Exam 3 fundamentals.

Question 1

(ACE) inhibitors? aka Angiotensin-converting enzyme

Answer 1

Angiotensin-converting enzyme (ACE) inhibitors are medications that help relax the veins and arteries to lower blood pressure. ACE inhibitors prevent an enzyme in the body from producing angiotensin II, a substance that narrows blood vessels.

Question 2

Gastroenteritis?

Answer 2

inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection and causing vomiting and diarrhea. Aka stomach flu. has a limited course meaning it only takes a few days to heal. important to take a lot of water.

Question 3

DKA diabetic ketoacidosis

Answer 3

DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat and protein for fuel. This process produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in your body. The reason your body does this is because even though there’s glucose in the blood it thinks that there is not any glucose because it can’t enter the cell. Also when there’s a lot of glucose in the blood your body tries to get rid of it in the form of urine taking water and electrolytes with it in a process called in osmotic diuresis. This results in excessive amounts of urine, dehydration, and excessive thirst. 

Question 4

Planning a teaching session for a patient. SMART

Answer 4

SMART
 Specific
 Measurable
 Attainable
 Relevant
 Time Frame

Question 5

What is healing by secondary intention?

Answer 5

Secondary intention healing means a wound will be left open (rather than being stitched together) and left to heal by itself, filling in and closing up naturally. It will mean you need regular dressings to the area for up to six weeks, but the time to full healing depends on the size, depth and site of the wound.

Question 6

The Joint Commission
Standards?

Answer 6

 Patient Needs Assessment
 The ability of the patient assessment
 Readiness to Learn
 Educational Plan
 Educational Intervention
 Evaluation of Effectiveness of Teaching

Question 7

Documentation

Answer 7

 Needs assessment
 Interventions
 Methodology
 Whether pt required return demonstration
 Pt stated or demonstrated understanding
 Appropriate referrals made
 How pt has met goals

Question 8

Evaluation

Answer 8

This is after you implement the teaching. What is the understanding? Remember teach back show back. This is part of the evaluation. You are evaluating what the patient understood and how they are progressing towards the expected outcomes. It is not a given that they are going to meet the goal right away. It will take time and multiple teachings.

Question 9

Discharge Teaching?

Answer 9

 Any instruction necessary i.e. Danger signs
 Specific instructions outlined by MD
 Provide written material/ phone numbers/
appointments
 Equipment & supplies necessary
 Document response to education

Question 10

Factors that influence
teaching/learning?

Answer 10

Nurse
 Knowledge of material
 Communication skills
- Verbal: Should match educational level
of pt.
Avoid medical jargon
Nonverbal communication: Don’t
appear hurried
Cultural Issues
- Active listening skills: nonverbal clues
- Ability to demonstrate empathy

Readiness to learn
- Emotional readiness
- Experiential readiness
 Ability to learn
- Physical Condition
- Cognitive Ability
- Level of Education
Ability to Learn (con’t)
- Literacy/Health Literacy
- Communication skills
- Primary language
Important to assess learning abilities in order to
ID teaching strategies
Learning Strengths
- Successful learning in the past
- Above average comprehension/
reasoning, memory, psychomotor
skills
- High motivation
- Strong network
- Adequate financing

Question 11

Factors that can interfere with
learning?

Answer 11

 Lack of Time
- Shorter hospital stays
- Begin teaching on admission
 Lack of Knowledge
- More specialties
- Floating
- New equipment
Disagreement with patient or family
- Set goals with pt
- Realistic goals
 Powerlessness, frustration
- Nurse
- Patient
Language Barrier
- Interpreter
- Set aside time
- Assess cultural influences

Question 12

Planning?

Answer 12

Goal Setting
- Write clear and measurable learning objectives
- Long term goals
- Short term goals

Question 13

Planning?

Answer 13

Goal Setting
- Write clear and measurable learning objectives
- Long term goals
- Short term goals

Question 14

Case Scenario:
20 year old, s/p I&D (incision & drainage) for a left
leg abscess. The wound is healing by secondary
intention. Before she is discharged, she will need
to perform her own wound care

Answer 14

Pt will be able to describe the rationale and importance of performing a wet to moist dressing change on her first post-op day
Pt will be instructed on the importance of performing a wet to moist dressing change
Pt will perform a wet to moist dressing change in front of the nurse using the correct technique before discharge on 9/7
Pt will be able to perform her own dressing changes

Question 15

Teaching strategies:

Answer 15

Teaching Strategies:
“Teach Back”
“Show Back”

Peer teaching in a support group for patients with eating disorders.

