Chapter 1 Introduction To Medical Surgical Nursing

Question 1

The primary focus of medical surgical nursing care is to meet the biologic, psychosocial, cultural, and spiritual needs of the adult patient in a mutually trusting, respectfull, and caring relationship. These basic needs are referred to as…

Answer 1

Concepts

Question 2

What does TJC stand for?

Answer 2

The Joint Commission

Question 3

What does NPSGs stand for?

Answer 3

National Patient Safety Goals

Question 4

What are important IHI interventions to save patient lives?

Answer 4

1. Deploy Rapid Response Teams
2. Provide reliable, evidence-based care for acute myocardial infarctions
3. Prevent central line infections
4. Prevent adverse drug events (ADEs)
5. Prevent surgical site infections (SSIs)
6. Prevent ventilator-associated pneumonia (VAP)

Question 5

What are some IHI interventions to prevent patient harm?

Answer 5

1. Prevent harm from High-Alert Drugs (e.g. Anticoagulants, insulin, opioids)
2. Reduce surgical complications
3. Prevent pressure ulcers
4. Reduce methicillin-resistant Staphylococcus aureus (MRSA) infections
5. Provide reliable, evidence-based care for congestive heart failure
6. Get boards of health care organizations to support measures to promote safe patient care

Question 6

What does IHI stand for?

Answer 6

Institute for Healthcare Improvement

Question 7

Define “medical harm”

Answer 7

Physician incidents and all errors caused by members of the healthcare team or system that lead to patient injury or death

Question 8

What does RRT stand for?

Answer 8

Rapid Response Teams

Question 9

Define “Rapid Response Teams”

Answer 9

Team of critical care experts that save lives and decrease the risk for harm by providing care to patients before a respiratory or cardiac arrest occurs. Also called “Medical Emergency Team.”

Question 10

! Nurse safety priority

Critical Rescue

Answer 10

Early clinical changes in condition occur in most patients up to 48 hours before a “Code Blue.” Therefore observe or, document, and communicate early indicators of patients decline, including decreasing blood pressure, increasing heart rate, and changes in mental status.

Question 11

Define “intensivist”

Answer 11

Physician who specializes in critical care

Question 12

Define “hospitalist”

Answer 12

Family practitioner or internist employed by the hospital

Question 13

What does IOM stand for?

Answer 13

The Institute of Medicine

Question 14

Examples of knowledge needed to develop the IOM/QSEM patient-centered care competency

Answer 14

1. Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values
2. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic a pain and comfort
3. Examine how the safety, quality, and cost-effectiveness of healthcare can be improved through the active involvement of patients and families
4. Explore ethical and legal implications of patient-centered care

Question 15

Examples of skills needed to develop the IOM/QSEN patient-centered care competency

Answer 15

1. Provide patient-centered care with sensitivity and respect for the diversity of human experience
2. Assess presence and extent of pain and suffering
3. Engage patients for designated surrogates in active partnerships that promote health, safety and well-being, and self-care management
4. Facilitate informed patient consent for care

Question 16

Examples of attitudes needed to develop the IOM/QSEM patient-centered care competency

Answer 16

1. Recognize personally held attitudes about working with different ethnic, cultural, and social backgrounds
2. Recognize personally held values and beliefs about the management of pain and suffering
3. Respect patient preferences for degree of active engagement in care processes
4. Respect and encourage individual expression of patient values, preferences, and expressed needs

Question 17

Define “patient-centered care”

Answer 17

Care that recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient’s preferences, values, and needs

Question 18

What does QSEN stand for?

Answer 18

Quality and Safety Education for Nurses

Question 19

“Speak Up”

Answer 19

S speak up if you have questions or concerns, and if you don’t understand, ask again. It’s your body and you have a right to know
P attention to the care you are receiving. Make sure you’re getting the right treatment and medications by the right healthcare professionals. Don’t assume anything.
E educate yourself about your diagnosis, the medical tests you are undergoing, and your treatment plan.
A ask a trusted family member or friend to be your advocate
K know what medications you take and why you take them. Medication errors are the most common health care errors.
U use a hospital, clinic, surgery center, or other type of healthcare organization that has undergone a rigorous on-site evaluation against established state-of-the art quality and safety standards, such as that provided by The Joint Commission
P participate in all decisions about your treatment. You’re the center of the healthcare team

Question 20

What are the three essential ethical principles that nurses and other healthcare professionals should use as a guide for clinical decision-making?

