WEEK 6 Flashcards
clinical judgment
the decision made regarding a course of action based on a critical analysis of data when nursing knowledge is applied to a clinical setting
what do sound clinical judgments help ensure?
safe care
high-quality care
client-centered care
communication
transfer of information
Shannon-Weaver communication model (1948)
sender
encoder
channel
decoder
receiver
noise
ABX model (Theodore Newcomb)
message sender
topic
message receiver
David K Berlo’s model
S-M-C-R model
sender
message
channel
reciever
define channel
method of medium used to deliver a message
what are the five levels of communication
emotional
energetic
verbal
auditory
physical
verbal and physical communication in nursing
use therapeutic communication with both verbal and nonverbal communication
auditory communication
what the receiver hears when the sender speaks a message.
included the speed and tone of voice the receiver perceives
emotional communication
A form of communication that expresses feelings and emotions.
energetic communication
The speaker’s presence or vibration that is expressed when communicating.
what are the four models of communication
verbal
nonverbal
electronic
written
verbal communication
commonly refers to oral communication. This mode can occur through face-to-face communications and via telephone
what communication style do baby boomers rely on
verbal to convey messages
nonverbal communication
body language. Actions such as eye contact, facial gestures, posture, and overall appearance send messages to the receiver in addition to what the sender is saying.
example of nonverbal communication
is the nurse placing the computer on wheels between them and the client as they ask questions. This blocks the ability of the nurse to make eye contact with the client, and the client may perceive this as the nurse not being compassionate or empathetic.
electronic communication
This mode includes email, texting, video conferencing, and social media. This technology can allow health care team members to communicate with each other and their clients more efficiently, but also can lead to privacy violations, mistakes from typographic errors, and distractions
written communication
includes electronic communication and can be in the form of a letter, handwritten or typed, or an email or computer-based post.
what does written communication lack?
nonverbal cues that face to face interaction possess, leading some users to view them as detached
what are the four communication styles
aggressive
assertive
passive
passive-aggressive
what is the most effective type of communication styles
assertive, due to its cooperative and straightforward style
passive communication
communication style have developed a pattern to avoid conflict, expressing feelings or opinions, or standing up for themselves when boundaries are crossed
Communication style that does not act or openly express discomfort.
assertive communication
viewed as most effective because they communicate clearly and honestly. They advocate for their opinions, rights, and needs without violating the rights of others.
what is assertive communication fundamental for?
good communication
mental health
healthy relationships
aggressive communication
developed a pattern of expression that is verbally, and sometimes physically, abusive, such as “This is all your fault. I will make you pay.”
uses “you” statements to blame others
passive aggressive communication
appear passive on the surface but are angry deep down
Communication style that finds indirect ways to protest or express unhappiness with a situation.
example of passive aggressive communication style
A nurse using an aggressive communication style might tell a new nurse, “It’s your fault the client fell. You never listen to me.”
nontherapeutic communication
Techniques that hinder communication, such as stating the person is wrong.
therapeutic communication
nurses use listening skills, empathy, and a desire to build a professional relationship with the client to provide holistic and patient-centered care.
therapeutic communication: open-ended questions
Questions that require more than a yes or no answer.
therapeutic communication: restating
A therapeutic communication technique where the receiver summarizes or paraphrase the message back to the sender to ensure understanding.
therapeutic communication: reflection
instead of repeating the client’s message back to them, the nurse attempts to reveal the client’s feelings behind the message.
most used when clients are asking nurses for advice
therapeutic communication: active listening
focusing on the client’s verbal and nonverbal cues
OARS
open-ended questions
affirmations (which are positive comments that help build the receiver’s confidence)
reflective listening
summarizing
TJC: National Patient Safety Goals (NPSG)
Goals designed to focus on client safety, safe and effective delivery of health care, and recommendations to avoid adverse outcomes.
NPSG: Identify Clients Correctly
The goal of identifying clients accurately has two components:
use two client identifiers
ensure that the medication, treatment, procedure, or care is intended for that specific client.
what are some client identifiers
the client’s name, date of birth, designated hospital number, telephone number, or alternative client-specific documentation.
NEED TWO
NPSG: Improve Staff Communication
critical results:
Lab or diagnostic procedure results that are outside the expected reference range and can be life-threatening or potentially fatal if not immediately improved.
