Nursing Quality Improvement and ED Care
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Questions and Answers

What is a potential consequence of hypocalcemia?

  • Decreased heart rate
  • Tetany (correct)
  • Increased blood pressure
  • Increased urine output
  • What is one of the potential causes of hypomagnesemia?

  • Thiazide diuretics
  • Hyperparathyroidism
  • Bone tumors
  • Alcoholism (correct)
  • What happens when the RAAS system is activated?

  • Decreased blood volume
  • Decreased arterial constriction
  • Increased blood pressure (correct)
  • Increased urinary output
  • What is a potential cause of a decrease in blood flow to the kidneys?

    <p>Hypovolemia (B)</p> Signup and view all the answers

    What is a potential complication of hypomagnesemia?

    <p>Cardiac arrest (C)</p> Signup and view all the answers

    What is a primary responsibility of a registered nurse (RN) in quality improvement (QI)?

    <p>Recognizing and addressing areas for improvement (B)</p> Signup and view all the answers

    What does 'failure to rescue' primarily refer to in nursing practice?

    <p>Not recognizing changes in a patient's condition (D)</p> Signup and view all the answers

    Which of the following best describes the role of the rapid response team (RRT)?

    <p>To address sudden changes in a patient's condition (A)</p> Signup and view all the answers

    In the emergency department, what does a primary survey prioritize?

    <p>Immediate life-threatening issues (D)</p> Signup and view all the answers

    What does the '5 rights of delegation' primarily involve?

    <p>Assigning the right task to the right person under the right circumstances (C)</p> Signup and view all the answers

    What is the primary goal for oral fluid intake in a patient requiring treatment for hemoconcentration?

    <p>64 ounces (B)</p> Signup and view all the answers

    Which of the following is NOT a symptom of fluid volume deficit?

    <p>Stable weight (A)</p> Signup and view all the answers

    Why should potassium be administered only after urine output is adequate?

    <p>To prevent hyperkalemia (C)</p> Signup and view all the answers

    Which of the following treatments is appropriate for fluid volume deficit in children?

    <p>Employ infusion pumps for accurate intake (B)</p> Signup and view all the answers

    What type of fluid is typically avoided for treating hemoconcentration?

    <p>Concentrated glucose (C)</p> Signup and view all the answers

    Which of the following is a common cause of fluid volume deficit in children?

    <p>Infections (C)</p> Signup and view all the answers

    How does aging affect fluid balance in the elderly?

    <p>Difficulty obtaining fluids (B)</p> Signup and view all the answers

    Which of the following signs would indicate dehydration in an infant?

    <p>Sunken fontanel (B)</p> Signup and view all the answers

    What are the components of the triad of death associated with trauma complications?

    <p>Hemorrhage, airway compromise, hypothermia (D)</p> Signup and view all the answers

    Which process involves the movement of water from an area of low solute concentration to an area of high solute concentration?

    <p>Osmosis (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of fluid volume overload (FVO)?

    <p>Oliguria (A)</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with fluid volume deficit (FVD)?

    <p>Weight loss (A)</p> Signup and view all the answers

    What is the primary treatment approach for managing fluid volume overload (FVO)?

    <p>Diuretics (C)</p> Signup and view all the answers

    Which electrolyte is NOT considered a cation in the context of fluid and electrolyte balance?

    <p>Phosphate (D)</p> Signup and view all the answers

    How is homeostasis maintained in organisms?

    <p>By dynamic equilibrium processes such as diffusion and osmosis (A)</p> Signup and view all the answers

    What are sensible losses in fluid volume assessment?

    <p>Urine output and diarrhea (B)</p> Signup and view all the answers

    What is a critical symptom of hyponatremia?

    <p>Seizures (A)</p> Signup and view all the answers

    What is one of the primary complications of Systemic Lupus Erythematosus (SLE)?

    <p>Lupus nephritis (D)</p> Signup and view all the answers

    Which of the following interventions is a priority for treating hypokalemia?

    <p>Monitoring cardiac function (C)</p> Signup and view all the answers

    What electrolyte imbalance is indicated by muscle weakness and cardiac dysrhythmias?

    <p>Hypokalemia (C)</p> Signup and view all the answers

    What is a characteristic skin manifestation of Systemic Lupus Erythematosus?

    <p>Butterfly rash (B)</p> Signup and view all the answers

    Which of the following treatments should be tapered gradually to prevent an adrenal crisis?

    <p>Prednisone (D)</p> Signup and view all the answers

    Which of the following is a possible cause of hyperkalemia?

    <p>Adrenal insufficiency (B)</p> Signup and view all the answers

    What is one of the risks associated with the use of steroids in treating SLE?

