.
A member of staff who is nursing a patient with an infection should not be
treating a patient who is in protective isolation. Furthermore, any staff
with any infections should not be permitted into the room at any time. A
notice stating that the patient in the room is in isolation should be clearly
visible on the door of the room, and the situation should be closely and

constantly monitored. All staff and visitors should be made aware

of

the protective isolation and the risks thereof. Staff members who are
given access to the room should wear rubber gloves and masks for the
extra security of the patient. Visitors are not usually allowed when a
patient is in protective isolation.
Explain the technique of taking the pulse.
How do I check the pulse on my wrist?

Place your index and middle fingers on the inside of your wrist,
below your thumb.

Use a watch with a second hand and count your pulse for 60
seconds.

Write down your pulse rate, the date, time, and which side was used
to take the pulse. Also write down anything you notice about your
pulse, such as that it is weak, strong, or missing beats.

How do I check the pulse on my neck?

Place your index and middle fingers on one side of your neck, just
under your jaw, where your neck and jaw meet.

Use a watch with a second hand and count your pulse for 60
seconds.

Write down your pulse rate, the date, time, and which side was used
to take the pulse. Also write down anything you notice about your
pulse, such as that it is weak, strong, or missing beats.

How would you ensure your patient/residents would have a


happy life?

Each patient should be assessed on an individual basis about their

likes and dislikes


Every effort should then be made to ensure that each individuals
likes are addressed eg 'playing bingo or other games, receiving

books to read, watching television programmes, going on trips out.


Ensuring they are receiving food and drinks that they like
Ensuring they are comfortable at all times especially if they are

bed/chair bound
Being respectful of their religious beliefs and having ministers visit if

they request
Ensuring dignity is maintained at all times
Promoting their independence

Could you explain why diet is important for elderly patients?

Maintaining your cardiovascular health during the later years of life


is important, particularly because heart disease was avoid eating
foods that contain unhealthy fats and to increase your intake of

healthy fats. Unhealthy fats -- such as trans fats found in processed


As you age, your bones begin to lose strength. Bone-related
diseases, such as osteomalacia and osteoporosis, are associated
with increased risk of fractures. Vitamin D and calcium are

important nutrients that can help you maintain strong bones.


Good nutrition can help you sustain your mental health. Older
people are at increased risk of experiencing depression, according

to the Centres for Disease Control and Prevention.


Older adults are at increased risk of developing cardiovascular,
metabolic and cancer-related diseases due to inadequate dietary
intakes of nutrients; prolonged malnourishment results in rapid
deterioration of health and early death. Healthy nutrition habits as
you age are imperative not only for physical wellness, but also
mental well-being and quality of life. Improving the nutrition habits
of an elderly patient involves recognizing the physiological changes

that impact appetite and creatively formulating a plan that

works for the individual.


Calories supply the body with energy to conduct normal daily

activities.
A nutritious diet can significantly improve health and quality of life
in older adults. Along with avoiding tobacco and remaining physical
active, a healthy diet can reduce the risk of developing chronic
conditions such as cardiovascular disease and cancer.

If you had a patient has problems with falling a lot, how would
you manage this? What do you think some of the causes would
be?

Speak with the patient and find out why they think it is happening.
Try to find out the cause and manage it appropriately (eg: what

is their diet like, have they got pains,


Assess patient safety and commence any protocol seen necessary

to prevent further falling


Ensure nurse call bell is to hand at all times

What do you understand the word dignity to mean?

Dignity is

term

used

in moral, ethical, legal,

and

political

discussions to signify that a being has an innate right to be valued

and receive ethical treatment.


The RCN believes that every member of the nursing workforce
should prioritise dignity in care, placing it at the heart of everything
we do. Yet while dignity is clearly a vital component of care, the RCN

is concerned that it is beginning to be lost.


