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NUR150 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are some techniques for effective collaboration among team members? (3)

A

Closed-loop: sender and receiver confirm the info is correct

Readback: reading back the info to the sender to make sure there are no misunderstandings

SBAR: situation, background, assessment, recommendation

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2
Q

What are some of the characteristics related to professionalism? (8) Can you describe the three most important?

A

Knowledge: theoretical, practical, and clinical; EBP; sharing knowledge with others

Autonomy: working independently, being aware of barriers to autonomy and eliminating them

Advocacy: assisting pts with their learning needs and being knowledgeable about procedure and policies, concern for the patient’s welfare

Accountability
Honesty
Integrity
Respectful
Ethics and Values
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3
Q

What is civility?

A

Civility is an ethical code that most people live by, polite act.

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4
Q

What are some examples of incivility or bullying?

A

humiliation, sabotage, withholding information, excluding others, unfair assignments, or downplaying accomplishments, damaging professional identity, limiting career opportunities

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5
Q

What are three types of surgery?

A

Elective (planned)
Emergency (urgency)
Ambulatory (same day-OP)

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6
Q

What are the components of the assessment of a preoperative patient? (7)

A 
Preop Interview (patient hx)
Psychosocial Assessment (anxiety/fears)
Past Medical hx
Medications
Herb Products
Allergies
Review of Systems
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7
Q

When should anticoagulants be discontinued? ASA?

A

anticoagulants- hold 7-10 days prior to surgery

aspirin- hold 2 days prior to surgery

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8
Q

What common pre-op teaching does the nurse give to the preop patient? (5)

A
  • deep breathing
  • coughing
  • early ambulation
  • splinting incision
  • incentive spirometry
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9
Q

What needs to happen in order to have informed consent? (5)

A
  • surgeon gets it, NOT nurse
  • disclosure of dx, risks, procedure, outcomes
  • pt must be sound of mind and not under sedation
  • must be voluntarily signed
  • must be signed in the presence of a witness
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10
Q

What is the one exception to getting an informed consent?

A

If there is a threat to the patients life and the patient or legally authorized person is unavailable

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11
Q

What is on a typical preop checklist? (10)

A
  • informed consent
  • H&P
  • diagnostic tests
  • patient allergies
  • ID band in place
  • marked surgical site
  • NPO
  • voided before preop meds
  • baseline vital signs obtained
  • nail polish, dentures, and jewelry removed
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12
Q

What are the typical activities a UAP can perform?

A

routine VS (stable pts)
feeding
ambulating stable patients
bathing and hygiene

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13
Q

What are the five rights of delegation?

A 
right task
right circumstances
right person
right directions and communication
right supervision and evaluation
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14
Q

What are some of the preoperative meds that are often prescribed? (5)

A

benzodiazapine- reduce anxiety, induce sedation

anticholinergic- reduce oral and respiratory secretions

opioids- reduce pain during preop procedures

antiemetics- decrease N&V

antibiotics- prevent postop infections

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15
Q

What are the three areas of the surgery department?

A

Unrestricted- street clothes can speak with surgical attire (holding area, nursing station, staff locker room)

Semirestricted- surgical attire and head and facial hair covering is required

Restricted- surgical attire, head and facial hair covered and a mask

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16
Q

What are a few (4) of the activities of the scrub nurse?

A
  • prepares the OR
  • hands supplies
  • keeps counts of sponges and needles
  • monitors aseptic technique of self and others
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17
Q

What are a few (4) of the activities of the circulating nurse?

A
  • documents during the procedure fluid volume loss, sponge count, drugs given
  • prepares lab samples
  • coordinates with the blood bank as needed
  • gives handoff report to the PACU nurse
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18
Q

What is done during a surgical time-out?

A

STOP AND VERIFY

  • patient ID
  • consent
  • procedure
  • site
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19
Q

What is moderate sedation used for?

A

procedures done outside of the OR, *NO ACP PRESENT

ex: reduction of dislocated joint

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20
Q

What is monitored anesthesia care used for?

A

diagnostic or therapeutic procedures done in OR outside of OR

ex: colonoscopy, eye surgery

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21
Q

What is general anesthesia used for?

A

surgical procedures of long duration, needing muscle relaxation, require uncomfortable positioning, or require control of ventilation

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22
Q

What is local vs regional anesthesia?

