NUR 380-01 Theory Final Exam

Indicators of Magnet Status

- Transformational leadership

- Structural empowerment

- Exemplary professional practice

- New knowledge, innovations, improvements

- Empirical outcomes (quality results)

Roles of a Professional Nurse

- Caregiver

- Advocate

- Educator

- Communicator

- Leader

- Manager

- Coordinator

- Collaborator

- Researcher

Nurse Practice Act

- What nurses are allowed to do (scope of practice)

- What nurses are not allowed to do

- The qualifications needed to become a nurse

- The standards of professional practice

- Disciplinary actions for unsafe or unethical behavior

** Protects patients

Primary Prevention

Preventing disease or injury before it occurs

- Immunizations

- Education

- Wearing seatbelts and helmets

Secondary Prevention

Early detection or prompt treatment to stop or slow disease progression

- Screenings

- Pap smears

- Colonoscopies

- Mammograms

Tertiary Prevention

Reduce complications, improve quality of life, and prevent disability from disease

- Occupational therapy

- Physical therapy

- Medication adherence

- Support groups

- Disease management

A.D.P.I.E

Assessment

Diagnosis

Planning

Implementation

Evaluation

Critical Thinking

Ability to analyze information, evaluate evidence, and make informed decisions to provide safe, effective patient care. It involves reflective, logical, and independent thinking

Interventions of critical thinking

Actions taken by nurses to achieve desired patient outcomes. They are based on assessment data, nursing diagnoses, and patient goals

Steps of planning interventions

- Assess patient needs

- Identify expected outcomes

- Select appropriate interventions

- Implement interventions

- Evaluate outcomes

Phases of the Helping Relationship

- Pre-interaction

- Orientation

- Working Phase

- Termination

Pre-interaction Phase

Before the nurse meets the patient

Orientation Phase

Nurse and patient meeting and getting to know one another

Working Phase

When the nurse and the patient work together to solve problems and accomplish goals

Termination Phase

Occurs at the end of a relationship

Examples of caring touch

- Hold a patient hand

- Back massage

- Gently position

- Communicate

Verbal Communication

Use of spoken or written words to convey messages, ideas, or feelings

- Giving patient instructions ("Take your medication twice a day")

- Explaining procedures

- Documenting patient care in charts

- Asking assessment questions ("Do you feel any pain?")

- Providing emotional support through words

Non-verbal communication

The transmission of messages without words, using body language, facial expressions, gestures, posture, eye contact, and tone of voice

- Smiling or frowning

- Nodding to indicate understanding

- Touch (e.g., hand on shoulder for reassurance)

- Eye contact

Assertivness

- The ability to express your thoughts, feelings, needs, and rights clearly, confidently, and respectfully, without being passive or aggressive.

- Helps advocate for patients, communicate effectively with colleagues, and maintain professional boundaries.

Zones of personal space

- Intimate zone (0-18 inches)

- Personal zone (18 inches to 4 feet)

- Social zone (4 to 12 feet)

- Public zone (12 feet and greater)

Care measures for patients with challenging communication issues

- Assessment and identification (hearing impairment, speech disorder, language barrier, cognitive deficit, etc)

- Establish therapeutic environment (minimize background noise and distractions, adequate lighting, sit at eye level facing the patient)

- Use appropriate communication techniques (verbal, non-verbal, augmentative)

- Validate understanding (ask patient to repeat or demonstrate their understanding)

Delegation of tasks to assistive personnel for restraints

- Applying restraints

- Routine checking of the restraints

What is important in critical thinking and making decisions?

- Prioritization: severity / urgency, patient safety, evidence-based practices, patient preferences, etc

Body Alignment

- Correct positioning of the body so that bones, joints, and muscles are in proper relation, reducing strain and promoting balance

- Ensures that the individual's center of gravity is stable, which helps maintain posture and prevents injury

Balance

- Ability to maintain the body's center of gravity over its base of support

- Prevents falls and allows safe movement

- Depends on muscle strength, coordination, and proprioception (body awareness)

Gait

- The manner or style of walking, including rhythm, speed, and coordination of movement

