Final Exam Study Guide
Final Exam Study Guide NUR 220
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This 42 page Study Guide was uploaded by Katelyn Paccione on Saturday May 2, 2015. The Study Guide belongs to NUR 220 at Purdue University taught by Kirby and Keubler in Fall. Since its upload, it has received 192 views. For similar materials see Essentials of Nursing Practice II in Nursing and Health Sciences at Purdue University.
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Date Created: 05/02/15
Comprehensive Final Exam Study Guide Information from Exam 1 NUR 220 Medication Administration and Provider Orders 0 Types of Medications 0 Oral I Solid forms 0 Tablets 0 You cannot crush an enteric coated tablet 0 Capsules 0 You have to have an order to open a capsule I Liquid forms 0 Elixir clear contains water alcohol sweeteners and avor 0 Suspension finely divided undissolved particles in a liquid medium I Solution drug dissolved in another substance I Syrup medication combined in a water and a sugar solution I Routes of Administration 0 Oral route swallow drug whole 0 Enteral route administer drug through an enteral tube 0 How to administer medication through an enteral tube some medications require to be diluted with water some medications need to be administered on an empty stomach and feedings should be withheld 1 hour before and after medication administration administer each medication separately use liquids when possible when liquids are not possible use ONLY immediaterelease solid doses crush the medication and dilute the medication with water ush the tube again after each medication and after all medications have been administered to the patient I Sublingual administration place under tongue I Buccal administration place drug between tongue and inside of cheek O Topical I Types of medications 0 Skin applications 0 Want to rotate sites O Parenteral Eye instillations and irrigations Ear instillations and irrigations Nasal instillations O Nasal sprays Vaginal applications Rectal instillations O Suppositories I Routes of Administration Subcutaneous subcutaneous tissue 0 Inject at a 45 degree angle Intramuscular muscle tissue 0 Inject at a 90 degree angle 0 Different sites I Ventrogluteal triangle of the upper butt cheek I Vastus lateralis outer thigh I Deltoid muscle upper arm RECOMMENDED SITE I Dorsogluteal NO LONGER RECOMMENDED Intradermal corium under the epidermis 0 Inject at a 515 degree angle Intravenous vein Intraarterial artery Intracardial heart tissue Intraperitoneal peritoneal cavity Intraspinal spinal canal Intraosseous bone I Want to administer injections With the bevel up I What to consider When choosing a needle Route of administration 0 Intramuscular versus subcutaneous Viscosity thickness of solution How much solution Will be administered Body size of patient 0 Bigger patient bigger needle 0 Smaller patient smaller needle Type of medication I Containers that injectable medications are prepared Ampules Vials Prefilled cartridges Types of Medication Orders 0 O O 0 Standing order I Carried out until cancelled by another order PRN order I As needed STAT order I Carried out immediately NOTE Medications must have a medication order from a licensed practitioner in order to give that medication Parts of the Medication Order 0 00000 0 Patients name Date and time of written order Name of the drug that is to be administered Dose of drug Route by which the drug should be administered How frequently the drug should be administered Signature from the person writing the order Things to keep in mind with prescriptions O 0 Person who prescribes the medication must have a license to do so Verbal orders should be repeated for clarification and MUST be given faceto face no telephone orders Documenting Medication Administration O 0000 0 Name of the medication Dose given Route and time of administration Nurse s initials Medications not given and reasons why I Intentional or inadvertently omitted drugs I Refused drugs Any and all medication errors Controlled substances require specific information 0 O O O 0 Name of the patient receiving the narcotic Amount of drug Hour the drug was given Name of prescribing physician Name of administering nurse Factors that affect medications O O 0 Developmental considerations I Adult versus a child weight sex genetic and cultural factors 000 O psychological factors pathology environment timing of administration 0 Therapeutic Action of Drugs 0 Types of Adverse Events I Iatrogenic unknown disease I Allergic effects 0 Signs and Symptoms of Drug Allergy O Rash Urticaria aka hives Fever Diarrhea Nausea Vomiting Anaphylactic reaction I Lifethreatening allergic response 000000 I Toxic effects I Idiosyncratic effects 0 Structural or behavioral characteristic peculiar to that individual or group I Drug to drug interactions 0 Conversions for calculating drug dosages O 0 000 O Mcggtmggtggtkg I Divide by 1000 Mcgltmgltgltkg I Multiply by 1000 30 ml 1 oz 8 oz 1 cup 15 ml 1 tablespoon 5 ml 1 teaspoon 0 Type of Medication Errors 0 00000 0000 Inappropriate prescribing of the drug Extra omitted or wrong dose Medication given to the wrong patient Medication was given using the wrong route Medication was given at wrong rate Failure to give medication within prescribed timeframe I Check per facilities policies Incorrect preparation of a drug Improper technique administering the drug Giving a drug that has deteriorated expired After giving the medications and realizing there were an error I Check the patient s condition for adverse effects I Report to physician I Describe the error in the medical record I Complete specific reporting forms per facility Most commonly errored medication 0 Insulin 0 NOTE It is helpful to have 2 or even 3 nurses to double check your work when it comes to administering insulin BE AWARE OF PATIENT S ALLERGIES TO MEDICATIONS 0 Penicillin most common Prevent Medication Errors by establishing the Six Rights of Medication Administration 0 1 Right drug I Do you have the right drug I Be careful not to mix up similar drug names 0 LASA look alike sound alike medications 0 2 Right dose I Did you administer what is prescribed I Is what was prescribed a safe dose for the patient 0 As a nurse you are responsible to know this 0 Use caution with children 0 Weight kg 0 3 Right route I What if the patient can t swallow pills Can it be crushed 0 4 Right time I How often is the medication given and at what times 0 5 Right patient I MUST verify the patient with their ID band and having the patient recall their name BEFORE administering medication 0 6 Right documentation I Document on the MAR the name of the medication time given route dose given ALSO prevent medication