Directions: Answer the following questions using critical-thinking. All answers must be typed into the document
Chapter 1
1. Describe role of the rapid response team (RRT). Describe three patient changes where it would be appropriate for the nurse to notify the RRT.
Answers:
2. QSEN identified patient-centered care as a nursing competency. Describe one way in which nurses can encourage patients and their family members to become empowered. How will this make the healthcare experience safer?
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Chapter 2
3. Discuss the role of activity/mobility in the older adults’ life. Discuss implications of poor physical functioning.
Answers:
4. For each of the SPICES categories/conditions, describe one physiological age-related change that may be responsible for the condition.
Answers:
Chapter 3
5. Discuss the implications of treatment of pain with an opioid: side effects, adverse effects, nursing assessment.
Answers:
6. Discuss the following concepts:
a. Neuropathic vs. nociceptive pain
Answer:
b. Referred vs. radiating pain
Answer:
Please answer the questions from those key points. No citation,no outside sources,and no references.Instructor stated ” Summarize on your own english without copy from key point”
Ignatavicius: Medical-Surgical Nursing, 8th Edition
Chapter 01: Introduction to Medical-Surgical Nursing Practice
Key Points
• One of the most successful IHI initiatives was the creation of the Rapid Response Team (RRT), also called the Medical Emergency Team (MET).
o Rapid Response Teams are one initiative to save lives and decrease the risk for patient harm before a respiratory or cardiac arrest occurs.
o Members of such a team are critical care experts who are on-site and available at any time to respond to calls for assistance.
o Early clinical changes in condition occur in most patients for up to 48 hours before a “Code Blue.”
o Therefore, observe for, document, and communicate early indicators of patient decline, including decreasing blood pressure, increasing heart rate, and changes in mental status.
Quality and Safety Education for Nurses Core Competencies
• The six core competencies for health care professionals based on research by the Institute of Medicine (IOM; http://iom.edu/) and Quality and Safety Education for Nurses (QSEN; http://www.qsen.org/) are: PATIENT-CENTERED CARE, TEAMWORK AND COLLABORATION, EVIDENCE-BASED PRACTICE, QUALITY IMPROVEMENT, INFORMATICS, and SAFETY.
• Nurses, as advocates for the patient and family, teach them how to be empowered and have more control over their care.
• The Joint Commission recently started a Speak Up™ campaign to provide information to patients and families to increase their empowerment.
• The three ethical principles to consider when making clinical decisions are self-determination, beneficence, and justice.
• Respect for people is one of six basic ethical principles that nurses and other health care professionals should use as a basis for clinical decision making.
• Respect implies that patients are treated as autonomous individuals capable of making informed decisions about their care.
• Patient autonomy is referred to as self-determination or self-management.
• The second ethical principle is beneficence, which emphasizes the importance of preventing harm and assuring the patient’s well-being.
• Nonmaleficence follows the QSEN core competency of safety, ensuring patient SAFETY and preventing harm.
Chapter 02: Common Health Problems of Older Adults
Key Points
Priority concepts applied in this chapter include NUTRITION, MOBILITY, SENSORY PERCEPTION, COGNITION, ELIMINATION, and TISSUE INTEGRITY.
• Learning about the special needs of older adults is important for health care professionals in a variety of settings.
• The percentage of people older than age 65 years in the United States is about 13%.
• The four subgroups of the older adult population are the young old, middle old, old old, and elite old.
• The fastest growing subgroup is the old old, sometimes referred to as the “advanced older adult” population. Members of this subgroup are sometimes referred to as the “frail elderly,” although a number of 85- to 95-year-olds are very healthy.
• Frailty is a clinical syndrome in which the older adult has unintentional weight loss, weakness and exhaustion, and slowed physical activity, including walking. Frail elders are also at high risk for adverse outcomes.
• The vast majority of older adults live in the community at home or within an environment that offers assistance. Only 5% are in long-term care (LTC).
