study guide final exam (brief)

1. Discuss the risk factors for complications of the patient undergoing surgery. (Ch. 50, pp. 1369-1375)
-age, nutrition, obesity, obstructive sleep apnea, immunocompromise, F&E imbalance, pregnancy, medical history, lifestyle choices, and socioeconomic factors

2. Discuss the signs and symptoms of the patient experiencing dyspnea. (Ch. 40, pg. 920)
-clinical sign of poor tissue perfusion marked by shortness of breath
*exaggerated respiratory effort, increased depth and RR, and activity intolerance

3. Discuss the nurse’s responsibility to safe medication administration. (Ch. 35, pg. 687)
-evaluate the effects of medications on health status
-teach patients about medications and side effects
-ensuring adherence with medication regimen
-evaluate client’s ability to self-administer

4. Discuss the responsibility of the nurse when a medication error has occurred. (Ch. 35, pg. 705)
-prepare written occurrence report or incident report to be filed within 24 hours
-feel comfortable and fear no repercussions; safety of the patient first

5. Discuss the nursing actions that will maintain dignity and respect to patients.
-good communication skills
-following through
-knowledgeable

6. Discuss the nursing interventions to promote communication with a patient with aphasia. (Ch. 24, Table 24-10)
-be patient and attentive
-ask simple questions, allowing time to answer
-encourage conversation
-do no speak loudly
-use communication aids and collaborate with speech therapists
-let patient know if you do not understand

7. Discuss the purpose of the implementation phase of the nursing process. (Ch. 19, pg. 279)
-achieve goals and expected outcomes to support or improve the patient’s health status

8. Discuss the purpose of open-ended questions when obtaining subjective data. Provide examples. (Ch. 16, pg. 239)
-technique leads to the patient actively describe their health status and strenghthen the nurse-client relationship
*tell me how you are feeling
*your discomfort affects 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

9. Discuss the nursing interventions to prevent vascular complications for an immobile patient. (Ch. 47, pg. 1247)
-mobilize the patient as soon as their physical condition allows for them to do so
-teach client to breathe out while repositioning themselves in bed
-lower extremity exercises, frequent fluids, and position changes

10. Differentiate between evaluation and assessment. (Ch. 20, pg. 291).
-evaluation is ongoing and whenever there is contact with the patient
-to compare the status before the assessment stage and after a nursing intervention to redirect nursing care if necessary

11. Explain autonomy. Provide examples. (Ch. 24, pg. 348 and Ch. 22, pg. 314)
-self-direction of nurses to make choices and accept outcomes of action like owning medication errors if they occur
-inclusion of patients in all aspects of care like signing consent forms before surgery

12. Discuss the nursing responsibilities for the patient while in the PACU. (Ch. 50, pg. 1394)
-focuses on monitoring and maintaining airway, respiratory, circulatory, and neurological status and on managing pain

13. Discuss strategies to ensure safe administration of medication. (Ch. 35, pp. 705-709)
-standards: right medication, right dose, right client, right route, right time, right documentation
-medical reconciliation: verify client’s current list of medications, clarify the list is accurate with as many people as necessary, reconcile discrepancies between new medication orders and current medications, and transmit updated and verified list to caregives and client

14. Discuss the assessment needed for the patient with fluid imbalance. (Ch. 41, pp. 978-984)
-age
-medical history including present medication
-lifestyle
-socioeconomic factors
-daily weights and I&Os

15. List the criteria for writing a correct outcome or goal. (Ch. 18, pg. 265-267)
-client centered and is specific and measureable reflecting wellness and independence
-realistic
-mutually set by nurse and patient

16. Discuss the criteria needed for writing an accurate nursing diagnosis. (Ch. 17, pg. 252)
-client centered problem based on validated objective and subjective data
-within nursing scope of practice
-includes diagnostic label, related factor (related to…), and etiology (as evidenced by…)

17. Discuss strategies that promote effective communication. (Ch. 24, pp. 348-355)
-use therapeutic communication techniques
-use active listening
-use professional communication
-provide comfortable and safe environment with favorable conditions

18. Discuss the role of the health care team when developing an initial plan of care. (Ch. 18, pp. 268-269)
-which interventions will be dependent nursing interventions
-communicate nursing care priorities to other health care professionals

