Week 1; Concepts of Complexity

Question 1

DKA Review

Answer 1

Occurs with type I diabetes, on-diagnosed diabetes – undetected, 3 P’s (polyuria, polydipsia, polyphagia).
Can occur with Type II

Question 2

DKA causes

Answer 2

Stressful situation, skipping meals – “starvation mode” – starts burning fats, corticosteroids, infection, trauma, omission of insulin, medications that antagonize insulin

Question 3

DKA assessment findings

Answer 3

Kussmaul respirations – rapid deep breaths, lower CO2 (sign of metabolic acidosis), fruity breath, nausea, abdominal pain (frequent in pediatric patients), dehydration or electrolyte loss, polyuria, polydipsia, weight loss, dry skin, sunken eyes, lethargy, coma

Question 4

DKA vs HHS

Answer 4

DKA symptoms occur suddenly as opposed to HHS – occur gradually

Question 5

DKA lab findings

Answer 5

Serum glucose > 300 mg/dL or >200 mg/dL for pediatrics, positive urine ketones, serum pH <7.35, serum HCO3 <15 mEq/L, Ketones-positive, serum Na varies low, normal, or high, BUN >30 mg/dL, creatinine >1.5 mg/dL, serum potassium increased(mild); decreased (severe)

Question 6

DKA interventions

Answer 6

1. Correct Dehydration
2. glucose level
3. correct metabolic acidosis
4. electrolyte balance

Question 7

HHS (hyperosmolar hyperglycemic nonketotic state)

Answer 7

Results from a sustained osmotic diuresis. Serious, life-threatening, slow onset. Results in severe dehydration. Patient secretes just enough insulin to prevent
ketosis. EXTREME hyperglycemia – blood is
concentrated (hyperosmolarity). Mostly in Type II in pt with infection or older adult

Question 8

HHS causes

Answer 8

Kidney disease, MI, sepsis, pancreatitis, stroke, some medications-glucocorticoids, diuretics, phenytoin, beta blockers, and calcium channel blockers.

Question 9

HHS assessment findings

Answer 9

Polyuria, polydipsia, hypovolemia, dehydration, hypotension, tachycardia, hypoperfusion, weight loss, weakness, nausea/vomiting, abdominal pain, stupor, coma, seizures

Question 10

HHS interventions

Answer 10

Admit to ICU if blood glucose > 700 mg/dL
Establish, maintain ventilation
Correct shock with adequate IV fluids Normal saline is
preferred.
* 1liter per hour until central venous pressure begins to rise.
* Half-normal saline for others.
If client is comatose, NG suction
Maintain fluid volume
Administer insulin to reduce blood glucose
Assess mental status and consult physician if changes
occur.

Question 11

Fluid replacement therapy

Answer 11

IV fluids or blood: most effective treatment for
hypovolemic shock. Fluids also used to treat septic, neurogenic and anaphylactic shock. Fluids administered alone or in combination; crystalloid solutions, colloid solutions, blood and blood products are administered in massive amounts through two large-bore peripheral lines or a central line

Question 12

Hypovolemic shock review

Answer 12

Hypovolemic shock affects all body systems
* Effects vary according to age, general state of health, extent of injury or severity of illness, time before treatment is provided, rate of volume loss
* Manifestations result directly from decrease in blood volume, initiation of compensatory mechanisms
* Shock stage progresses with sustained loss of ≥100 mL

Question 13

Cardiogenic shock review

Answer 13

Cardiogenic shock occurs when heart’s pumping ability cannot maintain CO, perfusion. Caused by MI (most common cause), cardiac tamponade, restrictive pericarditis, cardiac arrest, dysrhythmias, pathologic changes in valves, cardiomyopathies, complications of cardiac surgery, electrolyte imbalances, drugs affecting cardiac muscle contractility, head injuries causing damage to cardioregulatory center

Question 14

Obstructive shock review

Answer 14

Caused by obstruction in heart, great vessels. Impedes venous return or prevents effective cardiac pumping. Caused by impaired diastolic filling, increased right ventricular afterload, increased left ventricular afterload. Manifestations result from decreased CO and BP → reduced tissue perfusion, cellular metabolism.

