Concepts of Professional Nursing (RNSG ) FINAL Questions and Answers

Concepts of Professional Nursing (RNSG ) FINAL Questions and Answers Differentiate between the LVN & RN nursing roles according to the DifferentiatedEssential Competencies of Graduates of Texas Nursing Programs (DECs) Member of the Profession: commitment to growth, state and federal regulations, improve the discipline of nursing. Provider of Patient Centered Care: ADPIE to assess individuals and their families. Patient Safety Advocate: promote safety by following scope & standards of practice, report actual and potential unsafe practices. Member of a Healthcare Team: collaborating, coordinating and or facilitating care with a healthcare team. Discuss key concepts in the ANA definition of professional nursing Protect, promote and optimize healthcare ; prevent injury, illness and suffering ; advocate for client and family. Discuss Florence Nightingale's influence on nursing practices. Florence Nightingale "Lady with the lamp" volunteered during the war in 1853, first practicing nurse epidemiologist, "how to put the body in such a state as to be free of disease or recover from disease." First nursing philosophy based on health maintenance and restoration. She organized the first training program for nurses. Discuss the influence of War on nursing practices. Civil War stimulated growth among nurses with nurses caring for wounded soldier, cleansing wounds and providing for basic needs, hospitals and ambulances developed out of war. Discuss 20th century influences on nursing practices. movement toward developing scientific research based nursing knowledge. Mary Adelaide brought nursing to college level in 1906. 1920s development into nursing specialities. Discuss 21st century influences on nursing practices. nursing practices and school curriculum is ever changing to meet society needs. Importance of self care among nurses, demographic changes and the medically undeserved. Explain the impact of quality and safety initiatives on delivery of health care Patient Centered Care: client is in control and part of the healthcare team. Teamwork and Collaboration: use open communication, mutual respect, shared decision making. Evidence-based Practice: use current evidence, clinical expertise, client / family values for optimal healthcare QI: use data to monitor outcomes and improve care Safety: minimize risk of harm Informatics: use information & technology to communicate among healthcare team and mitigate errors. Explain the relationship between evidence-based practice and performanceimprovement. nursing care needs to be based off not only education but evidence based practice to reduce errors and improve patient safety. Explain the influence of nursing theory on a nurse's approach to practice. conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care. Theories offer a perspective for assessing your client's situation, and help to organize analyze and interpret data. Recall the major safety issues for clients and methods to promote client safety in the clinical setting Fall Risk: fall risk assessment, purposeful rounding, bed exit alarms, bedside commodes, low beds, assistance with transfer and ADLs, skid proof socks, fall risk identifiers, gait belt use --use more than 1 intervention Patient-inherent accident: use precautions when appropriate (seizure precautions, one to one) Procedure related injury: accidents caused by medical error, limit distractions and interruptions, safe patient handling techniques for client transfers to and from bed or chairs, recognize conditions which lead to a higher chance of medical errors and develop checks and balances to minimize error such as verifying patient with X2 identifiers. Equipment-related accidents: know your equipment! Workplace violence: can range from acts or threats of violence, verbal abuse, physical assault, can be mitigated by safety procedures and environmental adaptions. Discuss the role of the professional nurse in ensuring safety for client, visitors and staff. Know your protocols, know when you need help and how to get it, follow all safety measures every time, communicate with coworkers, be a patient advocate, report and document appropriately all actual and potential unsafe