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NSG 201 Test 3 map and study guide spring 2021 2
Fundamentals (NSG241)
Marian University
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Test Map and Study Guide Exam 3: NSG 201 A Spring 2021 40 multiple choice questions. Each worth 2 points
Questions will come from Modules 8-10 in the didactic class, Labs 10-11 in the clinical course, including reading assignments, PowerPoints presentations, video, and laboratory/clinical work.
Communicating with the Older Adult (9?, A: 335-336, 369-370, 374-379, table 19, 670, table 24, 829; T: 69-72, Box 6-2 & 6-3, 84-85, Handouts)
Types of Deficits (A: 335) o Hearing Loss – causes can be congenital, genetic, or acquired (such as infection or medication or excessive noise). Hearing is so important because it alerts people to changes in their environment Nursing Consideration – does not look any different! As we age, we have increased likelihood of presbycusis, which is hearing loss that occurs with aging. o Vision Loss – Humans rely greatly on their vision to interact and understand their world. Nursing Consideration – you lose access to those nonverbal cues. Presbyopia – lens of the eye becomes less flexible, which hinders accommodation. Impaired Verbal Communication Secondary to Speech/Language Deficits (A:335) o Speech d/o is impaired articulation, but a language d/o is impaired comprehension or use of spoken sounds o Nursing Considerations – people often use language to express self-need and control environmental events. o Aphasia – linguistic deficit (usually after CVA) Receptive – receiving and processing problem Expressive – understand what’s being said but cannot express in words Global – both Impaired Cognitive Processing (A: 336) o They have altered communication pathways. o Risks must be assessed, such as memory loss. Communication Deficits Associated with mental Disorders (A: 336) o Responses may not be appropriate, meanings are distorted. o May have a “flat affect” – i. not much visual expression or cues, which makes it hard to determine true meaning. Accommodations for Sensory Loss (A: 369-370)
o Sensory changes are NORMAL with aging (i. hearing and vision changes) o Hearing loss is a normal part of aging that begins after 50 years old. o Communication Strategies for Hearing Loss – Same level as patient, speak slowly and distinctly Annunciate words, repeat if needed. Eye contact Do they have a “better ear?” Lower voice, make face visible, be expressive, etc. Supports for the Elderly – o Social/Spiritual – they may have lost their “personal” support system at the age. So helping connect them to a personal God or church community may be helpful. o Independence – an external “loss of control” can lead to feelings of fear about surrendering their independence, especially in a healthcare setting. o Safety – promote quality of life while protective safety (respect food choices, provide mobility aids, safety modifications around the home, include in decision making, low impact exercises, home security, etc.) o Medication – meds have a stronger effect on the elderly, so they may need help to self-manage their medications safely. Make sure they know what they’re taking and why and when and how often. Elder Abuse (A: 375-376)- physical, emotional, sexual, financial. Most commonly it is neglect. Pride, embarrassment, and a desire to protect family members lead to difficulty reporting. Health Promotion – (A: 476-479) o Should be tailored to their stage in life o They have special needs regarding nutrition, exercise, sleep, and other needs. o Health teaching is necessary to help them manage what aging does to their bodies o Communication- Apraxia – loss of ability to take purposeful action even when muscles, senses, vocabulary seem intact. Table 19 – o Delirium – acute onset, acute symptoms, medical EMERGENCY. Lasts hours to weeks, resolves with tx. Comes and goes, worse at night, incoherent thinking, memory impaired. Disoriented to time and place, but not people. Gross distortions, illusions, hallucinations. o Dementia – insidious onset, chronic symptoms, progresses slowly, attention unaffected. “Sundown syndrome.” Thinking/speech impoverished. Impaired memory for immediate/recent events. Orientation may become impaired with progression. Sleep cycle disturbed. o Depression – relatively rapid onset, episodic symptoms. may last months to years, but at least two weeks, most things are intact, but colored by negative themes. speech is quiet, decreased, may be irritable. Summary of Care Elements (Table 24)