errors by completing the three checks of medication administration with all medications O 1 When retrieving the medication 0 2 Check the MAR before opening 0 3 Before giving to the patient 0 Always compare the medication against the MAR Nursing Implications O Remind the patient that they need to take the medication that is prescribed and for the length that it is prescribed 0 Remind patient that they have to take prescribe dose and cannot increase or decrease the dose without asking the physician first 0 Caution the patient to not share their medications with others What is CAM O Complementary and Alternative therapies Therapy of the body and mind Documentation amp Patient Medical Record Characteristics of effec O 0 Complete Accurate Factual Confidential Patient rights 0 O tive documentation Consistent With professional standards Organized and timely We document in military time Legally prudent Information pertaining to patients Name address phone fax social security Reason person is sick Treatments patient receives Information of past health conditions What can breach a patient s confidentiality Display the info on a public screen Sending out confidential emails using a public network Sharing printers among units Having conversations that can be overheard Faxing information that is confidential to unauthorized personnel Sending confidential messages overheard on pagers See and copy health record Update health record 0 Get a list of disclosures 0390 0 Record orders 0 Repeat the ord 0 Date and note 0 0 Review orders 0 Request a restriction on certain uses or disclosures Choose how to receive health information Policy for verbal orders in medical record er for clarity time of issued orders Record the verbal order along With the physician s name and nurse s initials Policy for verbal orders to be reviewed by physicians for accuracy Sign orders With name title and pager number I You can t write the order until this is done 0 Date and time orders signed 0 What if the verbal order is given over the phone 0 Record order in medical record 0 Read orders back for clarification Date and time orders issued Record the telephone order and nametitle of physician or NP Who issued orders Sign orders With name and title 0 Purpose of patient records 0 Communicate With other healthcare professionals Record orders Care planning ReVieWing quality of care Research To analyze information to make a decision Education Legal and historical documentation 39The patient s record can be pulled up in the future With past documentation Visible for healthcare team 0 Reimbursement 0 Change of shift report 0 Basic ID information about each patient 0 Current report of each patient s health status 39Changes in conditions 39Patient response to treatment Current orders Summary of newly admitted patients Report of discharged or transferred patients Benefits of nursing informatics 39Increase accuracy and completeness of documentation 39Improve work ow and eliminate redundant documentation 39Collection of nursing data 39Analysis of clinical data 0 Home healthcare requirements 0 Patient is to return home but still needs skilled care 0 Rehab potential 0 Patient does not have a stabilized status 0 Patient is making progress in expected outcomes of care OIOIO O Delegation amp Scope of Practice 0 Key terms 0 Leadership versus management I Leadership 0 Doesn t necessarily delegate tasks 0 A person that is informally recognized in a group 0 A leader in nursing inspires and motivates others I Has good communication and interpersonal skills I Management 0 Formal role I Carries out duties and responsibilities specific to title 0 Control over 0 Processes 0 Decision making 0 Work of others delegation 0 Licensure of Nursing Practice 0 Set by State Board of Nursing differ state to state I Include 0 Educational requirements 0 Licensing exam NCLEX 0 Maintenance and renewal 0 Suspension and revocation O For violating the nurse practice act I DrugETOH abuse MOST COMMON I Fraud I Conviction of felony I Negligence I Previous disciplinary actions in other states I Physical impairments I Mental impairments I Practicing after your license expires I Also regulated by laws 0 Ex HIPAA I Also regulated by Standards of Care 0 Ex J CAHO health care institutions state boards textbooks etc 0 Scope of practice 0 Nurses of all kinds are legally RESPONSIBLE for their actions 0 Delegation 0 Getting work done through others or directing goals to be accomplished from others O Transferring responsibility but YOU are still being responsible for the outcome 0 Why do we delegate I When there is too much work for one person I Patient acuity I Staff issues staff ratio I Deliver safe and quality care to our patients 0 How to delegate effectively I Select the right person I Explain the task and expected outcomes I Give the authority and resources necessary to complete the task I Providing opportunity for input and evaluation 0 Five Rights of Delegation I 1 Right task 0 Is it in their scope of practice 2 Right circumstances 3 Right person 0 Are the competent 4 Right directioncommunication 0 By clear on what you are asking the person to do 5 Right supervisionevaluation O Barriers of delegation I Attitude of superiority I Need to control situations I Interpersonal con ict I Fear of incompetence I Insecurity 0 What can t be delegated I Unstable patients I Activities that require 0 Assessment 0 Problem solving 0 Judgment 0 Evaluation I Where outcomes are unpredictable 0 You can delegate the task but not the knowledge Communication with Healthcare Team amp SBAR 0 Team communication 0 Way that team members function and coordinate with each other to produce desired outcomes Poor team communication can cost a patient their life 0 What is it I Information that is transferred accurately O Information given on newly admitted patients Information distributed on the patients treatment plan Appropriate information requests during emergencies All team members acknowledge communication Clear and direct requests made for team assistance All members of the team show a speakingup behavior 0 Benefits Increase in safety and performance Shift changes and handovers can result in error if proper communication is not performed Lower risk of morbidity rate with mutual trust and absence of con ict between nurses and physicians Patient outcomes 0 Improved satisfaction 0 Improved care 0 Decrease in length of stay 0 Reduction in medication errors Nursing and physician outcomes 0 Improved job satisfaction 0 Decreased job associated stress 0 Lower turnover rates 0 Improved communication 0 Improved understanding of roles 0 Improved system efficiencies 0 Now introducing ISBAR Introduction 0 O O O O Yourself your