Guidance for Final Exam NR 226 Final Review

Guidance for Final Exam NR 226 Final Review Guidance for Final Exam Total Questions= 65 questions (1.5 minutes per question) Ch. 23 (Torts and Confidentiality) 1. Torts: civil wrong acts or omission made against a person/property a. Intentional: Willful acts that violate another person’s right i. Assault: Intentional threat towards another person that places that person in fear of harmful, imminent or unwelcomed contact. 1. No actual contact is required ii. Battery: intentional offensive touching without consent or lawful justification. 1. Contact can be harmful and cause injury or can be offensive to the pt’s personal dignity 2. Ex: Provider performs a procedure that goes beyond the scope of the pt’s consent iii. False Imprisonment: unjustified restraint of a person without legal reason 1. Ex: nurses restrain a pt in a confined area to keep that person from freedom a. Pt must be aware of confinement for false imprisonment. b. Quasi Intentional: i. Invasion of Privacy: release of pt’s medical info to unauthorized person, such as press, pt’s employer or family or online. (can only b shared with healthcare providers for the purpose of medical treatment only ii. Defamation of Character: publication of false information that results in damage to a person’s reputation 1. Slander: speak falsely about another 2. Libel: write falsely about another c. Unintentional i. Negligence: below standard of care ii. Malpractice: professional negligence to carry out duty of care2. Confidentiality a. HIPAA: pt right to consent to the use and disclosure of their protected health info, to inspect and copy one’s medical record and to amend mistakes or incomplete info. b. Limits who’s able to access pt records. c. Privacy and confidentiality d. Informed consent: nurse is witness that pt signed and is competent Ch. 37 x 9 Questions (See topics below) Types of Grief: a cluster of ordinary emotions arising in response of a significant loss. Intensified and complicated by the relationship to the person or object lost 1. Normal uncomplicated grief: common universal reaction 2. Anticipatory grief: before the actual loss of death ex caring for pt with dementia or ALS 3. Disenfranchised Grief: relationship to deceased person not socially sanctioned, cant be openly shared or seems less significant a. Ambiguous loss: the person is physically present but not psychologically available. Ex: dementia or brain injury 4. Complicated Grief: prolonged significant difficulty moving forward after a loss a. Chronic: normal grief response experienced over a long period of time b. Exaggerated: self destructive or maladaptive behavior, obsessions, or psych disorders. Suicide risk c. Delayed: avoidance because the loss is so significant. Ususally triggered by a second less significant loss d. Masked: behaves in a way that interferes with normal functioning Box 37-10, Care of the Body after Death 1. African American: presence of large extended family and church family. Mourning short with memorial service and public viewing of the body or wake before burial. Organ donation and autopsy allowed2. Chinese: death negative life event. No afterlife. Dead treated same as living, may b buried with food and artifacts. Extended family stay with deceased 8 hrs. Oldest son or daughter bathes the body under direction of an older relative or temple priest a. Body should remain intact. No organ donation or autopsy 3. Hispanic or Latino: amulets, rosary, folk medicine and prayer. Grief expressed openly. Death is the will of God. Catholic. 