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134 Cards in this Set
- Front
- Back
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What are the six steps of evidence based practice? |
1) Ask a clinical question 2) Search for the most relevant and best evidence that applies to the question 3) Critically appraise the evidence you gather 4) Apply or integrate evidence along with your clinical expertise, patient preferences, and values in making a practice decision or change 5) Evaluate the practice decision or change 6) Communicate your results |
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What is the purpose of evidence based practice? |
It is a way of using a step-by-step approach that ensures you will obtain the strongest available evidence to apply patient care. |
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What is the spirit of inquiry? |
An ongoing curiosity about the best evidence to make clinical decisions. |
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What is evidence based practice? |
The process of making informed decisions about the way you care for patients. (Research shows us how long we should wash our hands, etc.) |
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What is a PICOT question? |
A format that is used to ask a question in a clearly worded manner. |
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What is the P in PICOT stand for? |
Patient population of interest. In this portion you should identify your patient by age, gender, ethnicity, disease, or health problems. |
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What is the I in PICOT stand for? |
Intervention or issue of interest. In this portion you should discuss which intervention you think is worthwhile to use in practice. |
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What is the C in PICOT stand for? |
Comparison intervention or issue of interest. In this portion you should discuss which standard of care is currently being used and compare it to the new intervention. |
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What is the O in PICOT stand for? |
Outcome. What is the result you are attempting to achieve via the intervention? |
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What is the T in PICOT stand for? |
Time. How long does it take for an intervention to achieve the outcome? |
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Do PICOT questions require the use of all five elements? |
No, many times other elements are not necessary. |
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What is a peer reviewed article? |
An article that has been evaluated by a panel of experts familiar with the topic or subject matter of the article. |
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What is the strongest strength of evidence? |
A random controlled trial that has had the opinion of expert clinicians. |
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What is CINAHL? |
The Cumulative Index of Nursing and Allied Health Literature. This database includes studies in nursing, allied health, and biomedicine. |
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What is MEDLINE? |
A database that includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. |
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What is EMBASE? |
A database the focuses on biomedical and pharmaceutical studies. |
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What is psycINFO? |
A database that focuses on psychology and related health care disciplines. |
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What is the Cochrane Database of Systematic Reviews? |
A database of containing full text of regularly updated systematic reviews prepared by the Cochrane Collaboration which includes completed reviews and protocols. |
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What is the National Guidelines Clearinghouse? |
A repository for structured abstracts (summaries) about clinical guidelines and their development and also includes condensed version of guideline for viewing. |
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What is PubMed? |
A health science library at the National Library of Medicine which also offers free access to journal articles. |
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Which databases represent the most comprehensive scientific knowledge base on health care? |
CINAHL, PubMed (MEDLINE), and the Cochrane Database. |
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Which database would you use when you want to develop a plan of care for a patient? |
National Guidelines Clearing House. |
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According to EBP, what can poor communication cause? |
Misunderstanding, clinical errors, and poor outcomes. |
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What are the four things that cannot be designated to NAPs? |
Clinical Judgement, Assessment, Education, and Critical Thinking. |
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When does planning for discharge begin? |
It begins at admission and continues throughout the patient's stay in the agency. |
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What does discharge planning achieve? |
It achieves specific outcomes including identifying a patient's ongoing health needs, determining the level of care required, proper referrals, proper resources, and transitioning the patient for their next level of care. |
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What is active listening? |
An interpersonal process whereby a person hears a message, decodes the meaning, and conveys an understanding about the meaning to the sender. |
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What is cadence? |
Pace or rate of verbal communication. |
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What does clarifying mean? |
An attempt to put into words vague ideas or unclear thoughts of a patient to enhance the nurse's understanding, or asking the patient to explain what he or she means. |
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What is comforting? |
