Fundamentals of Nursing Exam 1

Fundamentals of Nursing Chapter 1 – Introduction of Nursing EXAM REVIEW FROM CLASS* Box 1-2 pg.12 Health people 2020 guidelines: 4 Goals 1. 2. 3. 4. High quality, longer lives free of preventable diseases, disability, injury, and premature death Health equity, eliminate disparities, and improve the health of all groups Create social and physical environments that promote good health for all Promote quality of life, healthy development, and healthy behaviors across all life stages Leading Health Indicators • • • • • • • • • • • • Access to health services Clinical preventive services Environmental quality Injury and violence Maternal, infant, and child health Mental health Nutrition, physical activity and obesity Oral health Reproductive and sexual health Social Determinants Substance abuse Tobacco Health Literacy – degree which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions END OF REVIEW FROM CLASS BELOW IS JUST EXTRA REVIEW* Nursing – person who nourishes, fosters, and protects and who is prepared to take care of the sick, the injured, aged, and dying people. *MAIN ROLE OF NURSE – CAREGIVER* Development of Nursing in the 16th Century ❖ ❖ ❖ ❖ ❖ Theory of animism – explained the changes in bodily functions, belief that everything in nature was alive with invisible forces: Good spirts brought health and evil spirts brought sickness. Temples became the centers of medical care Mosaic Health Code for relationships, mental health, and disease control Nurses cared for sick people in home and were nurse midwives Beginning of 16th century western societies ties shifted from religious orientation to emphasis on warfare, exploration, and expansion on knowledge Birth of Modern Nursing *Florence Nightingale - Founder of Modern Nursing ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ First training school for nurses Standards eds for hospital management Nursing education Recognize the 2 components: Health & Illness Nutrition is important Occupational & Recreational Therapy Maintaining records, nursing research Defined Nursing as an art and science Meeting personal needs of the client within the environment World War II – woman worked outside of home became more independent and assertive *Clara Barton - care for wounds in the Civil War. Established Red Cross in the US in 1882 *Mary Elizabeth Mahoney – first African American nurse *Isabel Hampton Robb – organized nursing school at John Hopkins Hospital. The first president of the Nurses associated alumnae of the US and Canada (American Nurses Association) *Dorothea Orem – self-care is a human need, nurses design interventions to provide or manage selfcare actions to sustain health 4 Broad Aims of Nursing Practice 1. Promote Health – physical, social, and mental components, Nurses promote health by identifying, analyzing, and maximizing each patient's own individual strengths 2. Prevent Illness – teaching and personal examples 3. Restore Health- performing assessments that detect illness (BP, blood sugars), asking other health care providers questions. planning, teaching, and carrying out rehabilitation for illnesses such as heart attacks, arthritis, and strokes. 4. Facilitate coping with disability or death – maximizing the persons strengths, through teaching, and through referral to community support systems. • Nursing Process – assessing, diagnosing, planning, implementing, and evaluating • Compassion fatigue – loss of satisfaction from providing good patient care • Burnout – state of frustration with work environment that develops over time • Secondary Traumatic Stress – feeling of despair caused by the transfer of emotion tion distress from a victim to a caregiver, develops suddenly. Ponte & Koppel STOP TECHNIQUE 1. 2. 3. 4. S – stop and take a step back T – take a few breathes O – Observe inside yourself P – Proceed after your pause BPTPR Technique 1. BP – being present 2. T – Tracking important number (BP, weight, blood sugar, lipid levels) 3. P - practicing health and wellness behaviors 4. R – refueling Chapter 2 Theory, Research, and Evidence-Based Practice EXAM REVIEW FROM CLASS* Deductive Reasoning – which one examines a general idea and then considers specific actions or ideas. Inductive Reasoning – the reverse process is uses- one builds from specific ideas or actions to conclusions about general ideas Nursing Theories o o o General Systems Theory - (primary theorists Ludwig von Bertalanffy) - how to break whole things into parts and then learn how the part work together in “systems” Adaptation Theory – adjustment of living matter to other living things and to the environmental conditions. Human Adaption 1. internal 2. Social 3. Physical Developmental Theory – the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death. Erikson (psychosocial Development) & Abraham Maslow (theory of human needs in terms of physical and psychosocial needs considered essential for human life) Conceptual Framework – a set of concepts and propositions that follows an understandable pattern 4 Concepts in Nursing Theory 1. 2. 3. 