NUR2032C Care Management I/ NUR 2032C Exam 3 Study Guide

NUR2032C Care Management I/ NUR 2032C Exam 3 Study Guide1 NUR2032C Care Management I/ NUR 2032C Exam 3 Study Guide Exam III – Study Guide Please note that this is to prepare you for the Exam#3. You are responsible f ...

NUR2032C Care Management I/ NUR 2032C Exam 3 Study Guide1 NUR2032C Care Management I/ NUR 2032C Exam 3 Study Guide Exam III – Study Guide Please note that this is to prepare you for the Exam#3. You are responsible for all the content in Taylor textbook (Chapters 8, 9, 30, 42 & 44, Handouts: therapeutic communication, defense mechanisms; Corresponding Chapters in ATI book, PowerPoints) Chapter 8  Forms of communication – verbal and non-verbal o Nonverbal (body language)  Facial expressions, touch, eye contact  Posture, gait, gestures  General physical appearance  Mode of dress and grooming  Sounds, silence  Electronic communication  Levels of communication (4 levels?) o Intrapersonal  Self-talk; communication within a person o Interpersonal  Occurs between two or more people with a goal to exchange messages o Group  Small-group – ie. staff meetings  Organizational communication – ie. committee meetings  Group dynamics - how well group members work with one another  SBAR o Situation, background, assessment, recommendatino  Phases of a Helping relationship o Orientation phase: Getting to know one another; formal and informal contract, parameters of the relationship, confidentiality, establishing trust.2 o Working phase: implementing nursing interventions to achieve outcomes; promoting problem-solving skills and self-esteem. For example:. client shows awareness of his/her difficulties. o Termination phase: End of relationship; client achievement of independence; client stability; resolution o See page 460 Box 20-3  Therapeutic vs. nontherapeutic communication (do’s and don’ts)  Interviewing techniques (nursing considerations) o Open-ended questions or comments o Closed questions or comments o Validating questions or comments o Clarifying questions or comments “are you saying …” o Reflective questions or comments o Sequencing questions or comments o Directing questions or comments  Strategies to include to foster therapeutic communication with clients  Communicating with hearing impairment  Communicating with clients with language barrier  Open and closed communication questions Chapter 9  Learning Domains and examples of each o Cognitive: storing and recalling of new knowledge in the brain (mental skills (knowledge)  such as learning food portions to maintain a calorie count o Psychomotor: learning a physical skill. (manual or physical skills (skills.).  Demonstrating how to change a wound dressing or care for an umbilical cord o Affective: changing attitudes, values, and feelings (growth in feelings or emotional areas (attitude or self)  Expressing renewed confidence following a teaching session Chapter 303  Informed Consent for surgery o Dr – explain risk, benefits, alternative and procedure o Nurse – advocate and witness o Description of procedure and alternative therapies o Name and qualifications of person performing procedure o Explanation of risks and how often they occur o Explanation that the client has the right to refuse treatment or withdraw consent o Explanation of expected outcome, recovery, rehabilitation plan, and course of treatment  Perioperative phases and what happen at each phase o Caring for the client during the three phases of surgical intervention:  Preoperative: Teaching (splinting), answering questions, complete checklist, ; begins with decision to have surgery, lasts until client is transferred to operating room or procedural bed  Intraoperative: begins when the client is transferred to the OR bed until transfer to the post anesthesia care unit (PACU)  Postoperative: lasts from admission to recovery room (PACU) to complete recovery from surgery and last follow-up physician visit o Types of procedures  Nurses role during each of the perioperative phases o Perioperative:  Manager/director  Clinical practitioner  Educator  Researcher  Expanded and advanced practice roles e.g., CNOR, RNFA; CNS/ARNP; CRNA o Pre:  Ensure that a complete H & P has been performed and recorded  Ensure that tests and operative procedures are explained to the client by the surgeon.  Ensure that appropriate lab specimens are collected.  Ensure that results/findings are recorded in client records.  Ensure that abnormal results are reported to surgeon/anesthesia.4  Ensure that preoperative medications have been administered as per order  Preoperative Teaching has been performed  Classification of surgical procedures and purpose of each class o Classifications of surgical procedures are based on three factors:  Elective  Urgent  Emergency o Additional considerations include:  Risk Factors: related to current client’s condition  Purpose of the procedure: diagnostic, curative, preventive, ablative, palliative, reconstructive, transplantation or constructive  Support systems following surgery  Postoperative complications of anesthesia o General Anesthesia  Malignant Hyperthermia  CV and/or Respiratory Problems o Regional Anesthesia  Loss of movement/sensation after surgery  Allergic Reaction o Prevent pneumonia – incentive sper o Collapsed lung o Blood clot – two types throm – stationary em is moving  Preventing respiratory and cardiovascular complications post-surgery o Monitoring vital signs (q 2 – q 4Hrs as ordered, including temperature) o Checking incisional sites for bleeding; monitoring amount, color & consistency o Implementing deep breathing exercises as ordered o Coughing (as needed) o