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NUR 419 Midterm Study Guide Questions And Answers
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NUR 419 Midterm Study Guide Questions And Answers
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Solution 2024/2025Pepper
NUR 419 Midterm Study Guide Questions And
Answers
Touchpoints are,
"Any place patients and families go during the care experiences such as the waiting room, exam room, lab..."
Touchpoints,
"Shadowing",
Direct observation of process, which can help you. Understand patients' and families' frustrations, confusions, and
anxieties. Identify the aspects of care experiences that patients and families view as positive. Feel a renewed sense of
empathy for patients and their families, which can lead to a sense of urgency to make improvements. Reveal
inefficiencies that waste time — not only your time as a caregiver, but the valuable time of patients and families.
Understand that data is not always the best tool to motivate change. Gain qualitative information, i.e., "This is how it
feels," not just "This is how it looks." "For the sake of objectivity, it's preferable to shadow a care experience with which
you are relatively unfamiliar" "Cross-shadow": Shadowing can lead to an "a-ha!" moment.
Asking,
Ask the questions. Example: blank (unfilled) data fields in EMR. Sexual history. End-of-Life desires. What do we
remember?. First skill: Not first communication
"A Century of Change",
1900: PNA or Flu as cause of death Life expectancy = 47 Die at home Family covers medical costs Little disability before
death 2000: Cardiac disease as cause of death Life expectancy = 75 Die in hospital/LTC Insurance to cover most costs At
least 2 years of disability before death
Resource Stewardship,
US leader in wasteful care: 16% GDP Norway, Germany, Switzerland, Israel: < 1.9% Think of a potential wasteful situation
What are the costs?
, Solution 2024/2025
Pepper
Quality Improvement and Change,
Plan Do Study Act
Change as process,
Innovation →pilot → implement → spread Unfreezing → change/transition → refreezing
Making the change stick,
"Hardwiring" The steps we take to prevent us from slipping back to the comfortable position after we identify a better
way of doing something. Some tactics for hardwiring include: Documenting the flow of the new process — the new way
of doing things Providing training on the new process Teaching people new skills that might be required of them Making
changes to job descriptions, policies, procedures, and forms Addressing supply and equipment issues Assigning day-to-
day ownership for the improvement and maintenance of the new process Having senior leaders remove any barriers
that might allow slippage back to the old process
Change:
People and Innovation, Innovation Early adopters Early majority Late majority Laggards What have YOU observed? What
can YOU change?
2016 National Patient Safety Goals
The National Patient Safety Goals (NPSGs) were established in 2002 to help accredited organizations address specific
areas of concern in regards to patient safety, The first set of NPSGs was effective January 1, 2003 The Patient Safety
Advisory Group advises The Joint Commission on the development and updating of NPSGs
Patient Safety Advisory Group,
Panel of widely recognized patient safety experts Nurses, physicians, pharmacists, risk managers, clinical engineers,
other professionals Hands-on experience in ddressing patient safety issues in wide variety of health care settings Advises
The Joint Commission how to address emerging patient safety issues NPSGs, Sentinel Event Alerts, standards and survey
processes, performance measures, educational materials, Center for Transforming Healthcare projects
2016 NPSGs
No new Goals for 2016 Clinical Alarms NPSG: Phase 2 is now effective. Hospitals are expected to establish and
implement policies and procedures for managing clinical alarms and to educate individuals about alarm systems.
Patient Identification,
Goal 1: Improve the accuracy of patient identification. NPSG.01.01.01: Use at least two patient identifiers when
providing care, treatment and services. Applies to: Ambulatory, Behavioral Health Care, Critical Access Hospital, Home
, Solution 2024/2025
Pepper
Care, Hospital, Laboratory, Nursing Care Center, Office-Based Surgery. NPSG.01.03.01: Eliminate transfusion errors
related to patient misidentification. Applies to: Ambulatory, Critical Access Hospital, Hospital, Office-Based Surgery
Improve Communication,
Goal 2: Improve the effectiveness of communication among caregivers. NPSG.02.03.01: Report critical results of tests
and diagnostic procedures on a timely basis. Applies to: Critical Access Hospital, Hospital, Laboratory.
Medication Safety,
Goal 3: Improve the safety of using medications. NPSG.03.04.01: Label all medications, medication containers, and other
solutions on and off the sterile field in perioperative and other procedural settings. Applies to: Ambulatory, Critical
Access Hospital, Hospital, Office Based Surgery NPSG.03.05.01: Reduce the likelihood of patient harm associated with
the use of anticoagulant therapy. Applies to: Ambulatory, Critical Access Hospital, Hospital, Nursing Care Center
NPSG.03.06.01: Maintain and communicate accurate patient medication information. Applies to: Ambulatory, Behavioral
Health Care, Critical Access Hospital, Home Care, Hospital, Nursing Care Center, Office-Based Surgery.
