Exam 5 Material Flashcards
Why is Patient education important?
- essential component of safe, patient-centered care
- standard for professional nursing practice
- falls within the scope of nursing practive
what do we teach?
- health analogies
-resortation of health - coping with impaired functions
- promotion of health and illness and prevention
The nurses role
- Determine ~ what pts/families need to know
- provide the time to teach
identify patients
exisiting knowledge
learning preferences
readiness to learn
Nursing goals
assist the pt
promote pt understanding
three domains of learning
Cognitive
affective
psychomotor
Cognitive learning
- requires thinking
- 1 on 1 or group
- intellectual behaviors
Affective learning
- expression of feelings
- attitudes, opinions, or values
- 1 on 1
- role play
psychomotor learning
- “hands on” skills
- Demostration
-Practice
Basic learning principles (4)
- stimulus to learn
- readiness to learn
- Ability to learn
- learning environment
Motivation to learn
Acts on or within a person to cause the person to behave in a particular way
Theory to learn
matches a persons learning needs
culture to learn
respect ps identity and needs
active participation to learn
implies an eagerness
Attentional Set
- mental and physically
- positive factors
- obstacles
Psychosocial adaption
assist the patient after an incident
Grieving
allows the patient
- accept the reality of their illness/injury
- new normal
Developmental capability
affects the persons ability to learn
The developmental stage of a child determines…
capability to learn
infant learning
hold infant firmly while smiling and speaking
toddler learning
use play to teach
preschooler learn
simple explanations and demostrations
school-age learn
psychomotor skills
discuss health problems
adolescent learn
use teaching as collaborative activity
allow to make decisions about health
Adults- self directed learn
critically think
direct own learning
adults- pt centered
collaborate with adults
young and middle-aged adults learn
-effects of health problem
- encourage participation
older adults learn
- teach when alert and rested
- discussion or activity
- individualize
phycial capability influences on learning
- level of personal involvement
- energy
- physical health
Neurosensory issues
- feel
- see
- hear
-grasp
health literacy affects the patients ability to
understand basic health care information
- read and write
conflicting schedules - teacher
nurses time
pt availablility
lack of space and privacy
teacher not seen as a
priority
Teaching tactics
entrusting
reinforcing
one to one
teacher presents to an indiviual patient
Group
effiecent ~ more then one student
Preparatory
provides inforamtion prior to a procedure
most effective when
the patient observes the nurse
Analogy
familiar images make complex ones understandable
Simulation
problem- solving, application, and thinking
Printed materials
patients literacy be assessed beforehand
Follow with reinforcement
- question and answer session
- discussion of the material
- printed materal
teaching strategies
-establish trust
- short sessions
teaching strategies are important why?
important to figure out at the beginning of the session
Behaviors
observe abd evaluate pt abilities to perform desired behaviors
Guildelines for older adults
only present most significant info
types of tubes
- NG tube
- PEG tube
- Button
closed system
Nutritional solution added during manufacturing
system cannot be opened
safely hang for 24-36hours
more common
open system
empty bag , can of nutrition to pour in bag
prepared by nurse at bedside
administered by enteral pump
types of infusions
continuous
cyclic
intermittent
bolus
contunuous nutrition
given over 24hour period using an enteral pump
- initial dose full strength at slow rate
-rate increased every 8-12 hours until goal reached
- HOB @ 30 degrees ALL TIMES
***risk for aspirations
Cyclic Nutrition
-given in less than 24 hours
- pt may eat during day
- HOB @ least 30 degrees
Intermittent Nutrition
- Begin at full strength with specified volume
- 5-8 feedings a day
- given over 30 mins via enteric pump or syringe
- GOAL** to provide needed calories and volume in 4-6 feedings
- keep HOB up at least 1 hour after each feeding
Bolus nutrition
Syringe is used to deliver forumla into stomach by gravity
- raising or lowering syringe regulates flow
- delivered more rapidily than intermittent feeding
- keep HOB 30 degree for at least 1 hour
- flush with 30ml of sterile water
Enteral Nutrition
high risk for
- Diarrhea
- N/V
- Gas/bloating/cramping
- constipation
- dehydration
- hyperglycemia
BIGGEST RISK *** ASPIRATION
signs of aspiration
- cough
- SOB
- Gurgling
- Raspy voice
what should you do if aspiration is suspected
** Stop the feeding**
make sure the bed is elevated
turn pt on their right side
notify doc
check placement with order
Assess before feeding - abdominal signs
- Distenstion
- Firm
- Tense
- Guarding
- Discomfort
Nausea
- antiemetics
- minimize narcotics
- check for constipation
- notify doc
emesis
hold feeding
check for constipation
notify doctor
Gastric residular checks in what pt populations?
- critically ill surgery pts
-critically ill trauma pts - head injury
- postop abdominal surgery
- Obtunded/vegetative state
Gastric residual checks - to dos
1st put pt on right side for 20mins
- elevation 30 degrees
discontinue after 48-72hrs if <500ml and no abdominal signs present
before proceeding with a feed
- assess bowel sounds , presentation of abdominal, correct label on enteral tube
- HOB @ 30 degrees or higher
- is prepared feeding room temp?
- is tubing primed?
Checking tube placement steps
- verify tube placement with xray
- aspirate to assess tube patency
- measure contents and return
- flush with 30mL sterile water
- Document findings
DO NOT PROCEED IF….
if > 500 mL residual
- return resdual and flush 30mL sterile water
- recheck in 4hrs
- if still > 500 mL, hold tube feedings
Gravity administration feedings
- ensure HOB 30 degrees
- Connect device and administer via gravity flow ~ slowly
- flush with 30mL sterile water
- keep HOB up at least 1 hour