4. Person Environment Health Nursing Table 2-6 Research Journal Article Abstract – beginning of aritcle: summary Introduction – Review of literature and statement of purpose Method – subjects, design, data collection, data analysis: how the study was conducted Results – findings: words, charts, tables, or graphs Discussion (conclusion) - purpose of the study and literature review, suggestions for further research → References – article, books, and websites used → → → → → END OF CLASS REVIEW OTHER IS EXTRA NOTES* Sources of Knowledge 1. Traditional Knowledge – passed down from one generation to another 2. Authoritative Knowledge – from an expert and is accepted as truth based on the persons perceived expertise (EX: senior staff nurse) *most authoritative EBP 3. Scientific Knowledge – obtained through the scientific method (thorough research) Nursing Theory in Clinical Practice – independence & self-governance NINR – funds research Methods of Conducting Nursing Research 1. Quantitative Research – involves es basic & applied research *NUMBERS* 2. Qualitative Research – analyzes words instead of numbers *QUALITY* ▫ Phenomenology – describe experiences as they are lived by the subjects being studied (EX: having a heart attack) ▫ Grounded Theory – how people describe their own reality and how their beliefs are related to their actions in a social scene (EX: coping with a sick child) ▫ Ethnography – examine issues of a culture that are of interest in nursing ▫ Historical – events in the past to increase understand of the nursing profession today Essential Elements of EBP 1. Integration of best research and other forms of evidence to guide practice 2. Viewing clinical expertise as a component in care effectiveness 3. Considering patients preferences, values, and engagement in care decisions • • • • • P – population/ patient or problem of interest (setting or subgroup) I – Intervention of interest (treatment, diagnostic test, predicting factor) C – comparison (treatment or standard care) O – Outcome T – Time Systematic Review – summarize finding from multiple studies of a specific clinical practice question or topic, and recommend practice changes and future directions for research Theoretic Framework – advanced nursing knowledge & practice Concept – abstract idea or objects that relates to other abstract ideas or objects Scientific Process & Nursing Research Order 1. 2. 3. 4. 5. Identifying what ones needs to know or is curious about Deciding approach to finding the answer Devising plan Implementing plan Assessing Outcomes Chapter 3 Health, Wellness, and Health Disparities EXAM REVIEW FROM CLASS* Illness Behaviors • • • • Stage 1: experience symptoms (rash, fever, bleeding, or a cough) Stage 2: assuming the sick role (choose OTC treatment, doctor, or nothing) Stage 3: Assuming the Dependent Role: decision to accept the diagnosis and follow the prescribed treatment plan Stage 4: Achieving Recovery and rehabilitation Health Disparity – health difference that is linked with social, economic, and environmental disadvantages. → INFLUENCED BY: race, ethnicity, poverty, biological sex, age, mental health, education level, disabilities, sexual orientation, health insurance, and access to health care. The Health Promotion Model – developed to illustrate how people interact with their environment as they pursue health. I • Incorporates individuals characteristics and experiences (good if person will incorporate and use health behaviors), behavior specific knowledge and beliefs to motivate health-promoting behaviors (that there will be a positive outcome), sociocultural factors (help predict given health related habit) • Nurses us to design and provide interventions to promote health for people, families, and communities Health Promotion and Illness Prevention Primary Promoting health and preventing development of disease processes or injury Health-style self- test PCAM (patient centered assessment method) – tool nurses use to asses patients complexity using the social determinants of health that often explain why some patients engage and respond well managing their health while other with similar conditions do NOT. FACTORS: lifestyle, ability to enjoy daily activities, ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ Weight Loss Diet Exercise Smoking cessation Reduced alcohol consumption Avoidance of illicit drugs Farm Safety Seat belts and child safety seats Immunizations Water treatment Safer sex practices Effective parenting ➢ Screenings (BP, cholesterol, glaucoma, HIV, Skin cancer) Pap smears Mammograms Testicular examinations Family Counseling Caring for wounds Medication Medical Therapy Surgical treatment Rehabilitation Physical Therapy Occupational therapy Job training Support Groups physical and mental health, social environment, economic status, culture Secondary Screening for early detection of disease with diagnosis and treatment. Reduce severity Tertiary After illness is diagnosed and to help rehabilitate patients to a maximum level of functioning. ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ END OF CLASS REVIEW OTHER IS EXTRA NOTES* Holistic Health Care – care the addresses many dimensions: must understand and respects each person own definition of health and response to illness Morbidity – how frequently a disease occurs Mortality – numbers of death resulting from a disease Disease - medical term, the pathologic changes in the structure or function of the body or mind Illness – the response of the person disease (Signs & Symptoms) Remission – disease is present but the person does not experience symptoms Exacerbation – the symptoms of the disease disappear Health Equity – attainment of the highest level of health for all people Social Determinants of Health – conditions of environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes Vulnerable Populations – racial and ethnic minorities, those living in poverty, women, children, older adults, rural and inner-city residents, people with disabilities. *HUMAN DIMENSIONS* → Physical Dimensions – genetic inheritance, age, developmental level, race, and biological sex → Emotional Dimensions – how the mind affects the body functions and responds to body conditions. → Intellectual Dimensions – cognitive abilities, educational background, and past experiences → Environmental Dimensions – housing, sanitation, climate, and pollution of air, food, and water → Sociocultural Dimensions – health practices and beliefs are strongly influenced by a person economic level, lifestyle, family, and culture → Spiritual Dimensions – spiritual beliefs and values are important components of a person’s health and illness behaviors Chapter 4 – Health of the Individual, Family, and Community EXAM REVIEW FROM CLASS* Developmental Tasks of Families Duvall (1984) - identified the critical family developmental task and stages in a family life cycle. Based on Erikson theory of psychosocial development. Duvall states that all families have certain basic tasks for survival and continuity, as well as specific tasks related to developmental stages throughout the life of the family. (Table 4-2, Pg.73) Family – basic unit of human society *Nuclear Family - traditional family – composed of two parents and the children *Extended Family – aunts, uncles, and grandparents *Blended Family – another form of nuclear family, when parents bring unrelated children from previous relationships together to form a new family Basic Human Needs *Physiologic Needs (physical) – Oxygen is most important. Nurses assess oxygen by skin color, vital signs, anxiety levels, Responses to activity, restlessness, and mental responsiveness *Safety and Security (environmental): sterile techniques, administere medications properly, and correctly moving patients *Love and Belonging (sociocultural): understand of acceptance and receiving love *Self-Esteem (emotional): person to feel good about himself/herself. Nurses can help by respecting values and beliefs *Self- Actualization (Intellectual and spiritual): reach full potential EX: feelings of happiness, acceptance of self, respect END OF CLASS REVIEW OTHER IS CLASS NOTES* *Community– specific population of people living in the same geographic area under similar regulations and having common values, interests, and needs. EX: neighborhood within a city or large rural area *Community Health Nursing – focuses on whole populations within a community. *Community-Based– focuses on individuals and familied in that population. Provide interventions to manage acute and chronic health problems, promote health, and facilitate care. Holistic Approach to Health: Physical, emotional, spiritual, and well-being Friedman – identified the importance of family-centered nursing care. Chapter 5 Cultural Diversity EXAM REIVEW FROM CLASS Table 5-1 Common Health Problems in Specific Populations → Native American/Alaska Natives – Heart disease, Cirrhosis of the liver, Diabetes Mellitus, Fetal Alcohol Syndrome → African Americans – hypertension, Stroke, Sickle Cell Anemia, Lactose Intolerance, Keloids → Asians – Hypertension, Cancer of the Liver, Lactose Intolerance, Thalassemia (blood disorder, body make abnormal or inadequate hemoglobin → Hispanics - Diabetes Mellitus, Lactose Intolerance → Whites – Breast Cancer, Heart Disease, Hypertension, Diabetes Mellitus, Obesity → Eastern European Jews – Cystic Fibrosis, Gauchers Disease (lipid storage disease), Spinal Muscular Atrophy (loss of motor neurons and progressive muscle wasting), Tay-Sachs Disease (Metabolic Disorder – lipids accumulate in the brain) Poverty Culture ▪ ▪ ▪ ▪ ▪ ▪ ▪ Feeling of despair, resignation, and fatalism Day-to-day attitude towards life, no hope for the future Unemployment and need government assistance Unstable family structure Decline in self respect Lead to higher crime rates Psychological Problems such as schizophrenia, alienation, and feeling of worthlessness Concepts of Cultural Diversity and Respect Cultural Diversity – coexistence of different ethnic, biological sex, racial, and socioeconomic groups within one social unit (different religion, language, physical size, sexual orientation, age, disability, occupational status, and geographic location) Cultural Respect – enables nurses