NUR125 Module Content Review Guide PDF

**Exam 1 Key Concepts Module 1, 2 & 3** [Module 1 & 2-Medication Administration-]\ Administering medications safely requires an understanding of the legal aspects of health care.\ Apply knowledge of the four major pharmacokinetic processes---medication absorption, distribution, metabolism, and...

**Exam 1 Key Concepts Module 1, 2 & 3** [Module 1 & 2-Medication Administration-]\ Administering medications safely requires an understanding of the legal aspects of health care.\ Apply knowledge of the four major pharmacokinetic processes---medication absorption, distribution, metabolism, and excretion---to time medication administration, select the route of administration, and evaluate a patient's response.\ When a medication is prescribed, the goal is a constant blood level within a safe therapeutic range.\ Prompt recognition and reporting of adverse medication events prevents serious patient injury.\ In health care agencies, patients with known medication allergies have their allergy information recorded in a clearly identifiable place.\ The route prescribed for administering a medication depends on the medication's properties and desired effect and on a patient's physical and mental condition.\ Metric units are easy to convert and calculate using simple multiplication and division, with each basic unit of measurement organized into units of 10.\ A health care provider prescribes a patient's medications, and the pharmacist prepares and distributes the prescribed medications. Nurses, physicians, and other health care providers work together to evaluate the effectiveness of medication therapy.\ Distractions may cause a medication error. Distractions include a page, phone call, or request from a colleague or patient that draws away, disturbs, or diverts.\ attention from a current desired task or that forces attention on a new task, at least temporarily.\ The ten rights of medication administration include the right medication, right dose, right patient, right route, right time, right documentation, and right indication, right evaluation, right to refuse, and right to health education.\ Medications that are time critical most likely cause harm or have subtherapeutic effects if they are not administered on time (usually 30 minutes before or after the scheduled dose).\ Before administering medications, perform a physical assessment, which will reveal physical findings for any indications or contraindications for medication therapy.\ Responsibilities of medication administration include knowing medication therapeutics, assessing a patient before administration, calculating doses, administering\ medications using the seven rights, monitoring and evaluating medication effects, and assessing a patient's ability to self-administer medications.\ For patient safety, it is essential that you refer to the MAR each time you prepare a medication and have it available at the patient's bedside when administering medications.\ Collaboration with patients and their family caregivers is essential, particularly if patients will require assistance with self-administration and if medication regimens are complicated.\ Evaluation of medication administration is an essential role of professional nursing that requires assessment skills, clinical judgment, analysis, and knowledge of medications, physiology, and pathophysiology [Module 3-Infection Prevention] Transmission of infection can occur if the six elements of the infection chain are present and uninterrupted.\ Normal body flora and body system defenses help the body resist infection by reducing the number of pathogenic organisms.\ The vascular response to acute inflammation includes rapid vasodilation, allowing more blood to be delivered near the location of the injury. The increase in local blood flow causes the redness and localized warmth at the site of inflammation, and the body releases chemical mediators that increase the permeability of small\ blood vessels, which leads to edema of interstitial spaces. The cellular response results in an increase in WBCs to the site of inflammation. If the inflammation becomes systemic, cellular responses result in increased WBCs in the bloodstream.\ Health care--associated infections lead to adverse patient events and significantly higher health care costs that are often not reimbursed.\ Multiple factors influence a patient's susceptibility to infection; patients may have one or more of these factors. Careful analysis of data and cues allow you to recognize patient risks such as poor nutrition, stress, chronic disease, and treatments that compromise the immune response.\ Signs of localized infection are more targeted and include swelling, redness, pain, and restriction of movement in the affected body part, whereas the signs and symptoms of systemic inflammation are more generalized and include fever, fatigue, nausea/vomiting, malaise, and lymph nodes that are enlarged, swollen, and tender.\ You use basic medical aseptic techniques such as handwashing and use of barrier precautions with all patients to break the chain of infection.\ Surgical asepsis, such as sterile gloving, is a more stringent technique than medical asepsis.\ Proper handling and management of urinary catheters and drainage sets prevents infection by eliminating a potential portal of entry for microorganisms.\ Proper storage and refrigeration of food prevents a reservoir of infection from developing in food.\ Standard Precautions are applied in all patient care activities to prevent patients and health care workers from transmitting infection even in the absence of disease.\ Hand hygiene using antiseptic hand rub or washing with soap and water is the most effective basic technique in preventing and controlling infection transmission. Hands must remain in contact with antimicrobial agent long enough to clean hand surfaces.\ Transmission-based precautions, including airborne, droplet, contact, and protective environment, are used in addition to Standard Precautions for patients with highly transmissible pathogens. For example, Droplet Precautions focus on diseases that are transmitted by large droplets expelled into the air and by being within 3\ feet of a patient, requiring use of a surgical mask when within 3 feet of the patient, proper hand hygiene, and dedicated personal protective equipment.\ Proper application of personal protective equipment protects the patient and health care worker from transmission of pathogens. When entering isolation, apply a cover gown first, followed by a surgical mask or respirator, then eyewear or face shield and, finally, clean gloves.