- Proper alignment, balance, and coordinated muscle activity

Orthostatic Hypotension

- Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions

- Systolic BP dropping by 20mmHg or more

Proper sitting alignment

- Feet on the floor

- Knees at 90 degree angle

- 1-2in of popliteal space between chair and legs

- Arms resting on armrest

Transfer from the bed to wheelchair

- Wheels of wheelchair and bed locked

- Gait belt on / assistive equipment ready

- Mentally review the steps for transferring

Responses to patient fall

1. Assess the patient

2. Notify the provider

3. Documentation

4. Incident report

Fall risk factors

- Age 65+

- Reduced vision

- Orthostatic hypotension

- Lower extremity weakness

- Gait and balance problems

- Urinary incontinence

- Improper use of walking aids

- Effects of various medications

Environmental factors for fall risk

- Inadequate lighting

- Unleveled flooring

- Scattered rugs

What is lateral violence?

- Aggressive and destructive behavior or psychological harassment of nurses against each other

What does poorly functioning health care teams lead to?

- Poor patient outcomes and increased adverse safety incidents for patients

Interprofessional Education Collaborative Competencies (IPEC)

- Communication

- Teams / teamwork

- Values and ethics

- Roles and responsibilites

First step in achieving culture competence

- Assess personal biases

Four domains of professional identity for nurses

- Competence

- Knowledge

- Values and ethics

- Nurses as a leader

Patient autonomy

- Freedom from external control, patients able to make decisions about their care

External variables impacting a patient's illness

- Family and social support

- Socioeconomic status

- Cultural and religious beliefs

- Environmental factors

- Access to healthcare

- Social roles and lifestyle

- Community and public policy

Proper patient interventions when starting to mobilize after a period of bedrest

- Assessment (vital signs, level of consciousness, muscle strength and joint mobility, fall risk assessment, pain level)

- Promote patient safety (assistive devices, clear path, staff assistance)

- Proper body mechanics (support trunk and legs, encourage patient to use legs and arms to help with standing up)

- Gradual progression (dangle legs bedside, bed to chair, short walks)

Consequences of immobility

- Muscle atrophy

- Atelectasis/pneumonia

- Venous stasis

- Increased coagulability

- Pressure ulcers

- Constipation

- Depression

- Sleep disturbances

- Disorientation

Braden Score

Higher the number, the lower the risk for skin breakdown

- Sensory perception (full sensation, neuropathy, paralyzed)

- Moisture (always dry, frequently incontinent)

- Activity (bedrest, walks frequently, etc)

- Mobility (ability to reposition themself)

- Nutrition (good or poor diet)

- Friction and shear (risk of sliding or rubbing in bed)

Polypharmacy

- Concurrent use of many medications

- 5 or more medications

Medication reconciliation

- A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery

- Reduces adverse effects and allows providers to administer only the current medications

Consequences of polypharmacy

- Falls

- Sleep disturbances

- Cognitive impairment

- Harmful drug interactions

Presbycusis

- Hearing loss due to old age

S.B.A.R

- Consistent, clear, structured, and easy-to-use method of communication between health care personnel

- Situation

- Background

- Assessment

- Recommendations

Normal sensory changes in older adults

- Loss of night vision

- Hearing deficits

- Decreased taste sensitivity

- Reduced sense of smell

- Reduction of tactile sensitivity

- Slower reflexes

Founder of the patient safety movement

Dr. Lucian Leape

Percentage of annual victims to medical errors

- 10%

- 50% of those victims are from preventable errors

High-Reliability Organization (HRO)

- An organization that consistently performs safely, efficiently, and with high quality even in the face of complex, high risk work

Five pillars of a high-reliability organization

- Preoccupation with failure

- Reluctance to simplify interpretations

- Sensitivity to operations

- Commitment to resilience

- Deference to expertise

Most common errors in an acute inpatient hospital setting

- Communication errors from interdisciplinary teams

- Faulty systems

Gerontology

- The study of aging and older adults, multidisciplinary, focus on healthy and successful aging, addresses diversity among older adults and complexity of care

Ototoxic medications

- Aminoglycoside antibiotics (Gentamicin)

- Loop diuretics (Furosemide)

- Chemotherapy agents (Cisplatin)

- Salicylates (high doses of Aspirin)

