PN245 Exam Review: Weeks 3-5

123 Vocabulary flashcards covering vulnerable populations, perioperative care, community assessment, and disaster management based on PN245 course content.

Social determinants of health

Conditions in a community that affect health, including economic stability, education access and quality, health-care access and quality, neighborhood and built environment, and social/community context.

Health disparity

A difference in health status or health outcome between individuals or populations.

Health inequity

An unfair or unjust difference in health treatment, access, or structural/institutional conditions.

Vulnerability

Having multiple risk factors that increase the likelihood of negative health outcomes.

PN245 Vulnerable Populations

People affected by violence, substance-use disorders, mental illness, poverty, homelessness, rural residence, migrant work, veteran status, disability, sexual or gender minority status, incarceration, adolescent pregnancy, immigration, and refugee status.

Health risks for people subjected to violence

Trauma, homicide, depression, isolation, fear, low self-esteem, malnutrition or dehydration, unmet basic needs, and mental anguish.

Migrant

A person who moves for economic or seasonal reasons.

Immigrant

A person who chooses to settle in another country and can return home.

Refugee

A person who is forced to flee because of war, violence, or persecution.

Health risks for migrant workers

Tuberculosis from crowded living, pesticide exposure, dental problems, and increased workplace injury, illness, and death.

Health risks for immigrants and refugees

Trauma-related mental-health effects and unmanaged health conditions caused by medication, insurance, and access barriers.

Health risks for people with substance-use disorders

Homelessness, kidney/liver disease, infections, accidents, violence, disability, suicide or homicide, and fetal/newborn complications.

Health risks for people with mental illness

Substance use, suicide, chronic disease, and inadequate treatment.

Health risks associated with poverty and homelessness

High stress, chronic disease, premature death, hospitalization, HIV, TB, mental illness, substance use, malnutrition, dental and skin problems, exposure illness, and trauma.

Health risks for rural residents

Higher infant and maternal morbidity, diabetes, obesity, respiratory disease, skin cancer, depression, suicide, injury, heart disease, stroke, and occupational risks.

Health risks for veterans

Hearing or vision impairment, traumatic brain injury, chronic conditions, PTSD, depression, anxiety, alcohol-use disorder, and suicide.

Health risks for people with disabilities

Poor self-image, isolation, abuse, and injury.

Health risks for sexual and gender minorities

Depression, anxiety, substance-use disorder, suicide risk, and negative health-care experiences.

Health risks for incarcerated people

Violence and communicable disease transmission related to crowded living conditions.

Health risks for pregnant adolescents

Violence, poverty, homelessness, malnutrition, low-birth-weight infant, and premature birth.

Warning signs of human trafficking

Repeated STIs or pregnancies, pelvic or rectal trauma, bruises/burns/scars, malnutrition, dental problems, substance withdrawal, fearfulness, another person speaking for the client, lack of control of documents, inconsistent story, or ownership tattoos.

Priority nursing action for suspected trafficking

Interview the client privately, use trauma-informed communication, assess immediate safety, and do not confront the suspected trafficker in front of the client.

Methods for communicating needs to policymakers

Lobby officials, join nursing organizations, serve on legislative committees, and provide population-health data or testimony.

Advocacy Nursing Organizations

ANA, AWHONN, and AONL.

Culturally inclusive assessment components

Ethnicity, religion, family structure, food patterns, health practices, language, literacy, education, beliefs about illness, environmental beliefs, time orientation, and decision-making patterns.

CLAS

Culturally and Linguistically Appropriate Services.

Key CLAS actions

Use qualified interpreters, provide information in the preferred language, and deliver culturally competent care.

Interpreter communication guidelines

Speak directly to the client, use short clear statements, pause for interpretation, avoid using children as interpreters, and confirm understanding with teach-back.

Cultural competence

Developing knowledge and skills to provide respectful and effective care across cultures.

Cultural humility

Recognizing personal limits, avoiding assumptions, remaining open, and allowing the client to teach the nurse about individual beliefs and values.

Population-based care rule

Know common population risks, but assess the individual and never assume the person follows every population trend.

Perioperative phases

Preoperative, intraoperative, and postoperative.

