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NURS 1110 Exam 3
nursing roles, physiological needs
| Question | Answer |
|---|---|
| roles of the nurse in different care settings | caregiver, teacher, advocate, researcher, communicator, manager, member of the profession |
| nonverbal communication | body language, appearance, lack of communication (silence), facial expression |
| influence of social and economic changes on professional nursing practice | re-imbursement, roles for prevention vs. illness, medical homes, HITECH Act, IOM and practice, increasing number of uninsured, cultural disparities |
| HITECH Act | federal legislation that mandates all providers of healthcare use electronic records which must be shareable with other care providers |
| intrapersonal communication | talking, reviewing, reflecting to oneself |
| interpersonal communication | communication between two people |
| why communication is important for nurses | better collection of assessment data, initiate interventions, evaluation of outcomes, intimate moment of connection that makes the difference in the quality of care and meaning for the client and the nurse |
| small group communication | communication between more than two people |
| public communication | communication with a large group of people, examples include nurse educators, boards, public speaking |
| therapeutic relationship | relationship that occurs when someone is providing care for another; relationship does not exist outside the care setting |
| social relationship | relationship that exists in many different contexts |
| cultural factors which may influence communication | type of culture, social order, gender roles/views, personal space requirements, eye contact, generational factors |
| developmental stage factors which may influence communication | age, language, cognitive development, social development, developmental delays |
| gender factors which may influence communication | gender roles, sexism |
| factors related to stress and illness which may influence communication | poor concentration, poor listening, increases the amount of background noise a person experiences, inability to make clear decisions, pain or physical condition may make it difficult to communicate effectively |
| learning | process by which a person acquires knowledge, process of change |
| verbal communication techniques which enhance the therapeutic relationship | encouraging/accepting, paraphrasing/restating, validating/perception checking, clarifying, open-ended questions/statements, direct questions, speaking slowly and clearly |
| verbal communication techniques which inhibit the therapeutic relationship | advising, stereotype response, reassurance, probing, overuse of direct questions, disagreement/disapproval/rejection, leading questions, false assurance, gossip, advice |
| nonverbal communication techniques which enhance the therapeutic relationship | eye contact; appropriate use of silence; appropriate use of touch, reflection; facing the other person; relaxed, open-posture; appropriate distance |
| nonverbal communication techniques which inhibit the therapeutic relationship | being defensive; standing over patient; not enough personal space |
| specific communication techniques for care of the culturally diverse patient | respect personal space, gear communication toward whether person's culture is individualistic or collective, use appropriate eye contact, touch, time orientation, respect social order |
| oral communication in healthcare | assessment, health history, meeting patient's needs, communicating information about condition, teaching, communication between healthcare providers |
| written communication in healthcare | documentation, patient teaching information, communication between healthcare providers |
| electronic communication in healthcare | documentation, communication between healthcare providers |
| legal guidelines used in healthcare documentation | must be legible, nurses must sign each entry, may not erase/change, must be accurate |
| ethical guidelines used in healthcare documentation | charts are legally protected private records, use is restricted, document what is seen and heard rather than interpretations, quote the patient directly in the chart, the person that performed the procedure or observation should chart it, chart after |
| technical guidelines used in healthcare documentation | be brief, full sentences are not necessary, use correct terms and acceptable abbreviations, chart exact times of occurrences, chronological order, sign each entry, do not leave blank areas at the end of lines, new entry for forgotten data, date and time |
| type of information that is documented and communicated by nurses | what you see, what you hear, what you smell, what you feel, what you do, response, what you do to protect the patient, what you do to protect property, special assessments |
| purpose of recording data | facilitate patient care, serve as a financial and legal record, help in clinical research, support decision analysis, communication between healthcare professionals, care planning, quality control, education, research |
| prohibited abbreviations | qd, qod, MS, MSO4, MgSO4, U or u, IU, 1.0, .1, m(symbol)g, chemotherapy meds, ear or eye abbreviations |
| writing time in nursing documentation | use 24 hour military time |
| techniques which may facilitate communication | appropriate use of silence, appropriate use of touch, encouraging/accepting, paraphrasing/restating |
