237 Study Cards Flashcards
Define atelectasis.
closure or collapse of alveoli
What is the most common type of atelectasis?
acute atelectasis
What are common causes of atelectasis?
- post operation
- immobilization with shallow, monotonous breathing pattern
- excess secretions or mucus plug
- chronic airway obstruction (e.g. lung cancer)
What are the clinical manifestations of atelectasis?
- Usually insidious
- Cough, sputum production, and increasing dyspnea
- Tachycardia, tachypnea, pleural pain and central cyanosis may be anticipated
- Difficulty breathing in supine position and is anxious
What steps can you take to prevent atelectasis?
- Frequent turning
- Early mobilization
- Strategies to expand lungs and manage secretions
- Deep breathing every 2 hours
- Incentive spirometry
- Directed cough
- Suctioning
- Aerosol nebulizer treatment followed by chest physical therapy
- Bronchoscopy
What are the components of the ICOUGH program?
I - incentive spirometry
C- coughing and deep breathing
O - oral care (brushing teeth and mouth wash twice daily)
U - understanding (patient and staff education)
G- getting out of bed at least 3x daily
H - head-of-bed elevation
What is the pathophysiology of atelectasis?
- reduced alveolar ventilation or any type of blockage that impedes the passage of air to and from the alveoli
- Monotonous low tidal breathing pattern may cause airway closure and alveolar collapse. Can be caused by anesthesia or analgesic agents, supine positioning, splinting of chest wall because of pain, abdominal distension
- Impaired cough mechanism
- Excessive pressure on the lung tissue
What is involved in the assessment and diagnostics for atelectasis?
- Increase work of breathing and hypoxemia
- Decreased breath sounds and crackles
- Chest x-ray, SpO2-low saturation (<90%) or lower PaO2
What risk factors are there for atelectasis?
- Post op patients are at a high risk due to the effects of anesthesia or analgesic agents (surgical procedures: upper abdominal, thoracic, or open-heart surgery).
- Immobilized
- People with shallow, monotonous breathing patterns
- Those in a supine position
- Patients with impaired cough mechanisms
- Excessive pressure on the lungs
- Airway obstruction (cancer, mucus)
- Pain can impair the cough reflex
- Increased abdominal pressure/distension
- Age
- Exposure to pollutants
What are signs and symptoms of infection with chronic atelectasis?
- Chest pain
- Sputum production with yellow/green colored expectorant
- Pain on deep breathing
- Pain on exhalation, inhalation or both
- Fever
What assessments and assessment outcomes are involved with identifying atelectasis?
- Monitor vital signs (RR higher, temp, SpO2)
- Do a respiratory assessment (thorax and lungs)
- Monitor change in behaviour, mental status, and LOC
- Increased work of breathing (tachypnea, use of accessory muscles, tripod position breathing)
- Hypoxemia (check skin, nails, lips color)
- Increased respiratory rate
- Decreased breath sounds
- Crackles over affected areas
- Chest X-ray (revealing patchy infiltrates or consolidation areas)
- V/Q Scan
- Pulse Oximetry (SpO2) lower than 90%
- Low PaO2
- Physical assessment of dependent (lower part), basilar, and posterior areas of lung
What lab values are relevant with atelectasis?
- Less than 90% SpO2 (Sa02)or lower than normal PaO2 (normal PaO2 is 80 - 100 mm Hg)
- Blood gasses- low PA02 (partial pressure of arterial oxygen).
- Using a spirometer airflow values greater than 80% is normal.
- WBC if query infection, Sputum culture
- Difference between alveolar and arterial o2- normal value is less than 10 mm Hg (torr)– Atelectasis Increased A-a O2 gradient
- L/S ratio: 2:1 concentration of lecithin rapidly increases-sphingomyelin concentration decreases
- Decreased Po2 and o2 content
What diagnostic findings are associated with atelectasis?
- Chest X-ray would reveal patchy infiltrates or consolidated areas (MOST COMMON)
- Thoracentesis is done to remove fluid from the pleura
- Bronchoscopy, CT, imaging tests can confirm a diagnosis.
- Sp02 may be lower (less than 90%)
- Lower partial pressure of oxygen (Pa02)
- V/Q scan
How is atelectasis managed using pharmacological agents?
