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178 Cards in this Set
- Front
- Back
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What is the definition of nutritional status? |
The degree of balance between nutrient intake and nutrient requirements. |
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What is nutritional status affected by? |
- physiologic (illness) - psychosocial (family & psychological support) - developmental (age) - cultural - economic (can afford healthy food?) |
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What is optimal nutritional status?
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- Sufficient nutrients are consumed to
support day-to-day body needs - more active - have fewer physical illnesses - live longer than persons who are malnourished |
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What is undernutrition? |
When nutritional reserves are depleted and/or when nutrient intake is inadequate to meet day-to-day needs or there are added metabolic demands that are not met. |
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What are the vulnerable groups for undernutrition? |
- infants - children - pregnant women - recent immigrants - persons with low incomes - hospitalized people - aging adults, |
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What are the results of undernutrition? |
- impaired growth and development - Delayed wound healing |
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What is overnutrition? |
Consumption of nutrients, especially calories, sodium, and fat in excess of body needs |
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What can overnutrition lead to? |
- Obesity - Heart disease and hypertension - Type II diabetes - Sleep apnea - Osteoarthritis |
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What is the definition of overweight? |
A BMI of 25 or higher |
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What is the definition of obesity? |
A BMI of 30 or higher |
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What are adult years an important time for? |
Education to preserve health and to prevent or delay onset of chronic diseases. |
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What are some lifestyle factors that can lead to poor health? |
- cigarette smoking - stress - lack of exercise - excessive alcohol intake - diets high in saturated fat, cholesterol, salt, and sugar and low in fiber |
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What are some chronic conditions that are caused by poor lifestyle choices? |
- hypertension - obesity - atherosclerosis - cancer - osteoporosis - diabetes mellitus |
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What are some changes that occur in the aging adult than can affect their nutritional status? |
- poor dentition - decreased visual acuity - decreased saliva production - slowed gastrointestinal motility - decreased gastrointestinal absorption - diminished olfactory and taste sensitivity
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What is unique about traditional eating customs of immigrants? |
Immigrants commonly maintain traditional eating customs long after language and manner of dress of adopted country become routine |
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Why would a newly arrived immigrant be at risk for nutritional issues? |
- Familiar foods are difficult or impossible to obtain - Low income may also limit their access to familiar foods - When traditional food habits are disrupted, borderline deficiencies or adverse nutritional consequences may result |
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What kind of cultural value might conflict with optimum nutrition? |
Many cultures worldwide consider obesity an indication of beauty, affluence, and well-being |
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To achieve cultural competence, what factors must be considered? |
- Cultural definition of food (what food means to them) - Frequency and number of meals eaten away from home - Form and content of ceremonial meals - Amount and types of foods eaten, and regularity of food consumption |
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Describe the most common occurrences of lactose intolerance. |
affects 30 - 50 Million Americans - Up to 80% of African Americans - 80% to 100% of American Indians - 90% to 100% of Asian Americans - Least common among people of northern European descent |
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Why is it important to know a person's religious practices related to food? |
Enables you to suggest improvements or modifications that do not conflict with dietary laws Other issues are fasting and other religious observations that may limit a person’s food or liquid intake during specified times |
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Give some examples of culture affecting food practices. |
- Jewish Kosher practices does not allow mixing of meat and milk products, prohibits eating of pig meat and crustaceans - Islamic culture also prohibits consumption of pig meat - Muslims, during Ramadan, do not eat during daylight hours and eat only twice a day, before dawn and after sunset |
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What are the various methods for collecting current dietary intake?
