Study Guide Test 1
Study Guide Test 1 NRSG 102
Ivy Tech Community College Bloomington
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This 25 page Study Guide was uploaded by Lucy Notetaker on Wednesday September 28, 2016. The Study Guide belongs to NRSG 102 at Ivy Tech Community College Bloomington taught by Cassie Mann in Fall 2016. Since its upload, it has received 10 views. For similar materials see Med Surg in Nursing Registered Assoc. Deg at Ivy Tech Community College Bloomington.
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Study Guide for Med-Surg Exam #1 Chapter 1- Definitions Accountable Care Organization (ACO)- an organization aimed at providing accessible, comprehensive, and coordinated primary care focused on illness prevention for patients and families. Page 13 Care Bundle- a small set of evidence-based interventions for a defined patient population and care setting aimed at improving patient outcomes. Page 8 Clinical Reasoning- complex process that uses cognition, metacognition, and discipline-specific knowledge to gather and analyze patient information, evaluate its significance, and weigh alternative actions. Page 3 Code of Ethics- an established and agreed on group of principles of conduct that provide a frame of reference for nursing behaviors that are congruent with professional values. Page 9 Core Competencies- standards that a profession agrees are essential for a person to be deemed competent in his or her field. Page 3 Critical Thinking- self-directed thinking that is focused on what to believe or do in a specific situation. Page 4 Delegation- to effectively assign appropriate work activities to other members of the healthcare team. Page 14 Dilemma- a choice between two unpleasant, ethically troubling alternatives. Page 11 Ethics- Principles of conduct. Page 9 Health Information Technology (HIT)- the system supported by the U.S. government designed to promote free exchanges of health information while protecting patients’ privacy and improving safety, efficacy, and quality of care. Page 14 Health Literacy- people’s ability to obtain, process, communicate, and understand basic health information and services. Page 12 Interprofessional Care- care delivered by intentionally created and usually relatively small work groups in health care as having a collective identity and shared responsibility for a patient or a group of patients. Page 8 Medical-Surgical Nursing- the health promotion, health care, and illness care of adults, based on knowledge derived from the arts and sciences and shaped by knowledge (the science) of nursing. Page 2 Nursing Process- the series of critical thinking activities nurses use as they provide care to patients; this logical approach to care ensures that patients receive comprehensive and effective care. Page 5 Nursing-Sensitive Quality Indicators (NSQIs)- patient outcomes that are influenced significantly by quality nursing interventions. Page 8 Patient- the person, family, or community with who and for who nursing care is designed and implemented. Page 3 Patient-Centered Medical Home (PCMH)- accessible, comprehensive, and coordinated primary care focused on illness prevention for patients and families. Page 13 Patient Protection and Affordable Care Act (ACA)- landmark federal legislation enacted in 2010 and designed to provide access to health care services for more Americans and create new models of health care. Page 2 Professional Boundaries- the borders between the vulnerability of the patient and the power of the nurse. Page 11 Quality Improvement- systematic evidence-based methods used to evaluate and improve patient care. Page 8 Standard- a statement or criterion that can be used by a profession and by the general public to measure quality of practice. Page 10 Transitional Care- interventions designed to improve the ability of patients and caregivers to manage care needs in preparation for transitions from one healthcare setting to another or to home. Page 13 Triple Aim- an initiative launched by the Institute of Health Improvement (IHI) aimed at simultaneously improving the patient care experience, improving the health of population and reducing per capita costs of healthcare. Page 3 Conversions- if number to the right is greater than or equal to, round up. 1 teaspoon (t/tsp) = 5 milliliters (mL) 1 pound (lb) = 16 ounces (oz) 3 teaspoons (t/tsp) = 1 tablespoon (T/tbs) = 15 milliliters (mL) 1 ounce (oz) = 30 milliliters (mL) 1 liter (L) = 1000 milliliters (mL) 1 cup = 8 ounces (oz) = 240 milliliters (mL) 2 cups = 1 pint (pt) Adults- round to the nearest tenth 2 pints (pt) = 1 quart (qt) = 1 liter (L) Children- round to nearest hundredth 60 milligrams (mg) = 1 grain (gr) 1000 milligrams (mg) = 15 grains (gr) 15 milligrams (mg) = ¼ grain (gr) 0.4 milligrams (mg) = 1/150 grain (gr) 1000 micrograms (mcg) = 1 milligram (mg) 1000 milligrams (mg) = 1 gram (g) 1000 grams (g) = 1 kilogram (kg) 1 kilogram (kg) = 2.2 pounds (lb) = 1000 grams (g) Florence Nightingale (1820-1910) Started modern nursing and founded the first school of nursing – St. Thomas’ Hospital (London) These nurses became the Diploma Nurse Started implementing hand hygiene and patient safety Requirements of the Nurse Knowledge of the body systems and disorders Communication skills Coordination and delegation o *if we delegate, we are still responsible* Clinical reasoning skills o Critical thinking- self-directed thinking that is focused on what to believe or do in a specific situation Ex: nurse challenges