Fundamentals Exam 2 Study Guide
Safety and Quality
Patient Education on safety in home
● Avoid having throw rugs
● Clean up spills to avoid falls
Maintaining safety
● Notify a provider if you notice any changes to body function
● Use assistive devices when needed
Safe Patient Handling
● Use necessary amount of people needed to transfer a patient
● Use gait belt to help prevent falls
● Watch for cords/ IV to keep patient out of harm
Prioritizing Patients
● ABC’s
● Serious conditions to least severe
Pain Management
What is pain?
● Unpleasant subjective sensory and emotional experience associated with
actual or potential tissue damage
Modifiable Factors of Pain
● Attention (Social)
● Previous experience with pain (Social)
● Family and social support (Social)
● Spiritual factors (social)
● Anxiety (Psychological)
● Coping style (Psychological)
● Cultural factors
Non-modifiable factors of Pain
● Age
○ Developmental considerations
● Fatigue
○ Heightens the perception of pain
● Genes
○ Increases or decreases person sensitivity to pain
● Neurological functions
○ Any factors that interrupts normal pain reception or perception
Assessing Pain
● OLDCART
○ O: onset
○ L: location
○ D: duration
○ C: characteristics
○ A: Aggravating/ Alleviating Factors
○ R: Relieving Factors/ Radiating
○ T: Treatment
● PQRST
○ P: palliative or precipitating factors
○ Q: quality of pain
○ R: region or radiation
○ S: subjective description of pain
○ T: Time of pain
Chronic Pain:
● Non-protective
● Serves no purpose
● Dramatic effect on person’s life
● Last > 6 months
Acute Pain:
● Protective
● Identificable cause
● Short duration
● Limited tissue damage
● Limited emotional response
Other types of pain:
● Chronic episodic pain:
○ Occurs sporadically over an extended period of time: hours, days,
weeks
○ EX: migraines
● Referred Pain:
○ Pain at different site than the actual injury
● Idiopathic Pain
○ Chronic Pain in absence of identifiable physical or psychological
cause
● Phantom limb pain:
○ Pain in an extremity that is no longer existing on the body
Alternative interventions for pain:
● Relaxation
● Guided imagery
Distraction
● Music
● Cutaneous stimulation
● Herbals
Pharmacological Pain Therapies:
● Analgesics
○ Non-opiods
◆ NSAIDS and acetaminophen
○ Opioids
◆ Narcotics
○ Adjuvants
Self Concept:
Altered self- concept in patients:
● Can be due to illness, loss of body part
Promoting self esteem in older adults
● Remind them they are doing well in healing process
● Compliment their ADL’s
●
Activity and Exercise
Application of Body Mechanics
● Erect posture
● Use longest and strongest muscles of arms and legs
● Use internal girdle and long midriff to stabilize pelvis and protect
abdominal muscles
● Work as close to object as possible
● Slide, roll, or push object when possible
● Use weight of body to push
● Stand shoulder width apart for wider base
● Flex knees to come closer to object
ROM Exercise:
● Active Exercise (w/o help)
○ Unless contraindicated
○ Promotes muscle mass and strength
● Passive Exercise (With help)
○ Improve joint mobility
○ Help prevent fluid status
◆ Move each joint until resistance, not pain
◆ BID
◆ Increase HR should return after 3 minutes of exercise
Adult Education on exercise
● Cardiovascular
Reduces cardiovascular disease: lower BP and HR
○ Improved venous return
○ Increased circulating fibrinolysis
◆ Breaks up small clots
● Respiratory
○ Improved alveolar ventilation
○ Decreased work of breathing
○ Improved diaphragmatic excursion
● Musculoskeletal:
○ Increased muscle efficiency
○ Increased flexibility, coordination
○ Increased efficiency of nerve impulse transmission
APA & Literature Paper
Purpose
● Familiarize students with nursing literature that effects nursing care of
patients
Topic
● Anything relevant to NURS 121/122 —> older adults and safety
Content
● Minimum of two articles
● Must be between 2016-2021
● MUST BE PROFESSIONAL NURSING JOURNALS
Paper
● Four pages
● Reference rubric
● APA format
● Five nursing interventions
○ Bullet points in paper
○ Numbered at end of paper
Criteria:
● Articles need to relate to care provided in clinal
● Summary of article
○ Concise
○ Cleary written
○ Highlights major concepts
● Five nursing interventions are from two articles
APA 7th Edition
● Citation in paper
● Title page
● Reference page
DUE OCTOBER 19, 2021 at beginning of class
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100 points
Evidence- Based Practice
What is EBP
● Use of best nursing research, clinical expertise, practice trends, and pt.
