Exam 2: NUR2349/ NUR 2349 (New 2022/ 2023) Professional Nursing I / PN I Exam Review | Complete Guide with Questions and Verified Answers |100% Correct | Rasmussen
QUESTION
Where is an intestinal obstruction most common?
Answer:
in the small intestine
QUESTION
What is a mechanical intestine obstruction?
Answer:
conditions that cause a blockage
QUESTION
What would you hear when you auscultate bowel sounds for a pt that has an intestinal
obstruction?
Answer:
Usually no bowel sounds or occasional splashing sound
QUESTION
How is an intestinal obstruction treated?
Answer:
decompression
surgery
Exam 2: NUR2349/ NUR 2349 (New 2022/
2023) Professional Nursing I / PN I Exam
Review | Complete Guide with Questions and
Verified Answers |100% Correct | Rasmussen
QUESTION
What is the common age group for colorectal cancer patients?
Answer:
pts 50 and older
QUESTION
How does colorectal cancer begin?
Answer:
Begins as an adenomatous polyp (noncancerous growth)
QUESTION
What risk factors put a pt at higher risk for colorectal cancer?
Answer:
history of breast and/or ovarian cancer
Ulcerative Colitis
Crohn’s Disease
Polyps
QUESTION
What are the s/s of colon cancer? (2 things)
Answer:
rectal bleeding
changes in stool
QUESTION
what is the treatment for colon cancer?
Answer:
resection/colostomy
QUESTION
What are the s/s of irritable bowel syndrome?
Answer:
Abdominal pain
bloating
diarrhea and/or constipation
hyperactivity of GI tract
LLQ abd pain
stool – constipated, hard followed by softer diarrheal, watery with mucus
QUESTION
What is the tx for irritable bowel syndrome?
Answer:
diet changes
increased fiber
stress reduction
bulk-forming laxatives for constipation
antidiarrheal agents (Imodium) for diarrhea
QUESTION
What is irritable bowel syndrome usually called?
Answer:
Ulcerative Colitis or Crohn’s Disease
QUESTION
What is the etiology of chron’s disease and ulcerative colitis?
Answer:
unknown
most likely genetic
QUESTION
What does ulcerative colitis affect?
Answer:
affects large colon
progressing distally to proximally
QUESTION
What does chron’s disease affect?
Answer:
patchy involvement of small intestine
QUESTION
What do the abscesses from ulcerative colitis lead to?
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What is the function of the kidneys?
function to maintain volume and composition of body fluids by filtering blood
What is urine?
What is it composed of?
waste product excreted by the kidneys.
Composed of nitrous wastes, inorganic salts and water.
What is the function of the urinary system?
rids the body of waste products
What is the function of ureters?
2 tubes (one from each kidney) that carry the urine from the kidneys to the bladder
What type of muscle is the bladder made up of?
smooth muscle
How many layers of muscles does the bladder have? What are they known as?
Composed of 3 layers of muscles known as detrusor muscles
When does the urge to void come about?
When bladder pressure increases enough to stimulate the stretch receptor – urge to void occurs
What is the urethra?
Does the male or female have a longer urethra?
What does that mean?
Tube that carries urine from the bladder to the exterior of the body
male
the male is at a decreased risk for developing a UTI
What is the nephron?
the functional unit of the kidney
How many mL of urine/min does the kidney produce normally?
1 mL/min
What is the minimum amount of urine production for an hour?
30 mL/hour
Where are water, electrolytes, glucose, and protein reabsorbed within the kidney?
proximal tubule
Where are sodium and chloride reabsorbed within the kidney?
loop of henly
How does urine move from the kidneys through the ureters into the bladder?
by peristaltic waves
How many mL of urine are usually in the bladder of an adult when they feel the urge to urinate?
200-300 mL
What is micturation?
urinating
What are the geriatric considerations of the urinary system?
-decreased ability of kidney to concentrate
-decreased size and elasticity of bladder
-decreased muscle tone, contractility, and stasis
-increased urgency and frequency
-nocturia
-incomplete emptying
-increase in a chance of UTI’s
-possible change in cognition and mobility which results in an increase of incontinence issues
What is the pH range of urine?
What is the average pH?
4.5-8.0
6.0
What foods make the urine more acidic?
foods high in protein, meds, cranberry juice, meat
What foods make the urine more alkaline?
What other characteristic makes the urine more alkaline?
standing around, dairy products, citrus fruits, meds
What is the normal specific gravity of urine?
1.010-1.025
What is the specific gravity of urine when it is more dilute?
lower than 1.010
What is the specific gravity of urine when it is more concentrated?
higher than 1.025
What are the normal constitutes of urine?
Normally composed of urea, creatinine, pigments, Sodium, Potassium, Calcium
What is likely the cause of fruity smelling urine?
keytones= uncontrolled diabetes
What is likely the cause of musty smelling urine?
liver disease
What are the 13 factors that affect voiding?