19. Compare and contrast legal decision making and ethical and moral principles. (Ch. 22, pp. 314- and Ch. 23, pp. 328-332)
-legal decision making: advance directives, standards of care, informed consent, mental health parity act
-ethical and moral principles: autonomy, benefiecience, maleficience, justice and fidelity; code of ethics including advocacy, responsibility, accountability, and confidentiality

20. Discuss the nursing care of the patient with a urinary catheter. (Ch. 45, Table 45-3)
-prevent bacterial growth
-promote comfort, check for displacement
-assess purpose and need for catheter

21. Discuss the patient education needed for the patient scheduled for surgery. (Ch. 50, pp. 1379-1380, 1386)
-understand pre-op instructions and exercises
-state the time of surgery
-understand to post-op location and where family will be able to wait during and after surgery
-understand the post-op monitoring and therapy
-understand surgical procedures and post-op treatment
-understand post-op activity resumption
-understand pain-relief measures
-can openly express feelings about surgery

22. Discuss the nursing care of the patient who is confused. (Ch. 41, pp. 973-974)
-may be evidence of electrolyte imbalance
*monitor I&Os, daily weights, vital signs…
*per physician order: correct imbalance by administering diuretic or IV fluid electrolytes

23. Discuss the complications of general anesthesia. (Ch. 50, pg. 1392)
-side effects of anesthetic agents like cardiovascular depression or irritability, respiratory depression, and liver/kidney damage

24. Discuss the nursing interventions to prevent thrombophlebitis in the post-operative patient. (Ch. 50, pp. 1401-1403)
-leg exercises unless contraindicated
-apply stocking or devices to prevent circulatory stasis
-encourage ambulation as soon as possible after monitoring vital signs and safety measures
-reposition effectively
-anticoagulant drugs as ordered
-adequate hydration

25. Discuss the risk factors of the elderly patient undergoing surgery. (Ch. 50, Table 50-4)
-reduced cardiac function, skin integrity, respiratory function, renal function, metabolic function and sensory loss
-good vs. harm of patient going to surgery

26. Discuss the assessment needed for the patient with diarrhea. (Ch. 46, pp. 1185-1188)
-assess frequency, volume, and consistency
-inspect mouth and abdomen
-assess usual elimination patterns of patient

27. Discuss the nursing interventions for the patient with impaired skin integrity. (Ch. 48, pp. 1301-1305)
-maintain skin care, reposition to improve circulation and use devices if necessary to avoid further impairing skin integritry and educate the patient

28. Discuss causes of bradycardia. (Ch. 40, pp. 918-922)
-age, lifestyle choices, and socioeconomic factors may cause decreased elasticity of heart muscle, thicker and stiffer heart valves, and calcification of vessels

29. Discuss the assessment needed for the patient with the diagnosis of Activity Intolerance. (Ch. 47, pg. 1240)
-extent of ROM, ability to perform ADLs, varying degrees of pain perception/tolerance before and during activity

30. Discuss the signs and symptoms of severe hypoxia/hypoxemia. (Ch. 40, pg. 917)
-cyanosis, declined RR, low SpO2 as a result of respiratory fatigue

31. Discuss the nursing interventions needed to promote oxygenation of the post-operative patient. (Ch. 50, pg. 1401)
-breathing exercises: diaphragmatic breathing, coughing exercises, and incentive spirometer
-use respiratory devices when/if patient uses them at home or oxygen if ordered
-promote comfort: assist in turning and oral hygiene
-remove secretions

32. Discuss the preparation needed to safely transfer the patient to the operating room. (Ch. 50, pp. 1389-1391)
-use stretcher
-double checks for identification
-standards to prevent falls; rails up after medication administration
-void before surgery

33. Discuss the nursing interventions needed to promote ambulation. (Ch. 47, pp. 1246-1275)
-maintain circulation and muscle use to prevent ambulation complications
*ROM exercises, repositioning, breathing exercises, devices designed to improve circulation