Answer 20

1. Self-determination or self management
2. Beneficence
3. Social justice

Question 21

Define “collaboration”

Answer 21

The planning, implementing, and evaluation of patient care using an interdisciplinary (ID) plan of care

Question 22

What does CM stand for?

Answer 22

Case Management

Question 23

Define “case management”

Answer 23

The process of assessment, planning, implementation, evaluation, and interaction for patients who have complex health problems and incur a high cost to the health care system. Goals include promoting quality of life, decreasing fragmentation and duplication of care across health care settings, and maintaining cost-effectiveness.

Question 24

Requires a broad knowledge base to meet the needs of adult patients in a variety of settings across the continuum. The scope is to promote health and prevent illness or injury in patients from 18 to older than 100 years of age.

Answer 24

Medical surgical nursing

Question 25

What does SBAR stand for? Modified version is I- SBAR and I-SBAR-R

Answer 25

S situation: Describe what is happening at the time to require this communication
B background: Explain any relevant background information that relates to the situation
A assessment: Provide an analysis of the problem or patient need based on assessment data
R recommendation: State what is needed or what the desired outcome is

Question 26

What does SHARE stand for?

Answer 26

S standardize critical content: providing details of the patient’s history to receive, emphasizing key information about the patient, and synthesizing information from various sources before passing it on
H hardwire within your system: developing standardized forms, tools, and methods, such as checklists; identifying new and existing technologies to assist in successful hand-off; and stating expectations about how to conduct a successful hand-off
A allow opportunity to ask questions: Using critical-thinking skills when discussing a patient’s case as well as sharing and receiving information as an interdisciplinary team (“pit crew”). Receivers should expect to receive all key information about the patient, scrutinize and question the data, and exchange contact information with the sender for additional questions
R reinforce quality and measurement: Demonstrating leadership commitment to hand-offs, such as holding accountable, monitoring compliance with use of standardized forms, and using data to determine a systematic approach for improvement
E educate and coach: teaching staff throughout the organization and what constitutes a successful handoff, standardizing training on how to conduct a hand-off, providing performance feedback at the time of the hand-off, and making successful hand-offs an organizational priority

Question 27

Define “delegation”

Answer 27

The process of transferring to a competent person the authority to perform a selected nursing task or activity in a selected patient care situation
The nurse is always accountable for the task or activity that is delegated!

Question 28

What does UAP stand for?

Answer 28

Unlicenced Assistive Personnel

Question 29

Define “supervision”

Answer 29

Guidance or direction, evaluation, and follow-up by the nurse to ensure that the task or activity is performed appropriately

Question 30

What are the delegation and supervision five rights?

Answer 30

1. Right task: The task is within the USP’s scope of practice and competence
2. Right circumstances: The patient care setting and resources are appropriate for the delegation
3. Right person: The UAP is competent to perform the delegated task or activity
4. Right communication: The nurse provides a clear and concise explanation of the task or activity, including limits and expectations
5. Right supervision: The nurse appropriately monitors, evaluates, intervenes, and provides feedback on the delegation process as needed

Question 31

Define “evidence-based practice”

Answer 31

Care that nurses provide that is based on research and identified standards and considers that patient’s preferences and values and the nurse’s clinical expertise
The best source of evidence is research

Question 32

What are medical-surgical nurses expected to do?

Answer 32

1. Identify indicators to monitor quality effectiveness of healthcare
2. Access and evaluate data to monitor the quality of healthcare
3. Recommend ways to improve care processes
4. Implement activities to improve care processes

Question 33

What does EHR stand for?

Answer 33

Electronic Patient Record

Question 34

What are the nine key areas where nursing practice should be improved?

Answer 34

One. Medication administration
Two. Clearly communicating patient data in clinical assessments
Three. Attentiveness/surveillance of patients
Four. Clinical reasoning or judgment
Five. Prevention of errors or complications
Six. Intervention
Seven. Interpretation of authorized provider orders
Eight. Professional responsibility and patient advocacy
Nine. Mandatory reporting

Question 35

Define “informatics”

Answer 35

A specialized computer science that involves using information and technology to communicate, manage knowledge, mitigate error, and support decision making.