Food/fluid intake + loss
Developmental factors
Older adults – loss of muscle control
Retention/incontinence
Activity/Muscle tone
Stress
UTI
Medications (diuretics)
Prostate issues
Kidney stones
Neurological conditions
Spinal cord injury
Job/Lifestyle
Which kidney is lower?
right kidney
Which kidney is larger?
left kidney
What needs to be done when a pt is on a 24 hour urine collection?
Discard first void
All urine must be kept on ice or refrigerated
Foley bags kept on ice and emptied regularly into a container that is kept on ice
How do you get a sterile urine specimen?
straight catherization or indwelling catheterization
When a person has a urinalysis, what are the abnormal results?
Blood, pus, WBC, RBC, protein, glucose, bacteria, ketones
What is the normal BUN level?
10-20 mg/dL
What causes BUN to increase? and why?
Kidney disease
causes inadequate excretion of urea
Many drugs elevate BUN (antibiotics, lasix)
What causes BUN to decrease? and why?
Liver disease
causes decreased synthesis of urea
What is the normal serum creatinine?
What do increased levels signify?
0.6-1.2 mg/dL
kidney impairment
What is the BUN and creatinine ratio?
What does it mean when both rise together?
20:1
when both rise together indicates kidney failure or disease
What is anuria?
failure of kidney function; less than 100 mL/24 hours
What is dysuria?
difficult or painful urination
What is enuresis?
involuntary urination; usually children at night
What is glycosuria?
glucose in the urine
What is hematuria?
blood in the urine
What is nocturia?
urination at night
What is oliguria?
decreased urine production; scant 100-400 mL/24 hours
What is polyuria?
excessive urination
What is proteinuria?
protein in the urine
What is pyuria?
pus in the urine
What is urinary urgency?
need to suddenly void
What is urinary retention?
unable to urinate; incomplete emptying of the bladder
What assessment findings would the nurse find if the patient has urinary retention?
Pt voids small amounts often
firm distended bladder
felling of fullness
normal intake/inadequate output
What are some nursing interventions for urinary retention?
Straight cath or bladder scan to determine how much urine
How do you treat urinary retention?
treat the underlying cause; remove obstruction
What is incontinence?
inability to hold urine in the bladder; involuntary release; brain is not receiving impulse or loss of external sphincter control
What does incontinence lead to?
impaired skin integrity
infection
rashes
UTI
social isolation
depression
increased risk for falls & injury
What is functional incontinence?
Inability of a usually continent person to reach the toilet in time to avoid unintentional loss of urine
What is overflow incontinence?
loss of urine in combination with distended bladder
What is stress incontinence?
Involuntary loss of small amounts of urine with increased intra-abdominal pressure, in the absence of overactive bladder
What is reflex incontinence?
due to neurological deficits (neuro signals to/from the brain)
What is urge incontinence?
Involuntary loss of larger amounts of urine accompanied by a strong urge to void
What is total incontinence?
continuous loss of urine due to a fistula
What are bladder irritants that may make you need to urinate more often?
alcohol
nicotine
artificial sweeteners
citrus
caffeine
What are some nursing interventions related to urinary elimination?
-Maintain voiding habits
-Scheduling, positioning, privacy, comfort,
allow adequate time to void, assist with
hygiene
-Promote fluid intake, at least 2,000 mL/day
-Strengthen muscle tone
-kegels 30-80/day for 6 weeks
-Stimulate urination
-sound of running water
-warm water over perineum, hands in warm
water, apply warm soaks over pubic area to
decrease muscle tension, sitz bath, apply
cold packs over abdomen to increase
muscle contraction
-Relaxation: breathing, imagery
-offer toileting frequently to decrease the risk of falls
What are some nursing interventions for urinary incontinence?
-bladder training
-external urinary device
-condom catheter
-indwelling catheter
-LAST RESORT
When a person has a condom catheter how often do you need to check on them?
What do you check?
q 2-4 hours
Maintain skin integrity
Tubing should be free from kinks/twists to promote free urinary drainage
Check for leakage from catheter itself
Check under patient for leakage (wet sheets/gown)
How often do condom catheters need to be replaced?
q 24 hours
If a pt has a condom catheter, how many inches do you need to leave between the top of the penis and the top of the catheter?
1-2 inches
Why are catheters used?
Keep bladder deflated during surgery
Measure residual urine
-PVR (post void residual) should be <50 mL
Relieve retention
Obtain sterile urine specimen
How long can catheters stay in without needing a reason to justify a continuance?
48 hours
What are the 9 causes for UTI’s?
Baths
Tight clothes
Nylon undergarments
Using powders in perineal area
Not urinating often enough
Not drinking enough fluids
Improper hygiene
Factors that upset pH
Catheters
What decreases the chance of UTI’s?
maintaining a sterile technique
doing catheter care at least once per shift, but more if perineal area is soiled
What is cystitis?