- Nebulizer or MDI (metered dose inhaler) treatments with a bronchodilator medication or sodium bicarbonate to assist with the expectoration of secretions
- Expectorants (such as guaifenesin) to thin and aid in removal of secretions or mucous plugs
- Use of oxygen therapy titrated to keep 02 saturations within acceptable range
- Antibiotics, antivirals to assist with the removal of infections
- If it is due to obstruction caused by lung cancer, various pharmacological interventions (Eg. chemotherapy & radiation) can be directed at shrinking the tumor to open airways and provide ventilation to the collapsed area
- Analgesics may be used if hypoventilation is caused by pain
What are some treatments for atelectasis?
- Frequent turning
- Early ambulation
- Lung volume expansion maneuvers (deep-breathing exercises, incentive spirometry)
- Positive end-expiratory pressure (PEEP) therapy (simple mask and one-way valve system)
- Continuous or intermittent positive pressure breathing
- Chest percussion and postural drainage
- Bronchoscopy
- Endotracheal intubation and mechanical ventilation
- Coughing/suctioning secretions
- Chest physical therapy to loosen secretions
- Radiation to shrink size of neoplasms causing compression of lung tissue
What is a pleural effusion?
- Collection of fluid in the pleural space
- Usually secondary to another disease
What are common causes of a pleural effusion?
- Heart failure (most common cause)
- Bacterial pneumonia
- Lung cancer
- Pulmonary embolism
- Pulmonary infection (often viral)
- Radiation therapy to the chest
- Nephrotic syndrome
- Hypothyroidism
- Liver disease
- Connective tissue disease
- Tuberculosis
- Infection
- Smoking
What are clinical manifestations of a pleural effusion?
- Those caused by the underlying disease process (eg. pneumonia, lung diseases) ; size of the effusion can affect severity of symptoms
- Severity of symptoms relates to the size of the effusion, speed of formation, and underlying lung disease
- May include:
- Fever
- Dyspnea
- Chest pain- increased with breathing and coughing (pleuritic pain)
- Small (dyspnea minimal) vs large effusion (shortness of breath present, lots of pressure on lungs from fluid)
- Asymmetrical chest expansion
- Decreased tactile fremitus
- Orthopnea (difficulty breathing unless sitting up or standing)
- Shallow, rapid breathing– crackles
- Fatigue, Loss of appetite, LOC
What is the pathophysiology of a pleural effusion?
- Typically secondary to other disease processes such as pneumonia, malignant effusions
- Abnormal volume of fluid accumulates into pleural space. Fluid has pathological significance. Can be serous, purulent, or sanguineous.
- Clear fluid may be transudate - which is filtrate of plasma moving through capillary tissues = occurring when there is an imbalance in hydrostatic or oncotic pressures - not diseased
- This can indicate that the pleural membranes are NOT diseased - in this case HF is the most common cause
- Or it can be exudate -which is leakage of blood, lymph or other fluid into tissues/cavities= which usually results from bacteria or tumors within the pleural surfaces
What is involved in the assessment of a pleural effusion?
- VS - increased Resp rate, shallow resps, tachycardia, decreased Sp 02, Increased HR and BP
- Respiratory assessment-
- Decreased or absent breath sounds over lung field
- Decreased tactile fremitus
- dull flat sound on percussion.
- Asymmetrical chest expansion - delayed or diminished expansion on side of effusion
- Patient may appear in respiratory distress on observation evidenced by:
- increased work of breathing
- Tachypnea
- use of accessory muscles, or
- have orthopnea when lying supine.
- Neurological assessment
- Pt may appear confused
- Reduced level of consciousness
- Tracheal deviation may be noted away from the affected side (rare).
What lab values are associated with a pleural effusion?
- Pleural fluid analyzed by:
- Bacterial culture
- Gram stain
- Acid-fast bacillus stain (for TB)
- Interferon-gamma concentrations
- Red and white blood cell counts
- Chemistry studies (glucose, amylase, dehydrogenase, protein)
- Cytology analysis for malignant cells
- pH (different pH results can be indicative of the type of effusion)
- CBC
- Increased white blood cells count
- Sputum culture
- Blood gases
What diagnostic tests are involved in diagnosing a pleural effusion?