assumptions, overtly identifies and acknowledges the values and beliefs brought to the situation, considers the influence of context, generates possible explanations, and deliberately maintains healthy skepticism. o Deductive reasoning- process of starting out with one or more general statements and examining the possibilities to reach a locally certain conclusion. Ex: a nurse may use what she knows about the time frame during which the effects of insulin peak to determine the best time to assess the patient for signs and symptoms of hypoglycemia. o Inductive reasoning- reasoning that moves from the specific to the general Ex: a nurse takes care of several patients that are recovering from surgery. Through the experiences of caring for individual patients, the nurse discovers the expected patterns of recovery and uses specific cases to generalize predictions about normal post-op healing. o Dialectic reasoning- thinking about situations in a holistic way. “A dialectic thinker believes the whole is greater than the sum of the parts and that the whole organizes the parts.” Ex: nurse assesses the strengths and challenges related to a patient’s problem rather than focusing solely on the pathophysiologic aspect of the illness. o Divergent thinking- ability to weigh the importance of information. Ex: nurse collects data from the patient and is able to sort out the data that relevant for care for the care and that are not relevant, and explore alternatives to draw a conclusion. *abnormal data are usually considered relevant; normal data are helpful but may not change the care provided.* o Reflective thinking- two kinds Reflecting-in-action: occurs while a situation is being addressed Ex: nurses engage in reflecting-in-action when they purposefully monitor and analyze a situation as it unfolds Reflecting-on-action: deliberate and occurs after an event and creates embodied knowledge and skillfulness that will influence what the nurse perceives as salient when confronted with similar patient situations in the future Ex: nurses remembers similar cases related to current situation o Systematic thinking- collecting, analyzing, and organizing information in a methodical manner that supports development of pattern recognition. o Creative thinking- clinical imagination that integrates science, skilled know-how, and practical knowledge to develop unique solutions to individual patient needs. Awareness of patient’s situation Ability to prioritize Nosocomial Infection- healthcare acquired infection Quality and Safety Education for Nurses (QSEN)- page 4 Table 1-1 (PET QIS) (PUT SEQ) Patient-centered care- recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. Teamwork and collaboration- function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care. Evidence-based practice (EBP)- integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal healthcare. Quality Improvement (QI)- use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems. Safety- minimize risk of harm to patients and providers through both system effectiveness and individual performance. Use Informatics- use information and technology to communicate, manage knowledge, mitigate errors, and support decision making. Nursing Process- page 5 (ADPIE) Assessment- critical element in each phase of the nursing process. It is collecting and interpreting the meaning of data. It is NOT forming judgements about a particular patient (page 6) Ex: assessment: “patient is pacing, talking loudly, and with a rapid cadence” Ex: judgement: “patient is angry and out of control” o Objective data- seen, heard, smelled, or touched and can be verified by another person (external) Ex: blood pressure, heart rate, temperature, drainage, color of skin o Subjective data- can only be felt by person experiencing it (internal) Ex: pain, dizziness, anxiety, itching, burning o Initial assessment- head to toe RN’s only. LPN’s not allowed to perform initial assessment o Focused assessment- one aspect Ex: if someone has glaucoma, the eye is the focused assessment Ex: if someone has a broken radius, the arm is the focused assessment Diagnosis- this is the nursing diagnosis, NOT the medical diagnosis. Page 6 &7 o Overview of Diagnostic Reasoning- Box 1-1 on page 7 Level I- identify significant cues Organize data Compare individual data to standards and norms Level II- cluster cues and identify data gaps Cluster significant cues Categorize clusters Identify data gaps and inconsistencies Level III- draw conclusions about the present health status Think of as many explanations as possible for each cue cluster. Then decide which hypothesis best explains it Identify problem Identify patient and family strengths Level IV- determine etiologies and categorize problems o Determine the etiologies of the problems o Categorize the problems according to your framework Verify the problem/diagnoses o Verify the diagnoses and strengths Label the problem/diagnoses o Choose standardized problem label o Prioritize the problems Record the data o Record the problem statements o Usually fall within three categories: Nursing problem/ actual nursing diagnoses- a health problem identified during assessment that can be relieved or resolved through nursing interventions Potential (or risk) nursing problem/diagnoses- a health problem that is likely to develop unless the nurse intervenes Collaborative problems- a health problem that requires both medical and nursing interventions; nurses monitor for and intervene to reduce complications o