Med-Surg cert

• ~ Participating in intra-professional collaboration
• ~ Avoiding conflicts of interest
• ~ Maintaining respect for human dignity
• ~ Integrating professional values with personal values

• Moral principles that govern behavior
• Ideal standards

duty to allow patient to make independent decisions

duty to tell the truth

Duty to keep promises and commitments

Duty to provide equal and fair distribution of resources

Duty to promote good and take positive actions

Duty to do no harm and avoid negative actions

Duty to keep some information from disclosure without consent

Duty to protect physical body or information from unauthorized view

• Issues surrounding quality-of-life, end-of-life, and DNR orders 
• No clear course of action is apparent

• ~ Obtained a referral to ethics committee for disagreements about treatments:
• >Between family members
• >Among healthcare providers
• >Between healthcare providers and the patient or family

The action or series of actions that argues for, speaks in favor of, recommends, or supports another person, place or thing

Effective nursing advocate actively participates in supporting patients wishes and needs through listening, education, and collaborating

The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient

• Denial: Avoiding the inevitable
• Anger: Expressing emotions previously bottled up
• Bargaining: Trying to find a way out
• Depression: Acknowledging the inevitable
• Acceptance: Moving forward

• A leadership style
• Unilateral, dictatorial
• Works toward a single goal
• meets resistance from mature, experienced staff

• A leadership style
• Team Approach
• Staff participation
• retains responsibility for outcome

• A leadership style
• Little control
• Leaves decision to others
• works well with committed, motivated staff who can analyze well

• Trigger emotional response
• Eloquent communicator and persuader

Connection between leader and follower increases motivation for problem solving

Compliance via reward/punishment system

• Flexible
• Noncontrolling
• analytical and empathetic
• visionary team player

• Matches style to situation
• High stress situations are best handled by task-oriented leaders
• Moderate situations are best handled by relationship-oriented leader

• ~A model of nursing practice designed to improve work environment, satisfaction, and nurse retention
• ~ Champions staff as most important asset of organization
• ~ Encourages autonomy, empowerment, involvement, and participation
• ~ Teams and groups are designed to be self-led and self-managed

Bedside nurses are given equal footing with managers and leaders in the creation of policies, procedures, and other decision-making processes that directly affect nursing practice within the organization

• Education process should reflect nursing process:
• ASSESS
• PLAN
• INTERVENE
• EVALUATE

• Mental and physical capabilities
• Perception of the problem
• Preferred learning style

Establish mutual goals with patient that are specific, practical, attainable, relevant, and culturally sensitive

• Use multiple methods to enhance learning
• Ensure methods use vocabulary suited to learners comprehension

• Observe the patient/family implement new skills
• Request a "teach back" from patient
• Assess comments and conversations for misinformation or gaps in learning

• Physiological: basic needs such as air, food, shelter, comfort
• Safety: free from harm or threat of harm; stability
• Love/Belonging: friendship, acceptance, affection; support system
• Esteem: self-respect, self-confidence, rewarding work/relationships
• Self-actualization: truth, justice, beauty, personal growth

• These drives (needs) are met in order from physiological to self-actualization. 
• Illness can change a patients focus to meeting basic needs as the priority.

• Activity/Rest
• Comfort
• Coping/Stress Tolerance
• Elimination
• Growth/Development
• Health Promotion
• Life Principles
• Nutrition
• Perception/Cognition
• Role Relationships
• Safety/Protection
• Self-perception
• Sexuality

• Diagnosis: (ex) imbalanced nutrition: Less than body requires
• Related to: insufficient caloric intake
• Evidenced by: weight loss

Expected Outcomes: (ex) The patient will achieve and maintain adequate weight

Nursing Interventions: (independent and collaborative) Use words such as assess, monitor, teach, assist, provide, and record. For collaborative, use words such as obtain consult and administer medications, tube feeds, etc.

Evaluation: The patient achieves and maintains optimal weight

A list of over 560 interventions that nurses perform: includes direct, indirect, collaborative, and independent interventions that address both physiologic and psychosocial aspects of pt care. 

