Questions and Answers
What should be discussed with the provider regarding nutritional supplements?
Whether to include them as part of the daily routine
Vaccines prevent tens of thousands of hospitalizations each year.
True
Which age group is recommended to take the flu shot?
Which vaccine is recommended for those aged 50 and older?
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Who should receive the pneumonia vaccine?
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Match the symptoms of UTI on older adults:
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What is an advance directive?
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Palliative care is the same as hospice care.
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Which of the following is a sign of impending death?
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What does DNR stand for?
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What is Narcan used for?
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Delirium develops slowly and is often related to dementia.
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What are the three checks for medication administration?
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What symptoms may indicate risk of aspiration?
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The stages of grief include: denial, anger, bargaining, ___, acceptance.
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Which of the following are essential DO's of charting? (Select all that apply)
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You should chart symptoms without indicating what you did about those symptoms.
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What does the acronym SOAP stand for in documentation?
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What is the purpose of an incident report?
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The first stage of the nursing process is ______.
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What are the two types of data collected during the Assessment phase?
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What is considered a first level priority in patient care?
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It is okay to use abbreviations for words that aren't widely accepted in charting.
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Match the types of IV fluids with their classification:
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What are the signs that indicate a UTI?
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Which of the following represents a way to assess whether a patient is in pain?
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The condition where a patient stops breathing while sleeping is called ______.
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What is an important precaution when dealing with a patient who is sleepwalking?
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What is the critical range for pulse rates?
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A nursing action for an incorrect dose of medication includes immediately assessing the patient.
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Study Notes
Documentation
- Importance of thorough charting: "If you didn't chart it, you didn't do it!"
- DO'S: Ensure documentation is complete, concise, accurate, and current; include date, time, and signatures.
- Use the SOAP method for documentation: Subjective, Objective, Assessment, Plan.
- DON'TS: Avoid altering patient records, generalizing information, or including personal opinions.
- Incident reports document unforeseen events, helping to identify patterns and improve safety.
Nursing Process
- Key steps: ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation).
- Emphasizes critical thinking and forming a Plan of Care (POC) based on patient goals.
- Evaluation of POC measures whether patient goals are met, partially met, or not met.
- Distinction between subjective and objective data: subjective originates from the patient; objective is observed by the nurse.
- Prioritization based on urgency: First-level (ABC's), Second-level (acute problems), Third-level (other health issues).
Hygiene
- Nurses must gather health history and assess skin and oral hygiene.
- Promote oral health through brushing, flossing, and examining for signs of gum disease.
Safety/Mobility
- Focus on patient support, pain management, and family involvement in therapy.
- Restraint use is a last resort; interventions include using bed alarms and sitters.
- Importance of body mechanics and safe patient handling techniques to minimize injury.
Asepsis and Infection Control
- Aseptic technique is critical during sterile procedures.
- HAIs pose risks to the immunocompromised, elderly, and those on ventilators; isolation precautions vary based on transmission type.
- Proper PPE use and hand hygiene are essential in preventing infection spread.
Vital Signs
- Normal pulse rate ranges from 60-100 bpm, with tachycardia over 100 bpm and bradycardia under 60 bpm.
- Blood pressure should be measured while the patient is relaxed; hypertension is a sustained high level.
- Educate patients on lifestyle changes to manage blood pressure.
Medical Administration
- In case of medication errors, assess the patient immediately and notify the necessary personnel.
- Pharmacokinetics: processes of absorption, distribution, metabolism, and excretion of medications.
- Familiarize with various injection sites for SubQ, IM, ID, and IV administration.
Legal/Ethical
- Patient advocacy emphasizes working in the patient's best interest and upholding fidelity.
Fluids and Electrolytes
- Understand the types of IV fluids: Isotonic (0.9% saline), Hypotonic (0.33%, 0.45% saline), Hypertonic (3.0% saline).
- Monitor sodium levels closely; hyponatremia and hypernatremia have distinct symptoms and implications.
Communication
- Utilize therapeutic communication techniques to foster ongoing dialogue with patients, encouraging open-ended responses.
Nutrition
- Dietary modifications for constipation include high fiber intake and adequate hydration.
- Different dietary types: clear, full, mechanical soft, and regular diets accommodate patient needs.
GI/Elimination
- Verify NG tube placement using pH tests or X-ray.
- Assess stomas for color and moisture; pink and moist is healthy.
GU/Elimination
- Clean catch specimen collection involves starting the flow, stopping, and then continuing to capture urine.
- Symptoms of UTIs include burning during urination and frequent urges; lab values show elevated WBCs.
Perioperative
- Post-operative assessments focus on vital signs, airway monitoring, and examining the surgical site for drainage type and amount.
Wound Care
- Identify stages of pressure ulcers from Stage 1 (redness) to Stage 4 (full thickness loss).
- Factors aiding in wound healing include adequate nutrition, circulation, and ambulation.
Oxygen and Perfusion
- Techniques like pursed lip breathing and incentive spirometry encourage respiratory function and lung expansion.
- Screening for nursing diagnosis related to respiratory distress includes assessing vital signs and lung sounds.
Pain Management
- PCA pumps allow patients to manage their pain while minimizing overdose risks; family misuse should be monitored.