| active listening | communication technique that requires the listener to hear, understand, interpret and evaluate what they hear |
| silence | to encourage individual to verbalize |
| encouraging | 1) convey interest, 2) keep an individual talking. Examples: I see, uh-huh, that's interesting. |
| restating | 1) show that you are listening and understanding, 2) let the individual know that you grasp the facts. Examples: If I understand, your idea is..., In other words, this is your decision... |
| reflecting | 1) to show that you are listening and understanding the content, 2) to let the individual know you understand how he feels. Examples: You feel that..., You were pretty disturbed by this, This really upset you. |
| summarizing | 1) to pull important ideas, facts, etc. together; 2) to establish a basis for further discussion; 3) to review progress. Examples: These seem to be the key ideas you have expressed. If I understand you, you feel this way about the situation. |
| goals/intended outcomes of patient learning/education | maintain health, promote health, prevent illness, restore health, facilitate coping |
| steps in the teaching-learning process | Assess, Diagnose/Plan, Implement, Evaluate, Document |
| factors that affect patient learning | age, developmental level, support, financial resources, cultural influences, language, health literacy |
| cognitive learning domain | compares, defines, explains |
| psychomotor learning domain | assembles, demonstrates, shows |
| affective learning domain | displays, values, relates |
| four elements that are essential to include in an assessment of patient learning needs | 1) KSA (Knowledge, Skills, Attitude), 2) readiness to learn, 3) ability to learn, 4) learning strengths |
| teaching strategies for the cognitive domain | lecture, printed materials, computer assisted teaching |
| teaching strategies for the affective domain | discussion, role-modeling, role-playing |
| teaching strategies for the psychomotor domain | demonstration, printed materials, a/v materials |
| factors that contribute to low health literacy | ability to read, understand, and act on health information; 20% read at or below 5th grade level; most patient materials written above 10th grade level; patients don't understand importance of learning about health |
| strategies that can help improve health literacy | Make sure the patient knows: What is my problem? What do I need to know? Why is it important for me to do this? |
| factors that influence patient compliance | understandable instructions, availability of support, comfort level, whether patient understands importance of compliance/consequences of noncompliance |
| nursing diagnoses that relate to patient learning needs | Anxiety, Fear, Impaired Parenting, Impaired Social Interaction, Risk Prone Health Behavior, |
| methods for evaluating patient learning | goals, should be measurable |
| components that should be included in documentation of the teaching-learning process | summary of learning needs, plan, implementation, evaluation, revision, resolution |
| nurse's role as a counselor | interpersonal process of facilitating patient decision-making |
| different types of counseling a nurse may engage in | short-term, long-term, developmental, motivational |
| sources and types of nursing knowledge | sources - traditional, authoritative, knowledge; types - science, philosophy, process |
| historical influences on nursing knowledge | Nightingale's contributions - demonstrating efficient and knowledgeable care, defining nursing practice as separate and distinct from medical practice, nursing training; societal influences such as nursing schools, role of women, war |
| theory | composed of a group of concepts that describe a pattern of reality |
| conceptual frameworks | group of concepts that follows an understandable pattern; model; analogous to a blueprint where the concepts are the building materials |
| deductive reasoning | method of reasoning in which one examines a general idea and then considers specific actions or ideas |
| inductive reasoning | method of reasoning in which one builds from specific ideas or actions to conclusions about general ideas |
| general systems theory | theory that describes how to break whole things into parts and then learn how the parts work together in "systems"; emphasizes relationships between the whole and the parts and describes how parts function and behave |
| adaption theory | adjustment of living matter to other living things and to environmental conditions; continuously occurring process that effects change and involves interaction and response; three levels of human adaptation: internal, social, physical |
| developmental theory | defines the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death; defined stages, but progress and behaviors of an individual are unique; Erikson and Maslow are two major players |
| concepts of person, environment, health and nursing that are common in most nursing theories | required for holistic care and influence nursing practice; the person is the most important |
| quantitative research | basic and applied research; includes descriptive research, correlational research, quasi-experimental research, and experimental research; measurable, results are often numbers |
| qualitative research | method of research conducted to gain insight by discovering meanings; results are often words or descriptions |