title the patient you are calling about Situation The problem of concern to the patient Background Patient s condition 0 Health history 0 Assessment findings 0 Subjective patient information Assessment What do you think the problem is Recommendation What should be done Clarify orders from the physician 0 When to use SBAR Change of shift report Transfer unit to unit or home 0 O Talk to family members Telephone to telephone most of the time With a physician Utilize When change is identified in patient Note onset and history of symptoms Review patient medical background Complete an assessment of the patient Contact the physician Document conversation With physician Document additional information on the back of the SBAR File the SBAR in the medical record 33 Rest and Sleep HealthIllness Continuum 0 Measures a person level of health 0 Health is constantly changing Sleep disorders can alter health 0 Increase risk of 39Heart disease HTN 39Obesity DM Short term sleep loss can cause 0 Decreased re exes response time judgment hearing sight and motivation O Irritability O Confusion 0 Agitation 0 Cardiac arrhythmias Long term sleep loss can cause 0 Effects on the immune system Complex circadian rhythms We need sleep to keep ourselves healthy Fight off infection Support metabolism Perform effectively in school Work effectively and safely Increase protein synthesis cell division tissue renewal Repair epithelial and brain cells BMR energy is conserved in our body Increases 02 Increases cerebral blood ow Improved memory increased learning GET LOTS OF SLEEP BEFORE A TEST 0 O O NREM 75 0 REM 25 Sleep considerations 0 Developmental Infants Adults 0 Dietary habits Environmental Mental o Illness O Medications Assessment of sleep 0 Nature and cau 0 Stages of sleep each cycle about 90 min Nonrapid eye movement Stage 1 and 2 0 Light sleep Stage 3 and 4 0 Deep sleep Rapid eye movement 1420 hours of sleep Children 1014 hours of sleep 79 hours of sleep factors Psychological stress health assessment How often do you feel sad Have you thought of harming yourself se of problem Signs and symptoms Restlessness Sleep postures Sleep activities Snoring Leg jerking 0 Date of occurrence 0 Effect on daily life Sleep diaries Time of lying in bed time try to sleep time fallen asleep time awakening during the night and resumption of sleep time wake up in the morning 0 Any stressors affecting sleep 0 Record of food drink medications 0 Record of physical activities 0 Record of mental activities 0 What was done 23 hours before bed 0 Presence of worries or anxieties affecting sleep 0 Severity of problem 0 Treatment of problem 0 How the patient is coping with the problem 0 Sleep Disorders 0 Dyssomnias Insomnia problem falling or staying asleep 0 More common in the elderly Hypersomnia want to sleep all day 0 More common in the obese 0 Also more common in victims of sleep apnea breathing problems when sleeping Narcolepsy no control of falling asleep Sleep apnea periods of not breathing followed by a snort and exacerbation of air 0 Tongue burrows back and occludes the airway Restless leg syndrome need to move legs all the time 0 Constant urge 0 Rest induced happens while resting 0 Gets better with activity 0 Worse in the evening sleeping rest 0 Nursing implications 0 No caffeine alcohol or smoking before going to bed 0 Parasomnias Sleepwalking somnambulism Sleep talking Night terrors people wake up screaming because they think the threat is real Bruxism grinding teeth at night sometimes indicates extreme stress Enuresis bed wetting 0 More common in children more specifically boys because their bladders are immature Sleeprelated eating disorders 0 People eat during the night and can t recall it 0 How to diagnose a sleeping disorder as a nurse using a nursing diagnosis 0 Disturbed sleep pattern 0 Ineffective coping 0 Interventions for sleep 0 Bedtime rituals 0 Restful environment 0 Appropriate snacksbeverages before bed 0 Relaxation 0 Comfort pain treatment Information from Exam 2 Elimination ostomies uid amp electrolvtes 1 Understand elimination methods physiology of elimination and nursing interventions for elimination issues a Healthy uid intake and losses i Intake output b Normal elimination urine 30 mLhour c Colostomies i Surgical opening that is made to help urine and feces move out the body ii Types 1 Si gmoid 2 Descending 3 Transverse 4 Ascending 5 Ileostomy a Why i To bypass the colon b More liquid stool d Colostomy Care i Keep client as free from odors as much as possible 1 Burping the bag a Empty the air 2 Emptying the bag a Empty all contents 3 Change the bag every 35 days ii Inspect the stoma frequently 1 Size a Stabilizes Within 68 weeks 2 Color a Should be a dark beefy red and moist b Yellow anemia c Blue loss of blood supply 3 Stoma should be protruding 4 Keep the skin around the stoma clean and dry iii iv Keep track of and document 1amp0 Encourage the client to look at stoma and to help care for the stoma e Nursing Diagnoses i ii Ready to learn Altered selfimage f Patient Education 1 ii iii iv V vi Community resources that are available to them Initially patient should avoid foods high in fiber Patients should avoid foods that can cause diarrhea or atus gas Drink 2 liters of water daily Encourage patient to limit eating dark green vegetables to control odor Resume all normal activities g Comfort measures i ii iii iv Diet and exercise Use medications PRN Apply ointments Use suppositories that contain anesthetics 2 Enteral nutrition administration nursing skills tools and interventions for each a Nutritional screening 1 ii iii iv v vi vii viii ix Disease Eating poorly Tooth health Economic hardship Reduced social contact Multiple medications Involuntary weight loss gain Needs assistance with selfcare Elder years above 80 b How else can we tell if someone is at risk for imbalanced nutrition i Lab test results c ORAL and NG tubes i ii Oral supplements 1 When nutrition intake is deficient we can use a Milk shakes b Pudding c Instant breakfast d Ensure etc e These are added to regular meals they are NOT supplements NG tubes 1 Salem sump a For temporary use b Used for decompression taking uids OUT 2 Dobhoff a For patient who are NPO b Tubing is small and can be fed through the small intestines 3 Advantages a Easy to place b Noninvasive c Weighted tip 4 Disadvantages a Clogs easily b Can be dislodged i Causes coughing and vomiting c Can knot or kink in GI tract iii PEG tube percutaneous endoscopic gastrostomy 1 Surgically placed tube 2 Before placing a Make sure that the patients G1 is intact b Make sure that you hear bowel sounds before placement c More comfortable than an NG tube and can remain in place for longer periods of time iv