Inflammation of bladder
Most common UTI
What are the symptoms of cystitis?
Dysuria
Urinary frequency and urgency (urge to urinate frequently in small amts)
Nocturia
Hematuria
What is pyelonephritis?
Inflammation of the renal pelvis and functional kidney tissue
What is acute pyelonephritis caused by?
bacterical infection
What is chronic pyelonephritis caused by?
Continued or repeated infections
What is a common infection that causes pyelonephritis?
from reflux of infected urine into ureters & kidney
What can pyelonephritis lead to if left untreated?
Can lead to renal failure if untreated
Who is at risk for developing pyelonephritis?
Urinary catheter
DM
chronic stones
immunosuppression
recent history of cystitis
What are the s/s of pyelonephritis?
Fever/Chills
Flank/Back pain
Tenderness along Costoverterbral Angle
General Malaise
Urgency, Frequency, Burning
Nocturia
How is pyelonephritis diagnosed?
-urinalysis
-urine C&S to identify the causative organism
-WBC level (assess if it’s elevated)
What is glomerulonephritis?
Inflammation of the kidney caused by immunological reaction (not infection) following a strep infection elsewhere
What is the cause of acute glomerulonephritis?
Immunological complexes get trapped in the glomerulus resulting in swelling and capillary death
Whats is the cause of chronic glomerulonephritis?
Does it have a history or no?
What results from chronic glomerulonephritis?
Is it a slow or fast onset?
Progressive destruction of glomeruli
Occurs without previous hx
3rd leading cause of End Stage Renal Disease
Slow onset
What would the nurse be assessing a patient with glomerulonephritis for?
Previous Group A beta-hemolytic strep infection
Check for lesions or sources of infection
Decreased urine output
Red Blood Cells and casts (particles of cells, protein or fat) in urinalysis
Smoky or coffee-colored urine (hematuria)
Proteinuria
Fluid volume overload symptoms
What are the s/s of fluid volume overload?
Increased respiratory rate
shortness of breath
crackles/rales in lung fields
Jugular vein distention
Bounding, increased pulse
Increased blood pressure
Edema
Weight increase
What nursing care should be done for a patient with glomerulonephritis?
Monitor fluid volume status
Monitor S/S End Stage Renal Failure
Fluid/Sodium restriction
Protein restriction
-Rationale: reduces nitrogen waste and can
slow the progression of renal failure.
Monitor Blood Pressure and Pulse
-to detect fluid volume overload
What are nursing interventions for a person with glomerulonephritis?
Treat underlying disorder
Administer diuretics
Administer antibiotics
Typically no treatment or cure
Plasmapheresis (removes damaging antibodies)
What is nephrotic syndrome and what is it usually caused by?
Clinical manifestations arising from protein wasting caused by glomerular damage
Not a primary disorder, but a result of another problem such as glomerulonephritis
What is involved with nephrotic syndrome?
What are the s/s of this?
Increased glomerular permeability
-Large molecules pass through the
membrane into the urine
-Proteinuria
-Severe edema, facial swelling
-Hypoalbuminemia
How is nephrotic syndrome diagnosed?
kidney biopsy to identify the cause
What is the most common cause of upper urinary tract obstruction?
urinary caliculi
What is another name for renal caliculi?
nephrolithiasis
What is a urinary tract stone called?
urolithiasis
What is a ureter stone called?
ureterolithiasis
What are the risks for urinary caliculi?
Family history
dehydration
excessive intake of calcium
oxalate and proteins
previous history of stone formation
What is renal colic?
What are the s/s?
acute, severe flank pain on the affected side develops when the stone obstructs the ureter, causing spasm
N&V, pallor, cool, clammy skin
What could the obstruction from a renal urinary caliculi lead to?
What is hydronephrosis?
hydronephrosis
Increased pressure and distention behind the obstruction, structures are damaged and could lead to loss of renal function and failure
How do you dx urinary caliculi?
KUB xray
-kidney, ureter, and bladder
Urinalysis-assess for hematuria, presence of WBCs and crystal fragments
Chemical analysis of stones
What are the preventative measures for urinary caliculi?
drink plenty of fluids: at least 3,000 mL/day
stay clear of soft drinks
-they contain phosphoric acid which is a
stone inducer
stay clear of grapefruit juice
drink and eat citirus products
-you have to stay clear of grapefruit juice if
that is a causative manner for that patient in
urinary calculi formation
maintain a low oxalate diet
ensure that the patient has an adequate amount of calcium in their diet
-calcium is needed to bind to the oxalate in
order to prevent stones
What are 10 food examples that are high in oxalate?
beer
chocolate milk
hot cocoa
tea
nuts
strawberries and other berries
lemon peel, lime peel, and orange peel
purple or concord grapes
rhubarb
wheat bran
What are the treatment options for urinary caliculi? (8 things)
Analgesia, strain urine
Special diet depending on stone composition
Increase fluid intake up to 3L/day to flush and prevent stone formation
Allopurinol to lower uric acid levels
Adrenergic blocker (Flomax) to encourage parasympathetic activity
calcium channel blocker to relax ureteral muscle and promote passage of stone
Lithotripsy- shock waves to crush stone
Cystoscopy & ureteroscopy
-stent may be placed to dilate the ureter in
order to pass the stone
What parts of the body make up the gastrointestinal system?