to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients Culture – shared systems of beliefs, values, and behavioral expectations that provides social structure for daily living • Culture is learned by each new generation through both formal and informal life experiences Subculture – large group of people who are members of the larger cultural group but who have certain ethnic, occupational, or physical characteristics that are not common to the larger culture. EX: nursing is a subculture in the health care system • • Dominant Culture Group – control the values and sanctions *most times the largest group in the society Minority culture groups – physical or cultural characteristics (race, religious beliefs, or occupations) Cultural Assimilation – when a minority groups lives within a dominant groups they may lose the cultural characteristics that made them different and take on the values of the dominant culture. → Mutual Cultural Assimilation – obtaining both when moving to a new culture Culture Shock – when places in different culture that the person perceives strange – can lead to frustration, anxiety, and loss of self-esteem Ethnicity – sense of identification with a collective cultural group, largely based on the groups’ members common heritage Race – based on physical characteristics such as skin pigmentation, body stature, facial features, and hair texture. Cultural Competence – developing awareness of ones own existence, sensations, thoughts, and environment. Demonstrate knowledge and understanding of ones cultures. Accept Cultural differences. Do NOT assume health care beliefs, being open and comfortable with cultural encounters. Linguistic Competence – ability to do something successfully and efficiently. Purnell Model – Global Society – Family – Person > (Pregnancy (postpartum, birthing) > (Nutrition (rituals, common foods, limitations) > (High Risk Behaviors (tobacco, alcohol, drugs, safety) > (Biocultural Ecology (genetics, skin color, heredity) > (Workforce Issues (autonomy, language barriers) > (Family roles and organizations (priorities, lifestyle, social status ) > (Communication (dominate language, eye contact, greetings) > (Overview/Heritage (politics, education) > (Health Care Providers ( perceptions of practitioners) > (Health Care Practices (responsibly, religious beliefs, mental health, traditonal practices) > (Spirituality (meaning of life, prayer) > ( Death Rituals (bereavement) END OF CLASS REVIEW OTHER IS EXTRA NOTES Factors Inhibiting Sensitivity to Diversity      Stereotyping – Negative: racism, ageism, and sexism. Beliefs that someone of a race is superior Cultural Imposition – belief that everyone else should conform to your own belief system Cultural Blindness – when one ignores the differences and proceeds as though they do not exist Cultural Conflict – when people become aware of differences, feel threatened. Ethnocentrism – believes that’s ones’ ideas, beliefs, and practice are the best or superior Reactions to Pain  Holding or applying pressure to the painful area  Avoiding activities that intensify the pain  Uncontrollable expressions  Spontaneous Expressions of discomfort – facial grimacing & moaning Linguistic Competence – the ability of caregivers and organizations to understand and effectively respond to linguistic needs of patients and their families in health care encounter Health Disparities – refers to health differences between groups of people, they can affect how frequently a disease affects a group, how many people get sick, or how often the disease causes death Cultural Competence – ability to understand, communicate with and effectively interact with people across cultures ESFT MODEL E –Explanatory Model of Health & illness → → → What do you think caused your problem? What worries you most? What kind of treatment do you think you should receive? S – Social and Environmental Factors → → How do you get your medications? Are they difficult for you to afford? F – Fears and Concerns → → Does the medication sound okay? Are you worried about the adverse affects? T – Therapeutic Contracting → → Do you understand how to take the medications? Can you tell me how you will take it? Transcultural Nursing (Dr. Leininger*) - nurse who is culturally respectful has the knowledge and skills to adapt nursing care to cultural similarities and differences. *Chapter 6 Values, Ethics, and Advocacy EXAM REVIEW FROM CLASS Ethics – the formal systematic study of principles of right and wrong conduct, virtue and vice, and good and evil they relate conduct and human flourishing. The ability to be ethical 2 moral development theories: Kohlberg’s justice-based account & Gilligan care-based. Development of Values Transmission 1. Modeling – observing parents, peers, and significant others 2. Moralizing – value transmission taught a complete value system by parents or an institution (church or school) 3. Laisez-faire – leave children to explore values on their own. (no values set) 4. Rewards and Punishments – rewarded for demonstrating values taught by parents and punished for unacceptable ones 5. Responsible Choice – encourage children to explore competing values and to weigh their consequences *Professional Values* ♦ ♦ ♦ ♦ ♦ Altruism – welfare and well-being of others (EX: understand cultures & beliefs, advocating for patients, talking risk on behalf of patients, and mentoring other professionals) Autonomy – right to self-determination: respects patients right to make decisions about their health care. (Ex: planning care, providing information so patients can make informed choices) Human Dignity – respect the uniqueness of people and populations; respects everyone. (EX: culturally respectful and sensitive care, protecting patients privacy) Integrity – acting in accordance with an appropriate code of ethics and accepted standards of practice. Nurse is honest and provides care based on ethical framework. (EX: documentation, seeking errors made by self or others, demonstrating accountability, honest) Social Justice – upholding moral, legal, and humanistic principals. Nurse assures EQUAL treatment under the law and equal access to quality health care. (EX: supporting families, no discrimination, promoting universal health care, encouraging legislation and policy) Principles Based Approach ▫ ▫ ▫ ▫ ▫ Autonomy (self-determination) - respects rights of patients or family in making health care decisions Nonmaleficence – Avoid causing harm Beneficence - benefit the patient, and balance benefits against risk or harm Justice – Act fairly: distribute benifits, risks, and cost of nursing care. Fidelity – keep promises; be faithful Ethical Dilemmas –adherence of basic principles results in 2 conflicting courses of action Values - Beliefs about the worth of something, about what matters, that act as a standered to guide one’s behavior. Value System – organization of values in which each ranked along a continuum of importance, often leading to a personal code of conduct. (influence: *beliefs of human needs, health, and illness; the practice of health behaviors; the human response to an illness.) Values Clarification – process by which people come to understand their own values and value system Process of Valuing: 3 Main activities. 1. Choosing 2. Prizing (treasure) 3. Acting Principle-based Approach • • Utilitarian – the rightness or wrongness of an action depends on the consequences of the action (abortion) reason based Deontologic – action is right or wrong based on a rule, independent of its consequence. Care-based approach – nurse-patient relationship (EX: COMPASSION, EMPATHY, RELIABILITY) Feminist Ethics – critiques existing patterns of oppression and domination in society. Moral agency (moral capacity) - the ability to make moral judgements on some notion of right and wrong and to held accountable for these actions Virtues – human excellences, cultivated dispositions of character and conduct that motivated and enables us to be good human beings. Moral Stress – when you know that right thing to do but either personal or institutional factors make it difficult to follow the correct course of action Moral Resilience – developed capacity to respond well to morally distressing experiences and to emerge strong. Conscientious Objection – refusal to participate in certain types of treatment and care based on the fact that these activities violate nurses personal and professional ethical beliefs and standards. Chapter 7 Legal Dimensions of Nursing Practice EXAM REVIEW FROM CLASS Crime – violation punishable by the state Negligence - failure to take proper care of something Malpractice – describes negligence by a professional personnel ➢ Failure to follow standards of Care EX: not following standards of administrating insulin ➢ Failure to use equipment in a responsible manner EX: trying to use a bariatric patients lift the first time without help. ➢ Failure to Assess and monitor EX: not follow hospital standards on postoperative assessments after receiving patient ➢ Failure to Communicate EX: not communicate your concerns about elderly patients being discharged home when she lives alone ➢ Failure to Document Proof of Malpractice • • • • Duty – accurate assessment, alerting responsible health care providers, execution of safety measures Breach of Duty – failure to not and report, failure to execute and document Causation – failure to use safety measures Damage – cause of failing to do what you are supposed to do Impaired Nurse – 1 in 10 nurses may be impaired or are recovering from alcohol or drug addiction. BOX 7-5 Checklist to Ensure Informed Consent 1. Disclosure – informed of 1. nature of procedure 2. Risk & Benefits 3. Alternative including option of nontreatment 4. fact that no outcomes can be guaranteed 2. Comprehension – patient/Surrogate can correctly repeat in his/her own words of what the are consenting too 3. Competence – understands the information to make this decision 4. Voluntariness – consenting or refusing *Never Events – serious reportable events: extremely rare medical errors that should never happen to the patient *Sentinel Events – unexpected occurrence involving death or serious physical or psychological injury Sexual Harassment – EEOC