Role of the preoperative nurse

Assess the patient, review medications/allergies/history, verify NPO and consent, complete the checklist, teach the patient, reduce anxiety, and plan discharge.

Role of the intraoperative nurse

Protect and advocate for the patient, assist with positioning and monitoring, maintain safety and asepsis, document events, and prevent complications.

Role of the postoperative/PACU nurse

Monitor airway, breathing, circulation, neurologic recovery, vital signs, pain, nausea, temperature, surgical site, drains, GI/GU function, and readiness for transfer.

Scrub nurse role

Remain sterile, prepare and maintain the sterile field, anticipate the surgeon's needs, pass instruments, and participate in counts.

Circulating nurse role

Remain nonsterile, coordinate the room, document, add supplies to the sterile field, advocate for the patient, conduct or participate in time-outs, and perform counts with the scrub nurse.

Priority preoperative patient needs

Education, trust and confidence, informed consent, correct identification, medication/allergy review, NPO verification, and preparation for surgery.

Priority intraoperative patient needs

Meticulous monitoring, advocacy, safe positioning, teamwork, standardized communication, and prevention of infection, burns, hypothermia, blood loss, pressure injury, VTE, and retained objects.

Priority postoperative patient needs

Airway patency first, then breathing, circulation, level of consciousness, vital signs, urine output, surgical site, pain, anxiety, and nausea.

Responsibility for informed consent

The provider performing the procedure explains the procedure, risks, benefits, alternatives, and consequences of refusal.

Nurse's role in informed consent

Witness the signature, verify the patient received information and appears competent and voluntary, notify the provider about questions, and document teaching or interpreter use.

Timing for informed consent signature

Before sedating medications are administered.

Preoperative anxiolytics

Diazepam, lorazepam, and midazolam.

Anxiolytic priority monitoring

Oversedation, respiratory depression, hypotension, and falls.

Perioperative antibiotics

Penicillin, cefazolin, vancomycin, and gentamicin.

Purpose of perioperative antibiotics

They reduce surgical-site infection risk.

Priority risk of perioperative antibiotics

Monitor for allergic reaction or anaphylaxis.

Perioperative antiemetics

Metoclopramide and promethazine.

Antiemetic priority monitoring

Drowsiness, fluid/electrolyte changes, diarrhea, and constipation.

General anesthetic agents

Fentanyl, nalbuphine, oxymorphone, midazolam, propofol, desflurane, and nitrous oxide.

General anesthesia priority monitoring

Respiratory depression and hypotension.

Postoperative analgesics

Hydromorphone, morphine, fentanyl, and ketorolac.

OR medication-safety best practices

Use medication rights and two patient identifiers during preparation and before administration; label all medications and solutions.

Stages of the comprehensive surgical checklist

Preprocedure check-in, sign-in before anesthesia, time-out before incision, and sign-out before leaving the OR.

Preprocedure check-in verifications

Identity, procedure, site, consent, site marking, history and physical, preanesthesia and nursing assessments, diagnostic results, blood products, implants, devices, and special equipment.

Sign-in before anesthesia verifications

Identity, procedure, site, consent, allergies, pulse oximeter, difficult-airway or aspiration risk, blood-loss risk, available blood, and anesthesia safety check.

Surgical time-out actions

Other activity stops; the team confirms patient, procedure, incision site, consent, visible site mark, fire risk, images, equipment, critical events, blood loss, antibiotic timing, and sterility indicators.

Sign-out confirmations

Procedure name, sponge/sharp/instrument counts, specimen labels, equipment problems, wound classification, and recovery concerns.

Major intraoperative safety risks

Retained foreign objects, burns, wrong specimen labeling, hypothermia, blood loss, pressure or musculoskeletal injury, VTE, and infection.

PACU critical respiratory finding

Respiratory rate below $10$.

PACU critical oxygen finding

Oxygen saturation $92\,\%$ or less.

PACU critical renal finding

Urine output below $30\,mL/hr$.

Other PACU critical findings

Prolonged unresponsiveness, decreasing LOC, major HR/BP abnormalities, weak or absent pulses, or excessive bleeding.

