nur 231 exam 1 Question and Answers

nur 231 exam 1 Question and Answers what does primary health care focus on? health promotion and disease control -ex: pap smears, CV screenings, physicals, etc. what does secondary health care focus on diagnosis and treatment of ACUTE illness and injury -ex: oncologists, endocrinologists, cardiologists what does tertiary health care focus on? uses specialized treatment/care to treat pt usually in a hospital setting -ex: coronary bypass surgery, plastic surgery, chemotherapy, etc. what does restorative health care focus on? immediate follow-up care for restoring health and promoting self-care -ex: home health care, OT/PT, etc. what does continuing care focus on? addresses long term or CHRONIC health care needs over a period of time -ex: palliative care, end of life care, etc. what are Maslow's hierarchy of needs? -physiological -safety, -love/belonging -self esteem/respect -self-actualization Image: what are Maslow's hierarchy of needs? T/F: we CANNOT let a pt leave the hospital if the first 2 levels of Maslow's hierarchy of needs are NOT fulfilled TRUE *advocate for your patients!! what are 4 influences on health care delivery? -trends -population demographics -changing patterns of disease -advances in technology and genetics what are 3 trends currently happening in the healthcare world? 1. increased focus on PREVENTATIVE care 2. knowledgeable and engaged consumers 3. increase in mobile tools and heath aps what are 5 population demographics that impact pt care/overall outcomes? 1. the aging population 2. poverty 3. cultural diversity 4. chronic diseases 5. inequalities/barriers what are 2 ways to decrease disparities in healthcare? -work wit h an INTERDISCIPLINARY team (and have good communication) 2. make the pt the CENTER of care (plan WITH the pt) what 4 diseases are currently on the RISE? 1. TB 2. AIDS 3. STIs 4. Obesity T/F: the US has the lowest life expectancy out of all other "rich" nations TRUE *higher rates of obesity, opioid misuse, suicide, homicide, infant mortality, road accidents, etc. what is JOC? The Joint Commission *focuses on pt safety!! what are "never" events in the health care? -medical errors that the SEVERE consequences -ex: paralyzing a pt before surgery but NOT sedating them what are "sentinel" events in health care? -unexpected occurrences/errors -ex: something gets worse before changes are made for it to get better what does QSEN stand for and what does it do? Quality and Safety Education for Nurses *helps improve nurse safety education and improve pt outcomes what is the difference between INTRA-disciplinary team and INTER-disciplinary team? -INTRA: everyone on the NURSING team (everyone is a type of nurse) -INTER: everyone else that helps the pt (physician, dietician, PCT, radiology, social worker) what is continuity of care and who is ultimately responsible for it? what: continuing quality care even hen the are transferred to another unit, sent home, sent to a nursing home, etc. responsible: the nurse! (may not be doing everything but needs to make sure it is getting done by the right person!) why is report and transitions of care dangerous for the pt (pt changing a unit at shift change)? (3) -busy time -may not get a good report -dr. may not come to see them what should be used when a pt is being transferred? (2) -SBAR/ISBAR -good documentation what does "care transition" mean? -continuous process in which a pt care shifts from being provided in one setting to another -ex: changing units, changing hospitals, going home, going to a nursing home, etc. what does "care coordination" mean? -deliberate organization of pt care -uses nurses and social worker case coordinators why is care transition and care coordination so important? ensure pt continues to get quality care/help when the are moved/go home -prevents readmissions cues to communicate: what are the 2 main principles 1. IDENTIFY the problem (start with vitals) 2. ADDRESS the problem (may not have an exact answer but know when to call the dr.) what is apart of each part of the ISBAR? I - introduction: who you are/what floor S - situation: pt name and age, physician, admitting diagnosis, any related surgeries B - background: allergies, medications, treatments A - assessment: subjective and objective findings, condition of pt, current vitals/labs, diet, current