Description of professional identity

- Acting, thinking, and feeling like a nurse

Fulmer SPICES Overall Assessment

- Sleep disorders

- Problems with eating

- Incontinence

- Confusion

- Evidence of falls

- Skin breakdown

Actions when there is a fire (RACE)

- Rescue and remove patients from immediate danger

- Activate the fire alarm

- Confine the fire by closing doors and windows

- Extinguish the fire

TUG Assessment

- Timed Get Up and Go

- Measures the progress of balance, sit to stand, and walking

- Direct observation is the best way to get to know how a patient moves

Documentation for a patient in restraints

1. Justification for restraints

2. Type of restraint

3. Time and duration

4. Patient assessment

5. Interventions and care

6. Patient response

Most common type of vision loss in older adults

- Cataracts

- Surgery is definitive treatment

The four Ms of an age friendly health system

- What matters (motivating factor, what do they want?)

- Medications

- Mobility

- Mentation

Agnosia

- The inability to recognize familiar objects

- Example: trying to use a brush as a utensil

L.M.O.V.E.D

L

Myocardial stability

Oxygenation

V

Engagement (alert before moving the patient. Agitation should be used as a deterrent)

D

Etiquette when using an interpreter

- Look directly at the patient, not at the interpreter

- Pace your speech by using short sentences

- Observe the patients nonverbal and verbal behaviors

Vision pathway

- Cornea

- Lens

- Retina

- Optic nerve

- Brain

Psychological safety

- Shared belief of team members so that they can take personal risks and speak up, share concerns, and admit mistakes

National patient safety goals

- Screening for suicide from ages 8+

- Two patient identifiers (not room number)

- Nurse to patient ratios

Tanner's Clinical Judgement Model Sequence

- Recognizing cues

- Analyzing cues

- Prioritizing hypotheses

- Generating solutions

- Taking action

- Evaluating actions

Common themes of Tanner's CJM

- Clinical judgement is influenced more by nurses' experience and knowledge than objective data

- Knowing patients and typical pattern of responses

- Use a combination of reasoning

- Clinical judgement influenced by context of clinical situations and culture of patient care settings

Normal cognitive changes with aging

- Slower recall of events

- Mild decrease in multitasking ability

- Slower cognitive processing

- Slower interpretation of sensory input

Actions to prevent a medication administration error

- Right patient

- Right medication

- Right dosage

- Right route

- Right time

- Right documentation

Myths of aging

- Sexual activity declines completely

- Depression is normal with aging

- Older adults self-isolate by choice

- They are more forgetful

Facts on aging

- Cognitive changes are mild

- Sensory changes occur

- Slower reaction time

- Skin becomes thinner and less elastic

- Muscle mass and bone density decrease

- Chronic illnesses are more common

Gender dysphoria

- The condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex

CAT items (?)

- Concept: The underlying principle or knowledge behind nursing care (the "why").

- Attitude: The values, beliefs, and professional behaviors that guide nursing actions (the "approach").

- Technique: The practical skill or procedure used to provide care (the "how").

Founder of Modern Medicine & Epidemiology

Florence Nightengale

Founder of American Red Cross

Clara Barton

Benner's Stages of Nursing Proficiency

1. Novice

2. Advanced Beginner

3. Competent

4. Proficient

5. Expert

Autonomy in nursing

The ability and authority of a nurse to make independent clinical decisions based on their professional knowledge and judgment

Accountability in nursing

Being responsible and answerable for your actions, decisions, and the care you provide to patients

When does discharge planning begin?

At time of admission

The Code of Ethics

An American Nurses Association document outlining right versus wrong

Requirements to practice nursing post-graduation

- Receive associates or baccalaureate degree

- Apply for licensure with the state's board of nursing

- Register and pass the NCLEX

- Receive nursing license

- Meet state-specific requirements

Roles of Advanced Practice Nurses

- Nurse Practitioner (NP)

- Certified Registered Nurse Anesthetist (CRNA)

- Midwife

- Clinical Nurse Specialist

Modifiable health risk factors

- Poor diet

- Physical inactivity

- Smoking

- Excessive alcohol usage

- Obesity

- Poor sleep habits

Non-modifiabke health risk factors

- Age

- Biological gender

- Genetics

- Ethnicity

- Congenital conditions

Still learning (76)

You've started learning these terms. Keep it up!