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355 Exam 1
Med surg
| Question | Answer |
|---|---|
| What are the roles of med surge nursing? | Helping role, teaching-coaching, diagnostic and patient monitoring, effective management of rapidly changing situations, administering and monitoring therapeutic interventions and regimens, monitoring and ensuring the quality of healthcare practices |
| What are the competencies of med surge nursing? | Sciences: anatomy, physiology, chemistry, pathophysiology, pharmacology |
| How is an evidence based practice explained ? | o Develop the question. o Search and collate the best evidence. o Evaluate the quality of the evidence. o Integrate evidence into practice. o Evaluate outcomes of practice change. o Disseminate the evidence. |
| What does HCAHPS stand for? | o Hospital Consumer Assessment of Healthcare Providers and Systems |
| What do HCAHPS do? | Communication with providers Communication with nurses Responsiveness of hospital staff Pain management Communication about medications Discharge information Cleanliness of the hospital environment Quietness of the hospital environment Transition of care |
| Explain Categories in the QSEN(Quality and Safety Education for Nurses ) | • Patient-Centered Care • Teamwork and Collaboration • Evidence-Based Practice (EBP) • Quality Improvement (QI) • Safety • Informatics |
| Explain Interprofessional collaboration. | a partnership between a team of health professionals and a patient in a participatory and coordinated approach to shared decision making and communication. An important component is the inclusion of the patient and family in care and transition planning. |
| Describe your role in an Interprofessional team ? | o The registered nurse (RN) is the professional who utilizes the nursing process to care for the patient: to assess, plan, implement, and evaluate. |
| What is cultural competence ? | the ability of healthcare providers and organizations to effectively deliver healthcare services that meet the social, cultural, and linguistic needs of patients. |
| What is Cultural awareness? | the realization and recognition that personal beliefs and values impact cultural health beliefs and potentially the view of those who are different. |
| What is cultural sensitivity? | understanding, thoughtfulness, and kindness that leads to inclusiveness and equity. |
| Social determinants of health explanation | consist of a variety of circumstances and conditions “in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” |
| SDOH model has five key elements, what are they? | • Economic stability • Education • Social and community context• Health and healthcare• Neighborhood and built environment |
| What does the five key elements of the SDOH explain? | care provided to the patient acknowledges influence of each SDOH element on current health situation as well as the role each determinant in patient’s pathway to improved health. Failing consider it, is barriers to providing patientcentered care |
| What are some examples of ethical dilemmas in adult health? | DNR Withdrawal of fluids Experimental Procedures/ Stem cell Genetic |
| Explain Autonomy | individual’s personal right to make decisions |
| Explain Beneficence | people acting positively on behalf of the perceived well-being of others |
| Explain Fidelity | accountable for commitments made to others, self, and to the profession, based on the virtue of caring |
| Non-Maleficence is? | Do no harm |
| Paternalism is? | inappropriate when deciding for the patient |
| What is social justice? | is fair and equal treatment for everyone regardless of race, religion, or gender. |
| What is veracity? | To tell the truth |
| how are age-related physiologic changes for older adults ? | greater risk for illness because of the normal decline in adaptation that occurs in the body |
| What are some common health care needs if older adults? | in addition to the dangers of physical trauma from falls and accidents, older persons are at risk of injury from their own medications. |
| How does the skin change in older adults? | Slow wound healing Decreased collagen Decreased inflammatory responsiveness Decrease T cell function Dry rough skin Loss of dermal thickness |
| The three preventions of cancer and describe them. | 1. Primary prevention risk factor modification, immunization, chemoprevention 2. Secondary prevention cancer screening for early detection 3. Tertiary prevention reducing morbidity and mortality once the disease has been diagnosed (OT, PT) |