practices Fire Prevention - RACE R-rescue and remove patient in immediate danger A-activate the fire alarm, ALWAYS do this before attempting to extinguish the fire C-confine the fire by closing doors and windows and turning off oxygen and electrical equipment E-extinguish the fire with appropriate extinguisher Discuss interventions to prepare for disasters (internal and external). Joint Commission maintains plans and response mechanisms, requires all hospitals to- Communicate: internally and externally with community resources Supplies: maintain adequate supplies within facility Security: maintain adequate security to enable normal hospital function Staff: command structure in the event of a disaster Utilities: must be self sufficient for as long as possible with a goal of 96hours Clinical Activity: maintain normal level of care Number 1 way to maintain infection control? Wash Your Hands! Explain the differences between Inflammation and Infection, including the function of different cells in the processes Inflammation: CELLULAR RESPONSE to injury, infection, bodies protective REACTION Infection: a pathogen that invades tissues and begins growing within a host WBC (neutrophils/monocytes) pass through vessels into tissues causing swelling and begin eating the bacteria in a process called phagocytosis. This causes an increase in WBC called leukocytosis which provides the body immunity against the invading pathogen. Phagocytic release results in a fever, fibrinogen creates scab and basophils (histamines/kinins/heparins) begin tissue repair. Be able to perform quality reporting using ISBAR. Identify: yourself and the client Situation: -present nature of illness, what's happening acutely Background: clients medical history Assessment: head to toe and critical findings Recommendations / response: care plan, ensuring client is agreeable to the plan and goals Discuss guidelines for effective documentation that meets legal and ethical standards. complete, concise, accurate objectives document promptly and use appropriate abbreviations factual, accurate, complete, current and organized ADPIE Assessment : objective/subjective, vitals, presentation (must always be done first!) Diagnosis: mallows needs, actual / potential, cluster needs to develop patterns Planning: SMART (specific, measurable,attainable,realistic with a timeframe) Implementation: "action" cite the reasonings for EBP Evaluation: were the goal met, what needs to be changed? TANNERS: noticing, interpreting, responding,reflecting Maslow's Need Hierarchy Physiological: ABCs, food/water, sleep, sex Safety: self, employment, resources, family Love & Belonging: friends and family intimacy Esteem: confidence, achievement, respect Self-actualization: morality, creativity, problem solving NANDA acute pain related to tissue ischemia as evidence by patient stated pain 6/10. problem, related to, as evidenced by 10 rights of medication administration Right medication Right dose Right client Right route Right time / frequency Right documentation Right history / assessment Right to refuse Right drug to drug interaction Right education IM medications 90 degrees, Ztrack, aspirate, hold for 10seconds after giving medication before needle withdrawal vastus lateralis: most common site through preschool, deltoid: school age (4-5+) Sub Q medications pinch, no aspiration stomach 1in from umbilicus or back of arm Discuss the three purposes of patient education helps clients achieve optimal level of health health promotion, illness prevention and restoration / coping Summarize the differences between teaching and learning Teaching: imparting knowledge through a series of directed activities, conscious and deliberate Learning: conscious or unconscious permanent change in behavior, acquiring new knowledge, skills or attitudes that can measured ADPIE for teaching Assessment: determine clients learning needs, motivation, ability to learn, health literacy Diagnosis: three domains of learning or conditions that interfere with learning Planning: establish learning objectives, identify priorities and collaborate with client to develop a teaching method Implementation: actively involve client in teaching methods, include family and caregivers as well Evaluation: determine