TEST 1 Flashcards
NURSING OR MEDICINE?
Determines responses to health problems, level of wellness, and need for assistance
NURSING
NURSING OR MEDICINE?
Provides physical care, emotional care, teaching, guidance, and counselling
NURSING
NURSING OR MEDICINE?
Interventions aimed at prevention and assisting the client to meet his or her own needs
NURSING
NURSING OR MEDICINE?
Determines etiology of illness or injury
MEDICINE
NURSING OR MEDICINE?
Provides medical treatments and surgery
MEDICINE
NURSING OR MEDICINE?
Interventions aimed at preventing and curing injury or illness
MEDICINE
WHAT NURSING ROLE?
- compassionate, understanding, caring, empathetic
- offer skilled care to those recuperating from illness or injury
- alleviation of suffering through the diagnosis and treatment of human response
- prevention of illness and injury
- support patients at critical times
CAREGIVER
WHAT NURSING ROLE?
- daily care
- comprehensive care: complete care looking at potential complications
- collaborative care: working with other health professions
- requires critical thinking
CAREGIVER
WHAT NURSING ROLE?
- informed, communicative, patient, empathetic
- teach patients so that they can make informed decisions
- protection, promotion, and optimization of health and abilities
- and help them navigate the increasingly complex health care system
EDUCATOR
WHAT NURSING ROLE?
- requires effective communicative, assertion skills
- advocate for patients’ rights
- advocacy in the care of individuals, families, communities, and populations
- and help them navigate the increasingly complex health care system
- advocate for selves & peers
ADVOCATE
WHAT NURSING ROLE?
- requires good delegator, diplomatic, problem-solving skills
- policy development
LEADER OR MANAGER
WHAT NURSING ROLE?
nursing practice is dynamic and responds to increasing knowledge generated through research, reflection, and scientific discovery.
RESEARCHER
WHAT IS THE NURSING PROCESS?
ADPIE
ASSESS DIAGNOSE PLAN IMPLEMENT EVALUATE
WHAT PART OF THE NURSING PROCESS?
involves collecting subjective and objective information about the client
ASSESS
WHAT PART OF THE NURSING PROCESS?
analyzing the assessment data, drawing conclusions from the information, and labelling the human response
DIAGNOSE
WHAT PART OF THE NURSING PROCESS?
consists of setting goals and expected outcomes with the client and, when feasible, the client’s family and determining strategies for accomplishing the goals
PLANNING
WHAT PART OF THE NURSING PROCESS?
involves the use of nursing interventions to activate the plan. The nurse also promotes self-care and family involvement, where appropriate.
IMPLEMENT
WHAT PART OF THE NURSING PROCESS?
an extremely important part of the nursing process that is too often not addressed sufficiently
EVALUATE
WHAT PART OF THE NURSING PROCESS?
the nurse first determines if the identified outcomes have been met
EVALUATE
The NANDA list of accepted ________ _________ has been organized using a modification of Gordon’s (2006) functional health patterns. This framework is useful to analyze data to formulate actual nursing diagnoses, as well as nursing diagnoses for which the client is at risk.
nursing diagnoses
In the nursing diagnose, clinically relevant cues are clustered into functional ___________ ____________
health patterns
The two main purposes of NANDA are:
- to develop a diagnostic classification system (taxonomy)
2. to gather, identify, and standardize nursing diagnoses
ACUTE OR CHRONIC?
- is typically characterized by a sudden onset, with signs and symptoms related to the disease process itself.
- signs are typically objective manifestations of a condition, whereas symptoms refer to the subjective reports of the client.
- illness ends in a relatively short time, sometimes in recovery and sometimes in death
ACUTE
The simultaneous occurrence of several chronic medical conditions in the same person.
Multimorbidity
Having multiple chronic medical conditions is associated with many negative outcomes: clients have decreased quality of life, psychological distress, longer hospital stays, more postoperative complications, a higher cost of care, and higher mortality.
Multimorbidity
an increase in the seriousness of a disease or disorder as marked by greater intensity in the signs or symptoms of the patient being treated.
Exacerbation
What factors can contribute to and individual’s susceptibility to chronic illness
The key determinants of health are also critical considerations in the development of chronic illness.