Any nursing action taken to promote comfort of a patient, such as a back rub or change in position. |
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What is de-escalation? |
A communication strategy involving the reduction of anxious and/or agitated behaviors exhibited verbally or nonverbally by a patient. Using a calm yet firm approach diffuses the patient's increasing anxiety and/or agitated state, thereby minimizing potentially violent outbursts. |
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What is empathy? |
The ability to recognize and to some extent share the emotions and state of mind of another and to understand the meaning and significance of that person's behavior. |
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What is interviewing? |
The process of conducting an organized, systematic conversation with a patient. It is designed to gather information regarding a patient's level of health, response to care, or perception of symptoms or events. |
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What is the orientation phase? |
Period in the nurse-patient relationship when a nurse and patient first meet and set the tone for the rest of their relationship, assessing the patient's situation and setting goals. |
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What is paraphrasing? |
Transforming a patient's words into the nurse's words, keeping the meaning intact. |
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What is reflecting? |
A cognitive strategy that involves reappraisal of one's actions to evaluate outcomes. A communication strategy used to clarify what a patient is feeling and affirm that the patient's feeling are acceptable. |
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What is restating? |
A communication strategy involving the reiteration of a patient's verbal statements and/or questions using similar words. This affirms that the message was acknowledged by the nurse. |
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What is summarizing? |
A process in which an interviewer organizes and condenses information provided and verifies with the patient that the information is correctly interpreted. |
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What is the termination phase? |
The period in the nurse-patient relationship when a nurse and patient examine and evaluate their relationship and its goals and results. The time when they deal with the emotional content involved in saying good-bye. |
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What is therapeutic silence? |
The use of silence that encourages verbal description and reflection. Avoidance of premature verbal communication that may be caused by a nurse's anxiety. |
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What is the working phase? |
The period in the nurse-patient relationship when the focus is on communication strategies, interventions for problem resolution, and enhancement of self-concept. |
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What is communication? |
An interaction between two or more persons that involves the exchange of information between a sender and a receiver. It is an essential component of the human experience, involving the expression of emotions, ideas, and thoughts through verbal (words or written language) and nonverbal (behaviors) exchanges. |
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What is therapeutic communication? |
An application of the process of communication to promote the well-being of a patient. |
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What are some tips for communicating with a patient who speaks a different language? |
-Use a caring tone of voice and facial expressions to help alleviate patients' fears and anxieties. -Speak slowly and distinctly but not loudly. -Use gestures, pictures, and role playing to help patients understand. -Repeat a message in different ways if necessary. -Be alert to and use words that a patient seems to understand and use them frequently. -Keep messages simple and repeat them frequently. -Avoid using medical terms that a patient may not understand. -Use an appropriate language dictionary or have a medical interpreter or family member make flash cards to communicate key phrases. |
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How would you communicate with an anxious patient? |
Have a relaxed posture, stay at the patient's bedside, and have active listening skills. Provide reassurance to deescalate the situation. Help the patient with alternative coping strategies (deep breathing, visual imagery, etc.) Provide any necessary comfort measures. |
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How would you communicate with an angry patient? |
-Use gestures that are slow and deliberate -Use nonthreatening (non)verbal communication skills -Use therapeutic silence to allow patient to vent feelings. -Set limits on power struggle questions -Use redirection if necessary -Remain calm and professional -Notify proper personnel if harm is imminent -Maintain personal space -Maintain non-threatening position |
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How would you communicate with a cognitively impaired patient? |
-Face them and approach them from the front -Use a brief and simple introduction -Active listening/nonverbal behaviors -Use clear, concise, verbal techniques -Ask one question at a time -Do not overwhelm the patient -Do not attempt to guess what the patient is attempting to say -Repeat sentences if necessary -Use AAC devices if possible -Do not argue or correct the patient -Be creative if possible |
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What are some effective teaching techniques? |
Avoid asking questions about information that may not yet have been disclosed to the patient (e.g., human immunodeficiency virus [HIV] status, diagnostic test results). Avoid asking “why” questions; this causes increased defensiveness in the patient and prevents communication. When teaching, try to have a family member/significant other present with whom to reinforce the content of the instruction. If a patient is experiencing subjective distress in the form of pain or anxiety, take measures to minimize these subjective experiences. Controlling noise level and interruptions is also important. |
