NORCET ADVANCE TNC Series - 103 || Mosby solution || Daily 5.00 Pm || All NURSING EXAM

Key Concepts

• Medication Reconciliation: Comparing a patient's past drug and dosage history with their current prescriptions to avoid errors.
• NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): Medications like ibuprofen that inhibit prostaglandin synthesis, potentially leading to increased gastric acid secretion and GI bleeding.
• Melena: Black, tarry stools indicative of upper gastrointestinal bleeding.
• Tachycardia: A heart rate exceeding 100 beats per minute.
• Health Teaching: Educating patients about their disease, care, and self-management.
• Surgical Asepsis: Maintaining a sterile environment free from microorganisms.
• Dehiscence: Partial or complete separation of wound edges.
• Evisceration: Protrusion of internal organs through a surgical incision.
• Capillarity: The process by which moisture and microorganisms are drawn into a sterile field from a non-sterile surface.
• Local Anesthesia: Loss of sensation in a specific area of the body.
• Vasoconstriction: Narrowing of blood vessels.
• Vasodilation: Widening of blood vessels.
• Hypothermia: Abnormally low body temperature.
• Frostbite: Tissue damage caused by prolonged exposure to freezing temperatures.
• Paresthesia: Abnormal sensation, such as tingling or numbness.
• TENS (Transcutaneous Electrical Nerve Stimulation): A therapy that uses electrical currents to stimulate nerves for pain relief.
• Patient-Controlled Analgesia (PCA): A system that allows patients to self-administer pain medication intravenously.
• Postmenopausal: The period after menopause in women.

Detailed Summary

1. Medication Reconciliation

• Main Topic: The importance of medication reconciliation in patient care.
• Key Points:
  • Medication reconciliation is a process of comparing a patient's past drug and dosage history with their current prescriptions.
  • The goal is to prevent medication errors such as double-dosing or omissions.
  • Medication reconciliation should be performed during:
    • Admission to the hospital
    • Transfer to another ward
    • Discharge from the hospital
• Example: A patient taking 75mg of ecosprin daily at home is prescribed the same dose in the hospital without verifying their existing medication, resulting in a 150mg daily dose.

2. Arthritis, Ibuprofen, and Anemia

• Main Topic: The clinical indicators to expect in a client with arthritis who has increased their ibuprofen dosage and developed anemia.
• Key Points:
  • Ibuprofen is an NSAID that inhibits prostaglandin synthesis.
  • Prostaglandins protect the stomach lining.
  • Inhibition of prostaglandins can lead to increased gastric acid secretion, gastric irritation, and upper GI bleeding (melena).
  • Melena can cause anemia.
  • Anemia can lead to tachycardia as the heart compensates for reduced oxygen-carrying capacity.
• Logical Connections: Increased ibuprofen dosage leads to GI bleeding, causing anemia, which results in tachycardia.

3. Legal Implications of Health Teaching

• Main Topic: The nurse's role as a health teacher and the legal implications of providing patient education.
• Key Points:
  • Nurses have a responsibility to provide health teaching to patients before discharge.
  • This includes teaching about medication administration, diet, and disease management.
  • Nurses do not need an order from a healthcare provider to provide health teaching.
  • Family members should be included in teaching if the patient is incapable of self-care.
• Significant Statement: "The nurse was functioning as a health teacher."

4. Sink Faucets as Contaminated Surfaces

• Main Topic: Why sink faucets in a client's room are considered contaminated.
• Key Point:
  • Sink faucets are considered contaminated because they are frequently touched with dirty hands.
• Actionable Insight: Use disposable paper towels or one-time towels to turn faucets on and off.

5. Handwashing Principles

• Main Topic: The most important component of handwashing for removing microorganisms.
• Key Point:
  • Friction is the most important principle for removing microorganisms during handwashing.
• Mnemonic: "Factor is Friction" to remember the most important factor in handwashing.

6. Sterile Field Contamination

• Main Topic: The physical principle that causes a sterile field to become contaminated when a moist sterile gauze pad is placed on it.
• Key Point:
  • Capillarity is the principle by which microorganisms are drawn into a sterile field from a non-sterile surface via moisture.

7. Surgical Asepsis

• Main Topic: The reason for using surgical asepsis during dressing changes.
• Key Point:
  • Surgical asepsis aims to keep the area completely free from microorganisms.
• Distinction: Surgical asepsis differs from medical asepsis, which aims to reduce the number of microorganisms.