34. Discuss the assessment needed for the patient who has been on bed rest and has an order to begin ambulation. (Ch. 47, pg. 1230-1237)
-assess mobility of the patient including range of motion, gait, exercise/activity tolerance, and body alignment
-ask or observe
-assess to protect patient safety: orthostatic hypotension

35. Discuss the purpose of bed rest. (Ch. 47, pg. 1225)
-reduce physical activity and oxygen needs of the body
-reduce pain
-allow ill or debilitated patients to rest
-allow exhausted patients uninterrupted rest

36. Discuss the correct procedure for administering a subcutaneous medication. (Ch. 35, pp. 744-750)
-use the rights of medication administration before giving injection and assess purpose and need for medication
*draw up syringe, cleanse proper injection site, pinch site and inject at 45-90 degree angle
*DO NOT RUB HEPARIN

37. Discuss the nursing care for the post-operative patient who had a nasogastric tube. (Ch. 50, 1404-1405)
-for decompression, not feeding, because stomach becomes paralyzed after surgery
-listen to BS, look BM, distension
-safely remove stomach contents to provide comfort for patient

38. Discuss the purpose of using an assistive device when moving patients. (Ch. 47, pg. 1224)
-reduce number of work-related injuries
-avoid unnecessary injury to nurse and patient

39. Discuss the correct procedure for suctioning a patient. (Ch. 40, pp. 934-941)
-suction to clear secretions a patient is unable to produce or clear

40. Discuss the physiological effects of prolonged bed rest. (Ch. 47, pg. 1239)
-poor circulation and muscle weakness
*slow wound healing, slowed or impaired GI/GU activity, activity intolerance, impaired respiration, lack of ROM, and muscle/fat loss

41. Discuss dependent nursing interventions for the patient experiencing nausea. (Ch. 41, pg. 975)
-may be evidence of fluid volume deficit or excess
*per physician order: diuretics, administering IV fluids, blood transfusions, laboratory tests…

42. Dosage and Calculations (Ch. 35, pp. 696- 698)
Can you calculate pills/tablets/injections?
-(dose ordered)/(dose on hand) x amount on hand = amount to administer
Can you calculate safe dosage ranges?
Can you safely administer medication (using the correct equipment)?

43. Can you utilize the nursing process given a specific case scenario?

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

Study Guide #3 (brief)

1. Discuss the education needed to prevent urinary infections.
-focus on client’s specific elimination problem
-learn significance of symptoms for prevention control

2. Discuss the goals/outcomes that will improve mobility.
-obtain appropriate assistive devices, reposition patient throughout the day, physical therapy, teach relaxation breathing, develop therapeutic relationship, and provide a positive, safe environment

3. Discuss factors that affect the nutritional status of the elderly patient.
-income, therapeutic diet, loss of teeth, dentures, risk for drug-nutrient interaction

4. Discuss the nursing care of the patient with enteral feedings.
-assess
-check for placement: aspirate or pump air, check for residual, elevate head to at least 30 degrees
-monitor weight, I&Os, lung sounds, O2, BS and BM
-maintain good oral hygiene

5. Discuss the nursing diagnoses appropriate for patients with oxygenation dysfunction.
-activity intolerance, anxiety, decreased cardiac output, fatigue, impaired gas exchange, impaired spontaneous ventilation, impaired verbal communication, ineffective airway clearance, ineffective breathing pattern, ineffective health maintenance, risk for imbalanced fluid volume, and risk for infections
-related to…patient etiology and as evidenced by…patient’s signs and symptoms

6. Discuss the nutritional education needed for patients who have fluid and electrolyte dysfunction.
-make a patient focused meal plan that includes patient’s preferences, income,

7. Discuss the education needed to prevent dehydration.
-avoid certain types of food, knowing medications which cause increased thirst, knowing daily values of water needed everyday, be aware of early signs and symptoms

8. Discuss the complications of diarrhea.
-serious fluid and electrolyte or acid-base imbalances

9. Discuss the interventions needed for the patient with a fecal impaction.
-laxatives, enemas, and digital removal of stool
-increased fiber diet, increased fluid intake, and bowel training

10. Discuss the assessment needed for the patient with hypoxia.
-defined as inadequate tissue oxygenation at the cellular level
-cyanosis, increased HR, increased RR and depth, increased BP
-apprehension, restlessness, inability to concentrate, declining level of consciousness, dizziness, behavioral changes, unable to lie down, appears fatigued and agitated