Effective teaching using demonstration and return
demonstration increases successful learning by the patient.

Using an app or a tv program.

Question 16

What is communication?

Answer 16

 The Oxford American College Dictionary defines communication
as “ the successful conveying or sharing of ideas and feelings.”
 Communication is the basic element of human interactions that
allows people to establish, maintain, and improve contact with
one and other

Question 17

Why is communication especially vital in nursing?

Answer 17

• Communication is vital in all nursing activities
  such as care planning, interventions,
  discharge, education, and health promotion
• Generates trust
• Enhances therapeutic relationship
• Strong communication is required for patient
  advocacy and safety
• Effective communication is essential for
  collaboration of care with the interdisciplinary
  team

Question 18

Why is communication especially vital in nursing?

Answer 18

• Communication is vital in all nursing activities
  such as care planning, interventions,
  discharge, education, and health promotion
• Generates trust
• Enhances therapeutic relationship
• Strong communication is required for patient
  advocacy and safety
• Effective communication is essential for
  collaboration of care with the interdisciplinary
  team

Question 19

Poor communication in healthcare

Answer 19

 The 2016 US Malpractice study found that:
1. 30 % of all malpractice claims filed between 2009 and 2013 involve
communication failures.
2. Hospitals and doctors’ offices nationwide could have avoided nearly 2,000
patient deaths — and $1.7 billion in malpractice costs — if medical staff and
patients communicated better
3. 70-80% of medical errors are related to interpersonal interaction issues

Question 19

Poor communication in healthcare

Answer 19

 The 2016 US Malpractice study found that:
1. 30 % of all malpractice claims filed between 2009 and 2013 involve
communication failures.
2. Hospitals and doctors’ offices nationwide could have avoided nearly 2,000
patient deaths — and $1.7 billion in malpractice costs — if medical staff and
patients communicated better
3. 70-80% of medical errors are related to interpersonal interaction issues

Question 20

Levels of communication.

Answer 20

1. Intrapersonal: Communication that occurs within an individual. *
   Also known as self-talk, self-verbalization, inner thought
   * Provides mental rehearsal for difficult tasks or situations;
   increase confidence.
   * NURSING RELEVANCE: – internal critical thinking and planning
2. Interpersonal:
   * Between 2 or more people
   * A 1:1 interaction between the nurse and another person.
   e.g patient, family, physician, colleague
   * Meaningful interpersonal communication results in an exchange of
   ideas and goal accomplishment.
   * NURSING RELEVANCE: Assessment, teaching, providing
   comfort and support
3. Transpersonal: Interaction that occurs within a spiritual domain.
   Communication with a higher power/God
   Nurses have a responsibility to assess a person’s spirituality
4. Group Communication: Between two or more people
   * A. Group communication: Interaction that occurs when a small number of
   persons meet – usually goal-directed and requires understanding of group
   dynamics; exchanges of ideas
   * E.g staff meetings, committee meetings, educational grps, self help grps,
   goals of care meetings
   * NURSING RELEVANCE: Provide patient advocacy
   * B. Public speaking: Involves interaction with an audience with varying
   degrees of interaction
   * e.g. presenting scholarly work in conferences and lectures
   * NURSING RELEVANCE: Educating nurses with evidence based studies,
   change of practice or policies and procedures, lobbying for new legislation

Question 20

Levels of communication.