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- 24-hour recall
- Food frequency questionnaire - Food diary - During hospitalization, documentation of nutritional intake can best be achieved through calorie counts of nutrients consumed and/or infused |
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What does a nutritional assessment include? |
- Dietary history and clinical information - Physical examination for clinical signs - Anthropometric measures - Laboratory tests |
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What kinds of questions are asked to assess eating patterns and are eating patterns objective or subjective data? |
- Number of meals/snacks per day? - Kind and amount of food eaten? - Fad, special, or alternative diets? - Where is food eaten? - Able to feed self? This is subjective data |
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What kinds of questions are asked to assess usual weight and is usual weight objective or subjective data? |
- What is your usual weight? - Recent weight change? This is subjective data |
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What kinds of questions are asked to assess changes regarding eating and is this objective or subjective data? |
Are there any changes in: - appetite - taste - smell - chewing - swallowing? - what type of change? - when did the change occur? This is subjective data |
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What kinds of questions are asked to assess if there is a need for extra nutrients and is this objective or subjective data? |
Has there been any recent: - surgery - burns - trauma - infection When? What type? How was it treated? This is subjective data |
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What kinds of questions are asked to assess chronic illnesses and is this objective or subjective data? |
- Type? - When diagnosed? This would increase a need for nutrients This is subjective data |
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What kinds of questions are asked to assess GI problems and is this objective or subjective data? |
Has there been any recent: - nausea - vomiting - diarrhea - constipation Why? How Long? This is subjective data |
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What kinds of questions are asked to assess food allergies or intolerances and is this objective or subjective data? |
- any problematic foods? - type of reaction? - how long? This is important for the EHR This is subjective data |
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What kinds of questions are asked to assess medications and nutritional supplements and is this objective or subjective data? |
Prescription medications? Nonprescription (OTC)? Use over a 24-hour period? !ype of vitamin or mineral supplement? Amount? Duration of use? Herbal and botanical products? Specific type/brand and where obtained? How often used? Who recommended? How does it help you? Any problems? This is subjective data |
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What kinds of questions are asked to assess self care behaviors regarding nutrition and is this objective or subjective data?
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- Meal preparation facilities?
- Transportation for travel to market? - Adequate income for food purchase? - Who prepares meals and does shopping? - Environment during mealtimes? This is subjective data |
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What kinds of questions are asked to assess alcohol or illegal drug use and is this objective or subjective data? |
When was last drink of alcohol? Amount taken that episode? Amount alcohol each day? Each week? Duration of use? Repeat questions for each drug used This is subjective data |
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What kinds of questions are asked to assess exercise and activity patterns and is this objective or subjective data? |
- amount? - type? (affects metabolism and how many nutrients are needed) This is subjective data |
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What kinds of questions are asked to assess family history and is this objective or subjective data? |
- Family or personal history of: - heart disease - osteoporosis - cancer - gout - gastrointestinal disorders - obesity - diabetes? - Effect of each on eating patterns? - Effect on activity patterns? This is subjective data |
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What questions are added to an assessment for an aging adult regarding nutrition and is this objective or subjective data? |
- How does your diet differ from when you were in your 40s and 50s? - Why? - What factors affect the way you eat? This is subjective data |
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In observation of general appearance during the nutritional assessment, what can be quickly detected and is it objective or subjective data?
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Obese, cachectic (fat and muscle wasting), or
edematous, can provide clues to overall nutritional status. This is objective data |
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In what areas can nutritional deficiencies be detected? Is this objective or subjective data? |
Because clinical signs are late manifestations of malnutrition, only in areas in which rapid turnover of epithelial tissue occurs, skin, hair, mouth, lips, and eyes, are nutritional deficiencies readily detectable. This is objective data, but these signs may have other causes and need to have labs done to make an accurate diagnosis. |
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What are anthropomorphic measures and are they objective or subjective? |
Measurement and evaluation of growth, development and body composition. This is objective data. |
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What are the most commonly used anthropometric measures? |
- Height - Weight |
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What is the Waist-to-hip ratio and is it objective or subjective data? |
Waist-to-hip ratio assesses body fat distribution as an indicator of health risk. Objective |
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What is android obesity and what risk does it increase? |
persons with greater proportion of fat in upper body, especially in abdomen (apple shape – at risk for cardiac problems)
(which phone do you prefer? Android or Apple's Iphone) |
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What is gynoid obesity? |
persons with most of fat in hips and thighs
(women are more prone to this and women see gynecologists) |
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Where is waist circumference measured? |
is measured in inches at smallest circumference below rib cage and above umbilicus waist circumference alone can be used to predict greater health risk |
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Where is hip circumference measured? |
is measured in inches at largest circumference of buttocks |
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How can height be measured for an elderly adult age 60 or over, or confined to a bed or wheelchair? Is this objective or subjective data? |
arm span, which is correlated with height, may be better measure for elderly. Objective |
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What are the best routinely performed laboratory indicators of nutritional status? |
Hemoglobin – detects iron deficiency anemia Hematocrit – also gives a good fluid volume Cholesterol – evaluates fat metabolism Triglycerides –”Blood Fats” screen for hyperlipidemia Total lymphocyte count – WBC count – can affect the production if malnourished |
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What does hematocrit measure? |
The percentage of red blood cells in the blood. |
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What are the serum proteins tested for nutritional status? |
- serum albumin - prealbumin - Serum transferrin - C-reactive Protein (CRP) |
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What does serum albumin measure?