Question 15

Distributive shock (vasogenic shock)

Answer 15

Several types of shock resulting from widespread
vasodilation, decreased PVR. Blood volume does not change → relative hypovolemia

Question 16

Septic shock (septicemia)

Answer 16

Leading cause of death for patient in ICUs. Part of progressive syndrome: systemic inflammatory response
syndrome. Most often result of gram-negative bacterial infection. May also follow gram-positive Staphylococcus, Streptococcus infections

Question 17

Neurogenic shock

Answer 17

Parasympathetic overstimulation → sustained vasodilation
* Dramatic reduction in systemic PVR
* Causes: head injury or trauma to spinal cord, insulin reactions, CNS drugs, anesthesia, severe pain, exposure to heat

Question 18

S/S of shock

Answer 18

Signs of early shock may be nonspecific; as body compensates for hypotension, hypovolemia, signs of shock include: tachycardia, increased respiratory effort, decreased urine output, diaphoresis, drop in systolic BP, narrowing of pulse pressure, reduced cerebral blood flow → decreased LOC, progression to cardiopulmonary failure, death

Question 19

Shock treatment

Answer 19

ALL should receive oxygen
Also fluids (colloids) and drugs

Question 20

Complexity

Answer 20

Complexity theory, as a way of understanding how
nursing is organized and adapts. Related to the field of complexity science. The term complexity theory is often used interchangeably with other terms, most notably
complex adaptive systems.

Question 21

Complexity theory defined

Answer 21

Plsek1 defines complexity theory as ‘a collection of individual agents who are free to act in ways that are not totally predictable and whose actions are interconnected, such that one agent’s actions change the context for other agents.’

Question 22

Complexity theory use

Answer 22

Complexity science theory is a natural framework for
nursing educators and nurse leaders to use in
leading and solving complex, unpredictable
problems in highly complex organizations and
evolving health care systems.

Question 23

How complexity ties in with nursing

Answer 23

Nurses promote, restore, or maintain optimal health. Nurses must be able to apply developmental theory
and provide care appropriate to needs of patients. Nurses must understand and be able to apply
principles of SAFETY. Nurses must be able to understand cultural diversity and provide culturally sensitive care. Nurses must have knowledge, skills, and attitudes to be care coordinators, transition managers, caregivers, patient educators, leaders, and advocates for the patient and family

Question 24

Professional nursing concepts include

Answer 24

Patient-centered care, safety, teamwork and interprofessional collaboration, evidence-based practice, quality improvement, informatics and technology, clinical judgment, ethics, health care organizations, health care disparities

Question 25

Patient centered care attributes

Answer 25

Respect for patients’ values, preferences, and
expressed needs, coordination and integration of care, information, communication, and education, physical comfort, emotional support and alleviation of fear and anxiety, involvement of family and friends, transition and continuity, access to care

Question 26

Care coordination

Answer 26

Deliberate organization of and communication about
patient care activities. Takes place between two or more health care team members (including the patients). Facilitates appropriate, continuous health care to meet the patient’s needs
Case management; provides quality and cost-effective services and resources to achieve positive patient outcomes
Transition management; provides safe and seamless movement of patients among health care settings, health care providers, and the community for ongoing care to meet patient needs

Question 27

Interventions to Help Family Cope With Hospitalization

Answer 27

Provide written materials explaining the client’s diagnosis or condition, actively involve the family in team meetings, promptly follow up with family concerns or questions, encourage the family to go home and rest, encourage the family to call for updates when they cannot be present, suggest ideas for stress-reducing activities (e.g., walking, meditating), inform the family about on-site availability of a clergy member or chapel, encourage the family to participate in care activities as appropriate, keep the family informed of the client’s progress, help the family to identify sources of stress and develop strategies to work through and dissolve the root cause, provide anticipatory guidance regarding outcome and expectations for discharge

Question 28

Trauma informed nursing practice

Answer 28

Introduce Yourself and Your Role in Every Patient
Interaction, Use Open and Non-Threatening Body Positioning, provide Anticipatory Guidance, Ask Before Touching, Protect Patient Privacy, Provide Clear and Consistent Messaging About Services and Roles, Use Plain Language and Teach Back, Practice Universal Precautions