When dignity is absent from care, people feel devalued, lacking
control and comfort. They may also lack confidence, be unable to
make decisions for themselves, and feel humiliated, embarrassed

and ashamed.
Providing dignity in care centres on three integral aspects: respect,
compassion and sensitivity. In practice, this means:

Respecting patients' and clients' diversity and cultural needs; their


privacy - including protecting it as much as possible in large, open-

plan hospital wards; and the decisions they make


Being compassionate when a patient or client

and/or

their

relatives need emotional support, rather than just delivering

technical nursing care


Demonstrating sensitivity to patients' and clients' needs, ensuring

their comfort.
Patients and clients can also experience dignity - or its absence - in
what they wear, such as gowns, and in the physical environment

where treatment takes place. For example:


facilities such as toilets should be well maintained and cleaned

regularly
curtains between beds should close properly to offer some measure

of privacy
toilet doors should be closed when in use
bays in wards should be single-sex
gowns should be designed and made in a way that allows them to

be fastened properly to avoid accidental exposure


privacy should be provided for private conversations, intimate care
and personal activities, such as going to the toilet. (RCN)

What means the following scores: Glasgow and Waterlow?


The Glasgow Coma Scale or GCS is a neurological scale that aims to
give a reliable, objective way of recording the conscious state of a person
for initial as well as subsequent assessment. A patient is assessed against
the criteria of the scale, and the resulting points give a patient score
between 3 (indicating deep unconsciousness) and either 14 (original
scale) or 15 (the more widely used modified or revised scale).
GCS was initially used to assess level of consciousness after head injury,
and the scale is now used by first aid, EMS, nurses and doctors as being
applicable to all acute medical and trauma patients. In hospitals it is also
used in monitoring chronic patients in intensive care.

The Waterlow score permits patients to be classified according

to

their risk of developing a pressure sore.


The categories of risk factors are listed below:

weight for height

continence

skin condition

mobility

sex and age

appetite

special risks:
o tissue condition and perfusion
o neurological dysfunction
o major surgery or trauma
o medication

The score in each section is summated to give the overall score which
indicates the relative risk:

0-9 - low risk

10-14 - at risk

15-19 - high risk

20+ - very high risk

A systematic review found that the Waterlow score offers a high sensitivity
score (82.4%), but low specificity (27.4%), in the risk assessment of
pressure ulcers (2).

You are the nurse in charge and a patient comes to you to say, no
one has taken me to the toilet today and my pad is wet. What
would you do?

Take the patient to the bathroom and tend to their skin care needs

immediately.
Reassure the patient this matter will be dealt with, ask if this

happens regularly or if this is the first time.


Relieve the patients anxieties.
Offer a complaints form to the patient.
Investigate why this happened and deal with it appropriately...eg;
speak with the care assistants and the nurse in charge if seen

necessary.
Monitor this situation and ensure other staff are made aware of what
happened and that it should never happen again.

What is Urinary Tract Infections and which are the symptoms?


Urinary tract infections (UTI) aren't just a nuisance they can cause
serious health problems. A urinary tract infection happens when bacteria
in the bladder or kidney multiplies in the urine. Left untreated, a urinary
tract infection can become something more serious than merely a set of
uncomfortable symptoms. UTIs can lead to acute or chronic kidney
infections, which could permanently damage the kidneys and even lead to
kidney failure. UTIs are also a leading cause of sepsis, a potentially lifethreatening infection of the bloodstream.

The population most likely to experience UTIs is the elderly. Elderly


people are more vulnerable to UTIs for many reasons, not the least of
which is their overall susceptibility to all infections due to the suppressed
immune system that comes with age and certain age-related conditions,
according to the National Institutes of Health (NIH).
Younger people tend to empty the bladder completely upon urination,
which helps to keep bacteria from accumulating within the bladder. But
elderly men and women experience a weakening of the muscles of the
bladder, which leads to more urine being retained in the bladder, poor
bladder emptying and incontinence, which can lead to UTIs.
Symptoms of UTIs
The typical signs and symptoms of a UTI include:

Urine that appears cloudy

Bloody urine

Strong or foul-smelling urine odor

Frequent or urgent need to urinate

Pain or burning with urination

Pressure in the lower pelvis

Low-grade fever

Night sweats, shaking, or chills

What indicates the colour of the nails of a patient?

