NUR2115- Fundamentals of Professional Nursing Final Exam

NUR2115- Fundamentals of Professional Nursing Final Exam All Modules Review various nursing diagnoses related to specific patient problems · Oxygenation · Ineffective Airway Clearance: fatigue, COPD. Thick, yellow secretions · Impaired Gas Exchange: smokers, asbestos workers. Cyanosis altered blood gases · Ineffective Breathing Pattern: anxiety. Hyperventilating, tachypneic. · Infection · Risk for Infection: chronic illness (diabetes), alteration in skin integrity. S/S of infectious process, drainage or secretions. · Thermoregulation · Ineffective Thermoregulation: Trauma, illness environmental temp. Fluctuations in body temp above or below normal. Hyperthermia and Hypothermia. · Tissue Integrity · Impaired Tissue Integrity and Risk for Impaired Tissue Integrity: Alteration in metabolism, ex- tremes of age. Damaged or destroyed tissue. Module 1-3 Concepts: • P- Population/Problem • I- Intervention(s) • C-Comparison (optional) • O-Outcome • “What interventions reduce the incidence and severity of bed sores in residents of long-term care facili- ties?” • P- Elderly • I- Bedsores or pressure ulcers • C- None • O- Reduction in incidence and severity of bed sores • International Council of Nurses- Promotion of health, prevention of illness, and the care of ill, disabled, and dying people • American Nurse Association-Nursing is the protection, promotion, and optimization of health and abili- ties, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communi- ties, and populations. • Main concepts central to nursing: person, health, environment, nursing • Patient is “central focus” of all definitions – Includes physical, emotional, social, and spiritual dimensions of the patient • Review importance of documentation of patient assessments Identify actual and potential health problems Make nursing diagnoses Plan appropriate care Evaluate patient’s responses to treatment Formats for Nursing Documentation o Initial nursing assessment: obtained from nursing history and physical assessment o Care plan: patient’s dx, related goals, outcomes, interventions, resolutions to problems o Patient care summary: overview of valuable patient information such as documentation, lab and test results, orders, medications o Critical collaborative pathways: standardized plan of care developed for a specific patient popu- lation with a designated dx (can include list of interventions) o Progress notes: pt’s progress towards achieving expected outcomes… description of the status of the problem, related nursing interventions, pt responses, and needed revisions to the POC. o Communication: primary purpose of patient record!! Helps health care professionals from differ- ent disciplines (who interact with patient at different times) communicate with one another o Diagnostic and therapeutic orders: The chart contains any diagnoses, new and old, and MD or- ders and results of diagnostic tests o Care planning: Modify care plan based on patient’s baseline and ongoing data o Quality process and performance improvement: Accrediting agencies, such as TJC, can review patient records to determine if the hospital or facility is meeting it’s standards. They can review nurse’s charting to ensure patients are receiving quality and competent care o Research; decision analysis: Uses patient record to identify needs to promote EBP o Education: Students and health care professionals will learn from patient’s chart o Credentialing, regulation, and legislation: reviewers can monitor health care compliance within the facility o Reimbursement: Insurance (payers) need to use patient records to reimburse for health care re- ceived o Legal and historical documentation: Legal document in court!!! Historical document for patient to have if needed later on Characteristics of effective documentation o Consistent with professional and agency standards o Complete o Accurate o Concise o Factual o Organized and timely o Legally prudent o Confidential*** - See 16-1 Documentation Guidelines p. 342 Review types of nonverbal behavior which could promote improved communication -Also known as body language Touch- tactile sense, personal behavior that means different things to different people -factors like age and sex play a key role -most effective nonverbal ways to express feelings of comfort, love, affection. security, anger, frustration, aggression, excitement, and others Eye contact- communication begins here -some cultures suggest respect and willingness to listen and to keep communication open -absence often indicates anxiety or defenselessness or avoidance of communication -Asian and Native American = view eye contact as invasion of persons privacy -other cultures people are tough to avoid eye contact out of respect, or to not make eye contact with a superior -the eyes carry other nonverbal messages like : -in a stare during anger -tend to narrow in disgust -ordinarily open wide in fear -people who cant speak send message of anxiety with eyes -blank stare indicates daydreaming or inattentiveness Facial Expression- face