PN245 Complete Lecture Flashcards

194 source-based vocabulary flashcards for PN245, covering Weeks 3, 4, and 5 based on the provided lecture transcript.

Vulnerable population

A group with multiple risk factors for negative health outcomes.

Effect of social determinants of health

They affect the risks people face and the resources available to them.

Five social determinants of health in PN245

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.

Health inequity

Unfair or unjust treatment, access, or structural/institutional patterns that contribute to health disparities.

Identified vulnerable groups in PN245

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

Most important rule when assessing a vulnerable population

Know common population risks, but assess the individual and do not assume every member of the group has the same needs.

Common health risks: People subjected to violence

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

Common health risks: Migrant workers

Tuberculosis related to crowded living, pesticide exposure, dental problems, workplace injury, illness, and death.

Common health risks: Immigrants and refugees

Trauma-related mental-health effects and unmanaged health conditions related to medication, insurance, or access barriers.

Common health risks: People with substance-use disorders

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

Common health risks: People with mental illness

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

Common health risks: Poverty and homelessness

Stress, chronic disease, premature death, hospitalization, HIV, tuberculosis, mental illness, substance use, malnutrition, dental or skin problems, exposure illness, and trauma.

Common health risks: Rural residents

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

Common health risks: Veterans

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

Common health risks: People with disabilities

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

Common health risks: Sexual and gender minorities

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

Common health risks: Incarcerated people

Violence and communicable disease transmission in crowded living conditions.

Common health risks: Pregnant adolescents

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

How nurses communicate needs to public policy makers

Through organized advocacy supported by accurate data and professional participation.

Nurse lobbying targets

Laws, funding, programs, and access.

Professional advocacy organizations in PN245

ANA, AWHONN, and AONL.

Serving on a legislative committee

Gives nurses a direct role in shaping policy and communicating community needs.

Evidence provided to policy makers

Population-health data, reports, testimony, and examples of unmet needs.

Nurses should advocate for on behalf of underserved populations

Prevention, care coordination, equitable access, and elimination of health-care discrimination.

Requirements for culturally responsive care

Assessment, humility, communication in the client’s preferred language, and respect for individual preferences.

Cultural and spiritual assessment factors

Ethnicity, religion, spirituality, family structure, food patterns, health practices, language, literacy, education, beliefs about illness, environmental beliefs, time orientation, and how decisions are made.

Interpreter selection

A qualified interpreter.

Language for health information

The client’s preferred language.

Rules for cultural communication

Address them respectfully, introduce yourself, maintain a nonjudgmental attitude, and encourage questions.

Reason to avoid cultural assumptions

An individual may not follow every trend associated with the cultural group.

Handling cultural health practices

Explore the reasons behind them and incorporate safe preferences whenever possible.

Action for personal and institutional bias

Recognize it and work to eliminate discrimination.

Cultural competence

The development of knowledge and skills for providing care across cultures.

Cultural humility

Remaining open, avoiding assumptions, and allowing the client to teach the nurse about personal beliefs and values.

High-yield distinction: Competence vs. Humility

Competence is developing knowledge and skills; humility is staying open and letting the client define personal beliefs and values.

Three phases of perioperative care

Preoperative, intraoperative, and postoperative/PACU.

Overall role of the perioperative nurse

To protect and advocate for the patient throughout the preoperative, intraoperative, and postoperative phases.

Preoperative nurse main responsibilities

Assess the patient, review medications, allergies, and history, verify NPO status and consent, complete the checklist, provide teaching, decrease anxiety, and plan discharge needs.

Intraoperative nurse main responsibilities

Assist with positioning and monitors, protect the airway and body, prepare the site, maintain safety and asepsis, document events, perform counts, and advocate for the anesthetized patient.

Postoperative/PACU nurse main responsibilities

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

Scrub nurse role

Remain sterile, anticipate the surgeon’s needs, and pass instruments.

Circulating nurse role

Remain nonsterile, supply the sterile field, document, coordinate care, lead 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 and allergy review, NPO verification, and preparation for surgery.

Priority intraoperative patient needs

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

Priority postoperative patient needs

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

PACU priority rule

Airway before pain.

Postoperative responsiveness finding

Prolonged unresponsiveness or decreasing level of consciousness must be reported immediately.

Oxygen saturation requiring immediate report

Oxygen saturation of $92\%$ or less.

Respiratory rate requiring immediate report

Respiratory rate below $10/\text{min}$.

Cardiovascular changes requiring immediate report

Major pulse or blood-pressure changes.