    <p>Increased risk of infections (B)</p> Signup and view all the answers

    Which treatment should be avoided in the case of critical hyponatremia?

    <p>Encouraging fluid intake (B)</p> Signup and view all the answers

    What is a common symptom associated with hyperkalemia?

    <p>Muscle weakness (D)</p> Signup and view all the answers

    What is a primary symptom during Stage I of Lyme disease?

    <p>Erythema migrans (D)</p> Signup and view all the answers

    What is the normal range for sodium levels in the body?

    <p>135-145 mEq/L (B)</p> Signup and view all the answers

    What is a common side effect that requires monitoring while taking hydroxychloroquine?

    <p>Vision problems (C)</p> Signup and view all the answers

    Which of the following might indicate a kidney-related issue causing hypokalemia?

    <p>Adrenal gland hyperactivity (B)</p> Signup and view all the answers

    What onset time frame is typical for Type III hypersensitivity reactions?

    <p>1-3 weeks (A)</p> Signup and view all the answers

    What is a typical symptom of Type IV hypersensitivity reactions?

    <p>Delayed skin reactions (C)</p> Signup and view all the answers

    Flashcards

    Role of the RN in QI

    Registered Nurses identify improvements and implement actions in quality improvement processes.

    Clinical judgment

    The ability of a nurse to make informed decisions based on patient data and assessment.

    5 Rights of Delegation

    Guidelines ensuring safe delegation: right task, circumstance, person, direction, and supervision.

    Failure to rescue

    The inability to recognize and respond to changes in a patient's condition, leading to adverse outcomes.

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    Triage Level 1

    Patients at this level require immediate physician attention due to life-threatening conditions, like cardiac arrest.

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    Hemoconcentration

    A condition where the concentration of cells and solids in the blood increases due to decreased fluid volume.

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    Isotonic Solution

    A solution with equal osmotic pressure as the body's fluids, maintaining balance.

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    Hypotonic Solution

    A solution with lower osmotic pressure, causing cells to swell as water enters.

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    Hypertonic Solution

    A solution with higher osmotic pressure, causing cells to shrink as water exits.

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    Fluid Balance in Children

    A state where fluid output exceeds intake, potentially causing dehydration.

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    Signs of Dehydration

    Dry mucosa, sunken orbits, lethargy, and decreased urine output indicating fluid loss.

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    Rehydration Strategies

    Methods to restore fluid balance using oral or IV fluids to replace lost volumes.

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    Elderly Fluid Balance Risk

    The elderly are at greater risk for fluid volume deficit due to lower body water and thirst response.

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    Hypocalcemia

    A condition characterized by low levels of calcium in the blood, leading to symptoms like tetany and increased neuromuscular excitability.

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    Chvostek’s sign

    A clinical sign of hypocalcemia where tapping on the facial nerve causes twitching of the facial muscles.

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    RAAS system

    The Renin-Angiotensin-Aldosterone System, activated by low blood flow to kidneys, increasing blood volume and blood pressure.

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    Hypomagnesemia

    A condition with low magnesium levels, potentially causing neuromuscular changes and cardiac issues.

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    Tetany

    Involuntary muscle contractions due to low calcium or magnesium levels, causing spasms and cramps.

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    Triad of death

    Complications of trauma including hemorrhage, airway compromise, sepsis, and hypothermia.

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    Electrolytes

    Mineral salts that dissolve in water and separate into ions.

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    Homeostasis

    Dynamic state of equilibrium required for optimal functioning of living organisms.

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    Diffusion

    Movement of particles from high concentration to low concentration.

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    Osmosis

    Movement of water from low solute concentration to high solute concentration.

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    Fluid Volume Overload (FVO)

    Condition marked by weight gain and various symptoms like hypertension and dyspnea.

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    Fluid Volume Deficit (FVD)

    Condition marked by weight loss and symptoms like hypotension and dry membranes.

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    Diuresis

    The process of removing excess water from the body, often through medication.

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    Type III Hypersensitivity

    Immune complex-mediated reactions causing diseases like serum sickness and SLE.

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    Systemic Lupus Erythematosus (SLE)

    Chronic inflammatory disorder affecting connective tissues, damaging kidneys and heart.

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    Lupus Nephritis

    Kidney damage from SLE causing protein loss in urine.

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    Steroid Use in SLE

    Steroids decrease immune response, requiring careful tapering to prevent crises.

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    Type IV Hypersensitivity

    T-cell mediated immune responses seen in conditions like MS and RA.

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    Contact Dermatitis

    Local skin reactions caused by substances like poison ivy.

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    Lyme Disease

    Infection caused by Borrelia burgdorferi with distinct stages of symptoms.