Question 29

Medication Reconciliation and Safety

Answer 29

Formal Evaluative Process in which patient’s
actual current medications are compared to his
or her prescribed medications at time of
admission, transfer, or discharge. Important to know if patient has seen different providers. Medication errors occur from multiple meds from multiple providers, duplications, omissions, contraindications. Discrepancies can cause negative outcomes

Question 30

Patient harm and errors generally occur as a result of:

Answer 30

Lack of clear or adequate communication, lack of attentiveness, monitoring, lack of clinical judgment, inadequate measure to prevent health complications, errors in med administration, errors in interpreting provider prescriptions, lack of professional accountability and patient advocacy, inability to carry out interventions in an appropriate and
timely manner, lack of mandatory reporting

Question 31

Culture

Answer 31

Purnell (2014) defined culture as “the totality of
socially transmitted behavior patterns, arts,
beliefs, values, customs, lifeways, and all other
products of human work and thought
characteristics of a population of people that
guides their world view and decision making”.

Question 32

Culture characteristics

Answer 32

Learned, taught, shared by its members, dynamic and adaptive, complex, diverse, exist at many levels, common beliefs and practices, provides identity

Question 33

Ethnicity

Answer 33

Members share a common social and cultural
heritage. May include race, but not the same as race.

Question 34

Race

Answer 34

Based on biological similarities. Strictly related to
biology such as skin color, blood type, or bone
structure. Page 313 gives examples.

Question 35

Religion

Answer 35

Ordered system of beliefs

Question 36

Ethnocentrism

Answer 36

Tendency to think your own group (cultural,
professional, ethnic, or social) is superior to
others and to view behaviors and beliefs that
differ greatly from your own as somehow wrong,
strange, or unenlightened. Exist in all groups, not just the majority group.

Question 37

Health care disparities

Answer 37

Health Care Disparities; differences in patient access to or availability of appropriate health care services, especially older adults, ethnic minorities, LGBTQ

Question 38

Culture universals vs culture specifics

Answer 38

Are values, beliefs, and practices that people from all cultures share vs values, beliefs, and
practices that are special or unique to a culture.

Question 39

Archetype vs sterotype

Answer 39

Archetypes are something recurrent, based
on facts. Stereotypes are widely held but oversimplified
beliefs that have no basis in fact.

Question 40

Nursing as a Subculture

Answer 40

Nursing is the largest subculture in health-
care culture. Nursing values include; silent suffering as a response to pain, caring, nursing autonomy, use of nursing process, knowledge, critical thinking

Question 41

Unconscious incompetence –

Answer 41

not being aware you lack knowledge about another culture

Question 42

Conscious incompetence-

Answer 42

being aware you lack knowledge about another culture

Question 43

Conscious competence –

Answer 43

learning about the client’s culture, verifying generalizations about the culture, and
providing culture specific interventions

Question 44

Unconscious competence –

Answer 44

automatically providing culturally congruent care to clients of divers cultures

Question 45

Barriers to culturally competent care

Answer 45

Bias, ethnocentrism, cultural stereotypes, prejudice, discrimination, racism, sexism, language barrier, street talk, slang, jargon, lack of knowledge, emotional responses, self-knowledge

Question 46

BALI acronym

Answer 46

Be aware of own cultural heritage
Appreciate that the client is unique; influenced, but not defined by his culture
Learn about the client’s cultural group
Incorporate the client’s cultural values/behaviors
into the care plan

Question 47

LIVE and LEARN acronym

Answer 47

Like
Inquire
Visit
Experience
Listen
Evaluate
Acknowledge
Recommend
Negotiate

Question 48

Culturally and Linguistically Appropriate Services Standards

Answer 48

Healthcare facilities must provide language
assistance services such as bilingual interpreters, bilingual staff, face to face interpretation by trained person or telephone interpreters. Healthcare interpreters should be used to obtain informed consent and to assist the patent to understand the treatment plan.

Question 49

Never Events –

Answer 49

serious reportable events
(foreign objects left in patients after surgery,
administering wrong type of blood, falls and
trauma, infections from urinary and IV catheters,
DVT)