Urine output requiring immediate report

Urine output below $30\,\text{mL/hr}$.

Surgical-site finding requiring immediate report

Excessive bleeding.

Reason for perioperative medications

To reduce anxiety, prevent infection, provide anesthesia and analgesia, and control nausea.

Perioperative anxiolytics in PN245

Diazepam, lorazepam, and midazolam.

Purpose of perioperative anxiolytics

Relaxation and sedation.

Priority adverse effects of anxiolytics

Oversedation and respiratory depression.

Perioperative antibiotics in PN245

Penicillin, cefazolin, vancomycin, and gentamicin.

Purpose of perioperative antibiotics

To reduce the risk of surgical-site infection.

Priority risk of perioperative antibiotics

Allergy or anaphylaxis.

Perioperative antiemetics in PN245

Metoclopramide and promethazine.

Purpose of perioperative antiemetics

To prevent or treat nausea and vomiting.

Nurse monitoring for antiemetics

Fluids and electrolytes, drowsiness, diarrhea, and constipation.

General anesthetic agents in PN245

Fentanyl, nalbuphine, oxymorphone, midazolam, propofol, and inhaled gases such as desflurane and nitrous oxide.

Purpose of general anesthetic agents

To produce sedation and unconsciousness.

Priority adverse effects of general anesthetic agents

Respiratory depression and hypotension.

Postoperative analgesics in PN245

Hydromorphone, morphine, fentanyl, and ketorolac.

Purpose of postoperative analgesics

To lower pain.

Nurse monitoring for postoperative analgesics

Sedation, respiratory status, bleeding risk, and other adverse effects.

Two medication-safety practices

Use medication rights and two identifiers during preparation and before administration; label every medication and solution transferred from its original container.

Purpose of comprehensive surgical checklist

To prevent wrong-patient, wrong-procedure, wrong-site, medication, equipment, and communication errors.

Four stages of the surgical checklist

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

Preprocedure check-in verifications

Patient 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.

Required action before surgical time-out begins

Other activity must stop.

Team action during time-out

Team members introduce themselves.

Confirmed items during time-out

Patient, procedure, incision site, consent, visible site marking, fire risk, images, equipment, anticipated critical events, blood loss, antibiotic timing, and sterilization indicators.

Confirmed items during sign-out before leaving OR

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

Foundations of perioperative patient safety

Verification, asepsis, continuous monitoring, and rapid recognition of complications.

Who marks the surgical site?

The surgeon.

Prevention of retained foreign objects

By completing required sponge, sharp, and instrument counts.

Equipment injuries to prevent

Burns from electrocautery and other equipment.

Requirement for metal implants and hearing aids

Must be identified before surgery because they can create safety concerns with electrocautery or other equipment.

Prevention of pressure and musculoskeletal injuries

Safe positioning and padding.

Other intraoperative complications to prevent

Hypothermia, blood loss, VTE, infection, and incorrect specimen labeling.

Postoperative complications to monitor

Airway obstruction, cardiorespiratory instability, hypothermia, urinary retention, bleeding, wound complications, ileus, DVT or PE, pain, and nausea.

Reporting abnormal postoperative findings

Report with the least possible delay to the surgeon or anesthesia professional.

Timing for prevention education

Before surgery, then reinforced after surgery and at discharge.

Preventing atelectasis and pneumonia

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

Surgical-site infection prevention

Perform hand hygiene, follow incision and dressing care, keep the wound clean and dry as directed, and do not apply unapproved products.

Postoperative infection signs to report

Persistent drainage, edema, redness, or temperature above $38^{\circ}\text{C}/101.4^{\circ}\text{F}$.

Preventing postoperative VTE

Use SCDs or compression stockings as ordered, ambulate early and frequently, and perform ankle or leg exercises.

Preventing postoperative constipation

Ambulate, increase fluids and fiber when allowed, and use prescribed stool softeners or laxatives.

Postoperative pain medication education

Take it as ordered before pain becomes severe, avoid alcohol with narcotics, and report increasing pain.

Promoting postoperative healing

Advance the diet slowly, maintain hydration and nutrition, rest adequately, follow activity restrictions, and attend follow-up appointments.

Surgical asepsis

A technique that eliminates microorganisms and prevents contamination.

Items on a sterile field

Only sterile items.

Gloves for touching sterile materials

Sterile gloves.

Non-sterile parts of a sterile setup

The outer wrapping and the one-inch perimeter of the inner field.

Considered contaminated during sterile technique

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