Medical-Surgical Nursing Exam 1 Review question and answers.

Professional Nursing (Chapter 1: Harding Textbook) As a nurse, you (1) offer skilled care to those recovering from illness or injury, (2) advocate for patients' rights, (3) teach patients to manage their health, (4) support patients and their caregivers at critical times, and (5) help them navigate the complex health care system. Definition of Nursing Nursing is described as both an art and a science; a heart and a mind. - Nursing is putting the patient in the best condition for nature to act (Florence Nightingale). - The nurse's unique function is to aid patients, sick or well, in performing those activities contributing to health or its recovery (or to peaceful death) that they would perform unaided if they had the necessary strength, will, or knowledge--and to do this in such a way as to help them gain independence (Henderson). - Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (American Nursing Association). Brainpower Read More Nursing's View of Humanity (7 Dimensions of Wellness) 7 Dimensions of Wellness that contribute to health and quality of life: 1. Physical 2. Psychological 3. Social 4. Spiritual 5. Intellectual 6. Career (Occupational) 7. Environmental Scope of Nursing Practice The essential core of nursing is to deliver holistic patient-centered care. Describes the services that a qualified health professional is deemed competent to perform and permitted to undertake. - More education and experience can prepare nurses for advanced practice. An advanced practice registered nurse (APRN) is a nurse educated at the master's or doctoral level. Standards of Professional Nursing Practice The American Nurses Association (ANA) defines Standards of Professional Nursing Practice to guide nurses in how to perform professionally. - 2 Parts: - Standards of Practice: describes a competent level of nursing care based on the nursing process (ADPIE). - Standards of Professional Performance: describes behavioral competencies expected of a nurse. Quality and Safety Education for Nurses (QSEN) Addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments. - Defines specific competencies nurses need to possess to practice safely and effectively Nurse Practice Act (NPA) Defines the scope and limitations of professional nursing practice; vary from state to state - Defines the nursing scope of practice in addition to delegating patient care. Clinical Judgement The ability to make decisions and solve problems by making sense of information in a situation (the observed outcome of critical thinking and decision-making). Nursing Process Assessment Diagnosis Planning Implementation Evaluation Core Nursing Competencies (QSEN) Patient-Centered Care: Provide holistic, compassionate, and coordinated care based on respect for patient's preferences. Interprofessional Partnerships: Function effectively within nursing and interprofessional teams Safety: Minimize risk of harm to patients and providers. Quality Improvement: Use data to monitor the outcomes of care and to improve the quality and safety of health care systems. Informatics and Health Care Technology: Use information and technology to communicate, manage knowledge, reduce errors, and support decision making. Evidence-Based Practice: Integrate best current evidence with clinical expertise and the patient/caregiver preferences and values for delivery of optimal health care. Nursing Care Plans The comprehensive nursing care plan is the central source of information needed to guide holistic, goal-oriented care, and address each client's unique needs - Guides for routine care Coordinating Care Effective communication is key to fostering teamwork and coordinating care. To provide safe, effective care, team members must exchange information clearly and accurately among team members. - Situation-Background-Assessment-Recommendation (SBAR): Offers a structured way to discuss a patient's condition between team members. It allows you to attention and action. - Patient Handoff Report: The process of passing patient information to another team member during a transition. Clinical Pathways Interprofessional care plans outline the care and desired outcomes for a specific time for patients with a specific diagnosis. If a patient's progress differs from the planned path, a variance has occurred (These can be positive or negative) Delegation and Assignment Delegation allows a care provider to perform a specific nursing activity, skill, or procedure beyond their usual role. (Initial assessment, patient teaching, and evaluation CANNOT be delegated) (bathing, vital signs, ambulating, and feeding CAN be delegated) Assignment is referred to when a RN directs an LPN/VN/ or AP to do an activity or procedure that is part of their everyday job. 5 Rights of Delegation 1. Right task 2. Right circumstance 3. Right person 4. Right direction/communication 5. Right supervision/evaluation Evidence-Based Practice A problem solving approach to making clinical decisions using the best evidence available. - Steps of EBP Process: 1. Asking a clinical question 2. Searching for the best evidence 3. Critically appraise the evidence 4. Implement the evidence into practice 5. Evaluate the outcome 6. Share the results National Patient Safety Goals (NPSGs) Goals issued by the Joint Commission to improve patient safety in healthcare organizations nationwide -Improve accuracy of client identification. -Improve effectiveness of communication among caregivers. -Improve safety of using medications. -Reduce risk of health-care-associated infections. -Identify client safety risks inherent in its patient population. PICOT format P - Identify the population or problem (age, gender, ethnicity, disease/disorder) I - Intervention, or range of interventions of interest (exposure to disease, risk behavior, education) C - What will you compare the intervention against? (no disease, absence of risk factors, placebo or no intervention) O - Outcome of interest (risk of disease, rates of occurrence of adverse outcomes, accuracy of diagnosis) T - Time it takes for intervention to achieve the outcome (selected to observe the population or problem/condition) Care and Performance Initiatives that influence payment for health care services - Clinical outcomes - Patient satisfaction - Use of EBP - Occurrence of serious reportable events Accountable Care Organization (ACO) An organization of healthcare