Clinical Alarm Safety,
Goal 6: Reduce the harm associated with clinical alarm systems. NPSG.06.01.01: Improve the safety of clinical alarm
systems. Applies to: Critical Access Hospital, Hospital
Health Care-Associated Infections,
Goal 7: Reduce the risk of health care-associated infections. NPSG.07.01.01: Comply with either the current Centers for
Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand
hygiene guidelines. Applies to: Ambulatory, Behavioral Health Care, Critical Access Hospital, Home Care, Hospital,
Laboratory, Nursing Care Center, Office-Based Surgery. NPSG.07.03.01: Implement evidence-based practices to prevent
health care-associated infections due to multidrug-resistant organisms in acute care hospitals. Applies to: Critical Access
Hospital, Hospital. NPSG.07.04.01: Implement evidence-based practices to prevent central line-associated bloodstream
infections. Applies to: Critical Access Hospital, Hospital, Nursing Care Center. NPSG.07.05.01: Implement evidence-based
practices for preventing surgical site infections. Applies to: Ambulatory, Critical Access Hospital, Hospital, Office-Based
Surgery. NPSG.07.06.01: Implement evidence-based practices to prevent indwelling catheter-associated urinary tract
infections (CAUTI). Applies to: Critical Access Hospital, Hospital. (Note: This NPSG is not applicable to pediatric
populations. Research resulting in evidence-based practices was conducted with adults, and there is not consensus that
these practices apply to children.)
Reduce Falls,
Goal 9: Reduce the risk of patient harm resulting from falls. NPSG.09.02.01: Reduce the risk of falls. Applies to: Home
Care, Nursing Care Center
Pressure Ulcers,
Goal 14: Prevent health care-associated pressure ulcers (decubitus ulcers). NPSG.14.01.01: Assess and periodically
reassess each resident's risk for developing a pressure ulcer and take action to address any identified risks. Applies to:
Nursing Care Center
Risk Assessment
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Goal 15:
The organization identifies safety risks inherent in its patient population.
NPSG.15.01.01: Identify patients at risk for suicide.
Applies to: Behavioral Health Care, Hospital
(Applicable to psychiatric hospitals and patients being treated for emotional or behavioral disorders in general
hospitals.)
NPSG.15.02.01: Identify risks associated with home oxygen therapy, such as home fires.
Applies to: Home Care
Universal Protocol for Preventing Wrong Site,
Wrong Procedure, Wrong Person Surgery™ , UP.01.01.01: Conduct a preprocedure verification process. Applies to:
Ambulatory, Critical Access Hospital, Hospital, Office-Based Surgery. UP.01.02.01: Mark the procedure site. Applies to:
Ambulatory, Critical Access Hospital, Hospital, Office-Based Surgery. UP.01.03.01: A time-out is performed before the
procedure. Applies to: Ambulatory, Critical Access Hospital, Hospital, Office-Based Surgery
Heart Failure Situation,
Carlo Boccerini, 68 yo Caucasian man, has a 5-year history of systolic heart failure due to ischemic cardiomyopathy. His
current ejection fraction (EF) is 15%. Carlo comes to the ED for shortness of breath for the past 3 days. First it was just
dyspnea with activity, but now it occurs at rest. He reports he has now slept in the recliner the past two nights because
of worsening shortness of breath. He adds that his legs are all swollen and he can't get his shoes on. After being assessed
in the ED, oxygen at 6L NC is applied to Carlo and he is transferred to the cardiac step-down unit for monitoring and care
management.
Carlo's Past Medical History,
Myocardial infarction (MI) with coronary artery bypass graft (CABG x3). systolic heart failure secondary to ischemic
cardiomyopathy. Implantable cardioverter defibrillator (ICD) inserted after CABG surgery. Atrial fibrillation.
Hyperlipidemia. Chronic kidney insufficiency (CKI).
Pathophysiology leading to MI,
Carlo's hyperlipidemia likely contributed to atherosclerosis, the buildup of fatty plaque leading to the narrowing and
hardening of his coronary arteries. The plaque builds up over time and the narrowing can decrease or obstruct the
supply of blood and oxygen to the heart tissues leading to a myocardial infarction, or heart attack. Plaques can also
rupture leading to a blood clot which if becomes large enough, can completely block blood flow through a coronary
artery. Carlo had coronary artery bypass graft (CABG) surgery done to bypass the blocked section so that blood flow can
go around the artery and deliver oxygen to the heart.
Pathophysiology leading to Ischemic Cardiomyopathy,
When the arteries that bring blood and oxygen to the heart are blocked or very narrowed, over time, the lack of blood
supply can cause diffused inflammation and degeneration of the myocardial fibers of the heart. Carlo's heart muscle
damage from his prior infarction and ischemia leads to a weaken, dilated, and thin-walled L ventricle, the heart's main
pumping chamber. This leads to decrease contractility of the heart to pump blood. This causes ischemic
cardiomyopathy. Ultimately, the left ventricle cannot contract correctly and it becomes harder for the heart to push
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