NR 226 Exam 3

NR 226 Exam3

Name

Chamberlain University

NR-226: Fundamentals – Patient Care

Prof. Name

Date

NR 226 Fundamentals of Nursing Exam 3

Chapter 21: Managing Care

Prioritizing Patient Care

Prioritizing patient care is vital for nurses as it enables them to identify relationships among various patient problems. This approach helps avoid delays in taking necessary actions that could prevent serious complications. Immediate action is essential to stabilize patients’ conditions, following the ABC rule: airway, breathing, and circulation should always be the top priority.

The categorization of patient care prioritization is as follows:

Priority Level	Description	Examples
High	Emergency situations posing immediate threats to survival or safety.	Obstructed airway, anxiety attack
Intermediate	Non-emergency but important needs experienced by patients and families.	Anticipating patient education on new medications, managing post-operative pain.
Low	Issues not directly related to the patient’s current illness, focusing on developmental or long-term health needs.	Patient education required before discharge.

Types of Nursing

Nursing models play a significant role in the delivery of care. Various models include:

Nursing Model	Description	Cons
Primary Nursing	A single RN takes responsibility for a patient’s care, with limited patient assignments.	Does not necessarily reduce costs; care plans require approval for changes.
Total Patient Care	The RN oversees all aspects of patient care, working directly with the patient and healthcare team.	High RN demand makes it less cost-effective; communication lapses can affect continuity.
Functional Nursing	Care is divided among team members by function.	Potential fragmentation of care; may not provide holistic care.
Case Management	Coordinates healthcare services to streamline costs and enhance quality.	Direct care may not always be provided.
Team Nursing	An RN leads a team of RNs, LPNs, and MAs to provide care under supervision.	Delegation takes time, and RNs may not have adequate patient contact.

Magnet Hospital

Magnet hospitals are recognized for their clinical promotion systems, research initiatives, and commitment to evidence-based practice. Nurses within these organizations maintain professional autonomy and control over their practice environment. This empowerment fosters innovation and collaborative relationships, ultimately improving the quality of patient care.

Delegation to Medical Assistants and LPNs

Delegation involves transferring the responsibility for a task while retaining accountability for the outcome. Key aspects of delegation include assessing the knowledge and skills of team members and matching tasks appropriately. Effective communication is critical, requiring clear directions, active listening, and feedback. The Five Rights of Delegation include:

Rights of Delegation	Description
Task	Routine, non-invasive tasks requiring minimal supervision.
Circumstance	Appropriate patient settings and available resources.
Person	Matching the right person to perform the task and the right person to receive it.
Direction	Clear instructions about the task, including objectives and limits.
Supervision	Providing ongoing monitoring and support for the delegated task.

Chapter 24: Communication

Communication Techniques for Special Needs

Effective communication is essential, particularly for patients with special needs such as cognitive impairments, hearing loss, or vision loss. Strategies include:

Condition	Techniques
Cognitive Impairment	Use simple sentences, ask one question at a time, allow response time, and include family in conversations.
Hearing Impaired	Reduce noise, gain the patient’s attention before speaking, and ensure visibility of the speaker’s mouth.
Visually Impaired	Maintain a normal tone, use indirect lighting, and ensure print size is adequate.
Cannot Speak	Listen attentively, ask yes/no questions, and utilize visual aids.

Communication Techniques

Various communication techniques enhance interactions, including:

Technique	Description
Parroting	Repeating what the patient has said without paraphrasing.
Clarifying	Restating unclear questions to ensure understanding.
Focusing	Directing the conversation to key elements without interrupting.
Paraphrasing	Briefly restating the patient’s message in the nurse’s own words to confirm understanding.

SBAR Communication Method

The SBAR method standardizes communication about significant patient events. It encompasses:

Situation: Identify the current issue, including admitting and secondary diagnoses.
Background: Provide pertinent medical history and previous treatments.
Assessment: Include significant findings from assessments and vital signs.
Recommendation: Suggest a plan of care and highlight necessary actions.