Mouth
Pharynx and Esophagus
Stomach
Small intestine
Large intestine
Ancillary organs: Pancreas, Liver, Gallbladder
What are the three parts of the small intestine in order?
duodenum, jejunum, ileum
What are all the components of the large intestine?
appendix, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anus
What is the function of the esophagus?
How does it work?
transports food to the stomach
Peristalsis muscles contract in a synchronized way to move the food in one direction
What is the function of the stomach?
Secretes acid and enzymes that digest food into chyme
What is the function of the duodenum?
Neutralizes stomach acid with the help of liver, gallbladder and pancreatic enzymes
What is the function of the jejunum and ileum?
Main areas for absorption of folic acid, cobalamin, iron, fat-soluble vitamins, hormones, neurotransmitters, and absorption of fat
What are the 4 functions of the large intestine?
Absorption of water and electrolytes; 80% of water is reabsorbed along the passage
Forms feces
Feces reservoir until defecation occurs
Synthesizes Vitamin K and some B vitamins
What is the function of the pancreas?
pancreatic enzymes aid in digestion of proteins
What is the function of amylase?
changes starch to disaccharides
What is lipase needed for?
fat digestion
what is the liver and gallbladders function in the digestive system?
to produce bile to breakdown fats
What is the word for painful swallowing?
odynophagia
What is the word for difficulty swallowing?
dysphagia
What is the medical term for indigestion?
dyspepsia
What does the RUQ in the abdomen maintain?
liver, right kidney, gall bladder, colon, pancreas
What does the LUQ in the abdomen maintain?
stomach, left kidney, spleen, colon, pancreas
What does the RLQ in the abdomen maintain?
appendix, colon, small intestine, ureter, major vein and artery to right leg
What does the LLQ in the abdomen maintain?
colon, small intestine, ureter, major vein and artery to left leg
What does the midline of the abdomen maintain?
aorta, pancreas, small intestine, bladder, spine
What does the color of feces come from?
comes from yellow bile that bacteria changes to brown
What is the process of bowel elimination?
Fecal material reaches rectum
Stretch receptors initiate contraction of sigmoid colon/rectal muscles
Internal anal sphincter relaxes
Sensory impulses cause voluntary “bearing down”
External sphincter relaxes
What are the factors affecting bowel elimination? (14 things)
the pt’s developmental stage
personal factors
-privacy
-taking the time to defecate
Nutrition/hydration
-fibrous foods throughout the day
-fluids, activity, supplements
medications
infection
anesthesia
stress
surgery
pregnancy
spinal cord injury
food allergies
diverticulosis
ileostomy
colostomy
What are 7 things that promote regular bowel defecation?
Provide privacy
Correct position
timing
Encourage fluids throughout the day
Proper diet throughout the day
exercise
bowel training
What are the lab studies for feces?
Stool for occult blood (GI bleeds, colon cancer)
Stool for fecal fat
Stool for ova and parasites
What is gastritis?
inflammation of the stomach lining
What are the causes of gastritis?
H.pylori infection
Diet (poor diet and/or excessive spicy foods, citrus juices)
Excessive intake: alcohol, aspirin, NSAIDs,
corticosteroids, coffee, caffeine
Stress
Smoking
What are the s/s of gastritis?
Pain
Nausea and/or vomiting and/or dyspepsia (heartburn)
Hematemesis and/or melena
Worsened by ingestion of food
What can chronic gastritis lead to?
When chronic gastritis leads to that then what else may happen?
destruction of parietal cells and loss of intrinsic factor production which is needed for absorption of vitamin B12
pernicious anemia
What is peptic ulcer disease?
Ulceration in the protective barrier in the stomach and/or duodenum and tissue is not protected from acid
What are the main causes of peptic ulcer disease?
H.pylori infection
Delayed gastric emptying
what are the s/s of peptic ulcer disease?
Pain occurs 90 minutes to 3 hours after eating; often wakens patient at night
Nausea and/or vomiting and/or dyspepsia
(heartburn)
Hematemesis and/or melena
Relieved by ingestion of food
What may untreated peptic ulcer disease lead to?
perforation or peritonitis
who is appendicitis most common in?
adolescents and young men
What lab value is used to help dx appendicitis?