- Adjuvant analgesics may enhance the effect of primary pain medications.
Sleep and Rest
- Various sleep disorders include insomnia, sleep apnea, and narcolepsy; environmental and lifestyle factors impact sleep quality.
- Promote sleep hygiene through proper routines and minimizing disruptive factors.
Older Adults
- Aging affects cardiovascular health; encourage physical activity and regular health screenings to prevent heart disease.
- Nutritional needs evolve; older adults require low-fat, balanced diets with nutritional supplements as needed.
Loss, Grief, and Dying
- Advance directives clarify patient wishes regarding medical treatment; hospice care is an interdisciplinary approach for end-of-life management.
- Family dynamics play a significant role in the caregiving process during critical times.### Home and Bereavement Care
- Home care for dying patients is essential to provide comfort and dignity.
- Family members require bereavement care following a loved one's passing, addressing emotional needs.
- Ongoing research and education are vital to improving palliative care practices.
Palliative Care Essentials
- Palliative care focuses on maximizing patient comfort and quality of life, transcending the mere treatment of illness.
- The core goal is to prevent and relieve suffering for patients and their families.
- There is a critical need for interdisciplinary collaboration among healthcare professionals.
- Settings for palliative care include hospitals, outpatient clinics, and skilled nursing facilities.
- All hospice care falls under palliative care, but not all palliative care qualifies as hospice care.
Signs of Impending Death
- Symptoms indicating approaching death include difficulty speaking or swallowing, nausea, and abdominal discomfort.
- Physical indicators: incontinence, blood pressure decline, weak and irregular pulse, and temperature change leading to clammy skin.
- Respiratory changes involve noisy breathing patterns (Cheyne-Stokes respiration) and restlessness.
- Visual symptoms include mottling and cyanosis of extremities, alongside loss of movement and reflexes.
End-of-Life Decisions and Interventions
- Special orders like DNR (Do Not Resuscitate) respect patient wishes for a natural death without aggressive intervention.
- Terminal weaning involves gradually removing patients from ventilators as per doctors' instructions.
- Families may participate in voluntary cessation of eating and drinking as part of end-of-life decisions.
- Euthanasia options are classified as active (administering lethal doses) and passive (withholding treatment).
- Palliative sedation uses sedatives to alleviate suffering, potentially inducing unconsciousness.
Grieving Stages
- Five stages of grief: denial, anger, bargaining, depression, and acceptance, reflect emotional responses to loss.
Anesthesia Recovery Stages
- Recovery from anesthesia involves four stages: analgesia, disinhibition, surgical anesthesia, and medullary depression.
- Analgesia is characterized by reduced pain perception, while disinhibition presents delirium and irregular respiration.
- Surgical anesthesia ensures unconsciousness and pain reflex absence. Medullary depression indicates critical cardiovascular and respiratory issues, requiring intervention.
Pain Management Tools
- Common pain management scales include the Numeric Rating Scale, Wong-Baker FACES scale for children, and the FLACC scale for infants.
Cardiovascular Interventions
- Atropine therapy serves to enhance heart rate and mitigate secretions; also counters muscarinic side effects.
Dementia and Cognitive Disorders
- Dementia encompasses symptoms affecting memory, thinking, and social abilities, often due to brain damage.
- Alzheimer's disease shows gradual memory and reasoning decline, with signs like irritability and confusion.
- Delirium manifests as rapid-onset confusion due to various factors, requiring medication adjustments and supportive care.
- Sundowning syndrome presents late-afternoon/evening confusion in dementia patients, necessitating care strategies.
Aspiration Risks
- Aspiration risk factors include health issues affecting swallowing, poor oral hygiene, dysphagia, and dementia.
Medication Administration Checks
- The three checks of medication administration ensure patient safety: before removing medications, during preparation, and prior to bedside administration.
- Specific vital checks are crucial: apical pulse for cardiac medications and blood pressure before administering hypertensives.
Communication and Delegation
- The ISBAR communication tool aids in effective patient handover: Identify, Situation, Background, Assessment, Recommendation.
- Tasks suitable for delegation to an Assistant Personnel (AP) include vital sign collection and assisting with daily living activities.
Serum Level References
- Normal serum levels: Sodium (135-145 mmol/L), Potassium (3.5-5.0 mEq/L), Chloride (95-105 mmol/L), Phosphorus (3-4.5 mg/dL), Bicarbonate (23-30 mEq/L), Calcium (8.5-10.5 mg/dL), Magnesium (1.3-2.1 mEq/L), Albumin (3.4-5.4 g/dL).
General Knowledge from Previous Classes
- Disengagement theory addresses older adults stepping back from societal roles.
- Common myths about older adults include beliefs about their inability to learn or engage in new activities.
- Middle adulthood is marked by chronic illnesses and slower recovery.
- Anticipatory loss in health contexts pertains to imminent diagnosis effects.
- Useful interventions for insomnia involve creating a sleep-conducive environment and nutritional considerations.
- Hyperactive sleep disorders, such as narcolepsy, require appropriate management strategies.
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Description
Prepare for your Foundations final exam with this comprehensive study guide focused on documentation practices. Learn the dos and don'ts of charting, including the SOAP method, to ensure your notes are complete, accurate, and legally sound. This guide is essential for mastering effective clinical documentation.