| steps of the quantitative research process | 1) state the problem, 2) define the purpose, 3) review literature, 4) formulate hypothesis and variables, 5) select research design, 6) select population and sample, 7) collect data, 8) analyze data, 9) communicate findings |
| methods of quantitative research | descriptive, correlational, quasi-experimental, experimental |
| methods of qualitative research | phenomenology, grounded theory, ethnography, historical |
| evidence based practice | problem-solving approach to making clinical decisions using the best evidence available collected from reliable sources |
| rationale for evidence based practice in clinical practice | scientific evidence supports decisions; allows for better allocation of resources and services |
| steps involved in implementing evidence based practice | 1) ask a question, 2) collect most relevant and best evidence, 3) critically appraise the evidence, 4) integrate the evidence with clinical expertise, patient preferences, and values to make decision to change, 5) evaluate the practice decision or change |
| reliable sources for locating evidence based reports and clinical guidelines | published research, national standards and guidelines, review of targeted literature |
| APA formatting and style | format for research papers that determines organization, writing style, reference citation, and publication guidelines; allows readers to focus on the content because formatting will be familiar |
| role of the skeletal system in the physiology of movement | form & posture, protection, attachment, storage, production of RBC, joints |
| role of the muscular system in the physiology of movement | posture, motion, heat production |
| role of the nervous system in the physiology of movement | stimulates, regulates |
| factors that are important in normal movement and musculoskeletal function | body alignment, balance, coordination, postural reflexes |
| factors that affect an individual's body movement and alignment | developmental (muscle tone, coordination, age variations), physical (illness, pain), mental health, lifestyle, attitude or values, fatigue and stress, external factors (time, money, weather) |
| benefits of exercise and activity on major body systems | decreased HR, decreased BP, increased HDL, increased pulmonary function, increased strength, muscle tone, bone mass, metabolism, digestion |
| effects of immobility on major body systems | DVT risk, pneumonia risk, muscle atrophy, decreased digestion, increased risk of UTI, skin breakdown, depression |
| nursing and physical assessment skills to assess body alignment, mobility, and activity tolerance | history; observe ease of movement, gait, alignment, ROM of joints; assess muscle mass, tone and strength; evaluate endurance |
| nursing diagnoses related to mobility problems | Activity Intolerance, Impaired Physical Mobility, Chronic Pain, Impaired Walking, Noncompliance with Exercise Regimen, Impaired Transfer Ability, Knowledge Defecit |
| principles of body mechanics that promote safe patient handling and movement | use lifts when warranted, know limits, lift with bent knees, keep weight close to body, avoid repetitive movements, practice safe body alignment |
| physiological factors associated with nutritional intake | energy, metabolism, weight, growth, health |
| cultural factors associated with nutritional intake | economic factors, religion, meaning of food, diversity of food, traditions, language barriers, unavailability of certain foods, |
| body's mechanisms for regulating nutritional intake | appetite, metabolism, mental health status, illness, stress, trauma, stage of development, medication use, habits, lifestyle |
| MyPlate | new USDA graphic that emphasizes portion control and consumption of fruits, vegetables, whole grains and lower fat selesctions |
| MyPyramid | USDA graphic that shows recommendations for nutrients in an attempt to improve the American diet; encourages eating a variety of foods from all food groups and being physical active every day |
| healthy eating guidelines | consume a variety of nutrient-dense foods, eat balanced meals, limit intake of saturated and trans fats, cholesterol, sugars, salt, and alcohol; increase consumption of fruits, vegetables, whole grains |
| essential nutrients | carbohydrates, fats, proteins, vitamins, minerals, and water |
| current dietary guidelines for an adult | 20-35% of calories from fat 45-65% of calories from carbohydrates 10-20% of calories from protein <2,300 mg/day sodium <300 mg/day cholesterol RDA of vitamins and minerals |
| changes that need to be made to typical American diet to meet current dietary guidelines | fewer carbs, fewer fats, less sodium, less cholesterol, more vitamins and minerals, |
| normal digestion, absorption, and metabolism of nutrients | carbs - energy, protein - building/repairing muscle, fat - storage, absorption of vitamins |
| factors that affect an individual's nutritional needs | age, growth, pregnancy, lactation, illness, stress, size, metabolic rate, activity level |
| data indicating satisfaction or lack of satisfaction of the body's nutritional needs | weight, muscle tone, condition of hair, teeth, nails, skin |
| nutritional assessment | intake and output, history, lab values, physical assessment, dietary data, DETERMINE screening, barriers to eaing, BMI, weight, measurements, muscle tone, |