| Main Difference between benign and malignant. | 1. benign non-cancerous, localized 2. malignant cancerous, it can spread |
| Tumor staging | 1. Tumor size 2. Number of lymph nodes involved 3. Presence of metastasis |
| Describe adult Client with obesity clinical manifestation | Increased waist circumference, Increased weight |
| how to calculate BMI | Weight (kilograms)/Height (meters)2 convert height to inches and divide by 39.37 |
| What are some complications with adult obesity? | Increases mortality and morbidity (DM, heart disease), increase hospital stay length and healthcare costs |
| how do we prioritize and planning care for older adults? | Lab and diagnostic testing Weight loss therapy Diet therapy Physical activity Behavioral therapy Medications |
| What is safety alert on Adult client w/obesity | Tachycardia, fever, hypotension, and abdominal pain should be reported immediately because they may be signs of anastomosis leak, a life-threatening complication associated with infection and sepsis. |
| What is physical dependence | tolerance, withdrawal, and cravings - Dependence occurs because the body naturally adapts to regular exposure to a substance. |
| what is substance use disorders (sud) | a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems |
| what is the risk factors for substance use disorder? | genetics Ethnicity/gender/age other mental health disorders Early drug use Peer group pressure Childhood adverse advents/history of sexual abuse Increased stress/crisis Home environment/family beliefs and attitudes Academic failure or poor social skills |
| What does genetics have to do with substance abuse and disorder? | influences the risk for SUDs. Research supports a genetic component for nicotine, alcohol, cocaine, opioid, and cannabis use disorders |
| What are the essential features of mild, moderate, and severe substance use disorders? | The severity of an SUD is determined by the number of symptoms present: mild (two or three symptoms), moderate (four or five symptoms), or severe (six or more symptoms). In the DSM-5, the specific substance used is included as part of the diagnosis. |
| What are risk factors for alcohol abuse? | genetics Ethnicity/gender/agePresence of other mental health disorders Early drug use Peer pressure Childhood adverse advents/history of sexual abuse Increased stress/crisis Home environment/family beliefs attitude Academic failure or poor social skill |
| What are Clinical manifestations for alcohol abuse | tolerance, withdrawal, and craving—three symptoms of physical dependence—are also clinical manifestations that may be evident with the diagnosis of an SUD. |
| What are the types of headache | primary are tension type, migraine, and cluster headaches. Secondary headaches are caused by an underlying pathology such as infection, neoplasms vascular abnormalities, medicationinduced disorders, or idiopathic, and sudden onset of severe pain. |
| what is most common headache | Tension headache |
| what are the cranial nerves for the eyes | II Optic Transports visual information from retina to the brain responsible for vision III Oculomotor Controls pupil constriction, eyelid , eyeball movement lV Trochlear allows movement in a downward and lateral motiion VIAbducens Controls lateral move |
| What are Bacterial conjunctivitis clinical manifestations | infection of the conjunctivae caused by a microbe or bacteria gritty sensation ; patients often describe it as feeling like sand is in the eye. There is also often a purulent eye discharge and matting of the eyelashes upon awakening in the morning |
| What is Cataracts | clouding of the eye’s crystalline lens. |
| what are Post op interventions and education safety alert for cataracts? | Elevate hob o Use drops o No vigorous activity o Stool softeners (no straining) o Eye patch for a day or two |
| Define Muscular degeneration? | Macular degeneration is most commonly age related and is a disease that gradually destroys sharp, central vision. |
| What is the difference between Dry MD and Wet MD? | Dry MD drusen bodies, which are yellow deposits that are located under the retina Wet MD occurs when abnormal blood vessels located behind the retina start to grow under the macula |
| What are some Modifiable risk factors | High blood pressure High cholesterol Obesity Smoking Decrease in zinc blood levels |