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What are good tips to use when discharging a patient? |
-Use clear, concise descriptions in patient's own language. -Provide step-by-step description of how to perform a procedure (e.g., home medication administration). Reinforce explanation with printed instructions for the patient to take home. -Identify precautions to follow when performing self-care or administering medications. -Review any restrictions that may relate to activities of daily living (e.g., bathing, ambulating, and driving). -Review signs and symptoms of complications to report to health care provider. -List names and phone numbers of health care providers and community resources for the patient to contact. -Identify any unresolved problem, including plans for follow-up and continuous treatment. -List actual time of discharge, mode of transportation, and who accompanied patient. |
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What is an advanced directive? |
A document that gives a patient's directions about future medical care or designates another person(s) to make medical decisions if the individual loses decision-making capacity. |
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What are the different types of advanced directives? |
Living will, power of attorney for health care, or any notarized handwritten document. |
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What is asepsis? |
The absence of disease-producing (pathogenic) organisms. |
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What is aseptic technique? |
The methods used during patient care to prevent microbial contamination. They can either be clean (medical asepsis) or sterile (surgical asepsis) techniques. |
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What does colonized mean? |
The presence of bacteria on the surface or in the tissue of a wound without indications of infections such as purulent exudate, foul odor, or surrounding inflammation. All stage II, III, and IV pressure ulcers are colonized. |
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What is an invasive procedure? |
A procedure in which the normal protective barrier of the skin or mucous membrane is broken or compromised (e.g., and intravenous puncture or bladder catheterization). |
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What is isolation? |
Infection control and prevention methods such as barrier technique that are used to decrease the transmission of microorganisms. |
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What is medical asepsis? |
The techniques used to reduce and prevent the spread of microorganisms. It is also called a clean technique. |
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What is an HAI? |
Health care associated infection. Infection that was not present or incubating at the time of admission. |
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What are standard precautions? |
Techniques used to reduce the risk for the transmission of bloodborne pathogens or microorganisms present in moist body substances regardless of a patient's diagnosis or infection status. |
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What is surgical asepsis? |
Practices or techniques designed to render and maintain objects and areas free from pathogenic microorganisms. Also referred to as sterile techniques. |
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What are transmission based precautions? |
Techniques used to prevent the transmission of microorganisms from patients documented or suspected to be infected with highly transmissible pathogens for which additional precautions beyond standard precautions are needed. The three types are airborne, droplet, and contact precautions. |
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What is the most important and basic technique in preventing and controlling the transmission of infection? |
Hand hygiene. |
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How much soap do you apply when washing your hands? |
3-5 mL |
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When do you use sterile technique? |
When you perform a certain invasive procedure. |
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What is a strike through? |
A source of contamination by which moisture permeates a sterile field or barrier. |
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What are the three primary situations where surgical asepsis is needed? |
-During procedures that require intentional perforation of the patient's skin (central IV) -When the integrity of the skin is broken because of a surgical incision or burns -During procedures that involve insertion of devices or surgical instruments into normally sterile body cavities (urinary cath). |
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What are the principles of surgical asepsis? |
-All items used within a sterile field must be sterile -Punctures, tears, or moisture which permeates the field makes it no longer sterile -1" border around the edge is not sterile -Table drapes below the table are not sterile -When in doubt, not sterile -Sterile contacts sterile, unsterile contacts unsterile -Movement around the field must not contaminate -Below the waist or out of view=contaminated -Time (air exposure) will make things unsterile, complete procedure ASAP |
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Can the powder in latex gloves produce a latex allergy? |
Yes it can. |
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Which individuals are at a great risk for latex allergy? |
-Spina bifida -Congenital or urogenital defects -History or indwelling or repeated catheterization -History or condom catheter -High latex exposure -History of high childhood surgeries -History of food allergies |
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What is a type I allergic reaction? |