• Interventions fall into three categories:
• Illness prevention
• Illness treatment
• Health promotion

• The standardized language of these interventions should be used when creating patient care plans
• The interventions are sorted into 7 domains:
• basic physiological
• complex physiological
• behavioral
• safety
• family
• health systems
• community

• A system which describes patient outcomes sensitive to nursing intervention
• Includes over 500 outcomes
• A means of standardizing nursing language used in the nursing process.

NOC language is for outcomes, parallel to NANDA language for diagnoses and NIC language for nursing interventions.

• A means of focusing nursing interventions on the most important patient problems
• Usually follows Maslow's Hierarchy and the ABCDE mnemonic

• Once immediate ABC needs are met, pt and family should participate in formulation the plan of care, including prioritization. 
• What a nurse perceives as priority may not be priority in the patients mind.
• Assess the patient's thought processes through therapeutic communication and determine a course of action "with" the pt (not "for" or "to")
• Collaboration with the primary practitioners and therapists will further support autonomy while promoting excellent patient care (as defined by the patient)

A dynamic process that produces a synthesis of perspectives and shared responsibilities to address a problem set that cannot be handled by a single individual

• Standards of care that improve patient care and outcomes
• Data is submitted to CMS (Medicaid/Medicare)

Includes reports on diseases/conditions seen, hospital acquired conditions, Emergency department care, and surgical care improvement projects

• Immunization
• Tobacco Cessation
• Substance abuse

may tolerate 2nd/3rd generation cephalosporins but use with caution

Avoid anything with "Cef" of Ceph"

• Avoid any of the "sulfa" or "zulfa" meds 
• combo abx (septra or bactrim)
• furosemide or HCTZ
• HIV pt may have increased sensitivity to sulfa meds

• Use caution with contrast dyes is allergic to iodine or shellfish
• Can pretreat with sterioids and/or antihistamines

• Rarely a true allergy
• avoid opiates and semi-synthetic (hydro-/oxycodone)
• treat with synthetic opiates (fent, methadone, tramadol) if poss

Use alternate histamine suppressor (H2 blocker or epi pen)

Process of assigning responsibility or activities to another; usually from boss or superior to underlings

• Right task ~ ensure task is within scope of practice
• Right circumstance ~ ensure pt's current condition is appropriate
• Right person ~ ensure task does not exceed skills and knowledge of the person
• Right directions ~ ensure effective and thorough communication to all involved
• Right supervision/evaluation ~ ensure follow up and compliance with policies

• A collection of techniques that prioritize the physical, mental, and emotional well-being of the pt.
• Nurses provide pt's with support and information while maintaining a level of professional distance and objectivity

• ~Focus on present, not the past
• ~Instead of providing solutions, identify alternatives and choices
• ~Use broad statements "Is there something you'd like to discuss"
• ~Acknowledge pt feelings "It must be difficult to..."
• ~Use silence-used to slow conversation & allow reflection
• ~Clarify pt meaning:"Im not sure I follow...."
• ~Verbalize implied feelings "You feel diet is not benefitting u"
• ~Explore further: "Tell me more about..."
• ~Voice doubt when pt perceptions/expressions are distorted from reality "Really? Thats hard to believe"

• ~Use cliches or stereotyped comments: "it will all work out""You'll be home soon"
• ~Give advice "You should..."
• ~Give approval; sets up a standard of acceptability "You did the right thing"
• ~Ask "Why"; encourages invention of answers on the spot
• ~Disapprove; "Stop worrying"; introduces the nurse's value system
• ~Disagree/challenge "That's not true"
• ~Belittle feelings "I know how you feel"
• ~Defend staff; may reinforce pt belief that criticism is valid
• ~Change the subject "That reminds me.."

• Practice therapeutic interviewing to gather more information about circumstances, suicide plan, and actions already taken.
• Assess pt's ability to keep a meaningful contract
• Do not leave pt alone
• Involve family if pt consents (contact family if under 16)
• Admit for psych eval

• Beck Depression Inventory
• Geriatric Depression Scale
• Hopelessness Scale
• Suicide attempt self injury review
• Suicide ideation questionnaire for ages 13-18 or Columbia-suicide Severity rating scale

• *Stop at least 10-14 days prior to surgery
• Ginger
• Onion
• Garlic
• Ginseng
• Vit E
• Omega 3 Fatty acids (high doses)

• St Johns wart
• Milk thistle
• ginseng
• garlic
• licorice
• grapefruit juice
• caffiene