Nursing diagnoses HAVE to be NANDA approved. They cannot be made up. Start using Nursing Diagnosis Handbook! o Writing diagnoses Use phrases “related to” and “as evidence by” PES: Problem Etiology Symptoms- objective and subjective data Problem r/t etiology AEB signs and symptoms Ex: acute pain r/t surgical procedure AEB increased heart rate and increased blood pressure o Writing risks DOES NOT have signs or symptoms because that would be an actual nursing diagnosis PE Problem Etiology Problem r/t etiology Ex: potential risk for skin breakdown r/t surgical procedure Planning- nurse identifies the desired patient outcomes of care and nursing interventions to achieve these outcomes. Page 7 &8 o Nurses plan interventions for problems that require nursing management (nursing diagnosis) and for collaborative or clinical problems o Outcomes- patient related “Patient will…” Ex: Goal: patient will have pain of 2 out of 10 on a 0 to 10 scale o Interventions- nursing driven “Nurse will…” Ex: Nurse will administer Ibuprofen 600mg Q6⁰ PRN pain while under my care on 9-26-16 from 0630-1430. o Rationale: Ibuprofen, nonsteroidal anti- inflammatory drug (NSAID) that works by… If interventions states, “as prescribed by physician” nurse is allowed to carry out that intervention because it says “as prescribed by physician.” Doctor is saying what to give or do so the nurse can follow through with that intervention. o Evidence-based practice guidelines o Care bundles- group of interventions that are evidence-based and if you do A,B,C,D, and E, your patient should have good results. If you do A, skip B, C,D, and E, your patient may not have as good of a result Ex: CAUTI, SSI, BSI, VAP Implementation- carryout interventions and supervise assistive personnel (the “doing” phase). Page 8 & 9 o When implementing the planned interventions, the nurse follows several important principles: Set daily priorities, based on initial assessments and on the patient’s condition as reported during the change of shift report and/or documented in the patient’s chart. Ensure that critical assessments (such as status of invasive lines, infusing fluids, or changes in health status during the preceding shift) take first priority. Be aware of the interrelated nature of nursing interventions. Ex: while giving a bath the nurse can also assess physical and psychologic status, use of therapeutic communication, teach the patient, do range-of-motion (ROM)exercises, and provide skin care. Determine the most appropriate interventions for each patient, based on health status and illness treatment Ex: directly perform the activity for the patient Assist the patient to perform the activity Supervise the patient/family while they are performing the activity Assign and supervise nursing assistive personnel to perform the activity Teach the patient/family about healthcare Monitor the patient at risk for potential complications or problems Use available resources to provide interventions that are realistic for the situation and practical in terms of equipment available, financial status of the patient, and resources available (including staff, agency, family, and community resources). DOCUMENTATION of interventions is the last component of implementation and it is a LEGAL REQUIREMENT o Ongoing assessment Did what we do work? Were we effective? o Changes in plan if appropriate Do we need to call the doctor for anything? o DOCUMENT If you didn’t document, it says you didn’t do it Ex: if charting space for skin breakdown is left blank, that says you did not assess the skin. If you note “no known skin breakdown,” that says you assessed the skin but found no skin breakdown or skin issues o Set short term goals for outcomes. Ex: patient will ambulate to bathroom three times on 9-16-16 between 0630-1500 Evaluation- allows nurse to determine whether the plan was effective, as well as to continue the plan, revise the plan, or terminate the plan. The outcome criteria established during the planning phase provides basis for evaluation. Page 9 o Evaluation statement is a restatement of goal in past tense. o Evaluation is of GOAL ONLY. “Goal met” – interventions worked “Goal not met” – interventions did not work “Goal partially met” – interventions kind of worked Nursing process in the clinical experience is a framework with care based on patient’s specific, individual needs. Nurses promote health (#1), prevent illness (#2), and alleviate pain and suffering when patients succumb to a disease or illness (#3). If a patient comes into the ER coding, the nursing will be doing all five nursing process steps at one time. The nursing process takes practice and is a practice. Goals: 3 domains (verb) o Patient will what? Knowing = cognitive level (learn) Ex: patient will learn about diabetes. Effective = feeling level (feel) Ex: patient will have a sense of ease, relax, maybe have a lower pain level Psychomotor = doing level (do) Patient will ambulate three times on this day at this time Code for Nurses. Page 9 & 10. Box 1-3 (page 10) Code of ethics o Principles of conduct You do not have to agree or approve of what patients do BUT you HAVE TO RESPECT them o Criterion that defines a profession o Ethics- the study of conduct and character (decisions about right and wrong- good and bad) o Morals- the values and beliefs that guide behavior and decision making. Work where you are passionate Ex: oncology, NICU, elderly, trauma, pediatrics, labor and delivery Where is your belief system? Your own belief system may