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NUR150 > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

What are some techniques for effective collaboration among team members? (3)

A

Closed-loop: sender and receiver confirm the info is correct

Readback: reading back the info to the sender to make sure there are no misunderstandings

SBAR: situation, background, assessment, recommendation

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2
Q

What are some of the characteristics related to professionalism? (8) Can you describe the three most important?

A

Knowledge: theoretical, practical, and clinical; EBP; sharing knowledge with others

Autonomy: working independently, being aware of barriers to autonomy and eliminating them

Advocacy: assisting pts with their learning needs and being knowledgeable about procedure and policies, concern for the patient’s welfare

Accountability
Honesty
Integrity
Respectful
Ethics and Values
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3
Q

What is civility?

A

Civility is an ethical code that most people live by, polite act.

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4
Q

What are some examples of incivility or bullying?

A

humiliation, sabotage, withholding information, excluding others, unfair assignments, or downplaying accomplishments, damaging professional identity, limiting career opportunities

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5
Q

What are three types of surgery?

A

Elective (planned)
Emergency (urgency)
Ambulatory (same day-OP)

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6
Q

What are the components of the assessment of a preoperative patient? (7)

A 
Preop Interview (patient hx)
Psychosocial Assessment (anxiety/fears)
Past Medical hx
Medications
Herb Products
Allergies
Review of Systems
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7
Q

When should anticoagulants be discontinued? ASA?

A

anticoagulants- hold 7-10 days prior to surgery

aspirin- hold 2 days prior to surgery

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8
Q

What common pre-op teaching does the nurse give to the preop patient? (5)

A
  • deep breathing
  • coughing
  • early ambulation
  • splinting incision
  • incentive spirometry
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9
Q

What needs to happen in order to have informed consent? (5)

A
  • surgeon gets it, NOT nurse
  • disclosure of dx, risks, procedure, outcomes
  • pt must be sound of mind and not under sedation
  • must be voluntarily signed
  • must be signed in the presence of a witness
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10
Q

What is the one exception to getting an informed consent?

A

If there is a threat to the patients life and the patient or legally authorized person is unavailable

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11
Q

What is on a typical preop checklist? (10)

A
  • informed consent
  • H&P
  • diagnostic tests
  • patient allergies
  • ID band in place
  • marked surgical site
  • NPO
  • voided before preop meds
  • baseline vital signs obtained
  • nail polish, dentures, and jewelry removed
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12
Q

What are the typical activities a UAP can perform?

A

routine VS (stable pts)
feeding
ambulating stable patients
bathing and hygiene

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13
Q

What are the five rights of delegation?

A 
right task
right circumstances
right person
right directions and communication
right supervision and evaluation
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14
Q

What are some of the preoperative meds that are often prescribed? (5)

A

benzodiazapine- reduce anxiety, induce sedation

anticholinergic- reduce oral and respiratory secretions

opioids- reduce pain during preop procedures

antiemetics- decrease N&V

antibiotics- prevent postop infections

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15
Q

What are the three areas of the surgery department?

A

Unrestricted- street clothes can speak with surgical attire (holding area, nursing station, staff locker room)

Semirestricted- surgical attire and head and facial hair covering is required

Restricted- surgical attire, head and facial hair covered and a mask

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16
Q

What are a few (4) of the activities of the scrub nurse?

A
  • prepares the OR
  • hands supplies
  • keeps counts of sponges and needles
  • monitors aseptic technique of self and others
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17
Q

What are a few (4) of the activities of the circulating nurse?

A
  • documents during the procedure fluid volume loss, sponge count, drugs given
  • prepares lab samples
  • coordinates with the blood bank as needed
  • gives handoff report to the PACU nurse
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18
Q

What is done during a surgical time-out?

A

STOP AND VERIFY

  • patient ID
  • consent
  • procedure
  • site
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19
Q

What is moderate sedation used for?

A

procedures done outside of the OR, *NO ACP PRESENT

ex: reduction of dislocated joint

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20
Q

What is monitored anesthesia care used for?

