Nursing Unit 4 Objective questions
Nursing Unit 4 Objective questions NURS 1107
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This 9 page Class Notes was uploaded by Mikella Notetaker on Wednesday September 21, 2016. The Class Notes belongs to NURS 1107 at North Arkansas College taught by Gipson, Feighert in Fall 2016. Since its upload, it has received 14 views. For similar materials see Fundamentals of Nursing in NURSING at North Arkansas College.
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Date Created: 09/21/16
Unit 4 & 5 Objectives Chapter 7 & 24 1. Translate the process of communication. Foundation on which the relationship between the nurse and client is based. It is involved in client teaching, assessment of clients, interventions, evaluation of outcomes, and guards against litigation. Always occurring with or without words 2. Describe the benefits of communicating with other health care professionals. Effective team communication and collaboration skills are essential to ensure patient safety and optimum patient care. Competency in communication maintains effective relationships within the entire sphere of professional practice and meets legal, ethical, and clinical standards of care. 3. Discuss the principles of therapeutic interaction. Active listening: SOLER o S-Sit facing the client. o O-Open position/Observe movement/Posture o L-Lean toward the patient o E-Eye contact o R- RELAX Sharing Observations- “You look tired today”, “You seem different today”. Not assumptions. Sharing empathy- “It must be frustrating to not be able to do what you want” Sharing Hope- “I believe you’ll find a way to face your situation because I’ve seen your courage.” Sharing Humor- use during orientation phase and during working phase. Sharing Feelings- you can share your emotions to make a better connection. Using touch- hand holding; NOT face Using silence- allows patients to think and gain insight. Providing information- tells other people what they need or want to know so they are able to make a decision, experience less anxiety, feel safe and secure. Clarifying- “I’m not sure I understand, what do you mean by sicker than usual?” Focusing- “We’ve talked a lot about your medication; now look more closely at the trouble you’re having taking them on time.” Paraphrasing- patient says, “I’ve been overweight my whole life and never had any problems. I can’t understand why I need to be on a diet”. You say, “You’re not convinced you need a diet because you’ve stayed healthy.” Validation- “Tell me if I understand your concerns with surgery, …..” Asking relevant questions- use focused questions, not open ended here. Summarizing- “You’ve told me a lot of things about why you don’t like this job and how unhappy you’ve been. We’ve discussed possible ways to make things better, and you’ve agreed to try them and let me know if any of these help.” Self-disclosure- sharing experiences or feelings relative to the patients Confrontation- do this after patient trusts you; be gentle; “You say you’ve already decided what you are going to do, but yet you are still going over other options.” 4. Identify the barriers to effective therapeutic communication. Asking personal questions Giving personal opinions Changing the subject- when it is not necessary Automatic responses- “Older adults are always confused.” False reassurances Sympathy- “You probably feel devastated.” Asking for explanations- No WHY questions Approval or Disapproval- “you shouldn’t even think of assisted suicide. It isn’t right.” Correct: “I’m surprised you’re considering assisted suicide. Tell me more about this.” Defensive responses- “No one here would intentionally lie to you.” Passive or Aggressive responses- “Things are bad and there’s nothing I can do about it.” Arguing 5. Demonstrate proper therapeutic communication techniques. Initiate or encourage interaction Help client identify and express feelings Ensure mutual understanding Using broad openings when you have time 6. Name phases of the therapeutic relationships. Preinteraction phase- Before meeting the patient. o Review available data o Talk to other caregivers who have information on this patient o Anticipate health concerns that could arise o Plan enough time for the initial interview Orientation phase- when the nurse and patient meet and get to know one another. o Set tone for relationship by warm, empathic, caring manner o Recognize that the initial relationship is often superficial, uncertain o Expect the patient to test your competence and commitment. o Closely observe the patient and expect to be closely observed by pt. o Begin to make inferences and form judgements about behavior o Assess the patient’s health status. o Prioritize patient’s problems and goal o Form contracts with patient. o Let the patient know when to expect the relationship to be terminated. Working phase- nurse and patient work together to solve problems and accomplish goals. o Encourage and help the patient express feelings, self- exploration, set goals. o Provide information needed to understand and change behavior. o Take action to meet the goals set with the patient. o Use therapeutic communication skills. o Use appropriate self-disclosure and confrontation. Termination phase- during the ending of the relationship. o Remind patient that this is near to end. o Evaluate goal achievement. o Reminisce about relationship o Separate from the patient by relinquishing responsibility for their care. o Achieve a smooth transition for the patient to other caregivers needed. 