In the Hospital Case Scenario Flashcards

Question

How should airway maintenance be delivered as a nursing intervention to cardiopulmonary dysfunction? (Potter and Perry 980)

Answer 1

-Adequate hydration -Use of proper coughing techniques to remove secretions and keep airway open -Humidification of oxygen delivered to patient -Nebulization (adding moisture or medications to inspired air by mixing particles of varying sizes with the air) clears pulmonary secretions -Chest physiotherapy, group of therapies used in combination to mobilize pulmonary secretions, should be followed by productive coughing and suctioning

Answer 2

Necessary when a patient is unable to clear respiratory tract secretions with coughing -Oropharyngeal and Nasopharyngeal suctioning- -> Used when pt can cough effectively but unable to clear secretions by swallowing or expectorating -Orotracheal and Nasotracheal Suctioning- -> Used when patient with pulmonary secretions is unable to manage secretions by coughing and does not have an artificial airway -Tracheal suctioning- -> Used via artificial airway like endotracheal tube or tracheostomy tube -Open suctioning- -> Involves sterile catheter that is opened at the time of suctioning -Closed Suctioning- -Multi use suction catheter encased in plastic sheath, used on patients who require mechanical ventilation to support respiration

Answer 3

Used for patients with decreased LOC and an airway obstruction or to aid in the removal of tracheobronchial secretions -Oral Airway- Prevents obstruction of trachea by displacement of tongue into oropharynx -Endotracheal and Tracheal airway- Used for patients with decreased loc or airway obstruction, and aids in removal of tracheal bronchial secretions

Answer 4

*Noninvasive techniques* -Ambulation- ->Increases general strength and lung expansion -Positioning- ->Adequate ventilation and oxygenation are maintained through frequent position changes during daily activities ->Reduces risk of stasis of pulmonary secretions and decreased chest wall expansion -> Most effective = 35-45 degree semi-Fowler's pos -Incentive Spirometery- -> Method of encouraging voluntary deep breathing by providing visual feedback to patients about inspiratory volume *Invasive techniques* -Chest tubes- -> Used to remove air and fluids from the pleural space, prevent air or fluid from re-entering pleural space, and re-establishing normal intrapleural and intrapulmonic pressures

Answer 5

Oxygen Therapy- -> Used to relieve or prevent tissue hypoxia, should be treated as a medication -> Adequate safety precautions should be undertaken since oxygen is highly combustible -> Oxygen is supplied to patients via oxygen tanks or wall-piped system -> Oxygen is delivered through low-flow (provide oxygen in concentrations that vary depending on pt resp pattern) or high-flow (deliver oxygen higher than normal pt resp pattern) -Home Oxygen Therapy- -> Beneficial for patients with chronic cardiopulmonary diseases as it improves patient exercise tolerance, fatigue levels, and management of dyspnea

Answer 6

If patient is hypoxic is long and severe enough, cardiac arrest will occur, which results in O2 not being delivered to tissues and CO2 not transported. This necessitates cardiopulmonary resuscitation (CPR)

Answer 7

Involves actively helping patient to achieve and maintain optimal levels of health through controlled physical exercise, nutrition counselling, relaxation, and stress management techniques, prescribed medications and oxygen, and adherence to this plan.

Answer 8

Hydration- ->keeps mucous ciliary clearance via coughing easier ->recommended intake of 1500-2000mL of fluids per day -Coughing Techniques- ->Effective for maintaining patent airway, enables removal of secretions from airways -> Recommended every hour while awake and every 2-3 hours while asleep ->Cascade cough technique: Pt takes slow deep breath while contracting expiratory muscles, then opens mouth and performs series of coughs throughout exhalation ->Huff cough technique: Pt opens glottis by saying word huff ->Quad cough technique: Pt pushes inward and upward on abdominal muscles toward the diaphragm while pt breathes out with maximal expiratory effort, producing a cough -Breathing Exercises- -> Improves ventilation and oxygenation ->Pursed lip breathing technique: deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse -> Diaphragmatic breathing technique: Pt relaxes intercostal and accessory respiratory muscles while taking deep inspirations

Answer 9

Acute inflammation of lung parenchyma (tissues responsible for gas exchange) caused by a microbial agent

Answer 10

Likely to result when defense mechanisms of respiratory system (filtration, humidification, epiglottis closure, coughing, mucociliary, IGG A, alveolar macrophages) become overwhelmed by infection - Decreased LOC inhibits cough and epiglottis - Tracheal intubation inhibits cough, mucocilliary mechanism, humidification, and filtration -Air pollution, smoking, infections and aging inhibit mucociliary mechanism -Malnutrition inhibits IGG and alveolar macrophages

Answer 11

1. Aspiration from nose or mouth 2. Inhalation of microbes present in the air 3. Hematogenous spread from elsewhere in the body

Answer 12

Community-Acquired Pneumonia -> lower respiratory tract infeciton of the lung parenchyma with onset in community or first 2 days of hospitalization Hospital Acquired Pneumonia -> pneumonia occurring 2 days after hospitalization Fungal Pneumonia -> fungal cause of pneumonia Aspiration Pneumonia -> Abnormal entry of secretions or substances into lower airway, usually from the mouth or stomach Opportunistic Pneumonia -> altered immune response, become highly susceptible for resp infections

Answer 13

Fever, chills, tachypnea, tachycardia, dyspnea, nonproductive cough, hypoxemia, chest pain, confusion in older pts

Answer 14

Step 1. Congestion -> outpouring of fluid into alveoli after infectious agents reach alveoli via droplets or saliva. Agents spread and multiply in fluid, which interferes with lung function Step 2. Red hepatization -> dilation of capillaries occurs, alveoli are filled with agents, neutrophils, rbcs and fibrin. This results in the lung appearing red and granular Step 3. Grey hepatization -> blood flow decreases and leukocytes and fibrin consolidate in the affected part of the lung Step 4. Resolution -> resolution and healing occur if no complications are present

