NUR 242 - Exam 1 med surg study guide.
c c c c c c c c
Examc1cmedcsurgcstudycguide
Unitc1
Specialtycpracticecofcmedical-surgicalcnursing
Promote,crestore,corcmaintaincoptimalchealthcforcpatientsc18cyearscandcoldercN
ursescmustchavecknowledge,cskills,candcattitudesctocbe
CareccoordinatorscTr
ansitioncmanagerscC
aregivers
Ptceducatorsc
Leaders
Advocatescforcthecptcandcfamily
Thecjointccommission:ceffectiveccareccoordinationcandctransitioncmanagementcUnders
tandablecdischargecinstructionscforcthecpatientcandcfamilycExplanationcofcself
-carecactivities
Ongoingcorcemergencyccarecinformation
ListcofccommunitycandcoutpatientcresourcescandcreferralscKnowledge
cofcthecptsclanguage,cculture,candchealthcliteracycMedicationcreconcilia
tion
Safety
ThecabilityctockeepcthecpatientcandcstaffcfreecfromcharmcandcminimizecerrorscinccarecNursingcs
afetycprioritycboxes
Criticalcrescuec
ActioncalertcD
rugcalert
Thecjoinccommission:cacculturecofcsafetyc
Blame-freecapproach
Patientscandcfamiliescarecsafetycpartnerscw/hcpcandcorganizationscSeri
ousceventscmustcbecreported
Teamworkcandcinterprofessionalccollaboration
CollaboratecwithcinterprofessionalchealthccarecteamcInterprofessiona
lceducationccollaborativeccompetencies
Values/ethicscforcinterprofessionalcpracticec
Role-responsibilities
Interprofessionalccommunicationc
Teamscandcteamwork
Communication:cSBAR
Formalcmethodcofchand-
offccommunicationcbetweenctwocorcmorechealthccarecteamcmembers
4csteps
s-situationc(name,cage,cdx)
b-
backgroundc(history,chomecmeds,callergies)cA-
assessmentc(ivs,cv/s,clabs)cRecommendation/
requestc(plan,cptcupdates)
teamSTEPPS
, NUR 242 - Exam 1 med surg study guide.
c c c c c c c c
Delegation
ProcesscofctransferringcacselectedcnursingctaskcorcactivityctocaccompetentcUAPc(unlicensedc
assistivecpersonnel)
Thecnurseciscalwayscaccountablecforcthectask/activitycdelegated!cNugg
et**
Makecsurectheycunderstand,candcitciscwithinctheircscopecofcpractice!!cBecspecificcPriori
tizationcandcdelegation
Physiological,cpsychological,cacute,cchronic,cunstable,cstable,cunpredictable,cpredictablecFive
crightscofcdelegation
Rightctask
Rightccircumstancesc
Rightcperson
Rightccommunicationc
Rightcsupervision
Supervision
Guidancecorcdirection,cevaluation,candcfollowupcbycthecnursectocensurecactask/activityciscpe
rformedcappropriately
Evidence-basedcpracticec(EBP)
Integrationcofcthecbestccurrentcevidencecandcpracticesctocmakecdecisionscaboutcpatient
carecE
Considerscpatientcpreferencescandcvalues
Considersconecowncclinicalcexpertisecforcdeliverycofcoptimalchealthccare
thics
AddressescissuescandcquestionscaboutcmoralitycAttributes
AutonomycBene
ficencecNonmal
eficencecFidelity
VeracitycSoci
alcjustice
Commonchealthcproblemscofcoldercadultsc
Concepts
ThecprioritycconceptscarecmobilitycnutritioncandccognitioncSub
groupscofclatecadulthood
Youngcold-
c65ctoc74cyearscMiddlecoldc
75-84cyearscOldcoldc–
c85ctoc99cyearscElitecold-
c100cplus
CommonchealthcissuescandcconcernscP
erformancecofcadlscParticipatio
ncincsocialcactivitiescLosses
Healthcpromotion
, NUR 242 - Exam 1 med surg study guide.
c c c c c c c c
SpecialcconsiderationscforcoldercadultcclientscDecr
easectolerancectocmeds
DecreasecivcratectocavoidcfluidcoverloadcI
ncreasecriskcof:
Respiratorycdepressionc
PneumoniacDisorientat
ion
Skincbreakdownc
Problemscw/
Circulationc
NutritioncCo
nstipation
Fluidcandcelectrolytecbalancec
Increasecbalancecandcdecrasecfalls
Suddencincreasecincconfusionc
UrinecinfectioncHypox
ia
Electrolytecimbalancec
Clinicalcmanagement
Treatccoexistingcmedicalcdisordersc
Cardiaccproblems
Pvd
Neurologicalcdisorders
Nugget**
Copd
Resp.cissues
CommonchealthcissuescandcconcernscImpa
iredcnutritioncandchydrationcImpair
edcmobilitycstrokes,criskcfallscStress,c
loss,candccoping
Accidents
Drugcusecandcmisusec
ImpairedccognitioncS
ubstancecuse
Eldercneglectcandcabusec
Nugget**
Depression
Healthcneed:cseeingcMDcascneededcI
mpairedcnutritioncandchydration
Increasedcneedcforccalcium,cvitca/c/d,cfiber
Diminishedctastecandcsmell,ctoothcloss,cpoorcdenturesccancimpactcnutritioncstatuscCon
stipationcconcers
Lonelinessc
Skincbreakdown
, NUR 242 - Exam 1 med surg study guide.