WBC
Where does diverticular disease manifest itself?
When do outpouchings form?
Small outpouchings of the colon, but not rectum
Form when increased pressure causes herniations in colon wall
What factors may lead to diverticular disease?
Possibly lack of fiber
lack of activity & delaying defecation
does diverticulosis usually have any symptoms?
typically no, but the one symptom that may present is bleeding
What is diverticulitis?
What may this lead to?
Infection around diverticular sac
Undigested food and bacteria may collect in the sac impairing blood supply leading to ischemia & possibly perforation
What are the s/s of diverticulitis?
are s/s usually present?
usually no symptoms
may have intermittent LLQ pain
constipation
inflammation
low grade temp
rectal bleeding
What is the tx for diverticulitis?
Broad-spectrum antibiotics
bowel rest
surgical resection
if ruptured
Where is an intestinal obstruction most common?
in the small intestine
What is a mechanical intestine obstruction?
conditions that cause a blockage
What would you hear when you auscultate bowel sounds for a pt that has an intestinal obstruction?
Usually no bowel sounds or occasional splashing sound
How is an intestinal obstruction treated?
decompression
surgery
What is the common age group for colorectal cancer patients?
pts 50 and older
How does colorectal cancer begin?
Begins as an adenomatous polyp (noncancerous growth)
What risk factors put a pt at higher risk for colorectal cancer?
history of breast and/or ovarian cancer
Ulcerative Colitis
Crohn’s Disease
Polyps
What are the s/s of colon cancer? (2 things)
rectal bleeding
changes in stool
what is the treatment for colon cancer?
resection/colostomy
What are the s/s of irritable bowel syndrome?
Abdominal pain
bloating
diarrhea and/or constipation
hyperactivity of GI tract
LLQ abd pain
stool – constipated, hard followed by softer diarrheal, watery with mucus
What is the tx for irritable bowel syndrome?
diet changes
increased fiber
stress reduction
bulk-forming laxatives for constipation
antidiarrheal agents (Imodium) for diarrhea
What is irritable bowel syndrome usually called?
Ulcerative Colitis or Crohn’s Disease
What is the etiology of chron’s disease and ulcerative colitis?
unknown
most likely genetic
What does ulcerative colitis affect?
affects large colon
progressing distally to proximally
What does chron’s disease affect?
patchy involvement of small intestine
What do the abscesses from ulcerative colitis lead to?
lead to necrosis & sloughing of bowel mucosa.
Inflammation & edema further damages tissue
Is ulcerative colitis cureable?
no
what are the s/s of ulcerative colitis?
Blood loss
Anemia
Fatigue
Weight loss
Generalized weakness
Tachycardia
Hypotension
Pallor
What is chron’s disease?
Inflammatory disorder affecting any portion of the GI tract
What is the pathophysiology of chron’s disease?
transmural (whole thickness) inflammation causing thickening of the bowel wall, strictures and deep ulcerations
What are the complications of chron’s disease?
Malabsorption & malnutrition may develop, obstruction, fistulas
What is the treatment for chron’s disease?
Surgical resection
How long does acute diarrhea last?
what is it usually caused by?
Less than 1 week
Usually due to infectious agent
How long does chronic diarrhea last?
what is it usually caused by?
greater than 3-4 weeks
Lactose may do this if not broken down
Malabsorption
Endocrine disorders (hyperthyroidism)
What are the nursing interventions for diarrhea management?
Evaluate each patient’s elimination pattern to their own “normal”
Monitor stools to quantify diarrhea
Assess and monitor for fluid and electrolyte imbalance
monitor for fluid and electrolyte imbalance
Monitor for alterations in perineal skin integrity
proper dietary teaching
-BRAT diet is common (Bananas, rice,
applesauce, toast)
-increase fiber intake
Antidiarrheal medications
What is may be the cause of constipation?
Typically secondary to another disease/condition
May be due to tumor or obstruction
Activity – Sedentary
Dietary – Low fiber, inadequate fluids
Drugs – Antacids with aluminum, narcotics,
anticholinergics, diuretics, antidepressants
Psychogenic – Voluntary suppression of defecation
Systemic – age, pregnancy, cerebral vascular accident, Parkinsonism
What are the s/s of constipation?
Abdominal distention & discomfort
anorexia, fecal impaction (watery, foul-smelling liquid stool)
diminished bowel sounds
What is the treatment for constipation?
Hydration – increase water throughout the day, juice
Stool softeners/laxative
Enema
Increase mobility
Increase fiber throughout the day
Provide privacy
Position to facilitate defecation
What is the treatment for fecal impaction?
enemas
manual/digital removal (disimpacting)
What are two sources of evidence for EBP?
Agency for Healthcare Research and Quality (AHRQ)
The Cochrane Library
What is EBP?
the integration of the best current evidence and practices to make decisions about patient care with the goal of achieving maximum health benefits for the patient
What are organizations that are receiving funding from medicare or medicare obligated to be following?