Changes in the fingernails can indicate everything from heart


disease to thyroid problems and malnutrition. Here are some nail
conditions that might require medical attention.
Nail Separates from Nail Bed
What it looks like: Fingernails become loose and can separate from the
nail bed.
Possible causes:

Injury or infection

Thyroid disease

Drug reactions

Psoriasis

Reactions to nail hardeners

Yellow Nails
What it looks like: Yellow discoloration in the fingernails. Nails thicken and
new growth slows. Nails may lack a cuticle and may detach from the nail
bed.
Possible causes:

Respiratory conditions, such as chronic bronchitis

Swelling of the hands (lymphedema)

Spoon Nails
What it looks like: Soft nails that look scooped out. In spoon nails
(koilonychia), the depression usually is large enough to hold a drop of
liquid.
Possible causes:

Iron deficiency

Anemia

Nail Clubbing
What it looks like: The tips of the fingers become enlarged and the nails
curve around the fingertips.
Possible causes:

Low oxygen levels in the blood, which could point to heart disease

Inflammatory bowel disease

Cardiovascular disease

Liver disease

Opaque Nails
What it looks like: Nails look mostly opaque but have a dark band at the
tips (a condition known as Terry's Nails)
Possible causes:

Malnutrition

Congestive heart failure

Diabetes

Liver disease

If your senior parent has one of these nail problems, and it doesn't go
away, make an appointment with your doctor to get it diagnosed.

Which are the main types of diabetes and talk a little


about each one?
Type 1 Diabetes
Type 1 diabetes is an autoimmune disease. An autoimmune disease
results when the body's system for fighting infection (the immune system)
turns against a part of the body. In diabetes, the immune system attacks
and destroys the insulin-producing beta cells in the pancreas. The
pancreas then produces little or no insulin. A person who has type 1
diabetes must take insulin daily to live.
At present, scientists do not know exactly what causes the body's immune
system to attack the beta cells, but they believe that autoimmune,
genetic, and environmental factors, possibly viruses, are involved. Type 1
diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the
United States.
Symptoms include:

Increased thirst

Increased urination

Constant hunger

Weight loss

Blurred vision

Extreme fatigue

If not diagnosed and treated with insulin, a person with type 1 diabetes
can lapse into a life-threatening diabetic coma, also known as diabetic
ketoacidosis.

Type 2 Diabetes
The most common form of diabetes is type 2 diabetes. About 90 to 95
percent of people with diabetes have type 2. This form of diabetes is most
often associated with older age, obesity, family history of diabetes, and
physical inactivity,
Type 2 diabetes, formerly called adult-onset or noninsulindependent
diabetes, is the most common form of diabetes. This form of diabetes
usually begins with insulin resistance, a condition in which fat, muscle,
and liver cells do not use insulin properly. At first, the pancreas keeps up
with the added demand by producing more insulin. In time, however, it
loses the ability to secrete enough insulin in response to meals. People
who are overweight and inactive are more likely to develop type 2
diabetes.
The symptoms of type 2 diabetes develop gradually. Their onset is not as
sudden as in type 1 diabetes. Symptoms may include:

Fatigue

Frequent urination

Increased thirst and hunger

Weight loss

Blurred vision

Slow healing of wounds or sores

Some people have no symptoms.

Treatment includes taking diabetes medicines, making wise food


choices, exercising regularly, controlling blood pressure and cholesterol,
and taking aspirin dailyfor some. Read more on Type 2 Diabetes

Gestational Diabetes
Some women develop gestational diabetes late in pregnancy. Although
this form of diabetes usually goes away after the baby is born, a woman
who has had gestational diabetes is more likely to develop type 2 diabetes
later in life.

How can you control diabetes?