providers accountable for the quality, cost, and overall care of Medicare beneficiaries who are assigned and enrolled in the traditional fee-for-service program National Quality Forum (NQF) Reduces the occurrence of serious reportable events by providing a list of effective Safe Practices to e used in health care settings. Preferred Provider Organization (PPO) and Health Maintenance Organizations Provide health care services with charges established with predetermined reimbursement rates or capitation fees in advance of the medical, hospital, and other care services delivered. Social Determinants of Health (Chapter 2: Harding Textbook) Social and cultural factors influence equity in health care. Health disparities are differences in the incidence, prevalence, mortality rate, and burden of diseases that exist among specific population groups. Social Determinants of Health: Are nonmedical factors that (1) influence the health of persons and groups and (2) explain why some people have poorer health than others. Health status A holistic concept that is more than the presence or absence of disease. It encompasses life expectancy and self-assessment of health. Examples of Social Health Determinants - Neighborhood - Economic Stability - Health Care - Education - Community Health Disparities and Health Equity Health disparities occur because of social, economic, or environmental disadvantages. Health equity is achieved when every person has the opportunity to attain their health potential, and no one is disadvantaged. Stereotyping Refers to an overgeneralized viewpoint that members of a specific culture, race, or ethnic group are alike and share the same values and beliefs. Ethnocentrism Refers to the belief that one's own culture and worldview are superior to those of others from different cultural, ethnic, and racial background. Culture A way of life for a group of people. It includes the behaviors, beliefs, values, traditions, and symbols that the group accepts, generally without thinking about them. Values The set of rules by which persons, families, groups, and communities live. They are the principles and standards that serve as the basis for beliefs, attitudes, and behaviors. Acculturation The lifelong process of incorporating cultural aspects of contexts in which a person grows, lives, works, and ages. Cultural imposition Occurs when we impose our own cultural beliefs and practices on another person or group of people. Cultural safety Describes care and advocacy for a person of another culture determined by that person or family. Cultural competence The ability to understand, appreciate, and work with people from cultures other than your own. - 4 components of cultural competence are: (1) cultural awareness (2) cultural knowledge (3) cultural skill (4) cultural encounter - Providing culturally competent care may increase patient satisfaction, promote health equity, increase patient safety, and prevent misunderstandings. Cultural Factors Affecting Health and Health Care Folk Healers and Traditions: Folk healers speak the person's native language and cost less than conventional HCPs. Spirituality and Religion: Spirituality refers to a person's effort to find purpose and meaning in life. Religion is a more formal and organized system of beliefs, including belief in or worship of God or gods. Cross-Cultural Communication (verbal, nonverbal, and silence): Communication refers to an organized, patterned system of behavior that may be verbal or nonverbal. Verbal communication includes not only one's language or dialect but also voice tone, volume, timing, and ability to share thoughts and feelings. Nonverbal communication may take the form of writing, gestures, body movements, posture, facial expressions, and personal dress in some cultures. Silence: In some cultures, silence signifies understanding, and it some circumstances people may become uncomfortable with silence. Family Roles and Relationships Family roles differ from one culture to another. It is important for you to determine who should be involved in communication and decision making related to health care. Some cultural group emphasize interdependence while other prefer independence. Touch Physical contact with patients convey various meanings depending on the culture. Performing a physical assessment requires touching a patient. Personal Space Personal space zones are the variable and subjective distance as which 1 person feels comfortable talking to another. - Intimate Zone: Ranges from 0-18 inches (emotional) - Personal Zone: Ranges from 18 inches-4 feet (friendly gathering) - Social Zone: Ranges from 4-12 feet (unfamiliar people) - Public: Ranges from 12 feet+ (addressing a group) Nutrition An important part of cultural practices is food, including both the foods that one eats, and ritual and practices associated with food. Immigration and Immigration Several conditions drive migration, such as overcrowding, natural disasters, geopolitical conflict, persecution, and economic forces. Drugs Genetic differences among people diverse ethnic or racial groups may explain differences in drug choice, dosage, or administration. For example, some drugs are more effective in certain ethnic groups than others. Psychological Factors Symptoms are interpreted through a person's cultural norms and may vary from the recognized interpretations of Western medicine Nursing Management: Social Determinants of Health and Culturally Competent Care Self-Assessment: The first step in promoting health equity and providing culturally competent care is for you to assess your own cultural background, values, and beliefs, especially those that are related to health and health care. Assessment: Assess patients for risks of reduced health care services because of limited access. inadequate resources, age, or low health literacy. Implementation: Although the issues associated with health disparities can seem overwhelming, several strategies are available to reduce and eliminate health disparities: - Advocacy - Standardized Guidelines - Communication Health History and Physical Examination (Chapter 3: Harding Textbook) During an assessment, you will obtain a patient's health history and perform a physical examination. The interprofessional team, also known as the interdisciplinary or multidisciplinary team, is made up of health care professionals to provide care to a patient. - The findings of your nursing