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PCC 2 > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Definition of delegation

A

Transferring responsibility for the performance of an activity or task while retaining accountability for the outcome (ANA)

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2
Q

Advantages of delegation

A

Improved efficiency, productivity, job enrichment

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3
Q

What are the five rights of delegation?

A

Right task, right circumstances, right person, right direction/communication, right supervision

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4
Q

What is direct delegation

A

Verbal direction for an activity/task- directed to a specific person

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5
Q

Indirect delegation

A

Approved list of activities/tasks- general

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6
Q

Right task

A

Within scope

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7
Q

Right circumstances

A

Is this situation being handled appropriately? I.e. X2 assist is not going to be one person assisting the X2 pt by themselves

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8
Q

Right person

A

Is this the person with the best skill set for this task?

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9
Q

Right direction/ communication

A

Closed-loop communication= feedback (i.e. repeat back task to delegator) ex: code team

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10
Q

Right supervision example

A

First day on the job? Trainer must be there with them.

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11
Q

Ancillary personnel

A

Clericals

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12
Q

What is a good rule of thumb to remember if you are not sure about whether a task can be delegated or not?

A

If you are not licensed to give it, you are not licensed to verify it- you cannot delegate it to them

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13
Q

Can ancillary staff perform pt care?

A

No

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14
Q

Unlicensed assistive personnel- UAP examples

A

CNA, NA, NI, PCP
ADL’s, baths, feeding, repositioning, no meds, no stitches and staples removal, central line insertion or maintenance

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15
Q

Ancillary personnel are not to

A

Lay hands on pt, but can bring things like water, direct call lights to proper personnel

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16
Q

What is the delegation decision making grid?

A

Level of pt acuity
Level of UAP’s ability
Level of licensed nurse capability
Potential for harm
Frequency of performance of skill
Level of decision making
Ability for self care

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17
Q

considerations for delegation

A

Safest person for skill
Scope of practice
Training for task
Experience

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18
Q

If a nurse delegates to another personnel, who is responsible for outcomes ?

A

The nurse who delegated- you maintain responsibility even if you did not physically do it yourself

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19
Q

What are the pain scales we talked about in class?

A

FLACC, Wong-baker, numeric scale

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20
Q

Who do we use the FLACC scale for?

A

Unconscious/nonverbal

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21
Q

Wong-baker scale is

A

Faces

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22
Q

Example of pain intensity

A

Mild, severe, moderate, excruciating

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23
Q

Pain quality

A

Sharp, stabbing, aching, dull ,deep

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24
Q

Things to know about pain

A

Location, anything makes it better, worst, quality, intensity

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25
Q

Pain is

A

Subjective

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26
Q

The patient is the

A

Determinant of pain

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27
Q

T/F: chronic pain is purely psychological

A

False

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28
Q

ABCDE of pain

A

Ask
Believe
Choose
Deliver
Empower

29
Q

A of ABCDE of pain

A

Ask about pain regularly, assess systematically

30
Q

B of ABCDE of pain

A

Believe the client and family about reports of pain and what relieves it

31
Q

C of ABCDE of pain

A

Choose pain control options appropriate for the client ,family and setting

32
Q

D of ABCDE of pain

A

Deliver interventions in a timely, logical

33
Q

Narcan/naloxone is a reversal for

A

Opioids

34
Q

Dantrolene

A

Tx for malignant hyperthermia

35
Q

Romazicon or ________

A

Flumazenil

36
Q

Flumazenil is a

A

Reversal agent for benzodiazepines

37
Q

Types of anesthesia

A

Local, general, conscious

38
Q

Local anesthesia

A

Used to numb or as a regional anesthetic. Ex= stitches

39
Q

Role of circulating nurse

A

Maintaining safety of the client; sterile field, monitors, items, counts Supplies before and after

40
Q

Assess for paralytic ileus

A

Listen for 5 min each quadrant; ask if they have passed gas or had a BM

41
Q

General anesthesia

A

Used for invasive surgeries, ex= open heart surgery

42
Q

Conscious anesthesia

A

Procedures like endoscopies, client subconsciously maintains their own airway

43
Q

How do you prevent a DVT post-op?

A

TEDS, SCDs, lovenox (blood thinner

44
Q

How to prevent post-op pneumonia

A

Coughing and deep breathing exercises, incentive spirometer, early ambulation

45
Q

What are the conditions to be eligible to give consent?

A

Must be 18 or older, in their right mind, not under any influence

46
Q

How would an individual not be able to give consent for a procedure or tx?

A

If they are under 18, under any type of influence, or physically unable to (i.e coma)

47
Q

How does having a disability affect giving consent?

A

It does not change their rights to consent if they are still in their right mind to do so. WE would accommodate to THEM (i.e. deaf, blind)

48
Q

What are the classifications of surgery?

A

Urgent, elective, emergent
Minor/major

49
Q

Monitoring during conscious sedation

A

Maintain an airway on their own, start an airway if needed

50
Q

Dementia

A

Progressive, long-term condition

51
Q

Delirium

A

Short-term, after surgery; effects from coming out of anesthesia

52
Q

What is the difference between delirium and dementia?

A

The speed of onset

53
Q

What is the normal range for BP?

A

120/80

54
Q

What is considered a hypertensive crisis?

A

Anything over 180/100

55
Q

HTN medication education

A

Take it at the same time everyday, do not skip doses, avoid alcohol, do not abruptly stop the pill, know what type of diuretic you are on (potassium sparing vs wasting)

56
Q

Education for HTN pts on a potassium sparing diuretic

A

Avoid salt substitutes and foods containing potassium
Bananas and white potatoes

57
Q

Education for HTN pts on a potassium wasting diuretics

A

Potassium supplements, eat potassium rich foods

58
Q

Reversible risk factors, another name is______

A

Modifiable risk factors

59
Q

Modifiable risk factors example

A

Diet, activity, lifestyle, smoking, alcohol

60
Q

Irreversible risk factors, another name is ________

A

Non-modifiable risk factors

61
Q

Non-modifiable risk factor examples

A

Age, gender, family history, ethnicity

62
Q

What is sensory overload

A

two or more stimulants occur simultaneously, overwhelming the client

63
Q

What is sensory deprivation

A

stimulants for the senses (sight, hearing, touch, etc,) are not present- pt begins to lose sensory function

64
Q

Sensory overload causes examples

A

lights,people, monitors, conversatoins, machines, TV, pictures, bedding

65
Q

Sensory deprivation causes examples

A

no pictures, magazines, color, human interaction, noise, light

66
Q

Nursing interventions for sensory overload

A

quiet environment(cluster care, limit visitors), low lighting, close door, tv off

67
Q

Nursing interventions for sensory deprivation

A

provide entertainment (TV, coloring, crosswords), allow visitors, pictures on walls, door open, check on pt and talk with them

68
Q

What are some care and safety measures that can be implemented for someone with sensory limitations or impariments?

A

Do not change the organization of the room , ensure the room is clutter free, arrange food in a clock arrangement on plate, ensure good lighting, accommodate to limitations

PCC 2 (3 decks)

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