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What are the most important roles of the nurse (5) - CORRECT ANSWER-Caregiver Advocate Educator Researcher Leader What are the 5 steps in the nursing process? - CORRECT ANSWER-(1) Assessment (2) Nursing Diagnosis (3) Planning (4) Implementation (5) Evaluation *** All of the above require critical thinking! Define Assessment - CORRECT ANSWER-Collects comprehensive data pertinent to the patient's health and/or situation.
Interventions must be measurable criterion indicating that objectives have been met. Define the PLANNING stage of the nursing process - CORRECT ANSWER-Develops a plan that prescribes strategies and alternatives to attain expected outcomes.
How is communication used in the Assessment phase of the nursing process? - CORRECT ANSWER-Verbal interviewing and history taking Visual and intuitive observation of nonverbal behavior Visual, tactile, and auditory data gathering during physical examination. Written medical records, diagnostic tests, and literature review. Define REFERENT - CORRECT ANSWER-The referent motivates one person to communicate with another. Examples of referents: sights, sounds, odors, time schedules, messages, objects, emotions, sensations, perceptions, ideas, etc. Define SENDER in communication - CORRECT ANSWER-The person who encodes and delivers the message. Sender puts ideas or feelings into form that is transmitted and is responsible for accuracy and emotional tone of message content What is the RECEIVER in the communication process? - CORRECT ANSWER-The person who receives and decodes the message ** senders message acts as a referent for the receiver, who is responsible for attending to, translating, and responding to the message. MESSAGE in communication process - CORRECT ANSWER- Content of communication.... verbal, nonverbal & symbolic language.
CHANNELS in communication process - CORRECT ANSWER- These are the means of conveying the message through visual, auditory, and tactile senses. Facial expression = visual message Spoken word = auditory Touch = tactile FEEDBACK in communication process - CORRECT ANSWER- The message that the receiver returns. This indicates if receiver understood meaning of message. Sender can evaluate effectiveness of communication. Explain the communication process briefly - CORRECT ANSWER-The source has a message and encodes the message. Message is sent through a channel Receiver must first decode the message Before message can be fully received What are the 5 levels of communication in nursing? - CORRECT ANSWER-Interpersonal Interpersonal Small group Public Transpersonal Define Intrapersonal - CORRECT ANSWER-a.k.a. SELF-TALK Define Intrerpersonal - CORRECT ANSWER-Occurs between two people or groups
Define Small Group Communication - CORRECT ANSWER- Committee or a conference Public Communication - CORRECT ANSWER-Interaction of one person with a group of people Transpersonal Communication - CORRECT ANSWER-Within a person's spiritual domain Forms of Communication - CORRECT ANSWER-Messages conveyed verbally and nonverbally, concretely and symbolically. Expression through: Words, movements, voice inflection, facial expression, and use of space Elements can work in harmony to enhance a message OR conflict with one another to confuse it. Example Forms of Communication VOCABULARY What is the role of the nurse? - CORRECT ANSWER-Nurse often the interpreter of medical terminology Example Forms of Communication DENOTATIVE AND CONNOTATIVE What is the role of the nurse? - CORRECT ANSWER- Denotative is the exact meaning Connotative is shades of the meaning Be selective in word choice and avoid easily misinterpreted words. Example Forms of Communication PACING