is most expressive part of body -can convey anger, joy, suspicion, sadness, fear, and contempt -some people have extremely expressive face -some mask it (makes it difficult for us to know what they’re thinking -as a nurse you need to control your facial expressions Posture- the way a person holds the body carries nonverbal messages -people in good health and positive attitude usually hold their bodies in good alignment -depressed people likely to slouch -provides nonverbal cues for pain and physical limitations: rigid, stiff appearance might me indictor of tension and pain Gait- bouncy purposeful walk carries message of wellbeing -less purposeful shuffling gait can mean person is sad or discouraged -certain gaits can indicate illness -ex: people recovering from abdominal surgery walk eighty bent over and slowly Gestures- using various parts of the body can carry numerous messages -example thumbs up = victory -kicking an object= anger -wringing hands or tapping foot = anxiety or anger -waving hands (towards ) = come on -wave other way (away)= leave -usually used when two people in different languages attempt to communicate General Physical Appearance- mot illnesses cause at least some alterations in general physical appearance -nurses observe and evaluate -example: person w insufficient intake of fluids has dry skin that wrinkles easy, sunken eyes, dull in appearance, poor muscle tone Mode of Dress and Grooming- persons clothing and grooming carry nonverbal message -healthy people: tend to pay attention to details of dress and grooming -ill people: demonstrate little interest in personal appearance -often a sigh of returning health when interests in their physical appearance and mode of dress returns Sounds- crying, moaning, gasping, sighing are oral but nonverbals -person crying: sadness or joy -gasping: fear or pain or surprise -sigh: sign of reluctant agreement to do something or of relief Silence- periods of silence are important nonverbal -between two people: indicates an understanding, both are thinking or angry with each other LMAO Review the importance of QSEN in nursing education o Overall concept is to prepare future nurses to have knowledge, skills, and attitudes necessary to continuously improve quality and safety of health care systems. - Patient centered care - Teamwork and collaboration - Quality improvement - Evidence-based practice - Informatics Review what a sentinel event is o A sentinel event is a Patient Safety Event that reaches a patient and results in any of the follow- ing: - Death - Permanent harm - Severe temporary harm and intervention required to sustain life o Such events are called "sentinel" because they signal the need for immediate investigation and response. Review examples of health promotion activities for primary, secondary and tertiary o Primary: directed toward promoting health and preventing the development of disease processes or injury. o Examples are immunization clinics, family planning services, poison-control information, and accident-prevention education. o Secondary: focus on screening for early detection of disease with prompt diagnosis and treatment of any found o Examples are assessing children for normal growth and development and encouraging regular medical, dental, and vision examinations. o Tertiary: begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate patients to a maximum level of functioning o Examples include teaching a patient with diabetes how to recognize and prevent complications, using physical therapy to prevent contractures in a patient who has had a stroke or spinal cord in- jury, and referring a woman to a support group after removal of a breast because of cancer. - See Table 3-2 Examples of Nursing Activities by Level of Health Promotion and Preven- tative Care. Pg. 50. Review use of ISBARR model of communication • I - Introduction: People involved in the handoff identify themselves, their roles, and their jobs • S - Situation: Complaint, diagnosis, treatment plan, and patient’s wants and needs • B - Background: Vital signs, mental and code status, list of medications, and lab results • A - Assessment: Current provider’s assessment of the situation • R - Recommendation: Identify pending lab results and what needs to be done over the next few hours and other recommendations for care • Other R is read back for orders • Q - Question and answer: An opportunity for questions and answers Review teaching for a patient on anticoagulant therapy- safety considerations -Electric shavers are usually recommended when the patient is receiving anticoagulant therapy or has a bleeding disorder and are especially convenient for ill and bedridden patients. -A patient taking gingko biloba (an herbal), aspirin, and vitamin E (dietary supplement) may have to have surgery post-poned due to an increased risk for excessive bleeding, because each of these sub- stances have anticoagulant properties. Age related safety concerns Falls, Motor Vehicle accidents, elder abuse, sensorimotor changes, fires Developmental theories: focus on Erickson’s (I added Maslow’s too)