Answer 15

Antibiotic therapy -Oxygen therapy -> hypoxemia -Analgesics -> chest pain -Antipyretics -> fever -Plenty of rest and limit activity -Nutritional Therapy -> 3L of fluid per day and 15000 calories per day

Answer 16

. ppl who have chronic illnesses 2. ppl who are recovering from a severe illness 3. Older adults (>65 yrs) 4. Residence in a long-term care facility 5. Immunosuppressed individuals (recom every 5 yrs)

Answer 17

- Poor cooperation and coordination of care -Errors at handover lead to inaccurate diagnoses, incorrect treatment, and medication errors -Leads to different perceptions of situations and what is required to manage them -Delayed response to deteriorating patients -Compromised patient safety in surgical interventions

Answer 18

Leadership -> awareness, understanding, purpose, planning, responsibilities Mutual Support -> Feedback, assistance, trust Situation monitoring -> review team performance, adjust +adapt Communication-> sharing information, clear communication, acknowledge and check for interpretation

Answer 19

-Attentional tunnelling (only paying attention to one aspect of a challenge) -Confirmation bias (only consider confirming evidence) -Memory failures (lapses or slips in carrying out actions) -Inaccurate mental models (erroneous model of what decisions and actions are required)

Answer 20

Those further down hierarchy may be hesitant to challenge those further up the hierarchy, resulting in reluctance to speak up, even if the hcp perceives a high risk

Answer 21

Hierarchal gradient Rudeness or intimidation from other stuff Poor leadership and relationships in healthcare team Fear of response from others Concerns about appearing incompetent in ambiguous or complex situations

Answer 22

Education and training programmes -Checklists + readback protocols -Instigating structured communication tools (SBAR) -Introducing briefing and debriefing procedures

Answer 23

Conducting handovers with the patient present -Including patients in beside rounds -Providing patients with tools for communicating with their care team such as the use of a whiteboard -Actively involve patients on planning committees -Encourage and allow time for questions -Get input from the patient and family about the care plan -Give them access to relevant information, presented so they can understand -Be creative in how you relay information as learning styles will vary from patient to patient -Ask patients for feedback, encourage them to speak up if they are uncomfortable, afraid, if they see something unsafe, or dont understand something

Answer 24

Core team - small group of care providers who work independently to manage a set of assigned patients from point of assessment to discharge or disposition, involved with direct care with patient Contingency team - time-limited team formed for emergent or specific events and composed of members from various teams Coordinating Team - Team comprising those work area members who are responsible for managing the operational environment that support the core team Ancillary and Support Services Team - provides direct, task-specific, time-limited care to patients Administration team - includes executive leadership of a unit or facility and have accountability for the overall function and management of the organization

Answer 25

1. Its the right thing to do 2. Its the safe thing to do 3. It enables innovative solutions 4. Its an expectation standard

Answer 26

Complete - Communicate relevant and important information Clear - Convey information that can be plainly understood, using common terminology, avoid using acronyms Brief - Communicate information in a concise manner Timely - Avoid delays in communication, be dependable and offer or request information in an appropriate timeframe

Answer 27

A strategy used to communicate important or critical info -Informs all team mebers simultaneously during emergent situation -Helps team members anticipate next steps -Directs responsibility to a specific individual responsible for carrying out the task

Answer 28

The use of closed-loop communication to ensure that information is conveyed by the sender is understood by the receiver as intended 1. Sender initiates the message 2. Receiver accepts the message and provides feedback 3. Sender double-checks to ensure that the message was received

Answer 29

Transfer of information during transitions in care across the continuum, including an opportunity to ask questions, clarify and confirm Consists of 1. Transfer of responsibility and accountability 2. Clarity of information 3. Acknowledgement by receiver 4. Opportunity to review I- Introduction P- Patient A- Assessment S- Situation S- Safety B- Background A- Actions T- Timing O- Ownership N- Next

Answer 30

A refusal of vaccination or a delay in an immunization schedule due to concerns about immunization

Answer 31

Lack of understanding about the vaccine being given and about immunizations in general -Conflicting info from various sources -Mistrust of source of information -Perceived risk of serious adverse events and concerns regarding injections -Lack of appreciation of severity and incidence of vaccine preventable diseases -Sociocultural beliefs

Answer 32

Adopt a vaccine recipient-centered approach (ability to decide, transparency and honesty, dialogue) -Respect differences of opinion about immunization (listen to origins of vaccine hesitancy, non-judgemental and non-confrontational) -Represent the risks and benefits of vaccines fairly and openly (communicate risks of disease, safety of vaccines) -Clearly communicate current knowledge using an evidenced-based approach (present evidence in an understandable way, use of positive terms, varied information formats, less stress)

Answer 33

1. Vaccines work - immunization is the most effective way to protect against vaccine preventable diseases 2. Vaccines stimulate and strengthen the immune system, they train it to defend rapidly against vaccine preventable infections before illness can occur 3. Vaccines are safe 4. The risk of vaccine preventable diseases are many times greater than the risk of a serious adverse reaction to a vaccine 5. Vaccines are not linked to chronic diseases 6. Multiple injections are an effective way of ensuring up to date immunization 7. Vaccine preventable diseases can occur at any time because these pathogens have not been eliminated 8. Unvaccinated individuals have a much greater chance of getting a vaccine-preventable disease than people who have been vaccinated, even in countries with high levels of immunization

In the Hospital Case Scenario Flashcards

(57 cards)