PN1 Review/Blueprint for Final Exam Summer 2017 (complete guide) Summary

PN1 Review/Blueprint for Final Exam Summer 2017 Review the Definitions and Concepts for the Following Terms 1. Evidenced-based practice - a framework for clinical practice that incorporates the best available evidenc ...

PN1 Review/Blueprint for Final Exam Summer 2017 Review the Definitions and Concepts for the Following Terms 1. Evidenced-based practice - a framework for clinical practice that incorporates the best available evidence with the expertise of the clinician and patient's preferences and values to make decisions about health care. 2. Various parenting styles (Authoritative, Authoritarian, Permissive) - Authoritarian parenting - Clear vision of who is control and they must obey, families with lower socioeconomic status use this. Authoritative parenting - Is also described as democratic or active parenting. Permissive parenting - Can be described as a "hands-off" approach to parenting. 3. Diverse Family Units (such as Nuclear, Intergenerational…etc) – intergenerational (grandparent, parent, child or parent, child, and grandparent), nuclear (married man and woman with children), attenuated (single parent with children), gay and lesbian (two individuals of the same sex), grandparents raising children (mother or father is not available and grandparents assume responsibility of raising their child’s children), blended (child may come from one or both parents through remarriage), incipient (married couple with no children), and cohabitating (couple having never married). 4. Laboratory results related to infection a. Normal Values for WBCs, Albumin, Potassium, Sodium, ABGs, aPTT, PT/INR, C-Reactive Protein – WBC *4,500-10,000 Albumin *3.4-5.0 Potassium *3.5-5.5 Sodium *135-145 ABGs *(pH 7.35-7.45, CO2 35-45, pO2 80-100, HCO3 22-26) aPTT *1.5-2.5 PT *11-14 INR *0.8-1.2 C-Reactive Protein *0-3 5. Lab values to monitor associated with wound healing 6. Roles of nurses (client advocate, director of care, caregiver, educator..) – Client Advocate - assist in decision making in regards of making the best options for care. The nurse promotes advocates for, and strives to protect health, safety and the rights of the patient. Clients depends on the nurses to ensure that proper care has been given, the role of the nurse as client advocate actively pursues promotion of the clients rights for autonomy. 7. Respiratory and Metabolic Acidosis and Alkalosis (Know lab values and some causes of each) - Metabolic acidosis: pH <7.35 alkalosis: pH > 7.45 7.32=more basic Respiratory acidosis:: pH <7.35 alkalosis: pH > 7.45 8. HIPPA (Violations) - Discussing the patient's condition in the hospital dining room; leaving a chart lying open on top of the medication cart in the hallway outside the patient's room; telling your neighbor about a mutual friend hospitalized for treatment of a sexually transmitted disease. 9. Therapeutic communication strategies (and poor communication) - Common communication challenges: Diverse Cultures, Non English speaking clients; readiness; environment; pain level. Examples of various therapeutic communications are Providing General Leads: Encourages initiation or elaboration of a conversation. Some examples would be: • “I see what you are saying, and then what happened?” • “Tell me what treatment plan Dr. Smith talked to you about yesterday.” Using Silence: Utilizes pauses or silence for up to several minutes without verbalizing. An example would be sitting quietly and waiting for the patient to explore thoughts and feelings. Offering Self: Shows concern and willingness to help. An example would be “What can I do to help you?” Using open-ended questions or statements: Encourages elaboration and discourages answering questions with one or two words. An example would be “Tell me more about...” Using restatement: Restates in different words the heart of what a patient said. Encourages further communication. Also conveys to the patient that you were actively listening. An example would be: Patient: “My daughter made me so mad yesterday!” Nurse: “Your daughter upset you yesterday?” Seeking Clarification: Helps to verify that the message sent was what was intended. This is necessary if the communication has detoured into many topics. An example would be “Are you saying...?” Giving Information: Provides relevant information. An example would be “You will need to report to the x-ray department at 8:00 a.m.” Using reflection: Reflects same words back to the patient. This encourages verbalization of feelings. An example would be: Patient: “I’m so anxious about what my tests will show.” Nurse: “You are anxious about your test results?” Looking at Alternatives: Helps patients explore options when making decisions about their care. An example would be “Have you thought about...?” Summarizing: Sums up the important points. An example would be “It looks like you’ve covered everything...” 