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    Stages of Lyme Disease

    Stage I: flu symptoms; Stage II: cardiac and neurological issues; Stage III: arthritis.

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    Hyponatremia

    A condition where sodium levels in the blood are low, leading to decreased osmolarity.

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    Symptoms of Hyponatremia

    Signs include confusion, seizures, hypertension, and edema.

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    Causes of Hyponatremia

    Common causes include water excess, adrenal issues, and dehydration.

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    Treatment for Hyponatremia

    Encouragement of oral rehydration or diuretics to manage fluid retention.

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    Symptoms of Hypokalemia

    Signs include muscle weakness, diarrhea, and cardiac dysrhythmias.

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    Causes of Hypokalemia

    Common causes include GI losses, kidney failure, and certain medications like diuretics.

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    Critical Symptoms of Hypokalemia

    Severe symptoms include dysrhythmias, hypotension, and bradycardia.

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    Study Notes

    Preparatory Module

    • Role of the RN in Quality Improvement (QI): Focuses on improving systems, clinical judgment, critical thinking, prioritizing cues, and reporting.
    • Clinical reasoning and systems thinking are crucial in QI.
    • Rapid Response Team (RRT) vs. Code Team: RRT used for sudden changes in patient condition, Code Team used for cardiopulmonary arrest.
    • Safe delegation involves specific guidelines; assessment/evaluation and education cannot be delegated. Tasks that can be delegated should follow the 5 rights of delegation.
    • Scope of practice and policies should be followed.
    • Failure to recognize changes in patient condition and failure to respond appropriately are critical concerns.

    ED Nursing

    • Vulnerable populations and social determinants of health are key considerations.
    • Prioritizing care involves a primary survey (ABCDE). Assessing for bleeding, airway, breathing, circulation, disability (GCS), and exposing/protecting the patient are critical first steps.
    • Triage categorizes patients needing immediate care, 5-minute wait, hours for a full evaluation, hours of minimal care, or days for no immediate care.

    Fluid, Electrolytes, and Homeostasis

    • Fluids are water with dissolved substances (glucose, proteins, ions, and cells).
    • Electrolytes are mineral salts that dissolve in water and separate into ions (charged particles).
    • Homeostasis is maintained through several processes: diffusion (high to low), osmosis (low to high), filtration (high to low), and active transport (low to high).
    • Fluid distribution occurs between different spaces in the body (kidneys, vascular, interstitial).

    Fluid Volume Assessment

    • Fluid volume assessment (FVO) includes intake and output measurement, physical examination, lab work, and daily weights.
    • Sensible losses (measurable losses) include urine, diarrhea, and emesis.
    • Insensible losses include respiratory and skin losses.
    • Weight gain, hypertension, tachycardia, tachypnea, bounding pulse, crackles, dyspnea, and orthopnea are signs to note.
    • Pitting edema, jugular vein distention, and periorbital edema reflect fluid overload.

    Fluid Volume Deficits (FVD)

    • Fluid volume deficit (FVD) symptoms include weight loss, hypotension, tachycardia, poor/tenting turgor, and dry mucus membranes.
    • Oliguria (decreased urine output) also signifies FVD.
    • Treatment involves oral solutions (water and salts), or intravenous (IV) solutions, to replenish fluids.
    • Ensure the output doesn't exceed intake.

    Electrolyte Imbalances

    • Common electrolyte imbalances (sodium and potassium) are defined, along with their symptoms and causes.
    • Treatment and nursing strategies for each electrolyte imbalance are described.

    Acid-Base Balance

    • Normal blood gas parameters are defined (pH, CO2, HCO3-).
    • Respiratory and metabolic acidosis and alkalosis are categorized, along with possible causes and conditions.

    Immune System

    • Components of the immune system are named (tonsils, adenoids, thymus, lymph nodes, spleen, bone marrow, Peyer's patches, and specific cells).
    • Immune system functions to protect the body.

    Hypersensitivity Reactions

    • Different types of hypersensitivity reactions are described along with their causes, symptoms, and treatments.
    • Epinephrine use in anaphylaxis and acute allergic reactions is outlined.

    Other Topics

    • Additional topics covered include specific conditions (e.g., SLE, contact dermatitis, Lyme disease).
    • Information on preventative measures for these conditions, treatment, and nursing interventions is provided.
    • HIV transmission, stages, and management are discussed.
    • Different types of hematological conditions and their specific considerations are covered (e.g., anemia, blood transfusions).

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    Description

    This quiz covers the essential roles of registered nurses in quality improvement and emergency department (ED) nursing. It highlights critical concepts like clinical reasoning, the Rapid Response Team distinguishes from the Code Team, and safe delegation within nursing practice. Additionally, it addresses the importance of assessing vulnerable populations and social determinants of health.

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