NR 224 Exam 1 Key Concepts

NR 224 Review of Knowledge (ROK) NR224 – Fundamentals of Nursing I Unit 1 Concepts NR 224 Exam 1 Key Concepts Chapters 15, 16, 28,29,38, & 39. Key Concepts Chapter 15: Critical Thinking in Nursing 1. Discuss the importance of critical thinking in nursing practice. • Be able to think in a systematic and logical manner • Having open-mindedness, continual inquiry, and perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant. • Analyzing information and evaluating and drawing conclusions • Using evidence- based knowledge in critical thinking • Basically using the nursing process ... 2. Discuss the factors that need to be considered when making clinical decisions. i. Discuss the levels of the critical thinking model. Basic, Complex, Commitment Basic Critical Thinking- Basic critical think level - the learner trusts that expert have the right answers for every problem. • They are likely to follow the procedure step by step without adjusting it to meet a patient’s unique needs • Inexperienced • Typically has weak competencies • Inflexible attitudes Ex: positioning to minimize the patient’s pain or mobility restrictions. For example: Referring to hospital policy and procedure for guidelines in inserting a Foley catheter. May not be able to modify for patients with unique needs. • Answers to complex problems as either right or wrong. • Learns to accept the diverse opinions and values or experts. • Inexperience, weak competencies, inflexible attitudes restrict a person’s ability to move to the next level of critical thinking. Complex Critical Thinking – • Begin to rely less on experts and trust their own decisions more. Ex: rather than using a procedure manual, you analyze the clinical situation and examine choices more independently. • A complex thinker considers different options from routine procedures. • More experience than basic • Uses different approaches for same therapy Commitment – • You anticipate when to make choices without assistance from others and accept accountability for decision made. • You choose an action or belief that is based on the available alternatives and support it. • You consider the results of the decision and determine whether it was appropriate. 3. List the critical thinking attitudes. Confidence- • Gaining more experience in reasoning and decision making, does not hesitate to disagree and be troubles, thereby acting as a role model to colleagues. • Speaks with conviction to a patient when you begin an intervention • Do not lead the patient to think you are unable to perform a task. Thinking independently- • Be open minded about different interventions. • Talk with other nurses to share ideas about nursing interventions. Fairness- • Listen to both side of a discussion. Responsibility and authority – • Ask for help if you are uncertain about a nursing skill • Responsible for correctly performing nursing care activities on the basic standard of practice Risk Taking- • If your knowledge causes you to question a healthcare providers order, do so • Be willing to recommended alternative approaches to nursing care when colleagues are having little success with patients. Disciple • Be through in whatever you do • Used known scientific and practice-based criteria for activities such as assessment and evaluation. Mange your time effectively. • Perseverance: Determined to find effective solutions • Creativity: Original thinking. • Curiosity: Always ask "why?" • Integrity: Continually test your own knowledge and beliefs. • Humility: Admit to personal limitations in knowledge and skill. 4. List and provide an example of each critical thinking skill. • Interpretation: Collect and clarify data (nursing diagnosis) • Analysis: Be open-minded as you look at data. Do not make assumptions-is data true or are there options? • Inference: Look at meaning and significance-does the data confirm a problem exists? Are there relationships about finding? Do data about the patient help to see the problem? • Evaluation: Look objectively. Use criteria such as expected outcomes. • Explanation: Support your findings and conclusions. Use knowledge and experience to choose strategies to use in the care of patients. • Self-regulation: Reflect on our experiences. Identify ways to improve performance. 5. Discuss and provide an example of each of the concepts of a critical thinker. Truth seeking- Seek the true meaning of a situation. Be honest and objective when asking questions. EX: Open-mindedness- Be tolerant of different views. Be sensitive to your own prejudices. Respect the rights of others with differing opinions. Analyticity- Analyze problematic situations. Anticipate results or consequences. Use evidence- based knowledge. Systematicity- Be organized, focused, work hard in any inquiry Self-confidence- Trust your own reasoning process. Inquisitiveness- Be eager to acquire knowledge. Maturity- Reflect on your own judgments, cognitive maturity. 