4. Native Americans: Some don’t touch the body. Some cleanse the bosy, paint the face, dress it in clothes, attach eagle feathers to symbolize a return home. a. Mourners have a ritual to cleanse their own body b. Dead buried on the deceased homeland 5. Islamic: Deceased body ritualistically washed, wrapped cried over, prayed for and buried as soon as possible after death. Eyes and mouth closed. Faced turned towards mecca. a. Muslims of the same gender prepare the body b. Bodies are buried not cremated c. Proximity of loved ones is imp since soul stay with body until buried d. Autopsy prevents to quickness of burial 6. Buddhist: believe in afterlife inwhich humans manifest in different forms. Death is preferred at home. Minimize emotional expression to maintain peaceful, compassionate atmosphere. Male family members prepare the body. Budhists recommend not touching the body after death to facilitate a smooth transition to afterlife. The body is not left alone. Family and friends pay respects until cremation. 7. Hindu: Body in the floor with the head placed north. Same gender handles the body. The body is cremated to purify with fire. 8. Jewish: Orthodox Judaism: Jewish burial society. Family stays with the body until the burial, which is within 24 hrs but not on the Sabbath. Some but not all types avoid cremation, autopsy, and embalming Types of Loss,1. Actual Loss: Person can no longer feel, hear, see or know a person or object a. Necessary Loss i. Maturational Loss: Normally expected changes across life span, normal life transitions Ex: toddler separation anxiety, kid leaving old classroom friends and teacher, college student leaving campus after graduating Help pt develop coping skills for unplanned, unwanted or unexpected loss ii. Situational Loss: brought about by sudden unpredictable external event Ex: car accident injury leads to physical change so pt loses job, life goals, self esteem 2. Perceived Loss: uniquely defined by the person experiencing the loss and is less obvious to other people a. Ex: rejection by a friend leads to loss of confidence Stages of Dying, 1. Denial: cant accept the fact of the loss 2. Anger: resistance or intense anger at God, other people or the situation 3. Bargaining: cushions or postpones awareness of the loss by trying to prevent it from happening 4. Depression: the person realizes the full impact of the loss 5. Acceptance: the person incorporates the loss into life Ch. 50 (Surgery) x 18 Questions (Whole Chapter) Important Lab Values Prior to Surgery, Hb 12-16; 14-18 Hct 37-47; 42-52 Platelet: 150,000-400,000 Wbc 5k-10kNa 136-145 K 3.5-5.0 Cl 98-106 Co2 23-30 BUN 10-20 Glucose 70-110 Creat .5-1.1; .6-1.2 PT 11-12.5 sec; 85-100% PTT 60-70 sec INR 0.76-1.27 Activated PTT 30-40 Pre-Op Meds and Surgery (Table 50-5), 1. Antibiotics a. Enhance anesthesia b. Aminoglycosides (mycin) = mild resp distress b/c depressed NM transmission: stop 2 weeks before 2. Antidysrythmias a. Beta Blockers reduce contractility and impair cardiac conduction during anesthesia 3. Anticoags a. Hemorrhage/bleed so stop 48 hrs before 4. Anticonvulsants a. Alters metab of anesthesia 5. Antihypertensives a. Beta blockers and ca channel blockers = bradycardia, hypotension and impaired circulation by inhibiting NE 6. Corticosteroids a. Chronic use = adrenal atrophy so body cant withstand stress. So must be inc before and during surg 7. Insulin a. Need inc due to stress or dec due to NPO8. Diuretics a. Lasix=electrolyte imbalance (K) after surgery 9. NSAIDS a. Inhibit platelet aggregation and prolong bleeding time= Postop bleeding 10.Herbals (ginger, ginko, gensing) a. Inhibit platelets = post op bleeding. b. Gensing: inc hypoglycemia with insulin therapy Medical Conditions and Risk for Surgery (Table 50-4), 11. Bleeding disorders: Risk hemmorage during and after 12. DM: Hyperglycemia, infection, impaired wound healing 13. Heart dz: Anaesthesia depress cardiac function and Stress of surg inc myocardial oxygen demand 14. HTN: Inc stroke and inad tissue oxygenation during anesthesia 15. OSA: Opiods inc risk airways obstruction after surgery and pts Desat: dec in pulse ox 16. URI: Inc risk pneumonia and laryngeospasm during anasthesia 17. Renal dz: Alters excretion of anesthesia drug and their metabolites = inc risk acid-base imbalance 18. Liver dz: alters metab and elimination of drugs. Impaired wound