NR224 EXAM 1 STUDY GUIDE.NR224 EXAM 1 STUDY GUIDE., Exams of Nursing

Download NR224 EXAM 1 STUDY GUIDE.NR224 EXAM 1 STUDY GUIDE. and more Exams Nursing in PDF only on Docsity! Exam 1 Study Guide Chapter 15: Critical Thinking in Nursing Practice 1. What is the definition of critical thinking? – the ability to think in a systemic and logical manner with openness to question and reflect on the reasoning process 2. What are characteristics of critical thinking? – open-mindedness, continual inquiry, perseverance, combined with a willingness to look at each unique patient situation and determine which identified assumptions are true and relevant. 3. What is clinical decision making? – a product of critical thinking, focuses on problem resolution. 4. Describe and explain the critical thinking model, what are the components and levels? a. Includes 3 levels i. Basic – Nurses follow a step-by-step process without deviation from the plan. ii. Complex – Nurses analyze and examines choices; they realize that alternative (or even conflicting) solutions exist iii. Commitment – Nurses anticipate needs and make choices with no assistance from others b. Components of critical thinking i. Specific knowledge base – allows nurse to better anticipate or identify problems by understanding their origin and nature ii. Experience iii. Competencies – applying critical thinking to each part of the nursing process iv. Attitudes – how does the nurse approach the problem v. Standards – intellectual (logical / rational) and professional (ethical) c. What is needed first before anything else? 5. Describe the following terms and know examples of each: a. Interpretation – an explanation. Be orderly in data collection, look for patterns to categorize data, and clarify any uncertain data. b. Analysis – recognizing patterns or trends and comparing them with standards. Be open minded when you look at patient information, make accurate assumptions. c. Inference – conclusion based on evidence and reasoning. Look at meaning and importance of findings, does the patient’s data help you see that a problem exists? d. Evaluation – A process that critically examines a program. Look at all solutions objectively. Use criteria to determine results of nursing actions, reflect on your own behavior. e. Explanation – A statement that makes something clear. support your findings and conclusion. f. Self-regulation – reflecting on your own experiences and connecting your actions with outcomes. g. Confidence – belief in oneself, feeling certain about an accomplishment or task. Learn how to introduce yourself with a patient, speak with conviction, be well prepared and encourage patients to ask questions. Don’t let patients think you’re unable to perform care. h. Independence – challenging ways others think and considering all sides of the situation. Develop this by looking at different views on the same subject – talk with other nurses, read different literature. i. Fairness – dealing justly with situations without prejudice or bias. Listen to both sides. j. Responsibility – knowing your accountable for your decisions, actions, and critical thinking k. Risk taking – recommend alternatives and questioning approaches using your knowledge l. Discipline – being orderly and systematic when collecting information or taking action, be thorough in what you do with good time management m. Perseverance – means to keep looking for more resources until you find a successful approach. n. Creativity – look for different approaches if interventions aren’t working for the patient. o. Curiosity- always ask why, explore and learn more about the patient. p. Integrity – recognize when your opinions conflict with those of the patient. Do not compromise nursing standards or honesty in delivering care. q. Humility – recognize when you need more information to make a decision. Ask for help when needed. r. Truth seeking – seek the true meaning of a situation. 19. List and describe the 6 components in the chain of infection. Provide examples for each. a. infectious agent – a pathogen - bacteria, viruses, or parasites b. reservoir – where germs live – people, animals, fomites, food, oxygen c. portal of exit – how germs get out – mouth (vomit / saliva), cuts in skin, stool d. mode of transmission – how germs get around – contact, droplets, airborne e. portal of entry – mouth, cuts in skin, eyes f. host – the next sick person – immunocompromised people, children, elderly, anyone 20. List and describe the different body defense mechanisms a. Normal floras in the body b. Each organ system has defense mechanisms i. Skin – provides barrier, sebum ii. Mouth – mucousa, saliva iii. Eyes – tearing and blinking iv. Respiratory tract – cilia, macrophages v. Urinary tract – flushing action of urine vi. GI tract - acidity, peristalsis vii. Vagina – vaginal secretions lower PH c. Inflammation / inflammatory exudate i. Vascular and cellular responses ii. Exudate 1. Serous – clear 2. Sanguineous – contains RBC / blood 3. Purulent – contains WBC and bacteria / pus-like iii. Signs of local inflammation and infection are identical d. Tissue repair 21. Describe the factors that influence infection prevention and control a. Age, nutritional status, stress, disease process, treatments or conditions that compromise the immune response 22. Describe examples of patients at high risk for infection – immunocompromised, elderly, young children 23. What lab result signifies infection when it is elevated? WBCs ?? 