enforces – unwelcome sexual advances, request for sexual favors, and other verbal or physical conduct of sexual nature END OF CLASS REVIEW OTHER IS EXTRA NOTES Law – standard or rule of conduct established amd enforced by the government that is intended chiefly to protect the rights of the public → Statutory Law – legislative body – both federal constitution and the state constitution EX: Nurse Practice Acts → Administrative Laws - executive officers (President, state goveners, and city mayors) → Common Law – “let the decision stand” Tort – (may be intentional or unintentional) subject to action in a civil court with damages usually being settled with money – can be held liable of assault or battery, invasion or privacy, false imprisonment, and fraud (willful or purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property) • • • • Defamation of Character – intentional tort in which one party makes derogatory remarks about another that diminish the other parties reputation Slander – spoken defamation of character Libel – written defamation Confidentiality Chapter 11 The Health Care Delivery System EXAM REVIEW FROM CLASS BOX 11-2 Primary, Secondary, and Tertiary Health Care Care Level Goal Practice Site Activites Primary Health CARE Common health problems (sore throat, diabetes, arthritis, depression, or hypertension) preventive measures (immunizations, mammograms) Specialized clinical expertise -Family Planning Centers *Medications *Family planning *Health risk *screenings *Diagnostic test Secondary Health Care Tertiary Health Care Management of rare and complex disorders -Primary care centers -Urgent care centers -Employment health centers *Hospital *ER *Psychiatrist *Same-day surgery Tertiary care medical centers (cardiovascular surgeons, hematologist) Disease identification and management Rare and complex disease Diagnosis Related Groups (DRG’s) - prospective payment plan based on patients classification categories. To control rising health care costs. Pays the hospital a fixed amount that is predetermined by the medical diagnosis or a specific procedure rather than by the actual cost of hospitalization and care. If the cost of hospitalization is greater the hospital must absorb additional cost Ambulatory care – centers and clinics – facilities that deliver outpatient medical care Specialized Care centers 1. Daycares – some for healthy infant and children and some are for children with minor illnesses. Eldercare centers provide place for older adults to socialize and receive care while family members work 2. Mental Health Centers – may be within a hospital or independent facility. Crisis-centered or long-term. Services are group counseling, medications, and assistance with independent living. Most time provide 24 hotlines for those who are suicidal, abusing drugs or alcohol, or in abusive situations. 3. Rural Health Centers – located in geographically remote areas that have very few health care providers. Most time APRN’s 4. Schools – major source of health assessment, health education, and emergency care for the nations children. Provide many services: maintaining immunization records, providing emergency care for physical or mental illness, administering prescribed medications, health screenings, and providing health information. 5. Industry – focus on preventing work-related injury and illness by conducting health assessments, teaching for health promotion, using safety equipment, caring for minor accidents and illnesses, and making referral for serious health problems 6. Homeless Shelters – include immunizing children, teaching pregnant women, treating infections and illnesses, referring diagnosis and treatment of STI, and providing information to maintain health 7. Rehabilitation Centers – those who require physical or emotional rehabilitation and for treatment of chemical dependency. END OF CLASS NOTES OTHER ARE EXTRA Respite care – care provided for caregivers of homebound ill, disabled, or older adults Chapter 12 Collaborative Practice and Care Coordination Across Settings EXAM REVIEW IN CLASS Qualities of Nurse – knowledgeable and skilled, independent at making decisions, and accountable Situations-back-ground-assessment-recommendation (SBAR) • • • • S-Situation: complaint, diagnosis, treatment plan, and patients wants and needs B-Background: Vital signs, mental and code status, list of medications, and lab results A-Assessment: Current providers assessment of the situation R-Recommendation: Identify the pending lab results and what needs to be done over the next few hours and other recommendations for care Roles of a Nurse* – patient advocate, coordinator of services, and patient & family educator Transferring Patients – Handoff Technique – transferring responsibility for a patients from one car giver to another with the goal of providing timely, accurate information about the patients care plan, treatment, current condition and anticipated changes → → → → Who should be involved in the handoff communication Opportunities for people involved to ask questions SBAR Print information Transfer within a Hospital – personal