\ In the home setting, educating patients and caregivers on infection prevention is critical, adapting interventions to a patient's unique home environment. Postmortem Loss comes in many types based on the values and priorities learned within a person's sphere of influence (i.e., family, friends, religion, society, and culture); these types include loss of known environment, significant other, aspect of self, or life itself. The grief experience is a process that is personal, cannot be prevented, and involves a journey that no two people experience the same way. There are three major forms of grief: normal, anticipatory, and disenfranchised. Normal grief is a common and universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual responses to loss and death, whereas anticipatory grief occurs before an actual loss, especially in situations of prolonged or predicted loss. Knowledge of grief theories and normal responses to loss helps you to better understand these complex experiences and how to help a grieving person, remembering that reactions to grief vary widely and thus your practice must consider the complexity and individuality of grief responses. A person's development, coping strategies, socioeconomic status, personal relationships, nature of loss, and cultural and spiritual beliefs influence the way a person perceives and responds to loss and grief. Assessing a person in grief requires exploration of the person's own unique history, context, and resources to make meaning out of their loss experiences. Listen as patients share the experience in their own way. When developing a plan of care for a person facing a loss such as death, include the wishes of a patient and family for end-of-life care, such as the preferred place for death, desired level of intervention, and expectations for pain and symptom management. Providing palliative care requires you to establish a caring presence and use effective communication strategies to encourage patients to share feelings to the degree they are comfortable. Collaborate with other members of the health care team to provide holistic care for management of symptoms and to provide a variety of support measures to the patient and family. High-quality end-of-life care focuses on improving quality of life through management of symptoms such as pain, anxiety, depression, and nausea. Pain is a common priority requiring you to conduct ongoing assessments of a patient's pain level to evaluate the patient's response to interventions. Hospice is a philosophy of family-centered, whole-person care for individuals with a life-limiting illness likely to result in death within 6 months. After determining that an autopsy will be performed, the body of the deceased is cared for and treated with the same level of care and compassion, respect, and dignity as when the person was alive. \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- **Exam 2 Key Concepts Module 4, 5 and 6** [Module 4-Safety and Mobility]\ Clinical judgment is complex when promoting safety because it requires understanding a\ patient's perspective of safety as well as the risks posed by any physical conditions.\ Vulnerable populations (e.g., infants, children, older adults, persons with chronic disease)\ are especially at risk for alterations in safety because of reduced access to health care, fewer\ resources, and increased morbidity\ Common environmental hazards to safety include vehicle accidents, poisonings, conditions\ causing falls, and fire hazards.\ A nurse's role in managing environmental hazards is to educate patients about the common\ hazards in the home and at work, teaching them how to prevent injury and emphasizing the\ hazards to which patients are the most vulnerable.\ A patient's developmental stage can create threats to safety because of lifestyle choices,\ cognitive and mobility status, sensory impairments, and safety awareness.\ Conduct a fall risk assessment in a hospital by using a validated tool containing major risk\ categories such as age, fall history, elimination habits, high-risk medications, mobility, and\ cognition. At a minimum, conduct the assessment on admission, following a change in a\ patient's condition, after a fall, and when the patient is transferred to a new health care\ setting.\ A procedure-related accident is less likely to occur when you strictly follow policies and\ procedures or standards of nursing practice, and when you minimize distractions and\ interruptions.\ An assessment of psychosocial factors that influence patient safety must include a review of\ a patient's health literacy, cultural background, and perception of health and safety.\ Patients with actual or potential risks to safety require you to make clinical judgments\ necessary in selecting the patient-centered interventions that prevent and minimize the\ specific threats to safety.\ It is important to learn a patient's routines and willingness to make changes in the\ environment, because decisions on ways to change the environment require the patient's full\ participation.\ Evidence-based alternatives to physical restraints include offering diversional activities,\ using de-escalation techniques, providing visual and auditory stimuli, and promoting\ relaxation techniques.\ Before applying restraints, review the medical record for underlying cause(s) of agitation\ and cognitive impairment, assess whether the patient has a history of dementia or depression,\ and review medications and current laboratory values.\ When a patient is in a physical restraint, assess the placement of the restraint, and note skin\ integrity, pulses, skin temperature and color, and sensation of the restrained body part. Injuries or disease processes that affect coordination and regulation of muscle groups\ pathologically influence mobility.\ Periods of immobility due to disability or injury or prolonged bed rest during hospitalization\ cause major physiological, psychological, and social effects; the greater the extent and the\ longer the duration of immobility, the more pronounced the consequences.\ Immobility increases the risk of skin breakdown and is also directly related to the\ development of deep vein thrombosis (DVT) and pulmonary embolus (PE).\ Immobility can negatively affect the ability to complete daily activities and can lead to\ boredom and social isolation.\ Clinical judgment in your approach to caring for patients who are immobilized is\ complicated. Anticipate the physical effects of any restrictions in movement caused by a\ sudden illness or injury and apply knowledge of a patient's preexisting health conditions so\ you can consider a broad number of potential complications.\ Observe the appearance of extremities and measure the range of motion (ROM) of joints in\ various body positions to assess for correct body alignment and mobility.\ Critical analysis of all assessment data and comparing findings with the anticipated effects\ of mobility alterations reveal patterns of data indicating nursing diagnoses.