treatment, IV status/rates R - recommendation: nursing care priorities Q - questions (READ back and orders to clarify) when does discharge planning start for a pt? on admission what is apart of discharge planning? (6) -assessing/identifying pt needs -setting goals WITH the pt -pt/family edu -any referrals needed (home health care, OT/PT, follow up app.) -provide appropriate written and verbal instructions -eval. discharge effectiveness when do we refer pt to other disciplinary teams? (10) -lack of knowledge/expertise -social isolation -recent diagnosis of chronic disease -major surgery -long rehab -emotional/mental instability -complex home care/regimen -financial difficulty -lack of available/appropriate resources -terminal illness can a pt leave AMA? when are they NOT allowed to leave? YES - pt is legally free to leave *can ONLY keep them if they are a threat to themselves or others Image: can a pt leave AMA? when are they NOT allowed to leave? what must a pt do in order to leave AMA? -sign a form saying they know the consequences and has been educated *must have a witness signature as well Image: what must a pt do in order to leave AMA? T/F: the AMA form becomes part of the medical record TRUE what does preoperative mean and when does it start? -before surgery -begins with the decision to proceed with surgical intervention what does intraoperative mean and when does it start? -during operation -begins at OR bed what does postoperative mean and when does it start? -after surgery -beings in PACU what is apart of preoperative care? (5) -full history and physical assessment -preadmission testing -verified consent signed -review/edu on preop instructions -establish/maintain safety precautions -what is apart of the preoperative assessment? (11) -nutrition/fluid status -dentition -assess all body systems -psychosocial factors -spiritual and/or cultural beliefs -perceptions about surgery -medications -smoking habits -allergies -preop screening -any special conditions? what meds are almost always held for surgery? (8) -corticosteroids -diuretics -phenothiazines -tranquillizers -opioids -anticoagulants -OTC drugs -herbal products what drugs might you still give before surgery? (6) -insulin (may reduce dose due to fasting) -antibiotics -antiepileptics -antipsychotics (phenothiazines) -cardiac meds (particular beta blockers) -resp. meds T/F: physician or surgeon must complete a History and Physical (H&P) w/in 30 days of surgery TRUE go over... -gen. survey -head and neck -integument (skin) -thorax and lungs -CV system -neuro system what questionnaire is used to assess obstructive sleep apnea (OSA)? STOP BANG what the STOP BANG questionnaire ask? Snoring? Tired during day? Observed-anyone observed you stop breathing at night Pressure-HTN? BMI over 35? Age over 50? Neck circumference over 40 cm? Gender=male? answering __ or more on the STOP BANG questionnaire for obstructive sleep apnea risk means you are at HIGH risk for OSA 3 or more answering __ or less on the STOP BANG questionnaire for obstructive sleep apnea risk means you are at LOW risk for OSA 2 or less what does informed consent include? (5) explanation of... -procedure -risks -benefits -alternative to surgery -how to withdrawal consent if mind changed what is the nurses role in informed consent? (3) -witness consent from pt or POA -ensure pt is capable of making decisions -clarify any information (cannot provide new/additional info) what 5 things are needed for consent to be VALID? -aged 18+ (or emancipated minor) -no coercion -obtained by a physician -witness by professional staff -pt has capable mental capacity what are some things that will make an informed consent INVALID? (5) -pt is under 18 -coercion involved -pt is cognitively impaired -pt is mentally ill -pt does not have capacity when is consent NOT required? (2) -emergency procedures needed to be done ASAP -routine procedure under local anesthetic (ex: sutures) when is informed consent always required? (5) -invasive procedures/surgeries -anything needing general anesthetic or sedation -radiation -blood products administrated -high risk non-surgical procedures what are the preoperative nursing interventions (5) -pt edu -anxiety prevention/maintenance -preventing preop complications -sorting any preop nursing concerns -safety how to tackle preop pt