hinder the care you give o If you do not believe in abortions, do not work in an abortion clinic o There are too many areas to work in the nursing profession for you to be unhappy. Dig deep, find what drives you. o What can you compromise on? o What fields should you avoid? o ICN Code- International Council of Nurses (2012) Helps guide nurses in setting priorities, making judgments, and taking action when they face ethical dilemmas. Specifies what nurses are accountable for in terms of people, practice, society, coworkers, and the profession. Nurses are responsible for promoting health, preventing illness, and alleviating pain and suffering. o ANA Code- American Nurses Association (2001) States principles of ethical concern, guiding the behavior of nurses and also defining nursing for the general public (Box 1-3) REVIEW BOX 1-3 on page 10 ANA Code of Ethics for Nurses Ethical Principles- test questions will be asked by scenario, NOT by definition Autonomy- the right to make one’s own personal decisions, even if not in one’s own best interest o Ex: physician assisted suicide, stopping chemo treatments Beneficence- positive actions to help others* o Similar to nonmaleficence Fidelity- agreement to keep promises o Like marriage for example o NEVER TELL A PATIENT IT WILL BE OKAY As much as we want too, we cannot guarantee that they will be Justice- fairness in care delivery and use of resources o Treat everyone the same o No special treatment Nonmaleficence- avoidance of harm and injury* o Similar to beneficence Basic Principles of Ethics Advocacy- support of client’s health, safety, and personal rights o Being an advocate for the patient Responsibility- willingness to respect obligation and follow through on promises o Do what you say you will do. Don’t forget about getting them water or pain medicine Accountability- ability to answer for one’s own actions o It is okay to say, “I’m sorry” o Sometimes warranted to do so Confidentiality- protection of privacy without diminishing access to high quality care Dilemmas in Ethical Behaviors- page 11 Dilemma- choice between two unpleasant, ethically troubling alternatives o It is the patient’s right to refused treatment but you still have to do the right thing, doing good for the patient, and prevent harm at the same time Confidentiality o HIV status- it is the patient’s right to disclose any information Treat every patient as if they were HIV+ Ex: if patient knew they had HIV and participated in activities, such as sexual relations, it can be considered a weapon. Patient rights o Patient has the right to refuse any treatment Ex: 17 year old patient wants to stop chemo treatments for brain tumor. That is their right Issues of death and dying Ex: 17 year old patient wants to end life and not live in a nonviable state. Patient travels to another state where doctor helps patient with Physician assisted suicide. It is the patient’s right to live or die even though she is under age. Health Information Privacy Ethical Code Federal Law HIPPA- Health Insurance Portability and Accountability Act o “When in doubt, leave it out” o Standards for privacy of individually Identifiable Health Information Technology and Facebook is a “no no” in clinical setting Standards of Nursing Practice Standard- statement, criterion used by profession and general public to measure quality of practice o It is what we should be doing o If it is “standard,” it has been evaluated, looked at, and agreed that it is the right thing to be doing for the patients Nurses’ responsibilities to society- account for his/her own behaviors within role o Never allowed to party again? No, but you have to think about your actions and reputation as a nurse. Would your actions be deemed appropriate by your profession? ANA Standards of practice (2010)- Table 1-3 on page 10 (ADOPI) o Assessment- the RN collects comprehensive data pertinent to the patient’s health or the situation o Diagnosis- the RN analyzes the assessment data to determine the diagnoses or issues o Outcomes identification- the RN identifies expected outcomes for a plan individualized to the healthcare consumer or the situation o Planning- the RN develops a plan that prescribes strategies and alternatives to attain expected outcomes o Implementation- the RN implements the identified plan, coordinates care delivery, and employs strategies to promote health and a state of safe environment. The advanced practice RN also provides consultation and uses prescriptive authority, procedures, referrals, treatments, and therapies. Professional Boundaries- borders between vulnerability of patient and power of nurse Act in best interests of patient- ALWAYS Easy to take advantage of situation where patient is vulnerable Cannot use patients illness or situation to make a point Do NOT get involved in patient’s personal relationships o Do NOT give advice o If it is not part of their care, leave it alone Avoid use of position for personal gain o Don’t use patient’s as personal gain on a personal level o You want extra ice cream? That will be a dollar. NOT ALLOWED o No personal gain because you are in a position of authority Nurses’ responsibility to establish and maintain boundaries o If a patient flirts with you, it is your job to stop it! Nurse as Caregiver Role in 1900s to 1960s o Florence Nightingale o Primarily personal care Started with giving baths and feeding people o Carried out physician’s orders We did what we were told Role today o Independent and collaborative Holistic approach o