A

diagnostic or therapeutic procedures done in OR outside of OR

ex: colonoscopy, eye surgery

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21
Q

What is general anesthesia used for?

A

surgical procedures of long duration, needing muscle relaxation, require uncomfortable positioning, or require control of ventilation

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22
Q

What is local vs regional anesthesia?

A

local: topical, nebulized, injected
regional: peripheral nerve block, spinal, epidural

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23
Q

What is a dissociative anesthetic?

A

Ketamine- may cause hallucinations or nightmares (treat with a benzodiazepine if these symptoms occur)

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24
Q

What is MH and how do we treat it?

A

Malignant Hyperthermia (MH) can be caused from anesthetic agents.
Symptoms: hyperthermia, muscle rigidity, tachycardia, tachypnea
Treatment: Dantrolene

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25
How do we assess airway on the postop patient in the PACU? (3)
- patency - laryngeal mask airway - endotracheal tube
26
How do we assess breathing on the postop patient in the PACU? (5)
- check gag reflex - respiratory rate, quality - auscultated breath sounds - pulse oximetry - supplemental O2
27
How do we assess circulation on the postop patient in the PACU? (6)
- ECG monitoring - BP - temperature - capillary refill - color, temp, moisture of the skin - apical and peripheral pulses
28
How do you assess neuro in the postop patient in the PACU? (3)
- level of consciousness - orientation - sensory and motor status (reflexes) - PERRLA
29
How do you assess GU on the postop patient in the PACU?
-urine output
30
How do you assess GI in the postop patient in the PACU? (4)
- N&V - intake (fluids and irrigations) - output (vomitus) - bowel sounds - abdominal distention
31
What are some of the common post-operative complication? (9)
- pain - hypovolemic shock - thrombophlebitis (DVT) - PE - atelectasis - pneumonia - surgical site infection - hemorrhage - wound dehiscence and evisceration
32
What is pneumonia and how does it reach the lungs (3)?
Pneumonia is an infection of the lung parenchyma through - aspiration of normal flora - inhalation of microbes present in the air - hematogenous spread from a primary infection elsewhere in the body
33
What is the differentiation of CAP vs HAP vs VAP?
CAP- not been hospitalized or in long term care within 14 days HAP- nonintubated patient that begins 48 hours or longer after admission to the hospital VAP- more than 48 hours after ET tube placement
34
What are the signs and symptoms of pneumonia? (9)
- fever, chills, flushing, diaphoresis - cough (may or may not be productive) - pleuritic chest pain - dyspnea - tachypnea - tachycardia - elevated WBC - decreased O2 sat - confusion (especially in older adults)
35
How do we diagnose pneumonia? (4)
- chest xray (can show consolidation and fluid buildup) - sputum culture and sensitivity (tell us which microorganism is causing the infection) - pulse oximetry - CBC (white blood cell count)
36
What kinds of medications are patient with pneumonia prescribed? (4)
Antibiotics- cephalosporin (freq stools) or penicillin, start with IV and then switch to PO, obtain sputum before giving Antipyretics- reduce fever Anti-inflammatory- prednisone to decrease airway inflammation (may cause hyperglycemia in diabetic patients) Bronchodilators- anticholinergics (ipratropium) or Beta2 Adrenergic Receptors (albuterol) Adjunctive Therapies- mucolytics or expectorants
37
What is pulmonary embolism?
a substance (solid, liquid, or gas) enters venous circulation and lodges in pulmonary vessels
38
What are the risk factors for PE?
- peripheral vascular disorder - DVT - oral contraceptive - obesity - postoperative - chronic atrial fibrillation - central venous catheters
39
What are the signs and symptoms of PE?
- dyspnea (MOST IMPORTANT) - hypoxemia - tachypnea - tachycardia - hypotension - cough - chest pain - crackles/wheezing - impending doom - pressure in the chest - petechiae
40
How do we diagnose PE? (3)
- Spiral CT or CT Angiography (IV contrast to view pulmonary vessels) - Ventilation perfusion scanning (inhaled radioactive gas - d-dimer- measures the cross-linked fibrin fragments normal range is less than 0.4mcg/ml
41
What are two examples of anticoagulants that prevent PEs from getting bigger?