A true latex allergy that can be life-threatening. Reactions vary based on the latex protein and degree of individual sensitivity, including local and systemic. Symptoms include hives, generalized edema, itching, rash, wheezing, bronchospasm, difficulty breathing, laryngeal edema, diarrhea, nausea, hypotension, tachycardia, and respiratory or cardiac arrest. |
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What is type IV hypersensitivity? |
A cell-mediated allergic reaction to chemicals used in latex processing. Reaction including redness, itching, and hives, can be delayed up to 48 hours. Localized swelling, red and itchy or runny eyes and nose, and coughing may develop. |
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What is Irritant dermatitis? |
A nonallergic response characterized by skin redness and itching. |
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If you are allergic to latex gloves and need to perform a sterile procedure but there are only latex gloves available, what can you do? |
Put on a pair of synthetic gloves before donning the latex sterile gloves. |
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What are ADEs? |
Adverse drug events. Unfavorable reactions to medications that present during the normal course of treatment. The effect of and ADE may range from minimal harm to significant injury or death. |
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What is an idiosyncratic reaction? |
A response to a medication or therapy that is unique to an individual. |
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A nurse is getting ready to develop a plan of acre for a patient who has a specific need. The best source for developing this plan of care would probably be what? |
NGC |
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A well developed PICOT question helps the nurse do what? |
Search for evidence. |
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EBP is a problem-solving approach to making decision about patient care that is grounded in what? |
Systematically conducted research studies. |
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When conducting research and looking at articles, what should you look at first? |
The abstracts. |
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In a PICOT question, what letter corresponds with the usual level of care? |
C |
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The nurse is not sure that the procedure the patient requires is the best possible for the situation. Which resource would be the quickest way to review research on the topic? |
The Cochrane Library |
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When EBP is used, patient care will be what? |
Variable according to the situation. |
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The nurse wants to determine the effects of cardiac rehabilitation program attendance on the level of post myocardial depression for individuals who have had a myocardial infarction. Which type of study would best capture this information? |
A qualitative study. |
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What is parenteral medication? |
Medication not given through the digestive system. |
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What is a unit-dose system? |
System of drug distribution in which a portable cart containing a drawer for each patient's medications is prepared by the pharmacy with a 24-hour supply of medications. |
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What must occur when discarding narcotics? |
A second nurse must witness the disposal of the unused narcotic and the record must be signed by both nurses. |
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If a medication error occurs, what must be done? |
Patient's safety and well being must first be addressed. Notify the healthcare provider immediately. Report the incident to the proper person in the agency (ex. nurse supervisor). Prepare a written incident or occurrence report within 24 hours. |
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What is an air embolus? |
A quantity of air that circulates the bloodstream to eventually lodge in a blood vessel. |
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What is an anaphylactic reaction? |
Exaggerated hypersensitivity reaction to a previously encountered antigen. It is a severe and sometimes fatal systemic reaction characterized by itching, hyperemia, angioedema and, in severe cases, vascular collapse, bronchospasm, and shock. |
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What is an ampule? |
Small sterile glass or plastic container that usually contains a single dose of solution to be administered parenterally. |
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What is a blunt-tip vial access cannula? |
A needleless cannula designed to be inserted into a vial adapter or for needleless access to fill a syringe. |
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What is CSQI? |
Continuous subcutaneous infusion. A method of medication administration in which medication is administered continuously into the subcutaneous tissue using a medication infusion pump. |
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What is extravasation? |
The inadvertent infiltration of IV fluids or medications into the subcutaneous tissues surrounding the infusion site. |
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What is induration? |
Hardening of a tissue, particularly the skin. |
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What is infiltration? |
The presence of intravenous fluids within the subcutaneous space surround a venipuncture site. |
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What is the Z-track method? |
A method for injecting irritating medications into muscle without tracking residual medication through sensitive tissues. |
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What are facts about a ventrogluteal injection site? |
-Deep and situated from major blood vessels/nerves -Identified via bony landmarks -Preferred for meds that are more viscous, irritating, or in larger quantity -Less painful |
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What are facts about a vastus lateralis injection site? |
-Absence of major blood vessels/nerves -Rapid drug absorption |