healing and clotting b/c altered ptn metab 19. Fever: predispose to fluid/electrolyte imbalance and indicate infection 20. Asthma, emphysema, bronchitis: reduce acid base compensation. Anesthesia reduces respiratory function = hypoventillation 21. Immune disorders: inc risk of infection and delayed wound healing after surgery 22. Alcohol abuse/street drugs: withdrawl during and after surgery 23. Chronic pain: higher tolerance. Inc analgesics needed to control post op pain Anesthesia Types, 1284 General: pt loses all sensation, consciousness, and reflexes including gag and blink. Muscle relaxation and amnesiaRegional: Loss of sensation in an area of the body by anesthetizing sensory pathway Elevation of upper body to prevent resp paralysis Local: loss of sensation at desired site by inhibiting peripheral nerve conduction Moderate Conscious Sedation: used routinely for shortterm surgical, diagnostic, and therapeutic procedure. Depress level of consciousness. Pt breathes on own. Pt responds to light touch and verbal stimuli Surgical Classifications, 1. Seriousness a. Major: extensive reconstruction or alteration of body part. Poses greatest risk to well being i. CABG, colon resection, removal of larynx, lung resection b. Minor: minimal alterations to body part. Correct deformities. Minimal risk i. Cataract extraction, facial plastic surg, tooth extraction 2. Urgency i. Elective: pt choice. Not essential not necessary 1. Bunion, face plastic, breast, hernia ii. Urgent: necessary for pt’s health to prevent tissue destruction or impaired organ function 1. Excise cancer, remove gallbladder, CABG iii. Emergent: must b done immediately to save life or preserve function 1. Appy, control internal hemorrage 3. Purpose i. Diagnostic: exploratory ii. Ablative: removal of dz body part: appy iii. Palliative: relieve or reduce intensity of dz but not cure: colostomy iv. reconstructive/restorative: restores function or appearance: fx, scar revision v. procurement for transplantvi. constructive: restores function lost from congeital anomaly: cleft lip or palate vii. cosmetic: approve personal appearance: rhinoplasty How to Turn a Post-Op Patient, 1301 Turn every 2 hrs Lie supine, one leg bent and one straight, grab straight leg side rail with opposite hand Post-Op Wound Care, Inspect Skin, Dressing COCA, Surgeons prefer to change dressings for the first time, Braden scale risk for developing pressure ulcers (sensory, moisture, mobility, activity, nutrition, friction/shear) 15-16 low risk 12 and under high risk Post-Op Medication Care, Control pain with PCA or epidural Pain Control and Surgery, Most pain 24-48 hrs after surg IV PCA or epidural Post-Op Diets, Pt’s who chew gum experience faster GI return Ice chips - clear fluids- nml diet Go slow, prevent nausea Ch. 44 (Pain) Ch. 46 (Urinary Elimination) Common urinary elimination problems CH 47 Stool Testing/Samples, (ch 47)Guic test: 3 samples. Develepor on back detect blood turns blue Ova and egg stored warm Communication Therapeutic Communication, (ch 24) Discharge Planning, ch 18 p248-249, ch 26 p 365-366 Starts at admission, include family, include home equiptment/assistance Paperwork: meds, diet, community resources, who to contact and followup Nursing Process (ch 15, 16, 17, 18, 19, 20), Nursing Process and Concept Map 1. Steps to the Nursing Process a. Assessment: collect, verify, analyze data i. Patent centered interview 1. Orientaton (set agenda), working phase (interview), terminaton 2. Observaton of nonverbal, open ended questons, leading questons (uh huh go ahead, encourages pt to say more),, probing (is there anything else you can tell me), closed ended questons (yes or no) b. Nursing Diagnosis: provides the basis for selecton of nursing interventons to achieve outcomes for which you the nurse are accountable i. Allow nurses to practce independently with patent educaton and symptom relief ii. Problem focused: pts response to health problem, based on assessment (Problem