\ Understanding what a patient can physically do compared with what the patient potentially\ and realistically can achieve helps you set realistic patient-centered outcomes for the plan of\ care.\ Patients with impaired body alignment and mobility require the use of correct positioning\ techniques.\ Working collaboratively with health care providers, a nurse will identify patient risk factors\ for DVT and employ nursing interventions that reduce risk, such as early ambulation; leg,\ foot, and ankle exercises; regularly provided fluids; and frequent position changes.\ When a care plan includes interventions designed to prevent complications of immobility,\ compare a patient's baseline with the signs and symptoms of complications for which the\ patient is most at risk. [Module 5-Skin Integrity and Wound Care\ ] To plan interventions to reduce or eliminate risk factors and prevent pressure injury\ formation, it is important to understand and examine how risk factors contribute to pressure\ injury formation in at-risk patients.\ Pressure injury Stages 1 through 4 describe the depth of tissue injury, which will guide\ treatment.\ Acute wounds are usually traumatic or surgical and should move predictably through the\ normal wound-healing process. Chronic wounds are caused by vascular compromise, reinjury, or chronic inflammation and\ fail to close or heal in a timely fashion.\ In primary intention wound healing, the skin edges are approximated, or closed, and the risk\ of infection is low. Healing occurs quickly, with minimal scar formation, if infection and\ secondary breakdown is prevented.\ In secondary intention wound healing, the wound is left open until it becomes filled by scar\ tissue. It takes longer for a wound to heal by secondary intention; therefore, the chance of\ infection is greater. If scarring from secondary intention is severe, loss of tissue function is\ often permanent.\ Clinical judgment is important when assessing for and planning interventions for patients\ with impaired skin integrity and wound care.\ Assessment of the patient with a wound will include the systemic and local complications\ that affect wound healing and must be addressed with the appropriate interventions that\ address those complications.\ Use valid and reliable risk assessment tools to assess a patient's risk for developing a\ pressure injury; these are completed on admission to a health care agency and on a regularly\ scheduled basis.\ Factors that promote wound healing include adequate protein and nutritional intake, normal\ circulation, clean dry peri wound skin, adequate hydration, and normal hemoglobin.\ Factors that impede wound healing include poor tissue perfusion as with hypovolemic\ shock, poor circulation as in peripheral vascular disease or diabetes mellitus, incontinence,\ immunosuppression, and preexisting infection.\ A wound assessment provides the foundation for developing a care plan, revealing data that\ aid in identification of nursing diagnoses and the selection of wound therapies best targeted\ for the condition of the patient's wound.\ Exposure to heat and cold causes normal systemic and local responses but can also cause\ injury to the skin if applied too long or incorrectly.\ An elastic bandage applied too tightly can result in circulatory impairment. [Module 6-Personal Hygiene & Bed] Making Various health beliefs, personal, sociocultural, economic, and developmental factors influence patients' hygiene preferences and practices. Sound clinical judgment requires you to consider a patient's condition, anticipate any risks or problems, gather thorough assessment data, and then analyze data to form nursing diagnoses. Hygiene needs, preferences, and the ability to participate in care change as people age. Assess a patient's skin, feet and nails, oral mucosa, hair, and eyes and ears to obtain a complete assessment of the patient's hygiene needs. Assess a patient's physical and cognitive ability to perform basic hygiene measures. Vascular insufficiency and reduced mobility, cognition, and sensation increase a patient's risk for impaired skin integrity. Diabetes mellitus and peripheral vascular diseases increase the patient's risk for foot and nail problems. Clinical judgment and critical thinking about a patient's hygiene preferences, needs, and ability to participate in care results in patient-centered hygiene care matching the patient's needs and preferences. Administering therapies to relieve symptoms such as pain or nausea before hygiene better prepares patients for any procedure. Position patients and make suction available to reduce the risk for aspiration when providing oral care to unconscious patients. A patient's environment needs to be comfortable, safe, and large enough to provide care and allow the patient and visitors to move about freely. Evaluation of hygiene procedures is based on outcomes of care; a patient's sense of comfort, relaxation, and well-being; and a patient's understanding of hygiene techniques. \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- **Exam 3 Key Concepts Module 7, 8 and 9** [Module 7 Oxygen Therapy and Surgical Asepsis:] The cardiopulmonary system consisting of the heart, lungs, airways, and blood vessels function to provide and deliver oxygen to the tissues and to remove carbon dioxide from the body. Ventilation, diffusion, respiration, and perfusion are processes for providing adequate oxygenation from the alveoli to the blood. Cardiac output is determined by the patient's heart rate, strength of contraction, amount of blood in the ventricle, and amount of resistance the heart has to overcome to eject the blood. Myocardial blood flow is the path the blood takes to perfuse the muscles of the heart. Systemic circulation allows for the perfusion of tissues, delivering oxygen to the tissues and taking carbon dioxide and other waste substances away from the tissues. Patients with decreased cardiac output have difficulties in delivering oxygen to the tissues. Patients who are hypoxic are at risk for decreased cardiac output. Altered level of consciousness, tachypnea, dyspnea, and anxiety are all signs of hypoxemia. Abnormal conduction can cause cardiac dysrhythmias and decreased cardiac output, leading to decreased delivery of oxygen to the tissues. Myocardial ischemia can damage the cardiac muscle, thereby decreasing cardiac output, which leads to decreased oxygen delivery to the tissues. Decreased hemoglobin levels, seen in patients with anemia or blood loss, alter a patient's ability to transport oxygen, causing disturbances in oxygenation. Age (both young and the elderly), nutritional intake, hydration status, level of exercise, exposure to smoke or other environmental pollutants, and stress can all have a negative impact on a patient's oxygenation status. A nurse uses clinical judgment by assessing a patient's presenting condition and comparing with signs and symptoms anticipated from known medical conditions to