Transcript certification review 3 Sp10

CNL Certification
Exam Review
Systems
Macro vs. Micro systems
Microsystems
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Assess, Diagnose, Treat, Evaluate
All players including patient
Health Care Improvement
Quality Improvement( CQI, QA)
Risk Management
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Sentinel events
Patient injury
Outcomes Management
Advanced Med Surg
Key populations
Safety
Meds
Emergency/critical thinking
Vaccines
Chronic illness
Gerontology
Care Issues- Vulnerable
Populations
Groups of persons who may be compromised in their ability to give
informed consent, who are frequently subjected to coercion in their
decision making, or whose range of options is severely limited,
making
them vulnerable to health care quality problems.
Children
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All infants, children, and adolescents, i.e., all individuals who have
not reached the legal age for consent.
Disabled
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Persons with physical or mental disabilities that affect or limit their
activities of daily living and that may require special
accommodations. These include cognitively disabled,
communicatively disabled, mentally disabled, and physically
disabled
Frail Elderly
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Older adults or aged individuals who are lacking in general strength
and are unusually susceptible to disease or to other infirmity
Homeless
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Persons who have no permanent residence,
including children and adolescents with no fixed
place of residence.
Illiterate/Low-literate Populations
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Persons with low levels of education.
Immigrants
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Persons coming into a country of which he or she
is not a native for the purpose of setting up
residence. This category is also defined to include
refugees, asylees, and undocumented aliens or
immigrants.
Medically Uninsured
Mentally Ill
Minority Groups
Non-English Speaking Populations
Poverty Populations
Prisoners
Rural Populations
Terminally Ill
Transient/Migrants
Urban Populations
Women
IOM
Care Issues
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Frailty associated with old age - preventing falls
and pressure ulcers, maximizing function, and
developing advanced care plans
Hypertension - focus on appropriate management
of early disease
Asthma - appropriate treatment for persons with
mild/moderate persistent asthma
Cancer screening that is evidence-based - focus
on colorectal and cervical cancer
Care Coordination (cross cutting)
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Immunization - children and adults
Ischemic heart disease - prevention, reduction of
recurring events, and optimization of functional
capacity
Major depression - screening and treatment
Medication management - preventing medication
errors and overuse of antibiotics
Nosocomial infections - prevention and
surveillance
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Obesity (emerging area)
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Pain control in advanced cancer
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Pregnancy and childbirth - appropriate prenatal and
intrapartum care
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Self-management/health literacy (cross-cutting)
Severe and persistent mental illness - focus on treatment
in the public sector
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Stroke - early intervention and rehabilitation
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Tobacco dependence treatment in adults
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Children with special health care needs
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Diabetes - focus on appropriate management of early
disease
End of life with advanced organ system failure - focus on
congestive heart failure and chronic obstructive
Exam Content
Illness/Disease Management
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Knowledge Management
Health Promotion and Disease Prevention &
Injury Reduction/Prevention Management
Evidence-Based Practice
Exam Content
Uses clinical judgment and decisionmaking skills to make clinical decisions
regarding patient care decisions,
delegation of patient care activities, and
nursing care outcomes
Uses care management skills and
principles to provide and supervise client
care within specific episodes and across
episodes of illness and disease
Illness/Disease Management
1. Assumes responsibility for the provision and management
of care at the point of care in and across all environments
2. Provides care at the point of service to individuals across
the lifespan with particular emphasis on health promotion
and risk reduction services
3. Performs a comprehensive health assessment, including a
comprehensive history and physical assessment
4. Identifies patient problems that require intervention, with
special focus on those problems amenable to nursing
intervention
16. Uses advanced knowledge of pathophysiology and
pharmacology to anticipate illness progression, response
to therapy and to guide/teach patients and families
regarding care
CHF
Treatment goals:
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Prevent initial cardiac injury
Prevent further injury; aggressive tx post MI
Prevent post injury deterioration( ACE)
General tx
Prevent life threatening complications: PE
COPD
Stop smoking
Bronchodilators; short term, long term
Steroids
Antimicrobials
Oxygen- acute and chronic
Vaccines
Pulm rehab
Surgery
High Alert Medications
Insulin, Oral hypoglycemics
Anticoagulants-Heparin...