Answer 20

1. Intrapersonal: Communication that occurs within an individual. *
   Also known as self-talk, self-verbalization, inner thought
   * Provides mental rehearsal for difficult tasks or situations;
   increase confidence.
   * NURSING RELEVANCE: – internal critical thinking and planning
2. Interpersonal:
   * Between 2 or more people
   * A 1:1 interaction between the nurse and another person.
   e.g patient, family, physician, colleague
   * Meaningful interpersonal communication results in an exchange of
   ideas and goal accomplishment.
   * NURSING RELEVANCE: Assessment, teaching, providing
   comfort and support
3. Transpersonal: Interaction that occurs within a spiritual domain.
   Communication with a higher power/God
   Nurses have a responsibility to assess a person’s spirituality
4. Group Communication: Between two or more people
   * A. Group communication: Interaction that occurs when a small number of
   persons meet – usually goal-directed and requires understanding of group
   dynamics; exchanges of ideas
   * E.g staff meetings, committee meetings, educational grps, self help grps,
   goals of care meetings
   * NURSING RELEVANCE: Provide patient advocacy
   * B. Public speaking: Involves interaction with an audience with varying
   degrees of interaction
   * e.g. presenting scholarly work in conferences and lectures
   * NURSING RELEVANCE: Educating nurses with evidence based studies,
   change of practice or policies and procedures, lobbying for new legislation

Question 21

Albert Mehribian’s Communication
Model – 7-38-55 Formula

Answer 21

Research study in 1971; “ Silent
Messages”
Formula applies to communication
of feelings and attitudes; not to ALL
communications
Only 7% of meaning is in the words
that are spoken
38% of meaning is in the tone of
voice
55% of meaning is in facial
expression

Question 21

Albert Mehribian’s Communication
Model – 7-38-55 Formula

Answer 21

Research study in 1971; “ Silent
Messages”
Formula applies to communication
of feelings and attitudes; not to ALL
communications
Only 7% of meaning is in the words
that are spoken
38% of meaning is in the tone of
voice
55% of meaning is in facial
expression

Question 22

Forms of communication:

Answer 22

1. Verbal Communication:
   Uses spoken or written words:
   Influenced by educational
   background, culture, age and
   experiences, influenced by:
   Vocabulary
   Denotative Meaning - literal
   Connotative Meaning - implied
   Clarity and Brevity – appropriate
   words
   Intonation - tone
   Pacing -speed
   Credibility
   Humor-Use cautiously
2. Non-Verbal Communication
    Facial expression
    Gestures
    Personal Appearance
    provides clues to professionalism, culture, religion,
   socioeconomic status, livelihood and feelings
    Touch
    May convene affection, concern, or encouragement

Question 23

Factors that affect comunication:

Answer 23

1. Environment
    Quiet, private, comfortable
   Developmental differences
    Physical and cognitive
   development
    Language skills
    Level of Education
    Maturity
   Gender
    Difference in
   communicating and
   interpreting
    Males tend to be goal/task
   focus
    Females also seek to
   establish personal
   relationship
2. Personal Space
    Varies according to
   relationship with the
   other person
    Intimate distance – <18”
    Personal distance – 18”
   to 48’’
    Social distance – 4-12’;
   formal or with a group
    Public Distance - > 12’;
   when communicating
   loudly, focus on group
   not on individual

Question 24

Professional nursing relationships:

Answer 24

Nurse-Healthcare team:
Teamwork and
collaboration
Nurse-Patient:
Involve
patient in care
management
Nurse-Family:
Involve
family in care of patients
and discharge teaching
Nurse-Community:
health
fairs, and public bulletin boards.

Question 24

Professional nursing relationships:

Answer 24

Nurse-Healthcare team:
Teamwork and
collaboration
Nurse-Patient:
Involve
patient in care
management
Nurse-Family:
Involve
family in care of patients
and discharge teaching
Nurse-Community:
health
fairs, and public bulletin boards.

Question 25

Nurse-to-nurse communication:

Answer 25

Transition of Care
-High-alert Medications
-Recognizing Fatigue
* Be assertive, not aggressive
* Advocate for patients
* Advocate for yourself
* If needed, decline
respectfully and explain
* Use a proper chain of
command

Question 26

SBAR

Answer 26

Introduce yourself
 S – Situation
 What is going on with your patient? What are you concerned about?
 B – Background
 Clinical background and data
 A – Assessment
 What is your assessment of the situation
 R – Recommendation
 What is your recommendation for the situation

Question 27

Creating a therapeutic relationship

Answer 27

The client is the center of focus.
The therapeutic relationship focuses on improving the health of the
client.
Therapeutic communication is client-centered communication
directed at achieving client goals.

