NUR 102 Exam 3 Study Guide
Older adult pathologic changes
Changes: Physical strength and health HTN arthritis heart disease cancer diabetes sinusitis
(Erikson) Trust vs. Mistrust (infancy)
The infant learns to rely on caregivers to meet basic needs of warmth, food, and comfort, forming trust in others. Mistrust can result from inconsistent, inadequate, or unsafe care.
16. Both our verbal and nonverbal communication can convey a lot to our patients. What nonverbal behavior would show caring to a patient?
Touch, Eye Contact, and Facial Expressions would all show caring to a patient.
25. What are the types of leadership we discussed Page- 510-512
* Autocratic- also called directive leadership or authoritarian leadership, involves the leader assuming control over the decisions and activities of the group. Efficient process, people may resent this leadership approach. High staff turnover and burnout. * Democratic- also called participative leadership, is characterized by a sense of equality among the leader and other participants. Decisions and activities are shared. participants develop their skills and strengths within the group. Group satisfaction and motivation are excellent benefits of this style. * Laissez-Faire- also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. This approach encourages independent activity by group members. Depends on strengths of followers to direct the group activities. T his style is rarely useful because task achievementis difficult when each nurse is working independently, and the staff on most units and departments have varying levels of clinical maturity. * Quantum- (Porter O'Grady and Malloch), in quantum leadership- views an organization and its members as interconnected and collaborative- a helpful approach when unpredictable events and changing environemnts present themselves. the quantum age- change is conceived as dynamic, ever present and continually unfolding. we are forced to experience change at the same time we perceive it, giving no time plan and manage. * Transactional- task and reward orientation. Team member agree to a satisfactory salary and working conditions in exchange for commitment and compliance to their leader. Health care have often used transactional leadership strategies to provide direction and recognize employees' progress in meeting pre-established goals and work deadlines. reward good behavior, punish bad b
21. What is the best way to evaluate a patient's understanding after your teaching?
1. cognitive domain learning may be evaluated through oral questioning (Open-end questions). explain to me how you use insulin 2. affective domain learning through the patient's response (emotional) personal feeling abut how they feel about something 3. psychomotor domain learning by a return demonstration.
(Piaget) Sensorimotor (birth-24 months)
0-1 month- Demonstrate basic reflexes, such as sucking. 1-4 months- Discovers enjoyment of random behavior (such as smiling or sucking thumb) and repeats them. 4-8 months- relates own behavior to a change in environment, such as shaking a rattle to hear the sound or manipulating a spoon to eat. 8-12 months- Coordinates more than one though pattern at a time to reach a goal, such as repeated throwing an object on the floor; only objects in sight are considered permanent. 12-18 months- Recognizes the permanence of objects, even if out of sight; can understand simple commands. 18-24 months- Begins to develop reasoning and can anticipate events.
8. What does pulse oximetry measure? What limitations does it have?
measures the arterial oxyhemoglobin saturation (SaO2 or SpO2) of arterial blood. The reported result is a ratio, expressed as a percentage, between the actual oxygen content of the hemoglobin and the potential maximum oxygen-carrying capacity of the hemoglobin. Be aware of the patient's hemoglobin level before evaluating oxygen saturation because the test measures only the percentage of oxygen carried by the available hemoglobin. Thus, even a patient with a low hemoglobin level could appear to have a normal SpO2 because most of that hemoglobin is saturated. However, the patient may not have enough oxygen to meet body needs. (p.1414-1415)
13. What are the phases of the helping relationship? What takes place in each phase? In a helping relationship, what is the best way to convey medical information to a patient who does not understand medical terminology?
1). Orientation Phase- Tone and guidelines are established. Roles of nurse and patient are clarified. An agreement or contract is established. Provide orientation to the facility, its services, admission routines, and any pertinent info the patient requires to decrease anxiety 2). Working Phase- Nurse works with the patient to meet physical and psychosocial needs. Interactions are purposeful to ensure achievement of goals or objectives agreed upon. Teacher and counselor are performed primarily in this phase. 3). Termination Phase- Conclusion of initial agreement acknowledged (change of shift, patient discharge, or nurse leaves on vacation or another employment). Evaluate goals/outcomes and whether they have been reached or what progression has happened. **Best way to convey medical information if patient does not understand medical terminology, is to speak at their level of understanding. Use different approaches if needed.
