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CNOR > Individualized plans of care and expected outcomes > Flashcards

Individualized plans of care and expected outcomes Flashcards

1
Q

The AORN developed what to support perioperative nursing practice across the continuum?

A

a standardized nomenclature

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2
Q

What doe a nurse do as appropriate to influence patient outcomes?

A

the nurse selects PNDS data elements

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3
Q

What is an example of an outcome statement using the PNDS?

A

the patient will be free from signs of symptoms of surgical infection

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4
Q

When is an individualized plan of care created?

A

at the time of the pre-operative interview

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5
Q

What 3 things in the individualized plan of care based on?

A
  1. type of surgery to be performed
  2. the positioning needed to optimize the exposure of the surgical site
  3. specific needs associated with safety promotion
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6
Q

What are the 4 NANDA diagnoses?

A
  1. health promotion
  2. problem-focused
  3. risk
  4. syndrome
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7
Q

What were developed in 1982 and used to guide nurses and strengthen awareness related to the promotion of patient safety, improved patient outcomes, and quality of care

A

NANDA diagnoses

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8
Q

How does the national library of medicine define PNDS?

A

standardized nursing language (used) to support evidence-based perioperative nursing practice

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9
Q

What are the four main domains in the perioperative patient-focused model?

A
  1. behavioral responses relate to the patient’s behavioral response to perioperative care
  2. patient safety - promotion of patient safety in the surgical environment
  3. physiologic responses - patient’s physiologic response to the surgical intervention
  4. the health system - where the perioperative care is provided and the resources available
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10
Q

What is the goal of any plan of care?

A

ensuring safe patient care

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11
Q

What is the purpose of an individualized plan of care? and…

A

to identify desired outcomes and then selected nursing interventions that will help the patient achieve them

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12
Q

What are some individual variations related to the patient’s responses to surgery?

A
  1. age-specific needs
  2. cultural diversity
  3. legal and ethical issues
  4. any other special patient needs
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13
Q

What are goals also known as?

A

patient outcomes

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14
Q

What is the course of action also known as?

A

plan of care

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15
Q

What was initially developed for colorectal procedures, but we are now seeing in vascular, thoracic, and urologic procedures?

A

ERAS

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16
Q

What are 4 strategies that have been found to improve outcomes and reduce post complications?

A
  1. preoperative counseling, where patients take ownership and responsibility for their role in the health care team
  2. optimizing nutrition by limiting the amount of time the patient is NPO, avoiding intraoperative fluid overload, and aggressively treating postoperative N&V
  3. Standardizing analgesic and anesthetic regimens to include plans for multimodal pain management
  4. encouraging early mobilization to decrease the risk for postoperative complications (DVT and pneumonia
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17
Q

What does a plan of care encompass?? What 6 things?

A
  1. the patient’s anticipated physiologic responses
  2. the patient’s behavioral responses to the operative or invasive procedure
  3. the nursing interventions required to achieve desired patient outcomes
  4. specific patient considerations - age, diversity, DNR status
  5. perioperative safety considerations
  6. a mechanism for evaluating patient responses to the plan of care with ongoing updates
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18
Q

What are age-specific considerations for temperature in infants?

A

increased body surface-to weight ratio and thin layer of subcutaneous fat

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19
Q

What are age-specific considerations for temperature in older patients?

A

physiologic responses to hypothermia (shivering, vasoconstriction) may tax an already compromised cardiovascular system

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20
Q

what 3 things does the perioperative plan of care include to help support blood flow and oxygenation?

A
  1. supplemental oxygen
  2. maintaining normothermia
  3. ensuring adequate volume replacement
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21
Q

What puts older adults at an increased risk for altered tissue perfusion?

A

acute and chronic cardiovascular and respiratory conditions

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22
Q

what is one intervention that the RN can employ to help older adults who have acute and chronic cardiovascular and respiratory conditions?

A

pad the patient’s bony prominences to avoid excess pressure that compromises circulation and leads to pressure injury

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23
Q

Tissue that is not well oxygenated is at increased risk for what 2 things?

A
  1. infection
  2. delayed healing
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24
Q

What are 2 behavioral responses that have physiologic and psychological ramifications can influence surgical outcomes?

A

anxiety and stress

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25
Q

What 3 things can excessive anxiety do the patient?

A
  1. trigger the fight or flight response
  2. interfere with problem solving - which can affect judgment, concentration, and the ability to make sound decisions
  3. decrease immune response
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26
Q

During the perioperative period, underrated or unacknowledged anxiety may result in what?

A
  1. increased anesthesia induction time
  2. prolongation of the effects of medications
  3. increased length of stay
  4. increased pain with resulting increased need for analgesics
  5. increased risk of postoperative complications
27
Q

What are some examples of nonpharmacologic techniques we can use to help reduce anxiety?

A
  1. clear communication skills
  2. distraction techniques - humor and music
28
Q

Adolescents (ages 12-21) should be given as much what in both the preoperative interview and during any preoperative preparation of the surgical site?