• Considerations of multiple older adult health issues in other types of institutions (prisons) include alcohol and substance abuse and poor NUTRITION.
• The number of homeless older adults, including veterans of war, continues to rise. These individuals are often faced with chronic health problems, including mental/behavioral disorders.
HEALTH ISSUES FOR OLDER ADULTS IN COMMUNITY-BASED SETTINGS
• Health status can affect the ability to perform daily activities and participate in social activities.
• Increased dependence on others may have a negative effect on morale and life satisfaction.
• Loss of autonomy is a painful event with far-reaching effects.
• Older adults often experience personal losses that can affect their sense of control over their lives.
• Many older adults are not prepared for retirement in view of increased expenses and income that is not adequate to meet basic needs, health care treatments, and medications.
• Many are discharged from health care facilities and require home health services or live in long-term care settings.
• Coordinate care by collaborating with members of the health care team when providing care to older adults in the community or inpatient setting.
• Provide information regarding community resources for older adults to help them meet their basic needs.
• Common health issues and geriatric syndromes affecting the older adults include decreased nutrition and hydration, decreased mobility, stress and loss, accidents, drug use and misuse, mental health/cognition problems (including substance abuse), and elder neglect and abuse.
• Decreased NUTRITION and hydration are two health problems experienced by older adults.
o Reduced income, chronic disease, fatigue, and decreased ability to perform activities of daily living are other factors that contribute to inadequate nutrition among older adults.
o Some older adults are at risk for geriatric failure to thrive (GFTT)—a complex syndrome including under-nutrition, impaired physical functioning, depression, and cognitive impairment.
o Many older adults are at risk for under-nutrition, most often protein-calorie malnutrition, also known as protein-energy malnutrition.
o Older adults may respond to loneliness, depression, and boredom by not eating.
o Diminished senses of taste and smell often result in a loss of desire for food, and poor dental status can affect their ability to chew.
o The risk for dehydration is greater in older adults because of many factors, including diuretics, incontinence concerns, and decreased thirst mechanism.
• Decreased MOBILITY
o Exercise and activity are important for older adults as a means of promoting and maintaining health.
o Teach older adults about the benefits of regular physical exercise.

• Stress and Loss
o Stress can speed up the aging process over time, or it can lead to diseases that increase the rate of degeneration. It can also impair the reserve capacity of older adults and lessen their ability to respond and adapt to changes in their environment.
o Relocation stress syndrome is the physical and emotional distress that occurs after the person moves from one setting to another and may cause sleep disturbance and physical symptoms, such as GI distress.
• Accidents
o The biggest concern regarding accidents among older adults in both the community and inpatient setting is falls.
• Older adults need to be aware of safety precautions to prevent accidents, such as falls.
• Incapacitating accidents are a primary cause of decreased mobility in old age.
• Changes in vision, touch, and motor ability can create challenges for older adults in any environment.
o Motor vehicle accidents are the most common cause of injury-related death in the young old population, those between 65 and 74 years of age.
• Health care professionals play a major role in identifying driver safety issues.
• Since 1996, the Hartford Institute for Gerontological Nursing has worked to ensure that all hospitalized patients 65 years of age and older be given quality care.
• The Fulmer SPICES framework was developed as part of the NICHE project and identifies six serious “marker conditions” that can lead to longer hospital stays, higher medical costs, and even deaths. These conditions are:
o Sleep disorders
o Problems with eating or feeding
o Incontinence
o Confusion
o Evidence of falls
o Skin breakdown
• Use the SPICES assessment tool for identifying serious health problems that can be prevented or managed early.
• Follow The Joint Commission’s National Patient Safety Goals (NPSGs) and best practice guidelines to prevent agency-acquired pressure ulcers.
• Physical and chemical restraints should not be used for older adults until all other alternatives have been tried. If necessary, use the restraint that is least restrictive first.