edu? use the NURSING PROCESS!! what are some common topics for preop pt edu (be familiar) (9) -estimated length -hospital gown, denture use, jewelry, nail polish allowed? -family waiting room, visiting restrictions -length of stay postop (same-day discharge?) -bowels/voiding/catheter use -skin prep -IVs/fluids needed -safety precautions -pain, meds T/F: anxiety is rare and is just unnecessary worrying FALSE: anxiety is a common reaction due to fear physiological S&S of anxiety (5) -increased bp -increased hr -increased resp -diaphoresis (sweating) -restlessness psychological S&S of anxiety (5) -anger -denial -withdrawal -hyperactivity (pacing, twitching, nail biting) -confusion Image: psychological S&S of anxiety (5) ways to decrease preoperative anxiety (7) -assess pt first -distraction -calm voice -deep breathing -pt edu -remove pt from situation for some time -medications Image: ways to decrease preoperative anxiety (7) pt edu for postop (9) -cough/deep breathing -use incentive spirometer -mobility restrictions/expectations -pain management -dietary restrictions -urinating/BM (want pt to urinate/poop) -drains/IVs -coping -discharge teaching (ambulatory) when do surgical pt become fall risks? what can we do to prevent falls before we give the pt meds? when: PREmedication for surgery what: have pt void BEFORE giving meds T/F: shaving is the standard practice for all surgeries and should be done by the pt at home before surgery so time is not wasted. FALSE! shaving is no longer a routine practice because it can cause micro-cuts that increase risk for infection. *IF pt needs to be shaved; should be done at hospital by staff with an electric safety razor. how are preoperative pt washed/bathed? CHG baths (use wipes) Image: how are preoperative pt washed/bathed? nursing preoperative goals for the pt? (3) 1. promote safety and pt dignity (pt edu, safety precautions, keep pt as covered as possible) 2. make sure pt is ready for OR (pt edu, consent, IVs, H&P, pre-medicated if needed) 3. optimize postoperative health (pt edu) T/F: pt decisional capacity can change TRUE - capacity can change per question, per hour, per day, etc. what is the nursing process (5) 1. Assessment 2. Diagnosis 3. Planning 4. Implementation 5. Evaluation Image: what is the nursing process (5) what does the PREoperative nurse do? (6) -begins surgical experience -confirms all surgical orders -verifies informed consent -checks labs (informs surgeon of any abnormal) -starts IV -preps pt for procedure what does the INTRAoperative nurse circulator do? (7) -assess pt before and during procedure -collaborate with surgeon, anesthesia, etc. -manages OR (sterility, equipment, surgical counts, etc) -verifies consent completion -reviews pre-op checklist -initiate Time Out -ensure pt safety what does the scrub nurse/surgical tech do? (7) -preforms hand scrub -sets up sterile field -prepares supplies/equipment -passes instruments to surgeon and assists in surgery -tracks instruments/sponges/sharps -confirms specimens with circulating nurse -assist with tracking irrigation fluids and blood loss Image: what does the scrub nurse/surgical tech do? (7) what does the anesthesia personnel/CRNA do? (4) -assess medical readiness -maintain pt airway -monitor and control pts vitals and fluid balance -control pt pain and LoC during procedure Image: what does the anesthesia personnel/CRNA do? (4) what does the PACU nurse do? (2) -monitor pt vitals, LoC, and pain after surgery -prepare pt for next phase of recovery (Aldrete score) Image: what does the PACU nurse do? (2) what does the Aldrete scoring system assess? (5) Assesses... -activity -respiration -circulation -conscience -O2 saturation Image: what does the Aldrete scoring system assess? (5) what is the maximum Aldrete score and what score is needed for the pt to transition to the next level of care? -max: 10 pt -minimum for transition: 8/10 or higher what are the 2 areas in surgery? -restricted -semi restricted explain the restricted area of surgery (3) -traffic is limited -personnel are required to cover head and facial hair -masks are required where opened sterile supplies are in use Image: explain the restricted area of surgery (3) explain the semi restricted area of surgery -peripheral support areas surrounding restricted area -storage areas for clean and sterile supplies -scrub