34. We discussed some terms related to mental impairment in older adults? What are the terms related to mental impairment? pg437
1. Dementia - various disorders/blanket term Alzheimer-Irreversible, progressive, eventually can not perform simple tasks. Sundowners-Habitual confusion, restless and agitated after dark. No treatment known and can no longer perform adl's. 2. Delirium-a temporary state of confusion, is a acute illness that can last hours to weeks and can be resolved with treatment. Metabolic, drug interactions, nutritional deficiencies, or worsening illness. 3. Depression- does not resolve without treatment frequently underdiagnosed. (use geriatric depression scale.
19. What are the barriers to communication that we discussed. Consider examples.
1. Failure to perceive the patient as a human being. -Nurses must focus on the whole person, not just the diagnosis. -Patient report that nothing is more discomforting than being treated as an object rather than a patient. -Address pt by formal name such as: Mr. , Mrs., Ms., or Dr. rather than slag terms such as "honey" or "sweetie". -What distinguish nurses from other health profession is that we focus on the person as a whole, not just the illness or dysfunction. Example: 2. Failure to listen -Patient might not might not feel able to speak freely to the nurse. - Often, signals indicating their readiness to talk is subtle. - Don't approach patient with a closed mind. - Don't focus on your own needs rather than on the pt's needs. - Nurses lacking confidence in the ability to meet challenges a pt present might become defensive in response to a pt's comment. - Nurse's defensiveness is a huge barrier to open and trusting communication. Example: Nontherapeutic Comments and Questions Certain types of comments and questions should be avoided in most situations because they tend to impede effective communications. A description of each type follows. 1. Using Clichés- A cliché is a stereotyped, trite, or pat answer. Most health care clichés suggest that there is no cause for anxiety or concern, or they offer false assurance. Patients tend to interpret them as a lack of real interest in what they have said. Avoid the following common clichés because they tend to impede effective communication: Example: "Everything will be all right." "Don't worry. You will be just fine in another day or two." "Your doctor knows best." "Cheer up. Tomorrow is another day." Another type of cliché makes a sweeping generalization that does not necessarily apply to a specific patient. It also tends to cut off communications
11. If a pt is hypoxic we can administer oxygen in several different ways. What are the methods and what rate of oxygen do we use for each (see table 38-5)? With a high flow nasal cannula what side effect might the flow have for the patient and what might we use to provide comfort for the patient?
1. Nasal cannula Low Flow 1-2 L/min = 23%-30% 3-5 L/min = 30%-40% 6 L/min = 42% 2. Simple mask Low Flow 6-8 L/min = 40%-60% (5 L/min is minimum setting) 3. Partial rebreather mask Low Flow 8-11 L/min = 50%-75% 4. Nonrebreather mask Low Flow 12 L/min = 80%-100% 5. Venturi mask High Flow 4-10 L/min = 24%-40% Side effect caused by high flow: Oxygen dries and dehydrates the respiratory mucous membranes. What to use for comfort: humidifying devices (supplying 20%-40% humidity) are commonly used when oxygen is delivered at higher flow rates. Distilled or sterile water is commonly used to humidify oxygen. When moving patients receiving humidified oxygen, make sure that water from the humidifier does not enter the tubing through which the oxygen is flowing. Additional suggestions for transporting a patient with a portable oxygen tank are given in Guidelines for Nursing Care 38-2.
18. What are the interviewing techniques we discussed? What are examples? Contrast open VS closed-ended questions. Be able to distinguish them.