identify if physical manifestations of altered oxygenation exist. Nurses and health care providers should ask patients about their risk factors for altered oxygenation, such as smoking history, substance abuse, exposure to pollutants and environmental substances, exercise patterns, diet patterns, and chronic illnesses. Nursing assessment includes respiratory rate and pattern, presence of cough and/or secretions, fatigue, dyspnea, wheezing, chest pain, oxygen saturation, vital signs, and signs of respiratory infection. In addition, assess for signs of chronic hypoxemia, such as clubbed fingers or barrel chest. Nursing plan of care should include positioning, medication administration, oxygen administration, respiratory muscle training, and airway suctioning. Oxygen therapy, either by nasal cannula, mask, or mechanical ventilation, helps to improve tissue oxygenation by increasing the amount of oxygen available to the patient. Breathing exercises, such as diaphragmatic breathing and pursed-lip breathing, benefit patients with chronic pulmonary disease. Chest physiotherapy is reserved for use in patients with thick secretions to help them mobilize those secretions. Vaccinations, smoking-cessation programs, exercise programs, and nutritional support are health promotion strategies to utilize when working with patients and their families. Mobilization of secretions through positioning and adequate hydration helps to maintain the airway. Suctioning may be necessary to maintain airway patency in patients who have difficulties in maintaining their own airway. Artificial airways may be used in patients who cannot maintain their own airway. Assess breath sounds, SpO2 levels, breathing rate and patterns, activity tolerance, level of fatigue, and ability to maintain airway to determine a patient's response to therapies. [Module 8 Urinary Elimination and Specimen Collection ] Micturition involves complex interactions among the central nervous system, bladder, and urinary sphincter. Multiple factors affect urinary function such as fluid intake, medications, functional ability, environment, medical problems outside the urinary tract, and dysfunction within the urinary tract. Common urinary tract symptoms include urgency, dysuria, frequency, hesitancy, polyuria, oliguria, nocturia, dribbling, hematuria, and urinary retention. The presence or recent history of an indwelling catheter increases risk for a urinary tract infection (UTI). To minimize the risk for infection when caring for a patient with a closed bladder drainage system, nursing care must include careful attention to aseptic technique. Planning care for a patient who is incontinent requires selecting interventions specific to the type of incontinence. Inserting a catheter using aseptic technique, maintaining a closed urinary drainage system, and removing an indwelling catheter as soon as it is no longer needed are essential in preventing CAUTIs. Integrating a patient's typical voiding habits into the plan of care and ensuring patient privacy foster a patient's normal urinary elimination. Interventions that prevent UTIs include promoting adequate fluid intake, promoting perineal hygiene, and encouraging patients to void at regular intervals. Prevention of catheter-associated urinary tract infection (CAUTI) requires use of an evidence-based "bundle" to perform all elements of care at one time. [Module 9-Bowel Elimination, Ostomy & Nutrition-Self-Concept] Bowel Elimination The GI tract consists of the alimentary canal, which extends from the mouth to the anus, and its accessory organs. The GI tract and organs work together to absorb high volumes of fluids and to help maintain fluid and electrolyte balance. The interaction among multiple physiological and psychological factors (e.g., age, diet, stress, physical activity, health status, and medications) affects a patient's elimination patterns. For example, stress, exercise, and increased fiber and fluid intake usually increase peristalsis. Listening carefully to patients and their family caregivers, completing a thorough physical assessment, and using clinical judgment to recognize and analyze cues are necessary to determine the appropriate plan of care for patients with alterations in their usual elimination patterns. When preparing patients for gastrointestinal diagnostic and/or screening procedures, use your clinical judgment to identify a patient's educational needs. Provide timely patient education about the diagnostic or screening procedure, preparation needed (e.g., bowel prep, NPO status), and what to expect following the procedure. Select patient-centered nursing interventions to promote normal bowel elimination, including lifestyle changes, medications, and procedures that patients need to learn to improve bodily function and quality of life. Your clinical judgment helps you determine the best approach, when to deliver the interventions, and when adjustments are needed. Nutrition Ingestion of a diet balanced with carbohydrates, fats, proteins, and vitamins and minerals provides the essential nutrients to carry out the normal physiological functioning of the body across the life span. Through digestion food is broken down into its simplest form for absorption by chewing, churning, and mixing with fluid and chemical reactions. Absorption is the movement of nutrients into the body through the processes of passive diffusion, osmosis, active transport, and pinocytosis. The MyPlate program provides guidelines for a heart-healthy lifestyle. The guidelines are focused on ways to balance calories; decrease portion size; increase healthy foods; increase water intake; and decrease fats, sodium, and sugars. Guidelines for dietary change for the general population recommend reduced fat, saturated fats, sodium, refined sugar, and cholesterol and increased intake of complex carbohydrates and fiber. Breastfeeding is recommended for infants for the first 6 months of life with supplemental food added for infants 6 to 12 months old. Dietary requirements for preschool-age children (3--5 years) are similar to those for toddlers. They consume slightly more than toddlers, and nutrient density is more important than quantity. School age-children grow at a slower and steadier rate, with a gradual decline in energy requirements per unit of body weight; however, they still require adequate protein and vitamins A and C. There is a reduction in nutrient demands as the growth period ends. Mature adults need nutrients for energy, maintenance, and repair. Patients with alterations in chewing and swallowing (e.g., patients with reduced consciousness, mouth surgery, or stroke) are at risk for aspiration. Conducting a thorough dietary and health history along with taking anthropometric measurements, reviewing pertinent laboratory data, and completing a physical examination will provide the nurse with