FILE_9423.docx

Exam #2 Study Guide Chapter 9 (Culture and Diversity) Know definitions of ethnocentric, acculturation and stereotyping and what examples. Ethnocentric: The belief that one’s own way of life and view of the world are inherently superior to others and are more desirable. Tendency to hold one’s own way...

Exam #2 Study Guide Chapter 9 (Culture and Diversity) Know definitions of ethnocentric, acculturation and stereotyping and what examples. Ethnocentric: The belief that one’s own way of life and view of the world are inherently superior to others and are more desirable. Tendency to hold one’s own way of life as superior to that of other. Characteristics where we put our own ethnicity at the center of everything we believe. Ex: A nurse believes for a patient to heal properly from an infection they need antibiotics, but the patient/patient’s family believes in prayer to cure infection and want to hold daily prayers uninterrupted, and the nurse tries to administer medication during prayer times because she disregards their beliefs. Acculturation: An individual or group transitions from one culture and develops traits of another culture – may lead to changes in diet, physical activity level, and environmental exposures. Adaptation to the new cultures, traditions, customs, and language. Can lead to stress when the values of the transitioning culture differ from the accepted traits of another. Assimilation: is the process in which the individual adapts to the host’s cultural values and no longer prefers the components of the origin culture. EX: A previously underweight and malnourished patient from a country with an inadequate food supply comes to the U.S and has rapid and unhealthy weight gain resulting in becoming overweight quickly and suffer health issues. Stereotyping: Making assumptions of people based on their age, skin, color, religion, or sex (associating a characteristic with a specific group). Occurs in two cognitive processes… Activation of a stereotype when an individual is categorized into a social group beliefs and prejudices come to mind about what members of that particular group are like. People use activated beliefs and feelings when they interact with individuals. Ex: Thinking all nurses should be females and refusing service from a male nurse. Know what social determinants of health are: external factors that affect a person’s health. The conditions in which people are born, grow, live, work, and age that affect health functioning and quality of life outcomes. Determine economic stability, social & community context, neighborhood & environment, health care, education. Responsible for health disparities – be aware of them as nurses. External factors Affecting People’s Health: Age Race, ethnicity Religion Economic stability Access to Healthcare Access to nutritious foods Transportation resources Sexual orientation Literacy level Level of education Disability (physical & cognitive) Neighborhood & environment How can nurses develop culturally competent practices? Cultural Competence: means that professional health care must be culturally sensitive, culturally appropriate, and culturally competent to meet the multifaceted health care needs of each person, family, and community. Cultural Awareness is the process of conducting a self-examination of one’s own biases toward other cultures and the in-depth exploration of one’s cultural and professional background. It also involves being aware of the existence of documented racism and other “isms” in health care delivery. Cultural Knowledge is the process in which a health care professional seeks and obtains a sound educational base about culturally diverse groups. In acquiring this knowledge, health care professionals must focus on the integration of three specific issues: health-related beliefs and cultural values, care practices, and disease incidence and prevalence. Cultural Skill is the ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patient’s presenting problem, as well as accurately conducting a culturally based physical assessment. Cultural Encounter is a process that encourages health care professionals to directly engage in face-to-face cultural interactions and other types of encounters with patients from culturally diverse backgrounds. A cultural encounter aims to modify a health care provider’s existing belief about a cultural group and to prevent possible stereotyping. Cultural Desire is the motivation of a health care professional to “want to” (and not “have to”) engage in the process of becoming culturally aware, culturally knowledgeable, and culturally skillful in seeking cultural encounters. What is the first step toward developing these skills (hint: begins with awareness of your own cultural beliefs and practices. I ASKED (Cultural Awareness, Skill, Knowledge, Encounter, Desire) Chapter 22 (Ethics & Values) Know definitions of: autonomy, beneficence, nonmaleficence, justice, and fidelity Autonomy: Individuals have the right to determine their own actions and the freedom to make their own decisions (refers to freedom from external control). Autonomous decisions based on: Individual values Adequate information Freedom from coercion Reason and deliberation Beneficence: refers to taking positive actions to help others. the best interests of the patient remain more important than self-interest. It implies that nurses practice primarily as a service to others, even in the details of daily work. Nonmaleficence: refers to the avoidance of harm or hurt. Justice: refers to fairness and the distribution of resources. Fidelity: refers to