Organizations receiving Medicare and/or Medicaid funding are obligated to follow EBP
What is the process of quality improvement?
Monitor outcomes, identify errors and develop solutions to change and improve care
What is the DMAIC model and what is it for?
it is for quality improvement
Define the issue or problem
Measure the key aspects of the current process for the issue (collect data)
Analyze the collected data
Improve or optimize the current process by implementing an evidence-based intervention/solution
Control the future state of the intervention to ensure continuity of process
What are morals?
Morals consider what is good or bad; right or wrong
What are ethics?
Ethics is a formal process of making logical and consistent decisions and how we conduct ourselves based upon morals
What is a dilemma?
When a choice must be made and there are conflicting principles
When choices have no clear right or wrong option
What are influences on morals and ethics?
Personal life events
Family
What is happening in the world
Culture, Custom, Tradition
Religion
Education
Values: a basis for behavior based on what we perceive to be the worth of something
Attitude: feelings toward a person, object or idea
Beliefs: an idea that one accepts as true
What are bioethics?
When we apply general ethical principles to healthcare, such as, direct patient care, allocation of resources, utilization of staff, and research
What are nursing ethics?
Ethical issues specific to nursing practice
The extent and manner in which you provide patient care
What is moral distress?
Knows what is right or wrong, but for some reason is unable to carry out the decision
When the nurse knows the right thing to do but either personal or institutional factors make it difficult to do the right thing.
What does intermediary mean?
Caught between what the patient and/or family wants and the physician’s plan or the organization’s policies
What are external constraints of moral distress?
Afraid of what a physician, the organization, other nurses, patients and/or families might think or say
Fear of lawsuits
What are internal constraints of moral distress?
Lack of courage
Lack of knowledge
Concern for reputation
Socialized to follow orders and not to question
What is moral outrage?
Belief that others are acting immorally but feel powerless to prevent it
What is fidelity?
The obligation to be loyal and keep promises or obligations
What is the MORAL model and what is it used for?
used to problem solve
Massage the Dilemma
-Identify and define the issues and
information gaps
Outline the options
Resolve the Dilemma
-Apply basic moral principles
Act by applying the chosen option
Look back and evaluate
What is autonomy?
Why is it important?
An individual’s right to choose and the ability to act on that choice (self-determination)
Patient will be more willing to follow through with recommendations if he/she has input into his/her care
What is veracity?
The duty to tell the truth
What is social justice?
All patients should be treated equally and fairly
Regardless of age, gender, ethnicity, education, religion, sexual orientation, race
What is the American Nurses Association (ANA) Code of Ethics?
formal statements of expectations and standards for professional behavior
What is non-maleficence?
Duty to prevent harm by identifying causes or possible sources of harm
-Example: checking the 5 rights before
giving medications
Discontinuing treatments that may be invasive that could cause harm or injury
-advocating for catheter removal when
unneeded
What is beneficence?
Duty to do good; positive action to help others
Explaining benefits versus negative effects of an intervention for the patient’s well-being
What are the patient’s bill of rights?
Describes what patients can expect in terms of the responsibilities of the health care provider and who to contact in the event of a breach
What are the 8/10 ammendments on the bill of rights, that play a critical role in health care?
Right to privacy
Right against self incrimination
Protection from cruel and unusual punishment
(restraints)
Freedom of speech
Freedom of religion
Freedom of the press
Protection of property rights
Equal protection under the law
Can the provider delegate the process of obtaining informed consent to RN?
The provider cannot delegate the duty to the RN
Is the need of informed consent waived in an emergency situation?
In an emergency situation in which life or limb is at risk, the process of informed consent is waived
Can consent forms have multiple procedures per form?
Consent forms can only have one procedure per form
Can a family member of a pt give informed consent?
If yes, who needs to witness it?
A family member can sign informed consent for a patient who does not have the ability, but two nurses need to witness
When can advanced directives be changed?
anytime
What is an advanced directive?
A directive that lists a variety of treatments depending on the patient’s condition at the time, and lets the patient decide how much or little care he/she wants
If a person wishes to change their advanced directives do they have to write it down or can they verbalize it to the physician?
Changes can be written
Oral changes given to the physician generally have priority over any statement made in an advance directive so long as the patient is able to decide for him/herself and communicate his/her wishes
What is the living will?
Directives from competent individuals to medical personnel and family members regarding the treatment he/she wishes to receive when he/she can no longer make decisions for him/herself
What is the five wishes directive?
What does it include?
“Five Wishes” directive is a legal document that presents what an individual wants if he/she is unable to verbalize wishes
Who can make decisions, kind of medical treatment, information to be shared with loved ones
What are the 4 purposes of law in nursing?
