PCC, exam 2 Questions and Answers

PCC, exam 2 Questions and Answers primary Caring is _______ -Caring determines what matters to a person. -Caring helps you provide patient-centered care. Patient's perspective of caring -When patients sense that health care providers are sensitive, sympathetic, compassionate, and interested in them as people, they usually become active partners in the plan of care. -Patients value the affective dimension of nursing care -Connecting with patients and their families -Being present -Respecting values, beliefs, and health care choices Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:06 / 0:15 Full screen Brainpower Read More we preserve their dignity What do we do when we care for others? (hint: preserve it) self-care we need to recognize the importance of what part of caring? presence Providing _________ is a person-to-person encounter conveying a closeness and sense of caring. -Nursing ________ is the connectedness between the nurse and patient -Being with and being there: includes physical presence, communication and understanding [empathy] -Body language -Listening -Eye contact -Tone of voice -Positive and encouraging attitude Principles of presence (6) through active listening how do you begin to truly know your patients and what is important to them? spiritual health What is achieved when a person can find a balance between his life values, goals, and belief symptoms and those of others? spirituality What offers a sense of intrapersonal, interpersonal, and transpersonal connectedness? intrapersonal relationship is when persons are connected to themselves [mind] interpersonal relationship exists when one is connected with others and the environment [body] transpersonal relationship exists when one is connected with God, an unseen force, or a higher power [spirit] -Task-oriented biomedical model -Institutional demands -Time constraints -Reliance on technology, cost-effective strategies, and standardized work processes 4 challenges of caring holistic & humanistic If health care is to make a positive difference in patients' lives, health care must become more ________and __________ D. assess the patient's emotional needs. [by assessing emotional needs, you are also doing A,B, & C When a nurse enters a patient's room and says "Good morning" before starting care, the nurse combines nursing tasks and conversation. An important aspect of care for the nurse to remember is the need to: A. establish a relationship. B. gather assessment data. C. treat discomforts quickly. D. assess the patient's emotional needs. C. a sense of presence A female patient has just found a large lump in her breast. The physician needs to perform a breast biopsy. The nurse helps the patient into the proper position and offers support during the biopsy. The nurse is demonstrating: A. enabling. B. comforting. C. a sense of presence. D. maintaining belief. strong nursing team works together to achieve the best outcomes for patients building a nursing team Effective team development requires team building and training, trust, communication, and a workplace that facilitates collaboration. Patient care units where teamwork is stronger had fewer reports and incidents of missed nursing care, leading to improved quality and safety of nursing care for patients Traditional models -Team nursing -Primary nursing Today's models -Patient-centered care -Total patient care -Case management nursing care delivery methods team nursing RN is the leader who leads a team of other RN's, PN's and Nursing Assistive Personnel (unlicensed personnel UAP) who provide direct patient care primary nursing supports a philosophy regarding nurse and patient relationships. It is typically not practiced today because of the high cost of an all RN staffing model. patient and family centered care -mutual partnerships with the patient, family, and health care team for care. Core concepts: Respect and dignity, ensuring that the care provided is given on the basis of the patient's and family's knowledge, values, beliefs, and cultural backgrounds. Information sharing, meaning that health care providers communicate and share information so patients and families receive timely, complete, and accurate information to effectively participate in care and decision making. Participation, whereby the patients and families are encouraged and supported in participating in care and decision making. Collaboration, demonstrated by the health care leaders collaborating with patients and families in policy and program development, implementation, and evaluation, and patients who are fully engaged in their health care total patient care -RN responsible for all aspects of care for one or more patients during a shift *Requires high degree of collaboration with other health care professionals* Registered nurse works directly with patient, family, and health care team members. RN is responsible for patients during shift of care, although care can be delegated. Approach may not be cost-effective owing to high number of RNs needed. Patient satisfaction is high case management -emphasizes supervision, overseeing care of other health care providers Collaborative process of assessing, planning, facilitating, and advocating for options and services to meet an individual's health needs. Clinicians oversee the management of patients with specific, complex health problems and are usually held accountable for some standard of cost management and quality. Often the case manager is an advanced practice nurse (APN), who helps improve patient outcomes via specific interventions. 1) clinical care coordination 2) team communication 3) delegation 4) knowledge building 4 leadership skills for nursing students clinical care coordination skill for nursing students that includes: -Clinical Decisions (Apply the nursing process, Know your patient, Use clinical decision making practices, Accurate clinical decision-making keeps you focused on the proper course of action) -Priority Setting (determine which patient's needs should be addressed first: High priority: immediate threat to patient survival or safety, Intermediate priority: nonemergent, non-life threatening, Low priority: actual or potential problems may or may not be directly related to patient's illness or disease) -Organizational Skills (need to be effective and efficient to implement nursing care, Do the right things. Do things right. Inform and prepare patient. Clean and organize work area. Keep patient's needs at the center of attention.) -Use of Resources (Appropriate use of resources is an important aspect of clinical care coordination. Administration of patient care occurs more smoothly when staff members work together.) -Time Management (Remain goal oriented. Identify priorities. Establish personal goals) -Evaluation (Evaluate process, Evaluate patient, response, Evaluate therapy efficacy, Evaluate patient and expected outcomes) team communication skill for nursing students that requires: Respect other's ideas Share information Stay informed Strive to improve your communication Share expectations of communication Use structured communication techniques delegation skill for nursing