- Chest X-ray, chest CT scan, and thoracentesis used to confirm the presence of fluid (in the pleural space)
- In some cases, lateral decubitus X-ray is obtained (have patient lay on affected side in side-lying position, which allows for layering out of fluid, producing a visible air-fluid line)
- Pleural biopsy (to look for cancer, infection, or other condition)
What is involved in the pharmacological management of a pleural effusion?
- Objective is to treat the underlying cause in order to prevent the re-accumulation of fluid
- Use of chemical pleurodesis to ensure recurrence of fluid build up does not occur (prevents fluid accumulation) → Chemical irritating agents are installed into the pleural space (bleomycin or talc)
- Chemotherapy to treat cancer (cancer can cause pleural effusion)
- Pain management
- Antibiotics to treat underlying infections
- If pleural effusion is a result of treatment of conditions, such as HF, diuretics may be used
- Bronchodilators
What are the treatment modalities for a pleural effusion?
- Prevent re-accumulation of fluids:
-
Thoracentesis to remove fluid (specimen analysis, relief of dyspnea and respiratory compromise)
- Prepare and position patient for thoracentesis, offering support throughout.
- Record thoracentesis fluid amount and send for appropriate lab testing
-
Thoracentesis to remove fluid (specimen analysis, relief of dyspnea and respiratory compromise)
- Tube Thoracostomy (chest drainage using a large diameter intercostal tube)
- Pain management of test tube and least painful positioning
- Chemical pleurodesis (for malignant effusions, obliterates the pleural space to prevent re-accumulation of fluid)
- Surgical pleurectomy, insertion of a drainage catheter, implantation of a pleuroperitoneal shunt
- Patient education of drainage system and care of catheters if outpatient
What is anemia?
Condition in which the hemoglobin concentration is lower than normal and reflects the presence of fewer than the normal number of erythrocytes within circulation. As a result, O2 delivered to body tissues is decreased. By far the most common hematologic condition.
What are the different classifications of anemia?
- Hypoproliferative: caused by a defect in their production (marrow cannot produce adequate #s of erythrocytes
- Hemolytic: By destruction of erythrocytes
- Bleeding: by the loss of erythrocytes
What are some complications of anemia?
- Heart failure
- Paresthesias
- Delirium
What are risk factors associated with anemia?
- A diet lacking in certain vitamins and minerals (such as iron, vitamin B12, folate, and iron)
- Family history
- Excessive blood loss due to injury, surgery, heavy menstruation
- Age - people over 65 are at risk
- Chronic conditions (IBD, HIV/AIDS, cancer, autoimmune diseases, and chronic kidney disease)
- Mediterranean origin
- Medications inhibiting effective absorption of nutrients
- Alcoholism affecting production of RBCs
What is the pathophysiology associated with anemia?
- The level of hemoglobin is lower than normal in the circulation causing less oxygen being delivered to the body tissues
- Many different types that can affect the reason as to why there is low hemoglobin:
- Decreased erythrocyte (RBC) production due to bone marrow damage either due to medications, chemicals or lack of factors needed for RBC formation = hypoproliferative anemia
- Premature RBC destruction -> causing hemoglobin to be released into plasma -> which is then converted into bilirubin causing the concentration within the blood to increase-> leading to tissue hypoxia = known as hemolytic anemia
- Bleeding causing a loss of RBCs
What are the clinical manifestations of anemia?
- The more rapid the anemia develops the more severe the symptoms.
- A healthy person can tolerate as much as 50% gradual reduction, where as the rapid reduction can be tolerated to >30%. 30% rapid loss can cause vascular collapse.
- Tachypnea on exertion and fatigue (most common)
- Those who are more active will have more significant symptoms.
- Nausea, vomiting, malena
- Neuro symptoms; weakness, ataxia, muscle pain
- Fatigue
- Jaundice with hemolytic anemia
- General malaise
- Tongue (smooth and red with iron deficiency anemia and beefy red and sore with megaloblastic anemia)
- Cheilosis
- Iron-deficiency may crave ice, starch, or dirt (pica)
- Nails can become brittle, ridged, and concave
What assessments are involved in identifying anemia?