faithfulness or the agreement to keep promises. Veracity: Telling the truth, not lying Know the steps in following an ethical dilemma: recognize a dilemma exists, gather all the necessary data, develop a statement of the problem, list all possible courses of action, decide and implement the action and then evaluate the outcome. Review Box 22.3 Step 1: Ask: Is this an ethical problem? When strong emotions are triggered and when you are in a situation in which the action you take will demonstrate your personal or professional values, then you may have an ethical problem. You will likely feel conflicted between opposing courses of action. Step 2: Gather information relevant to the case. Info about the patient, patient’s family, health care agency, and social perspectives are important sources of relevant information. Step 3: Identify the ethical elements in the situation by clarifying values and recognizing the principals involved. Distinguish among fact, opinion, and values. Step 4: Name the problem. Speaking aloud encourages you to use the right language and allows you to get feedback from others. A clear, simple statement of the problem is not always easy, but it helps to ensure effectiveness in the final plan and facilitates discussion. Step 5: Identify possible courses of action. Access others for their input and be creative in identifying different options. Know your resources: colleagues, leaders, interprofessional team, consultation services, professional organizations, boards of nursing. What are the options and who is available to help. Step 6: Create and implement an action plan and carry it out/negotiate outcome Gather support from others and identify an alternative action if the chosen one does not achieve resolution. Step 7: Evaluate the action plan Determine whether further action is needed or if lessons learned in this experience can be applied forward. Chapter 23 (Legal Implications) What is negligence? What has to be proved? Negligence: is conduct that falls below the generally accepted standard of care of a reasonably prudent person. Nurses are negligent when they had a duty of care that is breached, and their patient is physically harmed. What are major causes of negligence in nursing? Hanging the wrong intravenous solution for a patient Applying a warm compress that causes a burn. Not implementing a pressure injury or fall prevention protocol. Failure to communicate important information to another health care provider. Failure to document appropriately Failure to assess and monitor a patient. Inappropriate delegation of nursing tasks. What does the nurse practice act do? Defines the legal scope of nursing practices. Scope of practice: the range of care you are allowed to legally perform. Independent nursing interventions pertain to activities of daily living, health education and promotion, and counseling. EX: Tonya selects the following independent nursing interventions for Mr. Lawson to resolve his acute pain: positioning, relaxation therapy, and exercise promotion. Chapter 24 (Communication) What are the zones of personal space and where do nurses most often practice? Intimate distance (0–18 inches) Holding a crying infant Performing physical assessment Bathing, grooming, dressing, feeding, and toileting a patient Changing a patient’s surgical dressing Where nurses most often practice- where nursing actions happen. Personal distance (18–40 inches) Sitting at a patient’s bedside Taking a patient’s nursing history Teaching an individual patient Social distance (4–12 feet) Giving directions to visitors in the hallway Asking whether families need assistance from the patient doorway. Giving verbal report to a group of nurses Public distance (12 feet and more) Speaking at a community forum Lecturing to a class of students Testifying at a legislative hearing Special Zones of Touch Social Zone (permission not needed) Hands, arms, shoulders, and back Consent Zone (permission needed) Mouth, wrist, and feet Vulnerable Zone (special care needed) Face, neck, and front of body Intimate Zone (permission and great sensitivity needed) Genitalia and rectum What are the communication phases of a nurse-patient relationship? Preinteraction phase: occurs before meeting the patient Review available data, including the medical and nursing history (e.g., ability of patient to communicate, pathology of any speech mechanisms, medications affecting mood, reports of previous behavior problems). Talk to other caregivers who have information about the patient. Anticipate health concerns or issues that arise. Identify a location and setting that fosters comfortable, private interaction. Plan enough time for the initial interaction. Orientation phase: when you and a patient meet and get to know each other. Set the tone for the relationship by adopting a warm, empathetic, caring manner. Sit down next to the patient if possible. Recognize that the initial relationship is often superficial, uncertain, and tentative. Expect the patient to test your competence and commitment. Let the patient know when to expect the relationship to be terminated. Closely observe the patient and expect to be closely observed by the patient. Begin to make inferences and form judgments about patient messages and behaviors. Assess the patient’s health status. Prioritize the patient’s problems and identify expected outcomes. Clarify the patient’s and your roles. Form contracts with the patient that specify who will do what. Working phase: when you and a patient work together to solve problems and accomplish outcomes. Encourage and help the patient express