Question 28

Phases of the patient-nurse therapeutic relationship

Answer 28

1. Pre-interaction Phase: Before meeting patient
   Review chart/pre-lab
   Talk with caregivers/nursing handoff
   As Student- prelab for clinical
   As patient – anxiety may be high as pt acknowledges the need
   for healthcare
   Goal – Get info about patient to establish plan of care
2. Orientation Phase: When nurse and patient first meet
    Introduce yourself
    Ask how pt wants to be addressed
    Set tone by adopting a warm and empathetic manner
    Students often tentative and uncertain
    Expect to test your competence and commitment
    Goal – establish rapport and trust using verbal and non-
   verbal communication; leads to more openness from patient
    Clarify roles
    Once relationship/ role is defined, orientation phase ends
3. Working Phase:
    Bulk of therapeutic relationship occurs in this phase – active part
    Goals: pt able to clarify feelings and concerns honestly
    Mutual respect maintained
    Active listening, providing clear instructions
    Professional relationship requires trust, confidentiality mutual respect
    Work together towards a goal
4. Termination Phase:
   Evaluate goals achievement with the patient
   Reviewing the care achieved and care needed to be passed on to
   the next shift
   Achieve a smooth transition for the patient to other caregivers
   Prepares for future interaction
   Affects patient outcome and nurses’ job satisfaction

Question 29

Therapeutic communication:

Answer 29

1. Active Listening:
   -Pay attention
   -Show that you are listening
   -Use clarification
   -Respond appropriately
2. Share Observations: “You
   seem quiet today. What’s in
   your mind?”
3. Reflection of feeling: “I see
   that you are upset with the
   phlebotomist.”
4. Restating/Clarifying
5. Use open-ended questions
6. Focusing: pursing a topic
   until its importance is clear
7. Using silence – allows
   a person time to organize
   thoughts

Question 30

Non-Therapeutic communication:

Answer 30

 Excessive use of closed-ended questions
 Avoid asking “why”; Say “what concerns you” instead
 Giving advice – giving solution negates pt’s participation in decision making
 False reassurance: “everything will be alright”
 Showing approval and disapproval- don’t impose your personal beliefs on someone else
 Stereotyping: assumptions made based on patients background, education, culture etc.
 Patronizing – communicates superiority or disapproval
 “You should have called before getting up”

Question 31

Non-Therapeutic communication:

Answer 31

 Excessive use of closed-ended questions
 Avoid asking “why”; Say “what concerns you” instead
 Giving advice – giving solution negates pt’s participation in decision making
 False reassurance: “everything will be alright”
 Showing approval and disapproval- don’t impose your personal beliefs on someone else
 Stereotyping: assumptions made based on patients background, education, culture etc.
 Patronizing – communicates superiority or disapproval
 “You should have called before getting up”

Question 32

Other barriers to effective communication :

Answer 32

 Medications that might interfere with speech, cognition, or LOC
 Language barriers such as primary language, whether an interpreter (native language or sign language) is needed
 Health literacy
 Baseline cognitive function/LOC
 Hearing, vision impairment
 Expressive or receptive aphasia
 Physiological barriers such as dyspnea, artificial airway, anxiety, pain

Question 33

Other barriers to effective communication :

Answer 33

 Medications that might interfere with speech, cognition, or LOC
 Language barriers such as primary language, whether an interpreter (native language or sign language) is needed
 Health literacy
 Baseline cognitive function/LOC
 Hearing, vision impairment
 Expressive or receptive aphasia
 Physiological barriers such as dyspnea, artificial airway, anxiety, pain

Question 34

How to treat a patient with Aphasia

Answer 34

 Use yes/no answers
Visual cues
Communication aids such as a
writing board or keyboard
Allow for extra time
Let the patient know if you have
not understood them

Question 34

How to treat a patient with Aphasia

Answer 34

 Use yes/no answers
Visual cues
Communication aids such as a
writing board or keyboard
Allow for extra time
Let the patient know if you have
not understood them

Question 35

How to treat a patient with a cognitive impairment?

Answer 35

 Use simple sentences
Present one question,
instruction, or statement at a
time
Involve the patient’s family
Allow for extra response time

Question 36

How to treat a patient with mental health issues?

Answer 36

 Avoid denying or arguing with them
about their reality
Use short sentences in a calm and non-
threatening voice
Validate the person’s own experience of
frustration or distress
Reflection of feelings
Re-direct focus to the person’s positive
experience