1. Open-ended Question or Comment -Used when obtaining a nursing history -Allows a wide range of responses from pt. -Allows pt. to express what they understand to be true, preventing digression from the topic. -Encourages free verbalization -Greatest advantage of this technique is to prevent patient from giving simple yes or no answer that has the effect of limiting a pt's response. Example: Nurse: What medicines have you been taking at home? Patient: Let me see, my doctor gave me a water pill and a blood pressure pill to take every day. 2. Validating Question or Comment -These types of questions or comment serves to validate what the nurse believes he or she has heard or observed. -Overusing validating questions and comments might lead the pt to think the nurse is not listening, however. -The example below shows how the nurse could validate the patient's reply: Example: Nurse: At home, you have been taking both a water pill and a blood pressure pill every day. Did you take them today? Patient: Yes, I took one of each with my breakfast. 3. Clarifying Question or Comment -Allows nurse to gain an understanding of a patient's comment. -When used correctly, can prevent possible misconceptions that could lead to innapropriate nursing diagnosis. -Overuse of clarifying questions or comments can lead the patient to believe the nurse is not listening or lack of knowledge. Patient: I have never needed to take medicine before in my life. Nurse: Is this the first health problem you have had? Patient: Yes, I've always been healthy. 4. Sequencing Question or Comment -Used to place events in chronological order or to investigate a possible cause-and-effect relationship between events. -Makes nursing assessment easier when events leading to a problem are placed in sequence. Example: Patient: I don't feel like myself anymore
35. Maslow's hierarchy of needs pg59
1. Physiological -air, water, sex, elimination, physical activity and rest. 2. Safety and security - (being free of fear and anxiety) Hand Hygiene, sterile technique, using electrical equipment properly, administering medications Knowledgably, skillfully moving and ambulating patients, teaching parents about household chemicals that are dangerous to children 3. Love and belonging needs-the understanding and acceptance of others in both giving and receiving love 4. Self esteem needs- The need for a person to feel good about ones self 5. Self actualization needs - the need for one to reach their full potential
How can we provide culturally competent nursing care for a patient in pain?
1. Recognize that culture is an important component of individuality and that each person holds (and has the right to hold) various beliefs about pain. 2. Respect patients' right to respond to pain in their own manner. 3. Never stereotype a patient's perceptions of or responses to pain based on the person's culture.
28. What is the difference between growth and development? What does cephalocaudal and Proximodistal refer to related to growth and development? Page- 371& 373
Growth- is an increase in body size or changes in body cell structure, function and complexity. Development- is an orderly pattern of changes in structure, thoughts, feelings, or behaviors resulting from maturation, experiences, and learning. Development is a dynamic and continuous process as one proceeds through life, characterized by a series of ascents, plateaus and declines. Cephalocaudal- Proceeding from head to tail. Development is the first trend, with the head and brain developing first, followed by the trunk, legs, and feet. Proximodistal- second trend, which means that growth progresses from gross motor movements (such as learning to lift one's head) to fine motor skills (such as learning to pick up a toy with the fingers).
3. When a patient is sick with pneumonia and her oxygen saturation is low, what does mean on a physiological level?
Hemoglobin carries less than normal amounts of oxygen, carbonic acid levels go up. Incomplete lung expansion or the collapse of alveoli, known as atelectasis, prevents pressure changes and the exchange of gas by diffusion in the lungs. Areas of the lung with atelectasis cannot fulfill the function of respiration (p. 1490, 1400)
(Erikson) Autonomy vs. Shame and Doubt (Toddler)
As motor and language skills develop, the toddler (ages 1-3 years) learns from the environment and gains independence through encouragement from caregivers to feed, dree, and toilet self. If the caregivers are overprotective or have expectations that are too high, shame and doubt as well as feeling of inadequacy, might develop in the child.
(Erikson) Ego Integrity vs Despair (Later adulthood)
As one enters the older years, reminiscence about life events provides a sense of fulfillment and purpose. Some older adults may not be fearful of dying if they feel they have achieved integrity. If one believes that one's life has been a series of failures or missed directions, a sense of despair might prevail.
36. What is caregiver role strain and how id it recognized?
A caregiver's felt or exhibited difficulty in taking care of others.
32. Distinguish normal age-related changes from pathologic changes in the aging adult. How might we need to change our behaviors when working with these patients? Page- 419-438
Middle Adult The Older adult *Begins at 65 *Young-Old 65-74 *Middle-Old 75-84 Oldest-old above 85 years
6. Your patient is having respiratory distress. What interventions can you do to support his breathing?
Positioning (Fowler's/high Fowler's) Maintaining adequate fluid intake (to break up secretions) Provide oxygen Provide humidified air Incentive spirometry Teach pursed-lip breathing Ambulate, as appropriate Teach diaphragmatic breathing Admin pain meds as prescribed Maintain a patent airway Auscultate breath sounds, noting areas of decreased or absent ventilation and presence of adventitious sounds. Initiate a program of respiratory muscle strength and/or endurance training, as appropriate. p.1418-1420)