Utilizing Incentive spirometry (Teaching) o Changing positions q2hours o Ambulating prn as ordered o Maintaining hydration o Monitoring responses to analgesics  When and what to teach clients in preparation of surgery5 o Description of procedure and alternative therapies (in lay terminology and in native language) o Name and qualifications of person performing procedure o Explanation of risks and how often they occur o Explanation that the client has the right to refuse treatment or withdraw consent o Explanation of expected outcome, recovery, rehabilitation plan, and course of treatment  Postoperative exercise and purpose of each  Preventing aspiration for postoperative clients following general anesthesia  Priority interventions on care of postoperative clients o Check every 10 to 15 minutes:  Respiratory status (ABC; + pulse oximetry)  Cardiovascular status (ABC, blood pressure)  Temperature  Central nervous system status (level of alertness, movement, shivering, pain)  Fluid status  Wound status  Gastrointestinal status (nausea and vomiting)  General condition  Postoperative assessment of clients o Same as above  Binder use for postoperative clients with an abdominal incision o  Prevention of venous stasis and thrombus formation in postoperative clients o Move/raise legs and feet frequently  Signs and symptoms of postoperative hemorrhage o Blood that soaks through the bandage covering your incision o Anxiety or confusion o Faster heart rate than normal for you o Faster breathing than normal for you, or shortness of breath o Urinating less than usual, or not at all  Surgery and aspirin use by clients  Teaching about pain management6  Monitoring urine output after surgery  Positioning postoperative semiconscious clients  Nursing considerations when a post-op patient resumes solid food following general anesthesia Chapter 42 STRESS AND ADAPTATION  Physiological effects on the body after relaxation activity  General Adaptation Syndrome (GAS) phases (Manifestations at each phase) o GAS: describes stress reaction o Alarm stage  Fight or flight response  Also called the shock phase  Increased energy, oxygen intake, cardiac output, blood pressure and mental alertness o Stage of resistance  Body attempts to adapt to the stessor  Vital signs, hormone levels, and energy production return to normal o Stage of exhaustion  Adaptive mechanisms can no longer provide defense  Identifying Maladaptive coping (Negative consequences) o self-harm, binge eating and substance abuse  Effects of the Sympathetic and Parasympathetic Nervous System on the body during stress o  Difference between Adaptation vs coping mechanisms o Coping: how a person deals with problems/issues  Short-term response o Adaptation: the change that take places as a result of the responses to a stressor  Long-term response  Commonly occurring defense mechanisms (Taylor: Table 41-2) and handout (eg Denial) o Compensation o Denial o Displacement7 o Introjection o Projection o Rationalization o Reaction formation o Regression – acting like a child, tantrum o Repression – unconscious (suppression is conscious) o Sublimation o Undoing  Stages of Anxiety. Manifestations at each stage o Mild  Present in day-to-day living  Use for problem solving  Increased questioning and restlessness o Moderate  Narrows a person’s perceptual field  Focus is on immediate concerns  Tremors, muscle tension, “butterflies” in the stomach, slight increase in vitals, quavering voice o Severe  Extreme fear  Impaired learning ability – cannot teach this person  Easily distracted  Tachycardia, hyperventilation, headache  Maladaptive behavior (Examples: self-harm, binge eating and substance abuse) o Panic  Loss of control  Experience of dread and terror  Distorted perception  Irrational thoughts  Difficulty communicating verbally; agitation; sensory changes; dyspnea; palpitation, chest pain/pressure o This level can lead to death  Nurses interventions caring for patients under stress  Nursing diagnoses for patients undergoing stress o Caregiver role strain  Defense mechanisms Chapter 448  Types of Aphasia and nursing interventions o Expressive (motor type). The inability to name common objects or express simple ideas in words or writing. For example, a patient understands a question but is unable to express an answer. o Sensory or receptive: The inability to understand written or spoken language. A patient is able to express words but is unable to understand questions or comments of others. o Global: The inability to understand language or communicate orally.  Discharge instructions to a patient with visual alterations o Make sure they don’t have rugs, good lighting, and a cane to feel around clear walkway  Disturbed sensory perceptions: o sensory deprivation, sensory overload, sensory deficits, sensory poverty – isolation room o Sensory overload  Effect from environmental elements (eg. crowding, noise, mass media, technology) (minimize stimuli eg private room, seclusion room, can use ear plugs) ensure there isn’t too many smells o Sensory deprivation  Deliberate restricted environmental stimulation. Sound, light, and smell minimized (eg. Isolation rooms (be there for patient) i.e isolation room o Sensory deficit o a defect in the function of one or more of the senses. o Sensory poverty o technology replacing exposure/experiences. e.g. cell phone  (patients who are at risk for each and nursing interventions for each)  Teaching tips to stimulate senses  Meeting the needs of patients with reduced hearing  Assisting clients with temporary loss of vision  Caring for a client with artificial eye9 Ensure that during your study you include: TERMINOLOGY