| nutritional counseling as part of health teaching | educate patients about food safety, nutrition basics, |
| nursing actions to relieve or minimize nausea and vomiting | medication, keeping patient upright after meals, offering palatable foods, foods that are easy to digest |
| nursing actions to maintain or improve intake or appetite | small frequent meals, pleasant environment, cater to food preferences if possible, control pain/nausea, good oral hygiene, make sure patient can easily reach food, comfortable position, facilitate rituals |
| types of diets | soft diet, fat-restricted diet, pureed diet, mechanical soft diet |
| carbohydrates | simple sugars and starches, cellulose and other water-insoluble fibers, water-soluble fibers |
| proteins | amino acids |
| fats | triglycerides, saturated, unsaturated (monounsaturated and polyunsaturated) |
| vitamins | water-soluble (C, B) or fat-soluble (A, D, E, K); organic compounds found in plants or animals |
| minerals | inorganic compounds; macrominerals: calcium, phosphorus, magnesium, sulfur, sodium, potassium, chloride; microminerals: iron, iodine, zinc, copper, manganese, fluoride, chromium, selenium, molybdenum, cobalt |
| water | vital to life; can be consumed in pure, liquid form or in other foods; required for all chemical reactions in the body, acts as a solvent and aids in digestion, absorption, circulation and excretion |
| risk factors for poor nutritional status | illiteracy, language barriers, lack of knowledge about nutrition, lack of caregiver or social support, social isolation, limited ability to obtain or purchase food |
| influence of nutrition on growth and development throughout the life cycle | nutrition needs change in relation to growth, development, activity and age-related changes in metabolism and body composition. Increased nutritional requirements during periods of intense growth/development - infancy, adolescence, pregnancy, lactation |
| nursing diagnoses that are related to nutritional problems | Imbalanced Nutrition: Less Than Body Requirements, Imbalanced Nutrition: More Than Body Requirements, Risk for Imbalanced Nutrition: More Than Body Requirements |
| nursing interventions to help patients achieve their nutritional goals | Nutrition Management, Nutrition Therapy, Nutrition Counseling, Nutritional Monitoring, Exercise Promotion, Weight Management |
| Medical homes | ways of grouping people together to manage care proactively instead of reactively - emphasis is on preventative care; |
| IOM | Institute of Medicine; came out with huge study in October 2010 that made some significant recommendations for nursing practice |
| Basic elements of the communication process | referent, sender and receiver, message, channels, feedback, interpersonal variables, environment |
| referent | object or idea to which a word refers |
| channel | can be verbal or nonverbal |
| feedback | verbal or nonverbal cues that let you know how your message was received |
| interpersonal variables | position, background noise (internal or external), anything that could be a distraction, something that interferes with hearing a message, can be cultural or environmental |
| environment | can be internal or external, one's state of |
| sender | person conveying a message to another |
| receiver | person that receives a message from another |
| characteristics of the communication process | ongoing, dynamic, multidimensional |
| characteristics of professional communication | respect, use of names, privacy, confidentiality, trust, autonomy/responsibility, assertiveness |
| forms of communication | verbal, nonverbal, symbolic, metacommunication |
| symbolic communication | examples include artwork, music |
| metacommunication | making sense of what something means, putting it all together |
| tips for developing conversation skills | control voice tone, be knowledgeable about topic, be flexible, be clear and concise, avoid words that might have different interpretations, be truthful, keep an open mind, take advantage of available opportunities |
| barriers to listening | personal bias, environmental factors, stress, health, open-mindedness, type of communication |
| developing listening skills | sit when communicating with a patient, be alert and relaxed, keep the conversation as natural as possible, maintain eye contact if appropriate, use appropriate expressions & gestures, think before responding, listen, use silence, touch and humor wisely |
| SPICES | tool for gathering information through communication during assessment: Sleep disorders, Problems with eating/feeding, incontinence, Confusion, Evidence of falls, Skin breakdown |
| amount of time a person can actively listen before needing to interject | 2 minutes |
| types of nursing relationships | patient/client, family, health care team, community |
| characteristics of a helping relationship | does not occur spontaneously, unequal sharing of information, built on patient's needs, dynamic, purposeful and time limited, person providing assistance is professional accountable |
| roles of group members | task-oriented, group building or maintenance, self-serving |
| phases of the helping/therapeutic relationship | orientation phase, working phase, termination phase |
| orientation phase | establish tone and guidelines, clarify roles, orientation to healthcare system, introduce each other |
| working phase | meet patient's needs, provide assistance, provide teaching and counseling |
