hodgepodge
What degenerative joint disease is often called wear-and-tear arthritis and can present as stiffness in the joints lasting less than 30 minutes.
OA osteoarthritis
How do we prevent wrong site, wrong procedure, wrong patient?
conduct pre-procedure verification process where you verify all 3 things, involve patient, identify what is needed for procedure, use a standardized list to verify item availability, match items by ensuring procedure matches pt.
THINK BLUE RIDGE CLINIC
mark procedure site: especially if there is more than 1 procedure site, spinal procedures, mark before procedure, SURGEON IS THE ONE WHO MARKS, If it is in an area that cannot be marked or pt refuses to be written on use org written alt process
perform TIME-OUT: immediately before starting procedure or making incision, all questions/concerns must be resolved before procedure starts, designated team member starts TO, MINIMUM AGREEMENT 1 correct pt 2. correct site 3. correct procedure MULTIPLE PROCEDURES on 1 PT. each procedure needs a new time out. DOCUMENT completion of TO.
What are some barriers to reporting?
fear, time, embarrassment, lack of trust/feedback, unclear definitions, "patient fine"
what is a conflict management style useful for trivial issues or when emotions are high?
Avoiding-ignoring or withdrawing from conflict
What is the most common type of MS?
Relapsing-Remitting MS (RRMS)-flare up then periods of remission. > 50% leads to SPMS
Secondary-Progressive MS (SPMS)-relapses are followed by progressive worsening of disability
Primary-Progressive MS (PPMS)-15% of cases. Steady progression from onset, no remissions.
Progressive-Relapsing MS (PRMS)-5% of cases. Progressive from onset with sudden, clear relapses.
What is education that can be given to a MS patient
Avoid hot temperatures and stressful situations
What is a crucial step in preventing med errors?
What should the RN be sure to have with an ortho procedure?
X-rays and blood
What should you assess before giving NSAIDs and pain medication to a pt with back pain.
kidney and liver function tests
Implementation for risk for Peripheral Neurovascular Dysfunction
Assess 6 P q1-2h
Assess cap refill and edema
Assess for deep throbbing unrelenting pain
Assess for weak absent pulse (use doppler)
Monitor cast tightness; prepare for bivalve if too tight
*If compartment syndrome suspected, contact PHCP, STAT assist with compartment pressure measurement
Elevate injured extremity NOT ABOVE HEART if compartment syndrome is suspected (to maintain arterial flow).
Of the 6 healing stages of fractures, what is the stage where a hard callus of woven bone replaces the soft callus
4 Ossification
How long are you supposed to stay with a patient after initiating the administration blood products?
15 minutes after start
reassess after 15 minutes
VS within 30 minutes PRIOR to administering blood products.
What precautions should be in place for a pt at ^ risk for falls?
bed alrm, sign on door, side rails, non-slip socks, limit fluid at night, use bright lights, safety checks every 2 hours
What is ORIF?
Open Reduction Internal Fixation: two-part orthopedic surgery used to stabilize severe, displaced, or comminuted bone fractures that cannot heal with casting alone. It involves surgically opening the site (reduction) and using hardware like plates, screws, or rods to fix the bones
Conflict management style useful for emergencies or when quick, decisive action is needed.
competing-pursuing one's own concerns at the others expense.
A RN must never delegate what she can...??
EAT (evaluate, assess, teach)
Hospital must develop and implement written procedures for managing critical results
definition of critical results
who reports and to whom
acceptable time and length between availability and reporting
documentation requirements.
What are the 3 levels of prioritization?
1. ABCs and VS
2. psych (mental status), untreated issues, pain, elimination, imminent risks
3. education, chronic issues, rest, coping
What are some implementations for Disturbed Sensory Perception NDx
Assess ability to differentiate sharp/dull, presence of paresthesia/paralysis q1-2h.
Elevate injured extremity above heart (unless compartment syndrome is suspected)
Support injured extremity above/below fracture when moving.
*Client regains prior level of function
*client experiences no complications
*client understands and follows home care instructions
*Client lists symptoms to report immediately.
What are the 5 rights of delegation? with explanations/examples
Task delegate's job description or facility policy, doesn't require nursing judgment
Person-delegatee must possess appropriate skills and knowledge for task
Circumstance-client is in stable condition, any changes must be communicated to the nurse, she/he must reassess
Communication/Direction-NURSE provides SPECIFIC instructions. Delegatee must understand and agree cannot make modifications without consulting RN.
Supervision-RN monitors, follows up, evaluates outcomes, intervenes as necessary, ensures documentation. Delegatee communicates info to nurse.
med errors and sentinel events must have
root cause analysis
What prevents misunderstandings and promotes a culture of quality and safety?
common language (ISBAR)
conflict management style that is useful when the issue is more important to the other person or to preserve feelings.
accommodating-giving in to the other party's wishes.
What are 3 types of traction and nursing implications to maintain them.
TRACTION-aligning bones with a constant, steady pulling action.
Manual-applied by hand
Skin-applied to skin (Buck's traction)
Balanced Suspension-Supports injured limb in sling
Skeletal-pins inserted into bone, weights applied
Nursing Implications-Maintain line of pull, ensure weights hang freely, monitor