o Clock Drawing test – quick and easy, scored based on position of numbers and hands, can help measure apraxia, early dementia, etc. o Mini-Cog – less biased and easier than MMSE. Mixes short-term memory with executive functioning. Handouts – see lab modules
Communicating with Groups and Families (8? A: 130-133, 135-6, 141-148, N: 387, 394-395, T: 411)
Communicating in Groups (A: 130-133) o Group – human communication system of 3+ people, interacting with a common goal in mind. o Primary group – informal structure, close personal relationships Membership is automatic (family) or voluntary because of interest (long term friendship) o Secondary group – represent time-limited group relationships with est. beginning and end of the relationship. Size is determined by goals of the group Formal structure, designated leader, specific goal. o Functional similarity – choosing group members that are similar enough to interact in a meaningful way (i. intellectually, emotionally, experientially) o Group Norms Group Norms – universal unwritten behavioral rules of group members Universal normal – explicit behavioral standards, which must be present in all groups to achieve effective outcomes. Group-specific norms – constructed by group members. Group Process (A: 135-136) o Forming – members come together as a group. (Orient to purpose, introduce themselves, group rules est.) o Storming – power and control issues, testing boundaries/comm styles/personal reactions. This helps the group prioritize what to do first or next and establish goals. o Norming – become aligned with group goals (which make the group “safe”) Brainstorming – think of as many ideas as possible. Criticism is not permitted in early stages. Later? Prioritize Cohesiveness – relational bonds that link the group together. This helps with optimum group productivity. Sources? Shared goals, working through and solving problems, and the nature of group interaction. o Performing – where the work gets accomplished. Group members are interdependent, accepting of each person’s value, and feel loyal to the group. This allows them to be comfortable, safe, productive. o Adjourning – reviewing accomplishments, reflect on meaning of the work, creating deliverables, and making plans to move on.
o Balancing tasks/group maintenance allows for the group to both get stuff done and have good group satisfaction. o Self-roles – roles a person uses unconsciously to meet their own needs at the expense of other members. This takes time from group issues and creates discomfort among members. Types of Groups (A: 141-146) o Monopolizing – negative form of power used to advance a personal agenda with no concern for the needs of others. o Therapeutic Groups – offer structure that allows a person to experience his or her natural healing potential and get higher levels of functioning. o Inpatient Therapy Groups – Psychotic Patients- co-leadership is recommended due to intense demands from the patients. It’s better to ask the group to discuss a topic rather than asking to share their feelings. o LTC Reminiscence Groups – life review and pleasurable memories. Supportive/ego-enhancing. There is usually a weekly focus (first day of school, holiday, pets, etc). Reality Orientation – used for confused patients to maintain contact with their environment. Reduces confusion about orientation. They usually use props (clock, calendar) to help. Resocialization – confused elderly patients who may be too limited for a remotivation group, but need friends and socialization. SIMPLE social setting (such as a meal together). Remotivation – stimulate thinking about ADLs. Goal is to reach the uninjured area of the patient’s personality (places that remain healthy). Tap into strengths with discussions of realistic scenarios. Help stimulate and build confidence. o Therapeutic Activity Groups Activity groups – “variety of self-expressive opportunities” Occupational therapy (life skills) Recreational therapy groups Exercise/movement Art Poetry, bibliotherapy, etc. o Self-Help/Support Group Emotional/practical support to patients and/or families exp chronic illness, crises, or ill health of a family member. Usually more informally led. o Educational Groups – usually have applications, help with learning about lifestyle changes. Ex. Childbirth, parenting, stress reduction. o Discussion Groups – Carefully plan questions and use feedback of members.
V?
Communicating with Clients Experiencing Communication Deficits (8?, A: 340-343, T: 139, 142, 150-151, 298-299, Cognitive assessment handouts.)