| What are some Non modifiable risk factors | Age (patients over age 60 are at greatest risk) Family history of macular degeneration Gender (women are more likely than men) Race (more common in Caucasians) |
| What could be a complication for cataract | blindness |
| what is glaucoma | is not just a single eye disease but a group of eye conditions that present with increased IOP and result in damage to the optic nerve, leading to loss of vision. |
| For glaucoma what are their medication and purpose | Oral medications may also be prescribed, such as a carbonic anhydrase inhibitor, to help further reduce IOP. These medications work by reducing the production of aqueous humor, leading to a decrease in IOP. |
| What is post op care for the eye | restrictions on strenuous activities, bending at the waist, and lifting of heavy objects (greater than 25 lb) and avoiding constipation for at least the first 2 weeks postoperatively. |
| Define Retinal detachment | condition that may cause permanent vision loss and is considered a medical emergency, requiring the patient to seek immediate attention by an eye care professional. |
| Define Eye trauma | Significant causes of visual loss are related to blunt and penetrating trauma Blunt trauma, the more common of the two, occurs when the eye is struck with a finger, fist, racket, tennis ball, or other solid object |
| Eye Charts and what are they used for? | • Vision Charts Snellen, Ishihara, Rosenbaum o Snellen Chart Visual Acuity test o Ishihara Chart Color Blind test o Rosenbaum chart Reading vision test |
| What is the Safety for the visually impaired | Decreased visual acuity increases the risk of falls and other injuries. |
| What is a Prostaglandin | type medications- Latanoprost (Xalatan), bimatoprost (Lumigan) Increases the outflow of aqueous humor and thus decreases volume, therefore decreasing intraocular pressures |
| Beta-blockers are? | Timolol (Betimol, Timoptic), betaxolol (Betoptic), and metipranolol (OptiPranolol) Reduces the production of aqueous humor, therefore decreasing intraocular pressure |
| Eye-Drop Instillation | patient to tilt head back eyes open and looking upward.Retract lower lid downward. bottle rest wrist patient’s cheek. squeeze bottle prescribed number of drops,not contaminate the bottle by touching the eye or other foreign objects patient close eyes. |
| Which cranial nerve is in the ear | VIII (8) |
| What is external otitis | is a condition commonly referred to as “swimmer’s ear” because it is most often related to infectious organisms that are contracted through swimming. |
| What os otitis media | is a common disease process that causes an inflammation of the middle ear canal, most commonly by a bacterial source. |
| Hearing loss is from? | Excess cerumen, chronic infections, trauma, medications (furosemide, acetylsalicylic acid, quinine) |
| What are some preventions for hearing loss | yearly hearing evaluation ; use of earplugs, earmuffs, or other protective equipment in the presence of loud noise to protect; limiting use of earbuds for listening to music at levels beyond recommended levels, cotton swabs should not be used |
| What are the types of hearing loss (conductive) | Obstruction (foreign body, cerumen, external otitis) - Pain, feeling as if ear is “plugged” Otitis media - hearing loss, pain, pressure in ear, fever Ear trauma- Pain, bloody, visible blood on otoscopic Tumors Unilateral hearing loss, visible lesion |
| Define tinnittus | most described as a noise or ringing in the ears and is a relatively common affliction that is often a manifestation of an underlying disorder. |
| What are some nursing interventions for tinnitus | Vital Signs increase blood pressure pulse respirations Physical assessment Diagnostic results- An MRI/CT Age-related consideration |
| When do the manifestation occur with tinnitus | advancing age; 40 years is when clinical manifestations often begin to occur, peaking at ages 65 to 79. |
| Describe the character of the tinnitus sounds | the buildup of cholesterol deposits may cause vessels close to the middle ear to lose some elasticity making flow more turbulent and creating tinnitus, while with CN VIII tumors, the pressure on the nerve causes the abnormal sounds. (*ringing ear) |
| What is vertigo | Is a clinical manifestation that evokes a feeling of illusory movement and like tinnitus, is not a specific disorder. |