belonging must be moved, records are moved to the new unit. When the patient is transferred the previous nurse gives a verbal report to the new nurse (name, age, providers, admitting diagnosis, surgical procedures, current condition, allergies, medications and treatment, lab data, and special equipment. Transfer to Extended Care Facility – sent with copy of medical record, original stays with the hospital, patients belonging are sent, prescriptions and appointment are sent. Discharge Patients the patient or caregiver has the knowledge and skills to provide and additional care still needed, discharged planning (ensure patient and family needs are consistently met as the patient moves from care setting to home. **asses strength and limitations, family or support, environment, implementing care plan. Admissions Admitting office to collect patients information, ID (name, providers name, etc) DOB, sign consent form for treatment ***Medication Reconciliation – completed in admission. Ensure all medications have been correctly ordered. AMA – leaving the hospital against medical advise – must sign and release form that releases the provider and health care institutions from and legal responsibility for the patients health status. END OF CLASS NOTES OTHER EXTRA NOTES Advocacy – the protection and support of another rights – important role of community nurses Continuity of care – process by which health care providers give appropriate uninterrupted care and facilitate the patients transition between different settings and levels of care Chapter 24 Asepsis and Infection Control EXAM REVIEW FROM CLASS Means of Transmission ▪ ▪ ▪ ▪ Direct Contact – requires close proximity between the susceptible host and an infected person or carrier Indirect Contact – contact with living creature (vector) or equipment or countertops (Fomite) Droplet Transmission – larger then 5 mcm Airborne Transmission – smaller 5 mcm Infection Cycle BOX 24-1 Laboratory Data Indicating an Infection → Leukocyte Levels – Normal 5,000 to 10,000 → Neutrophils – Normal 60-70% (increased in acute infections that produce pus, increased risk of bacterial infection if decreased, may increase due to stress → Lymphocytes – Normal 20-40% increased in chronic bacterial and viral infections → Monocytes – Normal 2-8% increased in severe infections: function as a phagocyte → Eosinophil – Normal 1-4& increased in allergic reaction and parasite infection → Basophil – Normal 0.5-1% unaffected by infections → Pathogen are present in Urine, blood, or wound drainage → Red blood cell settle to bottom of the tube when infection is present Asepsis – included all activities to prevent infection or break the chain of infection 1. Medical Asepsis – clean technique that reduces the number of pathogens 2. Surgical Asepsis – sterile technique 3. Transient Bacteria – easily removed through handwashing, can adjust to environment on skin and become resident bacteria 4. Nosocomial – something taking place in the hospital 5. Iatrogenic – when it results from treatment or diagnostic procedure 6. Bundles – EBP proven positive outcomes Box 24-5 Preventing Needlestick Injuries to Home Health Care Workers • • • • • Avoid recapping or bending needles that might be contaminated Keep sharps container away from children Participate in your employers blood borne pathogen training Use Devices with safety features Report and needle stick Providing Care in Special Situations • • • • • • • • Ensure health care provider is healthy Restrict visit from friends and family members who have colds or contagious illness Avoid collection of standing water (humidifiers) to prevent bacteria Avoid Plants and flowers = soil bacteria and mold Follow hospital protocols PPE Wash Hands frequently Do not handle animal waste How to open a sterile Kit 1. 2. 3. 4. 5. Perform Hand hygiene Identify patient Check that package kit is dry and unopened Worker area waist level or higher Open that outside cover and remove kit. Place in the center of the work surface with the topmost flap positioned on the far side of the package 6. Reach around the package and grasp the outer surface of the end topmost flap, holding no more than 1 in from the border of the flap. Pull open away from the body, keep arm outstretched away from the inside of the wrapper 7. Stand away from package END OF CLASS REVIEW OTHER ARE EXTRA NOTES Aerobic - bacteria that require oxygen to live and grow Anaerobic – bacteria that can live without oxygen ▫ ▫ ▫ Fungi - (mold & Yeast) plant-like organisms – present in air, soil, and water Parasites – organism that live on or in a host and rely on it for nourishment Virulence – its ability to cause disease Chapter 25 Vital Signs Vital Signs - indicators of physiologic functioning and reflect the health status of a person (temperature, pulse, respiration, blood pressure, 5th Pain) BOX 25-1 When to Assess Vital Signs → → → → → → → Admission Based on institution policy Change in patients condition Loss of consciousness After surgical or invasive diagnostic procedure Before and after activity that may increase risk EX: ambulation after