11. Discuss the signs and symptoms of urinary retention.
-bladder distention causing pressure, discomfort, tenderness, restlessness, and sweating
-absence of urine output or only small amounts (dribbling) over several hours

12. Discuss the assessment needed for patients with allergies.
-ask about allergen exposures, the type and degree of allergic response, and what improves or worsens the condition

13. Discuss the assessment needed for patients with sodium imbalance.
-weight change, dry and sticky mucosa, personality change, increased RR, decreased BP with postural change, changes in HR, and dry and flushed skin

14. Discuss the assessment needed for patients with altered perfusion.
-SpO2, RR, HR, BP, lung sounds, heart sounds, changes in activity tolerance, shortness of breath, difficulty breathing

15. Discuss the physiological factors that affect oxygenation.
-decreased oxygen-carrying capacity
-decreased inspired oxygen concentration
-hypovolumia: shock or severe dehydration resulting in extracellular fluid loss and reduced circulating blood
-increased metabolic rate and increased oxygen demand

16. Discuss factors that affect immobility.
-loss of muscle, negative nitrogen balance, increased weakness, decreased nutritional intake

17. Discuss the assessment needed for the patient at risk for aspiration.
-coughing during eating, change of voice after swallowing, abnormal mouth, tongue, and lip movements, unusual speech, regurgitation, abnormal gag, pooling of food, and delayed swallowing

18. Describe the nursing interventions for the patient experiencing respiratory distress.
-breathing/coughing techniques: promotes relaxation and effective breathing and more productive coughs
-positioning: positions patient in more comfortably to breath and drain secretions effectively
-suctioning: dislodge and loosen secretions to clear airway

19. Describe the assessment needed for patient in respiratory distress.
-increased RR, difficulty breathing, irregular lung sounds, increased HR, pain, fatigue, lifestyle, health risks, medications and allergies

20. Discuss the education needed for a healthy diet.
-meal plan patient focused with preferences and income integrated with daily values and food guidelines (MyPyramid)
-high fiber, low fat

21. Discuss the nursing interventions needed for the patient with urinary incontinence.
-schedule toileting, bladder training exercises, use absorbent product, limit fluids 2 hours before bedtime

22. Discuss the nursing interventions for the patient in acute respiratory distress.
-breathing/coughing techniques, airway maintenance, suctioning, humidification, nebulization, postural drainage and chest percussion

23. Discuss the signs and symptoms of patients with excess fluid volume.
-decreased LOC, convulsions, and coma

24. Discuss the nursing interventions for the patient receiving oxygen therapy.
-keep patient hydrated, teach coughing techniques, teach breathing exercises, improve muscle strength and endurance for increased activity tolerance with respiratory muscle training

25. Discuss the assessment needed for the patient with a productive cough.
-inspect sputum speciman of color, changes in color, odor, quantity, consistency, and presence of blood

26. Discuss the education needed for the patient with a urinary diversion.
-manage diversion
-enhance coping and adaptation to lifestyle and body-image changes
-ability to maintain normal ADLs

27. Discuss the assessment needed for the patient who just had a central venous catheter placed for TPN.
-check infusion rate of pump (not gravity driven), monitor complications like perforation through vessel and hyperglycemic reactions, monitor daily weights and I&Os, BS, and BM

28. Discuss the assessment needed for patients with fluid and electrolyte dysfunction.
-age, prior medical history, environmental factors, diet, lifestyle, medication, I&Os, laboratory studies

29. Discuss the assessment needed for the patient with GI dysfunction.
-urination pattern, symptoms of urinary alterations, factors affecting urination, skin and mucosal membranes inspection, kidney palpation, bladder palpation, urethral meatus inspection, and assessment of urine (subjective and objective)

30. Discuss the purpose of the various suctioning techniques.
-oropharyngeal and nasopharyngeal: patient effectively coughs, but is unable to clear secretions
-orotracheal and nasotracheal: patients with pulmonary secretions, no artificial airway, and no effective cough
-tracheal: dislodge and loosen secretions in artifical airway