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PN1 Final Exam. Best Practice (Pg.5) To promote client safety and continuity of care excellent practice is for a nurse to use I-SBAR-R when contacting a health care provider for an order I=Identification of self an ...

PN1 Final Exam. Best Practice (Pg.5) To promote client safety and continuity of care excellent practice is for a nurse to use I-SBAR-R when contacting a health care provider for an order I=Identification of self and client S=Situation B=Background A=Assessment R=Recommendation R=Read back Inter-Generational Families (Pg. 18) Also called multigenerational families 2 or more related generations living together as a functioning family. (Sometimes 3-4 generations) Reasons- economic support, child care, emotional support Lab data for malnutrition (Pg. 675) Have a BMI of less than 20 when undernourished Decreased Albumin level of <3.8 g/dL is seen with protein deficiency Serum proteins (most widely used) Serum Albumin, creatnine and BUN How to assist a patient and family through a crisis (Pg. 843) Be an active listener Assist family to cope with situation in positive manner Keep family informed Prepare family to cope with an unwanted outcome Help family understand clients condition so they understand Parenting styles (Pg. 25-26) Authoritarian: Most common Clear division of who is in control and who must obey. Parents set the rules and distribute consequences and rewards depending on child’s adherence to parents rules and guide lines Authoritative Democratic or active parenting Provides behavioral guidelines and encourages children to think about the consequences of behavior Parents actively reinforce child’s positive behavior and are significantly involved in monitoring child’s behavior and explain expectations Permissive: “Hands off” parenting technique, thought as neglectful bc of minimal parental interventions Freedom to learn from their own mistakes Children raised this way struggle as adults because they do not recognize boundaries or limits Distress family and communication (Pg. 26 Box 2-3) Poor communication between members, including dishonesty, hostility, sarcasm, silent treatment and frequent misunderstandings Neglect of basic needs Anger control issues Unrealistic expectations of family members Acidosis/Alkalosis (know the change in pH) (Pg. 222 Figure 11-1) Normal is 7.35-7.45 Acidosis: <7.35 (7.0 Neutral, 6.8 Death) Alkalosis: >7.45 (7.8 Death) Therapeutic communication (Pg. 32) Active listening: Really listening to what client is saying and attempting to understand. Take in voice tone, pitch and inflections, watch body language and explore and clarify to ensure accurate understanding. At times humor, touch, silence or confrontation maybe appropriate. Show empathy, be able to imagine one’s self in their circumstances An offer of sympathy may hinder therapeutic communication because the client may not feel comfortable when someone “feels sorry for them” Communication challenges (Pg. 33) Language barriers, cultural barriers, vision and hearing impairment Lack of time to talk with patient because nurse is so busy, jump to conclusions about what clients’ needs are based on past interactions Divorced families: Unresolved issues of anger that complicate communication Domestic Violence: Issues of domestic violence present an extremely difficult communicative climate Confrontation (Pg. 33) Negative meaning, angry feelings, harsh words and conflict Productive confrontation Can be used as a technique in a respectful, tactful and nonthreatening manner, doing this can help facilitate the client’s move toward self-examination and opportunities for growth This can be used when patient is engaging in maladaptive or poor defense mechanisms such as denial Should be productive, respectful, tactful and non-threatening Prodromal- incubation- convalescence (Pg. 74) Incubation: Time between entry of infectious agent in the host and the onset of symptoms. Prodromal: Time from the onset of nonspecific symptoms until specific symptoms begin to manifest. Host maybe infectious Convalescent: The beginning of the disappearance of acute symptoms until the client returns to previous state of health What are the risk factors for an infection (Pg. 77) Imbalanced Nutrition: Less than body requirements or more Ineffective protection Impaired tissue integrity Impaired oral mucous membrane Impaired skin integrity Deficient knowledge What is the meaning of systemic infection (Pg. 74) Affect entire body and involve multiple organs, such as AIDS Alkalosis and OTC medications (Pg. 233 Table 11-4) Antianxiety: Ativan & Xanax Benzo’s/Sedatives/Hypotics: Ambein, Restoril, Halcion & ProSom Centrally acting skeletal muscle relaxants: Valium, Lioresal & Dantrium Electrolyte Supplements: Calcium plus vitamin D, Potassium chloride (K-Dur) Look up (All ready answered on question 80) Respiratory Acidosis Respiratory Alkalosis Metabolic acidosis Metabolic Alkalosis Osmosis and diffusion (Pg. 203-204) Osmosis: is diffusion of water through a semipermeable membrane from a region of higher water concentration to a region of lower water concentration. Only water (solvent) molecules move through the membrane; the dissolved molecules do not Diffusion: Tendency of molecules of gases, liquids or solids move from a region of higher molecular concentration to a region of lower molecular concentration until an equilibrium is reached. This movement is caused by kinetic energy in molecules. For example Carbon dioxide moves by diffusion from the blood stream where the concentration is higher, into the lungs for elimination IV therapy, what to react to first (jugular and hand distention) Jugular- pneumothorax Hand distention- phlebitis, dislodgement Drops per min on an IV (Pg. 253) (total fluid volume)/(Total time (min)) Drop factor Drop per min Infusion related infection (Pg. 257) Phlebitis Look up signs and symptoms of TB (Pg. 351) Low grade fever that recurs in a specific pattern Persistent cough Hemoptysis Hoarseness Dyspnea on exertion Night sweats/ fatigue Weight loss and enlarged lymph nodes What to teach a patient about Lasix Take in AM Do not take if planned activities in AM What are common medication for asthmatics (Pg. 364) Aminophyline Steriods Bronchodilators Theophylline Histamine Corticosteroids Mucolytics Anticholinergics What does a patient with pneumothorax look like? (Pg. 386) Pneumothorax occurs when blunt trauma to chest causes a broken rib that pierces the pleura and lung, allowing air to enter between the pleura. Short of breath, shifted trachea, Dyspnea and cyanosis, Cough is forceful and unproductive, Resp and heart rate are elevated, and Breath sounds are diminished. Claims to feel very anxious How do you use an incentive spirometer, and what does it look like (Pg. 347) Measures the amount of air in one inhalation, is ordered to air the client when coughing and deep breathing are inadequate Plastic device with number on the side, ball inside a tube with a hose and a mouth piece that you place your mouth around and inhale What are the signs and symptoms to know if suction is needed Patient is gagging on secretions, coughing without being productive, choking on sputum, cyanotic How to improve cardiac output Pulmonary edema (Pg. 380) Life threatening condition characterized by a rapid shift of fluid from plasma into pulmonary interstitial tissue and alveoli. Gas exchange is impaired, generally has cardiac cause such as left ventricular failure or MI. Excess fluids in the lungs, collects in numerous air sacs in lungs Cough, pink/frothy sputum, Dyspnea How to prevent venous thrombosis (Pg. 458) Wear BLT compression stockings (Antiembolism stockings) Take anticoagulants or thrombolytic meds are prescribed What do the following look like?