Preference to guide nurses decisions about care provided to patients.
Why it’s used
● Helps make effective, timely, and appropriate clinical decisions in
response to broad political, professional, and societal forces present in
today’s health care environment
BEST research to use
● Peer- Reviewed
○ Articles are reviewed for
◆ Accuracy
◆ Validity
◆ Rigor
◆ Approved by experts before publication
Types of research
● Qualitative Research
○ Study of phenomena that are difficult to categorize
◆ EX: patient perception of illness or quality of life
○ Describes information obtained in nonnumeric form
◆ Aimed to understand patient experience
○ Use of inductive reasoning
◆ Development of generalization or theories from specific
observations
● Experimental
○ Investigator controls study variable and randomly assigns subjects to
different conditions to test variable
◆ EX: comparing CHG to butadiene for IV site infection prevention
● Correlational
○ Explore relationship between variables without any active
interventions by researcher
◆ EX: RN educational levels and satisfaction in nursing role
● Quantitative Nursing Research
○ Study of nursing phenomena that offers precise measurement and
quantification
◆ Study with new pain therapy measures participants pain severity
◆ Study testing different forms of dressing measures in wound
healing
○ Precise, systematic, objective
Numerical data, statistical analysis, controls to eliminate bias
● Experimental Study
○ Randomized control trial
○ Tightly controls condition to eliminate bias
○ Generalizes results to similar groups of subjects
● Non-experimental Research
○ descripttive studies
○ Describe, explain, or predict phenomena
● Surveys
○ Quantitative research
○ Obtain information via
◆ Frequency
◆ Distribution
◆ Interrelation of variables
● Evaluation Research
○ Measures how well a program, practice, procedure, or policy is
working
Steps of research process
. Cultivate a spirit or inquiry
. Ask clinical question in PICOT form
○ P: patient population of interest
○ I: intervention of interest
○ C: comparison of interest
○ O: Outcome
○ T: time
. Search for the most relevant and best data
. Critically appraise the evidence gathered
. Integrate all evidence with your clinical expertise and patient preference
and values
. Evaluate the outcomes of practice decision or changes using evidence
. Share the outcomes of EBP changes with others
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NURSING PROCESS
. Assessment
. Diagnosis
. Planning
. Implementation
. Evaluation
RESEARCH PROCESS
. Identify area of interest or clinical problem
. Develop research question/ hypothesis
. Determine how study is to be conducted
. Conduct the study
. Analyzes the results and use findings
Caring in Nursing
What is caring?
● Universal phenomena influencing the way in which people think, feel, and
behave in relation to one another
Theorist on caring in nursing
● Leininger: transcultural caring
○ Concept of care: essence and central unifying and dominant domain
that distinguishes nursing from other health disciplines
○ Caring helps individual/ group improve human condition
○ Stress importance of nurses understanding cultural caring behaviors
○ Different culture does not always mean different country
● Watson: transpersonal caring
○ Holistic model for nursing that suggest conscious intention to care
promotes healing and wholeness
○ Rejects disease orientation of health care
○ PLACES CARE BEFORE CURE
○ Emphasis on nurse-patient relationship
● Swanson: Theory of Caring
○ Nurturing way of relating to individuals
○ Five caring processes
◆ Knowing
◆ Striving to understand
◆ Being with
◆ Being emotionally present
◆ Doing for
◆ Golden rule
◆ Enabling
◆ Facilitating the passage through life transitions
◆ Maintaining belief
◆ Sustaining faith in other’s capacity to transition
Ways to show caring
● Providing presence
● Touch
● Listening
● Knowing the patient
● Spiritual caring
● Relieving symptoms and suffering
Family care
SPEAK UP:
● Initiative program by Joint Commission
○ Provides tools to help patients be effective part of health care team
○ Makes patients and loved ones more active in their care
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Ethics and Values
Advocacy:
○ Support of particular cause
Autonomy:
○ Freedom from external control
◆ Patients, nurses, provider
Beneficence:
○ Taking positive actions to help others
Confidentiality
○ Protection of patient personal information
◆ HIPPA
◆ Establishes fines for violations
Why do we do incident reports?
