Medsurg Exam 1 - Exam 1 notes PDF

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NS 250 Medical Surgical Blue Print Unit Exam 1 Spring 2021 Read Chapters 1-11, (except chapter 8) 13, 17-19 50 multiple choice/select all that apply questions Please note this is a guide to assist you with studying and is not all-inclusive.

Exam Topic: Chapter 1 Health, wellness and self-care and Health Promotion pp 5 -7 What are the 4 components of wellness as per hood and leddy?

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Capacity to perform to best of ability Ability to adapt to situations Report feeling of well being Feeling that everything is working together

How does the WHO define health/?

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State of physical, mental and social well being. Implies that health and illness are not polar opposite Px can be ill but want to be healthy in other domain

What is the ANA’s role?

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They created the code of Ethics And the Nursing social policy statement Nursing practice act state what we practice

National Patient Safety Goals pp. 8 - 9 What are they?

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Identify patients correctly ○ Multiple verification Improve staff communication - SBAR Using medication safely Alarms safely Prevent infection Identify px safety risk Prevent mistakes in surgery (WRIST BANTS)

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Psychological Safety and security Emotional - belonging and affection Esteem and self respect Self actualization

Maslow Hierarchy of needs pg. 5 What is maslow hierarchy of needs?

Evidence Based Practice pp. 7 -8 What does it mean to be evidence based practice?

Why is EBP relevant to nursing practice?

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Chapter 2 Prevention – primary, secondary and tertiary pp. 18 -19 What are they?

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This means nurses take their experience with research to promote the best outcomes and apply it to their practice. Components: patient values and expectations, best available clinical evidence, individual clinical expertise - to improve patient outcome To bridge gap between what we know and what we do Improve px outcomes Decrease unnecessary procedures It empowers nurses

Primary: tries to handle conditions prior to it existing. Health promotion and prevention of disease. Secondary: Focus on health maintenance and aimed for early detection. screens for px who are at risk Tertiary: Focus on minimizing deterioration. Improving quality of life. Helps px deal with condition to promote health

Safety and personal safety precautions for a home visit pg. 21-22 chart2.2 What do you do with px phone @ home visit? When should you schedule a home visit? Wjat takes place during the initial home visit? How does a home health nurse help with medication management?

Community based nursing mission and vision pp. 18-19

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Program agency information

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During daylight hours

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Evaluation of px and plan of care Practices policies and hours of operation Take insurance information

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Assist with wrong dosages Duplicate medications or omissions

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Chapter 3 Restraints pg. 33

Need an order for a restraint Should only be used if person is a threat to themselves or others and for a short amount of time

Nursing process planning and evaluation pg. 36 and 39 -40 Chapter 4 Maintaining Health p 48-49

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Chapter 5 Health assessment pp 6266 Components of physical examine palpation pg. 73 Components of nutritional assessment BMI pg. 76 Chapter 6 Physiological response to stress, fight/flight pg. 87 Cellular injury, temperature pg. 93

Chapter 7 Culturally mediated characteristics, eye contact pg. 107

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When a person’s temperature is elevated, hypermetabolism occurs and the respiratory rate, heart rate, and basal metabolic rate increase. With fever induced by infections, the hypothalamic thermostat may be reset at a higher temperature and then return to normal when the fever abates. The increase in body temperature is achieved through physiologic mechanisms.

Transcultural nursing, cultural taboos pg. 104 -105 Chapter 9 Definition of chronic disease or condition pg. 139- 142 Ensure quality health care for people with disabilities, chart 9-8 pg. 155 - 156 Chapter 10 Stages in the Development of pressure ulcers pg. 178 – 182 Chart 10-7 Nutritional status for Healing pp 184

tional Status. Nutritional deficiencies, anemias, and metabolic disorders also contribute to the development of pressure ulcers. Anemia, regardless of its cause, decreases the blood’s oxygen-carrying ability and predisposes the patient to pressure ulcers. Poor nutritional status can prolong the inflammatory phase of pressure ulcer healing and can reduce the quality and strength of wound healing (Thomas, 2015).

Purpose and Goal of Rehabilitation pp 164-165 Members of the Rehab team p165-166 Chapter 11 Age related changes, cardiovascular pg. 195-196

Delirium vs Alzheimer’s

myocardial hypertrophy, which changes left ventricular strength and function; increased fibrosis and calcified tissues that infiltrate muscles and conductive tissues causing stenosis (narrowing) of the valves; and decreased pacemaker cells. As a result, the heart valves become thicker and stiffer, and the heart muscle and arteries lose their elasticity, resulting in a reduced stroke volume

page 208 – 209 (also watch video on black board) What are signs of delirium?

Positive and negative perceptions of older adults p.202 Why do people have negative ideas about aging?

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Alzheimer is chronic and starts slow and progresses Delirium is sudden and reversible

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Either hyperactive or hypoactive Hyper easier to note Confusion Can lead to brain damage and sometimes death Attention span is short Begins with disorientation!!

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Fear of their own aging process Idea that older people compete for resources Not contributing to society

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Promoting health prevention Retirement Ensuring adequate income

What is nurses role in facilitating successful aging?

Chapter 13 Electrolytes --potassium, magnesium, sodium, phosphorus and calcium (clinical manifestations, diet and treatment of hypo and hyper Acid-Base balance -- ABGs be able to identify Chapter 17 Deep breathing and coughing pre operatively (see chart 17-5–p429) Informed consent –p. 422-423 Surgical classifications – 419

facilitating a diagnosis (a diagnostic procedure such as biopsy, exploratory laparotomy, or laparoscopy) a cure (e.g., excision of a tumor or an inflamed appendix), or repair (e.g., multiple wound repair). It may be reconstructive or cosmetic (such as mammoplasty or a facelift) or palliative (to relieve pain or correct a problem—such as debulking a tumor to achieve comfort, or removal of a dysfunctional

gallbladder). In addition, surgery might be rehabilitative (e.g., total joint replacement surgery to correct crippling pain or progression of degenerative osteoarthritis.)

Client teaching related to surgery – p428- 429 Chapter 18 Administration of blood during surgery— nurses’ role Malignant hyperthermia – p 450 -451 Chapter 19 Postoperative complications p 473 – 474 Determining readiness for PACU discharge – p456 – 457

Dehiscence/Evisceration – page 474

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Dehiscence: separation of suture but muscle is intact Evisceration: protruding bowel disruption of a wound occurs, the patient is placed in the low Fowler’s position and instructed to lie quietly. These actions minimize protrusion of body tissues. The protruding coils of intestine are covered with sterile dressings moistened with sterile saline solution, and the surgeon is notified at once

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Assess for symmetry of chest and wall movement absent breath sounds on left: endotracheal tube migrated right mainstem or that there is pneumothorax Snoring or stridor: can indicate poor oxygen

Assessing the patient’s airway p 457 -459

When do we take out tube? ATI Book Chapters 20, 23, 43, 44, 45,

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exchange

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When px can respond to commands, elevate head and use thoracic breathing...