7. Describe the influence of caring and compassion on the practice of professional nursing. This shows that you are concern and facilitate and emotional connection between you and your patient. 8. Relate the characteristics of a therapeutic relationship. Back in number 3. 9. Explain nursing roles that are important in demonstrating care and compassion. Nurse-patient caring relationship- promotes positive change and growth. Focus on a patient achieving optimal personal growth related to personal identity, ability to form relationships, and ability to satisfy needs and achieve personal goals. Nurse-family relationship- same concept and additional dynamics, needs, and relationships. 10. Discuss principles of delegation to follow when delegating patient care activities. Chapter 25 1. Explain the importance of patient education in today’s health care climate. Goal is to help individuals, families, or communities achieve optimal levels of health. Essential component of providing safe, patient-centered care. Can reduce health care costs and hardships on individuals and those surrounding them. 2. Relate principles of adult education to patient teaching. Able to reflect on their current situation critically but sometimes need help to see their problems and change their perspectives. Often able to identify their own learning needs Often become dependent in new learning situations An adult’s readiness to learn is often associated with his or her developmental stage and other events that are occurring in their life. Wide variety of personal and life experiences. Therefore, patient learning will be enhanced if they perceive the information to be relevant and are asked to use past experiences to solve problems. 3. Identify common barriers to learning. 4. Explain how learning varies throughout the life cycle. Evolving process Infant: Keep routines, hold infant firmly while smiling and speaking softly, have infant touch different textures Toddler: Use play to teach procedure, offer picture books that describe it, use simple words such as cut instead of laceration Preschooler: Role play, imitation, encourage questions and offer explanations, encourage children to learn together through pictures and short stories School-age child: teach psychomotor skills needed, offer opportunities to discuss health problems Adolescent: help learn about feelings and need for self- expression, use teaching as collaborative activity, allow them to make decisions about health, use problem solving to help make choices. Young or middle adult: encourage participation in teaching plan by setting goals, encourage independent learning, offer information so adult understands effects of health promotion Older adult: teach when patient is alert and rested, involve adult in discussion or activity, focus on wellness and person’s strength, use approaches that enhance patient’s reception of stimuli, keep teaching sessions short 5. Relate the teaching-learning process to the nursing process. Assessment: o Through the patient’s eyes o Learning needs o Motivation to learn o Ability to learn o Teaching environment o Resources for learning o Health literacy and learning disabilities Diagnosis: o Interpret data and cluster-defining characteristics to form diagnosis Planning: o Goals and outcomes o Setting priorities- timing, organizing teaching material o Teamwork and collaboration Implantation: o Maintaining and learning attention and participation o Building on existing knowledge o Teaching approaches o Incorporating teaching with nursing care o Instructional methods o Illiteracy and other disabilities o Cultural diversity Evaluation: o Through patient’s eyes o Patient outcomes 6. Discuss the nurse’s professional responsibilities related to teaching. Needs to knowledgeable about the subject matter and patient teaching principles in order to provide individuals with guidance, appropriately set the learning pace, and creatively introduce concepts to successfully achieve the desired learning objectives. Chapter 29 1. Describe the chain of infection. Infectious agent- bacteria, virus, fungi, protozoa. Depends on the number of microorganisms present; their virulence (ability to survive, strength), or ability to produce disease; ability to enter and survive in a host; and susceptibility of the host. Reservoir- place where microorganisms survive, multiply, and await transfer to susceptible host. People, equipment, water, food, wound drainage. To thrive organisms need a suitable environment like food, oxygen, water, temp, pH, light Portal of exit- skin, mucous membranes, respiratory, GI tract, urinary tract, reproductive tract, blood. Certain precautions come into play; standard, contact, and airborne. Modes of transmission- direct contact, ingestion, airborne. Touching contaminated objects, person contact, droplet. Unwashed hands. Portal of entry- same as exit; broken of skin, mucous membrane, GI tract, GU tract, respiratory tract. Susceptible host- immunocompromised, diabetes, surgery, cancer, very old, very young. Depends on individual’s degree of resistance to pathogens. 