NPSG: Use Medications Safely
This is a three-pronged goal:
label all medications, especially before a procedure
decrease the possibility of medication errors with anticoagulant (blood-thinning) medications
establish an accurate and current medications list for the client and have the provider reconcile the list with the new drugs ordered.
Using Medications Safely: Label all Medications
A medication should be discarded if it is found without a label on it, including the date and time it was mixed and the medication name and dose.
The nurse should never assume what the medication is.
Using Medications Safely: Decrease Errors Associated with Anticoagulant Medications
Pharmacists, providers, and nurses should review all of these elements. Clients should be informed of the risks and benefits of the medication, along with any precautions they need to take
Using Medications Safely: Reconcile the Client’s Medications
The process when the physician assesses the current home medications with the newly prescribed drugs. It must be completed on client admission, transfer, or discharge from the hospital.
NPSG: Use Alarms Safely
NPSG promotes using clinical alarm systems in health care settings. These audible alert devices, which are built into medical equipment, are intended to warn health care providers that a potentially serious event may be occurring
examples of clinical alarm systems
bed and chair alarms
feeding and IV infusion pumps
heart monitors
ventilators
NPSG: Prevent HAIs
main four:
CLABSIs
CAUTIs
VAPs
SSIs
how many people a year get HAIs
he Healthy People 2030 initiative reports that more than 500,000 persons acquire HAIs in health care facilities each year.
NPSG: Identify Client Safety Risks: Reduce the Risk of Suicide
This NPSG requires screening of clients who may be at risk for suicide or who have intentions of suicide. Clients who are at risk for suicide, as determined by the provider, are placed on round-the-clock surveillance while in a nonpsychiatric hospital
what is suicide ranked in numbers of deaths
10th leading cause of death in 2019 in USA
2nd leading cause of death in persons age 10 to 34 in USA
NPSG: Universal Protocol: Prevention of Adverse Events in Surgery
TJC mandates that a time-out—that is, a pause in all personnel activities within the operating or procedure room—take place before each surgery.
This brief suspension allows for the confirmation of the correct client, site, and procedure to be performed.
Safety: Infants and Preschools (0-4 Years)
is prone to burn injuries related to hot liquids or steam.
Preventive measures include keeping foods being cooked out of the reach of the child, setting water heaters no higher than 120°F (48.9°C), and ensuring homes have functional smoke and carbon dioxide alarms.
safety: school-age children (5-12 years)
sports injuries
safety: adolescents (12-19)
peer bullying and violence
safety: middle-aged adults
workplace accidents
safety: older adults
falls
R.A.C.E.
Rescue
Alarm
Contain
Extinguish
P.A.S.S.
Pull
Aim
Squeeze
Sweep
what 3 elements does fire need
oxygen
combustion material (wood, kerosene, alcohol)
heat
types of fire extinguishers
Class A: A water-based fire extinguisher for general combustible materials such as paper, wood, plastics, rubber, and cloth.
Class B: A carbon dioxide (CO2)–based fire extinguisher for oils, gasoline, paints, grease, and other caustic materials.
Class C: A dry chemical-based fire extinguisher specific for electrical fires, including those involving wiring, fuse boxes, computers, and other electrical devices.
Class D: A fire extinguisher for fires involving metals or flammable metal shavings from elements such as titanium, magnesium, potassium, and sodium.
Class K: A fire extinguisher specific for kitchen fires involving flammable oils and fats.
Class A, B, C: A multipurpose fire extinguisher that contain a dry chemical suitable for use on flammable materials and liquids or electric equipment.
What theory does the nursing school at Cumberlands use?
JEAN WATSONS THEORY OF HUMAN CARING
EXAM Q
communication styles by generations
gen Y: flexible, may use technology, frequent feedback
gen X: direct, to the point
silent gen: face to face, written, formal
gen X/post millennial: text/digital, short pieces of info, positive reinforcement
baby boomer: meeting face to face, sincere
what are the four main regions of the brain
cerebrum
cerebellum
diencephalon
brainstem
cerebral cortex
outer layer of the cerebrum
controls the perception of sensory information and process information to transfer it from short-term memory to long-term memory
brainstem
located at the base of the brain, consists of the midbrain, pons, and medulla oblongata.
midbrain
controls many of the motor functions.
diacenphalon
controls body temperature and the autonomic nervous system
located above the brainstem between the cerebral hemispheres and consists of the thalamus, hypothalamus, and pineal gland
thalamus
primary function is to process sensory information and regulate sleep.