10. Productive Confrontation - can be an important part of the communication process between the nurse and client if this technique is used in a respectful, tactful, and nonthreatening manner. 11. Cardiac Output and oxygenation - The cardiac output is simply the amount of blood pumped by the heart per minute. Necessarily, the cardiac output is the product of the heart rate, which is the number of beats per minute, and the stroke volume, which is amount pumped per beat. CO = HR X SV. The cardiac output is usually expressed in liters/minute. Oxygen saturation is the process by which concentrations of oxygen increase within a tissue. 12. Pain tolerance and narcotic use 13. Fluid balance regulation and mechanisms 14. Structures of the Skin, Heart, Lungs – (SKIN) Epidermis-outermost layer; waterproof barrier, creates skin tone. Dermis-beneath epidermis; contains tough connective tissue; contains hair follicles and sweat glands. Hypodermis-deeper subcutaneous tissue; made of at and connective tissue. 15. Modes of disease transmission (Vector-borne, Airborne, Direct Contact …) - Contact Precautions: **(Required PPE) Put on gloves and a gown when entering the room; wear gloves when touching patient’s intact skin and the surfaces and articles in close proximity to the patient, such as side rails and medical equipment. Plus standard precautions **(Indications for use) To prevent transmission of pathogens spread by direct or indirect contact; use in the presence of excessive wound drainage, fecal incontinence, and when the patient is infected with multiple-drug-resistant organisms, such as MRSA, vancomycin-resistant enterococci (VRE), and Clostridium difficile. Droplet Precautions: **(Required PPE) Put on a mask when entering the room. NOTE: If the patient has H1N1 flu, an N95 respirator is required. Instruct patient to follow respiratory hygiene/cough etiquette. Plus standard precautions. **(Indications for use) To prevent transmission of pathogens spread through close contact with respiratory secretions or mucous membranes. Examples include influenza (flu), group A streptococcus, bacterial meningitis, rubella (German measles), and Mycoplasma pneumonia. Airborne Precautions: **(Required PPE) Put on a fit-tested N95 or higher respirator when entering the room. Patient must be placed in an airborne infection isolation room with negative pressure. Plus standard precautions. **(Indications for use) To prevent transmission of pathogens small enough to be suspended in the air and spread through air currents. Examples include Tuberculosis, Rubeola (measles), Chickenpox, and severe acute respiratory syndrome (SARS). 16. Intensity, quality, aggravating and alleviating factors, and origins of pain – Quality of pain is scale 0-10; Intensity of pain is if it radiates, how it occurred, etc. 17. N95 Mask (Other than shape and colors, how is this mask different from surgical masks? - Information on N95 masks and use in home health care and why is a particulate mask used with TB - Caregivers should wear N95 particulate respirator masks because standard isolation masks do not prevent Mycobacterium tuberculosis from passing through. 18. Barrel-chest - condition seen with COPD and Emphysema. Normal Chest =1:2 (Height: Width); More oval shaped. Barrel Chest= 1:1(Height: Width); More circle shaped 19. Skin (wound), throat, blood cultures 20. Valve prolapse, insufficiency, stenosis - Mitral Valve Stenosis: The diseased valve becomes narrowed and the leaflets thickened, preventing blood from freely flowing from the left atrium into the left ventricle. Aortic Stenosis: The valve cusps become hard and calcify due to rheumatic fever, syphilis, a con- genital anomaly, or the aging process. Mitral insufficiency: The valve leaflets become hard and do not close completely. Blood backs up in both the left atria and ventricle, causing both chambers to hypertrophy. Aortic insufficiency: The valve cusps become so hardened they do not close completely. The blood no longer flows through the aorta but backs up into the ................................................................Continues