Test 2: LA 4-6

Question 0

What solution is given for central TPN?

Answer 0

D10W or more

Question 1

Where is TPN prepared?

Answer 1

In the pharmacy department under strict aseptic conditions

Question 2

What solution is given for peripheral TPN?

Answer 2

D10W or less

Question 3

After TPN leaves the pharmacy, can you add something to the solution?

Answer 3

Nothing can be added once it leaves the pharmacy

Question 4

Is it ok if you exceed the expiry date on the TPN bag? Why?

Answer 4

No, the solution is an excellent media for microbial growth

Question 5

When first started, TPN solution slowly titrates upward for how many hours? Why??

Answer 5

24-48 hours

To allow the pancreas to adjust to increased blood glucose levels

Question 6

What is a complication associated with prolonged nasal/oral feeding tubes?

Answer 6

Nasal erosion

Question 7

What size is a small bore nasal/oral feeding tube usually?

Answer 7

8-12 French (adult client)

Question 8

For a small bore nasal/oral feeding tube, what do you have to do after the tube placement is confirmed ?

Answer 8

Remove the guide wire

Question 9

What do you do with the guide wire after it is removed from a small bore nasal/oral feeding tube?

Answer 9

Tape it to the wall over the head of the bed

Question 10

When aspirating an enteral feeding tube, as a verification method, what do you need to assess?

Answer 10

Colour: intestinal secretions have a distinct yellow (bile) colour (gastric secretions do not)

Question 11

When irrigating a feeding tube, how do you want the patient to sit?

Answer 11

Unless contraindicated, place client in high Fowler’s (preferred) or semi Fowler’s (reduces risk of aspiration)

Question 12

When you open any can of nutrition what must you make sure to do?

Answer 12

Write the date, time and your signature

Question 13

When administering medication via enteral feeding tube, what position must the patient be in?

Answer 13

High Fowler’s (unless contraindicated)

Question 15

Why would you not want to crush or dissolve tablets or capsules together for enteral feeding tubes?

Answer 15

• meds may not be compatible

- if some of the medications spill, you will not be able to tell what is remaining.

Question 16

How would you d/c a patient off of TPN

Answer 16

D/C TPN involves weaning off over 24-48 hour period

Question 17

How fast can you infuse an lipid emulsion?

Answer 17

20% of lipid emulsion q4hr

Question 18

How often do you monitor blood sugar when a patient is on TPN

Answer 18

q 4-6 hr

Question 19

What is End-of-Life Care based on the Guiding Decisions About End-of-Life Care, 2009?

Answer 19

End-of-life care is grounded in the ethical values of nursing, which include respecting a client’s choice, well-being and life, maintaining commitments, and valuing privacy, confidentiality truthfulness and fairness. The guiding decisions about End-of-Life Care,2009 practice guideline aims to help nurses understand their roles and responsibilities when providing end-of-life care.

Question 20

What is an advance directive?

Answer 20

Advance directives: A document and communicate to a substitute decision-maker a client’s preferences regarding treatment in an event that the client becomes incapable of expressing those wishes. E.g., DNR or organ donation

Question 21

What is capable?

Answer 21

Capable: When the client is able to understand the decision relevant to treatment and predict consequences.

Question 22

What is End-of-Life care?

Answer 22

End-of-life care: The care that is provided to a client at the end of his or life. The goal of end-of-life care is to improve the quality of living and dying, and minimize unnecessary suffering. Encompasses; physical, spiritual, psychosocial, cultural, and emotional dimensions.

Question 23

In an emergency situation; treatment can be ______

Answer 23

In an emergency situation, treatment can be given without consent.

Question 24

What is informed consent?

Answer 24

Informed consent: a consent to treatment given by a client only after the client has received information about treatment (including the nature of the treatment, the expected benefits, material risks, material side effects, alternative courses of action and likely consequence of not having the treatment) which a reasonable person in the circumstances would require to make a decision about their treatment.
> Consent must include: relate to the treatment, be informed, be given voluntary, and not be obtained through misrepresentation or fraud.

Question 25

What is the interpersonal team?

Answer 25

Interpersonal team: multiple health care team which provides collaboration to delivery to provide quality care within and across the setting

Question 26

What is palliative care?

Answer 26

Palliative care: Care that aims to relieve client suffering and improve the quality of living and dying. Strives to help clients and families address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears.

Question 27

What is the plan of treatment?

Answer 27

Plan of treatment:
> Developed by the client or substitute decision maker, and one or more health practitioners.
> Deals with one or more health problems that a client has, it may also deal with one or more health problems that the client is likely to have in the future as a result of the client’s current health condition.
>Provides for the administration to the client of various treatments or courses of treatment.
>May provide the withholding or withdrawal of treatment in light of the client’s current health condition.