Everything Nurse as Educator Growing emphasis on health promotion o Illness prevention o Shorter hospital stays Health literacy- make informed decisions o Degree to which individuals have capacity to obtain, process, and understand basic health information and services Teaching-learning process o Education begins upon admission o Discharge education begins upon admission Nurse as Advocate Promote patient’s right to choose treatment options o Assist and support in decision making o Talk to family o Patients have a right to make a decision in the care they receive, support them in any decision that they make. Serve as a change agent in healthcare system o Communicate with other healthcare providers Participate in health policy formulation You can ALWAYS advocate for your patients Nurse as Leader/Manager Manage time, people, resources, and the environment Delegate, supervise, coordinate activities Models of care delivery o Primary nursing- Nurse is taking care of patient from day 1. Nurse does all vitals, labs, charting, and makes all the phone calls o Team nursing- RN does initial assessment and documents everything. LPN passes meds and does other assessments. RT stays on the floor for any patient that needs any respiratory care o Transitional care coordination Ensuring continuous care between settings Ex: making sure that what was done in ICU is communicated to the med-surg unit taking the patient so that the same interventions can take place Patient-Centered Medical Home (PCMH)- care coordinators are a major help in this area with helping make sure that patient goes home with right equipment and knowledge to recovery safely and effectively at home Accountable care organization (ACA) Lead by primary care centers that coordinate, send referrals, and manage quality of care and cost. o Ex. Nurse comes in with doctor every time but the nurse is the familiar face that knows more about you than the doctor does. o Delegation- appropriate worked delegated to appropriate people Nurse assigns appropriate, effective work activities to other members of the healthcare team Skills- it is important that who you are delegating to has the ability to do the tasks and activities delegated to them. o UAPs or nurse extenders- CNAs and techs Minimal nursing education or experience Hired to assist RN Affordable Care Act guidelines- control cost and don’t break HIPAA o Quality and safety- keeping patient safe, doing the right thing for the patient, and making sure to follow evidence. Ex: frayed electrical cords Improving performance and effectiveness of individuals and systems Health Information Technology (HIT) is critical for evidence- based practice guidelines Methods to evaluate patient care Actual care against standards What did we do extra for the patient? What did we do for this patient and what did the standards say should be done? Utilization and quality control peer review organization (PRO) Group that follows through to make sure that what we are doing is good Nurse as Researcher Identify problems in patient care Develop profession o Identify problems and develop profession o Work hard to make sure it is something that’s utilized by all people in the profession, not just us. Work to be utilized by community and organizations Every nurse is a researcher Collaboration- other disciplinary teams working within their scope Spiritual support staff Registered dieticians Lab techs Occupational therapist (OT) Pharmacist Physical therapist (PT) Provider Radiology tech Respiratory therapist (RT) Social worker Speech-language pathologist Care coordination Nurse assistant/ tech/ unit secretary Continuity of Care- Safe Handoff Patient movement throughout facility o Level of care o Facility to facility o Unit/department o Transitional care- involving other people from admission, transfer, discharge, and the care plan Consultations Discharge planning Care coordinator o Interdisciplinary o Admission/transfer/discharge/post o Care plan initiation/revision/evaluation o Facilitation of referrals I-SBAR-R- physician phone call Identify o Who you are and which patient you are calling about Situation o What did the patient come in for Background o What did the doctor do for them Assessment o What is going on right now Recommendation o Suggestions Read-back and Verify o Clarification- especially about meds Chapter 2 Applicability- how well research findings can be applied to specific patient care. Page 21 Appraisal- judgment of the value of external evidence. Page 20 Association- indicates only a relationship, not cause and effect in research. Page 23 Causation- indicates factor(s) that lead to an outcome. Page 23 Computer Literacy- familiarity and skills to use a computer. Page 18 Conceptual Variable- qualities of a variable of interest in research. Page 22 Dependent Variable- variable that is impacted by a manipulated variable; commonly an outcome variable. Page 22 Descriptive statistics-statistics used to depict variations within a data set. Page 23 Electronic medical records (EMRs)-electronic repository of all patient-related information. Commonly computer-based. Page 18 Evidence-based practice (EBP)- the practice of nursing in which the nurse makes clinical decisions on the basis of the best available current research evidence, his or her own clinical expertise including internal evidence of patient findings, and the needs and preferences of the patient. Page 19 External evidence- relevant research findings related to a specified clinical question. Page 20 