Establish licensing requirements
Protect clients/society
Define scope of nursing practice
Identify minimum level of care to be provided
What is a durable power of attorney for health care?
Allows patients to appoint a surrogate or proxy to make healthcare decisions in the event the patient is incompetent to do so. This does not include making changes to Advance Directives and/or Living Wills
What is Physician Orders for Life-Sustaining Treatment (POLST)?
Contains information on patient’s end-of-life directives
What is the patient self-determination act?
Mandates that patients must be queried about the existence of advance directives and that such advance directives be made available to them if they wish
What is the Emergency Medical Treatment and Active Labor Act (EMTALA)?
Ensures public access to emergency services regardless of the patient’s ability to provide proper identification, provide verification of insurance, or ability to pay
What are nurse practice acts responsible for?
Determines credentialing
Establishes licensing requirements
Defines the Discipline & Scope of Practice
Protects the public
Defines nursing practice, boundaries and standards for nursing
Protects the domain of nursing
What are the items under mandatory reporting laws?
Communicable disease
-HIV/AIDS is reported to the CDC
-STDs reported to county health departments
Abuse
-Reported to the institution board and
applicable authorities
What is the good samaritan law?
Enacted to allow health care personnel to deliver medical assistance without fear of incurring criminal and civil liability
CANNOT BE SUED UNLESS THE CARE THEY GIVE IS OUT OF THEIR SCOPE OF PRACTICE
-ex. OB nurse stabilizing a fracture that
resulted in a fat emolus can be help
accountable because their expertise and
scope of practice is with mom and baby
health maintenance
Where are the standards of practice derived from?
State Boards of Nursing Nurse Practice Acts
What is criminal law?
What may it lead to?
Federal or state government prosecutes
Addresses conduct that is harmful or offensive to society
Can lead to a fine, imprisonment, or death
What is civil law?
Allows for resolution of dispute between private parties
Enforced through courts as damages
May result in monetary compensation
What is contract law?
Dealing with agreements between individuals
Explicit or implicit
What is defamation?
False communication to a third person that results in harm (ridicule, hatred, contempt, being shunned)
What is tort law?
Dealing with duties and rights among individuals that are not covered by contractual agreements
A Tort is a civil wrong, usually with claims for damages
-Malpractice
-Negligence
What is slander?
Oral defamatory statements
What is lible?
Written defamatory statements
How do nurse protect themselves from the claim of assault and battery?
by explaining the procedure before we do it
What is negligence?
Failure to perform as a reasonable, prudent person would
Failure to follow standards of practice
No intent to harm is present
What is malpractice?
Professional form of negligence
Public has a right to expect higher standard of care from professionals
What is an elective surgery?
Convenient for the patient and physician
satisfies patient need
What 4 elements must be proved in court to prove that malpractice has occurred?
Existence of a duty: The nurse/patient relationship creates a duty by the nurse to the patient
Breach of the duty: Nursing actions failed to meet the standards of care – based on job description, policies & procedures, standards of care,
textbooks
Causation: Nurses action actually caused the patient’s harm/injury; type of injury was foreseeable, or a logical consequences of the breach of the nursing standard
Damages: Plaintiff must prove there has been an actual injury or damage
What are some common causes of nursing law suits?
Medication and treatment errors
Failure to use equipment in a responsible manner
Failure to act as a patient advocate
Infection caused by poor nursing care
Failure to follow “chain of command”
Failure to use sound clinical judgement
Failure to assess, analyze and diagnose
Failure to plan
Failure to implement a plan of care
Failure to evaluate
What is an urgent surgery?
Necessary to maintain health in non-life-threatening situations
usually within 24-48 hours to preserve life or function
What is an emergency surgery?
Requires immediate intervention to sustain life and/or preserve the function of body parts
Performed immediately
What is corrective surgery?
Excision or removal of diseased body part
What is palliative surgery?
To relieve symptoms
Example: masses that cause pain and/or obstruction
What is transplant surgery?
Removal of organs and/or tissues from a person pronounced brain dead for transplantation into another person
What is diagnositc surgery?
the removal of all or part of a suspected lesion for examination and testing to confirm or rule out a cancer diagnosis
What happens in preoperative nursing?
Begins with the patient’s decision to have surgery, ends with entry into the operating room
What happens in intraoperative nursing?
Begins with entry into the operating room and ends with admission to the recovery room (PACU)
What happens in postoperative nursing?
Begins with admission to recovery room, and ends with discharge from care
In the preoperative nursing phase what is gathered in the nursing history?
Key elements that pertain to the risks and needs
Obtaining legal documents (advance directives, living will, durable power of attorney)
What information is gathered in the medical history portion of preoperative nursing?
Past illnesses
Primary reason for seeking medical care
What information is gathered in the family support portion of preoperative nursing?
Extent of support from family and/or friends
Why are pts put on NPO status for surgery?