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measures visceral protein status. Indication of Long Term protein status
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What is prealbumin? |
It is a transport protein for T4. It has a short half life, so it is sensitive to acute changes in protein status. It is increased in renal disease |
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What is serum transferrin? |
It is an Iron transport protein. Low values indicate a mild protein deficiency. |
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What is CRP? |
A plasma protein marker of inflammatory status. Produced by the liver. Normally not detectable in the blood. Also monitors metabolic stress |
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What is the normal fasting level for glucose or blood sugar? |
Less than 100 |
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Describe glycosolated Hemoglobin. |
Hba1c tells us the average blood glucose level for the past 3 months. Normal is between 5% and 7%. A level of 7% may indicate prediabetic and a need for education. |
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Describe Low and High density lipoproteins |
Low density is bad cholesterol and high density is good cholesterol. You want the bad to be low and the good to be high. |
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With lab results, what should be considered with the elderly?
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All serum and urine data must be interpreted with understanding of declining renal efficiency and tendency for aging adults to be overhydrated or underhydrated
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What should be done to monitor nutritional status in malnourished individuals or in individuals at risk for malnutrition? |
A serial assessment should be done (an assessment made at regular intervals). Weight and dietary intake should be done weekly and other assessments made biweekly or monthly. |
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What are the classifications of malnutrition? |
- Obesity - Kwashiorkor (protein malnutrition) |
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What are the nutritional deficiencies? |
- Pellagra (niacin deficiency) - Metabolic Syndrome(MetS) |
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What is metabolic syndrome? |
A group of medical conditions present simultaneously. - high blood pressure (hypertension) - high cholesterol (hyperlipidemia) - excess abdominal fat (visceral fat) - risks for heart disease, stroke & diabetes Also called insulin resistance syndrome |
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What are the nursing diagnoses for nutrition? |
- Risk for imbalanced nutrition - Imbalanced nutrition: More than body requirements - Imbalanced nutrtion: Less than body requirements |
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What is culture? |
The behaviors and beliefs characteristic of a particular social, ethnic,or age group. |
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What is research saying about our diversity in 2050? |
That the majority of young people will be of ethnic heritage and whites will be a minority. The elderly will be comprised mostly of white non-hispanics. |
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What are the health disparities of culture care? |
- That ethnic people receive less quality health care even when coverage is the same. - That across America, babies born just a few miles apart have dramatic differences in life expectancy. |
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What can be done about health disparities of culture care? |
The more educated healthcare workers are at caring for patients of other cultures, the better the outcomes for health care. |
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What are the categories of immigrant populations? |
- legal residents (permanent residents of US) - naturalization (citizenship after birth) - non-immigrants (temporary entry in US) - permanent resident aliens (lawful resident) - refugees (not in their own country for fear of persecution) - unauthorized residents (illegal alien) |
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Why is it important for a nurse to know the immigrant category of a patient? |
If a patient is a willing immigrant, they are more likely to take part in their own health care. If they are a refugee, they may not be as much of a willing participant. |
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What are the 4 basic characteristics of culture? |
- learned - shared - adapted - dynamic |
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What is the learned characteristic of culture? |
Learned from birth, growing up and socializing |
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What is the shared characteristic of culture? |
It is shared among all the people of the cultural group. |
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What is the adapted characteristic of culture? |
The adaptation relates to the conditions of the environment and technical factors |
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What is the dynamic characteristic of culture? |
It is ever changing, always developing |
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What does the cultural iceberg mean and what does it mean for a nurse? |
It means with culture, there a lot more than what you see on the surface, if you're not familiar with the culture. You see the courtesies, not necessarily the beliefs. A nurse needs to know that there's no substitution for getting to know your patient like sharing experiences, building a relationship and getting to know your patient over time. |
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What is cultural competence? |
The complex integration of knowledge, attitudes and skills that all work together to enhance cross-cultural communication. It allows us to act in meaningful ways with our patients. |
