Exam 4 Fundamentals Flashcards
examples of therapeutic vs. non therapeutic non-verbal communication
therapeutic- head nodding, eye contact, face the pt, silence, active listening, touch, empathy (understand the pt)
non therapeutic- hands on hips, arms crossed, invading their personal space, bad facial expressions, personal opinions, false reassurance, sympathy (sorrow or pity for a pt)
how to talk to a pt that is hearing impaired
-talk in a normal tone, speak a little more slowly but not excessively slow
-let them see your lips! speak clearly & at eye level
-well lit, quiet room w/ no distractions
-provide interpreter if asked
-keep it short and simple, one question at a time
-give them time to ask questions
model used for active listening
SURETY
Sit at angle facing pt
Uncross legs/arms
Relax
Eye contact
Touch
Your intuition
how to talk to unconscious pt
-say their name during interactions
-communicate verbally & by touch
-speak to pt as if they can hear
-explain all procedures
-provide orientation to pt, place, time
-avoid talking about the pt to others in front of them
***hearing is the last thing to go!
how to talk to a pt
-simple short sentences
-give one step at a time
-non medical language
-refer to the same body part names they use as well as the proper term
never ask a pt this (therapeutic communication)
never ask a pt “why”
.. instead, say “can you tell me the reason you do this…” for example
open ended questions, avoid yes/no questions
therapeutic communication
this is a great question to ask your pt
“how dow that make you feel?”
**allow pts to express their feelings/share their concerns.
SBAR (communication tool)
Situation
Background
Assessment
Recommendation
what is an advantage of SBAR communication tool?
-you don’t miss any information in shift report, very detailed.
-reduces med errors & erros
-reduces loss of information
**be clear and concise!
difference between report to provider vs night shift nurse
provider- very specific to the problem
nurse- all details
how to make an environment more inducing to learn
-quiet, free of distractions
-normal comfortable temp
-well it room
-make sure pt is comfortable (ex: not in any pain)
first thing to teach a pt when teaching them about a dressing change
Wash their hands FIRST!
then remove old dressing
then clean it
then apply new dressing
what are the 3 teaching methods based on domains of learning
- cognitive (occurs when an individual gains info to further develop intellectual abilities, mental capacities, understanding, & thinking processes)
- affective (deals w/ learning how to express feelings & emotions & to develop values, attitudes, beliefs needed toward improving health)
- psychomotor (involves the development of manual or physical skills, such as leaning how to walk or how to type on a computer)
which type of teaching method has to do with demonstration, practice, returning demonstration, independent projects/games
psychomotor
which type of teaching method has to do with group discussion, role play, one on one discussion
Affective
which type of teaching method has to do with one on one discussion, group discussion, lecture, role play, independent project/field experience
cognitive
what teaching method occurs when an individual gains info to further develop intellectual abilities, mental capacities, understanding, & thinking processes
cognitive
what teaching method involves the development of manual or physical skills, such as leaning how to walk or how to type on a computer
pyschomotor
what teaching method deals w/ learning how to express feelings & emotions & to develop values, attitudes, beliefs needed toward improving health
affective
a pt demonstrating how to give themselves insulin is an example of what?
psychomotor teaching method
what type of teaching method is bloom’s taxonomy?
cognitive
this involves 6 cognitive behaviors in a hierarchy that increase in complexity.
**used to assess learning at a variety of cognitive levels & strategies to promote higher order thought in students by building on lower level cognitive skills.
Bloom’s taxonomy
this is the highest level of cognitive domain in Bloom’s taxonomy, used to be synthesis before it was revived to the newest Bloom’s taxonomy
*give example as well!
create
ex: pt will create a meal that will follow their new diet (nutrition)
order of bloom’s taxonomy starting from bottom of the pyramid
(bottom) Remember, Understand, Apply, Analyze, Evaluate, Create (top of pyramid)
what is the purpose of client education?
to prevent disease and help promotion/coping
what is the first part of the teaching process?