Nursing Managements 1 Check placement before each use a Initial chest Xray b Before each feeding check gastric pH Assess for bowel sounds before every feeding Check for residual before bolus feeding Elevate HOB before feedings Flush feedings with water Giving medications through feeding tubes a Use liquid medications when possible b Flush each medication with water c Only crushable tablets may be used i Crush into fine powder d Meds cannot go into the feeding bag i Must go directly into the tubing 7 Assess for aspiration diarrhea abdominal distention and QMPPP hyperglycemia 8 Provide frequent oral hygiene 9 Prevent infections a High glucose content can cause risk for infection b Follow proper cautions with tube placement 10 Monitor bowel function frequently 11 Continuous versus intermittent a Continuous 24 hours b Intermittent regular intervals c Bolus feeding all at once 3 12 NG tube should not be placed in a patient With no gag re ex Parenteral nutrition administration nursing skills and interventions used to provide safe care a Primarily carbohydrates and fat emulsion b Why would someone need parenteral nutrition i Pancreatitis ii GI obstruction iii Severe surgery or trauma iv Severe anorexia v Sever malabsorption c Types i TPN 1 Total parenteral nutrition 2 25 dextrose 3 MUST have a central line a Hickman i Insertion site jugular vein in the neck ii Tube runs into the chest b Peripherally Inserted Central Catheter PICC i In the basilic or cephalic vein in the upper arm c Subclavian i Vein under the clavicle d Port i Placed underneath the skin ii Why 1 Prevent wear and tear 4 If interrupted DlOW 5 Monitor blood sugars 1 Peripheral parenteral nutrition 2 5 dextrose 3 If interrupted D5W d Nursing management i Watch for 1 Pressure ulcers 2 Foleyrelated UTIs 3 Air embolism 4 Septicemia and infection a Local manifestations i Erythema ii Tenderness iii Exudate drainage at insertion site b Systemic manifestations i Fever ii Chills iii Nausea iv Vomiting V Malaise 5 Blood incompatibility 6 Retained objects in surgery ii Take vital signs every 48 hours iii Take daily weights iv Strict 1amp0 V Watch lab results for 1 Blood glucose a Tight glycemic control 2 Electrolytes 3 BUN 4 CBC 5 Hepatic enzymes vi Change dressings when appropriate and observe condition while changing the dressing vii Must use an infusion pump at a steady infusion rate Fluid and electrolyte physiology importance of intake and output nursing skills interventions comfort measures and nursing dX appropriate for patients a Compartments of uid in the body i ICF intracellular uid 1 Fluid within cells 2 70 ii ECF extracellular uid 1 Fluid outside cells 2 30 3 Intravascular and interstitial b Developmental considerations i Infants and the elderly are more prone to uid imbalances 1 Infants more easily loose ECF 2 Elderly increase in fat and muscle cells uid imbalance ii Total Body Water 1 Healthy person 5060 a Women and obese i Less total body water c The Nursing Assessment uid imbalances i Health history 1 Chief complaints a Nausea vomiting diarrhea b Difficulty swallowing chewing or breathing c Weight loss d Indigestion Increased thirst edema Food intolerances Muscle cramping Dry skin or mouth 2 Past medical history a GERD IBS UTI Renal failure Change in bowels Diabetes Chronic heart failure Cancer Burns Surgery or trauma k Treatments 3 Psychosocial a Medications i Steroids increase muscle mass ii Diuretics increase output Diet recall Food preferences Alcohol use Drug use Tobacco use Stress Typical bowel movements 1 Typical bladder movements 4 Family medical history a Kidney disease Fetchm quot1quotP C iquot 999 39WMFLPP b Cancer c Diabetes d Asthma e COPD 5 Systems to Review in relation to uid imbalances a Respiratory b Cardiac c Urinary d Nervous system e GI f Hormonal ii Physical Assessment 1 Vital signs a Fever increased loss b Pulse as it increases blood volume decreases c Decrease in blood pressure increase in loss 2 Skin mucous membranes thirst a Turgor b Edema i Also listen to the lungs for crackles pulmonary edema 3 Neurological 4 Fluid intake 5 Fluid losses 1amp0 a Sensible versus insensible i Sensible measured ii Insensible cannot be measured b Urine i Volume and concentration c Wounds i Drainage d Diarrhea e Nausea and vomiting 6 Daily weights iii Normal Values 1 Hgb a 1218 b Increased hemoconcentration i Increase of uids and particles into the blood due to the losses in the tissues c Decreased hemorrhage anemia post hemolytic 2 Hct a 4050 b Increased dehydration shock hemoconcentration uid shift c Decreased blood loss hemolytic uid overload 3 Na a 135145 4 K a 355 5 BUN a 1718 b Increased shock heart failure ketoacidosis starvation c Decreased malnutrition excess uid 6 Creatinine a 0415 b Increased heart failure shock dehydration c Decreased malnutrition decrease in muscle mass 7 Urine pH a 4682 8 Specific Gravity a 10051025 b Density of urine d AcidBase balance i Respiratory and metabolic 1 In respiratory pH and PaCO2 go in opposite directions 2 In metabolic pH and HCO3 go in the same direction ii Normal values 1 Blood pH a 735745 2 HCO3 a 2529 b How to decrease i Diuretics and diarrhea c How to increase i Baking soda for neutralization 3 PaCO2 respiratory a 3545 b lt35 hyperventilation anxiety fear c gt45 pulmonary edema cardiac arrest COPD asthma e AcidBase Imbalance i Respiratory Acidosis 1 PaCO2 gt 45 2 Symptoms a Dizziness b Muscle twitching c Unconscious d Headache e Weak ii Respiratory Alkalosis 1 PaCo2 lt 35 2 Symptoms a Lightheaded b Tinnitus c Palpitations d Sweating e Convulsions iii Metabolic Acidosis 1 HCO3 lt 22 2 Symptoms a Headache b Confusion iv c Nausea and vomiting d Increased respirations and increased depth Metabolic Alkalosis L HCO3gt26 2 Symptoms a Tingling b Decreased respirations c Tonic muscles contraction of the muscles d Dizziness f Nursing Diagnosis i ii iii iv Fluid volume excess Fluid volume deficit Risk for uid volume deficitexcess In uencing other systems 1 Risk for injury 2 Anxiety 3 Impaired skin integrity g Nursing Interventions i ii iii iv vi Dietary modifications 1 Sippy diet a This is no longer used b Risk for cardiac problems 2 BRAT diet a Bananas rice applesauce toast 3 Low Na Diet 4 K foods a Oranges bananas broccoli Modifications of uid intake 1 Push uids a Educate patient on When to drink uid to increase amounts 2 Limit uids a Offer frequent mouth care Medication administration 1 Lasix a Diuretic 2 K 3 Ca IV therapy Blood replacement TPN 1 Total parenteral nutrition Spirituality 1 Needs common to all people a Need for meaning and purpose b Need for love and relatedness c Need for forgiveness 2 Spirituality beliefs and practices of major religions in the US a Protestant Christianity i