Exam 4 Material Flashcards
(143 cards)
1
Q
What does AIDET mean?
A
Acknowlege
Introduce
Duration
Explanation
Thank you
2
Q
What dose SBAR mean?
A
Situation
Background
Assessment
Recommendation
3
Q
What does CUS mean?
A
I am Concerned about my pts saftey
I am Uncomfortable wtih my pts condition
I believe in the Safety of my pt.
4
Q
What are the steps to calling a provider?
A
-Personally assess pt.
-Verify abnormal VS or POC readings
-Discuss with charge nurse
-Review progress notes/previous assessments
-Pull up chart
-Call correct provider
5
Q
A patient hand off occurs when?
A
A transition in care occurs
6
Q
What does I PASS THE BATON mean?
A
Indroduction
Patient
Assessment
Situation
Saftey
Background
Actions
Timing
Ownership
Next
7
Q
What are the components of the affective learning domain?
A
Emotional
Integration of new concepts and knowledge
8
Q
What are the compenents of the psychomotor learning domain?
A
Physical movement
Skills acquisition that involves integration of mental and muscular activity
9
Q
What reading levels should patient education materials be written, and why?
A
Education materials should be written for a 4th-6th grade reading level
Average adults read at an 8th grade level, and the average medicare beneficiary reads at a 5th grade reading level
10
Q
The best method to apply for patient education is?
A
The teach back method
11
Q
What does DISCHARGE stand for in terms of patient education?
A
-Do refer/collaborate for physiological complications
-Interdisiplinary care
-Saftey (home care)
C-Community resources
H-Health promotion activities
A-Activity
R-Routine follow up care
G-Guidelines for medications
E-Equipment education
12
Q
An occurrence reporting is?
A
Used for communicating with risk management, administration, and other departments and is NOT part of the medical record.
13
Q
What are the 3 main categories of surgical classifications?
A
Seriousness
Urgency
Purpose
14
Q
Surgery classifications: Seriousness
Major
A
A serious major surgery classification involves extensive reconstruction or alteration in body parts and poses great risk to wellbeing
15
Q
What are examples of serious major surgery classifications?
A
Coronary Artery Bypass
Colon resection
Removal of larynx
Resection of lung lobe
16
Q
Surgery classifications: Seriousness
Minor
A
Involves minimal alteration in body parts
Often designed to correct deformities
Minimal risk compared to other major procedures
17
Q
What are some examples of a serious minor surgery?
A
Cataract extraction
Facial plastic surgery
Tooth extraction
18
Q
Surgery classifications: Urgency
Elective
A
Performed on basis of a patient’s choice
Not essential and is not always necessary for health
19
Q
What are some examples of elective surgeries?
A
Bunionectomy
Facial plastic surgery
Hernia Repair
Breast Reconstruction
20
Q
Surgery classifications: Urgency
Urgent
A
Necessary for patient’s health
Often prevents development of additional problems
Not necessarily an emergenvy
21
Q
Surgery classifications: Urgency
Emergent
A
Must be done to immediately save life or preserve function of body part
22
Q
What are some examples of emergent surgeries?
A
Repair of perforated appendix
Traumatic amputation
Control of internal hemorrhaging
23
Q
Surgery classifications: Purpose
Diagnostic
A
Surgical exploration to confirm diagnosis
Often involves removal of tissue
Ex: Ex lap
24
Q
Laparotomy and laproscopy are different how?
A
Laparotomy is where they open up the abdomen and laproscopy is where they use small cameras
25
Surgery classifications: Purpose
Ablative
Excision or removal of a diseased body part
EX: Amputation or removal of organ
26
Surgery classifications: Purpose
Pallative
Relieves or reduces intensity of disease symptoms but does not cure
Ex: Debridement of necrotic tissue
27
Surgery classifications: Purpose
Reconstructive or Restorative
Restores function or appearance to traumatized or malfunctioning tissues
Ex: Joint replacement, scar revision
28
Surgery classifications: Purpose
Constructive
Restores function lost or reduced as a result of congenital abnormalities
Ex: Repair of cleft pallate
29
Surgery classifications: Purpose
Cosmetic
Performed to improve personal appearance
Ex: Rhinoplasty
30
What is considered adequate food intake post op?
1500 k/cal
31
Why is obstructive sleep apnea considered a surgical risk factor?
Upper airway obstruction can cause death
32
Why are coagulopathies considered a surgical risk factor?
A DVT post op won't be reimbursed by insurance if it develops post op
33
Why are fluid inbalances considered a surgical risk factor?
Hypovolemia can be exacerbated by PONV (post-op nausea and vomiting)
34
Medication Reconcilation should occur at what points through the surgery process?
Pre-op to Intra-op to Post-op
*There is a medication shut down before a transfer between each phase
35
What are the Pre-op Labs/Testing?
