87. Mrs. Kann is an unconscious resident in a nursing home. Her doctor has ordered bed rails for Mrs. Kann's safety. The nurse assistant must keep the bed rails up: a) At all times except when giving bedside care b) Only when the doctor is present c) At all times regardless of the care being given d) Only when the resident is awake 88. While changing Mrs. Reed's colostomy bag, the nurse assistant notices signs of skin breakdown around the stoma. The nurse assistant must: a) Put petroleum jelly on the stoma and change the bag b) Tell the nurse about the breakdown c) Ignore the skin breakdown since this is normal d) Instruct the patient to be more careful with their colostomy bag 89. The doctor has ordered a timed urine specimen be collected from Mr. Lewis, a non-catheterized, independent patient in a long-term care facility. The equipment the nurse assistant should use to collect the initial sample from the resident is a: a) Paper cup b) Catheter c) Urine bag d) Bedpan or urinal 90. Mrs. Stuart is a resident with an ileostomy bag. The nurse assistant has been instructed to change Mrs. Stuart's ostomy pouch. Why is it important that the nurse assistant wear gloves? a) To avoid skin irritation to the nurse assistant's hands b) To avoid contact with potentially infectious body fluids c) To keep the nurse assistant from having to wash his/her hands often d) To avoid sensual contact with the resident's skin 91. Mr. Michaels has a respiratory disorder and his doctor has asked for a sputum specimen. Prior to collecting a sputum specimen from Mr. Michaels, the nurse assistant may ask the resident to: a) Rinse his mouth out with clear water b) Rinse his mouth out with mouth wash c) Expectorate onto sterile pad d) Expectorate into a tissue
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Hospitals are very concerned about the spread of germs in a hospital environment. For patient and guest safety, infection rates in any hospital are carefully monitored. Continuous efforts are made to reduce the chance of spreading infections among or between patients or guests. Unfortunately, studies reveal that every year in U.S. hospitals, nearly 2 million people are infected with a death rate approaching 80,000. Transmission of these infectious pathogens occurs most often through the contaminated hands of healthcare workers. This means that good hand hygiene is the most important infection control measure available. JQOS is a 100-bed hospital that offers a full range of services including emergency services, maternity, child care, orthopedic, cardiac, and general welfare. Management at JQOS has long believed that prevention is the best approach to any issue. They have decided to tackle the hand-washing issue head-on. Their goal is to improve hand-washing compliance among healthcare workers (doctors, nurses, caregivers, orderlies, etc.) throughout the hospital. a. Use Dr. Feigenbaum’s definition of quality and refer to the information provided. Describe the definition of quality for each of the major participants (doctor, patient, nurses, etc.). b. Describe how you would recognize Dr. Shewhart’s common cause variation in the process of maintaining a high level of doctor or nurse hand washing before touching a patient. c. Describe how you would recognize Dr. Shewhart’s assignable cause variation in the process of maintaining a high level of doctor or nurse hand washing before touching a patient. d. You are the senior team leader in charge of making improvements to the process of hand-washing compliance. You have recently attended a seminar focused on Dr. Deming’s teachings. Clearly state one of Dr. Deming’s 14 points that you will keep in mind as you focus on this situation. How will this point guide your actions and behavior as you tackle making improvements? e. Describe two clues that suggest that the hospital is practicing Juran’s little q versus big Q. If they were to practice big Q, describe one way in which their focus would need to change. f. During a meeting, someone has cornered you concerning the improvements and changes your team would like to make at the hospital. They accuse you of wanting to create a luxurious environment at the hospital. They said that a patient’s judgment of quality of the hospital is intangible and not measurable. They also said that there is an economics of quality. You recognize these statements as three of Mr. Crosby’s five erroneous assumptions about quality. Using what you know about Mr. Crosby’s approach to quality, pick one and argue against what this person has said.
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Mr J. is a 44 year-old man with no previous medical history presents to the emergency department with a chief complaint of severe abdominal pain, fever, and chills. He is subsequently admitted to the critical care unit after an open exploratory laparotomy where it was found that he had a perforated appendix and diffuse peritonitis. Intraoperatively he had an estimated blood loss of 350 mL and he received 1 Liter of crystalloid solution in the OR. He arrives at the critical care unit intubated and sedated with a right radial arterial line, a five-lumen pulmonary artery catheter, and an indwelling urinary catheter in place. CASE SCENARIO QUESTIONS: 1.The charge nurse and CCU nurse receiving the patient from the OR team had just finished getting the patient settled. The CCU nurse performs her admission assessment and documenting vital signs and pressure. Before she records his arterial, pulmonary artery pressure and right atrial pressure readings, what should she do first? Why? 2.Right after recording the PAOP, what is most important nursing action to prevent complications of an indwelling PA line? 3.The cardiologist asks the CCU nurse to obtain and give him current CVP reading for Mr. J. Which port on the PA line will the nurse need to access in order to obtain these readings? What does the CVP reading measures? 4.The RAP is reading 1 mmHg. What does this mean? What may have caused this? What nursing interventions do you expect Mr. J needs? 5.The night CCU nurse is now performing her beginning of the shift assessment. She zeroes her arterial and PA line via the transducer to phlebostatic axis. What level does the stopcock needs to be positioned in relation to the patient in order for the pressure readings to be accurate? What pressure reading on the monitor indicates successful zeroing? 6.What is important for the CCU nurse to include in the documentation of Mr. J’s pressure lines? What nursing interventions should be included during routine assessment of patient in regards to pressure lines? What are the complications of PA and arterial lines? 7.Since Mr. J is being weaned off mechanical ventilation, the cardiologist has ordered follow-up ABG to evaluate his tolerance to the weaning parameters. What line will the nurse need to access to obtain the ABG readings? 8. It is 4 hours post-op and Mr. J’s current BP is 82/53, and HR 119. The nurse noticed that his blood pressure has dropped from earlier reading of 95/65 mmHg and heart rate increased from 110 bpm. Mr. J’s urine output for past 4 hours has been approximately 20mL/hr. The intensivist orders for the nurse to administer a 1000mL NS bolus and start Dopamine drip to keep BP WNL. Which pressure line is required for patients on vasopressor drips? 9.One hour after IV NS bolus given and Dopamine drip started, Mr. J’s BP is now 105/68 mmHg and HR is 108 bpm with urine output of 30mL/hr. However, nurse noticed on reassessment that patient still requires high FiO2 concentration to keep his SaO2 >95%. The nurse documents his SvO2 which is 57% and pale skin color. Is the SvO2 reading normal and what does it measure compared to SaO2? What may be a contributing factor to this reading? What should the nurse expect the patient needs? What labs will need to be obtained? 10.After the blood transfusion, the nurse is documenting current vital signs and pressure readings. She notices the PAP suddenly dropped and performed a dynamic response test. What abnormal response could the nurse expect to observe on the monitor? What nursing interventions may be done to troubleshoot? 11.The CCU nurse found the tubing to be kinked in multiple areas along the pressure tubing. After straigtening the tubing, a dynamic response test was done and is normal. The nurse then zeroes the transducer/stopcock to phlebostatic axis. She inflated the balloon of the PA line to obtain the PAOP but was met with resistance after 1 mL of air is injected. Is this normal? What is the next nursing action? What may have caused this? .
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