Assess the pt’s physical & emotional needs aka their baseline.
THEN plan goals & evaluate the effectiveness of their learning rate aka how much they retained
we do this to evaluate our pt’s learning
Teach back- we have the pt teach us back verbally how to do the task
& return demonstration where the pt physically does the task in front of you.
having the pt verbalizing the s/s of infection is an example of what?
teach back!
When is teaching most effective?
when you’re responding to the learners needs
what to do if you can’t read handwritten provider’s orders or if you don’t understand the order
call provider to clarify
this is when most of the medication is in your system
the peak
this is when the least amount of medication is in your system
trough, so it’s time for the next dose
why do we take peaks & troughs?
to make sure medication is at a constant blood level within a safe, therapeutic range
when do we check a pt’s trough level?
immediately before the next dose (about 30 mins)
when do we check for a peak of the medication?
it varies, specific to the medication
what level of bloom’s taxonomy is the basic level where one recognizes & recalls facts, pt recalls dates
Remember
what level of bloom’s taxonomy is understanding what the facts mean, the 2nd level
Understand
what level of bloom’s taxonomy is applying the facts, rules, concepts, & ideas… the 3rd level
Apply
what level of bloom’s taxonomy is breaking down information into component parts, the 4th level
Analyze
what level of bloom’s taxonomy is judging the value of information or ideas, the 5th level
Evaluate
what level of bloom’s taxonomy is combining parts to make a new whole, the 6th / highest level
create
side effect vs adverse effect of meds
side effect: predictable/expected from meds (n/v, diarrhea, dizziness, constipation)
adverse effect: unpredictable/unexpected from the meds (rash, anaphylaxis)
this is the opposite of what you expect out of medication, kids are most susceptible to this
ex: child takes Benadryl (antihistamine) which is supposed to make them sleepy, but becomes hyper instead
idiosyncratic effect
this is when two medications are taken together and the effect is greater (heightened) than when taken 1 med separately
synergistic effect
if the wrong dose is ordered & the nurse gives the medication, who is responsible?
the nurse bc she didn’t ask for clarification from the provider
what do you do if a pt refuses a med?
document it, find out why they don’t want to take it (don’t ask why!!! Say “tell me the reason…”
notify the provider depending on the med (ex: if it’s a bp med then notify, if it’s a vitamin then don’t notify provider)
what would increase our pt’s risk of med toxicity?
if the pt has any renal or haptic insufficiency / problems
**kidney disease is a concern bc they can’t excrete the med so all the meds build up in their system
what to do with a med that the pt refuses to make?
discard it rather than returning it to the original container (unit-dose meds can be saved if they aren’t opened)
** If pt refuses opioid or any controlled substance, follow proper agency procedure by having someone else witness the “wasted” medication.
when does a pt need to eat if getting insulin
pt needs to eat within 15-30 mins after taking insulin
(Aspart = rapid acting, “get your ass parts moving!”)
what are the 7 rights of medication administration?
- right med
- right dose
- right pt
- right route
- right time
- right documentation
- right indication
what to teach a pt about insulin?
make sure to rotate site of injection!
what is alternative medication besides pharmacology?
-herbals / supplements
-Massage, chiropractor, acupuncture, reiki, meditation & breathing, pilates/yoga, art music, biofeedback, guided imagery, dance, tai chi, cupping, moxibustion (burning moxi)
what is the herbal medication that can interfere with Coumadin (warfarin)?
what does the med do?