Dietary restrictions 1 2 3 Fasting during certain times of the church calendar a Can include meats Alcohol may be prohibited Moderation a Gluttony and drunkenness are indicated as sins ii Common practices 1 2 3 4 5 6 Male head of household Baptism Prayer a Pray beads Eucharist a Commemorating the last supper Confirmation Last rites a Rites administered to a person who is about to die iii In healthcare 1 2 Be mindful of times of fasting Abstinence is preferred birth control method b Roman Catholicism i General info 1 2 Holy Trinity God the Father Son and Holy Spirit Jesus Christ is the Son of God and was crucified to free the world from sin by accepting the punishment we deserved The gifts of the Holy Spirit are wisdom understanding right judgment courage knowledge reverence and wonder and awe Baptism is thought to free people of their sins and welcome them into the church Confirmation is a process which strengthens and continues Baptism as well as seals people with the gift of the Holy Spirit ii In healthcare 1 Baptism can be performed by a priest but if the infant is likely to die it can be performed by any person with proper intent as long as certain phrases are spoken 2 Sacraments and blessings by a priest are very important particularly before a surgery or when a patient is close to death a Last Rites b Communion Eucharist c Confession iii Other preferences 1 9 May need a nonmeat or other special diet during the season of Lent no meat on Fridays Strict nocontraception beliefs so may prefer to only be taught about Fertility Awareness Method of birth control Father is generally head of the household Generally strongly opposed to abortions embryonic stem cell research invitro fertilization and sterilizations c Native American i Traditions l 2 3 4 Sacred items Do not touch Crystals and sacred stones may be used as part of healing Native Americans have preference for certain traditional foods during ceremonial times Especially particular teas The umbilical cord is often saved after birth for a burial service ii Physicaleye contact 1 2 3 Hugs and touching are rarely done do not initiate Greet with a gentle handshake Do not look straight in the eyes especially elders iii Family leader elders l Elders are respected and treated with honor They are seen as people who have a great deal of wisdom and knowledge which they share others of all ages iv In healthcare d Mormon 1 9 Provide male doctors and nurses for male patients and female doctors and nurses for female patients Native Americans are modest people try to ensure their bodies are not exposed to others Most Nations allow blood transfusions Navajos do not Wellbeing comes through walking in harmony with the forces of nature and the universe The spirits Seek treatment from a physician to care for the physical injury but also from a medicine manwomen or shaman to properly care for the spirit Some Native Americans do not believe in medications to treat illness Prefer the shaman healer i Overview of beliefs 1 2 3 4 There is a God Jesus The Son of God Jesus is the central figure of the religion God chooses men to represent him Priesthood ii Dietary requirements 1 2 No alcohol tobacco coffee or tea and no drug abuse Eat meat sparingly iii In healthcare 1 2 e Judaism Abortion is a serious sin except in cases of incest rape threat to the life or health of the mother or when the fetus will not survive beyond birth Miracles of God i General info 1 2 3 7 Believe that God appointed them to be his chosen people Focuses more on actions than on beliefs Euthanasia suicide and assisted suicide are strictly forbidden by Jewish law However where death is imminent and certain and the patient is suffering Jewish law does permit one to cease artificially prolonging life Rabbi Jewish law not only permits but in some circumstances requires abortion Where the mother39s life is in jeopardy because of the unborn child abortion is mandatory Jewish law requires to Keep Holy the Sabbath Day Some Jewish patients may not ask the nurse for anything on a Sunday or use electricity their electronic hospital bed Death is considered a celebration ii Dietary Requirements 1 The Jewish dietary laws are known as kashrut Food prepared kosher and food that is not kosher is also known as treifah or treif People who observe these laws are colloquially said to be quotkeeping kosher Forbidden parts of animals the blood some fats and the area in and around the sciatic nerve They do not believe in consuming dairy and meat products together f Jehovah s witness i General Info 1 Establishes all doctrines on the Bible but use their own translation 2 Consider themselves in the trut a Therefore all others are considered corrupt and under the in uence of Satan Baptism is a requirement for being considered a member of Jehovah s Witnesses Not practiced as an infant If one leaves the religion heshe is considered dissociated and is shunned ii In healthcare 1 2 3 4 5 iii Roles 1 g Islam No raw or rare meat Do not accept blood transfusions Do not observe holidays or other similar customs bc they are deemed to have pagan origins Refuse military service Do not use the symbol of the cross The husband or oldest male child is considered the leader of the household Women are taught to be the care providers a Only men can hold positions of responsibility Housetohouse preaching i General Info 1 2 3 4 Follow the Qur an Which contains the word of Allah Muslims Believe everything is predetermined by God Pray 5 times a day and face Mecca ii In healthcare 1 9 Muslims are very modest only expose part of body being examined Explain the reason behind asking questions about their personal life so they are less likely to be offended Follow a halal diet no pork or alcohol Fast during the month of Ramadan from sunrise to sunset once they become adults people exempt include very sick pregnantbreastfeeding females elderly diabetics and menstruating women Men hold responsibility for the wellbeing of family Childbirth is seen as a female responsibility medical staff should be female Husbands may be present during female examinations Right hand is seen as a clean hand and left hand is seen as unclean so they eat With their right hands try to use right hand When giving meds feeding and touching pt Culture 9 Males prefer male doctors and nurses for any examination 10 Some narcotics may be seen as intoxicants 11 Upon death the body is to be treated With the same respect and h Hinduism i Ayurveda i 1 U Buddhism medical staff of opposite gender are still not preferred Death Family surrounds person singing bhajanas songs chants mantras often in 24 hour vigi1 Believe that the physical body dies but the soul lives on Many patients Will not want to