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What is heritage consistency? |
We want to assess the patient's heritage consistency to see whether they are more traditional or more modern with their culture. |
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What is traditional health maintenance? |
It is important that we try to help the patient to maintain their own physical, mental and spiritual traditions if they want. We may use Western medicine, but we want to include their traditions as well as we can. |
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What is ethnicity? |
It describes a group united by; - common geographic region - migratory status - religion - race - language - shared values, traditions and symbols - food preferences |
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How does religion play into culture care? |
The healthcare provider may need to consult with the patient's spiritual leader in order to give the patient proper care. The patient trusts this leader and this leader may make a good middle-man to help the patient cooperate. |
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What is socialization? |
The process of being raised within a culture and acquiring the characteristics of that group. |
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What is acculturation? |
When someone comes to the US and holds onto their traditions and beliefs from their culture and may add some American traditions and beliefs into the mix. (A 2 way process of change) |
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What is assimilation? |
When someone comes to the US and their culture is absorbed into the American ways and there is a loss of customs and traditions. (a 1 way process of change) |
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How are health related behaviors affected by religion? |
Often times in different cultures, religion dictates how a person behaves health-wise. They may not want to discuss how they're feeling. It may affect their willingness to undergo a physical exam. |
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Give an example of how different cultures can see the same disease in different ways. |
Epilepsy is viewed by - the people of Uganda as contagious and incurable - Greeks as a family shame - Mexican-Americans as a physical imbalance - Hutterites as having endured a trial by God - Hmong that a great spirit has chosen the child |
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What are the steps to cultural competency? |
1. Understand your own heritage 2. Identify the meaning of health to the patient 3. Understand the healthcare delivery system 4. Understand the social background of the patient 5. Know the translator resources available |
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What is the proper name for a patient's head that is round, symmetric and relative size to their body? |
Normocephalic |
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What are some abnormal findings related to the skull? |
- Microcephaly (too small) - Macrocephaly (too large) - hydrocephaly (enlargement of the skull due to a buildup of fluid in the brain) - Acromegaly (excessively large skull - and body- due to an excess of growth hormone) - Paget's Disease (misshapen bones - including skull) |
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What is the skull palpated for? |
- Symmetry - smoothness - palpate the temporal artery, which should be elastic and nontender |
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What would be abnormal findings for the skull? |
- lumps - depressions - temporal artery more tortuous, hard or tender |
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What do you palpate the temporomandibular joint for? |
- tenderness - limited range of motion (back, forth, protrude and retract) |
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What nerve is the facial nerve? |
VII - it controls the facial muscles (expression) |
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What are the important facial structures that need to be inspected for symmetry? |
- palpebral fissures (eye creases) - naso-labial folds (crease from nose to mouth) |
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What would be abnormal findings when inspecting the face? |
- tense, rigid muscles - flat affect (may be depression) - excessive smiling - marked asymmetry with brain lesions (may have had a stroke) - abnormal facial structures - coarse facial hair - exophthalmos (big bulging eyes) - changes in skin color or pigmentation - peri-orbital edema (swelling around the eyes) - tics (such as blinking or licking lips) |
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What could a crease across the nose be indicative of? |
Allergies (always wiping the nose upward) |
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What are the parotid glands, where are they and are they palpable? |
They are the largest of the salivary glands located in the cheeks over the mandible anterior to and below the ear. They are not usually palpable. |
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What could a swollen parotid gland indicate? |
AIDS, a blockage, mumps |
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What is torticollis? |
condition in which the neck is twisted and the head inclined to oneside, caused by spasmodic contraction of the muscles of the neck. |
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What muscles would cause torticollis? |
- sternocleidomastoid (aka sternomastoid) - trapezius |
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What is the anterior triangle? |
The triangle created by the two sternomastoid muscles |
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What is the posterior triangle? |
The triangle created by the sternomastoid muscle, the trapezius and the omohyoid muscle. |
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Where is the thyroid gland? |
Straddles the trachea in the middle of the neck. |