Communication Deficits (A: 340-343) o Vision loss – vision assessment is recommended to provide the best care. Use vocal cues, but note that nonverbal signals will not be picked up upon. Therefore, we must use words to express these things. Enhance lighting, use touch as reinforcement, etc. Macular degeneration – stand to the side (exception to the rule) because they have better vision there. Orient them to environmental hazards! o Speech Impairment – Aphasia – inability to speak (expressive may find the correct word if given time/support). Receptive may need you to explain things more simply if they seem confused. o Mental Processing Deficits – Learning delays – put your message on an understandable level. Your patient may have both verbal and nonverbal communication difficulties. Unresponsiveness/failure to make eye contact may be normal for the patient. Try not to overwhelm them. Their visions/hallucinations are valid, do not tell them otherwise. They may be trying to communicate that way. Always speak to patient as if they can hear you because sometimes hearing stays intact. ALWAYS orient them to time, place, location, what you’re doing, etc for better outcomes. Age-Related Macular Degeneration (T: 139) o Most common cause of visual impairment after 50 years. o Impacts the macula, the central part of the eye. Causes loss of central vision. o Three stages: Early – medium sized drusen (human hair size), no vision loss Intermediate – larger drusen, pigment changes in retina. Only detected during dilated eye exam. Mild vision loss if any, but many have none. Late – vision loss from damage to macula. Geographic/dry is a gradual breakdown in cells in macula. Neovascular/wet is abnormal leaky blood vessels underneath the macula. Communicating with Adults with Vision Impairment (T: 142) o Assess for vision loss o Make sure you have their attention before speaking o Use lark, dark, printing o Speaking at their level o Use extra light
o Do not rearrange room, etc. Hearing Impairments (T: 150-151) o Watch for a hearing impairment. Note any signs of nonverbal deficit. o Never assume due to age unless other causes are ruled out. o Make sure hearing aids are well-functioning o Pause between sentences o Do not cover mouth o Lower tone of voice, etc. Alzheimer’s (T: 298-299) o Likelihood increases with age (3% 65-74, but 32% above 85) o Symptoms – memory loss (esp new information) depression and other health issues follow Cognitive Assessment Handouts – o See Lab Modules
Pediatric Skill Lab & Assessments (4?, CM and Labs, J: 142-143, 150-152, 169, 428)
CM –
Lab –
Do not assume who is in the room with the child (i. not mom and grandpa) Note relationship with primary caregiver (are they doing alright? Are they absent? What is the relationship like?) Play whenever possible! Give choices if you can. Give them time to get comfortable with you. Assessments will take longer because of this. Give older children a chance to talk without the parents. No big words, keep it simple! Know about fontanels (Anterior – 18mo) (Posterior – 2/3 mo) FACES – 4-5 years old FLACC – pre- or nonverbal Numeric for any that understand it.
J: 142-
Heart Rate Resting (Awake/Resting Asleep/Exercise or Fever) o Newborn 100-180/80-160/up to 220 o 1 wk to 3 mo 100-220/80-200/up to 220 o 3 mo to 2 yr 80-150/70-120/up to 220 o 2 to 10 yr 70-100/60-90/195- o 10 to 20 yr 55-90/50-90/195- Respiratory Rate o 0-1 yr 23- o 1-3 yr 22- o 4-6 yr 20-
J: 532
RLQ – cecum, appendix, right ovary/tube, right ureter, right spermatic cord RUQ – liver, gallbladder, duodenum, head of pancreas, right kidney/adrenal, hepatic flexure f colon, part of ascending and transverse colon. LUQ – stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal, splenic flexure of colon, part of transverse and descending colon. LLQ – part of descending colon, sigmoid colon, left ovary/tube, left ureter, left spermatic cord
J: 541 – bowel sounds (high-pitched, gurling, cascading, irregularly 5-30/min)
J: 379 – breast lymphatics (view diagram)
J: 386-392 – breast self-exams
J: 697 – testicular self-exam
J: 767 – complete health history
Nursing Process (1? L 10. PP) – see lab module
NSG 201 Test 3 map and study guide spring 2021 2
Course: Fundamentals (NSG241)
University: Marian University
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