A major goal of treatment is to control the ABCs of diabetes: A1C (blood
glucose average), Blood pressure, and Cholesterol.
Talk to your health care team about how to manage your A1C (blood
glucose or sugar), Blood pressure, and Cholesterol. This will help lower
your chances of having a heart attack, a stroke, or other diabetes
problems. Here's what the ABCs of diabetes stand for:

A for the A1C test. The A1C Test shows you what your blood
glucose has been over the last three months. The A1C goal for most
people is below 7. High blood glucose levels can harm your heart
and blood vessels, kidneys, feet, and eyes.

B for Blood pressure. The goal for most people is 130/80. High
blood pressure makes your heart work too hard. It can cause heart
attack, stroke, and kidney disease.

C for Cholesterol. The LDL goal for most people is less than 100.
The HDL goal for most people is above 40. LDL or "bad" cholesterol
can build up and clog your blood vessels. It can cause a heart attack
or a stroke. HDL or "good" cholesterol helps remove cholesterol from
your blood vessels.

What is a pressure ulcer?


A pressure ulcer is an ulcerated area of skin caused by irritation and
continuous pressure on part of the body. It starts as an area of skin
damage. The damage can then spread to the tissues underlying the skin.
In severe cases, there can be permanent damage to muscle or bone
underneath the skin. Pressure ulcers can be very painful and can take a
very

long

time

to

heal.

Pressure ulcers can affect any area of the body but are more common
over bony prominences (places where your bones are close to your skin).
Common areas for pressure ulcers to occur are around your sacrum (the
lower part of the backbone), your heels, your elbows, your hips, your
back, your bottom, the back of your head and your shoulders. Pressure
ulcers can develop very quickly. In people who are at high risk (see
below), it can take less than an hour for a pressure ulcer to develop.
What causes pressure ulcers?
Pressure ulcers are caused by the pressure from the weight of your body
pressing down on your skin. They usually occur when a bony prominence
is pressed against a surface such as a chair or a bed. This compresses the
skin and the underlying tissues and can also damage blood vessels.
Friction (rubbing) of your skin can also play a part in the formation of a
pressure ulcer. Friction can happen, for example, if you are dragged across
a

surface

such

as

bed.

If you are spending long periods in bed or in a chair, you may slide down

and need to be pulled back up again by someone else (or you may

be

able to pull yourself back up). However, as these sliding and pulling
movements happen, the layers of your skin also slide over each other, as
well as over the underlying tissues. These sliding or 'shearing' forces can
also contribute to pressure ulcer formation.
Changes to the skin as it ages may make this sliding of the skin more
likely. A lot of moisture around the skin (for example, if you have urinary
or faecal incontinence or you are sweating a lot) can increase the effects
of pressure, friction and shearing forces. Damp skin becomes softer and
more fragile.
Using the correct preventative measures (see below) should mean that
most pressure ulcers are avoidable.
Who gets pressure ulcers?
Most pressure ulcers occur when someone is admitted to hospital. They
affect between 1 to 5 in every 100 people admitted to hospital. However,
pressure ulcers can also develop in someone at home, or in a nursing or
residential home.
A pressure ulcer is more likely to develop if you:

Are seriously ill (including someone in an intensive care unit).

Are not very mobile (for example, you may be confined to a chair or
a bed), particularly if you are not able to change your position
without help from someone else.

Have had a spinal cord injury (this means you are unable to move or
feel your legs, and sometimes your arms).

Have a poor diet.

Are wearing a prosthesis (for example, an artificial limb), a body


brace or a plaster cast.

Are a smoker.

Are incontinent of urine or faeces (this causes damp skin which is


more easily damaged).

Have diabetes (this can affect sensation and ability to feel pain over
parts of the body).

Have chronic obstructive pulmonary disease (COPD) or heart failure.

Have Alzheimer's disease, Parkinson's disease or rheumatoid


arthritis.

Have recently had a broken hip or undergone hip surgery.

Have peripheral vascular disease (poor circulation in your legs or


arms, caused by narrowing of your arteries by atheroma).