Independent Variable- variable that is manipulates (commonly an intervention). Page 22 Inferential statistics- statistics that are based on the laws of probability. Allow generalized conclusions. Page 23 Information literacy- the ability to locate, evaluate, and use appropriate facts effectively. Page 18 Information technology (IT)- the mechanical infrastructure that supports the collection, recording, and utilization of patient information. Page 18 Internal evidence- a type of evidence used in evidence-based practice that includes nursing expertise and results of quality improvement and outcome evaluation. Page 20 Nursing informatics- nursing specialty integrating nursing, computer science, and information science. Page 17 Operational variable- the description of how a research variable is measured (commonly a dependent variable). Page 23 Patient preferences- individualized patient experiences and values that are considered when determining evidence-based nursing care. Page 20 PICOT- format for evidence-based practice question. Mnemonic for patient, intervention, comparison group, outcome, and time. Page 20 Qualitative research- a research approach that focuses on a participant’s experience and the perceived meaning of the situation of interest. Page 22 Quantitative research-the use of numerical computations and statistical analysis to answer empirical questions. Page 22 Reliability- describes that findings of a research study. Page 21 Research design- provides the structure for conducting a research study. Page 23 Statistical analysis- the manipulation and testing of data in quantitative studies to determine if changes seen are due to the experiment or due to chance. Page 24 Validity- the soundness of the scientific methods used in a study including control to reduce bias. Page 20 Take a breather- you are doing good! Chapter 3 Acute illness- an illness that occurs rapidly, lasts for a relatively short time, and is self-limiting. Page 36 Chronic illness- a condition that requires continuing management over a long period- years or even decades. Page 37 Community-based care-centers on individual and family healthcare needs. Page 39 Disease- literally meaning, “without ease,” this term describes alterations in structure and function of the body or mind. Disease may have mechanical, biologic, or normative causes. Page 35 Exacerbation-a period during chronic illness in which symptoms reappear. Page 37 Family- two or more persons joined by emotional closeness and shared bonds and who identify themselves as being part of a family. Page 29 Health-“a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” Page 28 Health-illness continuum- a visual representation of health as a dynamic process, with high-level wellness at one extreme of the continuum and death at the opposite extreme. Page 28 Holistic healthcare-care in which all aspects of a person (physical, psychosocial, cultural, spiritual, and intellectual) are considered as essential components of individualized care. Page 28 Home healthcare- the delivery of services to restore or maintain the health of individuals and families in the home. Page 40 Hospice care-a special component of home care, designed to provide medical, nursing, social, psychologic, and spiritual care for terminally ill patients and their families. Page 41 Illness- the response a person has to a disease; integrates the patient’s perception, as well as the pathophysiologic alterations and the psychologic effects of those alterations. Page 35 Manifestations-signs and symptoms of a disease or condition caused by alterations in structure and function. Page 35 Patient-centered medical home (PCMH)- accessible, comprehensive, and coordinated primary care focused on illness prevention for patients and families. Page 39 Primary care- comprehensive first contact health and illness care across the life span. Page 39 Rehabilitation- the process of learning to live to one’s maximum potential with a chronic impairment and its resultant functional disability. Page 40 Remission- a period in which symptoms are not experienced even though the disease is still clinically present. Page 37 Respite care- short-term or intermittent home care, often using volunteers. Give primary care givers some relief. Page 42 Transitional care-interventions designed to improve the ability of patients and caregivers to manage care needs in preparation for transitions from one healthcare setting to another or to home. Page 39 Wellness- an integrated method of functioning oriented toward maximizing an individual’s potential within the environment. Page 28 Health-illness continuum Figure 3-1 on page 28 Acute vs. chronic illness Acute- an illness that occurs rapidly, lasts for a relatively short time, and is self-limiting. Page 36 Chronic- a condition that requires continuing management over a long period- years or even decades. Page 37 Changes in adult patient- table 3-2 on page 31 Changes in Older adult- Table 3-3 on page 32 Tables 3-2 and 3-3 will be used to determine appropriate responses to disease processes and answer test questions for remainder of the course Disease vs. illness Disease- literally meaning, “without ease,” this term describes alterations in structure and function of the body or mind. Disease may have mechanical, biologic, or normative causes. Page 35 Illness- the response a person has to a disease; integrates the patient’s perception, as well as the pathophysiologic alterations and the psychologic effects of those alterations. Page 35 