• Treatment of disease or symptomology by using very small doses of natural substances that - given in larger amounts would cause disease symptoms in a healthy person
• Assumes the body has the ability to heal self

Homeopathy is generally regarded as safe, but is considered by many practitioners to produce results based on the placebo effect

• Dry eyes
• Slow growth rate
• increased infections
• infertility 
• Anemia

• Painful fissured tongue
• Greasy scaly facial skin
• Peripheral neuropathy
• Cognitive disturbances

• Nosebleeds
• Bleeding gums
• Plugged hair follicles
• frequent colds

• Bone pain
• muscle weakness
• asthma
• cancer
• depression
• sweaty head
• rickets

• Myocardial arrhythmia or infarction
• hyporeflexia or ataxia
• blindness
• dementia

• Hemorrhagic disease of the newborn
• Unusual bleeding
• Bruising
• Petechiae

• Unusual food/substance cravings (pica)
• fatigue
• lightheaded
• trouble breathing
• fissured tongue
• hair loss
• spoon-shaped nails

• Cold hands
• soft/brittle nails
• hyperactivity
• irregular heart beat
• high bp
• Tender calf muscles
• Brisk knee reflexes
• PMS

• weakness
• fatigue
• dyspnea
• constipation
• exercise intolerance

• Coarse hair
• Brittle nails
• Psoriasis
• Cataracts
• Depression
• Muscle cramps

• Ridged or white marked nails
• stretch marks
• hyperactivity
• PMS
• hair loss
• miscarriage

• smooth painful tongue
• gum disease

• Mitral and tricuspid
• Pulmonic and aortic

• The closure of the mitral and tricuspid valves (start of systole)
• Best heard over 5th intercostal, midclavicular line

• The closure of the pulmonic and aortic valves (end of systole)
• Best heard over 2nd intercostal, right sternal border

• Comes after S2
• Lub-dub-by - from fluid overload and/or valve insufficiency

• comes before S1
• Le-lub-dub - from acute MI, pulmonary HTN/embolus

Extra noise in between S-sounds; vibration, rumbling, woosh

• Hear during systole and sometimes diastole
• 3rd intercostal space, lower left sternal border

• Vena Cava 
• Right atrium
• Tricuspid Valve
• Right Ventricle
• Pulmonary veins
• Left atrium
• Mitral Valve
• Left ventricle
• Aortic valve
• Aorta
• Arteries
• Arterioles - Capillaries
• Venules
• Veins
• Vena Cava (superior and inferior)

high pitches, heard over trachea

• High pitched and loud
• heard next to trachea

• Mid pitch, med volume
• Heard next to sternum and between scapula

• Low pitches, soft
• heard over lung fields

• Also called rales
• Heard on inspiration when fluid-filled or collapsed alveoli pop open

• High-pitched on expiration, sometimes inspiration
• Asthma
• Infection

• Low pitches, rattling
• Indicates partial block by fluid
• Clear by cough

• High pitched on inspiration
• Indicated upper airway obstruction

• Low pitched on both inspiration and expiration
• Indicates pleural inflammation
• Often accompanied by pain with breathing

• Apnea, crescendo/decrescendo rate and depth of breath, then apnea
• Indicates damage to respiratory brain centers (stroke, TBI, metabolic encephalopathy), Carbon monoxide poisoning, chronic HF, Adjustments to altitude, or may also be seen after opioid administration

• Normal rate or fast deep gasping breaths
• Seen in DKA or other metabolic acidosis dx
• Kussmaul = DKA

• Also called cluster breathing
• Fast shallow breaths with abrupt apneic periods
• Indicates pons damage by stroke, trauma, brain herniation, or opioid use
• Sometimes considered equivalent to Cheyne-Stokes

• Regular deep breaths that progress to irregular breaths
• Results from lesions on brain stem that erroneously signal reduced CO2 levels in blood, thus stimulating respiratory center to over breathe and cause respiratory alkalosis
• Very Rare

• Nose/Mouth - laryngopharynx - epiglottis - larynx - trachea - carina - 
• Left and right mainstem bronchus
• lobar bronchi
• tertiary bronchi
• terminal bronchioles - respiratory bronchioles
• alveolar ducts - alveoli (300 million)

R lung has 3 lobes, L lung has 2 lobes