NUR 4120: STUDY GUIDE FOR FINAL EXAM

NUR 4120: STUDY GUIDE FOR FINAL EXAM Fall 2017 The final examination will contain 100 questions on the comprehensive final exam. For each disorder/condition listed below, please review: Assessment & diagnosis Categories or staging of disorder (when applicable) Signs and symptoms (clinical manifestations) Risk factors: modifiable and non-modifiable Pathophysiologic changes Complications Laboratory and diagnostic testing Nursing Interventions and outcomes Pharmacologic interventions Students should be able to integrate following concepts: Prioritizing care Managing care for a group of clients Delegating care to LPN, UAP Client and family education Client and family adaptation to illness, disability, hospitalization Synergy Model and care of critically ill clients (patient and family needs) 1) Basic Concepts a) AACN Synergy Model for Patient Care i) The needs or characteristics of clients and families influence and drive nurse’s competencies ii) Synergy results in the needs & characteristics of a client, clinical unit or system are matched with a nurse’s competencies iii) It is about the patient and the family not about you! iv) The goal of the nurse is always to return the patient to optimal level b) Client Characteristics are Unique to Each Care Situation i) 8 Client Characteristics (1) Resiliency* (a) Capacity to return to a restorative level of functioning using compensatory/coping mechanisms (b) The ability to bounce back quickly after an insult (c) Some patients are very resilient and some are not (d) Nurse must assess patient’s resiliency and the factors that affect it (2) Vulnerability (a) Susceptibility to actual or potential stressors that may adversely affect outcomes (3) Stability (a) Ability to maintain a steady-state; equilibrium (b) External and internal factors affect stability (c) Determine why they are not returning to optimal level (d) Many times this is beyond medical reasons (4) Complexity (a) Entanglement of 2 or > systems (i) Body, family, therapies (5) Resource Availability (a) Extent of resources the client/family/community bring to situation (i) Technical (ii) Fiscal (iii) Personal (iv) Psychological (v) Social (6) Participation in Care (a) Extent to which client/family engages in aspects of care (b) Try to get the family engaged; it may decrease their stress level (c) Have families and the patient participate in care; does not have to be hands on (7) Predictability (a) Allows one to expect a certain course of events or course of illness (b) Examples (i) A healthy 40-year-old female undergoing a pre-employment physical (ii) A critically ill infant with multi-system organ failure 2) Nurse Competencies: Concern to Clients, Clinical Units and Systems LEVEL 1,3,5 a) Level 1: novice nurse, less than < 1 year experience b) Level 3: some experience, about 3 years c) Level 5: expert d) Clinical Judgment i) Clinical reasoning ii) Decision making iii) Critical thinking iv) Global grasp of situation e) Advocacy & Moral Agency i) Working on another’s behalf & representing concerns of the client/family & nursing staff ii) Serves as an agent in resolving ethical & moral dilemmas f) Caring Practices i) Creating a compassionate, supportive, & therapeutic environment for clients & staff ii) Aim of promoting comfort & healing g) Collaboration i) Working with others (1) Clients/families (2) Health care providers ii) Promotes each individual’s contributions iii) Involves intra- and inter-disciplinary work with colleagues & community h) Systems Thinking i) Body of knowledge & tools that allow the nurse to manage environmental & system resources available i) Responsiveness to Diversity i) Sensitivity to recognize, appreciate, & incorporate differences into provision of care. ii) Difference may include: (1) Culture (2) Spiritual (3) Gender (4) Race (5) Ethnicity (6) Lifestyle (7) Socioeconomic status (8) Age (9) Values j) Facilitation of Learning i) Ability to facilitate learning for: (1) Clients/families (2) Nursing staff (3) Members of health care team (4) Community ii) May include both informal & formal learning k) Clinical Inquiry/Evaluator i) Ongoing process of questioning & evaluating practice ii) Creating practice changes through research utilization & experiential learning 3) The goal of nursing is to restore a client to an optimal level of wellness as defined by the client. Shock: Hypovolemic Distributive Obstructive Anaphylactic Septic Neurogenic Cardiovascular disorders: Angina (Stable vs. Unstable) Acute coronary syndromes (Acute MI: STEMI/NSTEMI) 1) Acute Coronary Syndrome (ACS) a) Emergent situation: acute onset of myocardia ischemia resulting in myocardia death if no intervention b) Unstable angina and acute myocardial infarction (AMI) are considered to be the same process but different points along a continuum c) Stable angina- direct response to a demand on the heart and once the resolves itself d) Unstable angina- does not resolve itself 2) Spectrum of ACS a) Unstable Angina i) (USA) b) Non-ST elevation myocardial infarction i) (NSTEMI) c) ST elevation myocardial infarction i) (STEMI) 3) When your patient has chest pain you need to: i) Assess pain ii) O2 iii) EKG- within 5-10 minutes (1) 12 leads 4) Pathophysiology of ACS/MI a) USA i) Reduced blood flow in a coronary artery (1) Due to rupture of an atherosclerotic plaque ii) Partial occlusion of an artery (1) Clot begins to form on coronary lesion, but artery isn’t completed occluded iii) Acute situation, can result in chest pain iv) Can have MI if interventions aren’t taken v) Atherosclerosis/plaque rupture b) MI i) Area of the myocardium is permanently destroyed ii) Plaque rupture, thrombus formation iii) Complete occlusion iv) Ischemia and necrosis of myocardium supplied by artery v) NSTEMI/STEMI vi) Causes of an MI cont’d (1) Vasospasm (a) Sudden constriction or narrowing of a coronary artery (2) Decreased oxygen supply from (a) Acute blood loss, anemia, or low BP (3) Increased demand for oxygen from (i) Rapid HR, thyrotoxicosis, or ingestion of cocaine c) Area of infarction develops over minutes to hours d) Cells deprived of oxygen  ischemia develops, cellular injury occurs, lack of oxygen results in infarction (cell death) e) 12 lead ECG identifies type and location of MI f) Goals of medical therapy  relieve symptoms, prevent or minimize myocardial tissue death, & prevent complications 5) Profound imbalance between myocardial oxygen demand and supply a) 6) Pathophysiology of ACS/MI 7) EKG Patterns: Ischemia, Injury and Infarction 8) Clinical Manifestations a) Chest pain that occurs suddenly and continues despite rest and medication b) Asymptomatic or prodromal symptoms c) May not be distinguished from unstable angina d) Cardiovascular i) JVD – may be seen if MI has caused HF ii) Chest pain not relieved by rest or nitroglycerin iii) S3 or S4 iv) Palpitations v) Hypertension/Hypotension (1) Hypertension – because of sympathetic stimulation (2) Hypotension – because of decreased contractility, impending cardiogenic shock, or meds vi) EKG changes (1) Tachycardia, bradycardia, other dysrhythmias vii) Irregular pulse – may indicate atrial fibrillation viii) ST segment, T-wave changes e) Respiratory i) Pulmonary congestion (1) SOB (2) Dyspnea (3) Tachypnea (4) Crackles ii) Pulmonary edema f) GI i) Nausea ii) Vomiting iii) Indigestion g) GU i) Decreased urinary output may indicate shock h) Skin i) Cool ii) Clammy iii) Diaphoretic iv) Pale or dusky v) May indicate cardiogenic shock