NR 226 Exam 3

NR 226 Fundamentals of Nursing Exam 3

Chapter 21: Managing Care

Prioritizing Patient Care

Effective prioritization of patient care is essential for nurses to manage multiple patient needs efficiently and safely. By identifying relationships among various patient problems, nurses can prevent delays in intervention and reduce the risk of complications. Immediate attention should be given according to the ABC rule: airway, breathing, and circulation are always the highest priorities in any clinical scenario.

The levels of patient care prioritization can be categorized as follows:

Priority Level	Description	Examples
High	Emergent situations posing immediate threats to survival or safety.	Obstructed airway, acute anxiety attack
Intermediate	Non-emergent but significant needs affecting patient or family well-being.	Patient education on new medications, post-operative pain management
Low	Issues not directly related to current illness, focusing on long-term health or development.	Pre-discharge patient education

Types of Nursing

Various nursing care models guide how care is delivered, each with distinct advantages and limitations.

Nursing Model	Description	Limitations
Primary Nursing	One RN assumes responsibility for comprehensive care of specific patients.	Care plans require approval for changes; cost reduction not guaranteed
Total Patient Care	RN provides all care aspects directly while coordinating with the healthcare team.	High demand on RN staffing; potential communication gaps
Functional Nursing	Tasks are divided among team members based on function.	Care can become fragmented; holistic patient focus may be limited
Case Management	Coordinates healthcare services to optimize cost and quality outcomes.	May not involve direct patient care consistently
Team Nursing	RN supervises a team of RNs, LPNs, and MAs to deliver care collaboratively.	Delegation is time-consuming; limited direct patient interaction for RN

Magnet Hospitals

Magnet hospitals are recognized for promoting nursing excellence through research initiatives, professional development, and evidence-based practice. Nurses in these institutions enjoy autonomy, professional empowerment, and collaborative relationships, ultimately improving patient care quality and fostering innovation.

Delegation to Medical Assistants and LPNs

Delegation involves transferring task responsibility to another healthcare team member while maintaining accountability for the outcome. Successful delegation requires assessing staff competency and assigning tasks appropriately. Clear communication and adherence to the Five Rights of Delegation are essential:

Right	Description
Task	Assign routine, non-invasive tasks that require minimal supervision.
Circumstance	Ensure appropriate patient setting and resources for the task.
Person	Match the correct team member to the task and identify the responsible receiver.
Direction	Provide precise instructions including objectives and limits.
Supervision	Maintain ongoing oversight and feedback throughout task completion.

Chapter 24: Communication

Communication Techniques for Special Needs

Nurses must adapt communication strategies to meet the needs of patients with specific challenges, such as cognitive impairments or sensory deficits.

Condition	Techniques
Cognitive Impairment	Use simple sentences, ask one question at a time, allow response time, include family in discussions
Hearing Impairment	Minimize background noise, gain patient attention, ensure visibility of speaker’s mouth
Visual Impairment	Speak in normal tone, provide adequate lighting, use large print materials
Nonverbal/Unable to Speak	Listen attentively, use yes/no questions, and employ visual aids

Communication Techniques

Effective communication can be enhanced using techniques that clarify and validate understanding:

Technique	Description
Parroting	Repeat the patient’s statements verbatim without paraphrasing
Clarifying	Restate unclear information to ensure comprehension
Focusing	Direct attention to critical aspects of the conversation without interruptions
Paraphrasing	Restate the patient’s message in the nurse’s own words to confirm understanding

SBAR Communication Method

The SBAR (Situation-Background-Assessment-Recommendation) framework standardizes communication during significant patient events:

• Situation: Identify the issue, including primary and secondary diagnoses.

• Background: Provide relevant medical history and prior treatments.

• Assessment: Share key findings from evaluations and vital signs.

• Recommendation: Suggest a care plan and necessary actions.

Types of Communication

Therapeutic Communication	Non-Therapeutic Communication
Encourages expression of feelings and conveys respect.	Can obstruct patient expression and harm professional relationships.

Zones of Personal Space

Zone	Distance	Examples
Intimate	0–18 inches	Physical assessment, dressing changes
Personal	18 inches–4 ft	Bedside conversation, history taking
Social	4–12 ft	Teaching, group discussions
Public	12 ft+	Lectures, community talks

Chapter 50: Care of the Surgical Patient

Surgical Classifications

Surgical procedures are classified according to urgency and purpose:

Classification	Description	Examples
Urgent	Necessary to prevent deterioration, not immediate.	Tumor excision
Elective	Patient-chosen, not essential for survival.	Hernia repair
Emergency	Immediate intervention needed to preserve life or function.	Internal bleeding control
Major	Extensive, high-risk procedures.	CABG
Minor	Minimal, low-risk procedures.	Tooth extraction
Diagnostic	Performed for diagnosis.	Exploratory laparotomy
Ablative	Removes body part.	Gallbladder removal
Palliative	Relieves symptoms without curing.	Colostomy
Reconstructive	Restores function or appearance.	Scar revision
Procurement	Organ removal for transplant.	Kidney transplant
Constructive	Corrects congenital loss of function.	Cleft palate repair
Cosmetic	Enhances appearance.	Rhinoplasty

Malignant Hyperthermia

Malignant hyperthermia is a rare but life-threatening genetic disorder triggered by anesthesia, presenting with hypercarbia, muscle rigidity, and rapid temperature increases. Nurses must closely monitor patients for early signs during surgery.

Pre-operative Care

Nurses play a pivotal role in preparing patients for surgery:

• Explain preoperative procedures and expectations.

• Review the surgical checklist and consent forms.

• Evaluate physical and mental readiness.

• Initiate IV access and fluid management.

• Monitor vital signs and administer conscious sedation if indicated.

Post-Anesthesia Care Unit (PACU)

In the PACU, nurses monitor critical recovery parameters, including:

• Vital signs and respiratory function.

• Cardiac status post-surgery.

• Pain assessment and peripheral circulation.

• Signs of nausea, vomiting, or other complications.

Types of Anesthesia

Anesthesia Type	Purpose	Potential Complications	Nursing Implications
General	Induces immobility and memory loss during surgery.	Cardiovascular/respiratory depression, organ damage	Monitor vitals, airway, and recovery
Regional	Numbs a specific body region without consciousness loss.	Hypotension, respiratory compromise	Monitor breathing, limb positioning
Local	Numbs a localized area	Limited motor impairment	Observe for adverse reactions
Conscious Sedation	Sedation while maintaining responsiveness	Similar risks as other anesthesia	Maintain airway, monitor patient response

Time Out Protocol

The Time Out protocol occurs immediately before surgery, involving all staff to confirm patient identity, procedure details, and the surgical plan to ensure safety.

Roles of the Circulating and Scrub Nurse

Circulating Nurse	Scrub Nurse
RN responsible for intraoperative care and documentation	Maintains sterile field and assists the surgeon
Monitors patient care and verifies instrument counts	Facilitates draping and instrument handoff

References

American Nurses Association. (2021). Nursing: Scope and standards of practice. American Nurses Association.

Black, J. M., & Hawks, J. H. (2016). Medical-surgical nursing: Clinical management for positive outcomes. Elsevier.

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2017). Medical-surgical nursing: Assessment and management of clinical problems. Elsevier.

NR 226 Exam 3

Potter, P. A., & Perry, A. G. (2022). Fundamentals of nursing. Elsevier.

Smeltzer, S. C., & Bare, B. G. (2020). Textbook of medical-surgical nursing. Pearson.