What do pressure ulcers look like?


Pressure ulcers can look different depending on how severe they are. They
are graded depending on their severity and how deep they go:

Grade 1 - your skin is permanently red but is not broken at all. It


may feel warm, hard or slightly swollen. In dark-skinned people,
your skin may be purple or blue in colour.

Grade 2 - the ulcer is still superficial. It may look like a blister or


abrasion.

Grade 3 - the ulcer goes through the full thickness of the skin and
there is damage to the tissues underneath the skin.

Grade 4 - this is the most severe form. The ulcer is deep and there is
damage to muscle or bone underneath.

Preventing pressure ulcers


The National Institute for Health and Clinical Excellence (NICE) has
produced guidelines with recommendations for best practice for the
prevention of pressure ulcers. NICE recommends that all people who are
admitted to hospital, a nursing home or similar, or people who are
receiving nursing care at home, should be assessed for their risk of
developing a pressure ulcer. This is usually done by a healthcare
professional (usually a nurse). This assessment should be reviewed
regularly

because

your

situation

may

change.

There are various pressure ulcer risk assessment scales that may be used,
looking at factors such as your diet, your mobility, your continence, your
consciousness level, any underlying illnesses that you may have, etc.
What treatments are often needed for pressure ulcers?

Pain relief - a pressure ulcer can be painful. Simple painkillers like


paracetamol may be helpful. Sometimes stronger painkillers are
needed.

A change to your diet - a poor diet can slow the healing of a


pressure ulcer.

Dressings - various different dressings may be used, including gel


and foam-based dressings.

Antibiotics - these may be needed if there are any signs of infection.

Surgery - sometimes surgery is needed to remove damaged or dead


skin. The medical term that is used for this type of surgery is

'debridement'. Sometimes plastic surgery may be used to


close a pressure ulcer that is not healing. Skin grafts may be
needed.
What are the main characteristics of a care plan?
1 Its focus is holistic, and is based on the clinical judgment of the
nurse, using assessment data collected from a nursing framework.
2 It is based upon identifiable nursing diagnoses (actual, risk or health
promotion)

clinical

judgments

about

individual,

family,

or

community experiences/responses to actual or potential health


problems/life processes.
3 It focuses on client-specific nursing outcomes that are realistic for
the care recipient
4 It includes nursing interventions which are focused on the

risk

factors of the identified nursing diagnoses.


A Care plan can address any number of issues that range from extreme
aggression, gaining weight, Physiotherapy or stopping smoking, to getting
more communication with other residents/family members

What it is essential when it comes to good medication ?


Build strong trusting relationships as these are fundamental to how well
care is delivered.
Take time to communicate, update records, and share information.
Ensure regular and formal reviews of care plans and medication.
Prioritise safety by protecting the drugs round, improving systems and
attention to detail.
Identify, capture and develop good practice and help disseminate this to
staff.

Make use of relevant health professionals to ensure medication


practices are safe.
Clarify roles and responsibilities to ensure smoother communication and
safer care.
Consider medication as part of a holistic approach to care to ensure that
decisions are always made in the interests of the resident and their voice
is heard.
In conclusion, care home staff need to be aware of the importance of
managing medicines safely; be confident to recognise and deal with
problems as they occur; and be encouraged to report and learn from
previous mistakes
It is also Important to:

Keep medicines locked away at all times


Will have their medicines at the times they need them and in a safe

way
Wherever possible will have information about the medicine being

prescribed made available to them for others acting on their behalf


Handle medicines safely, securely and appropriately
Ensure that medicines are prescribed and given by people safely
Follow published guidance about how to use medicines safely
Any medications administered are recorded immediately and
accurately

What key concepts that combine to make person-centred care a


reality are?

Person-centred care aims to ensure a person is an equal partner in their


health care. The individual and the health system benefit because the
individual experiences greater satisfaction with their care and the health
systems is more cost-effective.