What is the role of the nurse? - CORRECT ANSWER-Speak slowly and enunciate clearly! Too fast = unintended messages Too slow = impression of hiding the truth Example Forms of Communication INTONATION What is the role of the nurse? - CORRECT ANSWER-Tone of voice... be careful Example Forms of Communication CLARITY & BREVITY What is the role of the nurse? - CORRECT ANSWER-Simple - short - to the point & possible repeated Example Forms of Communication TIMING & RELEVANCE What is the role of the nurse? - CORRECT ANSWER-When it is appropriate to discuss issues & what is most important at that time. What are forms of Nonverbal Communication? - CORRECT ANSWER-Personal Appearance Posture and gait Facial Expression Eye Contact Gestures Sounds - sighs, moans, groans... Territoriality & Space What are the four phases of the Helping (Nurse-Patient) Relationship? - CORRECT ANSWER-Pre-interaction Orientation Working
Termination Describe the PRE-INTERACTION phase of the Helping Relationship. - CORRECT ANSWER-This takes place before meeting the patient:
What is therapeutic communication techniques? - CORRECT ANSWER-Specific responses that encourage the expression of feeling and ideas and convey acceptance and respect. Define the therapeutic communication technique of: Active Listening - CORRECT ANSWER-Being attentive to what patient is saying both verbally and nonverbally. ** Use SOLER to facilitate attentive listening Define acronym SOLER - CORRECT ANSWER-S - Sit facing the patient O - Open posture L - Lean toward the patient E - Establish & maintain eye contact R - Relax Define the therapeutic communication technique of: Sharing Observations - CORRECT ANSWER- Observations/perceptions can help start a conversation, but need to be careful not to anger patient or make assumptions. Define the therapeutic communication technique of: Sharing Humor - CORRECT ANSWER-Important but often underused resource in nursing interactions. It is a coping strategy that adds perspective and helps adjust to stress. Define the therapeutic communication technique of: Using Silence - CORRECT ANSWER-Allow patient to break the silence, particularly when he/she has initiated it.
Particularly useful when people are confronted with decisions that require thought. Define the therapeutic communication technique of: Providing Information - CORRECT ANSWER-To help patient understand, but do not preach Define the therapeutic communication technique of: Clarifying - CORRECT ANSWER-Check that understanding is accurate Restate an unclear message Rephrase to clarify Define the therapeutic communication technique of: Focusing - CORRECT ANSWER-Centers on key elements of concepts of message Helpful when patient is vague or rambles Define the therapeutic communication technique of: Restating - CORRECT ANSWER-or Paraphrasing this sends feedback that lets the patient know nurse is actively involved Define the therapeutic communication technique of: Open-ended Questions - CORRECT ANSWER-Asking relevant questions allows patient to fully respond Define the therapeutic communication technique of: Reflection - CORRECT ANSWER-Summarizing a concise review of key aspects of interaction. Especially helpful in termination phase Other techniques of therapeutic communication are: - CORRECT ANSWER-Sharing empathy Sharing hope Use of Touch
Sharing feelings Self-Disclosure Confrontation (with sensitivity after trust is established) What physical and emotional factors must a nurse assess through communication? - CORRECT ANSWER- Developmental - age, physiological status (pain, hunger, weakness) Socioculture Language Gender How can you communicate with non-english speaking patient?
Assist with gratification of human needs Allow for spiritual expression What are the Zones of Touch? - CORRECT ANSWER-Social zone Consent zone Vulnerable zone Intimate zone Social zone of touch is - CORRECT ANSWER-Hands, arms, shoulders, back Permission not needed Consent zone of touch is - CORRECT ANSWER-Mouth, wrists, feet Permission needed Vulnerable zone of touch is - CORRECT ANSWER-Face, neck, front of body Special care needed Intimate zone of touch is - CORRECT ANSWER-Genitalia, rectum Great sensitivity needed Zones of Personal Space - CORRECT ANSWER-Intimate - 0 - 18"