Commonly recognized sequence of illness behaviors- page 37 o Experiencing symptoms o Assuming the sick role o Seeking medical care o Assuming the dependent role o Achieving recovery and rehabilitation Disease classifications and definitions- table 3-6 on page 37 Acute- a disease that has a rapid onset, lasts a relatively short time, and is self-limiting Chronic- a disease that requires continuing management over a long period- years or even decades Communicable- a disease that can spread form one person to another Congenital- a disease or disorder that exists at or before birth Degenerative- a disease that results from deterioration or impairment of organs or tissues Functional- a disease that affects function or performance but does not have evidence of organic changes Malignant- a disease that tends to become worse and cause death Idiopathic- a disease that has an unknown cause Latrogenic- a disease that is caused by medical therapy Review box 3-4 on page 42- home safety assessment checklist Illness prevention Primary prevention activities- prevents disease and usually occurs within communities outside the healthcare system o Eating nutritious foods and balancing calorie intake with energy expenditure o Reducing exposure to industrial hazards such as noise and dust o Practicing safer sex o Obtaining immunizations o Eliminating the use of alcohol and cigarettes o Avoiding cell phone use and texting while driving Secondary prevention activities- usually occurs within the healthcare system and emphasizes early diagnosis and treatment of disease o Screening for common diseases such as hypertension, diabetes mellitus, malignancies, and glaucoma o Obtaining regular physical exams o Performing self-examinations for breast and or testicular cancer o Obtaining specific treatment for illness Tertiary prevention activities- preventing further health decline and reducing complications associated with disease o Specific rehabilitation programs for cardiovascular problems, head injuries, and strokes o Work training programs following illness or injury o Educating the public to employ rehabilitated people to the fullest possible extent Almost there! It will pay off in the end! Chapter 4 Anesthesia- use of drugs to produce sedation, analgesia, reflex loss, and muscle relaxation during a procedure. page 59 Anesthesia care provider (ACP)- licensed personnel delivering anesthesia. page 54 Circulating nurse- an RN who coordinates and manages a wide range of activities before, during, and after surgical procedures. page 62 Conscious sedation- anesthesia that provides analgesia and amnesia, but in which the patient remains conscious. page 60 Dehiscence-an unintended separation of wound margins due to incomplete healing. page 72 Evisceration- protrusion of body contents through a surgical wound. page 72 General anesthesia- deep sedation, which includes analgesia and muscle paralysis. page 59 Handoff- when responsibility for care is transferred from one individual or care unit to another. Page 51 Informed consent- disclosure of risks associated with the intended procedure or operation to the patient. page 51 Intraoperative phase- the time during surgery, from beginning to end. page 50 Perioperative phase- includes preoperative phase, intraoperative phase, and postoperative phase. page 49 Postoperative phase-period when a procedure or surgery has been completed and the patient is recovering from the stress associated with the surgery. page 50 Preoperative phase- time when preparation of the patient for surgery is conducted and completed. page 50 Regional anesthesia- anesthesia that desensitizes the area to be operated but does not involve the full central nervous system or cause sedation. page 59 Scrub person- prepares the sterile field, surgical supplies, and equipment for surgical procedures; also assists surgeon and physician assistant by passing instruments, suctioning blood, and maintaining the sterile field. page 62 Surgery- an invasive medical procedure performed to diagnose or treat illness, injury, or deformity. page 50 Phases of perioperative care Preoperative phase- focus on education o Teaching begins as soon as the decision is made to have surgery o Decision for surgery is made o Patient is transferred to OR Intraoperative phase- focus on safety o Where to place patient or what position to put them in o Entry into OR o Admittance to recovery room Postoperative phase- promote recovery o Pain is #1 o Cannot teach until pain is lowered o Admittance to recovery room o Complete recovery Classifications of surgical procedure Table 4-1 on page 50 Purpose o Diagnosis- determine or confirm a diagnosis o Ablative- remove diseased tissue, organ, or extremity o Constructive- build tissue or organs that are absent o Reconstructive- rebuild tissue or organ that has been damaged o Palliative- alleviate symptoms of a disease (not curative) o Transplant- replace organs or tissues to restore function Review Informed consent Review Box 4-1- Quality Indicators for Surgery Surgical risk and safety SCIP- Surgical Care Improvement Project Review Table 4-2- Nursing Implications for Surgical Risk Factors on pages 52 and 53 Know the risk factors, the associated risks, and nursing implications Risk factors: o Advanced age o Malnutrition o Obesity o Low socioeconomic status o Chronic conditions o Medical therapies o Risks of OR Patient and procedure identification o Patient must be actively involved in procedure- prior to incision o Joint Commission Universal