What factors can contribute to and individual’s susceptibility to chronic illness
- Lifestyle factors such as substance use and misuse and high-risk activities can be harmful to a person’s long-term health.
- influence of social, economic, and environmental factors on the decisions people make about their health.
Modifiable OR non-modifiable risk factors to chronic illness?
age, sex, and genetic makeup
NONMODIFIABLE
Modifiable OR non-modifiable risk factors to chronic illness?
Cultural and environmental risk factors, such as air pollution, may play a significant role in the development of chronic illness, and may be modifiable in some cases.
MODIFIABLE
Objective manifestations of a condition
SIGN
The subjective reports of the client
SYMPTOM
PREOPERATIVE NURSING ACTIONS
- final preoperative teaching, assessment, and communication of pertinent findings, and ensuring that all preoperative preparation orders have been completed and that records and reports are present and complete to accompany the client to the OR.
- verify the presence of a signed operative consent, laboratory data, a history and PE report, a record of any consultations, baseline vital signs, and nurses’ notes.
if the anxiety level is extremely high, cognition, decision making, and coping abilities are ___________.
diminished
HOW CAN The nurse decrease some PREOPERATIVE anxiety for the client?
by providing information about what can be expected
WHAT SHOULD THE NURSE DO IF A PATIENT’S PREOPERATIVE ANXIETY IS EXCESSIVE?
The surgeon should be informed
Discharge planning considerations during the preoperative period
Consideration of family support is important with the older adult. With the increase in outpatient surgical procedures and shorter postoperative hospitalization, family support is an important consideration in the continuity of care for the older client.
information required during the preoperative interview
- Determine the psychological status of the client in order to reinforce coping strategies for undergoing the proposed surgery.
- Determine physiological factors related and unrelated to the surgical procedure that may contribute to operative risk factors.
- Establish baseline data for comparison in the intraoperative and postoperative periods.
- Identify prescription medications and over-the-counter drugs and herbs that have been taken by the client that may affect the surgical outcome.
- Ensure that the results of all preoperative laboratory and diagnostic tests are documented and communicated to appropriate personnel.
- Identify cultural and ethnic factors that may affect the surgical experience.
- Determine if the client has received adequate information from the surgeon to make an informed decision to have surgery, and ensure that the consent form is signed.
- Identify any pyschosocial needs of the client, and assess the client’s ability to cope with stressors and change to lifestyle. Ensure that the client has supports in place for the postoperative period.
Preoperative nursing assessment
- Determine the client’s psychological and physiological factors that may contribute to operative risk factors
- Establish baseline data
- Identify and document the surgical site
- Identify prescription and over-the-counter (OTC) drugs and herbal products
- Confirm laboratory results
- Note cultural and ethnic factors that may affect the surgical experience
- Validate that the consent form has been signed and witnessed
Common fears associated with surgery include:
the potential for death, permanent disability resulting from surgery, pain, change in body image, or results of a diagnostic procedure.
Before nonemergency surgery can be legally performed, the client must sign a voluntary and informed consent in the presence of a witness.
INFORMED CONSENT
an active, shared decision-making process between the provider and the recipient of care
that protects the client, the surgeon, and the hospital and its employees.
INFORMED CONSENT
3 conditions must be met for consent to be valid.
- must be adequate disclosure of the diagnosis; the nature and purpose of the proposed treatment; the risks and consequences of the proposed treatment; the probability of a successful outcome; the availability, the benefits, and the risks of alternative treatments; and the prognosis if treatment is not instituted.
- the client must demonstrate clear understanding and comprehension of the information being provided. Because preoperative drugs may cloud a client’s comprehension, the operative consent must be signed before any preoperative medication is given.
- the recipient of care must give consent voluntarily. The client must not be persuaded or coerced in any way to undergo the procedure
3 exceptional circumstances for obtaining consent in an emergency situation include:
- when the client exhibits a life- or health-threatening episode,
- when treatment cannot be delayed without endangering the life or health of the client, and
- when the client is unable to consent for the procedure because of circumstances beyond his or her control.
Preoperative teaching involves 3 types of information:
sensory, process, and procedural.