Key concepts:

respect and holism


power and empowerment
choice and autonomy
empathy and compassion.

They may be thought of as making different contributions to the overall


idea of dignity.
A good care home will follow the principles of person-centred care. This
approach aims to see the person with vulnerability as an individual, rather
than focusing on their illness or on abilities they may have lost. Instead of
treating the person as a collection of symptoms and behaviours to be
controlled, person-centred care considers the whole person, taking into
account each individual's unique qualities, abilities, interests, preferences
and needs. Person-centred care also means treating residents with dignity
and respect

What do you understand by Safeguarding Vulnerable adults


principle?
Safeguarding Adults is the principle that all adults should be able to live
free from fear or harm and have their rights and choices respected.
Vulnerable adults are people who are at a greater than normal risk of
abuse. Older people are vulnerable, especially those who are unwell, frail,
confused and unable either to stand up for themselves or keep track of
their affairs.

Older people are more at risk they are normally dependent on


someone else.. Abusers may create a feeling of dependency and may also
make the vulnerable person feel isolated, that nobody else cares for them
and that they're on their own.
Broadly speaking, a vulnerable adult is aged 18 or over, receives or may
need community care services because of a disability, age or illness, and
who is or may be unable to take care of themselves or protect themselves
against significant harm or exploitation.

How will you make sure you fit into the team?
I will work hard to earn their respect. I will be friendly and professional to
all. I will also make an effort outside work to go to work functions and to
also become part of the community where I live. I find it easy to get on
with many people and never had problems before.
In case a care assistant refuses to do his job, what is your
attitude?
If any of your staff do anything or refuse to do something THIS MEANS THE
PATIENT will suffer for it.
You must try to resolve the issue with the staff member and try to get
their respect and understanding. IT is easier if everyone try to get on and
work nicely together.
BUT if you cant resolve the problem, you will have to get team leader or
manager involved to follow a disciplinary with the care assistant.
Please explain the mouth care procedure.

Perform hand hygiene and don non-sterile gloves, facemask and


shield.

To fully inspect oral cavity, use a flashlight and a 4 X 4 gauze to


facilitate lifting/moving of the tongue

Inspect top, sides and undersurface of tongue. Assess lips, back of


throat and mucous membranes for any bleeding, odor, discharge or
evidence of skin breakdown or ulceration

Inspect teeth to observe for breakage, missing teeth, dental carries


or recent trauma. Consider need for dentistry consult.

Remove any partial or full plates or dentures.

Palpate along cheeks, gum line and neck glands for signs of
swelling, enlarged lymph nodes or abscess.

Review ETT or NG tube placement and assess for associated


ulcers/early pressures; discuss with RRT if tube repositioning is
needed

Document findings in AI record.

In case a family member complaints about the care delivered to


their relative, what would you do?

1. I will take any complain very serious!


2. LISTEN TO THE PROBLEM
3. FIND WAYS TO SOLVE THE PROBLEM
4. MAKE THE MANAGER AWARE OF COMPLAIN
5. REASSURE THE PERSON WHO COMPLAINS THAT YOU WILL DO
SOMETHING

6. RESOLVE THE PROBLEM


7. GO BACK and EVELUATE to see if your plan has worked and if they are
now happy!

Can you name the symptoms of appendicitis?


Appendicitis typically starts with a pain in the middle of your abdomen
(tummy) that may come and go.
Within hours, the pain travels to your lower right-hand side, where the
appendix is usually located, and becomes constant and severe.
Pressing on this area, coughing or walking, may all make the pain worse.

If you have appendicitis, you may also have other symptoms, including:

feeling sick (nausea)

being sick

loss of appetite

diarrhoea

a high temperature (fever) and a flushed face

How can you determine levels of risks?


Several risk assessment tools or scales are available to help predict the
risk of a pressure ulcer, based primarily on those assessments mentioned
above. These tools consist of several categories, with scores that when
added together determine the total risk score. The Braden and Norton
Scales for predicting pressure ulcer risk are the most widely used in a
variety of healthcare settings. The clinician uses these tools to help

determine risk so that interventions can be started promptly.