- History/Genetics of Anemia in family:
- Sickle cell anemia
- Appearance:
- Pallor in hands, mouth, conjunctiva
- Condition of nails
- History of menstrual cycles for female patients
- Vital signs: low BP, high HR (if related to bleeding), decreased Sp02
- Respiratory: dyspnea, tachypnea
- Nutritional assessment
- Looking for potential deficiency in iron, vitamin B12, and folic acid
- Certain dietary approaches are at higher risk (e.g. strict vegetarians)
- Health History
- Medications (some can depress bone marrow activity, induce hemolysis, interfere with folate metabolism)
- Alcohol use
- Cardiovascular:
- Distended neck veins, edema, chest pain on exertion, murmurs, gallops
- Hypotension (below baseline)
- Hypertension (above baseline)
- GI system
- Stool assessment for occult blood
- Neurologic
- Assess for peripheral numbness and paresthesias
- Ataxia
- Poor coordination
- Confusion
- Possibility of delirium
What lab values are associated with anemia?
- Depends on the type of anemia (note: MCV measures the size and volume of red blood cells).
-
Hypoproliferative
- Iron deficiency: decreased MCV, decreased reticulocytes
- Vitamin b12: increased MCV
- Folate deficiency: increased MCV
-
Bleeding (RBC loss)
- Bleeding: decreased Hgb, Hct, and MCV
- Increased reticulocytes
-
Hemolytic
- Altered erythropoiesis: decreased MCV, increased reticulocytes
- Drug induced anemia and autoimmune anemia: increased presence of spherocytes
- Serum iron levels, total iron binding capacity. Vitamin B12 and folate levels. Haptoglobin and erythropoietin levels.
What diagnostic findings are related to anemia?
- Hemoglobin
- Hematocrit
- Reticulocyte count
- RBC indices - mean corpuscular volume and red cell distribution width
- Iron studies
- Serum B12 and folate levels
- Haptoglobin
- Erythropoietin levels
- Bone marrow aspiration
- Endoscopy - GI Bleed??
What pharmacological management is involved in the treatment of anemia?
- Transfusion of packed RBCs
- Supplemental iron, vitamin B12, folic acid
- Transfusions or IV fluid replacement to increase blood volume
- Erythropoesis Stimulating Agents (
- O2 therapy
- IV fluids
What are the treatment modalities for anemia?
- Managing fatigue (MOST COMMON SYMPTOM)
- Maintaining adequate nutrition (iron, B12, folic acid, and protein)
- Maintaining adequate perfusion - replacing lost volume with transfusions or IV fluids. Supplemental O2
- Promoting adherence with prescribed therapy - Educate on purpose of med, how to take, over what time, and manage side effects. Consequences of stopping meds (corticosteroids)
- Education on taking iron on an empty stomach unless GI upset
- Taking a stool supplement
- Blood transfusion
- Monitoring for signs and symptoms of heart failure
For post care of thoracentesis, what should you monitor for?
- Assess insertion site for bleeding and/or drainage
- Monitor for :
- Increased chest tightness
- Uncontrollable cough
- Blood tinged, frothy mucous
- Sudden, uncontrollable pain
- Signs of hypoxemia: increased respiratory rate, rapid pulse, anxiety, restlessness
- Nursing Assessments:
- Vital signs
- Respiratory assessment (note any diminished breath sounds near the insertion site)
- Interventions:
- Oxygen, notify physician
What are interventions to ensure adequate perfusion related to anemia?
- Monitor hemoglobin and ferritin levels
- Vital signs to assess for hypoxemia
- Supplemental oxygen and medications
What are interventions to address fatigue that is related to anemia?
- Prioritize activities and develop schedule with periods of activities balanced with rest
- At least daily physical activity/exercise as tolerated
What interventions address ensuring adequate nutrition related to anemia?
- Supplements: iron, folic acid, Vitamin B12
- Protein rich diet – not tea and toast
- Limit alcohol – inhibits absorption of nutrients and diminishes appetite
What interventions can address a patient with anemia adhering to prescribed therapy once discharged?
- Assess ability to maintain healthy diet once home – need family support? Meals on Wheels?