Also development of dreams
hypothalamus
acts as the control center for the autonomic motor system.
It is responsible for releasing hormones and regulating the body’s temperature
suprachiasmatic nucleus
located inside of hypothalamus
assists in the regulation of the circadian rhythm.
pineal gland
produces melatonin, a sleep hormone.
two internal biological mechanisms
circadian rhythm
sleep-wake homeostasis
circadian rhythm
Natural internal process that regulates the sleep–wake cycle within a 24-hour period.
sleepy at night, awake in the morning
what does the circadian rhythm synchronize to?
environmental cues such as light and temperature; however, the body can generally maintain circadian rhythms without prompts
sleep-wake homeostasis
Assists the body to remember to sleep after a given time.
The level of sleep is also controlled by, and will deepen according to, the amount of sleep deprivation that a client experiences.
what are the main structures of the brain that regulate sleep?
hypothalamus (deep sleep)
suprachiasmatic nucleus (SCN) (controls a client’s behavioral rhythm directly from the eyes through light exposure)
brainstem (shift between wake and sleep) (pons and medulla oblongata influence REM)
thalamus (block out external distractions)
pineal gland (melatonin)
Stages of Sleep: Stage 1
wake stage/lightest stage of sleep
alpha and beta waves
normal breathing and skeletal muscle tone is present
can last 1-5 minutes and approx. 5% of total sleep cycle
alpha waves
electrical brain waves in the freq range of 8-12 hertz
when a person closes their eyes and become drowsy, that is alpha waves dominating beta waves
beta waves
electrical brain waves in the freq ranges of 12-30 hertz
Stages of Sleep: Stage 2
deeper sleep
sleep spindles
becomes challenging to wake client up in the stage
heart rate and temp decrease
50% of total sleep cycle
do the number of cycles increase with age (stage 2)
yes
sleep spindles (stage 2)
or K-complex electrical waveforms that trigger
the superior temporal gyri
anterior cingulate
insular cortices
the thalamus.
Stages of Sleep: Stage 3
deepest sleep
consists of delta waves
if awoken in stage 3, clients may have a mental cloudiness for 30-60 minutes
immune systems strengths, muscles/tissues/bones repair and regenerate
can last up to 40 mins
15% of total sleep time
do number of stage 3 cycles decrease with age?
yes
delta waves
electrical brain waves, which are slower frequency, higher-amplitude signals.
Stages of Sleep: Stage 4
REM, dreaming stage
looks like an awake stage of sleep on an EEG, however there is a loss of skeletal muscles tone
breathing is irregular and erratic, and the HR may be elevated
lasts about 10 and will become longer as the night progresses
typically begins after 90 mins of falling asleep
can last up to 1 hour
20-25% of total sleeping time
Sleep Patterns: Newborns and Infants
NREM and REM occur every 45-60 mins
mostly remain in stage 3
up until 3 months of age, approx. 50% is REM cycle
after 1 year, the infant begins to progress towards an adult pattern of sleep
Sleep Patterns: Adults
age 20-35
spend 2-5% of sleep in stage 1, 45-55% in stage 2, 10-20% in stage 3, and 20-25% in stage 4
occur approx. 4-5 times while the client is asleep
Sleep Patterns: Older Adults
65+
have a decrease in stage 3 and an increase in stage 2
wake up more freq and have longer to fall asleep
Recommended Hours of Sleep: Newborns (birth to 28 days)
14-17 hours
Recommended Hours of Sleep: Infants (1 month to 1 year)
12-15 hours
Recommended Hours of Sleep: Toddlers (1 year to 3 years)
11-14 hours
Recommended Hours of Sleep: Preschool (3-6 years)
10-13 hours
Recommended Hours of Sleep: School-Age Children (6-12)
9-11 hours
Recommended Hours of Sleep: Adolescents (12-20)
8-10 hours
Recommended Hours of Sleep: Young Adults (20-35)
7-9 hours
Recommended Hours of Sleep: Middle Adults (35-65)
7-9 hours
Recommended Hours of Sleep: Older Adults (65+)
7-8 hours
Sleep Deprivation
When the body does not meet its biological sleep requirement, either chronically or acutely.