| how would you do teaching for vertigo in positioning | Change positions slowly Instructions to plan slow, methodical position changes help to decrease vertigo in patients. Decreasing the clinical manifestations of vertigo with changing position may also decrease the patient’s risk of falling. |
| How would you teach the patient and or family safety for vertigo | regarding potential falls are important. Clutter-free environments and use of assistive devices (such as a cane or walker) to steady patients when walking also are advisable in an attempt to prevent falls. |
| what are some examples for teaching pt with vertigo about medication/dietary | Compliance with dietary modifications and medications is increased if the patient understands the |
| Explain Meniere’s disease | is a disorder of the inner ear that affects the patient’s balance and hearing. First Prosper Ménière in 1861, this well-known disease is most noted for three clinical manifestations: unilateral sensorineural hearing loss, tinnitus, and vertigo. |
| What is the difference between conductive hearing loss vs Sensorineural | Conductive hearing loss Obstruction (foreign body, cerumen, external otitis) Otitis media Ear trauma Tumors Sensory Hearing loss Genetic disorders Noise exposure Presbycusis |
| how to speak to a patient with hearing loss | Face the patient directly when speaking to him or her Speak slowly and be attentive to enunciation Lower the pitch of voice Take care not to shout |
| What are the two hearing tests | Weber test- hearing loss vibrating tuning fork in the midline of the patient’s skull and ask tone sounds the same in both ears better in one. Rinne - patient should still be able to hear the vibrating sound if hearing is normal. |
| What are some hearing loss preventions | yearly hearing with physical examination; use of earplugs, earmuffs, protect sensitive structures of the ear for music; limiting use of earbuds for listening to music at levels well beyond recommended sound levels; |
| What do you NOT clean your ear with? | cotton swabs should not be used to “clean out” ear canals because of the risk of eardrum rupture or impaction of cerumen. |
| Medications and how to administer for ear? | bottle of ear-drops warm-bowl water for 3–5 minutes Tilt the head in the opposite direction of the ear that drops are to be instilled in Pull the pinna up/back correct number of drops of down side of the ear Gently head back and forth two or three times |
| Hearing impaired and what to do | frequently asking for instructions to be repeated • Turning the head or leaning forward to gain clarity on the question being asked • Loud conversation initiated by the patient • Failing to respond when spoken to |
| what is Presbycusis | Progressive hearing loss bilaterally in the presence of a normal neurological examination |
| what is Labyrinthitis | inflammatory disorder of the inner ear labyrinth that occurs as a complication of otitis media, which results in a disturbance in balance and hearings |
| Otosclerosis what is it? | This condition, which relates to abnormal bone growth in the middle ear, can create conduction disturbances that lead to tinnitus. |
| What is the overview of the skin | The skin layers include the epidermis and dermis five major functions of skin are protection, temperature, vitamin D metabolism, sensation, and excretion. Providing protection from the external environment, as well as to underlying structures and organs |
| What are some age related changes in the skin | (protection, temperature regulation, vitamin D metabolism, sensation, and excretion) becomes less efficient as the body ages. In older adults, the skin becomes increasingly fragile, takes longer to heal, and is more prone to age-related skin conditions |
| What are some signs of infection(skin) | include superficial cellulitis (a diffuse spreading infection of the dermis and subcutaneous tissues;), folliculitis (inflammation of the hair follicles; , impetigo, furuncles (boils), simple abscesses, and minor wound infections. |
| Treatment for skin infections | impetigo ointment limited lesions Folliculitis top ointment Clindamycin lotion benzoyl peroxide Furuncle incision drainage antibiotic Furunculosis ointmnt Carbuncle Incision drainage antibiotic Cellulitis antibiotics Cutaneous abscess drainage antibiotic |
| What are the Cellulitis nursing interventions | Vital signs htn, tachycardia, hyperthermia or hypothermia, disorientation, lethargy, and disproportionate pain can indicate worsening infection or sepsis. Wound and skin CBC Culture results Nutritional stats |