A

privacy

29
Q

Even though parents or other responsible party may be responsible for signing the consent form, RN should do what for adolescents?

A

ask if he or she wants the parent present during the preoperative assessment

30
Q

What are adolescents more likely to experience intraoperatively?

A

emergence delirium

31
Q

The geriatric population’s normal aging processes, along with the presence of comorbidities, may inhibit what?

A

an older patient’s ability to react to signs and symptoms of stress

32
Q

What is one way to help manage a patient’s anxiety?

A

include family members, significant others, or the primary caregiver in the surgical decision-making team

33
Q

What are 2 known carcinogens in the OR?

A

formalin and ethylene oxide

34
Q

What 2 substances can cause chemical burns and eye damage?

A
  1. hydrogen peroxide
  2. glutaraldehyde
35
Q

Occupational exposure limits are regulated by who?

A

occupational safety and health administration (OSHA)

36
Q

What does OSHA regulations require?

A

require manufacturers to supply safety data sheets for all hazardous materials

37
Q

Radiation safety is based on what 3 tenets?

A
  1. time
  2. distance
  3. shielding
38
Q

What does the plan of care include for radiation hazards?

A

includes implementing steps to minimize exposure to radiation and potential tissue damage for both the patient and the surgical team

39
Q

What is the health care organization required to provide for both the patient and perioperative personnel for radiation?

A

appropriate shielding devices to protect against potential tissue injury

40
Q

What are the 3 parts of the fire triangle?

A
  1. ignition source
  2. an oxidizer
  3. fuel
41
Q

What are examples of an ignition source?

A

electrosurgical unit, laser

42
Q

What are examples of an oxidizer

A

oxygen and nitrous oxide

43
Q

What are examples of fuel?

A
  1. drapes
  2. sponges
  3. hair
44
Q

What is a prevention strategy for the use of electrosurgery?

A

store electrosurgical unit pencil in holster when not in use

45
Q

What is a prevention strategy for use of a laser?

A

place laser in standby mode when not in use

46
Q

What is a prevention strategy for fiber-optic light cable

A

do not leave cable on drapes when light source is on

47
Q

What is a prevention strategy for head, neck, and upper chest procedures

A

evaluate need for supplemental oxygen during local or moderate sedation procedures and titrate to patient needs

48
Q

What is a prevention strategy for drapes covering head?

A

concentration of oxygen

49
Q

What is a prevention strategy for flammable skin prep solutions?

A

prevent pooling of prep solution and allow to dry completely

49
Q

What is a prevention strategy for hair left at surgical site?

A

tie or braid hair at surgical site when appropriate or use a water-soluble gel to coat hair

50
Q

The RN should be prepared to do what 5 things for lasers?

A
  1. provide the correct laser-specific protective eyewear for patient and team
  2. control access to the OR by posting warning signs on all OR doors
  3. ensure the anesthesia professional has fire-resistant endotracheal tubes available for intubating patients undergoing procedures involving the upper respiratory tract
  4. Ensure that anodized instrumentation is used
  5. ensure that a smoke evacuator is used during the procedure
51
Q

Positioning a patient safely is based on what 4 things?ti

A
  1. the surgical being performed
  2. surgeon’s preference
  3. anesthesia professional’s access to the patient’s airway and IV lines
  4. patient’s unique physiologic conditions
52
Q

How are pressure injuries caused?

A

caused by…
1. inadequate tissue perfusion
2. tissue trauma

53
Q

Surgeries lasting longer than how many hours put patients at an increased risk for pressure injury development?

A

3 hours

54
Q

Why are patients older than 70 years at an increased risk for pressure injury development?

A

due to…
1. loss of subcutaneous tissue
2. restricted ROM
3. compromised circulation from underlying comorbidities

55
Q

In addition to providing direct patient care, who serve as a valuable source of education for the Periop team?

A

interdisciplinary team members

56
Q

What does the Federal patient self-determination act of 1990 include?

A

patients rights related to informed consent, living will, power of attorney for health care, do-not-resuscitate or allow-natural-death (AND) orders, and organ procurement

57
Q

What does competency in transcultural nursing theory include?

A

being sensitive to differences in self-care practices (i.e. the individual’s responsibility for health)

58
Q

true or false: self care practices such as pain relief measures and coping strategies should be incorporated into the patient-specific plan of care whenever feasible

A

true

59
Q

What are 2 things an RN can do to support positive outcomes?

A
  1. explain unfamiliar terms
  2. facilitate dialogue
60
Q

What is the AND order

A

a physician-initiated directive that provides patients and families an opportunity to make proactive end-of-life decisions regarding what options are desired (fluids, meds, nutrition)

61
Q

What is important to remember when a DNR order is suspended or modified during the perioperative period?

A

a specific time for reinstating the order must be identified and documented

62
Q

How do the AND and DNR orders differ?

A

DNR specifies the actions not to take (CPR)

63
Q
A

CNOR (12 decks)

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