Personal - 18" - 4' Social - 4 - 12 ft Public - > 12 ft What is Intimate zone of personal space? - CORRECT ANSWER-Holding crying infant Performing physical assessment Bathing, grooming, dressing, feeding, and toileting a patient Changing patient dressing What is Personal Zone of personal space? - CORRECT ANSWER-Sitting at a patient's bedside Taking patient history Teaching patient Exchanging info at shift change What is Social Zone of personal space? - CORRECT ANSWER-Making rounds with physician Sitting at the head of a conference table Teaching a class for patients with diabetes Conducting family support What is public zone of personal space? - CORRECT ANSWER-Speaking at a community forum Testifying at a legislative hearing
Lecturing to a class of students INFECTION PHYSIOLOGY....... - CORRECT ANSWER-SEE NOTECARDS FOR MED-SURG EXAM, PART ONE to review vocabulary and basic understanding. THEN... proceed in this set of flashcards for the Nursing Care of Infections Nursing process for Infection: Assessment - CORRECT ANSWER-Assess all risk factors: age, nutrition, diagnostic procedures (IV, catheters), occupation, high-risk behaviors, travel history, trauma, stress Nutritional Status
โ Risk for infection = lab results (WBC 5,000-10,000/mmยณ), review current meds โ Identify potential sites of infection = IV, catheter โ Imbalanced nutrition = protein needed for healing โ Acute pain โ Impaired skin integrity or tissue integrity โ Social isolation Nursing process of Infection: Planning - CORRECT ANSWER- Goals & Outcomes Setting priorities โ Treatment is always a priority Collaborative care Nursing process of Infection: Implementation - CORRECT ANSWER-Health promotion - break chain of infection Nutrition Hygiene Immunization Adequate rest and regular exercise Nursing process for Infection: Evaluation - CORRECT ANSWER-Measure the success of infection prevention Measure the patient and family adherence to discharge plans
Wound status and healing ** did your patient get better or worse? Did your patient get an infection at hospital? Standard precautions taken with ALL patients protect health care workers from: - CORRECT ANSWER-Blood Body fluids (except sweat) Excretions Non-intact skin ** These precautions began in the 80's as a result of HIV/AIDS It is required to wash hands with water and soap when: - CORRECT ANSWER-Hands are visibly dirty When soiled with blood or other body fluids Before eating After toileting Exposure to spore-forming organisms (c-diff, bacillus anthracis) Use of alcohol-based waterless antiseptic agent for routinely decontaminating hands for following situations: - CORRECT ANSWER-Hands NOT visibly soiled Before/after/between direct patient contact After contact with body fluids or excretions, mucous membranes, nonintact skin, or wound dressing When moving from contaminated to a clean body site during patient care After contact with inanimate surfaces or objects in the patients room
Before caring for patients with sever neutropenia or other forms of immunosuppression Before putting on sterile gloves to insert invasive devices After removing sterile gloves Nursing process for Infection: Implementation in Acute Care Settings - CORRECT ANSWER-Use standard precautions Control or eliminate infectious agents Cleaning Disinfection/Sterilization Control or eliminate reservoirs Control of portals of exit Control of transmission hand hygiene Isolation & barrier protection Protective equipment Proper removal of PPE Role of infection prevent & control Prep for sterile procedures Restorative/long-term care
What is order of preparing to enter room on isolation? - CORRECT ANSWER-Gown Mask or Respirator Eye wear Gloves What is order of removal of protective equipment for isolation? - CORRECT ANSWER-Gloves Goggles Gown Mask Sterile field must have what size border? - CORRECT ANSWER-1 inch What are the vital signs? - CORRECT ANSWER-Pulse Pain Temp BP Respiration Pulse Ox When do you take vitals? - CORRECT ANSWER-When they first enter Appropriate intervals during stay Just before they leave Why must you know the baseline vitals for a patient? - CORRECT ANSWER-Any changes in vital signs can help the nurse immensely What are guidelines to measuring vital signs? - CORRECT ANSWER-Must get baseline by taking when first enter Measure correctly
