Unit 1
Specialty practice of medical-surgical nursing
Promote, restore, or maintain optimal health for patients 18 years and older
Nurses must have knowledge, skills, and attitudes to be
Care coordinators
Transition managers
Caregivers
Pt educators
Leaders
Advocates for the pt and family
...
Exam 1 med surg study guide Unit 1 Specialty practice of medical-surgical nursing Promote, restore, or maintain optimal health for patients 18 years and older Nurses must have knowledge, skills, and attitudes to be Care coordinators Transition managers
Caregivers Pt educators Leaders Advocates for the pt and family The joint commission: effective care coordination and transition management Understandable discharge instructions for the patient and family Explanation of self-care activities Ongoing or emergency care information List of community and outpatient resources and referrals Knowledge of the pts language, culture, and health literacy Medication reconciliation Safety The ability to keep the patient and staff free from harm and minimize errors in care Nursing safety priority boxes Critical rescue
Action alert Drug alert The join commission: a culture of safety Blame-free approach Patients and families are safety partners w/hcp and organizations Serious events must be reported Teamwork and interprofessional collaboration Collaborate with interprofessional health care team Interprofessional education collaborative competencies Values/ethics for interprofessional practice Role-responsibilities Interprofessional communication Teams and teamwork Communication: SBAR
Formal method of hand-off communication between two or more health care team members 4 steps s-situation (name, age, dx)
b-background (history, home meds, allergies)
A-assessment (ivs, v/s, labs) Recommendation/request (plan, pt updates)
teamSTEPPS Delegation Process of transferring a selected nursing task or activity to a competent UAP (unlicensed assistive personnel) The nurse is always accountable for the task/activity delegated! Nugget**
Make sure they understand, and it is within their scope of practice!! Be specific
Prioritization and delegation Physiological, psychological, acute, chronic, unstable, stable, unpredictable, predictable Five rights of delegation Right task
Right circumstances Right person
Right communication Right supervision Supervision Guidance or direction, evaluation, and followup by the nurse to ensure a task/activity is performed appropriately Evidence-based practice (EBP)
Integration of the best current evidence and practices to make decisions about patient care Considers patient preferences and values Considers one own clinical expertise for delivery of optimal health care Ethics Addresses issues and questions about morality Attributes Autonomy
Beneficence Nonmaleficence Fidelity Veracity Social justice Common health problems of older adults Concepts The priority concepts are mobility nutrition and cognition Subgroups of late adulthood Young old- 65 to 74 years Middle old 75-84 years Old old – 85 to 99 years Elite old- 100 plus Common health issues and concerns Performance of adls
Participation in social activities Losses Health promotion Special considerations for older adult clients Decrease tolerance to meds Decrease iv rate to avoid fluid overload Increase risk of: Respiratory depression Pneumonia Disorientation Skin breakdown Problems w/ Circulation Nutrition Constipation Fluid and electrolyte balance Increase balance and decrase falls Sudden increase in confusion Urine infection Hypoxia Electrolyte imbalance Clinical management Treat coexisting medical disorders Cardiac problems Pvd
Neurological disorders Nugget**
Copd Resp. issues Common health issues and concerns Impaired nutrition and hydration Impaired mobility strokes, risk falls Stress, loss, and coping Accidents Drug use and misuse Impaired cognition Substance use Elder neglect and abuse Nugget**
Depression Health need: seeing MD as needed Impaired nutrition and hydration Increased need for calcium, vit a/c/d, fiber Diminished taste and smell, tooth loss, poor dentures can impact nutrition status Constipation concers Loneliness Skin breakdown Nutrition support Avoid friction, shearing
Reposition and provide support surfaces Increase mobility and activity Clean skin, use moisture barriers Rehabilitation interprofessional team Nurses, nursing assistants Physicians and physician assistants Advanced practice nurses Physical therapists and assistants OT and assistants Speech-language pathologists and assistants Neuropsychologists Social workers Psychologists Spiritual care counselors Registered dietitians Pharmacists Cardiovascular and respiratory assessment Assess for decrease in cardiac output
Chest pain Weakness and fatigue Plan care to maximize limited energy resources Frequent rest periods Major tasks in morning Determine level of activity that can be done without invoking symptoms Nugget**
Fluid in lungs and DVTs
SOB
Crackles, rhonchi Improving physical mobility Safe patient handling practices Position changes (bed to chair, commode, or wheelchair) Provide assistance w/ transfers Gait training Use of assistive devices/ambulatory aids (canes and walkers) Implementing ROM routines/exercises Coordinate care w/PT and OT
Assess pts mobility levels using standardized tool Nugget** look at chart 6-1 Canes and walkers**
Cane opposite affected leg (COAL)
Walker, with, affected leg (wandering Wilma’s always late) Skin and tissue integrity assessment
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