What can sleep deprivation affect?
higher-order cognitive projects
impair judgment
decrease response time
trigger seizure disorders
migraines
tension headaches
high blood sugar in people with type 2 diabetes
obesity
keep naps what?
short and before 3pm
Sleep Disorders: Insomnia
ongoing ability to sleep despite having the opportunity to do so
Sleep Disorders: Apnea
condition in which there is an absence of inspiratory airflow for a minimum of 10 seconds
Sleep Disorders: Hypopnea
associated w/a decrease in O2 saturation and lasts 10 seconds or longer
Sleep Disorders: Obstructive sleep apnea (OSA)
related to the recurrent episodes of upper airway collapse and obstruction while sleeping combined with waking from sleep
Sleep Disorders: Narcolepsy
chronic sleep condition characterized by sudden sleepiness and sudden periods of sleep.
Sleep Disorders: Hypersomnia
disorder of excessive daytime fatigue without improvement after more sleep.
Sleep Disorders: Restless Leg Syndrome (RLS)
aka Willis-Ekbom disease
uncontrollable urge to move the legs during sleep.
how is obstructive sleep apnea diagnosed?
polysomnography
Which class of sleep medications is the most commonly prescribed?
Nonbenzodiazepine hypnotics (also known as the z-drugs) are the most commonly prescribed sleep medications
what is sleep essential for?
healing
EXAM Q
What year was The Joint Commission established?
1951
EXAM Q
is touch an effective technique?
yes
effective techniques for therapeutic communication
silence
active listening
presenting reality
asking questions
open-ended questions
clarifying techniques (restating, reflection, paraphrasing, exploring)
offering general leads, broad opening statements
showing acceptance and recongition
focusing
giving information
summarizing
offering self
TOUCH
sharing feelings
EXAM Q
why do older adults have an increased risk of falling?
decreased strength, impaired mobility and balance, improper use of mobility aids, unsafe clothing,
A nurse is caring for a client who has a history of falls. Which of the following actions is the nurse’s priority?
complete a fall risk assessment
what should clients who are at high risk for generalized seizures have?
a saline lock in place for immediate IV access
A nurse manager is reviewing with nurses on the unit in the care of a client who has had a seizure. Which of the following statements by a nurse requires further instruction?
“I will go to the nurse’s station for assisstance”
Never leave your client, use the call light to summon assistance
classes of fire extinguishers
class A: combustibles (paper wood rads, trash fires)
class B: flammable liquids or gases
class C: electrical fires
class D: metals/metal shavings
class K: kitchen fires (fats and oils)
Class A, B, C fire extinguishers
a multipurpose fire extinguisher that can be used for fires involving combustibles, flammable liquids, and electrical equipment.
A nurse observes smoke coming from under the door of the staff’s lounge. Which of the following actions is the nurse’s priority?
move all clients who are nearby
gen Y communication style preference
gen Y: flexible, may use technology, frequent feedback
gen X communication style preference
gen X: direct, to the point
silent gen communication style preference
silent gen: face to face, written, formal
gen Z/post millennial communication style preference
gen X/post millennial: text/digital, short pieces of info, positive reinforcement
baby boom generation communication style preference
baby boomer: meeting face to face, sincere
medical futility
doing treatments that are not helpful and will not extend a client’s life
narcolepsy (NT1) with cataplexy
caused by a lack of hypocretin
hypocretin is a hormone produced in the hypothalamus and is responsible for maintaining altertness
which part of brain TRANSMITS SENSORY DATA and include is used to develop dreams?
thalamus
fire-line sleep aid for older adults - medications?
controlled-release melatonin
potential adverse effect of OTC sleep aid medications
urinary retention
benefit of increased sleep that could prevent weight gain in someone who has insomnia
increased leptin production
what adverse effects of nonbenzodiazepine hypnotic
hallucinations
risk factor for developing obstructive sleep apnea
obesity
nurse is preparing to admin meds to a client. what is considered ototoxic?
loop diuretics
NSAIDS
aminoglycoside antibiotics
refraction test
preformed using lenses of various prescriptions strengths
diabetic neuropathy
inspect feet every day
wear close toed shoes
manage blood glucose