Decreases risk for aspiration
If you need to remove hair on a patient before they have surgery, do you shave the hair or clip it?
Remove hair by clipping (not shaving)
Who is part of the surgical team?
Surgeon (leader of the surgical team)
Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA)
Scrub nurse
Circulating nurse
OR Tech/Surgical technologist may be used in addition to nursing staff
What is the job of the scrub nurse?
Works in the sterile field passing instruments, sponges and other items needed for surgery
What is the job of the circulating nurse?
Control of the environment
Provision of resources
Performs a time out
All activity stops
Name, birthday, procedure, site, equipment
What is the job OR tech/surgical tech
Works in the sterile field with the surgeon
Ensures the surgery procedure is conducted under optimal conditions
Holds utensils during the procedure
What is general anesthesia?
method used when the surgery requires that the patient be unconscious and/or paralyzed.
A general anesthetic acts by blocking awareness centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur.
What is the Surgical Scrub, Gowning, and Gloving process?
A. The surgical scrub
Don surgical mask
Scrub under the nails
Remove all jewelry
B. Rinsing
After scrubbing and rinsing, the scrub nurse dries his hands and arms with a sterile towel inside the operating room and then is assisted into a sterile gown
C. The scrub nurse prepares sterile gloves.
D. The scrub nurse puts on his first sterile glove while the sterile gown is being tied in the back.
E. The scrub nurse puts on his second sterile glove
What are the risks of anesthesia?
Adverse reaction to anesthetic
Overdose
Unrecognized hypoventilation
N/V
Sore throat
Seizure or heart attack
Malignant hyperthermia (MH)
Numbness or loss of function
What is malignant hyperthermia?
Acute, life-threatening complication
Genetic – inherited
Begins with skeletal muscle exposed to a specific anesthetic agent
Causes increased calcium levels in muscle cells
Leads to acidosis, high temperatures, dysrhythmias
What are the s/s of malignant hyperthermia?
Muscle rigidity of the jaw and upper chest
Elevated body temperature
Tachycardia, hypotension, dysrythmias, tachypnea
Rise in CO2 (respiratory acidosis) and DECREASED O2 sat
Skin mottling
Cyanosis
Hypercalcemia leading to myoglobinuria
What are the complications for local/regional anesthesia?
Anaphylaxis
Incorrect delivery technique
Systemic absorption
Overdose
Local complications
How is malignant hyperthermia treated?
Stop the anesthetic agent
Intubate and Hyperventilate giving 100% oxygen
Administer a muscle relaxant
-Dantrolene is a common muscle relaxant
Administer cooling interventions
-Cooling blanket, iced IV solutions
Monitor for dysrhythmias
Possible cessation of surgery if symptoms are not controlled
How are the complications of local/regional anesthesia treated?
Establish open airway
Give oxygen
Fast-acting barbiturate (ex: phenobarbital) is usual treatment
Epinephrine for unexplained bradycardia
In a post op assessment, what is involved in cardiovascular monitoring?
Vital signs
Heart sounds, rhythm, pattern
Cardiac monitoring
Peripheral vascular assessment
Monitor for venous thromboembolism
What is surgical positioning?
Assess need for proper alignment and intervene to decrease risk of skin injury
Patient’s body must remain in physiologic alignment
What is surgical positioning dependent on?
The surgical procedure
Exposure at the surgical field
Surgeon’s preference
Patient’s condition
In a post op assessment, what is involved in the GI assessment?
Postoperative nausea/vomiting common
30% of patients experience nausea or vomiting after general anesthesia
Peristalsis may be delayed up to 24 hours
Monitor for bowel sounds
In a post op assessment, what is involved in the neuro assessment?
Cerebral functioning
-Level of consciousness should have returned
to pre-surgery level before being transferred
to the unit
-Assess and monitor ability to follow
commands
Assess and monitor pupillary response
Motor and sensory assessment after epidural or spinal anesthesia
When are montgomery straps used and why?
Montgomery straps may be used when frequent dressing changes are anticipated.
They help prevent skin irritation from frequent tape removal.
What potential complication should the nurse be assessing for that is most common on the 2nd postoperative day?
hypoxemia
atelectasis
What do drains do and help prevent?
provide exit route for air, blood, and bile
help prevent deep infections, abscess formation during healing
What are some DVT prevention interventions?
Ambulation
Active or Passive Range of Motion
Prophylactic Antiplatelet
Promotion of venous return
Sequential compression devices (SCD)
-push blood through the blood vessels in —
an upward motion
Thromboembolic stockings (TED hose)
-Compress superficial vessels in the legs
and force blood to flow through deep
vessels
What is conscious sedation?
this type of sedation does not require respiratory support and the patient is able to respond to verbal commands
sources;
https://www.gcu.edu/
https://yaveni.com/
https://www.rasmussen.edu/