6. Discuss the nursing process and its purpose. diagnose and treat human responses to actual or potential health problems including: Patient symptoms Physiological and psychological reactions to treatment Need for knowledge Patient's ability to cope with loss The nursing process allows nurses to help patients meet agreed-on outcomes for better health. Five steps: Assessment- gather information Diagnosis- identify problem Planning-set goals (outcomes) and appropriate nursing interventions Implementation- perform nursing actions Evaluation- determine if goals are met 7. Discuss the relationship between the nursing process and clinical decision making. Clinical decision making - Requires careful reasoning in choosing the best options for the best patient outcomes on the basis of the patient's condition and priority of problems. The nursing process allows nurses to help patients meet agreed-on outcomes for better health. 8. Discuss the purpose of a concept map. • A concept map is a visual representation of patient problems and interventions that shows their relationship to another. • Helps you better synthesize relevant data about a patient, including assessment data, nursing diagnoses, health needs, nursing interventions, and evaluation measures. • You learn to organize or connect information in a unique way Reflective journaling involves thinking back to clarify concepts. Reading assignments and lecture do not best provide an instructor the ability to evaluate students' abilities to synthesize data. 9. Discuss the principles that guide all of the components involved in the nursing process. • Assessment • Diagnosis • Planning • Implementation • Evaluation Chapter 16: Assessment 1. Discuss each step involved in the assessment phase of the nursing process. - Collection of information from primary sources and secondary sources - Interpretation & Validation of data to determine whether more data is needed or if data is complete 2. Describe the relationship between critical thinking and nursing assessment. - Nurse applies knowledge from physical, biological, and social sciences to ask relevant questions and to collect a complete history and physical. 3. Describe each step in the data collection process. Subjective Objective 4. Discuss the importance of each step in the data collection process. 5. Describe the sources of data collection. - Use information about a patients' needs to adapt your data collection - Be sure your data are as thorough as possible - Support subjective finding w/ objective findings Interpretation - - Recognize that further observations are needed to clarify info and begin to ID patient's health problems Cluster - - Cues that relate together, make inferences, and ID emerging patterns Validation - - validate information you have collected to avoid making incorrect inferences - Validate assessment data in comparison to other data sources to determine data accuracy - opens doors for gathering more assessment data b/c it involves clarifying vague or unclear data Primary source i. Discuss the differences between and provide an example of: Subjective data, Objective data - Patient Secondary Source - Family caregiver - family members - significant other - HC teams - Medical records 6. Discuss the components of nursing history. a. Discuss the components of physical assessment data. Chapter 28: Infection Control 1. Discuss infection control. - Prevents spread of infections in healthcare settings. 2. Discuss the importance of infection control in nursing practice. - Reduce healthcare risk and associated infections - Nurses are #1 spread of infections in hospital settings 3. Describe the most effective way to prevent the spread of infection. - Handwashing - Antiseptic handwashing - Antiseptic hand rub - Surgical hand antisepsis 4. Discuss the role of the healthcare provider in the prevention of the spread of infection. - Before touching patient - Before cleaning/aseptic procedures - After body fluid exposure risk - After touching patient - After touching patient surrounds - Between patients 5. List the stages in the chain of infection. - An infectious agent or pathogen - A reservoir or source of pathogen growth - a port of exit from the reservoir - a mode of transmission - a port of entry to a host - a susceptible host 6. Provide an example of each stage of infection. incubation stage of infection- interval between entrance of pathogen into body and appearance of first symptoms prodromal stage of infection- interval of onset of nonspecific signs / symptoms