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When inspecting the neck, what is a nurse looking for? |
- symmetry - ROM (chin to chest, turning to the sides, ears to shoulders, extend the neck backwards. - motions are smooth and controlled |
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What would be abnormal findings in the neck? |
- a head tilt - a rigid head or neck (could be the muscles) - pain or limited movement (may be arthritis or inflammation) |
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When inspecting and palpating the neck, what does a nurse test? |
Muscle strength with resistance. Have them turn their head against the hand. |
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Are salivary glands normally palpable? |
No, they should be recorded if they are. |
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What is the only normal pulsation in the neck? |
The carotid artery |
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What would be an abnormal finding regarding the thyroid? |
Enlargement or nodules. |
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Besides recording the finding, what should a nurse do if the thyroid is enlarged? |
Listen with a stethoscope for any bruits. |
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What is the trachea palpated for? |
A tracheal shift. It should be aligned in the center and a finger can be placed on either side near the base of the sternal notch. |
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Where are the supraclavicular lymph nodes and what drains into them? |
The run along the clavicle. The abdomen and thoracic drain into them. Common causes for enlargement would be lung cancer or stomach cancer |
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Where are the preauricular lymph nodes and what drains into them? |
They are located just anterior to the ears. The scalp and skin drain into them. Common cause for enlargement would be an infection of the external auditory canal. |
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Where are the posterior auricular lymph nodes and what drains into them? |
They are located just posterior to the ears. The ear and temporoparietal region of the skin drains into them. Common cause for enlargement would be a local infection of the skin (like an infected boil). |
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Where are the submandibular lymph nodes and what drains into them? |
They are located beneath the mandible on the angle of the jaw. The cheek, nose and mouth drains into them. Common causes for enlargement would be sinus infection, eye infection or ear infection. |
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Where are the occipital lymph nodes and what drains into them? |
Located on the occipital region of the head and the occipital region of the skin drains into them. Common cause for enlargement would be a local infection like an infected boil on the scalp. |
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Where are the jugulodigastric lymph nodes and what drains into them? |
Where the posterior belly of the digastric muscle crosses the internal jugular vein. (inferior to the ear at the angle of the jaw). The tonsils and posterior part of the tongue drain there. Common cause of enlargement: rubella or pharyngitis. |
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Where are the superficial cervical lymph nodes and what drains into them? |
They lie along the external jugular vein near the surface of the neck. The superficial parts of the head and neck drain into them. |
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Where are the submental cervical lymph nodes and what drains into them? |
They are located beneath the chin. The medial inferior lip, anterior tongue, teeth and chin drain into them. Common causes of enlargement would be mono, toxoplasmosis and dental pathology like periodontitis. |
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Where are the posterior cervical lymph nodes and what drains into them? |
They are located in the middle of the posterior triangle. Scalp, neck, skin of arms and pectorals, thorax, cervical and axillary nodes drain into them. Common causes for enlargement include TB, lymphoma, head and neck malignancy. |
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Where are the deep cervical lymph nodes and what drains into them? |
They run along the internal jugular vein. Most lymph nodes either drain directly or pass through the deep cervical nodes. |
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How are lymph nodes palpated? |
Using the fingerpads, thoroughly and systematically palpate using a gentle circular motion and rotating pattern and in a routine order. |
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How do normal lymph nodes feel? |
Movable, soft and non-tender. |
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What does a nurse check if they find an enlarged lymph node? |
The area that drains into that lymph node. |
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What is lymphadenopathy? |
Enlarged, warm, tender lymph nodes due to infection. They are freely movable. |
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What does an enlarged, fixed, non-tender lymph node signify? |
Typically, a neoplasm or tumor. Could be benign or malignant. |
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What can we assess in the eyes? |
- visual acuity (accuracy) or problems - neurological problems from pupil size or changes in vision - kidney disease (periorbital edema) - digestive disease (jaundice from liver disease) - endocrine issues such as diabetes when visualizing the fundus - cardiovascular (xanthelasma - fat deposits on the eyelids) |
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What does PERRLA stand for? |
Pupils are equal, round and reactive to light and accomodation. |
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When it is said that pupils are equal in size and round, what does that mean? |