the outcome, reinforce information as needed Domains of Learning Cognitive: thoughts and thinking (blooms taxonomy) Affective: emotions, values and attitudes (krathwol's affective taxonomy) Psychomotor: development of physical skills Bloom's Taxonomy (cognitive domain of learning) Remembering: recalling or recognizing from memory Understanding: interpreting, classifying, summarizing, comparing Apply: using a procedure through implementing Analyze: braking material down into parts than determining how the parts are related Evaluate: making judgements on criteria through checking and critiquing Create: putting elements together to form a functional whole, reorganizing into a new pattern Discuss how the three conditions necessary for learning to occur may affect variousaspects of the teaching-learning process Motivation: prepared/willingness to learn, perception of severity, patient goals, desire to learn, attitude toward healthcare, learning style Readiness / Ability: physical / cognitive ability, developmental level, reading level, physical strength, endurance, pain, fatigue, anxiety Teaching Enviornment: conducive to learning, limit distractions, interruptions, temperature, lighting, furniture Resources: family and SO support, financial, teaching tools (brochures), health literacy Health Literacy client's capacity to learn about and understand basic health information and services at risk populations for LOW health literacy: low income, frequently unemployed, lack of HS education, immigrant or ESL, elderly, minorities Teaching Approaches Telling: limited time such as emergency procedures Participating: client and RN discuss together Entrusting: supportive only, allows self care (diabetics) Reinforcing: positive or negative, verbal or physical Teach Back closed loop communication-explain new concept, ask patient to repeat/demonstrate, clarify any changes, ask them to repeat/demonstrate again used on all clients start with most important information first focus on 2-4 key points use plain language, avoid medical terminology RN role in Assessment Provider of Care: determine health status, needs of client through interpretation of data, utilize systematic approach to provide patient centered care, comprehensive assessment, nursing care plan, implementing care/teaching plans, delegation, evaluate responses and analyze data. Member of a Profession: assume accountability for the quality of care, client advocate, healthcare advocate for monitoring and promoting quality, participate in activities / be a leader to promote best practices in nursing profession. Heart Valves All Pigs Eat Too Much Aortic, Pulmonary, Ebs point, Tricuspid, Mitral--PMI 2---------2----------3------------4-----------5-----5MC Clear Liquid diet includes: Gelatin, popsicles, tea, coffee, carbonated drinks, ginger ale, fruit juice without pulp, bouillon Full Liquid diet includes: smooth textured dairy products, ice cream, strained soups, custards, cooked cereals, vegetable juice, pureed veggies, fruit juices, sherbets, puddings, frozen yogurt Thickened Liquids diet includes: scrambled eggs, pureed meat vegetables and fruits, mashed potatoes and gravy Mechanical Soft diet includes: cream soups, ground or finely diced meats, flaked fish, cottage cheese, rice, potatoes, pancakes, light breads, cooked vegetables, cooked or canned fruits, bananas, soups, peanut butter BMI Normal: 18.5-24.9 Overweight: 25-30 Obese: 30+ KCals Proteins & Carbs: 4KCals Fat: 9KCals Alcohol: 7KCals Malignant Hyperthermia A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs, may start immediately after anesthesia induction or hours into a procedure, S/S=tacycardia, dysrhythmia, muscle rigidity of jaw and upper chest, hypotension, tachypnea, skin mottling, cyanosis, LATE SIGNS =soda colored urine and rise in core temp as high as 111 degrees...earliest sign is unexpected rise in ETCO2 with decreased oxygenation and tachycardia. Only ADA approved treatment = Dantrolene Sodium CBC (complete blood count) RBC: 4.2-6.1 HgB: 12-18 Hct: 37-52% WBC: 5k-10k Type and Screen the patient's blood type Type and Crossmatch The patient's blood is typed, then is tested for compatibility with blood from a donor which is placed on standby in the lab for the patient Anesthetics