Exam (elaborations) RNSG 1137 (RNSG1137) RNSG 1137 Exam 2 Blueprint. A+ Guide. Lone Star College

RNSG 1137 Exam 2 Blueprint. A+ Guide. Lone Star College.1. EBP- Best practice and standards- Prioritizations: Evidence-based practice (EBP) in nursing is a problem-solving approach to making clinical decisions, using the best evidence available (considered “best” because it is collected from sources such as published research, national standards and guidelines, and reviews of targeted literature). Makic & Rauen (2016) identify essential elements of EBP as (1) the integration of best research and other forms of evidence to guide practice; (2) viewing clinical expertise as a component in care effectiveness; and (3) considering patients’ preferences, values, and engagement in care decisions as essential to providing optimal evidence-based care to patient and their families. The steps of EBP are as follows:  Cultivate a spirit of inquiry.  Ask the burning clinical question in Population/Patient/Problem, Intervention, Comparison, Outcome, and Time (PICOT) format.  Search for and collect the most relevant best evidence.  Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, and synthesis).  Integrate the best evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change.  Evaluate outcomes of the practice decision or change based on evidence.  Disseminate the outcomes of the EBP decision or change. EBP blends both the science and the art of nursing so that the best patient outcomes are achieved. To practice EBP, nurses carry out the following five steps: o Ask a question about a clinical area of interest or an intervention. There are several different methods that can be used to ask clinical questions. The most common method is the PICOT format o Collect the most relevant and best evidence o Critically appraise the evidence o Integrate the evidence with clinical expertise, patient preferences, and values in making a decision to change. o Evaluate the practice decision or change Pressure ulcers: 1. Conduct a pressure ulcer admission assessment for all patients  Ensure that risk assessment is done within 4 hours of admission  Include a visual cue on admission documentation record for skin/risk assessment  Agree on use of standard risk assessment tool  Use multiple methods to visually cue staff about patients at risk  Build shared pride in progress 2. Reassess risks daily  Adopt documentation tools to prompt daily risk assessment, findings and prevention interventions  Educate all levels of staff regarding risk factors and prevention strategies  Use validated risk assessment tools 3. Inspect skin daily  Adapt documentation tools to prompt daily skin inspection  Educate all levels of staff to inspect skin any time they are assisting the patient 4. Manage moisture: Keep the patient dry and skin moisturized  Design a process for periodic activities such as repositioning, assessing for wet skin, applying barrier agents, offering toileting opportunity  Provide supplies at bedside for at risk patients  Provide under pads that pull moisture away from skin 5. Optimize nutrition and hydration  Assist patient with meals, snack and hydration  Document amount of nutritional intake, notify provider or dietician if intake is inadequate  Offer water to every patient scheduled to be turned 6. Minimize pressure  Turn and reposition patient every 2 hours  Use pressure- redistribution surfaces Preventing Central Line Associated Bloodstream Infections: 1. Hand hygiene 2. Maximal barrier precautions 3. Chlorhexidine skin antisepsis 4. Optimal catheter site selection with avoidance of using the femoral vein for central venous access in adults 5. Daily review of line necessity, with prompt removal of unnecessary lines Catheter Associated UTIs: 1. Use strict aseptic technique during insertion of smallest possible catheter 2. Secure catheter to prevent movement 3. Frequently inspect urine color, odor, and consistency 4. Performing meticulous daily perineal care with soap and water 5. Maintain a closed system 6. Follow a manufacturer’s instructions when using catheter port to obtain urine specimen Ventilator Associated Pneumonia: 1. Elevate head of bed 2. Daily sedative interruption and daily assessment of readiness to extubate 3. Peptic ulcer disease prophylaxis 4. DVT prophylaxis 5. Daily oral care with chlorhexidine