A

local: topical, nebulized, injected
regional: peripheral nerve block, spinal, epidural

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23
Q

What is a dissociative anesthetic?

A

Ketamine- may cause hallucinations or nightmares (treat with a benzodiazepine if these symptoms occur)

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24
Q

What is MH and how do we treat it?

A

Malignant Hyperthermia (MH) can be caused from anesthetic agents.
Symptoms: hyperthermia, muscle rigidity, tachycardia, tachypnea
Treatment: Dantrolene

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25
Q

How do we assess airway on the postop patient in the PACU? (3)

A
  • patency
  • laryngeal mask airway
  • endotracheal tube
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26
Q

How do we assess breathing on the postop patient in the PACU? (5)

A
  • check gag reflex
  • respiratory rate, quality
  • auscultated breath sounds
  • pulse oximetry
  • supplemental O2
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27
Q

How do we assess circulation on the postop patient in the PACU? (6)

A
  • ECG monitoring
  • BP
  • temperature
  • capillary refill
  • color, temp, moisture of the skin
  • apical and peripheral pulses
28
Q

How do you assess neuro in the postop patient in the PACU? (3)

A
  • level of consciousness
  • orientation
  • sensory and motor status (reflexes)
  • PERRLA
29
Q

How do you assess GU on the postop patient in the PACU?

A

-urine output

30
Q

How do you assess GI in the postop patient in the PACU? (4)

A
  • N&V
  • intake (fluids and irrigations)
  • output (vomitus)
  • bowel sounds
  • abdominal distention
31
Q

What are some of the common post-operative complication? (9)

A
  • pain
  • hypovolemic shock
  • thrombophlebitis (DVT)
  • PE
  • atelectasis
  • pneumonia
  • surgical site infection
  • hemorrhage
  • wound dehiscence and evisceration
32
Q

What is pneumonia and how does it reach the lungs (3)?

A

Pneumonia is an infection of the lung parenchyma through

  • aspiration of normal flora
  • inhalation of microbes present in the air
  • hematogenous spread from a primary infection elsewhere in the body
33
Q

What is the differentiation of CAP vs HAP vs VAP?

A

CAP- not been hospitalized or in long term care within 14 days

HAP- nonintubated patient that begins 48 hours or longer after admission to the hospital

VAP- more than 48 hours after ET tube placement

34
Q

What are the signs and symptoms of pneumonia? (9)

A
  • fever, chills, flushing, diaphoresis
  • cough (may or may not be productive)
  • pleuritic chest pain
  • dyspnea
  • tachypnea
  • tachycardia
  • elevated WBC
  • decreased O2 sat
  • confusion (especially in older adults)
35
Q

How do we diagnose pneumonia? (4)

A
  • chest xray (can show consolidation and fluid buildup)
  • sputum culture and sensitivity (tell us which microorganism is causing the infection)
  • pulse oximetry
  • CBC (white blood cell count)
36
Q

What kinds of medications are patient with pneumonia prescribed? (4)

A

Antibiotics- cephalosporin (freq stools) or penicillin, start with IV and then switch to PO, obtain sputum before giving

Antipyretics- reduce fever

Anti-inflammatory- prednisone to decrease airway inflammation (may cause hyperglycemia in diabetic patients)

Bronchodilators- anticholinergics (ipratropium) or Beta2 Adrenergic Receptors (albuterol)

Adjunctive Therapies- mucolytics or expectorants

37
Q

What is pulmonary embolism?

A

a substance (solid, liquid, or gas) enters venous circulation and lodges in pulmonary vessels

38
Q

What are the risk factors for PE?

A
  • peripheral vascular disorder
  • DVT
  • oral contraceptive
  • obesity
  • postoperative
  • chronic atrial fibrillation
  • central venous catheters
39
Q

What are the signs and symptoms of PE?

A
  • dyspnea (MOST IMPORTANT)
  • hypoxemia
  • tachypnea
  • tachycardia
  • hypotension
  • cough
  • chest pain
  • crackles/wheezing
  • impending doom
  • pressure in the chest
  • petechiae
40
Q

How do we diagnose PE? (3)

A
  • Spiral CT or CT Angiography (IV contrast to view pulmonary vessels)
  • Ventilation perfusion scanning (inhaled radioactive gas
  • d-dimer- measures the cross-linked fibrin fragments normal range is less than 0.4mcg/ml
41
Q

What are two examples of anticoagulants that prevent PEs from getting bigger?