Etology Symptoms) 1. Related factor: etology or cause for the diagnosis. Allows you to individualize the nursing diagnosis 2. Defning Characteristc: physical sign or observable cue that supports the problem focused diagnosis 3. Ex: acute pain related to trauma of surgical incision as evidence by pt’s self report of pain intensity, guarding, behavior and the expression of grimacing iii. Risk: vulnerability for developing undesired response to health problem 1. Has risk factors 2. Ex: risk of infecton related to being hospitalized with an open surgical wound iv. Health Promoton: motvaton and desire to increase well being 1. Ex: readiness for enhanced knowledgev. Establish Priority 1. Highest: if untreated, results in harm/loss a. Airway, circulaton, safety, pain 2. Intermediate: non emergent non life threatening needs 3. Low: not directly related to specifc illness or prognosis but affect a patent’s well being c. Goals/Outcome: patent cantered and SMART d. Planning e. Interventons i. Nurse initated: independent 1. Related to nursing diagnosis and patent goals 2. Pertains to ADLs, health educaton and promoton and counseling ii. Health care provider initated: dependent 1. Providers response to treat or manage medical diagnosis 2. Requires nursing responsibility and technical nursing knowledge iii. Collaboratve: interdependent f. Evaluaton 2. Concept Map: visual representaton of patent problems and interventons that shows their relatonships to one another 3. Establishing patent care goals a. Patent centered, specifc/singular, measurable, atainable, realistc, tmed 4. Establishing Rapport 5. Comparing Data Vital Sign Parameters, Ch 30 1. Temperature Range 36-38C, 96.8-100.4F a. Oral/tympanic 37C, 98.6F b. Rectal 37.5C, 99.5F c. Axillary 36.6C, 97.7F 2. Pulse: 60-100 3. Pulse Ox: 95-100 4. Respirations: 12-20 5. BP: 120/80, pulse pressure 30-50 6. Capnography (CO2): 35-45 Fluid and Electrolytes Ch 42 Acid-Base Imbalances (ch 42),Normal Electrolyte Levels, (ch 42) Fluid Imbalances (Ch 42) IV Care, (ch 42 p 981-986) Chapter 41 Oxygenation Hypoxemia Vs Hypoxia, Hypoxemia: low levels of arterial O2. Stimulates rate and depth of ventilation Hypoxia: inadequate tissue oxygenation Clinical sx: apprehension, restless, inability to concentrate, dec LOC, dizzy, fatigue, agitation, cant lie flat, cyanosis Inc HR, inc RR and depth Oxygen Therapy, (ch 41) 1. Nasal Canula: 1-6L/min; 24-44% 2. Simple Face mask: 6-12L/min; 35-50% 3. Partial and NRB: 10-15L; 60-90%: humidity 4. Oxygen conserving Cannula: 8L/min; 30-50%; home use 5. High flow venture mask: 24-50%; humidity Respiratory Patterns, (ch 41) 1. Bradypnea: slow rate 2. Tachypnea: fast rate 3. Hyperpnea: labored, inc depth, inc rate 4. Apnea: resp cease 5. Hyperventillation: rate and depth inc 6. Hypoventillation: rate and dept dec 7. Cheyne Stokes: alternating apnea and hyperventilation; irreg 8. Kussmauls: abnormally deep and inc rate 9. Biots: abnormally shallow for 2-3 breaths followed by apnea; irregMobility Mobility/Immobility, (ch 28) Assistive Devices during Ambulation, Ch 28 Cane, walker, wheelchair, gaitbelt Hazzards with immobility metabolic = slowed wound healing, muscle atrophy, decreased subcutaneous fat respiratory = asymmetrical chest wall movement, dyspnea, increased respirations, crackles & wheezes cardiovascular = orthostatic hypotension, increased heart rate, 3rd heart sound, weak peripheral pulses, peripheral edema musculoskeletal = decreased ROM, erythema, increased calf or thigh, joint conracture, activity intolerance, muscle atrophy skin = break integrity elimination = decreased urine output, cloudy/concentrated urine, decreased frequency BM, distended bladder/abdomin, decreased bowel sounds Isolation Precautions and Diseases, ch 29? Contact: MRSA: private room. Gloves,gown,mask, wash hands soap and water Droplet: pertussis, scarlet fever, rubella, dipteria: N95 mask Airborne: TB, measles, varicella: negative pressure room. HEPA filtration. N95 mask