Postoperative atelectasis prevention

Cough and deep breathe at least hourly while awake, use the incentive spirometer every $1-2$ hours while awake, reposition, control pain, and ambulate early.

Postoperative VTE prevention

SCDs, compression stockings, early and frequent ambulation, ankle/leg exercises, and prescribed anticoagulants.

Postoperative constipation prevention

Early ambulation, fluids and fiber when allowed, and prescribed stool softeners or laxatives.

Signs of surgical-site infection

Persistent or increasing drainage, redness, edema, warmth, increased pain, purulent drainage, foul odor, wound separation, or temperature above $38\,C$ ($101.4\,F$).

Postoperative incision-care teaching

Perform hand hygiene, keep the incision clean and dry as directed, follow dressing instructions, avoid unapproved products, and report infection signs.

Medical asepsis

A process that reduces the number and spread of microorganisms.

Surgical asepsis

A process that eliminates microorganisms and prevents contamination.

Sterile field contamination: Borders

The outer $1\,inch$ border and outer wrapping are considered contaminated.

Sterile field contamination: Location

Anything below the waist, above the chest, out of sight, or touched by a nonsterile item.

Nurse movement around sterile field

Do not reach across, turn your back on, or leave a sterile field unattended.

Sterile field addition height

Items may be added no more than $6\,inches$ above the field.

Strike-through contamination

Moisture passing through a non-waterproof wrapper or drape and carrying microorganisms onto the sterile field.

Sterile package discarding rule

Discard packages that are wet, torn, punctured, expired, or otherwise questionable.

Correct order for opening a sterile package

Open the far flap first, then the side flaps, and the near flap last.

Sterile solution pouring technique

Keep the label in the palm, avoid splashing, pour without touching the bottle to the sterile receptacle, and follow facility policy for expiration.

Wound assessment criteria

Pain, location, tissue appearance, partial versus full thickness, exposed structures, approximation, closure type, drainage, periwound condition, size, depth, tunneling, and undermining.

Types of wound exudate

Serous, sanguineous, serosanguineous, and purulent.

Wound size documentation

Length $\times$ width $\times$ depth in centimeters.

Clock positions in wound care

Used to document the location of tunneling and undermining.

Sterile dressing change sequence

Hand hygiene; prepare disposal; establish sterile field; clean gloves remove old dressing; assess and measure; remove gloves and clean hands; don sterile gloves; cleanse outward/top to bottom using each gauze once; apply and secure ordered dressing.

Four components of a community assessment

People, place, environment, and social systems.

Assessment under 'People'

Demographics, mobility, density, census data, health status, genetics, age, gender, causes of death, occupation, education, income, crime, recreation, language, religion, values, and customs.

Assessment under 'Place'

Geography, terrain, type of community, location of health services, housing, animal control, blight, employment, and grocery access.

Assessment under 'Environment'

Industries, pollutants, water, contamination, weather/climate, flora/fauna, toxic substances, and vectors.

Assessment under 'Social Systems'

Health, economic, educational, religious, welfare, political, recreation, legal, communication, transportation systems, resources, and services.

Community data-collection methods

Informant interviews, community forums, existing/secondary data, participant observation, focus groups, surveys, and windshield assessment.

Windshield assessment

The motorized equivalent of a simple head-to-toe assessment of a community.

Urban food desert

A residence at least $0.5\,mile$ from a supermarket or grocery store.

Rural food desert

A residence at least $10\,miles$ from a supermarket or grocery store.

I PREPARE

Investigate exposures, Present work, Residence, Environmental concerns, Past work, Activities, Referrals/resources, and Educate.

Internal disaster

An event inside the facility that directly threatens staff and patients, focusing on immediate safety and containment.

Examples of internal disasters

Fire or explosion in the building, power or utility failure, bomb threat, and active shooter.

External disaster

An event outside the facility that causes a casualty surge or resource strain, focusing on managing patient influx.

Examples of external disasters

Transportation accident, chemical spill, community fire or explosion, natural disaster, or mass-casualty violence.

Main nursing role during a disaster

Follow the Emergency Operations Plan, assist with triage, evacuation, decontamination, PPE, and treatment, and do the greatest good for the greatest number.

Disaster management cycle

Mitigation, preparedness, response, and recovery.