- Affordability of supplements – need assistance?
- Strategies to manage side effects of supplements (constipation with iron therapy)
What principles are involved in setting priorities?
- Make sure you have the big picture of all the patient’s problems.
- Determine the relationship among the problems.
- Setting priorities is a dynamic, changing process.
- Develop a multidisciplinary problem list, and refer to it frequently.
What are the steps involved in setting priorities?
- Ensure patient and caregiver safety and prevent infection transmission.
- Assign high priority to first-level priority problems.
- Attend to second-level priority problems.
- Address third-level priority problems.
Define clinical judgment.
The definition of clinical judgment used for this concept presentation is “an interpretation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response.
What two ways is priority setting defined?
- Differentiating between problems needing immediate attention and those requiring subsequent action
- Deciding what problems must be addressed in the patient records
What are some methods of assigning priorities to patient needs?
- ABC method
- In emergency departments: life, limbs, and vision
- Maslow’s Hierarchy of Needs
What are the priority levels within Maslow’s Hierarchy of Needs?
Priority 1: Physiological needs - life threatening problems
Priority 2: Safety and security
Priority 3: Love and belonging
Priority 4: Self-esteem
Priority 5: Personal goals
When thinking about first-level priority problems, what does “ABCs plus V and L” represent?
Airway problems
Breathing problems
_C_ardiac and _c_irculation problems
+
Vital signs concerns (e.g., fever, hypertension, hypotension)
Lab values that are life-threatening (e.g, low blood sugar)
What are considered second-level priority problems?
- Mental status change (e.g., confusion, decreased alertness)
- Medical problems requiring immediate attention (e.g., a diabetic who hasn’t had insulin)
- Pain
- Urinary elimination problems
By what process do nurses arrive at clinical decisions? Think of Tanner’s model.
Using an interpretivist view of clinical judgment, what attiributes are associated with it?
- Holistic view of the patient situation
- Process orientation
- Reasoning and interpretation
- Ethical comportment
What does reflecting in action and reflecting on action refer to?
Reflection-in-action refers to the nurse’s understanding of patient responses to nursing actions while care is occurring. Reflection-on-action is consideration of the situation after the patient care occurs. In reflection-on-action, the nurse contemplates a situation and considers what was successful and what was unsuccessful.
What are casts used for?
- Immobilize a reduced fracture
- Correct a deformity
- Apply uniform pressure to underlying soft tissue
- Support and stabilize weakened joints
- Materials: nonplaster (polyurethane), plaster
What are some of the teaching needs associated with having a cast?
- Cast care: keep dry; do not cover with plastic
- Positioning: elevation of extremity; use of slings
- Hygiene
- Activity and mobility
- Report the following signs and symptoms: pain not relieved by elevating cast limb or by analgesics; changes in sensation, movement, skin colour, or temperature; and signs of infection or pressure areas
- Monitor neurovascular status and the potential for complications
What nursing interventions are there for patients with casts or immobilizers?
- Assess and maintain adequate neurovascular status:
- Assess circulation, sensation, and movement
- Five P’s (pain, paresthesia, pallor, pulse, paralysis)
- Notify physician at once of signs of compromise
- Elevate extremity to heart level
- Encourage movement of fingers or toes
What is traction?
- The application of pulling force to a part of the body
- Promotes and maintains alignment of the injured part of the body
- Surgical procedures such as open reduction with internal fixation (ORIF) have largely replaced the use of most forms of traction
What are the principles of effective traction?
- Traction must be continuous to be effective
- Weights are not removed unless intermittent traction is prescribed
- The patient must be in good body alignment in the centre of the bed
- Weights must hang freely and not rest on the bed or floor
- Prevent complications such as skin breakdown (repositioning), nerve damage, infection, circulatory impairment
What is an external fixator?
Used to manage open fractures with soft-tissue damage
Provide support for complicated or comminuted fractures
What nursing care is related to external fixators?
- Reassure patient concerned by appearance of device
- Discomfort is usually minimal, and early mobility may be anticipated with these devices
- Elevate to reduce edema
- Monitor for signs and symptoms of complications, including infection
- Provide pin care
Define immobility.
Inability to move about freely.
What are some metabolic hazards of immobility?
