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 be?

- 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 COURSES)

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 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 am 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,

Communication, Breathing, Eating and drinking, Elimination, Washing and dressing,

Controlling 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 a 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 a 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 life-threatening 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 daily—for 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

a 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 can’t 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 patient’s degree of exposure to incontinence, sweat, and

drainage?

Activity: What is the patient’s 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 6–23. The higher the patient’s 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: 15–18

Moderate Risk: 13–14

High Risk: 10–12

Very High Risk: ≤9

It is recommended that if other risk factors are present—such 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: 14–17

High Risk: 10–13

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 patient’s 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.