Understood & interpreted Communicated Body Temp normal range - CORRECT ANSWER-96.4-100. Body temp is affected by heat loss, what causes this? - CORRECT ANSWER-Radiation Conduction Evaporation Convection What produces heat in the body? - CORRECT ANSWER- Cellular Respiration What is considered a fever? - CORRECT ANSWER-Adult 102.2 โ Child 104 What is pyrexia? - CORRECT ANSWER-FEVER What is an Antipyretic? - CORRECT ANSWER-Medication that brings down fever Ex: Tylenol, NSAIDS How is temp measured? - CORRECT ANSWER-At the core or the surface by: Electronic Infrared Digital Disposable Chem Dot
What is pulse? - CORRECT ANSWER-Palpable bounding of the blood flow in a peripheral artery What are the locations for pulse? - CORRECT ANSWER- Temporal Carotid Apical Brachial Radial Ulnar Femoral Popliteal Posterior tibia Dorsalis pedis What is Tachycardia - CORRECT ANSWER-Pulse faster than 100 bpm What is Bradycardia - CORRECT ANSWER-Pulse slower than 60 bpm What is Blood Pressure - CORRECT ANSWER-Ability of the peripheral blood vessels to constrict and dilate that depends on cardiac output, PV resistance, blood volume, blood viscosity, and artery elasticity What are the blood pressure variations? - CORRECT ANSWER-Hypertension Hypotension Orthostatic hypotension Orthostatic Hypotension - CORRECT ANSWER-Looking for a drop in blood pressure during a rise in heart rate when person changes from lying to sitting to standing.
What is the Systolic Pressure? - CORRECT ANSWER- Ventricular contraction that forces the blood into the aorta What is the Diastolic Pressure - CORRECT ANSWER-Minimal pressure exerted against the arterial wall
What is Pulse Oximetry - CORRECT ANSWER-Looking at hemoglobin molecule to determine how saturated it is with oxygen. What is a weakness of Pulse Ox measure? - CORRECT ANSWER-CO can fake out the pulse oximeter because blood will be saturated with CO, not Oโ, but oximeter thinks that it is Oโ What is apnea? - CORRECT ANSWER-Absence of breathing How do we naturally release COโ? - CORRECT ANSWER-Sign or yawn up to 15 times an hour What is Chain-Stokes Respiration? - CORRECT ANSWER- Rhythm of acceleration of respirations followed by deceleration then followed by apnea. Why can pulse ox be an indicator of iron deficiency anemia? - CORRECT ANSWER-Patient doesn't have enough red blood cells to carry enough Oโ to meet metabolic needs What is a seizure? - CORRECT ANSWER-Uncontrolled electrical neuronal discharges from the brain that interrupts normal brain function. What causes seizures? - CORRECT ANSWER-Brain tumor Brain trauma concussion Infection Metabolic disorders Withdraw from alcohol Idiopathic (no known cause) How do you assess a seizure? - CORRECT ANSWER-Was seizure seen
Precipitating factors Where did it start How did it progress Type of movement in extremities Gaze deviation Incontinence? Mental status How long did seizure last? Mental status after seizure? Motor weakness after seizure Any injury from seizure Another term for a seizure? - CORRECT ANSWER-Irritable focus - or- Foci What is Postictal Phase? - CORRECT ANSWER-Altered state of consciousness that a person enters after experiencing a seizure. It usually lasts between 5 and 30 min, and is characterized by drowsiness, confusion, nausea, hypertension, headache or migraine and other disorienting symptoms. Nursing Diagnosis for Seizures - CORRECT ANSWER-โ Risk for injury โ Risk for aspiration - breathing fluid into lungs
โ Ineffective airway clearance related to relaxation of tongue and gag reflex secondary to muscle innervation โ Anxiety โ High risk of ineffective therapeutic regimen related to insufficient knowledge Nursing plan for Seizures - CORRECT ANSWER-Assess and detect signs of seizure Implement seizure precautions Medications as ordered Assess history, serum drug levels, compliance with drug regimen Nursing Interventions Before Seizures - CORRECT ANSWER- How to call for help Place pads on side rails Bed in low position Access to Oโ & suction Nursing Interventions during a seizure - CORRECT ANSWER- Attempt to turn patient on side Maintain airway Place Oโ on patient Suction mouth as needed