Both pupils are the same size, about 3 -5 mm and are round with a regular border and centered in the iris. Any inequality of .5mm or more is abnormal. |
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What does it mean for the eyes to be "reactive to light"? |
- there is a direct response when a light is shone obliquely into one eye and it constricts. - there is a consensual response when a light is shone obliquely into one eye and the other eye constricts, even if a card is placed between the eyes. |
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What does accommodation mean? |
It occurs when a patient moves his focus of vision from a distant object to a near object. The normal response is constriction of the pupils (accommodation) and convergence of the eyes. |
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What is normal visual acuity and what does it mean? |
20/20 is normal visual acuity. The numerator is the distance the patient is standing from the chart. The denominator is the distance which a normal eye can read the chart. That means that 20/50 means the patient is reading what a normal eye can read at 50 feet. 20/30 needs a referral to an eye doctor. |
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What does the handheld vision screener test for? |
Tests near vision. It is held 14" from the face and normal is 14/14. |
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What is myopia? |
Impaired far vision - second number is bigger than the first. The higher the denominator the poorer the vision. (20/40). |
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What is presbyopia? |
Impaired near vision - the decrease in power of accommodation with aging, when the person moves the card further away. Typically affects patients over 45. |
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What eye issues plague aging adults? |
- decreased adaption to darkness (need more light to read) - cataracts - glaucoma - macular degeneration |
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What are cataracts? |
Clouding of the eye lens. |
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What is glaucoma? |
a disease of the eye in which pressure within the eyeball damages the optic disc, impairing vision, sometimes progressing to blindness. Loses peripheral vision and depth perception. |
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What is Macular Degeneration? |
degeneration of the central portion of the retina resulting in a loss of sharp vision. |
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What is the normal aging process of the eye? |
- decreased tear production causing a feeling of dryness and burning - pupil size decreases - arcus senilis - the cornea shows infiltration of fatty material - the lens loses elasticity becoming hard and glasslike |
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What is the leading cause of blindness worldwide? |
Cataracts - mostly in third world countries. |
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What do the ears and urinary system have in common? |
They develop at the same time in utero so if there is an ear deformity, it could indicate kidney problems. |
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What could tinnitus or vertigo mean? |
It may be associated with cerebrovascular disease. |
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What does the respiratory system have to do with the ear? |
Because the eustachian tubes open into the middle ear, upper respiratory infections often precede ear infections, particularly in children. |
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What cranial nerve is responsible for hearing? |
Cranial nerve VIII |
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What are the risk factors for hearing loss? |
- genetic predisposition - congenital anomalies - preauricular tag - otitis media - fluid in inner ear - loud noises - micronutrient deficiencies - ototoxic medications - eardrum trauma - otosclerosis - viral infections of the inner ear - Meniere's disease - impacted cerumen |
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What is cerumen? |
Ear wax |
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How do you palpate and inspect the ear? |
- size, shape & symmetry - skin condition - tenderness - inspect the external auditory meatus - inspect the tympanic membrane and external canal with an otoscope |
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What does the tympanic membrane look like normally? |
- pearly gray, translucent, no bulging or retraction - slightly concave, smooth and intact - a cone shape reflection of the otoscope light is normally seen at 5 o'clock in the right ear and 7 o'clock in the left ear |
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What are two ways of testing hearing acuity? |
- Whispered voice test - Romberg test to rule out vestibular issue |
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What are the pathways of hearing? |
- Air conduction (normal pathway for hearing) - bone conduction (bones of the skull vibrate transmitting directly to the inner ear and CNVIII) |
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What is conductive hearing loss and what causes it? |
Mechanical dysfunction of the external or middle ear. A partial loss when the patient can hear if the amplitude is increased. Causes include, impacted cerumen, foreign bodies or a perforated tympanic membrane. |
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What is sensorineural hearing loss? |
Also called Perceptive hearing loss, is a pathology to the inner ear, damage to the cranial nerve VIII or damage to the auditory areas of the brain (the cerebral cortex). Increasing the amplitude will not help the patient to hear. Causes include presbycusis or ototoxic drugs. |
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What is presbycusis? |
Nerve degeneration with aging. |