| termination phase | examine goals for attainment, make suggestions for future efforts if needed, encourage patient to express emotions about termination |
| methods of documentation | source-oriented records, problem-oriented records, PIE charting, focus charting, charting by exception, case management model, computerized documentation, electronic medical record (EMR) |
| formats for nursing documentation | initial nursing assessment, Kardex and patient care summary, plan of nursing care, critical collaborative pathways, progress notes, flow sheets, discharge and transfer summary, home healthcare documentation, long-term care documentation |
| types of flow sheets | graphic record, 24-hour fluid balance record, medication record, 24-hour patient care records and acuity charting forms |
| POMR | Problem Oriented Medical Record; integrated, includes care plans, progress notes, defined database, problem list |
| Source-oriented medical records | tabs for different sources of information; EMR tend to be source oriented but fully integrated |
| SOAP note | Subjective, Objective, Assessment, Plan |
| PIE patient care note | Problem, Intervention, Evaluation |
| DAR note | Data, Action, Response |
| Collaborative pathways | also called critical pathways or care maps, used in case management model to specify the plan of care linked to expected outcomes along a timeline |
| Variance charting | charting of an unexpected event or failure to meet an expected outcome with the cause of the event, actions taken and discharge planning when appropriate |
| Types of report | change of shift report, telephone report, telephone and verbal orders |
| Methods of reporting | face-to-face, telephone conversation, written messages, audio-taped messages, computer messages |
| SBAR | Situation, Background, Assessment, Recommendations |
| change of shift report | includes basic identifying information about each patient, current appraisal of each patient's health status, changes in condition and response, current orders, new admits, report on patients transferred or discharged |
| Benefits of nursing informatics | increases accuracy and completeness of nursing documentation, improvement in workflow and elimination of redundant documentation, automate of collection and reuse of nursing data, facilitates analysis of clinical data |
| Documentation Rule #1 | If you didn't chart it, you didn't do it. |
| nursing process | Assess, Plan, Implement, Evaluate, Document |
| teaching strategies | planned; matched with learner outcome; dependent upon ease of method, patient factors, availability of resources such as lecture, demonstration, printed materials, discussion |
| types of joints | ball & socket, condyloid, gliding, hinge, pivot, saddle |
| Recommended reading level for patient materials | 5th grade Fleisch Kincaid reading level |
| learning domains | cognitive, psychomotor, affective |
| types of bones | flat, long, short, irregular |
| skeletal system problems | congenital or acquired, bone formation, joint mobility, trauma |
| muscular system problems | muscle development, trauma |
| types of muscles | smooth, skeletal, cardiac |
| points of attachment for muscles | point of origin, point of insertion |
| types of neurons | afferent (body -> brain), efferent (brain -> body) |
| nervous system problems | cerebral cortex, cerebellum, trauma |
| CNS | Central Nervous System, brain and spinal cord |
| PNS | Peripheral Nervous System, nerves branching off spinal cord that run throughout the body |
| Wide based stance | provides lower center of gravity, may indicate difficulty balancing |
| gait | how a person walks/moves |
| abnormalities of gait and posture | spastic hemiparesis, scissors gait, steppage gait, sensory ataxia, cerebellar ataxia, Parkinsonian gait, gait of old age, use of assistive devices for ambulation |
| Nursing interventions related to activity | safety, equipment and assistive devices, positioning, ambulation, range of motion, promoting wellness |
| ways to evaluate activity-related outcomes | ease of movement, gait, body alignment, joints, muscle (mass, tone, strength), endurance |
| body mechanics | your body position when moving |
| ergonomics | environmental factors/equipment that promotes safe body mechanics |
| activity-related concerns for the older adult | activity intolerance - decreased respiratory vital capacity, decreased transport of oxygenated blood; impaired physical activity - decreased range of motion, decreased stability of gait |
| flow sheet | documentation tools used to record routine aspects of nursing care |
| nursing informatics | specialty that integrates nursing science, computer science, and information science to manage and communicate date, information, and knowledge in nursing practice |
| Katz Index of Independence in Activities of Daily Living | tool that scores patients from 0-6 based on independence with bathing, dressing, toileting, transferring, continence and feeding. 6 = patient independent, 0 = patient very dependent |
| involuntary movements | tremors, tics, chorea, athetosis, dystonia, fasciculations, myoclonus, oral-facial dyskinesias |
| DETERMINE | Disease, Eating poorly, Tooth loss/mouth pain, Economic hardship, Reduced social contact, Multiple medications, Involuntary weight loss/gain, Needs assistance in self-care, Elder years above 80 |
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