Protocol- TIMEOUT Name and date of birth Staff communication Safe use of medications Prevent infection Prevent mistakes in surgery o Electrical razor must be used. NO MANUAL RAZORS Final count of all instruments and gauze PRIOR to closing! What are they, signs and symptoms, how do you prevent: page 56 Thromboembolism Hypothermia Surgical site infections Adverse cardiac events Lab values- Table 4-3 on page 57 Hemoglobin (Hgb)- male 13.5-18g/dL female 12-15g/dL Glucose 70-110mg/dL A1C- 2-5% WBC Count- 4.5-10K (4,500- 10,000) Platelet count- 150,000- 400,000 Carbon dioxide (CO2)- 22-30mEq/L Potassium (K+)- 3.5-5.1 mEq/L Sodium (Na+)- 135-145 mEq/L Chloride (Cl-)- 95-105 mEq/L Prothrombin time (PT)- 11-13 seconds Partial thromboplastin time (PTT)- 25-35 seconds (google) BUN- 5-25 mg/dL Meds discussed in class and on page 58 Table 4-4 ( know generic and brand name, action by category, and nursing implications) Antibiotics o Cefazolin (ancef) Benzos o Midazolam (versed) o Diazepam (valium) o Lorazepam (Ativan) Opiods o Morphine (morphine) o Fentanyl (sublimaze) o Oxycodone (Roxicodone) o Hydrocodone (vicodine) o Tramadol (ultram) Antacids o Sodium citrate (bicitra) H2 receptor antagonists o Cimetidine (Tagamet) o Famotidine (Pepcid) o Nizatidine (axid) o Ranitidine (zantac) Gastric acid pump inhibitors o Lansoprazole (prevacid) o Omeprazole (Prilosec) o Pantoprazole (protonix) Antiemetics o Metoclopramide (reglan) o Ondansetron (Zofran) Anticholinergics o Atropine sulfate (atropine sulfate) o Glycopyrrolate (robinul) o Scopolamine (scopolamine) Ketorolac- Page 61 o Administered post op o What is it for? o When would you give? o When wouldn’t you give? Propofol- Page 60 o Administered pre op o What is it for? o When would you give? o When wouldn’t you give? Narcan o What does it do? o What does it reverse? Romazicon o What does it do? o What does it reverse? Members of Surgical Team- what are their responsibilities? Surgeon o Team leader o Performs incision/ procedure Surgical assistant o Could be another physician, nurse, or PA o Expose operative site o Might do sponging or suctioning of wound while other person is working on it o Could possibly close the wound Suture wound Cauterize and ligating blood vessels Anesthesiologist/ CRNA o Completely and totally responsible for all anesthesia patient is receiving o Administer anesthesia o Monitor well-being of patient o Transfuse and blood or blood products o Responsible for IV fluids because they are putting medications into those IV fluids o Alert surgeon of any problems o Supervise patient afterwards Circulating nurse- huge responsibility! o Notes when meds are given o One who coordinates and manages wide range of activities before, during, and after procedure o Advocates for patient’s safety and formulates plan of care o Oversees physical aspects of OR o Placement of drains o Times the length of surgery (from first incision to last suture sewn) o Makes sure the temperature is appropriate o Transfers and positions patient appropriately o Prepares surgical site o May do scrub or shaving If shaving, use ELECTRIC RAZOR ONLY o Make sure there is no break in aseptic technique Makes sure no one touches the blue o Counts all sponges and instruments and keeps tally o Documents everything that is going on or is done to the patient Scrub person o Could be an RN or OR tech o Handles sutures and instruments o Usually standing next to physician handing them scalpel or whatever instrument they need Ex test question: “this person is doing x, y, and z. which surgical team member is this?” Anesthesia General anesthesia- deep sedation, which includes analgesia and muscle paralysis. page 59 Regional anesthesia- anesthesia that desensitizes the area to be operated but does not involve the full central nervous system or cause sedation. page 59 Conscious sedation- anesthesia that provides analgesia and amnesia, but in which the patient remains conscious. page 60 Green box on page 62 about pain and Cassie’s email explains acute pain vs chronic pain Acute pain –break your arm o How would a patient present? Chronic pain- back pain o Would vital signs stay elevated? No Blue box on page 64 about risk for the elderly with surgery Box 4-4 on page 59 Malignant Hyperthermia Hemorrhage Shock DVT PE Atelectasis Urinary complications o Retention o Less than 30mL/hr Review pages 66-70 about preop teaching, pre op labs, medication review, diagnostic tests, breathing exercises, leg exercises What would nurse do if she found a patient with any of these conditions: Primary intension Secondary intension Wound dehiscence Evisceration Patient positioning- example test question: “ the patient is going to have this procedure done. How would you position the patient?” Supine o Abdominal surgeries Prevents pressure sores Prevents shearing Prevents over stretching of limbs Prevents nerve damage Prevents decreased venous return to the heart o Dorsal recumbent Vaginal exams Possible abdominal surgeries o Fowler’s (high-90, normal- 45, low- 30) Neuro or head surgeries Neck Shoulder Face o Prone position Spinal surgeries Rectal surgeries o Lateral chest position Thoracic surgery Kidney surgery Hip replacement o Lithotomy position Gynecologic surgeries Perineal Rectal DVT risk Used for very quick surgeries and patients are monitored very closely o Jack knife position Spinal surgeries (some) Rectal Review drains- page 71 Box 4-7 Penrose Jp Hemovac Good luck on the test! You’ll do great!
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