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What are facts about a deltoid injection site? |
-Easily accessible but not well developed in most patients -Used for small volumes of medications -Faster absorption rate -Vaccination site for adults based on muscle development |
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What angle do you inject a IM injection? |
90 degrees. |
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What angle do you inject a subcutaneous injection? |
45 or 90 degrees, depending on the amount of tissue. |
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What angle do you inject an intradermal injection? |
5-15 degrees. |
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What is a Luer-Lok syringe? |
A syringe that has a tip where a needle can be added or removed by twisting. This design prevents the accidental removal of a needle from the syringe. |
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What is a Non-Luer-Lok syrninge? |
A syringe where the needle slips on. This does not have a designed twisting mechanism and the needle may be removed by pulling. |
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How are insulin syringes measured? |
In units. From 0-50 or 0-100 units. |
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How are TB syringes measured? |
In mL. From 0-1.00 mL. |
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What is the most common needle size for an IM injection? |
1" to 1 1/2" and a large 18-22 gauge needle. |
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What is the most common needle size for a subcutaneous injection? |
3/8 to 5/8" and a small 25-27 gauge needle. |
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How deep is an ID injection? |
3mm or 1/8" |
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At what rate do you inject into an ID site? |
1ml per 10sec |
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Why use an IM injection site? |
This route deposits medication into deep muscle tissue which has a rich blood supply and allows medication to be absorbed faster than by a subcutaneous route. |
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For an IM injection, which gauge needle would you use for a aqueous solution or immunization? |
20-25 gauge |
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For an IM injection, which gauge needle would you use for viscous or oil-based solution? |
18-21 gauge |
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What size needle would you use for an injection into the vastus lateralis ? |
16-25mm or 5/8 to 1 inch |
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What size needle would you use for an injection into the ventrogluteal region ? |
38mm or 1 1/2 inch |
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What size needle would you use for an injection into the deltoid? |
25-38mm or 1 to 1 1/2 inches |
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How far below the acronym process is the deltoid IM injection site? |
3-5 cm or 1-2 inches |
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How much medication can be injected into the deltoid site? |
2-3 mL for an adult. |
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What gauge is the needle for a TB syringe? |
25-27 gauge and is usually pre-attached. |
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When performing an IM injection in the ventrogluteal region, where must you place the palm of your dominant hand? |
Over the greater trochanter of the patient's hip. |
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What is micturition? |
The act of passing or expelling urine voluntarily through the urethra. |
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What is the normal rate for micturition in an adult? |
30 mL/2hr or 2200 to 2700 mL/24hr |
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What is required for placement of a urinary catheter? |
A medical order. |
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What size is the catheter in most adults? |
14-16 Fr |
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How much fluid should be used to inflate a 5mL balloon in a urinary catheter? |
5-10 mL |
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What position should a female be in for a urinary catheter insertion? |
The dorsal recumbent position (on back with knees flexed). An alternative position can be the Sims position with the upper leg flexed at the knee and hip. |
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What position should a male be in for a urinary catheter insertion? |
Supine with legs extended and thighs slightly abducted. |
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What are signs and symptoms of deficient fluid volume? |
Eyes: Sunken, dry, absence of tearing Mouth: Sticky, dry, cracked lips, decreased saliva, shrunken tongue Skin: Increased skin temperature, dry, scaly, poor tugor CV: Increased pulse, weak pulse, hypotension, decrease cap refill, flat neck veins GI: Sunken abdomen, vomiting, diarrhea, abdominal cramps Renal: Oliguria or anuria, increase in urine gravity |
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What are signs and symptoms of excessive fluid volume? |
Eyes: Periorbital edema, blurred vision, papilledema Mouth: Excessive salivation Skin: Edema, anasarca CV: Bounding pulse, S3 sound, distended neck veins GI: Vomiting, diarrhea, abdominal cramps Renal: Decreased urine specific gravity, diuresis |
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Why do we insert a urinary catheter? |
To drain urine. |
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What is a bladder scanner used for? |
It creates an ultrasound of the bladder in order to measure how much urine is in it. |
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What is PVR? |
Postvoid residual or the volume of urine in the bladder after a normal voiding. |
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When do you take a PVR reading? |
Within 10 minutes of voiding. |
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What is a normal PVR reading? |
Less than 50 mL |