● To have a full recollection of the event that occurred in the event a
patient or staff were to get injured or if one were to sue
Immobility
Reasons for turning patients
● To prevent skin breakdown
● Help patient be semi active
● Prevent joint and muscle stiffness
Effects of Immobility on different body systems
● Skeletal
○ Ossification: calcium resorption from bones
○ Immobility causes calcium to be released into circulation
◆ Kidney excrete extra calcium
◆ Kidney unable to excrete excess calcium= hypercalcemia
● Gastrointestinal Functioning
○ Difficulty passing stool
○ Pseudodiarrhea: passing area of fecal impaction
○ Fecal impaction
◆ Can cause blocked propulsion of liquid and gas, absorption
ceases and fluids and electrolytes disturbances worsen
● Respiratory
○ Atelectasis: partial collapse of lung
Hypostatic Pneumonia: inflammation of the lung from stasis or
inhalation of secretions
Cardiovascular
○ Orthostatic Hypotension
◆ Drop of BP great than 20mmHg systolic and 10mmHg in diastolic
◆ Dizziness
◆ Light-headed
◆ Fainting
◆ Pallor
◆ Tachycardia
◆ Fainting
○ Increased workload of heart due to
◆ Increased oxygen consumption
◆ Heart works harder= less efficient
○ Thrombus formation
◆ Accumulation of platelets, fibrin, clotting factors, and cellular
elements on the inner wall of vessels
○ Three factors that contribute to thrombus formation
. Damage to vessel walls
. Alteration of blood flow
. Alteration in blood constituent
◆ Also known as VIRCHOW’s Triad
Musculoskeletal
○ Cause permanent or temporary impairment
○ Loss of lean body mass
◆ Causes difficulty for sustained activity without fatigue
○ Disuse atrophy
○ Loss of endurance
○ Decreased muscle mass and strength
○ Joint instability
◆ ALL lead to higher risk of CVA
Urinary
○ Urinary Stasis
◆ Risk for UTI
◆ Renal calculi (kidney stones)
◆ Dehydration
◆ Indwelling (Foley) catheters
Integumentary System
○ Pressure Ulcers
◆ Impairment of the skin as a result of prolonged stasis in tissues
◆ Such a concern in immobile patients because the hospital is liable
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for all injuries occurring after initial admission assessment
What to do with patients with limited mobility?
● Try to have them turn as much as possible when in bed to prevent skin
breakdown
● ROM exercises
Assessing mobility in patients
● Nutritional assessment
● Anorexia and insufficient assistance with eating
● Reconditioning exercises
● Direct relationship between the success of rehabilitation and nutritional
status
Pain effects on mobility
● Patients do not want to get up when they are in pain
● Patients mobility can range from mobile to immobile
Friction
○ Force that occurs in direction opposite of movement
Shear
○ Forced exerted against skin while skin remains stationary and bony
structure moves
Muscle atrophy
○ Loss of muscle tone
○ Joint stiffness
Math
Ounces to mL
○ 1 oz = 30 mL
Inches to centimeters
○ 1 in = 2.54 cm
Intake and output
○ Multiply ice by half (1/2)
◆ EX: 6oz glass of ice —> 6oz glass x 30mL= 180mL/ 2= 90mL