sinks areas -corridors leading to restricted areas Image: explain the semi restricted area of surgery what does medical asepsis mean? practices that REDUCE the number, growth, transfer, and spread of pathogenic microorganisms *ex: washing hands, clean gloves, etc. Image: what does medical asepsis mean? what does surgical asepsis mean? practices that keep an area/objects FREE FROM ALL microorganism non-pathogenic and pathogenic (aka STERILE) *ex: sterile gloving, sterile water, etc. Image: what does surgical asepsis mean? what activities require SURGICAL asepsis? (5) -surgical skin prep -opening sterile items -surgical hand asepsis -inserting a foley -creating a sterile field how to wash hands for SURGICAL hand antisepsis (3) 1. 5-10 min systematic scrub of hands to ABOVE elbows 2. rinse with fluids flowing WITH gravity (hold hands ABOVE elbow to rinse) 3. dry hands starting at fingertip and progressing to elbows Image: how to wash hands for SURGICAL hand antisepsis (3) how to wash hands using the waterless surgical hand antiseptic (1) 1. start at hands and work up to elbow systematically *antimicrobial effects last up to 24 hours (contains CHG) Image: how to wash hands using the waterless surgical hand antiseptic (1) what is apart of the sterile field? (4) -area around pt -plastic overlays -blue/green drapes -table/stands with instruments *anything from waist/table and UP) Image: what is apart of the sterile field? (4) before surgery, what personal info is needed from the pt? (5) -2 pt identifiers -allergies -special needs/assistive devices -verification of consent, H&P, and meds/blood products -signing of surgical site what is time out in surgery? -systematic checklist preformed BEFORE surgery -ensures everything is in order for surgery *see picture for details!! Image: what is time out in surgery? during surgery what is done to ensure pt safety and best outcomes? (8) -surgical counts -specimen ID/labeling -equipment in order -safe positioning of pt -physical environment clear -infection prevention done -fire safety known -surgical smoke safety used what is a surgical count? when is it done? (3) -counting of sponges, sharps, instruments, and other items need for surgery -done before, during, and at the end of each procedure Image: what is a surgical count? when is it done? (3) who does the surgical count? -RN and 1 other person who is scrubbed in) what is apart of the minimal count? (2) -sponges -sharps Image: what is apart of the minimal count? (2) when are instruments counted? (1) when there is an open cavity what should the final count equal? the starting count *if not x-ray needed! what is the purpose of surgical counts? to make sure nothing gets left behind inside the pt *SPONGES=most common left inside pt Image: what is the purpose of surgical counts? what is apart of electrical injury prevention? (3) -proper grounding -prevent burns -fire prevention precautions *high risk due to oxygen use and lots of electrical equipment what is apart of chemical injury prevention? (1) know if pt has a latex allergy Image: what is apart of chemical injury prevention? (1) what are important things to do for pt positioning safety (6) -preserve pt's dignity -pad all bony prominences and restraints (if used) -maintain adequate resp. exchange -maintain adequate circulation -avoid hyperextension/strain -ensure perfusion to extremities (don't dangle or put pt on extremity) Image: what are important things to do for pt positioning safety (6) surgical care improvement project (SCIP) infection prevention for surgery (8) -preoperative bathing -blood glucose control (promotes healing) -antibiotic prophylaxis -VTE prophylaxis (ambulating, take out catheter asap) -surgical skin prep (appropriate hair removal) -nasal antisepsis (cream inside nares to prevent bacteria) -keeping pt normothermia) -beta blocker treatment (for anxiety/stress) Image: surgical care improvement project (SCIP) infection prevention for surgery (8) what is apart of the fire triangle? 1. O2 2. Fuel 3. Heat *need these 3 things to start a fire Image: what is apart of the fire triangle? what are some things that increase the risk of a fire during surgery? (6) -above the xiphoid process -using alcohol prep solutions -using open oxygen during procedure -using electrocautery -using burrs, saws, or drills -using light sources