assessment (1) contribute to a database that identifies the patient's current and past health status and (2) provide a baseline against which we evaluate future changes. Data Collection: Database The database is all the health information about a patient. It includes (1) nursing history and physical examination, (2) the medical history and physical examination, and (3) laboratory and diagnostic test results. Data Collection: Medical Focus A medical history is used primarily by the HCP to determine risk for disease and diagnose medical conditions. The information collected and reported by the HCP is used by nurses and other health care team members based on the focus of their care. Data Collection: Nursing Focus Nursing care is the diagnosis and treatment of human responses to actual or potential health problems or life processes. The information obtained from the nursing history and physical examination is used to determine the patient's strengths and responses to a health problem. Data Collection: Types of Data The database includes subjective and objective data. - Subjective data (or symptoms) are collected by interviewing the patient and/or caregiver during the nursing history. - Objective data (or signs) are data that we can observe or measure. Typically found through inspection, palpation, percussion, and auscultation. Data Collection: Interview Considerations The purpose of the patient interview is to obtain a health history of the patient's past and present health state. Effective communication is used in the interview process. Data Collection: Symptom Investigation At any time during the assessment, the patient may report a symptom such as pain, fatigue, or weakness. Because we do not observe symptoms patients experience, we need to ask further questions. PQRST: - P: Precipitating/Palliative: What makes the pain better or worse? - Q: Quality: Describe the symptoms. - R: Radiation: Where do you feel pain? Does it radiate to other locations? - S: Severity: Ask for their pain from 1-10 - T: Time: When did it start? Particular time? Sudden or gradual? Nursing History: Subjective Data Important Health Information - Health History: The health history provides information about the patient's prior state of health. - Medications: Ask for specific details related to past and current medications, including prescriptions and illicit drugs, OTC (over the counter) drugs, and vitamins. - Allergies: Explore the patient's history of allergies to drugs, latex, contrast media, food, and the environment. - Surgery and Other Treatments: Record all surgeries, along with the date, reason for the surgery, and outcome. Nursing History: Subjective Data (2) Functional Health Patterns - Health Perception-Health Management Pattern: This pattern focuses on the patient's perceived level of health and well-being and on personal practices for maintaining health. - Nutritional-Metabolic Pattern: This pattern assesses the processes of ingestion, digestion, absorption, and metabolism. Obtain a 24-hr dietary recall. - Elimination Pattern: The elimination pattern involves bowel, bladder, and skin function. - Activity-Exercise Pattern: Assessing this pattern looks at the patient's usual pattern of exercise, work activity, leisure, and recreation. - Sleep-Rest Pattern: Describes pattern of sleep, rest, and relaxation. - Cognitive-Perceptual Pattern - Self-Perception--Self Concept Pattern - Role-Relationship Pattern - Sexuality-Reproductive Pattern - Coping-Stress Tolerance Pattern - Value-Belief Pattern Physical Examination: Objective Data General Survey After the nursing history, make a general survey assessment. The major areas included in te general survey statement are (1) body features, (2) mental state, (3) speech, (4) body movements, (5) obvious physical signs, (6) nutritional status, and (7) behavior. Physical Examination: Objective Data (2) Physical Examination The physical examination is a systematic assessment of a patient's physical status. Explore any positive findings using the same criteria used when investigating a symptom in the nursing history. • Techniques - Inspection: The visual assessment of a part or region of the boy to assess normal conditions or deviations. Compare what is seen with the known, generally visible characteristics. - Palpation: The assessment of the body using touch. Using light and deep palpation can yield information about masses, pulsations, organ enlargement, tenderness, or pain, swelling, muscular spasm, or rigidity, elastically, vibrations of voice sounds, crepitus (crackling), moisture, and texture. - Percussion: A technique that produces a small sound and vibration to obtain information about the underlying area. - Auscultation: Involves listening to sounds produced by the body with a stethoscope to assess normal and abnormal conditions. Useful in evaluating sounds from the heart, lungs, abdomen, and vascular system. (The bell of the stethoscope is more sensitive to low-pitched sounds e.g. heart murmurs). (The diaphragm of the stethoscope is more sensitive to high-pitched sounds e.g. bowel sounds). Tyes of Assessment Emergency Assessment: An emergency assessment may be done in an emergency or life-threatening situation. Involves a rapid history and examination of a patient while supporting vital functions. Comprehensive Assessment: Includes a detailed health history and physical assessment of all body systems. Focused Assessment: An abbreviated health history and examination. Used to evaluate the statis of previously identified problems and monitor for signs and symptoms of new problems. Patient and Caregiver Teaching (Chapter 4: Harding Textbook) The general goals of patient teaching include health promotion, disease prevention, illness management, and appropriate choice and use of treatment options. Role of Patient and Caregiver Teaching Teaching may occur wherever you work as a nurse. Every interaction with a patient and a caregiver is a potential teachable moment. - A teaching plan includes (1) assessment of the patient's ability and readiness to learn, (2) identification of teaching needs, (3) development of learning goals with the patient, (4) implementation plans for the teaching, and (5) evaluation of the patient's learning. Teaching-Learning Process Teaching: is the act of conveying information to facilitate learning. Learning: is the act of acquiring knowledge or skills that may produce a change in behavior.