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What do ototoxic drugs affect? |
The hair cells in the cochlea. |
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What are some common ear problems? |
- swimmer's ear (otitis externa) - acute otitis media (fluid in the ear) - otalgia (earache) |
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What is inspected in the mouth? |
- teeth - gums - tongue - salivary glands |
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How many pairs of salivary glands are there and what are they called? |
Three pairs: - the parotid glands are in the cheeks - the submandibular glands are under the mandible at the angle of the jaw - the sublingual glands that lie under the tongue |
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How do you grade tonsils? |
0 - removed tonsils 1 - tonsils can barely be seen 2 - tonsils can easily be seen 3 - tonsils extend close to the uvula 4 - tonsils extend all the way to midline |
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What is a sentinal event? |
An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. |
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What is the Joint Commission on Accreditation of Healthcare organizations? |
An independent, not for profit organization that evaluates and accredits health care organizations and programs in the US. |
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What is a root cause analysis? |
A class of problem solving methods aimed at identifying the root causes of problems or events. |
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In 2006, what was a contributing factor in root causes analyses and 65% of sentinel events? |
Communication. |
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What can contribute to miscommunication in the medical field? |
- communication across a hierarchy can be intimidating - gender or cultural issues - feeling as though you're not being heard (often named as a cause of job dissatisfaction) |
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What percent of medication errors are caused by interpersonal communication? |
60% |
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What is the most common cause of adverse events triggering root cause analyses? |
Poor coordination of care (communication). |
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What are the steps to excellent healthcare communication? |
1. Clarify the problem and gather data 2. concisely describe the problem 3. actively listen to response 4. assert concerns if needed |
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What does SBAR stand for in SBAR communication? |
- Situation - Background - Assessment - Recommendation |
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How do you communicate "the situation"? |
State what is happening at the present time (Example: spiking a fever of 103 degrees) |
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How do you communicate "background"? |
Explain the circumstances leading up to the situation, putting the situation into context (example: post-op yesterday they had 102 degree fever) |
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How do you communicate "assessment"? |
What you think the problem is (example: may be developing an infection) |
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How do you communicate "recommendation"? |
What you would do to correct the problem (example: give antibiotics) |
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In practicing SBAR communication, what should be done before calling the physician? |
1. Assess the patient 2. Review the chart for the appropriate physician to call 3. Know the admitting diagnosis 4. Read the most recent progress notes and the assessment from the nurse of the prior shift (this is important) 5. Have available when speaking to the physician (chart, allergies, meds, IV fluids, and labs/results) |
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What is the first step when calling the physician? |
Gather and clarify all the information you need to provide to the physician - the nature of the problem - supporting information - clarify in your mind what's needed for the patient |
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What is the second step when calling the physician? |
State concisely to the physician the problems that the patient is experiencing. - nature of the problem - supporting information - question or issue on which you need their input - be direct |
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What is the third step when calling the physician? |
Actively listen to information communicated by the physician - listen to the plan of care - clarify areas which are unclear by asking appropriate questions |
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What is the fourth step when calling the physician? |
Know how to tactfully use assertive communication when necessary - state your concern - state information that supports your concerns - suggest a course of action - recap why you feel this action is the best option |
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What is effective communication essential to? |
- essential for real teamwork - essential for long term career satisfaction - essential for patient safety and quality care |
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68 year old woman, 2 day post-op. You're assigned to care for her. No problems were noted at sign-out other than pain. She was given pain meds. When performing your initial assessment, she's confused. What additional information do you need to gather prior to contacting the physician? |
- vital signs including pulse ox - name, dose and timing of last pain med - any additional info that you feel would be helpful |
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What should a nurse do when assertiveness doesn't work? |
- restate concerns in another way - engage another healthcare worker - Engage the supervisor - engage another physician on the team |