to more specific signs/ symptoms prodromal phase of infection- microorganisms grow and multiply - patient may be capable of spreading disease to others during this period in time illness stage of infection- interval when patient manifests signs / symptoms specific to that type of infection convalescence stage of infection- interval when acute symptoms of infection disappear 7. Describe what occurs during each stage of infection. Incubation Period - Chickenpox: 14-16 days after exposure - Common Cold: 1-2 days after exposure - Influenza: 1-4 days after exposure - Measles: 10-12 days after exposure - MUMPS: 16-18 days after exposure - Ebola: 2-21 days after exposure 8. Discuss the types of isolation precautions. Droplet Precaution- - Private room or Cohort patients - Mask or respirator Disease - Influenza - Adenovirus - Group A Strep - N. meningitides - Pertussis - Rhinovirus - M. pneumoniae - Diphtheria - pneumonic plague - Rubella - mumps Airborne Precautions- - Private room - Negative airflow - Mask / respiratory PPE - N95 respirator Disease - measles - chickpox - disseminated herpes zoster - mycobacterium tuberculosis - rubeola Contact precautions - - Private room / Cohort patients - Gloves - Gown Disease - Colonization or infections of multidrug-resistant organisms - major wound infections Protective Environment - - Private room - Positive airflow - HEPA filter for incoming air - Mask - Gloves - Gown Disease Allogeneic hematopoietic stem cell transplants 8. Discuss the different modes of transmission of infection. - Contact direct person-to-person physical contact between source and susceptible host Example : - HC providers hands - equipment - high-touch surfaces - Indirect Personal contact of susceptible host w/ contaminated inanimate object Example: - Needles - Sharp objects - Soiled linen - Dressing - Environment - Airborne - Organism can be carried in droplet nuclei or residue or evaporated droplets suspended in air during coughing or sneezing - Germs are aerosolized by medical equipment or by dust from a construction zone (nontuberculous mycobacteria or Aspergillus) - Droplet - an infected person coughs or sneezes, creating droplets that carry germs short distances Range in ft- 6ft - germs can land on susceptible person's eyes, nose, or mouth and can cause infection - Vehicles - Contaminated items (sharps injuries) can lead to infections (HIV, HBV, HCV) when bloodborne pathogens enter a person through a skin puncture by a used needle or sharp instrument Examples: - water - drugs - solutions - blood - food - Vectors - External mechanical transfer (flies) - internal transmission such as parasitic conditions between vector and host Examples: - Mosquito - Louse - Fleas - Ticks a. Discuss the type of patient that is at greatest risk for infection. Older adult is more at risk for infections 9. Discuss the guidelines for maintaining a sterile field. - Only sterile objects may be places on sterile field - keep all sterile items w/n field of view or they become un-sterile - sterile objects/ field may become contaminated w/ long-term exposure to air - Sterile surfaces in contact w/ wet, contaminated surfaces, become contaminated by capillary action - Fluid flows in direction of gravity - if gravity causes fluid to flow over surface of sterile field = contaminated - edge of sterile field / container is considered to be contaminated - create a 2.5 cm (1 inch border) around drape that is considered to be contaminated 10. Discuss the importance of wearing an N-95 mask. - higher filtration for airborne precautions - tighter face seal and filter at a higher level 12. Discuss the precautions needed for family members of a TB patient. - Isolation for the patient w/ known or suspect TB in a special negative-pressure room - always cover your mouth / nose when you cough or sneeze 13. Describe the difference between: Disinfection, Sterilization Disinfection- process that eliminates many or all microorganisms from inanimate objects It does not destroy – bacterial spores Sterilization – eliminates or destroys ALL forms of microbial life. Eliminates or destroys spores as well 14. Provide examples of equipment that should be: Disinfected, Sterilized Disinfected - bedpans - blood pressure cuffs - bedrails - linens - stethoscopes - beside trays - patient furniture - food utensils Sterilized - Surgical instruments - Cardiac or intravascular catheters - urinary catheters - implants 15. Describe the difference between: Clean technique, Aseptic technique, Sterile technique Clean technique - removal of organic material or inorganic material from objects - involves the use of water, detergent / disinfectant, and proper mechanical scrubbing - cleaning occurs before disinfection and