Exam 4 Flashcards
What is the definition of delegation?
Transferring responsibility for the performance of an activity or task while retaining accountability for that outcome
Advantages of delegation:
improved efficiency, productivity, efficiency, and job enrichment
5 rights of delegation
right: task, circumstance, person, direction/communication/ supervision.
What is Direct delegation?
verbal direction: specific person
What is Indirect delegation?
approved list of activities or tasks: within scope of practice, ex: (every 4 hours CNA’s are to get a list of vitals of patients).
If you have delegated a task to someone, and they do not report to you any information to you, who is at fault?
you
Who are UAP and what can they NOT do?
they can not insert iv, caths, give meds, They are cnas, Ma, NI
What can LPN’s not do?
can not do meds through a central line, no chemo, no narcatics
who are AP’s and what can they do?
clarical hushs, cant lay hands on the patients, they can bring juice, transfer call lights to the right person. Overall need to know what they can or can not do.
What can other licensed nurses do?
waste, TPN, insulin, and heparin drip wasting, if they are not licensed to give it then they can not witness waste
pain is always?
subjective
True or False? Clients who abuse substances overreact to discomfort
false
True or False? Administering analgesics regularly leads to drug addiction.
false
True or False? The amount of tissue damage in an injury accurately indicates a pain intensity.
false
True or False? Healthcare personnel are the best authorities on the nature of the clients’ pain.
false
True or False? Chronic pain is all psychological.
false
True or False? Clients who cannot speak do not feel pain.
false
examples of pain intensity words.
mild, severe, moderate, excruciating
Pain quality words
sharp, stabbing, cramping, aching, dull, weak
What do we need to know about the patient’s pain?
pain intensity, quality, location, what makes it better or worse, effects the pain has on the client’s life and pattern
What is an example of a question we can ask a patient to assess how the pain is affecting them?
Is the pain you are having, affecting your sleep?
A client’s ____ of pain is the single most reliable indicator of its existence and intensity.
self-report
A stands for
Ask about pain regularly; assess systematically
B stands for
Believe the client & family about reports of pain & what relieves it
C stands for
Choose pain control options appropriate for the client, family & setting
D stands for
Deliver interventions in a timely, logical & coordinated fashion
E stands for
Empower clients & families; enable them to control their course to the greatest extent possible
Types of pain scales?
Flacc, Faces, Numerical scale
Who do we use the FLACC scale for?
nonverbal, unconscious, or patients who can not self report pain
the pain scales measure what?
intensity
Who do we use the faces, and numerical pain scale on?
How do we deal with breakthrough pain?
Patients with pain patches will not reach full potential of pain management until 24 hours after patch has been placed so they might need another medicine with the first patch
What are the medicines we use as reversal agents?
Narcan (nalaxone), Dantrolene, Flumszenil
What is the most dangerous condition that can happen with inhaled anesthesia?
Malignant Hyperthermia
How do you treat malignant hyperthermia?
Stop Admin of Anasthesia, 100% of o2, IV Dantrolene, cooling blankets, monitor heart rate, urine output, and stop surgery ASAP
What is MH
the patient gets an allergic reaction to the anesthesia,
Types of anesthesia
General, local, regional/ block/ conscious sedation
What is conscious sedation?
(Twilight) patient is in control of their own breathing. They are mostly out but still have control of their breathing
What is important to monitor for with Twilight sleep?
Monitor their breathing. It is important they do not fall too far under sedation to the point where they do not breathe anymore
What is local anesthesia?
The patient loses sensation at the site of the area that is being operated on.
What is good about local anesthesia?
it decreases the amount of risk with surgery in general.
What is a regional block?
loss of sensation in an area of the body, like an epidural
What is general anesthesia?
The patient is fully under anesthesia and can not control their breathing. These patients have a tube that controls their breathing.
Types of procedures for local anesthesia?
sutures, stitches,
What type of anesthesia requires general?
open heart surgery
What is the role of the circulating nurse in the OR?
maintain safety of the client and be their advocate
Complications of surgery?
Paralytic ileus, DVT, post-op PNA
How long do we listen in each quadrant for bowel sounds before we can move on if we do not hear it?
5 minutes
What questions do we want to ask patients to assess for Paralytic ileus,?
Have you been passing gas?
When was the last time you had a bowel movement?
How can we prevent DVT’s?
SCD’s Early ambulation, lovanox shot. Ted
How to prevent Post-op Pneumonia?
Incentive Spirometer, cough, deep breathing, early ambulation
What is the Aldrete score to leave PACU?
8
Classifications of surgery
serious: major/minor
Urgency: elective/urgent
Life-threatening: Emergency
Ablative surgery?
???????
Palliative surgery
pain management, not curable, but helps with quality of life.
Elective surgery
life-enhancing, joint replacement
Urgent surgery
fix before it gets worse, adenectomy,
Emergency surgery
Aortic dissection, ruptured appendix.
What are the risks of surgery?
the more invasive the procedure the bigger the risks
Who can give informed consent?
cognitive, awake, over 18, right mind, not under the influence
If a patient has a question about the surgery who should they talk to?
the doctor or surgeon performing it
Can patients change their minds before the surgery?
yes
What is an example of a type of patient who can not give informed consent?
patient who is in a coma, a patient who is under 18, a patient who has dementia, patient under the influence.
What do we monitor under conscious sedation?
Their airway. If they go too far under sedation they will not be able to breathe so we will have to apply oxygen and make an airway for them.
Delerium is _______ whereas dementia is _______
Short-term, reversible: long-term, progressive
Can patients with dementia come out of surgery with delirium?
yes, they can have both.
The easiest way to tell if they have delirium?
speed of onset
How do we treat Delirium?
as the anesthesia wears off, we will assess them.
Basal is what?
continuous,
Bolus is what?
demand
what is a lockout?
patients can only get a set amount of a dose at a safe time.
Will they get the basal dose regardless?
yes
Hypertensive medication education
take every day at the same time, do not stop taking abruptly, do not skip doses, and Avoid Potassium-sparing. Keep bp log
What are potassium-sparing?
salt
Patients on blood pressure medicine will also most of the time be perscribed a what?
diuretic,
What is a type of loop diuretic we talked about that most patients on blood pressure medicine will take?
furosemide a potassium wasting loop diuretic
What is an example of a blood pressure that is a hypertensive crisis?
200/180
What is a low blood pressure?
70/40
What is hypertensive blood pressure?
150/90
Modifiable factors for hypertension
weight, diet, exercise, stop smoking, stress reduction
Non-modifiable factors for hypertension
age, gender, family history, genetics, ethnicity
Overstimulation in hospitals causes
alarm, noises, people, lights,
What is sensory overload?
so much stimuli the body can not process
How can we help reduce sensory overload?
cluster care, turn the lights off, limit visiting hours, turn monitors down, allow time for rest
What is sensory deprivation?
not enough stimuli to keep brain functioning
How can we keep from sensory deprivation?
color the walls, painting, clocks, tvs, and healing channel in the patients room, pet therapy
For patients with visual impairments, we should do what?
clock method with meal trays, keep floors clean, orient them to the room, and do not move stuff.
For patients with hearing impairments, how can we accommodate them?
ask how they prefer to communicate
If deaf then provide a medical interpreter
if they lip read make sure you are in view of them and facing them at all times. get on their level, do not scream, keep lights on when communicating
What does Romazicon (flumszenil) treat?
Benzo overdose,