students that includes: Nurse Practice Act along with principles of authority, accountability, and responsibility the basis of delegation Transfers responsibility while remaining accountable for outcomes Requires knowing which skills are transferable Results in improved quality, safe patient care, improved efficiency, increased productivity, an empowered staff, and skill development of others Right Task- repetitive, require little supervision, noninvasive and predictable results Right Circumstance- appropriate patient setting, resources, clinical decision making determine what to delegate Right Person- right task with people who are able to do it RN responsible for knowing Right Direction- clear, concise description of the task, including objective, limits and expectations. Must have communication with the person Right Supervision- appropriate monitoring, evaluation, intervention as needed must be provided the 5 rights of delegation B. primary nursing A travel nurse has taken an assignment at a health care facility where nurses assume responsibility for a caseload of patients over a period of time. This type of nursing exemplifies: A. team nursing. B. primary nursing. C. functional nursing. D. decentralized management. B. assess the knowledge of the certified nursing assistant. 2. A newly graduated nurse is assigned to care for a team consisting of herself and a certified nursing assistant. When delegating skills, she needs to: A. assign only bed-making and feeding skills. B. assess the knowledge of the certified nursing assistant. C. remind the staff member that she is working under the license of the RN. D. allow the staff member to perform only skills that the RN is able to teach certified nursing assistants to perform. muscle atrophy loss of muscle tone this can occur with temporary immobilization bed rest restricts patient movement- prolonged can cause physiological, psychological, and social effects on the patient (impaired physical mobility) care plan If restricting movement, you're putting pt. at risk for all hazards that come with immobility, need to have ____ ____ -Disuse atrophy -Footdrop, contractures, lose muscle memory and ability to move if you don't use them -Physiological -Psychological -Social -If you cant get out of bed, you are isolated and cant socialize or go to activities -In hospital and at home will effect mind, body, and spirit Effects of muscular deconditioning-Hazards of Immobility effects of immobility-cardiovascular changes Orthostatic hypotension: drop in B/P 15 mm Hg systolic, 10 mm Hg diastolic =patient at risk for falls when they get up In lab: Raising/lowering bed Thrombus: accumulation of blood products of wall of vein or artery= can lead to embolus and death Valve blocks blood flow bc you are immobile, things like fat/cholesterol sit on valve and pull and create clot Heparin injections In lab: TED hose stockings, Sequential compression devices *Basically everyone is at risk for these* effects of immobility-respiratory changes Lack of movement leads to atelectasis (alveoli collapse), atelectasis (secretions block bronchus =lung collapse), **can lead to pneumonia At some point in development of these complications there is a proportional decline in the patients ability to productively cough muscle atrophy, loss of muscle mass Why we do Range of Motion effects of immobility-muscle effects loss of endurance Osteoporosis: immobility can accelerate this disease process Joint contracture: an abnormal and possibly permanent condition characterized by fixation the joint when this occurs the joint can not achieve full ROM Caused by disuse, atrophy, and shortening of muscle fibers Footdrop: foot is permanently in plantar flexion from joint contraction- pt is unable to lift toes off the ground effects of immobility-musculoskeletal joint abnormalities, impaired calcium absorption effects of immobility-skeletal effects Urinary stasis: changes in peristalsis of the bladder= increase risk of UTI Renal calculi: prolonged immobility may lead to hypocalcemia and calcium stones that lodge in renal pelvis or pass thru ureters effects of immobility-urinary changes alter endocrine metabolism, GI system effects of immobility- metabolic changes fear, anxiety, depression, sadness, altered sleep patterns, isolation and loneliness effects of immobility- psychosocial effects Pressure ulcers: a result of decreased blood supply (ischemia) will see inflammation at the site must turn and reposition patient every two hours and/or encourage position changes older adults at greater risk When bone sits on hard surface, blood goes away from bony prominence and blood supply dies off to that area, can die outside in or outside in, tissue will not be able to move on own, so we turn and reposition [also why we use pillows] Turn and reposition every 2 hours, I&O, ROM, check calves effects of immobility-integumentary complications sensory alterations Altered sleep patterns Don't sleep as well without activity and exercise Progressive loss of bone mass occurs from: Decreased physical activity Hormonal changed Bone reabsorption Many walk slowly, smaller steps, less coordinated Medications can affect balance, b/p Always look at meds for liver and kidney functions especially, especially if it is a new medication mobility changes in older adults implementation w/ immobility Metabolic: Provide high protein, high calorie diet with vitamin B and C supplements Patients who are unable to eat provide nutrition parenterally or enterally Respiratory: Cough and deep breath- every 1- 2 hours Incentive spirometer- every 1-2 hours Chest physiotherapy Ensure that patients who are immobile take an adequate fluid intake. Unless there is a medical contraindication, an adult needs to drink at least 1100 to 1400 mL of noncaffeinated fluids daily. This helps keep mucociliary clearance normal. Cardiovascular: Get patient moving to reduce orthostatic hypotension This is a gradual lie-sit=dangle-stand with transfers Ways to reduce thrombus- position changes, ROM, fluids, anticoagulant therapy, intermittent pneumatic compression (IPC) [same as sequential compression devices], antiembolitic stockings (ted hose) Neuro checks when apply devices [check sensation above and below device] Proper positioning- want to decrease pressure areas to help with venous return ROM Musculoskeletal- exercises to prevent atrophy and contractures Passive ROM: Done for the patient Active ROM: Patient can perform CPM- continuous passive motion devices SCD- Sequential compression devices TED hose Integumentary system- Risk of pressure ulcers Turn and reposition every one to two hours Do more if pt has more risk factors Up in chair one hour- shift position every 15 minutes Pressure reducing devices in chair and mattress Elimination Systems Adequate hydration- ml of fluid - should be noncaffeinated Fruits, vegetables and fiber Constipation is a hazard of immobility, fruits/veggies/fibers can help prevent this Incontinent care as needed Psychosocial Changes Stimuli for patient orientation Involve patient in their care Developmental changes Elderly with restricted mobility increased risk Older patients who are frail and chro