These tools are only used for assessing adults. For those who work with
children, the Braden Q Scale has subcategories that relate to assessing
children (see Resources at the end of this course).
What is Braden Scale?
The Braden Scale consists of six categories:

Sensory perception: Can the patient respond to pressure-related


discomfort?

Moisture: What is the patients degree of exposure to incontinence,


sweat, and drainage?

Activity: What is the patients degree of physical activity?

Mobility: Is the patient able to change and control body position?

Nutrition: How much does the patient eat?

Friction/shear:

How

much

sliding/dragging

does

the

patient

undergo?
There are four subcategories in each of the first five categories and three
subcategories in the last category. The scores in each of the subcategories
are added together to calculate a total score, which ranges from 623. The
higher the patients score, the lower his or her risk. (For more information,
see Resources at the end of this course.)

Less Than Mild Risk: 19

Mild Risk: 1518

Moderate Risk: 1314

High Risk: 1012

Very High Risk: 9

It is recommended that if other risk factors are presentsuch as age,


fever, poor protein intake, or diastolic blood pressure less than 60 mm Hg
the risk level should be advanced to the next level. Each deficit that is
found when using the tool should be individually addressed, even if the
total score is above 18. The best care occurs when the scale is used in
conjunction with nursing judgment. Some patients will have high scores
and still have risk factors that must be addressed, whereas others with
low scores may be reasonably expected to recover so rapidly that those
factors need not be addressed (Braden, 2012).
What is Norton scale?
The very first pressure ulcer risk evaluation scale, called the Norton Scale,
was created in 1962 and is still in use today in some facilities. It consists
of five categories:

Physical condition

Mental condition

Activity

Mobility

Incontinence

Each category is rated from 1 to 4, with a possible total score ranging


from 5 to 20.

Low risk: 18

Medium Risk: 1417

High Risk: 1013

Very High Risk: <10

It is important that when the clinician uses a scale, the scale must not be
altered in any way, meaning there cannot be shortcuts or changes to the
definitions. Any changes would alter the accuracy and usefulness of the
scale in predicting the risk of developing pressure ulcers.
Risk assessment is more than an act of determining a numerical score; it
requires identification of those risk factors that contribute to that score
and minimizing the deficits by the appropriateness of the intensity and
effectiveness of prevention interventions (Kelechi et al., 2013).

What is PEG FEEDING?


PEG feeding is used where patients cannot maintain adequate nutrition
with oral intake.

When do you use PEG FEEDING ?


Indications
Adults
Indications include difficulties with oral intake often where obstruction to
the upper airway or gastrointestinal tract makes passing a nasogastric
tube difficult:

Neurologically unsafe swallowing:


o Acute ischaemic or haemorrhagic stroke: in patients with
acute stroke, gastrostomy feeding should be considered at 14
days post-stroke.
o Chronic progressive neuromuscular disease.

Failure of feeding:

o Dementia; however, there is insufficient evidence to suggest


that enteral tube feeding is beneficial in patients with
advanced dementia.[5] PEG insertion does not improve survival
in end-stage dementia and should be avoided except in
circumstances where it can be justified as a palliative
intervention, genuinely in the patients best interest.
o Cystic fibrosis: PEG feeding is safe, efficacious and acceptable
in children and adults with nutritional failure due to cystic
fibrosis but should be carried out only in the context of close
co-operation between cystic fibrosis chest physicians and an
enteral feeding team.
o Peritoneal dialysis: PEG insertion can improve nutritional
status but increases the risk of fungal peritonitis and failure of
dialysis. PEG insertion can be undertaken in patients on
peritoneal dialysis. Dialysis should be stopped for three days
and prophylactic antifungal therapy given.
o Oro-pharyngeal and oesophageal malignancy: enteral tube
placement into the stomach may hinder surgical techniques in
oesophageal cancer and should be avoided if curative
resection is planned.
PEG tubes may also be indicated in other clinical situations such
as malignant bowel obstruction,[6] head injury, Crohn's disease, fistulae,
other causes of short bowel syndrome, AIDS and HIV encephalopathy and
severe burns.