c c c c c c c c
NutritioncsupportcAvoi
dcfriction,cshearing
RepositioncandcprovidecsupportcsurfacescI
ncreasecmobilitycandcactivity
Cleancskin,cusecmoisturecbarriersc
Rehabilitationcinterprofessionalcteam
Nurses,cnursingcassistantscPhysicia
nscandcphysiciancassistantscAdvanc
edcpracticecnurses
Physicalctherapistscandcassistantsc
OTcandcassistants
Speech-
languagecpathologistscandcassistantscNeuropsychol
ogists
Socialcworkersc
Psychologists
Spiritualccareccounselorsc
RegisteredcdietitianscPh
armacists
CardiovascularcandcrespiratorycassessmentcA
ssesscforcdecreasecinccardiaccoutput
Chestcpain
Weaknesscandcfatigue
Planccarectocmaximizeclimitedcenergycresourcesc
Frequentcrestcperiods
Majorctaskscincmorning
Determineclevelcofcactivitycthatccancbecdonecwithoutcinvokingcsymptoms
Nugget**
FluidcinclungscandcDVTs
SOB
Crackles,crhonchic
Improvingcphysicalcmobility
Safecpatientchandlingcpractices
Positioncchangesc(bedctocchair,ccommode,corcwheelchair)cProv
idecassistancecw/ctransfers
Gaitctraining
Usecofcassistivecdevices/ambulatorycaidsc(canescandcwalkers)cImpleme
ntingcROMcroutines/exercises
Coordinateccarecw/PTcandcOT
AssesscptscmobilityclevelscusingcstandardizedctoolcN
ugget**clookcatcchartc6-1
Canescandcwalkers**
Canecoppositecaffectedclegc(COAL)
Walker,cwith,caffectedclegc(wanderingcWilma’scalwaysclate)cSki
ncandctissuecintegritycassessment
c c c c c c c c
Examc1cmedcsurgcstudycguide
Unitc1
Specialtycpracticecofcmedical-surgicalcnursing
Promote,crestore,corcmaintaincoptimalchealthcforcpatientsc18cyearscandcoldercN
ursescmustchavecknowledge,cskills,candcattitudesctocbe
CareccoordinatorscTr
ansitioncmanagerscC
aregivers
Ptceducatorsc
Leaders
Advocatescforcthecptcandcfamily
Thecjointccommission:ceffectiveccareccoordinationcandctransitioncmanagementcUnders
tandablecdischargecinstructionscforcthecpatientcandcfamilycExplanationcofcself
-carecactivities
Ongoingcorcemergencyccarecinformation
ListcofccommunitycandcoutpatientcresourcescandcreferralscKnowledge
cofcthecptsclanguage,cculture,candchealthcliteracycMedicationcreconcilia
tion
Safety
ThecabilityctockeepcthecpatientcandcstaffcfreecfromcharmcandcminimizecerrorscinccarecNursingcs
afetycprioritycboxes
Criticalcrescuec
ActioncalertcD
rugcalert
Thecjoinccommission:cacculturecofcsafetyc
Blame-freecapproach
Patientscandcfamiliescarecsafetycpartnerscw/hcpcandcorganizationscSeri
ousceventscmustcbecreported
Teamworkcandcinterprofessionalccollaboration
CollaboratecwithcinterprofessionalchealthccarecteamcInterprofessiona
lceducationccollaborativeccompetencies
Values/ethicscforcinterprofessionalcpracticec
Role-responsibilities
Interprofessionalccommunicationc
Teamscandcteamwork
Communication:cSBAR
Formalcmethodcofchand-
offccommunicationcbetweenctwocorcmorechealthccarecteamcmembers
4csteps
s-situationc(name,cage,cdx)
b-
backgroundc(history,chomecmeds,callergies)cA-
assessmentc(ivs,cv/s,clabs)cRecommendation/
requestc(plan,cptcupdates)
teamSTEPPS
, NUR 242 - Exam 1 med surg study guide.