Ginseng (herbal that lowers blood sugar, cholesterol, stress)
what is the principle behind therapeutic touch?
energy of provider brings positive influence into the pt’s energy field
**use a simple touch but make sure it’s ok to touch them .. hand on their hand or hand on their shoulder & listen to what they have to say
traditional Chinese medicine
yin & yang (opposing yet complementary phenomena that exist in a state of dynamic equilibrium (ex: night/day, hot/cold, and shady/sunny)
cold, shade, inhibition, inner part of body (viscera, liver, heart, spleen, lung, kidney)
Yin
fire, light, and excitement, outer part of body (bowels, stomach, and bladder)
Yang
what do practitioners believe when it comes to traditional Chinese medicine yin/yang
they believe disease occurs with an imbalance in the opposites
What is the difference between herbs/supplements vs pharmacological meds?
herbs/supplements are NOT FDA regulated and NOT FDA approved.. so herbals are controversial (you can look to see if it’s tested by a third party to make sure it has correct amount in it)
evaluate effectiveness of relaxation techniques
-lowered HR, RR, BP
-decreased muscle tension
-increased alpha brain activity
-increased peripheral skin temperature
-reduced neural impulses sent to brain (decreased activity of brain & other body systems)
what type of pain is sudden, short duration
(ex: incisional pain after surgery, acute injury, disease; maybe
worse when sitting up vs laying down)
acute/transient pain
what type of pain lasts longer than 3-6 months; always there/doesn’t go away
(ex: back pain from an car accident)
chronic/persistent non cancerous pain
what type of pain occurs sporadically over extended time period
(ex: migraines, arthritis)
chronic episodic pain
what type of pain has no identifiable physical or psychological cause
(ex: complex regional pain syndrome (CRPS)
*might be called somatic pain in psych pts
idiopathic pain
type of pain usually caused by tumor progression, invasive procedures, toxicities of chemotherapy, infection, and physical limitations
cancer pain
what type of data is pain?
subjective! bc nobody has the same pain
how to assess pain
scale 0-10, called Wong-Baker FACES (provides a pictorial representation of pain intensity, usually used w/ kids)
how to assess pain in nonverbal pts
FLACC Scale (Face, legs, activity, cry, consolability)
who can push a PCA pump?
only the patient (watch RR if pt has opioids in pump)
what do you monitor if pt has an epidural?
RR is priority!!!! also HR.
what is a non pharmacological that you can use for back pain?
heat, ice, TENS unit (electrical stimulator), relaxation
**adjuvants are pharmacological meds to give w/ main meds to increase the effect aka a synergistic effect
what do you do if you’re giving a pt morphine?
assess the pt before & after med, check vitals! Hold the morphine if RR is 10… normal RR is 12-20.
what are modifiable contributors to pain
attention, fear, fatigue, anxiety, coping style
what diet will a pt without teeth be on?
mechanical soft diet
what diet will a pt that is pregnant with no allergies be on?
regular diet
what diet will the pt be on with constipation and high blood pressure?
high fiber diet
symptoms of malnutrition?
nails will be spoon shaped (koilonychia), brittle, ridged
hair will be stringy, dull, brittle, dry, thin, sparse, depigmented
lips will be dry, cracked
A pt this is on this diet could have potential nutritional deficit of protein
vegan or vegetarian diet
what is the purpose of choose my plate
it’s a basic food guide to make healthy, balanced food choices
how to tell a blind pt to feed themself?
use clock face method, describe where the food is at on the plate according to a clock
what is enteral nutrition (feeding)
Receive formula via the nasoenteral route (nasogastric, nasoduodenal, and nasojejunal) or
through gastric (GI) tubes inserted into the stomach
** Parenteral nutrition (TPN) = feeding intravenously (through a vein). “Parenteral” means “outside of the digestive tract
cultural/religious dietary restrictions for muslims
-no pork
-no alcohol
-Ramadan fasting sunrise to sunset for a month; Ritualized methods of animal slaughter required for meat ingestion
cultural/religious dietary restrictions for judaism (jewish)
-no pork
-no predatory fowl
-no shellfish (eat only fish w/ scales)
-no rare meats, blood (blood sausage)
-no mixing of milk/dairy products w/ meat dishes
-must adhere to kosher food preparation methods
-24 hr fasting of Yom Kippur, a day of atonement
-no leavened bread eaten during passover (8 days)
-no cooking on the sabbath from sundown Friday to sundown