CONSIDERATIONS FOR PREOPERATIVE TEACHING: Different clients, with varying cultures, backgrounds, and experiences, may want ___________ types of information.
different
CONSIDERATIONS FOR PREOPERATIVE TEACHING: DOCUMENTATION
All teaching should be documented in the client’s medical record.
CONSIDERATIONS FOR PREOPERATIVE TEACHING: 3 POST-OPERATIVE EXERCISES
- DB&C
- REPOSITIONING
- LEG ROM
CONSIDERATIONS FOR PREOPERATIVE TEACHING:
3 CONSIDERATIONS FOR NUTRITION
- Most surgeries require NPO after midnight
- Increase diet slowly
- Nausea is common
CONSIDERATIONS FOR PREOPERATIVE TEACHING: AMBULATION
EARLY AMBULATION IS IMPORTANT AND HELPS PREVENT DVT
CONSIDERATIONS FOR PREOPERATIVE TEACHING: MEDICATION
Stop taking prescribed medications, OTC medications, and herbal remedies as suggested by the physician, anaesthesiologist, or surgeon
Types of control measures and purpose of those measures in the OR
- Filters and controlled airflow in the ventilating systems provide dust control
- Positive air pressure in the rooms prevents air from entering the OR from the halls and corridors
- The functional design facilitates the practice of aseptic technique by the OR team
- The temperature is controlled to remain between 20°C and 24°C & humidity is regulated at 30 to 60% to facilitate client comfort under the surgical drapes, team comfort during the procedure, and an environment that is unfavourable to bacterial incubation and growth
- There should also be proper ventilation in each room to provide both physical comfort and for proper air exchange, which helps remove toxic fumes and anaesthetic gas fumes
- The privacy of the client is achieved by restricting access by unnecessary hospital personnel and to visitors.
OR aseptic considerations
- Supplies should be opened as close as possible to the surgery start time.
- Each package should be checked for wrapper integrity and changed chemical indicators (both external and internal).
- The contents of any package with questionable wrappers or indicators should be considered unsterile.
- Fabric, plastic, or items wrapped in paper or plastic that are dropped on the floor should be considered unsterile.
- All materials that enter the sterile field must be sterile.
- If a sterile item comes in contact with an unsterile item, it is contaminated.
- If an item is contaminated before passing it to the scrub nurse, it should immediately be discarded.
- Sterile team members must wear only sterile gowns and gloves. Once dressed for the procedure, they should recognize that the only parts of the gown considered sterile are the front from chest to table level and the sleeves to two inches above the elbow.
- A wide margin of safety must be maintained between the sterile and the unsterile fields.
- Tables are considered sterile only at tabletop level; items extending beneath this level are considered contaminated.
- The edges of a sterile package are considered contaminated once the package has been opened.
- Bacteria travel on airborne particles and will enter the sterile field with excessive air movements and currents.
- Bacteria travel by capillary action through moist fabrics, and contamination occurs.
- Bacteria harbour on the client’s and the team members’ hair, skin, and respiratory tracts and must be confined by appropriate attire.
Identification process for OR:
Asking the client to state:
- her or his name
- the surgeon’s name
- the operative procedure and location.
A rare metabolic disease characterized by hyperthermia with rigidity of skeletal muscles that can result in death.
Malignant hyperthermia
The choice of discharge site is based on:
- client acuity,
- access to follow-up care,
- potential for postoperative complications.
specifically an arterial oxygen tension (PaO2) of less than 60 mm Hg, is characterized by a variety of nonspecific clinical signs and symptoms, ranging from agitation to somnolence, hypertension to hypotension, and tachycardia to bradycardia.
- Hypoxemia,
- The most common cause of postoperative hypoxemia is _____________, which occurs as a result of retained secretions or decreased respiratory excursion.
atelectasis
- Appropriate postoperative positions for recovery:
- the unconscious client is positioned in a lateral “recovery” position (keeps the airway open and reduces the risk of aspiration if vomiting occurs)
- Once conscious, the client is usually returned to a supine position with the head of the bed elevated (maximizes expansion of the thorax by decreasing the pressure of the abdominal contents on the diaphragm)