assessment data to identify a patient's nutritional problem(s). One of the most important responsibilities of a nurse administering enteral feedings is to take precautions to prevent patients from aspirating the feeding. The most important responsibility of the nurse monitoring parenteral nutrition (PN) is to implement interventions per agency protocol and take precautions to prevent patients from developing a catheter-related infection, hyperglycemia, or fluid overload. Medical nutrition therapy (MNT) is a recognized treatment modality for both acute and chronic disease states, including cardiovascular conditions; the focus of MNT is on balancing calorie intake of lean meats and vegetables, fat-free dairy products, and limited fats and sodium with exercise to maintain a healthy body weight. Plan and provide patient teaching on specialized diets based on patient health problems and nutritional needs, and consider patient preferences, culture, and budget. Ostomy Care A patient with a new ostomy has a unique combination of physical, emotional, and educational needs. Begin teaching patients early during their hospital stay to prepare them for discharge and ensure that they have appropriate follow-up care after discharge, which includes a referral to a nurse with specialized ostomy training. Nurses need to be proficient in the skills needed to relieve physical and psychological discomfort from altered bowel elimination. This proficiency ensures that the skills are delivered safely and effectively to patients and that the nurses meet the patients' individualized needs. Every patient has bowel elimination needs regardless of age, care setting, diagnosis, and co-morbid conditions. You use critical thinking and clinical decision making to promote normal bowel elimination and provide safe and effective nursing care to patients with altered bowel elimination. Self-Concept Components of self-concept including identity, body image, and role performance can be affected by developmental milestones and life events. Self-concept and self-esteem stressors include developmental and relationship changes, illness (particularly chronic illness involving changes in what were normal activities), surgery, accidents, and the responses of other individuals to changes resulting from these events. Self-concept and self-esteem change with developmental milestones and the person's response to those events. Health care providers can influence a patient's self-concept. A health care provider's self-concept is influenced by the practice environment and is positively affected by effective teamwork. Be aware of how cultural variations affect a patient's self-concept and self-esteem and incorporate culturally sensitive interventions. Assessing a patient's self-concept includes obtaining information about the patient's perception of self, families and significant other's perceptions, and coping strategies. Planning care for self-concept alterations must include collaboration with the patient in identifying measurable outcomes and methods to help patients achieve these outcomes of care. Implementing nursing interventions for self-concept disturbance involves using evidence-based care to expand the patient's self-awareness, encourage self-exploration, aid in self-evaluation, and help patients achieve outcomes of care. Evaluation for self-concept alterations must include the patient's response to nursing interventions and perceptions of changes in self-concept in addition to the health care evaluation of change. \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- **Exam 4 Key Concepts Module 10, 11 and 12** [Module 10-Sensory] Reception, perception, and reaction are the three components of any sensory experience. Your senses receive information from your environment. Perception occurs when you become conscious of a stimulus. You usually react to stimuli that are the most meaningful or significant. Sensory alterations occur when a person has difficulty receiving or perceiving stimuli (sensory deficits), when external stimuli are meaningless or deficient (sensory deprivation), or when there is excessive stimulation (sensory overload). Many factors affect sensory function. For example, aging results in a gradual decline of acuity in all senses, and excessive environmental stimuli cause sensory overload. Sensory alterations can affect a patient's well-being and limit the ability to interact and function within the environment. A thorough assessment of the sensory system, which includes components such as assessment of a patient's mental status, a physical assessment, and a survey of environmental hazards, allows you to develop and implement an individualized plan of care. You make clinical judgments about a patient's sensory problems by using critical thinking, anticipating expected signs and symptoms of a sensory condition, and matching with data you gather from a patient. While assessing a patient's sensory alteration, consider the pathophysiology of the patient's deficit and the degree to which the deficit affects the patient's lifestyle, health, and safety. Select nursing diagnoses after reviewing patterns of assessment findings that reveal alterations in the patient's ability to function. Involve your patient to develop a realistic plan and prioritize nursing diagnoses and outcomes after taking time to recognize and analyze cues that indicate what is important to your patient and how your patient is affected by sensory deficits. Preventive actions and the early identification of sensory alterations require periodic health screenings. Involve patients and their families to create effective individualized plans of care that help patients adapt to alterations in sensory function. Analyze hazards in the environment when recommending and implementing strategies to reduce the risk of injury in patients with sensory deficits. When evaluating care, include your patient's perceptions and use evaluative data to determine if your care improved or maintained your patient's ability to interact and function in the environment. [Module 11-Communication] Nurses use critical thinking in communication by considering past experiences and knowledge and by interpreting messages received from others to obtain new information, correct misinformation, and make clinical judgments for patient-centered care. Nursing actions that reflect caring in communication include being present and encouraging the expression of positive and negative feelings, instilling faith and hope, and promoting patient advocacy. Nurses use the five levels of communication in their interactions: intrapersonal, interpersonal, small group, public, and electronic. The circular transactional model of communication demonstrates the ever-changing nature of communication, and includes the referent, sender and receiver, message, channels, feedback, interpersonal