LMWH- Enoxaparin - subQ - antidote- protamine - frequent blood draws for PTT Warfarin (Coumadin) - oral - antidote- vitamin K - weekly blood draws PT and INR
42
What are two types of surgery can be done for treatment of PE?
Embolectomy- remove the embolus Vena Cava Filter- filter placed through femoral vein prevents migration of large clots to the pulmonary system
43
What are the s/s of pulmonary effusion?
- dyspnea - cough - sharp, nonradiating cp worse on inhalation - decreased movement of the chest on the affected side
44
How do we diagnose a pleural effusion?
cxr- reveals volume and location of the effusion
45
What is the treatment options for pleural effusion? (3)
- diuretics and NA restriction - thoracentesis - chemical pleurodesis
46
What are some psychobiological interventions? (3)
- medications - providing teaching about the medications - monitoring for adverse effects
47
What does the DSM-5 provide us? (3)
- establishes diagnostic criteria for mental health disorders - identifies expected findings for mental health disorders - assists nurses in plan, implement and evaluating their care
48
What are the guidelines for using physical or chemical restraints?
- must have written providers prescription (unless it is emergency, then within 30 minutes) - all other less restrictive measures have been exhausted - client is a threat to self or others - must check on patient every 30 minutes at least
49
What is the defense mechanism of altruism?
dealing with anxiety by reaching out to others ex: a nurse who lost a family member in a fire is a volunteer firefighter
50
What is the defense mechanism of sublimation?
dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression ex: angry with Maureen? Work out vigorously at the gym on lunch break
51
What is the defense mechanism of suppression?
voluntarily denying unpleasant thoughts or feelings ex: choosing to forget about drama in order to focus on a test
52
What is repression?
unconsciously putting unacceptable thoughts out of awareness ex: a person who has fear of the dentist forgets their dental appointments
53
What is regression?
sudden use of child-like behaviors that is not in line with their developmental stage
54
What is displacement?
shifting feelings related to one thing to another that is less threatening ex: kicking the dog because you lost your job
55
What is reaction formation?
unacceptable feelings or behaviors are controlled by overcompensating or demonstrating the opposite behavior ex: a person who is trying to quit smoking gives talks to kids about the dangers of smoking
56
What is projection?
attributing one's unacceptable thoughts and feelings onto another who does not have them ex: a married client who is attracted to another person accuses their partner of infidelity
57
What is splitting?
an inability to reconcile negative and positive attributes of self into a cohesive image ex: a client tells a nurse that they are the only one who cares about them, and next day will not speak to that nurse
58
What is conversion?
responding to stress through unconcious development of physical manifestations not caused by a physical illness ex: a client experiences deafness after their partner tells them they want a divorce
59
What is milieu therapy?
therapeutic community or therapeutic environment -environment that is supportive, therapeutic, and safe ex: community meetings
60
What is transference and countertransference?
Transference: client views a nurse as having characteristics of someone who was significant in their life Countertransference: nurse displaces characteristics of people in their past onto a client
61
What types of services are available in a community mental health facility?
- individual therapy - family therapy - medication dispensing programs - educational groups
62
Who is Assertive Community Treatment for?
ACT is for clients with severe mental illness who are nonadherent to traditional therapy
63
What is interpersonal psychotherapy?
assists clients in addressing specific problems socially
64
What is cognitive therapy?
mental health can improve by changing a clients attitude about it. Thoughts come before feelings and actions
65
What is behavioral therapy?
Changing maladaptive behaviors can occur without insight into the underlying cause -teaches systems to reduce manifestations
66
What is dialectical behavior therapy?
CBT for clients who have personality disorder and exhibit self harm behavior

NUR150 (8 decks)

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