24. Describe the following terms: a. Immunocompromised – having an impaired immune system b. Virulence – ability to produce disease c. Vector – an organism that doesn’t cause disease itself but spreads from one host to another d. Aerobic bacteria – requires oxygen e. Anaerobic bacteria – thrive with little or no oxygen f. Bacteriostasis – prevention of growth and reproduction of bacteria g. Bactericidal – destructive to bacteria 25. What are the stages of infection? a. Incubation period – interval between entrance of pathogen into body and the appearance b. Prodromal stage – interval from onset of nonspecific CM’s (malaise, low fever, fatigue) to more specific CMs, microbes grow and multiply, patient may be contagious c. Illness stage – interval when patients manifests CMs specific to type of infection d. Convalescence – interval when acute CMs of infection disappear 26. What are clinical manifestations of localized infection? a. Pain, tenderness, warmth, redness 27. What are clinical manifestations of systemic infection? a. Can become fatal, effects the entire body b. Sepsis, fever 28. Describe necrotic tissue, what happens, what process is it apart of? a. Necrotic tissue is the death of cells due to lack of oxygen and interrupted blood supply. Cells become acidic, releasing enzymes that break the cells. 29. Describe granulation tissue, when does it happen? Is it good or bad? a. New connective tissue that form on the surfaces of a wound during the healing process. This is good because its an indication of healing. 30. What is medical asepsis? – Clean technique, decreases the number of pathogens and prevents the transfer of pathogens a. Asepsis is the absence of pathogenic microbes b. What are some examples when it is used? - handwashing, bathing, PPE, antiseptics 31. What is surgical asepsis? – Sterile technique, eliminates microbes, prevents contamination of open wound, isolation of operative areas, maintains sterile field for surgery a. What are some examples when it is used? – urinary catheter, surgical procedures b. What if sterile technique is broken? What do you do? 32. What are the 7 principles of surgical asepsis? a. a sterile object remains sterile only when touched by another sterile object b. only sterile objects may be placed on a sterile field c. a sterile object / field out of range of vision or an object held below a person’s waist is contaminated d. a sterile object / field becomes contaminated by prolonged exposure to air e. when a sterile surface comes in contact with a wet, contaminated surface, the sterile object / field becomes contaminated by capillary action f. fluid flows in the direction of gravity g. the edges of a sterile field / container are considered to be contaminated 33. What is the difference between sterilization and disinfection? a. Sterilization is complete elimination of all microbes, including spores i. Examples are using steam, heat, hydrogen peroxide b. Disinfection is elimination of many or all microbes, EXCEPT spores, from inanimate objects i. Examples are chemical disinfectants, wet pasteurization 34. Standard precautions is the primary strategy to prevent HAI’s, what is used and when is it used? 35. Describe the different isolation precautions and give examples of each: a. Airborne – droplet nuclei / residue / evaporated droplets suspended in air during sneezing, coughing or carried on dust particles i. Wear gloves, gowns, N95 masks ii. Examples – chicken pox, TB b. Droplet – large particles that travel up to 3 feet during coughing, sneezing, or talking come in contact with susceptible hosts i. Wear mask, gown and gloves ii. Ex – influenza, mumps c. Contact i. Direct – physical contact between source and susceptible host. Wear gown and gloves. Ex – open wounds ii. Indirect – personal contact of susceptible host with contaminated object. Ex – malaria, measles d. Protective environment i. When is a positive pressure room used? – this room keeps vulnerable patients safe from infections and disease, usually those in operating theatres, patients with HIV, or other