BMP
CBC
Clotting Studies
LFTs
CXR
36
Pre-op Labs/Testing:
What are the lab values for the BMP?
K=3.5-5.1
Glucose =<120
BUN=10-20
Creatine=0.5-1.2
WBC=3.7-11
37
Pre-op Labs/Testing:
What are we looking for in the BMP?
Indicators of cardiac and hemodynamic stability
Kidney function
Drug elimination
Infection
38
Pre-op Labs/Testing:
What are the lab values for in the CBC?
Hemoglobin=12-16
Hematcrit=36-48%
39
Pre-op Labs/Testing:
What are we looking for in the CBC?
Indicators of volume status
O2 carrying capacity
Hemodynamic stability
40
Pre-op Labs/Testing:
What are the values of clotting studies (PT, INR, PTT, PLT) and what are we looking for?
Platelets 150-400
Indicators of liver function and possibly bleeding dificulties
41
Pre-op Labs/Testing:
What are the values for LFTs and what are we looking for?
AST<48
ALT<55
Drug metabolism/clotting
42
Pre-op Labs/Testing:
What are we looking for on the chest xray?
Clear lungs
No cardiomyopathy
No Atelectasis
-Id-ing potentially sig. risks for complications
43
Who determines which meds to stop and when and which meds continue?
The surgeon
Ex: ace inhibitors might be stopped due to a drop in BP
44
Who on the surgical team explains the procedure, risks, benefits, alternitives and prognosis if no surgery?
The Provider ONLY
45
Who on the surgical team obtains consent for anesthesia?
Anesthesiologist or CRNA
46
Who on the surgical team obtains consent for blood products?
Surgeon
47
What is the role of the RN on the surgical team?
Witness that informed consent was obtained and confirm that pt questions where answered
48
What are TED hoses or SCDs?
Anti-embolism devices that prevent DVTs during surgery
49
What is site marking?
Eliminating wrong sight and wrong procedure, marking esp. with left and right distinction
50
Patients with a latex allergy are normally?
Scheduled as early as possibly and latex free cart is available
51
What is the purpose of a time out?
An opportunity to slow down, verify and avoid medical error that involves verifing:
Right-
Pt.
Procedure
Site
Side
52
Anesthesia:
General
Unconscious, no sensation, reflexes, or perception of stimuli
Combination IV and Gas
53
Anesthesia:
What are the risks of general anesthesia?
Intubation-protect the airway
Aspiration
Dysrythmias
Hypotension
Hypothermia
Hypoxemia
Malignant hyperthermia
54
Anesthesia:
Regional
Loss of sensation in area/region of body
Nerve blocks, spinals, or epidurals
55
Anesthesia:
What are the risks of regional anesthesia?
Requires monitoring of motorsensory function along distal and nerve tracts:
Hypotension
Hypothermia
Spinal cord injury
Respiratory distress
CSF Leak=HA
56
Anesthesia:
Local
Loss of sensation at localized site by inhibiting nerve conduction
Injection or topical
57
Anesthesia:
What are the risks of local anesthesia?
Hives
Rash
Anaphylaxis
58
Anesthesia:
Moderate sedation
"Conscious sedation"
-decreased LOC
-IV sedative
-Rention of consciousness but induces amnesia
59
Where is an epidural inserted as opposed to a spinal?
Epidural-into the epidural space
Spinal-Into the spinal space (subarachnoid space) containing cerebrospinal fluid
60
Post Op:
How often is pt monitored in the PACU?
Every 15 minutes
61
Why is there a standardized scoring tool for assessment and discharge readiness in the PACU?
A patient must be able to meet these criteria before moving on
62
What are the priorities in the PACU or ICU?
ABCs
Preventing harm
Pain management
Tracing of all lines and labels
63
A post op patient in an ambulatory setting will need to do what before going home?
Eat and drink a small amount and void
64
What are the signs and symptoms of Malignant Hyperthermia?
Tachypnea
Hypercapnia
High fever
Muscle rigidity
Spasms
Tachycardia
Hyperkalemia
Muscle breakdown
Tim Hates How ManyBad Spasms He Really Tolerates.
65
How fast is the onset of malignant hyperthermia?
Onset within 35 minutes to 2 hours from anesthesia induction
66
What is the intervention for malignant hyperthermia?
Dantrolene and cooling
67
What are the early signs of a post op hemorrage?
Restlessness
Increased HR and RR
68
What are the late signs of a post op hemorrhage?
Lethargic
Rapid decrease in HR, RR, BP, and Sp02
69
What are the two main priority interventions if a patient is experiencing a post op hemorrhage?
Notify provider stat
Prepare for immediate transfer to the OR
70
How long do neonates sleep?
16 hrs
71
How long do infants sleep?
15 hrs total with naps
72
How longs do toddlers sleep?