2. Contrast various types of isolation precautions. Standard precautions: apply to blood, blood products, all body fluids, secretions, excretions (not sweat), no intact skin, and mucous membranes. o Hand hygiene before, after, and between direct contact with patients. o When hands are not visibly soiled with blood or body fluids, use hand sanitizer. If they ARE, wash hands. o Still wash hands even if wearing gloves. o Mask if respiratory hygiene or cough occurs. Contact precaution: VRE, MRSA, herpes simplex, scabies. o Private room or cohort patients, gloves, gowns. (patients may leave room, if infectious material is contained or covered.) Airborne precaution: measles, chickenpox, tb. o Private room, negative pressure airflow, mask or respiratory protection device, N95 respirator Droplet precaution: diphtheria, strep, rubella, pneumonia, scarlet fever, pertussis, mumps. o Private room or cohort patients, mask or respirator required. Protective environment: stem cell transplant. Very special patients. o Private room, positive airflow, mask to be worn by patient when out of room 3. Explain the role of assessment in preventing infection. Thoroughly assess each patient and critically analyze findings to ensure that you make patient-centered clinical decisions required for safe nursing care. Anticipate which patients are more at risk for an infection. Look at lab data: o WBC- 5,000-10,000 Neutrophils- increased in acute pus-forming infection, decreased in bacterial infection for older adults Lymphocytes- increased in chronic bacterial and viral infection, decreased in sepsis Monocytes- increased in protozoan, rickettsia, and tb Eosinophils- increased in parasitic infection Basophils- normal during infection o Erythrocyte sedimentation rate-up to 15 mm/hr for men and 20 mm/hr for women- inflammatory process o Iron level- 80-180 mcg/mL for men; 60-160 mcg/mL for women o Cultures of urine and blood o Cultures and gram stain of wound, sputum, and throat 4. Describe the nursing interventions that control infection. Health promotion: nutrition support, rest, personal hygiene, maintenance of physiological protective mechanisms, and recommended immunizations to protect patients. Explain infection prevention and control principles such as hand hygiene and methods of proper disposal of medical waste. 5. Practice skills related to reducing the transmission of microorganisms. Hand hygiene PPE Sterile field Breaking the chain of infection 6. Discuss the impact of healthcare- associated infections on patients, families, and healthcare systems. Increase the cost of health care. Odler adults have increased susceptibility to these infections because of chronic diseases and aging process. Extended stays in hospitals increase disability, costs of antibiotics, and prolonged recovery time for patient and hospital. Usually have multiple illnesses, older adults, poorly nourished and may have a compromised immune system. Exogenous infection- comes from microorganisms found outside the individual. Endogenous infection- occurs when part of the patient’s flora becomes altered and an overgrowth results. Staph, yeast Iatrogenic infection- caused by invasive diagnostic or therapeutic procedure. Bronchoscopy. 7. Identify strategies for teamwork and collaboration for the patient with an infection. Develop a care plan with multiple people. Know the patient’s cultural preference. Consult with expert in infection control in planning process. Before discharge consult with case management to complete a home assessment and identify home health needs. Home care nurse plans to ensure that home environment is infection free. 8. Identify appropriate nursing interventions for patients with latex allergies. Use latex free gloves Always ask patient if they have a latex allergy 9. Differentiate between endogenous and exogenous infections. Back in number 6. 10. Differentiate between systemic and local infections. Systemic- can be all over the body. Can become fatal if undetected or untreated. o S&S- fever, increased pulse and RR, anorexic, malaise, nausea, vomiting, enlarged lymph nodes Local- wound infection; patient usually experiences localized symptoms. o S&S- pain, tenderness, redness, edema, warmth of area, loss of use of that affected part 11. Discuss how the older patient presents when a systemic infection is present. Already at increased risk for infection Less capable of producing lymphocytes to combat challenges in the immune system. When antibodies are produced, the duration of their response is shorter, and fewer cells are produced. Risks associated with the development of infection include poor nutrition, unintentional weight loss, lack of exercise, poor social support, and low serum albumin levels.