8. Dehiscence and Evisceration

• Main Topic: Nursing actions for dehiscence and evisceration of abdominal surgical wounds.
• Key Points:
  • Dehiscence: Separation of wound edges with visible underlying tissues.
  • Evisceration: Protrusion of internal organs through the incision.
  • Risk Factors: Obesity, abdominal surgery, poor wound healing.
  • Priority Nursing Actions:
    1. Stay with the client.
    2. Position the client in a low Fowler's position with knees slightly bent.
    3. Cover the wound with a sterile towel moistened with normal saline.
    4. Take vital signs.
    5. Prepare for surgery.

9. Legal Considerations for Patients with Cognitive Impairment

• Main Topic: Determining who is to blame when a patient with dementia develops a pressure ulcer after refusing repositioning.
• Key Point:
  • Patients with cognitive impairments, such as dementia, do not have the right to refuse necessary treatment because they lack the capacity to make informed decisions.
  • Nurses have a responsibility to provide care, even if the patient refuses, to prevent harm.

10. Critical Reactions to Radiation Therapy

• Main Topic: Identifying the most critical reaction to radiation therapy in a client with oropharyngeal cancer.
• Key Point:
  • Mucosal edema is the most critical reaction because it can lead to airway obstruction.

11. Addressing Patient Concerns About Radiation Therapy

• Main Topic: How to address a patient's concerns about radiation therapy causing cancer.
• Key Point:
  • Explain that radiation therapy targets only a small part of the body and that modern techniques are precise, minimizing the risk to other areas.

12. Managing Radiation Burns

• Main Topic: The best nursing response when a client expresses concern about getting a radiation burn.
• Key Point:
  • Explain that radiation therapy does not cause burns but can cause localized skin reactions, which usually occur 3-6 weeks after treatment.
  • Emollients are contraindicated during radiation therapy.

13. Cold Therapy

• Main Topic: Clinical indicators of effective cold therapy.
• Key Point:
  • Cold therapy causes vasoconstriction, which can lead to local anesthesia, reduced edema, decreased pressure, and decreased discomfort.

14. Managing Hypothermia

• Main Topic: Clinical manifestations of hypothermia.
• Key Points:
  • Clinical manifestations of hypothermia include:
    • Stupor
    • Pallor
    • Drowsiness
    • Decreased respiration
    • Paresthesia
• Nursing Actions:
  • Avoid massaging extremities.
  • Obtain a rectal temperature.
  • Assess fingers for frostbite.
  • Determine the client's level of consciousness.
  • Ask for identification to notify family.

15. Post-Operative Pain Management

• Main Topic: Initial nursing actions for a client reporting severe pain after surgery.
• Key Points:
  • First, assess the characteristics of the pain.
  • Second, obtain vital signs.
  • Administer prescribed pain medication after assessing vital signs.

16. Patient-Controlled Analgesia (PCA)

• Main Topic: Nursing actions for a client using PCA who is still experiencing pain.
• Key Point:
  • Determine the integrity of the IV delivery system.

17. Transcutaneous Electrical Nerve Stimulation (TENS)

• Main Topic: Appropriate nursing actions when operating a TENS unit.
• Key Point:
  • Adjust the dial on the unit until the client reports that the pain is relieved.

18. Redium Reactions

• Main Topic: Redium reactions that a nurse should assess.
• Key Point:
  • Assess the client for pain, as it is a toxic effect of radiation.

19. Safety Precautions for Redium Removal

• Main Topic: Safety precautions for assisting with redium removal.
• Key Point:
  • Ensure that long forceps are available for removing the redium.

20. Managing Redium Implants

• Main Topic: Priority nursing actions for a client with a redium implant.
• Key Point:
  • Restrict visitors to a 10-minute stay.

21. Discharge Instructions for Redium Implants

• Main Topic: Important information to teach a client with a redium implant upon discharge.
• Key Point:
  • Advise the client to follow up with their healthcare provider for ongoing care.

22. Post-Operative Care for Bladder Laceration

• Main Topic: Priority nursing intervention for a client after corrective surgery for bladder laceration.
• Key Point:
  • Turn the client frequently to prevent obstruction.

23. Managing Chemotherapy

• Main Topic: Nursing actions for a client receiving chemotherapy who reports not feeling well.
• Key Point:
  • Preventing infection is the priority nursing action.

Synthesis/Conclusion

The transcript covers a wide range of fundamental nursing concepts, emphasizing patient safety, accurate assessment, and appropriate interventions. Key takeaways include the importance of medication reconciliation, understanding the mechanisms and side effects of various treatments, prioritizing patient education, and recognizing the unique needs of vulnerable populations. The detailed explanations and examples provide actionable insights for nurses to deliver high-quality care in various clinical settings.