variables, and environment. Verbal communication involves spoken or written words, and the vocabulary, meaning, pacing, tone, clarity, brevity, timing, and relevance of a message. Nonverbal communication, which occurs through the five senses and includes everything except the written or spoken word, is unconsciously motivated and more accurately indicates a person's intended meaning than spoken words, There is a natural progression of four goal-directed phases---preinteraction, orientation, working, and termination---that characterize the nurse-patient relationship, even during a brief interaction. Effective health care team communication using an approach modeled by the acronym SACCIA---Sufficiency, Accuracy, Clarity, Contextualization, and Interpersonal Adaptation---promotes working relationships that promote safe and effective care. Taking a patient-centered approach by seeking a patient's viewpoints and being aware of your own personal biases will help you assess and identify your patients' communication needs. Adapting your communication approach with older adults, such as encouraging them to share life stories and reminisce about the past, can enhance your assessment and promote an effective nurse-patient relationship. Use of both professional and therapeutic communication techniques contributes to achievement of patient outcomes. Practicing these techniques is essential in your development as a nurse. Nontherapeutic communication techniques damage professional and caring relationships; therefore, pay attention to your own communication to remove these blocking techniques from your responses. Patients with special communication needs require you to use specific techniques to facilitate mutual understanding, such as listening intently without interruption and ensuring patients use special devices to hear and see messages clearly. Being aware of and analyzing the outcomes of your conversations with patients and the health care team and adapting your communication approach as needed helps ensure that patients meet their outcomes effectively. [Module 11-Client Education] The three purposes of patient education are health promotion and illness prevention, health restoration, and coping with impaired function. The Joint Commission's (TJC's) Speak Up initiatives help patients understand their rights when receiving medical care and support them to become more active participants in their care by asking questions of health care providers. Steps of the teaching process are similar to those of the communication process. Just as effective communication involves feedback from the sender and receiver, an effective educator delivers instruction and then provides a mechanism (e.g., teach-back) for evaluating the success of a teaching plan by gaining feedback from the receiver. The most effective teaching plan often includes all three domains of learning: cognitive (understanding), affective (attitudes), and psychomotor (motor skills). Nurses consider the patient's needs and learning preferences and the content of what the patient needs to know to select the appropriate domain. Motivation to learn is influenced by an individual's belief in the need to know something; the more important people believe information to be, the stronger their motivation is to learn. An adult's readiness to learn is affected by health status, attentional set, and acceptance of the illness experience. The ability to learn depends on physical and cognitive attributes, developmental level, physical wellness, and intellectual thought processes. A person's learning style affects preferences for learning. The ideal environment for learning is well lit and has good ventilation, appropriate furniture, and a comfortable temperature. Self-efficacy is a concept included in many health promotion theories because it often is a strong predictor of motivation to learn healthy behaviors. People who have self-efficacy for health-promoting behaviors believe they can accurately complete a particular health behavior and are more likely to perform the behavior consistently and correctly. Knowledge of a patient's health condition and the patient information you gain from assessment during the nursing process allows you to critically select the topic and level of instruction required and allows you to determine the best time for teaching and how to engage the patient. A nurse assesses a patient's current level within a learning domain and then selects approaches to use to aid the patient in achieving a higher level of performance in that domain. The characteristics of learning within each domain influence your teaching and evaluation methods. Understanding each learning domain prepares you to select proper teaching techniques and apply the basic principles of learning. The nursing and teaching processes differ in that the nursing process requires assessment of all sources of data to determine a patient's total health care needs. The teaching plan focuses on a patient's learning needs as they relate to the patient's health status, as well as on a patient's motivation, ability, and readiness to learn. Health literacy is one of the most important predictors of health outcomes because it influences whether an individual has the skills needed to manage health and prevent disease. A nurse bases educational priorities on a patient's nursing diagnoses, outcomes established for the patient and the patient's perception of what information is most important, anxiety or physical comfort level, and the amount of time available to teach. When planning a teaching session, remember that patients need to learn essential content first. Learning progresses from simple to complex; thus, learners need to acquire simpler knowledge and skills within a learning domain before they can master more complex knowledge and skills. Nurses promote learning in patients with limited health literacy by creating a safe, shame-free environment, communicating clearly, using visual aids to reinforce spoken information, and carefully evaluating the patient and family caregivers' understanding of the content. At the end of a teaching session, a nurse uses the teach-back technique to evaluate learning by asking the patient to explain the material that was discussed or demonstrate a skill. [Module 12-Palliative and Hospice] When caring for patients who are experiencing loss, facilitate the grief process by helping them feel the loss, express it, and move through their grief. Loss comes in many types based on the values and priorities learned within a person's sphere of influence (i.e., family, friends, religion, society, and culture); these types include loss of known environment, significant other, aspect of self, or life itself. The grief experience is a process that is personal, cannot be prevented, and involves a journey that no two people experience the same way. There