Med Surg Exam 1 Study Guide

1. What is SBAR? (page 15) SBAR is a model for effective transfer of information by providing a standardized structure for concise factual communication from nurse-to-nurse, nurse-to-physician, or nurse-to-other healthcare provider. S=Situation; What is the situation you want to discuss? What is happening at the present time? Identify self, unit; Briefly state the problem. B=Background; What is the background or circumstances leading up to the situation? Provide admitting diagnosis and date of admission, list of current medications, allergies, IV fluids, most recent vital signs, date and time of lab tests and results from previous tests, synopsis of treatment to date, and code status A=Assessment; What do you think the problem is? What is your assessment of the situation? State what you think the problem is R=Recommendation/Request; What should we do to correct the problem? What is your recommendation? State specific treatments, tests needed, or patient needs to be seen now 2. How do you prioritize patient care? Base prioritizing care of a patient based on Maslow’s hierarchy of needs. Focus on the patient’s most essential needs first, including airway, breathing, and circulation, sleep status, pain status, and risk for injury. Then focus on less pressing matters, such as patient teaching and demonstration. It is all based on patient needs and safety. 3. What is EBP and how does it impact patient care? (page 11-12) EBP (evidence-based practice) is a problem-solving approach to clinical decision making involging the use of the best available evidence (e.g. research findings, data from quality improvement projects, professional organization standards) in combination with clinician expertise and patient preferences and values to achieve desired patient outcomes. It delivers the highest quality of care for the best patient outcome. Seven critical steps: 1) Creating a spirit of inquiry; 2) Ask the burning clinical question using PICOT (Patients, Intervention, Comparison, Outcome, Time period); 3) Collect most relevant best evidence; 4) Critically appraise and synthesize the evidence; 5) Integrate evidence with clinical expertise and patient preferences and values; 6) Evaluate the practice decision; 7) Share outcomes of the decision 4. How does a nurse provide culturally appropriate care? What is a cultural assessment guide? (page 31) -Treat all patients equally; Be aware of your own biases or prejudices and work toward eliminating them; Evaluate your own cultural beliefs and values; Learn about services and programs that focus on specific cultural/ethnic groups; Make sure that the same standards of care are followed for all patients regardless of culture or ethnicity; Identify healthcare practices and cultural practices that are important to that patient; Advocate for the patient and their cultural nursing beliefs; Ensure availability of culturally appropriate patient educational resources **See Table 2-4, 2-5, 2-6, 2-7, 2-8** -Cultural assessment guides facilitate the nursing process when working with different cultures that assess the patient’s health beliefs and health care practices and the patient’s perspective of the meaning, cause, and preferred treatment of the illness 5. What is ethnocentrism? (page 24) The belief that one’s own culture and worldview are superior to those of others from different cultural, ethnic, or racial backgrounds 6. What factors contribute to health disparities? (page 21) -Ethnicity and race -Age -Place -Sexual orientation -Income status -Disability status -Education -HCP attitudes -Occupation/unemployment -Lack of health care services access -Gender -Language barrier 7. How does a nurse develop cultural competency? (page 25) -Cultural awareness (ability to understand patient’s unique cultural needs): identify your own cultural background, values, beliefs, and biases -Cultural knowledge (learning key aspects of a group’s culture): learn basic general info about cultural groups; assess patients for cultural traits; do not make assumptions; research -Cultural skill (ability to collect relevant cultural data and perform cultural assessment): Be alert for unexpected responses with patient; become aware of cultural differences; develop assessment skills, especially those for other cultural groups -Cultural encounter (direct cross-cultural interactions between people): create opportunities to interact with cultural groups; attend cultural events; explore ethnic neighborhoods 8. What is the difference between subjective and objective data? (page 37) Subjective data (symptoms) is collected by interviewing the patient during the nursing history (what the patient says). Objective data (signs) is data that can be observed or measured. 9. Review all the aspects of a physical assessment (page 43) **See Table 3-4** 10. What are the different types of patient assessment and when is each used? (page 45) -Comprehensive: detailed assessment of one or many body systems including those directly not involved in the problem; head-to-toe; use: onset of care, admission, initial visits -Focused: abbreviated assessment that focuses on body systems that are the focus of care, includes assessment related to specific problem and monitors for signs of new problems; use: throughout hospital stay, revisits -Emergency: limited to assessing life-threatening conditions and conducted to ensure survival; use: in any setting where signs and symptoms of a life-threatening emergency is apparent 11. How can the nurse interact with a client who is taking an herbal remedy and what are the best actions for a nurse to take when collecting data? (page 85) Ask general, open-ended questions, while remaining nonjudgmental and respectful of the patient’s responses. Ask questions like, “Do you have any conditions that have not responded to conventional medicine? If so, have you tried any other approaches?” or “Are you using any vitamin, mineral, dietary, or herbal supplements?” or “Are you interested in obtaining information about complementary and alternative therapies?” 12. What are common skin changes in the elderly? What would be considered abnormal? (page 417) Skin: Increased wrinkling, sagging breasts and abdomen, redundant flesh around eyes, tenting, dry flaking skins, minimal to no perspiration, skin color uneven, bruising, solar lentigines on face and back of hands, decrease in rosy appearance, cool to the touch, diminished awareness of pain or temperature, diminished rate of wound healing Hair: Gray or white hair, dry, course hair, scaly scalp, thinning and loss of hair, baldness Nails: Thick, brittle nails with diminished growth, longitudinal ridging, prolonged capillary refill 13. Where does a nurse assess for cyanosis, jaundice, pallor in a dark-skinned person? (page 421) Cyanosis appears as ashen or gray color that is most easily seen in the conjunctiva of the eye, mucous membranes, and nail beds. Jaundice appears as a yellowish green color most obviously seen in the sclera of the eye, palms, and soles. Pallor appears as a lack of underlying red tone; in light-skinned African Americans, it is yellowish brown skin; in dark-skinned patients, it is ashen or gray skin. 14. Why is it critical to prevent skin breakdown/maintain skin integrity of older patients? (page 417) Older patients have decreased subcutaneous fat, which increases their risk for traumatic injury and skin shearing, which may lead to pressure ulcers, which can lead to multiple various complications.