24. Nurses have to be careful when delegating task to unlicensed assistive personnel. What may the nurse delegate?
Before the RN delegates any nursing intervention, a number of additional factors, including the qualifications and capabilities of the UAP, should be considered: (1) the stability of the patient's condition, (2) the complexity of the activity to be delegated (3) the potential for harm (4) the predictability of the outcome, and (5) the overall context of other patient needs (6) scope of practice so... this is just for me....just for my own knowledge.... Essentials of Effective Delegation The following will help you with the essential responsibilities and techniques of delegating care tasks: Know your state and institutional policies on delegation (the policy and procedure manual is available on each unit; for state policies, contact the state nurse association). Be clear on the difference between nursing process and nursing tasks. Know the training and background of the unlicensed assistive personnel (UAP). (Administration must have a standard and process to validate the UAP's preparation.) Know the patient's needs and what he or she is at risk for. Know what clinical cues the UAP should be alert for and why. Assess which tasks can be safely delegated. Have the UAP repeat your instructions to be sure you have communicated them clearly. Make frequent walking rounds to assess patients. When talking with the patient, members of the patient's family, or UAPs, listen for cues that indicate changes in the patient's condition. Take frequent mini-reports from the UAP. Evaluate the UAP's performance and the patient's response.
12. Congestive heart failure can be associated with pitting edema in the feet and ankles. What other respiratory findings might you expect in this patient.
Besides pitting edema, Pulmonary Edema would be another expected respiratory finding with CHF. (Coughing, SOB, dyspnea, rales/crackles, cyanosis, and fatigue is what Brandie got for an answer)
4. Respiratory rates are different for various ages. What is a normal adult respiratory rate? Newborn? Aged (old) adult?
Birth - 1 year: 30-55 breaths/min Normal adult: 12-20 breaths/min Aged (old) adult: 16-24 breaths/min (p. 1405)
1. Your patient has a chronic condition that makes breathing difficult. Name and describe nursing interventions to promote adequate respiratory functioning.
Positioning (Fowler's/high Fowler's) Maintaining adequate fluid intake (to break up secretions) Provide oxygen Provide humidified air Incentive spirometry Teach pursed-lip breathing Ambulate, as appropriate Teach diaphragmatic breathing Admin pain meds as prescribed Maintain a patent airway Auscultate breath sounds, noting areas of decreased or absent ventilation and presence of adventitious sounds. Initiate a program of respiratory muscle strength and/or endurance training, as appropriate. pg.1418-1420)
Middle adult pathologic changes
Cancer HTN Diabetes Rheumotoid arthritis Obesity Alcoholism Depression. Nursing Behavior: Teach about dangers of substance abuse, smoking, and alcohol consumption, low in fat and cholesterol diets, importance of regular exercise and normal weight , health examinations and screenings as recommended, following through medical recommendations, speaking with someone if things are overwhelming you, stress reduction, controlling chronic conditions.
(Erikson) Initiative vs. Guilt (preschool)
Confidence gained as a toddler allows the preschooler (ages 4-6) to take the initiative in learning so that the child actively seeks out new experiences and explores the how and why of activities. If the child experiences restrictions or reprimands for seeking new experiences and learning, guilt results and the child hesitates to attempt more challenging skills in motor or language development.
39. What is the cultural terminology from the power point?
Cultural imposition-The belief that everyone should conform to the majority belief system Cultural blindness- Ignores differences and proceeds as thought you do not exist. Cultural conflict- People become aware of differences and feel threatened. response to cultural conflict- ridiculing beliefs and traditions of others to make themselves feel more secure Ethnocentrisms - Beliefs that ones ideas beliefs and practices are the best or superior, or are the most preferred to those of others
17. What are the factors influencing communication?
Factors influencing communication include level of development; gender; sociocultural differences; roles and responsibilities; space and territoriality; physical, mental, and emotional state; and environment. 1. Level of development-
(Erikson) Industry vs. Inferiority (School-aged children)
Focusing on the end result of achievements, the school-aged child gains pleasure from finishing projects and receiving recognition for accomplishments. if the child is not accepted by peers or cannot meet parental expectations, a feeling of inferiority and lack of self worth might develop.