A

LMWH- Enoxaparin

  • subQ
  • antidote- protamine
  • frequent blood draws for PTT

Warfarin (Coumadin)

  • oral
  • antidote- vitamin K
  • weekly blood draws PT and INR
42
Q

What are two types of surgery can be done for treatment of PE?

A

Embolectomy- remove the embolus

Vena Cava Filter- filter placed through femoral vein prevents migration of large clots to the pulmonary system

43
Q

What are the s/s of pulmonary effusion?

A
  • dyspnea
  • cough
  • sharp, nonradiating cp worse on inhalation
  • decreased movement of the chest on the affected side
44
Q

How do we diagnose a pleural effusion?

A

cxr- reveals volume and location of the effusion

45
Q

What is the treatment options for pleural effusion? (3)

A
  • diuretics and NA restriction
  • thoracentesis
  • chemical pleurodesis
46
Q

What are some psychobiological interventions? (3)

A
  • medications
  • providing teaching about the medications
  • monitoring for adverse effects
47
Q

What does the DSM-5 provide us? (3)

A
  • establishes diagnostic criteria for mental health disorders
  • identifies expected findings for mental health disorders
  • assists nurses in plan, implement and evaluating their care
48
Q

What are the guidelines for using physical or chemical restraints?

A
  • must have written providers prescription (unless it is emergency, then within 30 minutes)
  • all other less restrictive measures have been exhausted
  • client is a threat to self or others
  • must check on patient every 30 minutes at least
49
Q

What is the defense mechanism of altruism?

A

dealing with anxiety by reaching out to others

ex: a nurse who lost a family member in a fire is a volunteer firefighter

50
Q

What is the defense mechanism of sublimation?

A

dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression

ex: angry with Maureen? Work out vigorously at the gym on lunch break

51
Q

What is the defense mechanism of suppression?

A

voluntarily denying unpleasant thoughts or feelings

ex: choosing to forget about drama in order to focus on a test

52
Q

What is repression?

A

unconsciously putting unacceptable thoughts out of awareness

ex: a person who has fear of the dentist forgets their dental appointments

53
Q

What is regression?

A

sudden use of child-like behaviors that is not in line with their developmental stage

54
Q

What is displacement?

A

shifting feelings related to one thing to another that is less threatening

ex: kicking the dog because you lost your job

55
Q

What is reaction formation?

A

unacceptable feelings or behaviors are controlled by overcompensating or demonstrating the opposite behavior

ex: a person who is trying to quit smoking gives talks to kids about the dangers of smoking

56
Q

What is projection?

A

attributing one’s unacceptable thoughts and feelings onto another who does not have them

ex: a married client who is attracted to another person accuses their partner of infidelity

57
Q

What is splitting?

A

an inability to reconcile negative and positive attributes of self into a cohesive image

ex: a client tells a nurse that they are the only one who cares about them, and next day will not speak to that nurse

58
Q

What is conversion?

A

responding to stress through unconcious development of physical manifestations not caused by a physical illness

ex: a client experiences deafness after their partner tells them they want a divorce

59
Q

What is milieu therapy?

A

therapeutic community or therapeutic environment
-environment that is supportive, therapeutic, and safe

ex: community meetings

60
Q

What is transference and countertransference?

A

Transference: client views a nurse as having characteristics of someone who was significant in their life

Countertransference: nurse displaces characteristics of people in their past onto a client

61
Q

What types of services are available in a community mental health facility?

A
  • individual therapy
  • family therapy
  • medication dispensing programs
  • educational groups
62
Q

Who is Assertive Community Treatment for?

A

ACT is for clients with severe mental illness who are nonadherent to traditional therapy

63
Q

What is interpersonal psychotherapy?

A

assists clients in addressing specific problems socially

64
Q

What is cognitive therapy?

A

mental health can improve by changing a clients attitude about it. Thoughts come before feelings and actions

65
Q

What is behavioral therapy?

A

Changing maladaptive behaviors can occur without insight into the underlying cause
-teaches systems to reduce manifestations

66
Q

What is dialectical behavior therapy?

A

CBT for clients who have personality disorder and exhibit self harm behavior

NUR150 (8 decks)

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