are three major forms of grief: normal, anticipatory, and disenfranchised. Normal grief is a common and universal reaction characterized by complex emotional, cognitive, social, physical, behavioral, and spiritual responses to loss and death, whereas anticipatory grief occurs before an actual loss, especially in situations of prolonged or predicted loss. Knowledge of grief theories and normal responses to loss helps you to better understand these complex experiences and how to help a grieving person, remembering that reactions to grief vary widely and thus your practice must consider the complexity and individuality of grief responses. A person's development, coping strategies, socioeconomic status, personal relationships, nature of loss, and cultural and spiritual beliefs influence the way a person perceives and responds to loss and grief. Assessing a person in grief requires exploration of the person's own unique history, context, and resources to make meaning out of their loss experiences. Listen as patients share the experience in their own way. When developing a plan of care for a person facing a loss such as death, include the wishes of a patient and family for end-of-life care, such as the preferred place for death, desired level of intervention, and expectations for pain and symptom management. Providing palliative care requires you to establish a caring presence and use effective communication strategies to encourage patients to share feelings to the degree they are comfortable. Collaborate with other members of the health care team to provide holistic care for management of symptoms and to provide a variety of support measures to the patient and family. High-quality end-of-life care focuses on improving quality of life through management of symptoms such as pain, anxiety, depression, and nausea. Pain is a common priority requiring you to conduct ongoing assessments of a patient's pain level to evaluate the patient's response to interventions. Hospice is a philosophy of family-centered, whole-person care for individuals with a life-limiting illness likely to result in death within 6 months. After determining that an autopsy will be performed, the body of the deceased is cared for and treated with the same level of care and compassion, respect, and dignity as when the person was alive. During the evaluation of a person in grief, successful outcomes reveal a patient moving through the stages of grief using successful coping mechanisms toward acceptance of the loss. \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- **FINAL EXAM Key Concepts Module ALL CONTENT PLUS Module 13 & 14** [Module 13 Rest/Sleep, Stress & Therapeutic Environment] Sleep/Rest The 24-hour sleep-wake cycle is a circadian rhythm that influences physiological function and behavior. The control and regulation of sleep depend on a balance among regulators within the CNS. During a typical night's sleep, a person passes through four to five complete sleep cycles. Each sleep cycle contains three NREM stages of sleep and a period of REM sleep; time in each stage varies. Sleep provides physiological and psychological restoration. Sleep requirements vary by age, with neonates sleeping on average 16 hours a day and older adults needing 7 to 8 hours of sleep a night. The hectic pace of a person's lifestyle, emotional and psychological stress, and alcohol ingestion frequently disrupt the sleep pattern. An environment with a darkened room, reduced noise, comfortable bed, and good ventilation promotes sleep. A regular bedtime routine of relaxing activities prepares a person physically and mentally for sleep. The most common type of sleep disorder is insomnia. Characteristics of insomnia include the inability to fall asleep, to remain asleep during the night, or to go back to sleep after waking up earlier than desired. If a patient's sleep is adequate, assess the usual bedtime, normal bedtime ritual, preferred environment for sleeping, and usual preferred rising time. When planning interventions to promote sleep, consider the usual characteristics of the patient's home environment and normal lifestyle. Important nursing interventions for promoting sleep in the hospitalized patient are to establish periods for uninterrupted sleep and rest and to control noise levels Use your patient's self-report to determine whether sleep was restful. Stress The general adaptation syndrome (GAS), an immediate physiological response to stress, has three stages: alarm (fight-or flight response), resistance (body responds to stress and attempts to compensate), and exhaustion (continued stress breaks down compensatory mechanisms) stages. Posttraumatic stress disorder begins when a person experiences, witnesses, or is confronted with a traumatic event and responds with intense fear or helplessness. Anxiety associated with PTSD is sometimes manifested by nightmares and emotional detachment. Many nursing theories, such as the Neuman Systems Model or Callista Roy's Adaptation Model, explain and describe stress and help you understand how an individual, family, or community effectively responds to stressors in the environment. Compassion fatigue is a state of burnout and secondary traumatic stress that can overwhelm health care providers and result in feelings of hopelessness, inadequacy, and anxiety. A regular exercise program improves muscle tone and posture, controls weight, reduces tension, and promotes relaxation. When personal stress is so severe, the person is unable to cope using any of the means that have worked before is experiencing a crisis. The process of crisis intervention aims to return the person to a precrisis level of functioning and promote growth. Assessment of a patient's stress level and coping resources requires that you first establish a trusting nurse-patient relationship because you are asking a patient to share personal and sensitive information. Three primary modes of intervention for stress are to decrease stress-producing situations, increase resistance to stress, and learn skills that reduce physiological responses to stress. In nursing, burnout results when nurses perceive that the demands of their work exceed perceived resources. It is manifested as emotional exhaustion, poor decision making, loss of a sense of personal identity, and feelings of failure. Therapeutic Environment/Caring Caring involves a mutual give-and-take and is specific and relational for each nurse-patient encounter. Nurses use a variety of caring theories to provide care in a respectful and therapeutic way for patients and family caregivers. Current evidence emphasizes what patients perceive from their caregivers and thus provides useful guidelines for practice. An ethic of care places the nurse as the patient's advocate, influences the nurse's clinical judgment, and helps guide clinical decision-making regarding ethical