20. What are factors that promote effective communication?
Despite the fact that patient stays in health care facilities are shorter than in the past and there is now an increased reliance on technology, therapeutic communication with patients and their families is essential and remains a vital part of a helping relationship. Nurses who are competent, honest, skilled communicators are viewed as effective and compassionate caregivers. This focus on helping relationships is a critical component of what nurses do and plays a vital role in promoting healing, enhancing safety, and improving clinical outcomes. Dispositional Traits A dispositional trait is a characteristic or customary way of behaving. Nurses who consistently demonstrate warmth and friendliness; openness and rapport; empathy, honesty, authenticity and trust; caring; and competence are well disposed to communicate effectively. WARMTH AND FRIENDLINESS The helping relationship depends on the nurse's ability to begin the orientation phase successfully. A pleasant greeting and friendly smile can facilitate this phase and place the patient at ease. By maintaining qualities of warmth and friendliness throughout the helping relationship, you will convey continuous acceptance of the patient and interest in discussing the patient's feelings and concern. OPENNESS AND RESPECT One key factor to effective communication is to be open, accepting, frank, respectful, and without prejudice. Patients who feel that a nurse is being judgmental might withhold significant information. You need to develop sensitivity to the unique challenges presented by each patient. Attention to patient variables that might influence the process of communicating (e.g., gender, developmental level, culture, life experience) can make the difference between effective and ineffective interactions. Box 20-4 highlights guidelines for relating to patients fr
(Piaget) Concrete operational stage (ages 7-11 years)
During this stage, children learn by manipulating concrete or tangible objects and can classify articles according to two or more characteristics. Logical thinking is developing, with an understanding of reversibility, relations between numbers and loss of egocentricity, in addition to the ability to incorporate anothers perspective. Children become increasingly aware of external events and realize that their feelings and thoughts are unique and may not be the same as those of other children their age. they have the ability to focus on multiple parts of a problem at the same time.
15. Describe the levels of communication we discussed in class.
IntRApersonal- Self-talk; communication withIN a person IntERpersonal- occurs between 2 or more people with a goal to exchange messages Group- small-group, organizational communication, group dynamics
26. What happens during the steps of Lewins classic theory of Change? Page- 516
Lewin identifies three stages of change. * Unfreezing: the need for change is recognized * Moving- Change is initiated after careful process of planning. * Refreezing: Change becomes operational Ex- not so long ago, childbirth in the united states was routinely "medicalized." Women came to the hospital to deliver their babies: pain medications that interfered with the natural process of labor were routinely administered, necessitating forceps and assisted deliveries; husbands, partners and siblings were banned from delivery room. Nurse midwives and others recognized the need for change (unfreezing) and set about researching childbirth and ways to improve infant and family outcomes. After careful process of planning (moving) multiple natural childbirth options in healthcare facilities and in the home were made available to women and couples; today they represent mainstream care (freezing)
23. What is the acronym TEACH? What does it stand for?
Like other clinical interventions, effective patient teaching demands analytic and problem-solving skills. To maximize the effectiveness of patient teaching, remember the acronym TEACH: T: Tune into the patient. E: Edit patient information. A: Act on every teaching moment. C: Clarify often. H: Honor the patient as a partner in the education process.
10. What interventions might a nurse suggest for a pt with congested lungs to help thin secretions?
Maintaining adequate fluid intake Patients can help keep their secretions thin by drinking 2 to 3 quarts (1.9-2.9 L ) of clear fluids daily. Fluid intake should be increased to the maximum that the patient's health state can tolerate.
30. Neonates must adapts to extrauterine life quickly. What is the most important adjustment that occurs? page-389
Neonates must adapt to extrauterine life through several physiologic adjustments. The most important occur in the respiratory and circulatory systems as the neonate begins breathing and becomes independent of the umbilical cord.
33. Nurses can help with the problem of polypharmacy by? pg 434
Nurses must be able to recognize adverse drug reactions in the population and not mistake them for age related reactions.
2. When patients have fluid, blood, or air in the pleural space they may require a chest tube. What are the guidelines for caring for a patient with a chest tube?
Nursing responsibilities include assisting with insertion and removal of a chest tube. Once the tube is in place, monitor the patient's respiratory status and vital signs, check the dressing, and maintain the patency and integrity of the drainage system Observe the dressing around the chest tube insertion site and ensure that it is occlusive. Gently palpate around the insertion site, feeling for crepitus, a result of air or gas collecting under the skin (subcutaneous emphysema). Tape all connections securely. Check that the drainage tube has no dependent loops or kinks. Make sure the drainage collection device is positioned below the tube insertion site to facilitate drainage. Observe the water-seal chamber for fluctuations of the water level with the patient's inspiration and expiration (tidaling). If suction is used, temporarily disconnect the suction to observe for fluctuation. Assess for the presence of bubbling in the water-seal chamber. Add water, if necessary, to maintain the level at the 2-cm mark, or the mark recommended by the manufacturer. Assess the suction control chamber if suction is in use. If water suction is used, ensure that water is at the appropriate level; add water to ensure that suction is adequate. Gentle bubbling in the suction chamber indicates that suction is being applied to assist drainage. Keep the drainage collection device secure so that it does not tip over. Check that two padded Kelly clamps are available and secured at the bedside. If the drainage unit requires changing, position one clamp 1½ to 2½ inches from the insertion site; position the second clamp 1 inch down from the first one until the unit has been switched. Alternately, many systems have integrated clamps on the tubing. The chest tube may be clamped before its removal to observe the patient's tolerance when it is discon