immunocompromised conditions 36. Describe procedures when caring for a patient with c. difficle. – using HAND HYGIENE or alcohol based hand product is preferred if you are hands are not visibly soiled a. Putting PPE on – b. Taking PPE off – gloves, gown, mask 37. How/why are diabetics at higher risk for infection? – because of general debilitation and nutritional impairment. a. As a nurse what areas would we assess specifically for wounds? Why? Chapter 30: Vital Signs Chapter 39: Activity and Exercise 47. What are the principles of safe patient transfer and positioning? – ergonomics, patient assessment criteria, algorithms for pt handling / movement, special equipment, back injury resources, after action review, no lift policy 48. What do you do before moving or transferring a patient? asses? the situation first. 49. Explain how to prevent lift injuries in health care workers. – use evidence- based nursing research about safe patient handling 50. Explain assistive devices and how to use them: a. Walkers: b. Canes: c. Crutches: i. How do you measure? ii. Explain the different crutch gates iii. Crutch walking on stairs 1. Which leg goes first when going up? 2. Which leg goes first when going down? iv. Sitting in a chair with crutches Chapter 28: Immobility 51. Describe how immobility can affect the: a. Respiratory system: i. Higher risk for respiratory and pulmonary complications ii. Most common is atelectasis (alveoli collapses) and hypostatic pneumonia (inflammation of the lung from stasis or pooling) b. Cardiovascular system: i. Orthostatic hypotension ii. Increased cardiac workload iii. Thrombus formation c. Integumentary system: i. Pressure ulcers – inflammation and ischemia (↓ O2) ii. Older adults at greater risk d. Musculoskeletal system: i. Muscle effects 1. Patient loses lean body mass 2. Muscle weakness / atrophy ii. Skeletal effects 1. Disuse osteoporosis 2. Joint contracture – impaired calcium absorption 52. How do nurses reduce orthostatic hypotension? – compression stockings? google 53. How do nurses reduce a patient’s cardiac workload? – vasodilators, calcium channel blockers 54. How do nurses prevent thrombus formation? – compressions and leg exercises? a. Describe sequential compression devices and elastic stockings and be able to explain the procedure 55. Explain what to do if a patient starts to fall and you do not have a chair nearby: a. Stand with feet apart to provide a broad base of support b. Extend one leg and let patient slide against it on the floor c. Bend knees to lower the body as the patient slides to the floor CH 48: Skin Integrity and Wound Care 1. Describe the dermis and the epidermis. 2. What are three pressure related factors that contribute to pressure ulcers? Why? 3. Describe the following terms: a. Granulation tissue b. Slough c. Eschar d. Exudate e. Necrotic tissue 4. Describe friction & shear. 5. What is the Braden scale and why do we use it? 6. A HOB of degrees or less reduces pressure on the coccyx and helps reduce pressure ulcers. 7. Explain the following methods of wound healing & give examples of each: a. Primary intention b. Secondary intention c. Tertiary intention - Which one is the most effective for wound healing? 8. Describe the different stages of pressure ulcers (1-4). 9. What are nursing interventions to help prevent pressure ulcers? 10. How does urinary incontinence lead to ulcers? 11. What is the differences between an abrasion, laceration, and a puncture? 12. How often should a patient get a tetanus shot? 13. Describe the following wound drainages: a. Serous b. Serosanguineous c. Sanguineous d. Purulent 14. What characteristics do we note about wound drainage? a. C: b. O: c. C: d. A: 15. What nutrient & element is important for wound healing? a. Protein b. (this is found in A&D ointment for diaper rashes) 16. When are montgomery ties utilized? 17. What is the purpose of a wet to dry dressing? a. Why do we not saturate these dressings before we remove them? 18. Describe a hydrocolloid dressing and when it is used. 19. Describe a Jackson Pratt (JP) drain and when it is used? a. Should the bulb be compressed or no? Why? 20. Describe a wound vac, how it works and when it is used. a. If it is sounding an alarm, always check for air leaks first! 21. What is wound dehiscence? 22. What is wound evisceration? a. What are the nursing interventions if a wound does eviscerate? 23. Because you will be a kind, compassionate nurse – you will do what before you rush in and perform a dressing change on a patient? Answer: “Assess for , and medicate if needed” 24. What must we clean with first before obtaining a wound culture? a. Why do we never give antibiotics before getting a culture of anything? 25. What are the stages of wound healing? What purpose does each stage serve?