Types of Communication

Therapeutic Communication	Non-therapeutic Communication
Encourages the expression of feelings and conveys respect.	Can hinder professional relationships and block expression.

Zones of Personal Space

Understanding personal space is crucial for patient interactions:

Zone	Distance	Examples
Intimate	0-18 inches	Performing assessments, changing dressings.
Personal	18 inches-4 ft	Sitting at a bedside, taking patient history.
Social	4-12 ft	Making rounds, teaching classes.
Public	12 ft and greater	Speaking at community events, lecturing.

Chapter 50: Care of the Surgical Patient

Surgical Classifications

Surgical procedures are categorized based on urgency and purpose:

Classification	Description	Examples
Urgent	Needed to prevent health deterioration; not emergent.	Excision of a cancerous tumor.
Elective	Patient choice; not essential for health.	Hernia repair.
Emergency	Immediate action required to save life or function.	Control of internal bleeding.
Major	Extensive alterations; higher risk.	Coronary artery bypass graft (CABG).
Minor	Minimal alterations; low risk.	Tooth extraction.
Diagnostic	Surgical exploration for diagnosis.	Exploratory laparotomy.
Ablative	Removal of a body part.	Gallbladder removal.
Palliative	Relieves symptoms; does not cure.	Colostomy.
Reconstructive	Restores function or appearance.	Scar revision.
Procurement	Removal of organs for transplant.	Kidney transplant.
Constructive	Restores lost function due to congenital issues.	Repair of cleft palate.
Cosmetic	Improves personal appearance.	Rhinoplasty.

Malignant Hyperthermia

Malignant hyperthermia is a life-threatening genetic disorder associated with anesthesia, characterized by symptoms like hypercarbia and muscular rigidity. Close monitoring of temperature is essential, especially when anesthesia is introduced.

Pre-operative Care

In the pre-operative unit, several steps ensure patient readiness for surgery, including:

Explaining surgical preparation steps.
Reviewing the pre-operative checklist.
Assessing physical and mental readiness for surgery.
Inserting an IV for fluids if necessary.
Monitoring vital signs.
Initiating conscious sedation.

Post-Anesthesia Care Unit (PACU)

In the PACU, the following parameters are assessed:

Vital signs and respiratory adequacy.
Post-operative cardiac status.
Pain levels and peripheral circulation.
Monitoring for nausea and vomiting.

Types of Anesthesia

Understanding the various types of anesthesia is crucial for managing patient care:

Anesthesia Type	Purpose	Complications	Nursing Implications
General	Induces immobility and lack of memory during surgery.	Cardiovascular and respiratory depression, organ damage.	Monitor vital signs and recovery status.
Regional	Loss of sensation in a specific area without loss of consciousness.	Sudden drops in blood pressure and impaired breathing.	Assess respiratory status and position of limbs.
Local	Loss of sensation at a specific site.	Limited motor function depending on injection site.	Monitor for adverse reactions and functional abilities.
Conscious Sedation	Provides sedation while maintaining patient responsiveness.	Similar risks as other anesthetics.	Ensure airway maintenance and monitor response to stimuli.

Time Out Protocol

The Time Out protocol occurs prior to surgery when all healthcare personnel convene to confirm the surgical plan and patient details, ensuring patient safety.

Roles of the Circulating and Scrub Nurse

The roles in the operating room include:

Circulating Nurse	Scrub Nurse
Must be an RN; oversees intraoperative care and documentation.	Maintains the sterile field and assists the surgeon.
Evaluates patient care and verifies instrument counts.	Assists with draping and instrument handoff.

References

American Nurses Association. (2021). Nursing: Scope and standards of practice. American Nurses Association.

Black, J. M., & Hawks, J. H. (2016). Medical-surgical nursing: Clinical management for positive outcomes. Elsevier.

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2017). Medical-surgical nursing: Assessment and management of clinical problems. Elsevier.

Potter, P. A., & Perry, A. G. (2022). Fundamentals of nursing. Elsevier.

NR 226 Exam3

Smeltzer, S. C., & Bare, B. G. (2020). Textbook of medical-surgical nursing. Pearson.