c c c c c c c c
Delegation
ProcesscofctransferringcacselectedcnursingctaskcorcactivityctocaccompetentcUAPc(unlicensedc
assistivecpersonnel)
Thecnurseciscalwayscaccountablecforcthectask/activitycdelegated!cNugg
et**
Makecsurectheycunderstand,candcitciscwithinctheircscopecofcpractice!!cBecspecificcPriori
tizationcandcdelegation
Physiological,cpsychological,cacute,cchronic,cunstable,cstable,cunpredictable,cpredictablecFive
crightscofcdelegation
Rightctask
Rightccircumstancesc
Rightcperson
Rightccommunicationc
Rightcsupervision
Supervision
Guidancecorcdirection,cevaluation,candcfollowupcbycthecnursectocensurecactask/activityciscpe
rformedcappropriately
Evidence-basedcpracticec(EBP)
Integrationcofcthecbestccurrentcevidencecandcpracticesctocmakecdecisionscaboutcpatient
carecE
Considerscpatientcpreferencescandcvalues
Considersconecowncclinicalcexpertisecforcdeliverycofcoptimalchealthccare
thics
AddressescissuescandcquestionscaboutcmoralitycAttributes
AutonomycBene
ficencecNonmal
eficencecFidelity
VeracitycSoci
alcjustice
Commonchealthcproblemscofcoldercadultsc
Concepts
ThecprioritycconceptscarecmobilitycnutritioncandccognitioncSub
groupscofclatecadulthood
Youngcold-
c65ctoc74cyearscMiddlecoldc
75-84cyearscOldcoldc–
c85ctoc99cyearscElitecold-
c100cplus
CommonchealthcissuescandcconcernscP
erformancecofcadlscParticipatio
ncincsocialcactivitiescLosses
Healthcpromotion
, NUR 242 - Exam 1 med surg study guide.
c c c c c c c c
SpecialcconsiderationscforcoldercadultcclientscDecr
easectolerancectocmeds
DecreasecivcratectocavoidcfluidcoverloadcI
ncreasecriskcof:
Respiratorycdepressionc
PneumoniacDisorientat
ion
Skincbreakdownc
Problemscw/
Circulationc
NutritioncCo
nstipation
Fluidcandcelectrolytecbalancec
Increasecbalancecandcdecrasecfalls
Suddencincreasecincconfusionc
UrinecinfectioncHypox
ia
Electrolytecimbalancec
Clinicalcmanagement
Treatccoexistingcmedicalcdisordersc
Cardiaccproblems
Pvd
Neurologicalcdisorders
Nugget**
Copd
Resp.cissues
CommonchealthcissuescandcconcernscImpa
iredcnutritioncandchydrationcImpair
edcmobilitycstrokes,criskcfallscStress,c
loss,candccoping
Accidents
Drugcusecandcmisusec
ImpairedccognitioncS
ubstancecuse
Eldercneglectcandcabusec
Nugget**
Depression
Healthcneed:cseeingcMDcascneededcI
mpairedcnutritioncandchydration
Increasedcneedcforccalcium,cvitca/c/d,cfiber
Diminishedctastecandcsmell,ctoothcloss,cpoorcdenturesccancimpactcnutritioncstatuscCon
stipationcconcers
Lonelinessc
Skincbreakdown
, NUR 242 - Exam 1 med surg study guide.
c c c c c c c c
NutritioncsupportcAvoi
dcfriction,cshearing
RepositioncandcprovidecsupportcsurfacescI
ncreasecmobilitycandcactivity
Cleancskin,cusecmoisturecbarriersc
Rehabilitationcinterprofessionalcteam
Nurses,cnursingcassistantscPhysicia
nscandcphysiciancassistantscAdvanc
edcpracticecnurses
Physicalctherapistscandcassistantsc
OTcandcassistants
Speech-
languagecpathologistscandcassistantscNeuropsychol
ogists
Socialcworkersc
Psychologists
Spiritualccareccounselorsc
RegisteredcdietitianscPh
armacists
CardiovascularcandcrespiratorycassessmentcA
ssesscforcdecreasecinccardiaccoutput
Chestcpain
Weaknesscandcfatigue
Planccarectocmaximizeclimitedcenergycresourcesc
Frequentcrestcperiods
Majorctaskscincmorning
Determineclevelcofcactivitycthatccancbecdonecwithoutcinvokingcsymptoms
Nugget**
FluidcinclungscandcDVTs
SOB
Crackles,crhonchic
Improvingcphysicalcmobility
Safecpatientchandlingcpractices
Positioncchangesc(bedctocchair,ccommode,corcwheelchair)cProv
idecassistancecw/ctransfers
Gaitctraining
Usecofcassistivecdevices/ambulatorycaidsc(canescandcwalkers)cImpleme
ntingcROMcroutines/exercises
Coordinateccarecw/PTcandcOT
AssesscptscmobilityclevelscusingcstandardizedctoolcN
ugget**clookcatcchartc6-1
Canescandcwalkers**
Canecoppositecaffectedclegc(COAL)
Walker,cwith,caffectedclegc(wanderingcWilma’scalwaysclate)cSki
ncandctissuecintegritycassessment