| What are some fungal infection | Tinea capitits= scalp Tinea coproris = body Tinea Cruis (jock itch) Tinea Faciei= Face Tinea versicolor= Upper chest, back, upper arms Onychomycosis= nail Oral thrush= mouth Vulycovaginal candidiasis= vagina vulva Intertrigo= skin fold |
| What is Herpes simplex | An HSV-1 infection causes a recurring oral mucosal lesion or “cold sore,” and HSV-2 is the cause of genital herpes (GH). Recently, however, researchers have found an increasing incidence of GH attributed to HSV-1. |
| What is serosanguinous for wound exudate | Appears blood-tinged, straw to amber colored, reflecting presence of serum and red blood cells Normal during first 48 hours after injury |
| What is purulent for wound exudate | o Creamy yellow pus o Colonization with Staphylococcus o Greenish-blue with a fruity odor o Colonization with Pseudomonas o Beige pus with fishy odor o Colonization with Proteus |
| Describe psoriasis | is a lifelong inflammatory disorder characterized by exacerbations and remissions of raised, scaling, erythematous plaques usually seen on the extensor surfaces of the body |
| What are some skin trauma | Traumatic injuries to the skin result of external sources and are classified as acute wounds. There are many types of traumatic skin injuries, including lacerations, abrasions, excoriations, friction blisters, skin tears, pressure injuries, and burns |
| What are some minor burns trauma and treatment | Are treated at the scene and followed up at a local er, full thickness burns 2-10% or partial thickness 15-25% |
| Describe pressure injuries | localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful |
| what are some stages of pressure injuries | Stage 1 Pressure Injury: Non-blanchable erythema of intact skin. Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis. Stage 3 Pressure Injury: Full-thickness skin loss. Stage 4 Pressure Injury: Full-thickness skin and tissue loss |
| What is a deep tissue injury | Persistent non-blanchable deep-red, maroon, or purple discoloration |
| what is safety alert for skin | proper positioning, and the use of lift sheets for reduction of friction and shear for patients at risk for pressure-related injury, even if they are on a redistributing support surface. |
| What is the braden scale | The scale is composed of six subscales that reflect sensory perception, skin moisture, activity, mobility, friction and shear, and nutritional status. |
| Definition of Tissue Types | Granulation red/pink granular tissue vessels; healthy, healing tissue Hypergranulation recognized by friable red appearance inflammatory Necrotictissue dead Thick, leathery, tissue; black/ o Slough Soft white, yellow, tan, green |
| What is Skin Cancers | most common types of skin cancers are categorized into two groups, melanoma and non-melanoma. |
| What is the difference between Basal Cell and Squamous | Squamous is mostly attributed cumulative exposure to UVB rays over extended p membrane of the epidermis, basal arise from epidermis can significantly damage adjacent tissue secondary to large excisions and damage vital structures. |
| What are some sunburn prevention | Limit time spent in the sun Wear clothing to protect as much of the skin as possible Use sunscreen with an SPF of at least 30, applied thickly Reapply often for best protection Wear sunglasses Avoid tanning beds Examine your body monthly |
| What is the ABCDE | A: Asymmetric appearance B: Irregular borders C: Variation of color (brown, black, tan, blue, red, white, or any combination) D: Diameter greater than 6 mm E: Elevation or an evolving, enlarging, and changing existing lesion |
| what are some treatment of burns | o Stop the burning process Remove clothing or jewelry Apply cool water soaks Infection prevention Nutritional support Restoration of mobility |
| Education on burns explain | o Infection control precautions o Can experience many feelings o Peer or support groups o Anticipate changes in appearance o Wear compression dressings o Massage scar with moisturizer daily |
| Describe ADPIE | Assessment: HX Risk factors, Culture, Social health, Physical Analysis/Diagnostics Assessment Data, Tools, Lab test Planning: Problem id, Goals InterventionNursing actions, Interdisciplinary collaboration, Patient family ED Evaluation: Goals met Not met |
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samanthaweber01
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