be on life support or have heavy anesthesia close to dying Pain Control Believe in keeping an ill person comfortable Childbearing Birth control medications are accepted Abortion is a sin and frowned upon Birthing ceremonies Diet Vegetarian diet Many use traditional home remedies Medicines may be refused by Hindus if they are derived from cows pigs or other animals i General Info 1 Ending suffering the cycle of rebirth and the concept of karma ii In healthcare 1 2 3 Modesty Some Buddhists are vegetarians Patients may need time to meditate provide them With peace and quiet Buddhism places a strong emphasis on mindfulness and so they may worry that analgesics lead to cloudy judgment altered mindset As such there is a greater desire for nonpharmacological pain management There may be a desire for prayer chanting Also the use of prayer beads and a picture of Buddha Near the end of life Buddhists believe that they are at a crucial point in terms of karma and that in order for maximal rebirth the patient must be facilitated to concentrate on meditation Buddhism states that the patient s body is not devoid of spirit immediately after death and so it is requested that the body is kept as still as possible Buddhism believes that certain religious rites must be performed upon death and so they may want to have access to the body a couple of hours after death 1 In uences that affect culturally competent healthcare a Barriers i Mistrust ii Previous experiences bias iii Utilization of alternative medicine iv Apprehensiveness V Lack of familiarity vi Lack of interpreters vii Culturally determined health beliefs viii Culturally insensitive education materials ix Physician attitudes and treatment decisions 2 Concepts of cultural diversity a revisit quality and culture quiz Loss Grief and Death 1 five emotional stages of dying per KublerRoss a Denial b Anger c Bargaining d Depression e Acceptance 2 physiologic psychological and spiritual care of a dying patient and family a comfort measures explain to the patient and their family the patient s condition help teach selfcare to patient to promote selfesteem incorporate family in teachings and assisting in care meet the dying patients needs i physiologic 1 hygiene pain control nutrition uids elimination respiratory care a semifowler s position can facilitate respirations ii psychological 1 be there for the patient fear of being alone 2 show that you care iii spiritual 1 help in obtaining what is needed per the patient s religious faith 3 ethical and legal issues in endoflife a mentioned in exam 3 information 4 signs of impending death a difficulty talking and swallowing 9906 QMPWP nausea atus abdominal distention urinary and bowel incontinence or constipation loss of movement and re exes decreased body temperature weak pulses noisy irregular respirations restlessness cool touch of extremities cyanosis discoloration of skin patchy molting W rrWMFLPP Information from Exam 3 Legal amp Ethical 1 Understand and identify specific concepts and pieces relating to legalities in nursing to include a Advanced directives i Written directive that allows people to state in advance what their choices for healthcare would be if certain circumstances should develop 1 Two types a Power of attorney b Living wills b Power of attorney i Makes the decisions for the patient when they can no longer take care of themselves c Living wills i Give specific instructions about the healthcare provided to an individual in particular situations d Incident reports i Never include these in documentation ii Use for Q1 the purpose is to identify risks e Medical malpractice i The failure of a person with professional training to act in a reasonable and prudent manner 1 aka professional negligence ii Improper illegal or negligent professional activity or treatment especially by a medical practitioner lawyer or public official iii There is a growing need for nurses to hold malpractice insurances that help protect some or all of their assets during a lawsuit f Negligence i Ordinary negligence 1 Performing an act that a reasonably prudent person under similar circumstances would not do OR failing to perform an act that a reasonably prudent person under similar circumstances would do ii Professional negligence 1 aka malpractice a SEE ABOVE definitions 2 Five components a A standard of care in place b There is a failure to meet this standard of care c Foreseeability of harm must exist d The correlation between harm and care must be able to be proven e Actual patient injury must occur 3 Not containing all information necessary may foresee harm in a patient 4 Nursing malpractice is independent of a physician s malpractice a This means that you cannot use the excuse that the doctor told me to do so g Intentional torts i False imprisonment 1 Unjustified retention or prevention of the movement of another person Without proper consent 2 Example use of physical restraints ii Assault 1 Threat or an attempt to make bodily contact With another person Without consent from that person iii Battery 1 Assault that is carried out 2 This includes anything that is on or attached to the person iv Invasion of privacy 1 All information pertaining to a patient is confidential and private 2 Example violation of HIPAA v Defamation of character 1 One party makes derogatory remarks about another that diminishes the other party s reputation h Credentialing etc i Standard of care 1 Minimal level of expertise that may be delivered to a patient ii The Nurse Practice Act 1 Defines What the function of nursing shall be and sets standards for licensure iii The Patient SelfDetermination Act PSDA 1 Educates staff and patients on the issues concerning treatment and endof life procedures iv Principles of Bioethics 1 Autonomy a Selfdetermination b Respect the patient s decisions 2 Nonmaleficence a Avoid causing harm 3 Beneficence a Balance benefits to risks 4 Justice a Act fairly to patients 5 Fidelity a Keep promises Do not give false hope V Patemalism 1 Acting Without patient s consent to prevent harm Health of the Individual and Family 2 Recognize the different family dynamic roles and concepts a How families deal With stress and coping i Family stressors 1 Changes in family structures or roles a In respect to the healthcare system a sick family member can change the roles and responsibilities of other family members 2 Anger feelings of helplessness guilt 3 Change in normal routines 4 Financial stress ii Families help in building our values and beliefs and that caries into our healthcare iii Family is a sort of social support that can help build coping mechanisms b How Maslow s hierarchy is used to determine nursing care i Individual characteristics 