NURS 251 final exam questions with correct answers

Safe Patient handling for immobile patients transfer devices, lift teams Safe Patient handling for patients that can assist •Wide base of support •Lower center of gravity •Equilibrium of an object is maintained as long as the line of gravity passes through the base of its support •Facing the direction of movement prevents abnormal twisting of the spine •Dividing balanced activity between arms & legs reduces the risk of injury •Leverage, rolling turning, or pivoting requires less work •When friction is reduced between the object to be moved & the surface on which it is moved, less force is required to move it. Patient Safety Goals Focus is on preventable medical events Pt. Safety goals focuses on Accuracy of patient ID. Wrong pt, wrong site, wrong procedure. Communication between caregivers. Prevent HAI. Patient saftey Information on Falls Common both in & out of healthcare settings. More common in elderly Result in pain, disability & death. Account for 90% of all incident reports Fall Risk: Intrinsic factors Surgery Decreased mobility Confusion & Delirium Patients perceived ability Fall Risk: Extrinsic Factors Unfamiliar environment Drains/Tubes Intravenous devices Catheters Fall Diagnosis instructions Leave side rails up Make sure everything is in reach of pt. Always ask for assistance getting out of bed Identify as fall risk Alternatives to restrains Types of Restraints Chemical & Physical Restraints ________ be ordered prn CANT When using a restrictive device: Assess circulation of limb every 15 min Offer food, fluids, toileting every 2h Remove restrains & do ROM Assess skin under restrains Reposition every 2h Communication An exchange of information, ideas, and feelings that requires interpretation, sensitivity, imagination, and active participation Referent Motivates one to communicate with another Sender and receiver One who encodes and one who decodes the message Message Content of the message Channels Means of conveying and receiving messages Feedback Message the receiver returns Interpersonal variables Factors that influence communication Environment The setting for sender-receiver interaction Critical thinking and communication Interpret messages received from others Analyze the content Make inferences about what the message means Evaluate the effect Explain the rationale for the technique used Examine the communication style/pattern Intrapersonal Occurs within an individual Interpersonal One-to-one interaction between two people Transpersonal Interaction within a persons spiritual domain Small group Interactions with a small number of people Public Interaction with an audience Factors influencing communication -perceptions -values -emotions -sociocultural background -knowledge level -roles and relationships -environments -space and territory Personal space (distance) Intimate 0-18 inches Personal 18 in - 4 feet Social 4ft- 12 ft Public 12 ft and up Touch zones Social zone (permission not needed) Consent zone (permission needed) Vulnerable zone (special care needed) Intimate zone (great sensitivity needed) Challenging factors influencing communication People who are: •Silent, withdrawn, •depressed •Angry •Uncooperative •Talkative •Demanding •Frightened, •Sensory impairment •Confused or disoriented •Unable to speak or understand English (or only a little) •Flirtatious Types of communication Verbal & Nonverbal Verbal Communcation Vocab Tone Clarity & Brevity Pace Timing & Relevance Nonverbal communication Personal appearance Posture and gait Facial expressions Eye contact Gestures Sounds Touch Nursing Process: Assessment Physical Factors: Visual or hearing deficits Emotional Factors: Mental illness Developmental factors: Infant vs adult Sociocultural factors: Cultural influence Gender: Men vs women Impaired verbal communication lacking skills in attending, listening, or responding, or self-expression Inability to articulate, inappropriate verbalization Difficultly forming words Difficulty with comprehension Interventions to communicate Speak slowly - not louder Actively listen, be patient Use augmented & alternative communication Communicating with patients who are cognitively impaired Always try to communicate first Dont rush Reduce environmental distractions Approach client directly Talk first, touch second Use verbal & written instructions Use short sentences Limit choices Communicating with patients who are hearing impaired Assess for hearing aide function Is pt able to read lips or use sign language? Face the patient, make sure they are aware of your presence, Speak closer to the less affected ear Minimize environmental noise Speak clear, slowly & natural (don't shout) Use simple language Use gestures paper & pencil or computer Rephrase rather than repeat same words For older adults: use lower pitch Communicating with patients who are visually impaired Describe room to help client understand room & activity Explain unfamiliar sounds (IV Pumps/alarms) Speak before you touch Avoid expressions "over there" Communicating with patients who are unresponsive Touch & speak as if they hear you. Consult with previous care providers to what pt responds to Speak calmly & slowly Explain all procedures Provide soothing music Communicating with Patients who do not speak a common language Learn about the culture Be respectful Use caution with touch Use short words & sentences Present one idea at a time Provide written teaching material Use trained medical interpreters Therapeutic communication techniques Specific responses that encourage the expression of feelings and ideas and convey acceptance and respect Active Listening: SOLER S - Sit squarely facing the client O - Observe an open posture L - Lean forward toward the client E - Establish eye contact R - Relax Therapeutic communication characteristics Empathy Respect Genuineness Concrete Confrontation Elements of professional communication appearance, demeanor, behavior, courtesy, use of names, trustworthiness, autonomy and responsibility, assertiveness Negative effects of poor communication in healthcare teams Job dissatisfaction Frustration Distrust Acrimony- harsh or biting sharpness of words, manner, or disposition Inferior care Great risk of error and adverse events Death of the patient Increase in readmissions How to fix poor communication Do not be afraid to use humor Assume you and the physician are on the same team and have the same goals Be assertive Always clarify Recognize you are equal to the physician when it comes to caring for the patient Arrange a meeting Report good news about the patient Be prepared for conflict Assertive communication is: Being organized in thought Possessing technical and social competence Seeking common understanding, ownership, and value from all members of the team. Starts with the phrase: "I am concerned." Where did SBAR communication start? The Navy on nuclear submarines SBAR Situation (current) Background (limit to essential info) Assessment (your assessment data) Recommendation (your suggested next steps or what you need to happen and when) Is pain subjective or objective Subjective How is pain defined Pain is an unpleasant and highly personal experience that may be imperceptible to others while consuming all parts of persons life Pain is a _____ and _____ experience Physical, Emotional