surgery Before administering medications that affect cardiovascular & Respiratory function BOX 25-1 Age-Related in Normal Vital Signs Newborn: Temp. 96.7-98.5 > Pulse/Beats 70-190 > Respirations 30-40 > BP 73/55 Infants: Temp. 98.7-100.5 > Pulse/Beats 80-160 > Respirations 20-40 > BP 85/37 Toddler: Temp. 98.7-100.5 > Pulse/Beats 80-130 > Respirations 25-32 > BP 89-46 Child: Temp. 98.2-100 > Pulse/Beats 70-115 > Respirations 20-26 > BP 95/57 Preteen: Temp.96.4-99.5 > Pulse/Beats 65-110 > Respirations 18-26 > BP 102/61 Teen: Temp. 96.4-99.5 > Pulse/Beats 55-105 > Respirations 12-22 > BP 112/64 Adult: Temp. 96.4-99.5 > Pulse/Beats 60-100 > Respirations 12-20 > BP 120/80 Adults (65+): Temp. 96.4-98.3 > Pulse/Beats 40-100 > Respirations 16-24 > BP 120/80 Temperature           Hypothermia (below 95) severe (82.4) - low body temp. From extreme cold Hyperthermia – high body temp. Afebrile – normal body temp Pyrexia (fever) - increased above normal temp Intermittent – body temp return to normal at least once every 24 hours Remittent – body temp does not return normal and fluctuates a few degrees up and down Sustained or Continuous – remains above normal with minimal variations Relapsing or Recurrent – returns to normal for 1 to 2 days with more episode of fever Respirations and pulse rate increase Headache, dry skin, thirst, muscle aches, weakness Apical Pulse – use stethoscope – apex of the heart END OF CLASS REVIEW OTHER IS EXTRA NOTES Hypotension – below 90/60 Hypertension – over 140/90 Orthostatic Hypotension – decreased systolic pressure of >20 or decrease in diastolic by >10 Chapter 27 Safety, Security, and Emergency Preparedness EXAM REVIEW FROM CLASS *CHART 27-1 TEACHING TIP PG. 765 REFERENCE BOOK* *CHART 27-2 BIOLOGIC AGENTS OF CONCERN PG.781 REFERENCE BOOK* Table 27-1 Fall Risk Factors Modifiable - lower body weakness, poor vision, balance issues, problems with feet or shoes, use of psychoactive medications, postural dizziness(position changes, hypotension, antihypertensives), hazards in home Intrinsic (person-based) - advanced age, previous falls, muscle weakness, balance problems, poor vison, Chronic Conditions (arthritis, diabetes, stroke, Parkinson's, incontinence, dementia), and fear of falling Extrinsic (environment-based) - lack of handrails, no bathroom grab bars, dim light, tripping hazards, slippery surfaces, psychoactive meds, improper use of devices (canes, walkers) Preventing Accidents – teaching, safety programs, early assessments on vulnerable patients BOX 27-2 Manifestation of Child Maltreatment Physical Abuse – unexplained repeated injuries – EX: bruises, fractures, burns, bite marks, head injuries, etc. Sexual Abuse – rape or sexual acts – can be manifested by vaginal discharge, UTI, difficulty walking or sitting, STD’s, or genital pain Emotional Abuse – harm child self-worth or emotional well-being – Manifestations – behaviors, sleep problems, headaches, avoiding activities Neglect – failure to meet a child needs; food, clothing, education, and access to medical care END OF CLASS REVIEW OTHER IS EXTRA NOTES Asphyxiation - suffocation Factors Affecting Safety – developmental level, lifestyle, mobility, sensory perception, knowledge level, communication ability, physical health state, and psychosocial state allows nurse to identify potential hazards and promote wellness Chapter 31 Hygiene *CH 31 PG 1001 CHART 31-1 REFERENCE BOOK* EXAM REVIEW IN CLASS Factors Affecting Personal Hygiene 1. 2. 3. 4. 5. Culture –personal hygiene preferences such as typical bathing habits and behaviors Socioeconomic Class – financial Spiritual – religious beliefs Developmental – what you learn growing up Health State – disease, surgery, or injury EXAMINE THE FOLLOWING* 1. 2. 3. 4. 5. 6. 7. Lips: colors, moisture, lumps, ulcers, lesions, and edema Buccal Mucosa: Color, moisture, lesions, nodules, and bleeding Color of Gum and surface of the gums: lesions, bleeding, edema Teeth: any loose, missing, or decayed. Presence of dentures or othodontics Tongue: Colors, symmetry, movement, texture, and lesions Hard and soft palates: intactness, color, patches, lesions, or petechiae (spots from bleeding) Oropharynx: movement of uvula, and condition of tonsils Bathing and Skin Care cleaning the skin, helping relax the person, promoting circulation, musculoskeletal exercises to increase mobility, stimulating rate and depth of respirations, promoting comfort, helping improve self-image, try to strengthen nurse-patient relationship ORAL CARE 1. Moisten toothbrush and apply toothpaste 2. Place brush at 45 degree angle to gum line and brush from gum line to crown of each tooth. Brush outter and inner surfaces. Brush back and forth across bitting surfaces of each tooth 3. Brush tongue gently 4. Have patients vigorously rinse with water 5. Assist with flossing 6. Offer mouth rinse 7. Offer lip balm 8. Remove equipment (gloves) and all other PPE END OF CLASS REVIEW OTHER IS EXTRA NOTES Hygiene – ears, nose, hair, nails, feet, and perineal and vaginal areas Oral Cavity – inspection of oral cavity and surrounding structures with attention to unusual odors