- Slowed wound healing, abnormal labs, muscle atrophy, decreased subcutaneous fat
- endocrine metabolism, calcium resorption, gastrointestinal function (constipation), negative nitrogen balance
What are some respiratory hazards of immobility?
atelectasis, hypostatic pneumonia, dyspnea, increased respiratory rate, crackles, wheezes, decreased air entry
What are some cardiovascular hazards of immobility?
- orthostatic hypotension
- thrombus
- embolus
- pulmonary emboli
- deep vein thrombosis (DVT)
What are some musculoskeletal hazards of immobility?
- loss of endurance, strength, and muscle mass;
- decreased stability and balance,
- osteoporosis,
- joint contracture
What are some urinary elimination hazards of immobility?
- urinary stasis
- urinary tract infection
- urinary retention
- decreased bowel movements
- distended bladder or abdomen
- decreased bowel sounds
- constipation
- anorexia, decreased appetite
- renal calculi, urinary tract infections
What are some integumentary hazards of immobility?
- ischemia
- pressure ulcers
What are some of the psychosocial effects of immobility?
- Decreased social interaction
- Social isolation
- Sensory deprivation
- Loss of independence
- Role changes
- Worry
- Depression
What are some risk factors for immobility?
- older adults due to physiological changes
- acute and chronic conditions
- chronic
- injury/trauma
Why is immobility especially concerning in children?
May interfere with their growth and development and intellectual and psychomotor functioning
What are the different materials used for casts?
- plaster
- non-plaster
- aircast
- half slab
- polyurethane (lighter)
What are some complications of casts?
- Compartment syndrome
- Pressure injuries
- Disuse syndrome
What does CSM stand for relative to patients in a cast?
C - circulation
S - sensation
M - movement
What is compartment syndrome?
Limb-threatening complication that occurs when perfusion pressure falls below tissue pressure within a closed anatomic compartment.
Involves a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur
What are the 5 Ps of neurovascular function to assess after a fracture?
- Pain
- Paresthesia
- Pallor
- Paralysis
- Pulselessness
What interventions can you undertake to address compartment syndrome?
- Reduce pressure by bivalving cast if full cast
- posterior cast with tensor
- fasciotomy
Though use of traction has reduced, what type traction is still common?
Halo traction
When are external fixators used with fractures?
- Manage open fractures with soft tissue damage
- Provide support for complicated or comminuted fractures
Nursing care of fracture with external fixator.
- Discomfort is usually minimal
- Elevate the limb to reduce edema
- Provide pin care
- Monitor for signs and symptoms of complications
What are early complications of fracture healing?
- Shock
- Fat embolism syndrome (signs include: hypoxemia, neurologic compromise, petechial rash)
- Acute compartment syndrome (MOST IMPORTANT sign is severe, unrelenting pain) - often occurs within 12 -24 hours
- DVT and PE
What are delayed complications of fracture healing?
- Delayed union and nonunion
- Avascular necrosis
- Reaction to internal fixation devices
- Complex regional pain syndrome
- Hetertrophic ossification
What are some factors that enhance healing?
- Immobilization of fracture fragments
- Max fragment contact
- Sufficient blood supply
- Proper nutrition
- Exercise: weight bearing for long bones
- Hormones: growth hormone, thyroid, calcitonin, anabolic steroids
- Electric potential across fracture
What factors can inhibit healing?
- Over 40 years old
- Bone loss
- Avascular necrosis
- Smoking
- Comorbidities
- Corticosteroids, NSAIDS
- Extensive local trauma
- Inadequate immobilization
- Infection
- Local malignancy
- Malalignment of fracture fragments
What are some causes of amputation?
- progressive peripheral arterial disease (MOST COMMON REASON)
- fulminating gas gangrene
- trauma
- congenital deformities
- chronic osteomyelitis
- malignant tumour
What are some complications of amputations?
- Hemorrhage
- infection
- skin breakdown
- phantom limb pain
- joint contracture
What nursing interventions are associated with amputations?
- Managing pain
- Minimizing altered sensory perception
- Promoting wound healing
- Enhancing body image
- Helping the patient resolve grieving
- Promoting independent self-care
- Helping the patient achieve physical mobility
- Monitoring and managing potential complications
- Promoting home, community-based, and transitional care
What teaching is critical to re-iterate with hip replacement patients?