• The most common accident among older patients in a hospital or nursing home setting is falling. A fall is an unintentional change in body position that results in the patient’s body coming to rest on the floor or ground.
• Maintaining TISSUE INTEGRITY is a major safety goal in the care of older adults. Prevention is key! The nurse uses evidence-based treatment for pressure ulcers, shear injuries, and skin tears. Supervising unlicensed assistive personnel in protecting fragile skin and coordinating interventions with the health care team is necessary to prevent harm and promote healing.
Chapter 03: Assessment and Care of Patients with Pain
Key Points
DEFINITIONS OF PAIN
• PAIN is what the patient says it is. Self-report is always the most reliable indication of PAIN.
• Factors that affect PAIN and its management include age, gender, genetics, and culture.
• Three major types of PAIN have been identified—acute, chronic cancer, and chronic non-cancer.
CATEGORIZATION OF PAIN BY DURATION
• The two major types of PAIN are acute and chronic.
• Acute pain often results from sudden, accidental trauma (e.g., fractures, burns, lacerations) or from surgery, ischemia, or acute inflammation. As injured tissue heals, SENSORY PERCEPTION changes.
• Chronic pain or persistent pain is further divided into two subtypes.
o Chronic cancer PAIN is associated with cancer or another progressive disease such as acquired immune deficiency syndrome (AIDS). The cause of PAIN is usually life threatening.
o Chronic non-cancer PAIN is associated with tissue injury that has healed or is not associated with cancer, such as arthritis or chronic back pain. This type of pain is the most common.
• Acute PAIN serves as a warning to the body, causing sympathetic responses such as increased heart rate, increased blood pressure and pulse, dilated pupils, and sweating.
• Both types of chronic PAIN do not cause sympathetic reactions. Therefore, some patients do not appear to be in pain, even when they are.
CATEGORIZATION OF PAIN BY UNDERLYING MECHANISMS
• Painful stimuli often originate in the periphery of the body.
o To be perceived, the stimuli must be transmitted from the periphery to the spinal cord and then to the central areas of the brain.
• Nociceptive Pain
o Normal pain processing, believed to be sustained by tissue damage or inflammation. Duration can be acute and/or chronic.
o The gate control theory involves a gating mechanism in the spinal cord. When the gate is opened, pain impulses ascend to the brain; when closed, the impulses do not get through and PAIN is not perceived.
o Nociception has four processes, including SENSORY PERCEPTION (involves the conscious awareness of PAIN).
o Somatic PAIN arises from the skin and musculoskeletal structure.
o Visceral PAIN arises from organs.
• Neuropathic Pain
o Sustained from abnormal processing of stimuli and can occur in the absence of either tissue damage or inflammation.
o Difficult to treat and often resistant to first-line pain agents.
o PAIN descriptors include “burning,” “shooting,” “stabbing,” and feeling “pins and needles.”
• Tolerance implies that the patient has adapted to a drug and, over time, its effects decline.
• Physical dependence is manifested by a withdrawal reaction.
• Addiction is a primary, chronic disease that occurs over a long period. Behaviors in addiction include craving, compulsive drug use, and continued use despite harm.
• The opioid full agonists are most effective for both acute and chronic PAIN management. They bind to mu receptors and block pain transmission.
o Equianalgesic charts are useful when changing from one opioid to another. A morphine dose of 10 mg is the standard dose against which other opioids are measured.
o Morphine and similar mu agonists are the gold standard drugs for both acute and chronic pain and are available in many forms, both short acting and long acting.
o Other commonly used mu agonists include oxycodone, hydromorphone, and fentanyl.
o Meperidine is an outdated drug and is rarely used. Its toxic metabolite (normeperidine) can accumulate, especially in the older adult or someone with decreased renal clearance, and can cause seizures and confusion.
o Observe for and prevent common side effects of opioids, including nausea and vomiting, constipation, sedation, and respiratory depression.

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