Name a few contra-indications to PEG.

Absolute contra-indications for use of PEG in adults:


o Active coagulopathies and thrombocytopenia (platelet count
less than 50 x 109/L) must be corrected before tube insertion.
o Anything that precludes endoscopy (such as haemodynamic
compromise, sepsis or a perforated viscus).

Relative contra-indications for use of PEG in adults include acute


severe illness, anorexia, previous gastric surgery, peritonitis,
ascites, and gastric outlet obstruction.

Cautions

Infection: active systemic infection increases the risk of early


mortality and morbidity post-PEG placement. Elevation of serum
CRP is the most accurate prognostic indicator of poor outcome.

Other comorbidity: poorer outcome, with increased PEG site and


systemic infection have been reported in patients with diabetes
mellitus, chronic obstructive pulmonary disease and low albumin
levels.

Ventriculo-peritoneal shunts: placement of PEG tubes increases the


risk of shunt infection but this risk decreases with increased time
between shunt insertion and PEG insertion. Prophylactic antibiotics
may further reduce the infection risk.

Anatomical considerations: in patients with severe kyphoscoliosis,


the stomach is often intrathoracic. This particularly applies to
patients with cerebral palsy. Radiological and endoscopic
approaches may be impossible. A combined laparoscopic and
endoscopic approach can be tried but this requires a general
anaesthetic, which also represents a considerable risk for the
patient.

PEG insertion method

In the majority of patients in whom there is an indication for


percutaneous enteral tube feeding, an endoscopic gastrostomy is
the procedure of choice.

The treating doctor has a duty to obtain informed consent from


competent patients and to undertake adequate consultation with
those closest to patients not competent to make the decision.

PEG tube placement should be carried out under full aseptic


technique.

Antibiotic prophylaxis is indicated to prevent skin site infection.

In areas of high meticillin-resistant Staphylococcus aureus (MRSA)


prevalence, oro-pharyngeal colonisation should be identified and
managed prior to PEG tube placement.

Benefits of PEG feeding

Benefits include:

It is well tolerated (better than nasogastric tubes).

Nutritional status is improved.

Ease of usage over other methods (nasogastric or oral feeding)


reported by carers.

Satisfactory use by home carers.[9]

Low incidence of complications.

Reduction in aspiration pneumonia associated with swallowing


disorders.

Cost-effective relative to alternative methods, particularly when


reasonably long survival is expected.

Management after insertion

Education of carers and patients is essential to reduce tube


problems and complications.

A number of studies indicate the support and education of patients


should be multidisciplinary, involving:
o Nurses (wound care and ostomy expertise).
o Dietitians (nutritional advice and support).

Ongoing care involves:


o Inspection and maintainance of the access device (see 'Care
of PEG tube', below).
o Wound care advice.
o Nutritional support and advice.

Explain the care of PEG tube.


This routine care can be performed by the patient and/or the carers with
suitable training. After about 10 days following insertion asepsis is not
required.

Examine the skin for infection/irritation around the site.

Note the measuring guide number at the end of the external fixation
device.

Remove the tube from the fixation device and ease away from the
abdomen.

Clean the stoma site with sterile saline.

Dry the area with gauze.

Rotate the gastrostomy tube to prevent adherence to sides of the


track.

Re-attach the external fixation device to the abdomen.

Attach the gastrostomy tube gently to the fixation device and


position as before according to the mark/number on the tube.

Avoid use of bulky dressings.

Complications
Immediate (within 72 hours):

Endoscopy-related:
o Haemorrhage or perforation.
o Aspiration.
o Oversedation.

Procedure-related:
o Ileus.
o Pneumoperitoneum.
o Wound infection.
o Wound bleeding.
o Injury to the liver, bowel, or spleen.