12 hours total with naps
73
How long do preschoolers sleep?
12 hrs per night
74
How long do school age children sleep?
Varies 9-12hr
75
How long do adolescents sleep?
8-10 hrs
76
How long do young adults sleep?
6-8.5 hrs per night
77
How long do middle adults sleep?
7-9 hr
78
How long do older adults sleep?
Varies, many have sleep problems
79
What is narcolepsy?
Dysfunction in processes that regulate sleep and wakefulness=excessive daytime sleepiness and rapid falling asleep with quick entry into REM sleep; uncontrollable 'sleep attacks'
80
What are parasomnias?
Occur during NREM and REM sleep
Confused arousals, sleepwalking, nigh terrors, nightmares, bruxism
81
What are the signs and symptoms of sleep apnea?
Loud snoring
Gasping
Snorting
Choking sounds with periods of silence lasting 10 seconds to 1-2 minutes
Daytime sleepiness
82
What causes sleep apnea?
Throat muscles relax
Soft palate and tongue drop
Upper airway collapses
Partial or complete blockage
Diminished or cessation of airflow
Periods of apnea
Hypoxic
Brief awakening
Airway reopened
83
What are the risk factors of sleep apnea?
Obesity
Large neck circumfrence
ETOH
Narrowed airways
Smoking
Only Large Elephants Never Smoke
84
What are the consequences of sleep apnea?
Hypoxic periods=SNS activation
HTN
HLB
MI
CVD
CVA
Metabolic synrome
Type 2 Diabetes
Non-alcoholic fatty liver disease
Deprived sleeping partners
85
What is the diagnosis and treatment of sleep apnea?
Sleep studies
Weight loss
Smoking cessation
CPAP at night
Oral appliances
86
What is aphasia?
inability to produce or understand language
87
What is Broca's (Expressive) Aphasia?
Typically due to damage in motor cortex and Brodmann's Area 44
Difficulty expressing speech
Problems with naming objects
Better with comprehension
88
What is Wernickes (Receptive Aphasia)?
Easier time understanding speech
Comprehension is largely impaired (both spoken and written)
89
What is global aphasia?
Produce few recognizable words and understand little to no spoken nor written language
Cannot read or write
Fully preserved intellectual and cognitive abilities unrelated to speech
90
What are complementary therapies?
Used together with conventional biomedical treatment
Ex: Chronic pain pt taking NSAIDs and practicing yoga
91
What are alterntive therapies?
Non-pharmaclogic therpies used in place of conventional pharm or medical procedures
92
Which herbal remedies increase bleeding risks when also using warfarin and anticoagulants
Ginseng
Ginko
Ginger
Garlic
93
What are the contraindicated drugs when a patient is using echinacea to stimulate immune system?
Anti-rejection drugs
Hepatotoxic drugs
Immunosuppressants
Antiretrovirals
94
What are the contraindicated drugs when a patient is using ginseng to increase physical endurance by enhancing adrenal and immune function?
BLEED risk with warfarin
MAO inhibitors
Anti-diabetic drugs
Aspirin
NSAIDs
Simulant drugs
95
What are the contraindicated drugs when someone is using Ginko to improve blood flow and memory?
BLEED risk with warfarin
Aspirin
NSAIDs
Many Psych drugs
96
What are some of the contraindications when someone is using Ginger to decrease GI spasms and cramps and decrease nausea and vomiting?
BLEED RISK with warfarin
Aspirin
NSAIDs
97
What are some of the contraindications when someone is using Ginger to decrease GI spasms and cramps and decrease nausea and vomiting?
BLEED RISK with warfarin
Aspirin
NSAIDs
98
What are the contraindicated drugs when someone is using garlic to increase an antitumor effect and platelet aggregation?
BLEED risk with warfarin
Caution with anti-HIV drugs
99
What does glucosamine do and what are the safety concerns?
Slows osteoarthritis by stimulating cartilage
-Shellfish allergy
antagonizes anti-diabetic drugs some chemo
NO COUMADIN (warfarin-Increased effect)
100
What does goldenseal do and what are the safety concerns?
GI disorders and gastritis
Acts as cardiac stimulant
Watch for hear arrbythmias and don't give with anticoagulants or hypertensive drugs
101
What is saw palmetto and what are the safety concerns?
Used for BPH
Watch for bloody urine
102
What is St. John's wart and what are the safety concerns?
Photosensitivity
Warfarin interaction
Don't take with MAOs or SSRIs
103
What is chamomile and what are the safety concerns?
Anti-inflammatory and interacts with drugs that cause drowsiness such as:
EtOH
Benzos
Narcotics
Antidepressants
Can't drink chammomile if your already drowsy.
104
Anyone who is immunocompromised should not receive what type of integrative healthcare?