Amides: two Is, metabolized in the liver, clients allergic to epinephrine can be given Mepivicaine Esters: one I, metabolized in the plasma, only used in clients with cirrhosis Lidocaine Toxicity SAMS: Slurred speech Altered CNS Muscle twitching Seizures Dehicence partial or complete separation of the outer wound layers, sometimes referred to as a splitting open of the wound Evisceration total separation of the tissue layers, allowing the protrusion of visceral organs through the incision Older Adult Health Risks 1-Heart Disease 2-Cancer 3-Lung Disease 4-Stroke Smoking, Alcohol Abuse Erickson Stages of Development Newborn= first 28 days of life Abuse vs Neglect Abuse: maltreatment of a person, physically, psychologically, financially Neglect: failure to give proper care to a person, can be self imposed Adult Health 3 D'S Dementia: Delirium: Depression: Daily Intake for Adult 2-3L Output= 30mL/hr 1L fluid 1Kg Sodium Na+ 136-145 Hyper S/S=big and bloated, flushed , tight skin, increased BP and fluid retention, edema, decreased urine output, agitation, low grade fever, thirst Hypo S/S : Hypovolemic-stupor/ coma, anorexia, lethargy, tachycardia Hypervolemic-generalized muscle weakness, orthostatic hypotension, seizures, headache, hyperactive GI OPPOSITE POTASSIUM Potassium K+ 3.5-5 Hyper S/S=muscle cramps, urine abnormalities, respiratory distress, decreased BP and HR, tall peaked Waves, wide QRS, prolonged PR intervals, increased DTR Hypo S/S=weak irregular pulse, orthostatic hypotension, shallow respirations, anxiety, confusion, hypoactive Gi, N/V/D, ST depression, shallow/inverted TWaves, prominent Uwave postassium sparing diuretic =spironolactone, never IV push always infusion OPPOSITE SODIUM Calcium Ca+ 9-10.5 Hyper S/S=bone pain, arrhythmias, cardiac arrest, kidney stones, excessive urination, decreased DTR Hypo S/S=convulsions, arrhythmias, spasms, stridor, numbness in fingers, face, limb -- Positive Trousseaus/Chvosteks sign calcitonin-puts calcium back into the bones, high risk for pathological fractures OPPOSITE PHOSPHATE Magnesium Mg2+ 1.8-2.6 Hyper S/S=low energy, low HR, BP, RR, decreased Gi, decreased DTR Hypo S/S=high HR, BP, RR, increased DTR, seizures, irritability, confusion Positive Trousseas / Chvosteks sign MATCHES CALCIUM Lab Values pH=7.35-7.45 PaO2=80-100 PaCo2=35-45 HcO3=22-26 Gtube placement confirmation requires XRAY, if dislodged leave out and notify MD, do NOT attempt to reinsert Respiratory changes associated with aging increased stiffness of chest wall decreased muscle mass reduced muscocilliary clearance reduced elastic fibers enlarged alveolar ducts/alveoli Ventilation vs. Perfusion Ventilation=physical act of breathing in and out Perfusion=gas exchange at the cellular level Hypoxia Hypoxia=early signs: RAT, restlessness, anxiety,tachycardia (palor, cyanosis) late signs: BED, bradycardia, extreme restlessness,dyspnea (clubbing, accessory muscle use) Oxygen Therapy Low Flow-nasal cannula, simple mask, partial rebreather, NRB High Flow-ventimask, trach collar Hypertension Goal BP 140/90 , 150/90 over 60yo most frequent side effects= ABC, achy head(headache), blurred vision, chest pain Stress Obesity Diet / Diseases (DB, kidney disease, heart failure, ) African American men / Age TX= Diet low in sodium, cholesterol, calories Reduce alcohol and caffeine Exercise =walking 30mins X5 / day Stop smoking and alcohol Stress reduction Cholesterol total cholesterol=200- triglycerides=150- LDL=100- (bad cholesterol comes from animal products) HDL=40+ Peripheral Vascular Disease (PVD) pooling of blood in extremities, NOT an oxygen problem, lesser of two evils, S/S= V-volumptious pulses (warm legs) Edema Irregular shaped sores No sharp pain -dull pain Yellow and brown ankles TX=elevate the legs Peripheral Artery Disease (PAD) narrow of arteries results in lack of oxygen / blood to extremities, OXYGEN problem, worse problem "bAd" Absence of pulse / hair, cold shiny skin Round, red, smooth sores Toes and feet that are pale from low oxygen, eschar=black dead tissue Sharp pain in calves during stress, exercise or elevation= intermittent claudication TX=hang the legs 6 P's of PVD and PAD PAIN-unrelieved at rest , PARATHESIA (numbness/tingling), Pulses, Pallor, Polar, Paralysis