22. If your patient does not speak or read your language what are your responsibilities regarding communication?
Patients Who Do Not Speak English 1. Use an interpreter whenever possible. 2. Use a dictionary that translates words from one language to another so that you can speak at least some words in the patient's language. 3. Speak in simple sentences and in a normal tone of voice. 4. Demonstrate or pantomime ideas you wish to convey, as appropriate. 5. Be aware of nonverbal communication. Remember that many nonverbal communication cues are universal.
35. Maslow's hierarchy of human needs? pg27
Physiologic and psychologic needs essential for human life. 5 needs are outlined that can happen simultaneously. (Ericson's stages are by age)
27. Review the developmental theories of Piaget and Erikson. Know the groups and relative tasks for these theories. page- Page 376
Piaget's theory of cognitive development- infancy through adolescence. Piaget believed that learning occurs as a result of the internal organization of an event, forming a mental schemata as one grows and develops. (Sensorimotor, Preoperational, concrete operational, formal operational) Erikson- developmental theory expanded from Freuds work to include cultural and social influences in addition to biologic processes. His psychosocial theory is based on four major organizing concepts: Stages of Development Developmental goals or tasks Psychosocial crises The process of coping. Erikson believed that development is a continuous process made up of distinct stages, characterized by the achievement of developmental goals. 8 stages
29. What are the stages of gestational period? In what stage is it most likely that teratogens will cause major congenital malformations? Page 387
Pre-embryonic stage- lasts for about 3 weeks. the zygote, which implants in the uterine wall, has three distinct cell layers. The endoderm (inner layer) becomes the respiratory system, the digestive system, the liver and the pancrease. The mesoderm (middle layer) becomes the skeleton, connective tissue, cartilage, muscles and circulatory system, lymphoid, reproductive, and urinary systems. The ectoderm (outer layer) becomes brain, spinal cord, nervous system, and outer body parts (skin hair nails) Embryonic- Stage occurs from the 4th through 8th week. Rapid growth and differentiation of the cell layers take place. BY the end of this stage, all basic organs have been established, the bones have begun to ossify, and some human features are recognizable. Because this is a period of such rapid growth and change, the embryo is especially vulnerable to any factor that might cause congenital anomalies (alcohol, nicotine, over-the-counter medications or drug) Fetal- 9th week to birth. all body organs amd systems continue to grow and devlop. at the end of the first trimester (12 weeks) some reflexes are present, kidney secretions begins, the heartbeat can be heard by doppler, and the sex of the baby is distinguishable by outward appearance. At the end of the second trimester (24 weeks) fetal heart tones are audible by stethoscope.
31. SIDS is a sudden death of an infant under one year of age without an explanation for the cause of death. What are the safe sleep guidelines recommended by the American academy of pediatrics? Page- 393
Refers to the sudden death of an infant under 1 year, when considerations of the infants history, a postmortem examination, and investigation of the scene where the death occurred fails to reveal a cause of death. In 2011, the American Academy of Pediatrics (AAP) issued updated safe sleep guidelines for infants that further emphasize the importance of all caregivers placing the child in the supine position for every sleep period, including those occurring in childcare settings. These guidelines also encourage removing bumper pads and avoiding loose bedding, soft objects, and pillows in the infant's sleep environment.
14. When is SBAR used? What does it stand for and what should be reported for each category?
SBAR is used at patient handoff during change of shift or nurse to physician communication. Situation- Patient name, patient room number, and the problem you are calling about Background- Admin diagnosis/date, medical history, treatment, vital signs, or any changes to vital signs Assessment- Give your conclusions about situation, what body system may be involved if conclusion is unknown, and severity of problem Recommendation- What you think will help
(Erikson) Generativity vs. Stagnation (middle adulthood)
The middle adults years are marked by involvement with family, friends and community. This is also a time for becoming concerned for the generation and desiring to make a contribution to the world. if this task is not met, stagnation results, and the person becomes self-absorbed and obsessed with ones own needs and regresses to an earlier level of coping.