Question 28

What is a power of attorney?

Answer 28

Power of attorney: A power of attorney is a voluntary decision; which is a legal document that gives another person the right to act on the client’s behalf with the regards to the client’s personal decisions.

Question 29

What is resuscitation:

Answer 29

Resuscitation: An invasive and immediate life-saving treatment that is administered to a client who has a sudden unexpected cardiac or respiratory arrest. (Includes: basic cardiac life support; mouth-to-mouth resuscitation/bagging/chest compressions, advance cardiac life support; intubation and defibrillator.

Question 30

What is the substitute decision maker?

Answer 30

Substitute decision maker: A person authorized to give or refuse consent on behalf of the incapable client.

Question 31

What is treatment?

Answer 31

Treatment: is the act that is performed for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health related purpose, and includes a course of plan of treatment.

Question 32

What are wishes?

Answer 32

Wishes: What a capable person expresses about their treatment or what the power of attorney expresses. The most recent wishes a client expresses while he or she is capable prevail over any earlier wishes the client may have given.

Question 33

What is palliative care?

Answer 33

Palliative care: is an approach to care for people who are living with a life-threatening illness, no matter how old they are. The focus of care is on achieving comfort and ensuring respect for the person nearing death and maximizing quality of life for the patient, family and loved ones.

Question 34

What is hospice care?

Answer 34

Hospice care: is end-of-life care. A team of health care professionals and volunteers provides it. They give medical, psychological, and spiritual support. The goal of the care is to help people who are dying have peace, comfort, and dignity.

Question 35

What is hospice palliative care?

Answer 35

Hospice palliative care: Hospice palliative care is whole-person health care that aims to relieve suffering and improve the quality of living and dying. It is a service that is offered in many different settings - hospices, hospitals, long-term care facilities and homes.

Question 36

What is beravement?

Answer 36

Bereavement: is the period of grief and mourning after a death. When you grieve, it’s part of the normal process of reacting to a loss. You may experience grief as a mental, physical, social or emotional reaction. Mental reactions can include anger, guilt, anxiety, sadness and despair.

Question 37

What is loss?

Answer 37

Loss: The state or feeling of grief when deprived of someone you value

Question 38

What is death?

Answer 38

Death: is the termination of all biological functions that sustain a living organism

Question 39

What is coroner’s case?

Answer 39

Coroner’s case: When a death occurs under under unusual or suspicious circumstances, the coroner is called in to investigate the cause of death. This is then referred to as a “coroner’s case.” Even a death attended by a physician may become a coroner’s case.

Question 40

What is guiding decisions?

Answer 40

When assisting clients in making choices and articulating their wishes about end-of-life care, nurses are guided by two core themes: communication and implementation. Clear and ongoing communication between the nurse, client and interprofessional team facilitates the implementation of client and interprofessional team facilitates the implementation of client wishes about treatment and end-of-life care.

Question 41

What is communication?

Answer 41

Nurses communicate with clients and members of the interprofessional team to guide informed discussion about the goals of treatment.

Question 42

What are the goals of coomunication?

Answer 42

> Assessing whether or not the client is knowledgeable of understanding treatment
Discuss and identify the end-of-life wishes with the client
Identify the client’s preferred treatment while discussing the client’s condition; in a therapeutic nurse-client relationship
Use appropriate communication techniques
Being involved and helping the client and family with discussions about treatment
Consult with other health care team members and set up meetings
Obtaining knowledge from; advance directives, power of attorney, substitute decision makers, document all instructions, review plan of treatment
Explain the clients wishes to all members of the health care team
Document any changes and other wishes
Advocating for the client

Question 43

What is implementation?

Answer 43

Nurses advocate for the client and help implement the client’s treatment and end-of-life care wishes

Question 44

What are goals of implementation?

Answer 44

> Ensure a plan of treatment that has involved members of the health care team and client or power of attorney which is given on the informed consent
Clarifying to the client; changed condition may need a change in treatment, provision or withholding treatment,
initiating treatment when; the wish for the treatment is in the informed consent, when the substitute decision maker decides on treatment, or it is an emergency situation
do not initiate treatment when; there is no signed informed consent, there is no substitute decision maker when the client is not capable of making their own decision, the client does not want treatment, the treatment does not have any improvement, the client exhibits obvious signs of death (VSA plus rigor mortis/tissue decay).
document all treatments
following client’s wish for DNR
when the client dies; identify the client who has died, notify the family and health care provider, identify family’s cultural or religious beliefs about management of the body, identify whether or not the family wants to see them, document according to policies and procedures.
possesses knowledge, skill and judgement to determine that death has occurred.
nurses do not have the authority to pronounce death