Med/Surg Week 1

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tville01
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191675
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Med/Surg Week 1
Updated:
2013-01-07 21:03:38
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Med Surg Week
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Med/Surg Week 1
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  1. What is the accrediting body for hospitals and other health care systems that creates and monitors safety goals
    TJC
  2. Identify 5 core competencies to help improve patient safety:
    • 1. Provide patient-centered care. 
    • 2. Collaboration with the IDT 
    • 3. Implement EBP 
    • 4.  UseQI in patient care 
    • 5.  Useinformatics
  3. SPEAKUP
    • S – speak up if you have questions or
    • concerns.
    • P – pay attention to the care you are
    • receiving.
    • E – educate yourself about your diagnosis
    • A – ask a trusted person to be your
    • advocate
    • K- Knowledge about medication
    • U – use an agency accredited by TJC or
    • some other recognized accrediting agency
    • P – participate in decision making
  4. A systematic strategy to improve communication and prevent errors.
    • SBAR
    • S- ituation
    • B- ackground
    • A- ssessment
    • R- ecommendation
  5. uses measure/indicators of quality, safety, and cost effectiveness
    QI
  6. using the electronic health record (ER) to document, store, and retrieve patient’s
    health record
    Informatics
  7. What three main concepts are used for EBP:
    • Bestevidence
    • Clinical experience and expertise
    • Patient values and preferences
  8. What are the steps of EBP
    • 1. Ask question
    • 2. Find best evidence
    • 3. Appraise and synthesize evidence
    • 4. Make recommendation to improve practice
    • 5. Implement recommendations
    • 6. Evaluate results
  9. What is the focus of medical surgical nursing
    holistic patient care for adult patients utilizing a therapeutic relationship
  10. What are the roles of a medical surgical nurse
    • Care coordinators
    • Collaborate with health team members
    • Provide care through the nursing process
    • Utilize critical thinking to solve problems
    • Develop continuity of care guidelines
    • Educate clients and their family members
  11. What assessment of the client to help to determine teaching:
    • pt educational level
    • pt socioeconomic status
    • Client support systems and family strengths
    • age
    • cultural background and its impact on their learning ability
    • language barriers
    • Spiritual beliefs
    • Capability to perform self care skills
  12. What is different about adult learning/teaching
    • pt must want to learn
    • family reinforces teaching
    • identify pt motivators
    • use visual aids
    • allow pt to learn in their own way
    • information portions
    • hands on learning
    • give resource recommendations
  13. What should be done during pre-op nursing assessment
    • pt health history
    • Age
    • smoking status (how much, how long)
    • medications (including OTC and illicits)
    • medical history
    • surgical history
    • pt last PO intake?(Usually NPO after MN)
    • Family or other support?
    • Will they need a driver?
  14. What is done during the physical assessment of a pre-op pt
    • VS, CV, respiratory, neurological, skin, and musculoskeletal assessments.
    • Review labwork –report any abnormals to
    • surgeon. 
    • Check if EKG and CXR are needed (history and age related).
  15. What labs are drawn for a pre-op pt
    • CBC
    • Urinalysis
    • Chem 7
    • CXR(sometimes)
  16. What is considered when performing the psychosocial assessment for a pre op pt
    • How good is the pt support system?
    • Who will care for the pt when they go home? 
    • Are they present and willing to be educated about pt post-op needs?
  17. During the planning stage of ADPIE for a pre op pt the nurse will
    • Assess pt & family’s understanding of procedure and outcomes (including restrictions).
    • Explain procedure again to pt & family clarifying any questions they may have.
  18. What are the interventions performed by a nurse for a pre op pt
    • Obtain informed consent
    • Be aware of medications(what to hold/give)
    • Bowel prep
    • skin prep
    • Inform pt of IV/drainage after surgery
    • Demonstrate post op exercises and restrictions
    • Try to decrease anxiety
  19. What types of consent forms are signed during pre op
    • Surgery consent(no abbreviation)
    • Anesthesia consent
    • Blood transfusion consent
  20. What can be found on an informed consent form
    • Description of procedure and alternative therapies
    • Underlying disease process and its natural course
    • Name and qualifications of person performing procedure
    • Explanation of risks and how often they occur
    • Explanation that patient has the right to refuse treatment or withdraw consent
  21. Who carries the responsibility of providing the patient with the information on a consent form
    Surgeon
  22. Who signs the consent form
    • Pt must be 18 years old to sign own consent or be an emancipated minor
    • Parent signs for dependent children
    • Patient must be competent
    • Patient must be alert & oriented
    • Consent may not be signed by patient after
    • receiving narcotics or sedatives
    • Not necessary if threat to life and patient or legally authorized person unavailable
  23. What are the three requirements that must be met with an informed consent
    • Adequate disclosure of diagnosis(purpose, risks, and consequences of treatment, probability of success, prognosis if not instituted)
    • Understanding & comprehension(patient must be drug free prior to signing consent)
    • Consent given voluntarily
  24. Anticoagulants and anti platelets are normally held for __ days before surgery
    7
  25. What medication can be taken with a sip of water for a pre op pt
    cardiac drugs
  26. When is bowel prep done and what is used
    • abd & bowel surgeries
    • Golytely
  27. Why is shaving not recommended for pre op pt
    increased risk of infection
  28. What should be done to make sure the pt medical record is ready for surgery
    • Pt ID bracelet on. 
    • Ht and Wt documented
    • Signed consent in chart
    • All preop orders must have documented completion – including “on call” medications.
    • All ordered lab/diagnostic  reports must be on the chart
    • The Preop Check List must be completed and signed
  29. What takes place during the final pt prep for pre op
    • hospital gown
    • Underwear off if appropriate
    • No makeup or jewelry
    • Bladder and bowel emptied
    • ID band
    • Prosthetic removed – glasses, dentures, hearing aids, etc.
    • No fingernail polish or artificial nails
    • Timeout-right pt, right surgery, right site
  30. Preop meds may be given while still on the Med/Surg unit or wait until the patient is in the surgical “holding area” These meds are to :
    • reduce anxiety
    • promote relaxation
    • Reduce GI secretions and saliva
    • Reduce risk of laryngeal spasm
    • Reduce the total amount of anesthetic needed for “induction”

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