feelings about health. Encourage and help the patient with self-exploration. Provide information needed to understand and change behavior. Collaborate with the patient to set individualized outcomes. Take action to meet the outcomes set with the patient. Use therapeutic communication skills to facilitate successful interactions. Use appropriate self-disclosure and confrontation. Termination phase: during the ending of the relationship. Remind the patient that termination is near. Evaluate achievement of expected outcomes with the patient. Reminisce about the relationship with the patient. Separate from the patient by relinquishing responsibility for care. Achieve a smooth transition for the patient to other caregivers as needed. Chapter 26 (Informatics & Documentation) What events require an incident (variance) or occurrence report? Incident or occurrence: any event that is not consistent with the routine, expected care of patient or standard procedures in place on health care unit or within an agency. E.g., falls, needlestick injuries, med admin errors, accidental omission of ordered therapies, visitor losing consciousness, any circumstances leading to injury or posing risk for patient injury such ad “near miss”. NOT INCLUDED IN/NOT MENTIONED IN THE CHART Nurse’s note going in chart (no mention of incident report) Objective description of what happened. Incident report goes to HR or Risk Management What is a SOAP note and what belongs in each section? Part of progress notes – how health care team members record and monitor patient progress towards resolving problem. S: Subjective— Chief complaint or other info the pt. or family member tells you. EX: Patient states, “My leg is so swollen. I’m worried about this blood clot. Do you know how they are going to treat it?” O: Objective— Factual, measurable data, S/S, VS, or test values. Ex: Patient asking question about medications and how DVT will be treated. Alert and oriented; responds appropriately to instruction. A: Assessment— Conclusions formulated as pt. problems or nursing diagnoses. EX: Patient lacks knowledge regarding anticoagulation therapy, seeking information about therapy. P: Plan – Strategy for relieving pt’s problems, including short- and long-term actions. EX: Discussed importance of bed rest and the reason for treatment with heparin infusion. Provided brochure on anticoagulation therapy for DVT. Explained rationale for bed rest and daily blood tests to check anticoagulation levels. Explained that heparin infusion will be stopped when PT/INR is at therapeutic level and that he can expect to take warfarin for about 6 months until clot resolves. What are threats to patient confidentiality? Hacking Ex- employees Family members Social media Discussing patient with other health care providers that are not on the patient’s team. Wanting to know about an interesting case, trying to access chart by myself, talking to family member, friend, etc. How can medical documentation be used? Allows one to determine the severity of a patient’s illness, the intensity of services received, and the quality of care provided during an episode of care. Insurance companies use this information to determine payment or reimbursement for health care services. It is necessary to document all the nursing care you provide for each patient, including assessment data, nursing problems or diagnoses, interventions, and evaluation of patient responses, in the health record. Accurate documentation of nursing services provided, as well as the supplies and equipment used in a patient’s care, clarifies the type of treatment a patient received and supports accurate and timely reimbursement to a health care agency and/or patient. Chapter 29 (Vital signs) What considerations should you take into account when taking a patient’s respirations? Altered breathing tends to be the first sign of clinical deterioration and is one of the most important indicators for predicting patient outcomes. Because respiration is tied to the function of numerous body systems, consider all variables when changes occur. Factors Influencing Respirations Exercise Acute pain Anxiety Chronic smoking Body position Medication Neurological injury Hemoglobin function If vital signs are delegated what is your responsibility as the RN? The RN responsibility is to go back and review the patient’s vital signs and identify if there were any abnormal assessment findings to support changing the frequency of vital sign measurement. What patients are at high risk of tachycardia/bradycardia? Tachycardia: is an abnormally elevated HR, above 100 beats/min in adults. EX: dehydration, hyperthyroid, anxiety, and fever Bradycardia: is a slow HR, below 60 beats/min in adults. Ex: Opioids, MI- myocardial infarction (“heart attack”) Know normal vital sign ranges and who might require immediate attention based on vital signs. Acceptable Ranges for Adults Temperature range Average Temperature range: 36° to 38°C (96.8° to 100.4°F) Average oral/tympanic: 37°C (98.6°F) Average rectal: 37.5°C (99.5°F) Axillary: 36.5°C (97.7°F) Pulse (Heart Rate): 60 to 100 beats/min, strong and regular Pulse oximetry (SpO2): 95% and above Respirations: 12 to 20 breaths/min, unlabored (effort), deep and regular (rhythm) Blood pressure Systolic <120 mm Hg Diastolic <80 mm Hg Capnography (EtCO2): Normal: 35-45 mm Hg BMI: 18.5 – 24.9 kg/m^2 (normal) Pulse pressure: 30 to 50 mm Hg Fever Patterns Sustained: little fluctuation Intermittent: spikes then normal Remittent: spikes, stay above normal Relapsing: spikes > 24 hours Sustained: A constant body temperature continuously above 