dilemmas by attending to relationships and giving priority to each patient's unique personhood. Caring is integral to a nurse's ability to establish therapeutic relationships with patients in a respectful and therapeutic manner. Presence is a person-to-person interaction, conveying closeness and a sense of caring that involves "being there" and "being with" patients or family caregivers. Touch expresses caring through task-oriented, caring, and protective touch. Listening is a therapeutic skill that includes interpreting, understanding, and respecting what a patient or family caregiver is saying and expressing that understanding and respect. Knowing a patient is at the core of the process the nurse uses to make clinical decisions about patient-centered care. Maintaining compassion in all aspects of nursing care contributes to the health and well-being of patients and improves patient and nurse satisfaction. [Module 14-Complimentary & Alternative Therapies & Pain Management] Complimentary, Alternative and Integrative Therapies Complimentary or integrative health care programs use the full complement of treatment approaches (biomedical and complementary) to provide patient-centered care to patients. Alternative therapy uses complementary therapies in place of conventional medical and pharmacological treatment; alternative therapies are the primary treatment that replaces biomedical care. The stress response is an adaptive response that allows individuals to respond to stressful situations. A chronic stress response is often maladaptive, leading to chronic muscle tension, mood changes, and immune changes. Some complementary therapies require commitment and regular involvement by the patient to be most effective and have prolonged beneficial outcomes. Continuously evaluate a patient's response to complementary therapies, as medication doses may need to change based on physiological responses. Complementary therapies accessible to nursing include relaxation, meditation and mindfulness techniques, and imagery. Evidence supports their use to decrease the effects of stress and improve overall patient well-being. Relaxation is an effective treatment for many patients. For example, relaxation can lower blood pressure, reduce cancer-related symptoms, manage depression and breathlessness, and reduce pain, opioid use, and anxiety. Nurses use clinical judgment to determine which relaxation techniques to use and when to use them with patients. Biofeedback is a mind-body technique that uses instruments to teach self-regulation and voluntary self-control over specific physiological responses. Biofeedback therapies are used to change thinking, emotions, and behaviors, which in turn support beneficial physiological changes, resulting in improved health and well-being. Therapeutic touch is a "touch therapy" that nurses include in many aspects of care. Other touch therapies include acupressure, healing touch (HT), and reiki, which blend ancient Eastern traditions with modern nursing theory. Acupuncture regulates qi, which flows through the body in medians. Acupuncturists insert needles in specific areas to influence and reestablish the flow of qi. Acupuncture is used to treat a variety of symptoms such as pain, chemotherapy-induced nausea and vomiting, and migraine and tension headaches. Many complementary therapies require additional education and certification, including biofeedback, touch therapies (therapeutic touch, reiki, and healing touch), and acupuncture. Herbal medicines are not approved for use as drugs and are not regulated by the FDA. A number of herbs are safe and effective for a variety of conditions. Some herbal medicines can be contaminated with prescribed medications, and it is important to understand the actions of herbal medicines and any potential interactions with patients' prescribed medications. Although there is increasing evidence to support the use of complementary therapies, additional research of sufficient quality and rigor is needed. Pain Management Nociceptive Pain provides a protective physiological series of events that allows individuals to become aware of events that may cause tissue damage. Understanding the four physiological processes of nociceptive pain (transduction, transmission, perception, and modulation) helps you recognize factors that cause pain, the accompanying symptoms, and the rationale for selecting therapies to treat or manage pain. Use assessment data and identify cues from your patient to categorize pain based on its duration (acute or chronic) or pathological condition (e.g., cancer or noncancer). Individual, physiological, psychological, social, cultural, and environmental factors influence pain and make each person's pain experience different. Cultural beliefs affect how individuals express, react to, and cope with pain. To make timely clinical judgments while assessing pain, you consider a patient's typical comfort level, the potential for pain based on a patient's health status, and the effects of the associated treatment. Analyze assessment data and patient cues thoroughly before making decisions regarding a patient's care and pain-management plan. Cues for acute pain include an identifiable cause, a sudden onset, and a short duration. In contrast, chronic pain is not protective, may not have an identifiable cause, and has a dramatic effect on a person's quality of life; it varies in intensity, and usually lasts longer than 3 to 6 months, beyond the expected or predicted healing time. Multimodal analgesia provides for safe analgesic administration because it combines drugs with at least two different mechanisms of action to optimize pain control, which allows for lower-than-usual doses of each medication. Thus, an individualized multimodal regimen lowers the risk of side effects while providing pain relief that is as good as or even better than could be obtained if each of the medications were administered alone. Use your clinical judgment when selecting different nonpharmacological and pharmacological approaches to pain management. For example, if you are caring for a patient experiencing moderate to severe acute pain, you use a combination of nonpharmacological therapies with pharmacological therapies to help relieve the pain. Significant individual and environmental factors create barriers to pain management. These factors include a lack of knowledge or misconceptions about pain and appropriate pain management in patients, caregivers and health care providers; cultural beliefs; lack of pain-management protocols; and poor access to care. To evaluate the response to pain treatment, you ask patients to describe how effective they believe their pain management has been. You also evaluate the patient's pain intensity, as well as side effects, behavior, and functional outcomes. \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--