Thrombolytics
Chemo agents
Adrenergic agonists- epinephrine, norepinephrine
Adrenergic antagonists- Beta blockers
Antiarrythmics- Lidocaine
Anesthetic agents
Dextrose, hypertonic- >20%
Epidural agents
Sedatives
Opiates
TPN
Source: www.ismp.org
Medications
Antihypertensives
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(il) ACE inhibitors Lisinopril
Ol) Beta blockers Metaprolol
(tan) Aldosterone II receptor blockers
(ine) Ca Channel Blockers Nifedipine
Antiadernergics ( dilation) Aldomet/Methyldopa
Vasoldilators
Human B-type natriuretic peptides
Diuretics
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K, K K!!!!
Fluid balance
Anticoagulants
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Antithrombin ( newer drugs)
Platelet inhibitors : clopidogrel, ticlopidine
Heparin
Coumarins( Warfarin)
Insulin control
Hypoglycemic agents
Emergency
Prevent sentinel events
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RRT
Principles of Triage
Critical lab values
Pain management
When and how much???
Case 1:
Mrs. S was diagnosed with Type II Diabetes 6 months
ago. She has been admitted twice with HHNKC. This
admission she came in with a BG of 650, and was
barely conscious. Her English is limited and she has
few financial resources.
Case 2
Mr. J is receiving palliative care for terminal cancer
of the stomach. His pain meds do not seem to be
effective. He is somewhat confused but moans
constantly. The nurses on the unit seem reluctant to
give him the prescribed medication. You have
noticed that the nurses do not medicate unless the
patient asks for the pain meds
Case 3
The patient, Mrs. B, in room 12 is complaining of tightness in her
chest; she is pale and diaphoretic. Her VS are as follows: (98/54,
103, 24, SaO2 89%.She has an IV at kvo rate. You have left
another RN in the room with her and you now have to reach the
MD..
What do you suggest be done to solve this
problem?
Who should be involved in the problem
solving?
What are the important considerations
during the problem solving process?
What CNL roles and competencies apply
to this scenario
Case 4
A nurse working on a medical nursing unit during an external disaster
is called to assist with care for clients coming into the emergency
room. Using principles of triage, the nurse initiates immediate care
for a client with which of the following injuries?
a. bright red bleeding from a neck wound
b. b. penetrating abdominal injury
c. fractured tibia
d. open massive head injury in deep coma
Case 5
Furosemide( Lasix) 40 mg po has been prescribed
for a client. The nurse administers 80mg at
10:00 am. Following discovery of the error, the
nurse completes an incident report. Which of the
following would be documented on the report?
a. Lasix 80mg was given instead of 40mg
b. The wrong dose of medication was given to the
client at 10 am
c. Lasix 80 mg administered at 10am
d. I meant to give 40mg but I was rushed to help
another patient and I gave the wrong dose
This has been the 4th Lasix error on the unit this
month
Case 6
The physician’s order reads heparin sodium 25,000
units in 250ml, 5% Dextrose in water to run
continuously at a rate of 800 units per hour by IV,
The nurse sets the pump to how many ml per hour?
a. 8
b. 32
c. 40
d. 80
What is the significant problem with Heparin that led to
use of Lovenox?
What are the nursing issues if the patient is going to
take Lovenox at home?
Case 7
The mouth care measure that should be used
with caution by the nurse when the client has
a nasogastric tube is:
a. regularly brushing teeth and tongue with a soft
brush
b. sucking on ice chips to relieve dryness
c. occasionally rinsing mouth with a nonastringent
solution and massaging gums
d. application of lemon swabs and glycerin to the lips.
What other complications may occur when a
patient has a NG tube ?
How do you prevent these?
Case 8
Forty-eight hours after a nephrectomy, a client complains of
increasing nausea and abdominal pressure. The nurse’s first
nursing action is:
a. change the client’s position to relieve pressure
b. ausculatate bowel sounds
c. administer a rectal tube to relieve flatus
d. administer 6mg Morphine SO4 as ordered for the relief of discomfort
You also find that he has a rigid abdomen and is diaphoretic. What will
you do now?
You have patient who is being treated for
clinical depression while he is on the
Med-Surg unit for exacerbation of his
liver disease and GI bleeding
What are the issues?