38°C (100.4°F) that has little fluctuation. Intermittent: Fever spikes interspersed with usual temperature levels (Temperature returns to acceptable value at least once in 24 hours.) Remittent: Fever spikes and falls without a return to acceptable temperature levels. Relapsing: Periods of febrile episodes and periods with acceptable temperature values (Febrile episodes and periods of normothermia are often longer than 24 hours.) Pyrexia: Fever (is a defense mechanism) Chapter 37 (Stress and Coping) What are physiologic responses to stress? Fight or Flight sympathetic NS Increased HR & BP Mydriasis (dilated pupils) Bronchodilation Decreased digestion Know General Adaptation Syndrome and examples of each stage. General Adaptation Syndrome (GAS), a three-stage set of physiological processes that prepare, or adapt, the body for danger so that an individual is more likely to survive when faced with a threat. Alarm Stage the central nervous system is aroused, and body defenses are mobilized; this is the fight-or-flight response. During this stage rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine, heart rate, blood flow to muscles, oxygen intake, and mental alertness. In addition, the pupils of the eyes dilate to produce a greater visual field. If the stressor poses an extreme threat to life or remains for a long time, the person progresses to the second stage, resistance. Resistance Stage also contributes to the fight-or-flight response, and the body stabilizes and responds, attempting to compensate for the changes induced by the alarm stage. Hormone levels, heart rate, blood pressure, and cardiac output should return to normal, and the body tries to repair any damage that occurred. However, these compensation attempts consume energy and other bodily resources. Exhaustion Stage continuous stress causes progressive breakdown of compensatory mechanisms. This occurs when the body is no longer able to resist the effects of the stressor and has depleted the energy necessary to maintain adaptation. The physiological response has intensified, but the person’s ability to adapt to the stressor diminishes. Even in the face of chronic demands, an ongoing state of chronic activation can occur. This chronic arousal with the presence of powerful hormones causes excessive wear and tear on bodily organs and is called allostatic load. A persistent allostatic load can cause long-term physiological problems such as chronic hypertension, depression, sleep deprivation, chronic fatigue syndrome, and autoimmune disorders. Know signs of PTSD Posttraumatic stress disorder (PTSD) begins when a person experiences or witnesses a traumatic event and responds with intense fear or helplessness. May Include: Flashbacks – recurrent and intrusive recollections of the event Secondary traumatic stress: the trauma a person experiences from witnessing other people’s suffering. Ex: nightmares and anxiety about the traumatic event. Severe emotional distress or physical reactions to something that reminds the person about the traumatic event. Factors influencing stress and coping Situational Job changes, illness, and caregiver stresss Maturational – growing & maturing to different life milestones. Vary with life changes Sociocultural Environmental, social, and cultural stressors Know about work-related stress High-acuity patient load, job environment, constant distractions, responsibility, conflicting priorities, and intensity of care (e.g., trauma, emergency, or critical care areas). In addition, changing shifts increases fatigue and work-related stress. Chronic Stress This chronic arousal with the presence of powerful hormones causes excessive wear and tear on bodily organs and is called allostatic load. A persistent allostatic load can cause long-term physiological problems such as chronic hypertension, depression, sleep deprivation, chronic fatigue syndrome, and autoimmune disorders. Acute Stress Time-related events that threaten a person for a relatively brief period provoke acute stress. Really be aware of this with your patients, staff, fellow students, and family. Chapter 40 (Hygiene) Know common nursing diagnosis related to hygiene. Activity intolerance Bathing self- care deficit Impaired physical mobility Risk for infection Ineffective health maintenance Impaired oral mucous membrane Know appropriate foot care for high-risk populations. Patients with diabetes and circulatory problems need special care. Do NOT soak feet of diabetic patients – can cause infections and skin breakdown. Know the definitions of cheilitis, dental caries, edentulous, gingivitis, glossitis, mucositis, stomatitis, and xerostomia. Definitions Cheilitis: cracked lips Edentulous: without teeth Glossitis: inflamed tongue Mucositis: painful inflammation of oral mucous membranes Stomatitis: causes burning, pain, and change in food and fluid tolerance/ inflammation of the oral mucosa. Brush with a soft toothbrush and floss gently. Xerostomia: dry mouth Gingivitis: inflammation of the gums Dental Caries: tooth decay What are the benefits of good oral hygiene? BAD ORAL HYGIENE CAN CAUSE PNEUMONIA Brushing Removes particles, plaque, and bacteria. Massages the gums. Relieves unpleasant odors and tastes. Flossing removes tartar at the gum line. (not flossing= bleeding risk) Rinsing removes particles and toothpaste. What can be delegated to a CNA with regard to hygiene care and other activities that can be carried out during those activities. CNAs can bathe/clean patients. CNA personnel can take vitals, but RN is ultimately responsible for interpreting/ care planning in regards to vitals