5. Children get more routine colds and infections when they enter daycare or school. Why? Is this considered normal? Should it be cause for concern?
The preschool child's eustachian tubes, bronchi, and bronchioles are elongated and less angular. Thus, the average number of routine colds and infections decreases until the child enters daycare or school and is exposed more frequently to pathogens. Young children who are not placed in daycare usually have not had the opportunity to develop antibodies for the variety of viruses and bacteria they may encounter in a school setting. No cause for concern unless its more serious problems i.e. otitis media, bronchitis, and pneumonia.
(Erikson) Intimacy vs Isolation (young adulthood)
The tasks for the young adult are to unite self-identity with identities of friends and to make commitments to others. Fear of such commitments results in isolation and loneliness.
33. What is Polypharmacy? pg419
The use of many medications at once.
(Piaget) Formal operational stage (age 11 and older)
This stage is characterized by the use of abstract thinking and deductive reasoning. General concepts are related to specific situations and alternatives are considered. The world is evaluated by testing beliefs in an attempt to establish values and meaning in life.
9. What education might you provide to a postoperative patient regarding respirations? TCDB? I/S?
Turn, Cough, Deep Breathe, and Incentive Spirometer Turn- Turn patient q2hr improves respiratory function and venous return. Splint incision while turning. To turn, raise one knee, grab side rail, and roll over pushing w/ leg and pulling with arm. Cough- Important postoperatively especially effective when combined with deep breathing. Splint incision and cough to remove retained mucous. Deep Breathe- Overcomes hypoventilation. Breathe deep enough to move bottom ribs. Inhale (Nose)- Exhale (Mouth). Nose warms, filters, and humidified air I/S- Visual reinforcement for deep breathing. Breathe slowly and deeply and to sustain maximal inspiration. Exhale completely, secure lips around mouthpiece, and inhale through mouth (no nose at all). 5-10x q1-2hr
(Erikson) Identity vs. Role Confusion (Adolescence)
With many physical changes occurring, the adolescent is in transition from childhood to adulthood. Hormonal changes produce secondary sex characteristics and mood swings. Trying on roles and even rebellion can be normal behaviors as the adolescent acquires a sense of self and decides what direction to take in life. Role confusion occurs if adolescent is unable to establish identity and a sense of direction.
7. What are the different types of adventitious breath sounds? Describe them and when in the cycle of respiration would you expect to hear them. What conditions might they be associated with?
Wheezes are continuous, high-pitched squeak or musical sound, produced as air passes through airways constricted by swelling, narrowing, secretions, or tumors. They are often heard in patients with asthma, tumors, or a buildup of secretions. Crackles, frequently heard on inspiration, are soft, high-pitched discontinuous (intermittent) popping sounds. They are produced by fluid in the airways or alveoli and delayed reopening of collapsed alveoli. They occur due to inflammation or congestion and are associated with pneumonia, heart failure, bronchitis, and COPD Friction Rub Rubbing or grating Loudest over lower lateral anterior surface Auscultated during inspiration and expiration Inflamed pleura rubbing against chest wall Stridor Harsh, loud, high-pitched Auscultated on inspiration Narrowing of upper airway (larynx or trachea); presence of foreign body in airway Rhonchi (Sonorous Wheeze) Sonorous or coarse; snoring quality Low-pitched, continuous sounds Auscultated during inspiration and expiration Coughing may clear the sound somewhat Air passing through or around secretions Rhonchi can be heard in patients with pneumonia, chronic bronchitis, cystic fibrosis or COPD (chronic obstructive pulmonary disease). Coughing will often clear rhonchi
37.How do we determine what a patients pain is when we see conflicting behavior related to pain? pg77
be sensitive to other signals of discomfort, such as holding or applying pressure to the painful area, avoiding activities that intensify the pain, and uncontrollable, spontaneous expressions of discomfort, such as facial grimacing and moaning. You also should not consider patients who freely express their discomfort as constant complainers with excessive requests for pain relief
(Piaget) Preoperational Stage (ages 2-7 years)
this stage is characterized by the beginning use of symbols, through increased language skills and pictures to represent the preschoolers world. This stage is divided into two parts: the preconceptual stage (ages 2-4 years) and he intuitive stage (ages 4-7 years). Play activities during this time help the child understand life events and relationships.