1 Physiological a 02 H20 food activity rest shelter warmth 2 Safety amp Security a Physical emotional b Freedom from fear 3 Love amp Belonging a Ability to love trust and respect b Friends family 4 SelfEsteem a Love and respect oneself b Four bases of SelfEsteem i Significance ii Competence 1 Persons ability to perform a job or role iii Virtue 1 Moralethical principles guiding a person s life iv Power 1 Control people have over their lives 5 SelfActualization a Ability for the individual to reach their full potential ii Individuals who do not complete the Maslow s stages are what we call vulnerable populations iii Family helps to meet the individual s Maslow stages iv Nurses use Maslow s to determine any unmet needs in a patient Health amp Wellness 3 Health promotion among individuals across the lifespan and family units a Risk factors b Genetic components c Primarysecondarytertiary prevention i Taylor page 47 ii Primary prevention 1 Primary prevent 2 Immunizations iii Secondary prevention 1 Screenings 2 Early identification of illness and treatment iv Tertiary prevention 1 Treatments 2 Returning to wellness after injury 3 Prevent recurrence of the problem v Examples 1 Mammograms can go under primary or secondary Primary if it is initial screenings to detect if something is wrong Secondary is when they already know something is wrong and they have scheduled mammograms to check progress 2 Education can be primary or tertiary Primary is to educate before the problem occurs Tertiary is if something is already wrong and education is implemented to help the patient live best possible quality of life or to manage disorder 4 Basic Human Needs a See Maslow s Hierarchy Stress Coping amp SelfPerceptionConcept 5 Discuss individual a Selfperception i How we perceive ourselves b Stress C i Local Adaptation System versus General Adaptation Syndrome 1 LAS a Re ex pain and in ammatory response 2 GAS a Feeling of alarm resistance and exhaustion i Alarms 1 Fight or ight response ii Resistance 1 All vitals return to normal defense mechanisms iii Exhaustion 1 Mechanisms give out and the body relaxes 2 Or death ii Homeostasis is achieved When stress is perceived and effective coping mechanisms are being used iii Anxiety is the most common response to stress iv Types of stress 1 Developmental a Occurs during stages of growth and development 2 Situational a Not predictable b Unique to the situation v Long term stress 1 Affects us physically 2 Increases risk for disease and injury 3 Compromise recovery and return to normal functioning 4 May be associated With specific diseases vi Types of stressors 1 Physiologic a Chemical agents physical agents infectious agents nutritional imbalances hypoxia disorders etc 2 Psychological a Real and perceived threats Coping strategies i What can affect adaptation to stress 1 The source of stress 2 Types of stress that has already been experienced by the patient 3 Personal factors ii A way to cope practice healthy ADLs 1 Exercise 2 Rest and sleep 3 Nutrition 4 Use of support systems 5 Use of stress management techniques a Relaxation b Meditation c Anticipatory guidance d Guided imagery e Biofeedback i Regulating things like heart rate and blood pressure f Crisis intervention i Identify the problem ii List alternatives iii Choose from alternatives iv Implement the plan v Evaluate the outcome d Appropriate nursing interventions e Lean I 6 Lean a b c i Nursing interventions l Adaptation to illness a General tasks i More concerned With the person ii Examples maintain selfesteem and help keep personal relationships b Illnessrelated tasks i Example managing symptoms and treating the illness Taylor page 1528 Table 422 Defense Mechanisms i Look over this table Purpose i ii Goal 1 ii iii Improve quality and safety Our VOC is the patients Improve quality of healthcare facility Improve patient satisfaction Improve healthcare professional work satisfaction Tools utilized i Systems view 1 Process and people a How does the process affect the people b Take a look at slide 20 of LEAN PowerPoint ii The 7 sees observe the environment See for yourself See what people actually do See how people spend their time See where people go See what really happens to your patients See who your teammates really are 7 See the wasted effort iii PDCA 1 Plan the majority a Establish the objectives and processes 2 Do a Implement the processes 3 Check a Monitor measurement of processes and product b Report the results 4 Act a Actions to continually improve process performance iv Spaghetti diagram 1 Depicts the ow of work v Process ow map 1 Mapping process in specific detail QMPPP vi Pie charts vii Bar graphs viii 5 S 1 Method organizing improving work ow better utilizing workspace visual management supply management 2 Mostly used to reorganize a space a Sort b Set in Order c Shine d Standarize e Sustain ix 5 Whys 1 Used to identify the problem d A3 DMAIC sections i D Define 1 What is the measurable problem a The extent of the problem 2 Why is it important 3 How does it affect the patient 4 What is the current performance standard ii M Measure 1 How Will the problem be measured 2 What is the current state current situation 3 What is our current data 4 What are the project objectives iii A Analyze 1 What are the obstaclesbarriers a The root cause to the problem 2 How did you identify the root cause 3 What are the goals of the project iv I Improve 1 What are the solutions Which Will be implemented 2 What Will the target state look like 3 What is the step by step implementation plan 4 What Will be the measurable outcomes V C Control 1 How Will these changes be sustained 2 What is the plan to follow up and monitor performance of changes New Information Healthcare Deliverv Svstemi 1 Compare and contrast settings and agencies that provide healthcare a Frameworks of healthcare delivery i Managed care systems 1 Provide care that controls the cost While maintaining the quality of care 2 Manager gatekeeper 3 Limited amount of choices for care providers 4 Specialty care requires approval ii Case management 1 Method of managed care 2 Nurses often identify protocols and timetables for care coordinating care 3 Controls costs 4 Improves access to healthcare iii Primary healthcare 1 Essential healthcare 2 Accessible to communities at a cost that is affordable 3 Bring healthcare close to Where people live and work b Healthcare settings i Hospitals ii iii iv vi Provides inpatient and outpatient care Vary in sizes Vary in services Can be profit or nonprofit Can be public or private More nurses are employed in hospitals What does a nurse do in the hospital a Direct care Manager of healthcare team Administrator Nurse practitioner NP Clinical