Study guide for final...

Hey everyone, here's my portion of the questions I answered from the study guide. Feel free to add in your two cents... and Don't be shy to SHAARREEE!!!

1. Discuss the risk factors for complications of the patient undergoing surgery.
(pp. 1369-1372)
Age- anesthesia can cause vasodilation and heat loss in underdeveloped young pts.
-Less physical capacity due to deterioration of body functions in older adults.
Nutrition- malnourished pts more prone to poor tolerance to anesthesia, negative nitrogen balance from lack of protein, delayed blood-clotting, infection, poor wound healing, and potential for multiple organ failure.
Obesity- reduced ventilation and cardiac function can lead to sleep apnea, hypertension, coronary artery disease, DM, and CHF à embolisms, atelectasis, and pneumonia.
Obstructive sleep apnea (OSA)- often results in sleep-associated oxygen desaturation.
Immunocompromise- increase risk for infection due to suppressed immune system.
F & E Imbalance- body responds to surgery as trauma, therefore the body retains sodium and water and loses potassium within the first 2-5 days post-surgery.
Pregnancy- all major system of the body affected during pregnancy due to increased metabolic rate and body’s response to trauma. Surgery only done on emergent or urgent basis.

***Cardiac conditions; respiratory disorders; bleeding disorders; DM; liver disease; neurological disease; mental retardation; anxiety; dementia (NOTES: Perioperative Nursing)


2. Discuss the signs and symptoms of the patient experiencing dyspnea.
(p. 920)- shortness of breath; clinical sign of hypoxia.
Exaggerated respiratory effort
Use of the accessory muscles of respiration
Nasal flaring
Marked increases in the rate and depth of respirations
Orthopnea



3. Discuss the nurse’s responsibility to safe medication administration.
(p. 696) –To safely administer medications to pts, nurses need to know how to calculate medication doses ACCURATELY. They also need to understand the different roles that members of the health care team play in the prescribing and administering of meds.
Prior to administration (NOTES)
-therapeutic effect
-side effects
-drug toxicity
-drug allergies
-cumulative effects
-drug interactions

4. Discuss the responsibility of the nurse when a medication error has occurred.
(p.705)*When an error occurs, the client’s safety and well-being being are TOP PRIORITY.
-assess and examine the client’s condition and notify the physician or prescriber of the incident as soon as possible.
-once client is stable, report incident to appropriate person in institution
-nurse is responsible for preparing written occurrence or incident report that usually needs to filed within 24 hours of the error. (includes client id info; location and time of incident; accurate, factual description of what occurred and what was done; nurse signature)
** Report all MEs, including those that do not cause obvious or immediate harm or near misses.


5. Discuss the nursing actions that will maintain dignity and respect to patients.
(pp. 100-103)
-promoting caring nurse-patient relationship/therapeutic communication
-nurses need to learn culturally specific behavior
-providing presence and active listening
-using the comforting approach such as touch
-providing privacy as well as advocacy
-providing client-centered care
-active listening
-getting to know your patient
-spiritually caring
-involving family and loved ones upon client’s request or consent


6. Discuss the nursing interventions to promote communication with a patient with aphasia.
(pp.1358-1359) **aphasia- unable to speak
Listen to the client, and wait for the client to communicate.
Do not shout or speak loudly.
Use simple, short questions and facial gesture to give additional clues.
Speak of things familiar and of interest to the client.
Simple yes or no answers. Offer pictures or communication board so client can point.
Be calm and patient; do not pressure or tire the client.
Avoid patronizing and childish phrases.


7. Discuss the purpose of the implementation phase of the nursing process.
(pp. 279)
The nurse initiates interventions that are most likely to achieve the goals and expected outcomes needed to support or improve the client’s health status.
Designed to improve patient’s level of health.


8. Discuss the purpose of open-ended questions when obtaining subjective data. Provide examples.
(p. 239) Open-ended questions prompts clients to describe a situation in more than one or two words. This leads to a discussion in which clients actively describe their health status. Open-ended questions strengthen your relationship with your pts because it shows you want to hear their thoughts and feelings.
**encourage and let client tell the story all the way through
**use good eye contact and listening skills
** back-channeling (“uh-huh,” “go on,” “all right”)
EXAMPLES: Tell me how you are feeling. Your discomfort affect your ability to get around in what way? Describe how your wife has been helping you. Give me an example of how you get relief from your pain at home. Tell me about the problems you are having. What might be causing this problem?
***Probe until exhaustion.

9. Discuss the nursing interventions to prevent vascular complications for an immobile patient.
(pp. 1247-1248 & NOTES) ***Clients who are immobile often experience orthostatic hypotension, increased cardiac workload, thrombus formation, deep edema, venous vasodilation and stasis, diminished cardiac reserve.
For a pt with orthostatic hypotension, mobilize pt as soon as they physical condition allows, even if it’s only dangling at the bedside or moving to a chairàmaintains muscle tone and venous return.
Discourage use of Valsalva Maneuver (baring down) as this decreases venous return and cardiac output.
In prevention of thrombus formation, interventions include: elevate lower extremities; leg, foot, and ankle exercises such as ankle pumps, foot circles, and knee flexions; regularly providing fluids; position changes; flexing and extending of feet; medications, Tedhose, SCDs require doctor’s orders.
ROM exercises reduce the risk of contractures and aid in preventing thrombi.

10. Differentiate between evaluation and assessment.
Assessment encompasses gathering information about the client’s condition both subjectively and objectively, as well as analyzing and clustering the data as a basis for developing nursing diagnoses, identifying collaborative problems, and developing a plan of individualized care.
Evaluation is a determinant of whether goals are met and outcomes are achieved. The key is to determine if you met your expected OUTCOMES, not if nursing interventions were completed.

11. Explain autonomy. Provide examples.
(p. 314) In regards to Professional Standards in nursing practice, autonomy refers to the commitment to include clients in decisions about all aspects of care.
Obtaining a signed consent after explaining potential procedures.
Involving client in end-of-life decisions.
Advance Directives: Living Wills & Durable Power of Attorney