Acupuncture or dry needling
105
What is spirituality?
Awareness of one's inner self and sense of connection to a higher being, nature, or purpose greater than oneself
106
What is self transcendence?
Authentically connecting to one's self
107
What is connectedness?
Being interpersonally connected with one's self, interpersonally connected with others and enviroment and transpersonally connected to god or an unseen power
108
What is faith?
Faith allows people to have firm beliefs despite lack of physical evidenve
109
What are the 5 subsets of spirituality?
Self transcendence
Connectness
Faith and Hope
Inner Strength and Peace
Meaning and purpose in life
110
In regards to spirituallity, what is the joint commission's stance?
The joint commission requires acknowledging patient rights to spiritual care, to assess for and provide spiritual needs
111
What does FICA stand for?
Faith or belief (Does pt identify with any?)
Importance and Influence (How important is this to pt)
Community (Who does the pt find to be a comfort)
Address (Interventions to address)
112
If signs and symptoms persist past the duration of the stressor, what is this considered?
A trauma
113
What is primary appraisal in regards to a stressor?
Evaluating an event in terms of personal meaning
114
What is secondary appraisal in regards to a stressor?
Process in which a person considers possibly available coping mechanisms or resources
115
What are the physiological manifestations of a stress response?
SNS activation: Increased HR, RR, BP
HPA axis activation: hypothalamus increases CRH -> anterior pituitary gland to increase ACTH ->adrenal cortex to increase cortisol levels
116
What are the manifestations of increased cortisol levels?
Protein and fat catabolism
Immunosuppression
Hyperglycemia
117
A disheveled patient is a sign of?
Ineffective or maladaptive coping
118
What is General Adaptation Syndrome (GAS)
A 3 stage physiological process that prepares and adapts the body for danger so an indivdual is more likely to survive.
119
What are the 3 stages of General Adaptation syndrome?
Alarm stage-fight or flight
Resistance stage-body attempts to compensate and stabilize
Exhaustion stage
120
What is allostatic load?
Excessive activation of hormone response with minimal adaptation response = wear and tear on organs
121
What are some of the symptoms of compassion fatigue?
Irritation, restlessness, unable to focus, difficulty engaging, cynicism, anxiety, feelings of inadequacy, poor decision making
122
What is second victim syndrome?
Effect on a healthcare provider when a medical error causes harm to a patient
123
Normal grief is?
A response to death or loss
124
Anticipatory grief is?
Grief before is actually occurs
125
Disinfrancized grief is?
When a relationship is not socially sanctioned and grief cannot be shared openly or seems less significant
126
What is ambigous loss?
A type of disinfranchized grief were the person is physically present but not psychologically
127
What is complicated grief?
Person has a prolonged or significantly difficult time mourning or moving forward after a loss
128
What is chronic grief?
a normal response for a long period
129
What is exaggerated grief?
Person exhibits self-destructiev or maladaptive behaviors
130
What is palliative care?
Care that focuses on pain, symptoms, and stress of serious illness to increase QOL and is for any patient with a serious illness regardless of life expectancy or prognosis
131
What is hospice care?
Care that focuses on providing comfort through pain and symptom management, psychosocial and spiritual support and is for patients with terminal prognosis measured in months <6 months to live if illness runs its natural course
132
Hospice care encompasses what?
Patient and family's holistic needs
133
A DNR has special complications regarding surgery, what are they?
A DNR has to be re-activated and dated each time a person is admitted to the hospital and after surgery
134
Who initiates organ donation with the family?
A specifically trained professional and not a member of the healthcare team
135
What is a durable power of attorney?
A designated person a patient wants to make health decisions on their behalf in the even they no longer can make decisions themselves
136
What is a living will?
Direct treatment according to the patient's wishes, able to declare which medical procedures are desired and those not desired when ill or in vegetative state
137
The biggest signs of death are?
Pallor, mottling and cyanosis
138
Why is it important to raise the bed 30 degrees after a person has died?
To avoid blood pooling in the face q
139
What supplies are should be gathered after a patient has died?
Shrout kit
Clean patient gown and linens
Extra chuck pads
Paper tape
4 by 4 gauze
Clamps
Sissors
140
What is included in a shroud kit?
White vinyl zippered bad to wrap the body in
Another bag for pts personal effects
A chinstrap
Tape
Ties
Tags
141
When does rigor morits occur?
30 minutes after death
142
What is important to remember when preparing a body for family viewing?
Do not remove lines or tubes unless hosptial policy requires you to do so
143
What are reportable deaths?
Homicide, suicide, accident, violent death
Sudden death not caused by readily recognized disease
Suspicious circumstances death
Death unattended by physician
Death as result of a stillbirth unattended by physician
Death in H.F w/in 24hrs of entering
Death w/in 24hrs after undergoing an invasive procedure in H.F