- Mobility limitations for life
- No adduction (no crossing legs, use pillow to keep knees apart)
- Hip cannot go below the knee
- Use pillow between knees
- No twisting so the hip does not dislocate
After fracture, who most frequently experiences a fat embolism?
adults younger than 40 and men; also those with multiple fractures
What are some of the signs of a fat embolism?
- Respiratory signs including PAO2 less than 60 mm Hg, cough
- Neuro changes
- Cardio: techy, chest xray shows snowstorm infiltrate
- Skin: pale, petechial rash occurs 2-3 days after symptoms begin
- Critical assessment is in first 12-72 hours
- fever greater than 39.5
- May find fat in urine
When assessing neurovascular compromise in cases of fracture, what element of assessment is important?
Check bilaterally and compare!
How often should you reposition someone to prevent skin breakdown if they cannot move themselves?
Every 2 hours
The nurse teaches which intervention to avoid hip dislocation after replacement surgery?
Never cross the affected leg when seated
Define teaching and learning.
✘Teaching is an interactive process that promotes learning.
✘Teaching and learning begin when a person identifies a knowledge or skill deficit.
✘Teaching is most effective when it addresses the learner’s needs, learning style, and capacity.
✘With successful teaching, patients can learn new skills or change existing attitudes.
What is the role of the nurse in teaching and learning?
- In patient education
- Create an environment to facilitate learning.
- Use a patient-centered approach (include patient’s perspective)
- Assess the learning needs of the patient (what they know versus what I need them to know)
- Use the most appropriate educational strategy.
- To be taught: information needed by the patient and family to make informed decisions regarding their care
What are the three learning domains?
Cognitive, affective, psychomotor
Define the cognitive domain of learning.
Includes all intellectual behaviors and requires thinking.
Define the affective domain of learning.
Expression of feelings and acceptance of attitudes, opinions, or values
Define the psychomotor domain of learning.
Involves acquiring skills that require integration of mental and muscular activity
List the key basic learning principles.
- Learning environment
- Ability to learn
- Emotional capability
- Intellectual capability
- Physical capability
- Developmental stage
- Learning in children
- Adult learning
What is an important consideration for emotional capacility?
Timing is important. Must consider anxiety.
What are important elements to include in a discharge summary?
- Use clear, concise descriptions in the patient’s own language
- Provide step-by-step instructions for how to perform any procedure that the patient or family will be doing independently; reinforce explanation with printed instructions
- Identify precautions to follow when performing self-care or administering medications
- Review signs and symptoms of complications that a patient or family member needs to report to a health care practitioner
- List names and phone numbers of health care providers and community resources that the patient or family member can contact
- Identify any unresolved problem, including plans for follow up and continuous treatment
- List actual time of discharge, mode of transportation, and who accompanies the patient
When does discharge planning happen?
Begins at admission.
What are some of the motivational factors for learning?
- Social motives
- Task mastery motives
- Physical motives
- Motivation and social learning theory
- Motivation and transtheoretical model of change
- A patient-centered approach to patient education
What are the goals of patient education?
- Maintaining and promoting health and preventing illness
- Restoring health
- Coping with impaired functioning
What physical attributes should be considered for learning psychomotor skills?
- Size (height and weight)
- Strength
- Coordination
- Sensory acuity
- Any physical condition (such as pain, fatigue, hunger) that depletes energy also impairs the ability to learn
When teaching adult learners, what approaches generally work well?
- They can be independent, self-directed learners, but become dependent in new situations
- Helps when they are encouraged to draw on past experiences to solve problems
- Also good to collaborate with them on educational topics and goals
- Address needs or issues that are important to the adult early on
Define motivation.
A person’s willingness or desire to learn; influences a person’s behaviour.
What are the stages of the transtheoretical model of change.
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
What is involved in the L.E.A.R.N.S model?
L - Listen to patient needs
E - Establish therapeutic relationship
A- Adopt an intentional approach to every learning encounter
R - Reinforce health literacy
N - Name new knowledge via teach-back
S - Strengthen self-management