sterilization Sterile Technique- processing items using steam, dry heat, hydrogen peroxide plasma, or ethylene oxide (ETO) - Decision to clean, clean and disinfect, or sterilize depends on the intended use of the contaminated item Chapter 29: Vital Signs 1. Discuss the meaning of Vital Signs - establishes a baseline for future assessments - indicator of health status What determines when a vital sign should be taken ? - a patients condition determines when, where, how or by whom vital signs are measured What does vital signs tell us as nurses – - measure that indicates the effectiveness of the circulatory, respiratory, neural, and endocrine body functions 2. List thy types of Vital Signs. Temperature 36 °C - 38 °C or 96.8-100.4°F Pulse 60-100 bpm - Strong -Regular Dr. CA Pulse oximetry 95% SpO2 Respiratory rate - 12-20 breaths/min - deep - regular Blood pressure Normal systolic pressure- 129 mmHg Normal diastolic - 80mmHg Capnography – 35-45mmHg 2. Discuss the importance of assessing Vital Signs. 3. List the normal ranges of Vital Signs for: Infants, Adults 5. Discuss orthostatic hypotension. occurs when a normotensive person develops symptoms and a drop in systolic pressure and diastolic pressure within 3 minutes of rising to an upright position 7. List the components of orthostatic hypotension. - Obtaining BP / Pulse in a sequence of the patient in a supine position, sitting and a standing position - hypotension is detected w/n a minute of standing 7. List the signs & symptoms of orthostatic hypotension. - fainting - weakness - blurred vision - light-headedness 8. Discuss the importance of performing orthostatic blood pressures. - allows us to monitor the change in pulse rate 9. Discuss pulse pressure. Pulse Pressure = Systolic Pressure - Diastolic pressure i. Patient has a Blood Pressure of 160/100 = Patient has a Pulse Pressure of _ 60 10. Discuss pulse deficit. - Difference between the apical and the peripheral pulse rates A common indicator of : - Lack of peripheral perfusion for some of the heart contractions 11. List assessment questions that should be asked prior to taking Vital Signs. - have you had anything hot/cold to drink or eat recently? - Have you had an AV fistula? - Have you had a mastectomy? - Have you smoked recently? 12. Discuss the importance of using the appropriate sized Blood Pressure cuff. - if improperly fitting cuff may cause inaccurate BP measurements 13. Discuss the importance of not disclosing to the patient that you are counting respirations. - a patient aware of a respiratory rate assessment can alter their rate and depth of breathing Dr. CA 14. Discuss the importance of knowing if your patient has had a mastectomy before taking a Blood Pressure. - carries risk of secondary lymphedema in the extremities if the lymph node as been removed Chapter 38: Activity and Exercise 1. Discuss the techniques required to maintain proper body mechanics when providing nursing care. -flex or bend your knees and hips (not your back) -maintain appropriate body alignment -keep your back straight -avoid bending from waist (can strain low back) -work @ height / comfortable level -avoid twisting spine -carry objects close to midline -widen base of support in direction of movement -stand directly in from of person or object you are working with -avoid reaching too far -slide, roll, push, or pull whenever possible instead of lift -alternate rest adn activity -know the maximum weight that is safe to carry (50lbs) -assess your own abilities and limitations and that of your partner, if working in pairs 2. Discuss the best position for proper body alignment for the patient lying in bed. - Lateral position / Side-lying position - because it keeps patients off their pressure points 3. Discuss the importance of exercise for patients. - conditions the body - improves health - maintains level of fitness - provides therapy for correcting deformity or restoring overall body to maximum state of health 4. Discuss and provide examples for: Range of Motion (ROM)- - Maximum amount of movement available at a joint in one of the three planes of the body that a client can perform independently COME BACK HERE TO REVIEW.. Passive Range of Motion (PROM)- - Range of motion through which a joint is moved with assistance 5. Discuss the actions of the nurse prior to ambulating a patient. - assess patient's ability to walk safely - evaluate environment for safety - assist patient to a sitting position - Dangle patient's leg over the side of the bed for 1-2 minutes before standing - provide support at the waist sot he patient's center of gravity remains at midline 6. Discuss nursing actions before lifting an object. Gait belt 7. Describe the nursing evaluation process for activity