nurse specialist CNS Patient and inservice educator g Researcher Primary care centers 1 What does a nurse do in primary care centers a Health assessments b Assist the physician c Provide patient health education Ambulatory care centers and clinics 1 Aka Urgent Care 2 What does a nurse do in an ambulatory center a Technical services b Determine priority of care needs c Provide teaching about all aspects of care Home healthcare 1 Payment system reimbursement 2 Older people With chronic illnesses 3 Provides care at home for a dignified death at home Longterm care facilities aging in place 1 Transitional subacute care 2 Intermediate and longterm care 3 Nursing homes 4 Retirement centers 5 Mentally or physically disabled residential institutions Specialized care centers 1 Daycare 2 Mental health centers 3 Rural health centers a in the middle of no Where Schools Industry companies Homeless shelters Rehabs NQP PWPE rhSDFLPP 891quot vii Healthcare services for caregivers and endoflife care viii Healthcare agencies c Types of care i Hospice 1 Physical psychological social and spiritual care for dying persons ii Respite 1 Caregivers of homebound ill disabled or elderly patients iii Parish 1 Holistic care health promotion disease prevention iv Voluntary agencies 1 Community based 2 Nonprofit 3 Provide a setting for support groups v Bereavement 1 Providing care to those who have lost a loved one due to death vi Palliative 1 Caring for and relieving the symptoms of a disease 2 Not curing the disease 2 Discuss and understand various methods of financing healthcare a Federal funded programs i Use a prospective payment plan that is determined based on the diagnosis ii Medicare iii Medicaid b Group plans i Health maintenance organizations HMO 1 Prepaid group managed subscribe to receive care through affiliated providers ii Preferred provider organizations 1 Allow members to choose outside physician for an additional cost c Private insurance i Allow members to choose their own physician d Longterm care insurance 3 Describe the members of the interdisciplinary healthcare team a Physician i Diagnosis of illness ii Medical and surgical treatment 1 Prescribe meds 2 Interpret lab results 3 Perform procedures and surgey b Physician assistant c Therapists physical respiratory occupational speech d Dietician e Pharmacist f Social worker g Nurse h UAP unlicensed assistive personnel Other Information The Nursing Process Assessment 0 There is a difference between a nursing assessment and a medical assessment 0 A nursing assessment focuses on the patients responses patient focused 0 Four types 0 Initial comprehensive I Upon admittance I Purpose to obtain info about present problem and care planning I Also collect info on all aspects of health 0 Focused I Gathering data about a condition that has already been dX may be initial or routine I Data about a specific problem 0 Emergency I When a physiological or psychological problem is present I Lifethreatening problems 0 Timelapsed I Comparing a patients status compared to What has been preViously reported I Also collect information to assess if there should be reVisions to care plan 0 Characteristics of data being collected 0 Purposeful 0 Complete 0 Factual and accurate 0 Relevant I Source of data 0 The PATIENT is always our primary source 0 Secondary sources family members patient record other healthcare professionals 0 The Nursing Interview 0 Preparatory phase I Prepare patient and environment 0 Introduction I Set the tone 0 Working phase I Patient database objective and subjective 0 Termination I Conclusion of the interview Diagnosis 0 Types of diagnoses 0 Nursing I Describes patient problems that can be helped by a nurse independently 0 Medical I Describes problems for Which the physician identifies and directs primary treatment 0 Interpreting data 0 Recognize significant data 0 Cluster common problems 0 Identify strengths and weaknesses O Recognize conclusion I No problem I Possible problem I Actual or potential nursing dx I Clinical problems other than nursing dx 0 Types of dx 0 Actual 0 Risk 0 Possible 0 Wellness 0 Syndrome 0 Components leading to a dx 0 Label 0 Define 0 Define characteristics ss 0 Related factors Planning 0 Three components 0 Initial I Initial care plan upon admission to health care I Made by the same nurse Who conducted the initial assessment 0 Ongoing I Continuous update of patients care I Carried out by any nurse that interacts With the patient I Revision can occur I Identifies nursing interventions to accommodate to patient goals 0 Discharge I Teaching and counseling the client I Carried out by the nurse who worked most closely with the patient 0 Prioritizing Nursing DX 0 High I Greatest threat to the wellbeing of the patient 0 Medium I Nonthreatening 0 Low I DX not related to present health concern 0 Maslow s Hierarchy of Needs 0 Physiologic needs 0 Safety needs 0 Love and belonging needs 0 Selfesteem needs 0 Selfactualization needs 0 Types of Interventions O Nurseinitiated I Actions performed by a nurse without a physician s order 0 Physicianinitiated I Action initiated by a physician in response to a medical diagnosis but carried out by a nurse following doctor s orders 0 Collaborative I TX initiated by other providers and carried out by a nurse Implementation 0 Types of Nursing Interventions O Nurseinitiated I Protocols and standing orders 0 Other interventions are collaborative with a physician or other healthcare providers 0 Nursing vs Client Focused Interventions 0 When a client is refusing current plan of care the CURRENT nurse should stick with the patient and reassess the plan Evaluation 0 Purpose patient s achievement of expected outcomes to direct future nursepatient interactions 0 Types of outcomes 0 Cognitive I Increase patient knowledge 0 Psychomotor I Patients achievement of new skills 0 Affective I Changes in patients values beliefs and attitudes 0 Physiologic I Physical changes in the patient 0 Evaluating these outcomes 0 Cognitive I Ask the patient to repeat or apply the new information 0 Psychomotor I Ask patient to demonstrate new skill 0 Affective I Observe the patient during conversation what is their behavior like 0 Physiologic I Collect and compare data using physical assessment 0 Criteria vs Standards 0 Criteria I Measureable qualities attributes or characteristics that specify skills knowledge or health status 0 Standard I Levels of performance accepted and expected by the nursing staff 0 How to make an evaluative statement 0 How well was the outcome met I Met I Partially met I Not met 0 List patient data and behaviors that support the decision to how the outcome is met
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