tolerance in a patient. Evaluate whether patient's expectations and/or goals of care have been reached Questions nurses woyld ask - - How well did you tolerate walking, and is that what you expected? -You have been walking regularly for a month now, how has it made you feel? 8. Define: Gait- Manner or style of walking - Rhythm - Cadence - Speed Unsteady gait - - caused by disease or damage to the legs and feet or to the nervous system that controls the movement necessary for walking Parts of the body to cause unsteady gait - - nervous system - Legs - Feet - Bones - Joints - blood vessels - muscles - other soft tissues Range of Motion - Posture- Position of body in relationship to the surround space Friction- - effect of rubbing or resistance that a moving body meets from the surface on which it moves - force that occurs in a direction to oppose movement 9. Describe the conditions that could cause an unsteady gait. - caused by disease or damage to the legs and feet or to the nervous system that controls the movement necessary for walking Chapter 39: Immobility 1. Discuss: Mobility, Immobility, Describe the assessment process used by nurses to determine mobility in a patient. MOBILITY ASSESSMENT ability to move about freely - begin assessment with the patient in the most supported positions - Move to higher levels according to patient's tolerance - Assessmnet normal start - - with the patient laying down End with – patient walking Start: -Laying down -Move to sitting position in bed - Transfers patient to chair Ends: - Patient walking IMMOBILITY- inability to move freely Assessment_- Musculoskeletal system - ROM - Muscle strength - activity tolerance - posture - body alignment Questions nurses ask- • Assess the patient’s body alignment, posture, and mobility . • Effect of impaired or limited mobility on patient’s overall physical, emotional, and social status. • 2. List questions asked during an assessment to help the nurse determine mobility status in a patient. - "Describe any changes you've noticed in your ability to walk and take care of yourself daily" " Have you experienced any stiffness, swelling of a joint, muscle or joint pain, or difficulty w/ walking? is so, describe how it impacts your movement and ADLs?" - "Have you noticed any shortness of breath; if so, does it worsen when walking?" 3. Describe the assessment process used by nurses to determine immobility in a patient. - Musculoskeletal system - ROM - Muscle strength - activity tolerance - posture - body alignment 4. List questions asked during an assessment to help the nurse determine immobility status in a patient. - "Describe your normal daily activity. Has it changed recently?" - How has your appetite and diet changed since you have had problems moving around?" - "Describe what you eat in a normal day?" - "Does your day seem very long?" - Describe for me a typical night's sleep" - "Have you noticed any places on your skin that are reddened or have any open sores?" - Describe any changes you've noticed in urinating and/or having bowel movements" i. Discuss & give an example of: Isometric Exercise, Isotonic Exercise Isometric exercise - - exercises prescribed to the patients that involves tightening or tensing muscles w/o moving body parts Example : - tightens or contracts a muscle group for 10 seconds and then completely relaxes Isotonic Exercise - Exercises causing muscle contraction and change in muscle length Examples : - Walking - swimming - jogging - bicycling Contraction bicycling Dr. CA What does it enhance ? - circulatory function - respiratory function Increases - - muscle mass - muscle tone - muscle strength Promote - osteoblastic activity that combats osteoporosis 5. Discuss the importance of assessing a patient’s mobility status prior to ambulating the patient. - determines whether a lift device or mechanical transfer is needed - determines the number of people needed to assist the patient to a standing position 6. List patient data needed prior to ambulating a patient. - Review medical records for most recent activity experience - review most recent recorded weight for patient - review any reports of patient's ability to stand and bear weight What does a review of medical records involve prior to ambulating a patient? - distances ambulated - use of assistance device - activity tolerance - balance - gait 7. List Nursing Diagnosis that could be used for immobile patients. 8. Discuss complications that may occur in the immobilized patient. 9. Discuss important patient teaching topics for the immobile patient. 10. List the side effects of prolonged bedrest. - loss of muscle strength - Causes atrophy of muscles - causes weight loss - decreases muscle mass - increases muscle weakness