NUR 311 Final
What should you use with anything above 4L with a nasal cannula
humidifier
Trach suctioning complications
hypoxemia, cardiac dysrhythmias, changes in BP, bronchospasm, pain, infection, bradycardia, bleeding
if you notice your patient losing LOC and vitals changing, they could be
hypoxic
cultural assessment
identify beliefs, values, and health practices that may help or hinder nursing interventions
When should you stop suctioning?
if there is a 20 beats per minute change in HR or if the pulse oximetry dropped below 90% or 5 % below the pt's baseline
how do you apply a nasal cannula?
if tips are curved, they should point downward inside the nostrils and loop tubing around the ears. make sure it is snug but not too tight without pressure on the pts nares or ears
anxiety
ill-defined, diffuse feeling of apprehension and uncertainty
What should you do if patient develops respirator distress during suction procedure?
immediately withdraw catheter and supply additional oxygen as needed
When washing hands, you should interlace fingers and rub your palms how?
in a circular motion at least 5 times
IOM made..
in disciplinary learning a core educational requirement with he assumption that education across health care sickliness will improve communication, increase collaboration and decrease errors -reduces stereotypes
where were nurses first?
in hospitals as cheap labor
when is noninvasive positive-pressure ventilation (NIPPV) contridicted?
in pt's with facial deformities, hemodynamic disability, inability to protect airway,excessive secretions, high FiO2 requirements, severe agitation, cardia arrest
Informal contract
in the termination phase
Where should the tip of a CVAD be placed?
in the upper body in the lower segment of the superior or inferior vena cava at or near the cavoatrial junction
ethnocentrism
inclination to view one's own cultural group as the standard by which to judge the value of other cultural groups
Noninvasive ways of airway management to promote open airway
include hydration, positioning, nutrition, chest physiotherapy, deep breathing, coughing, humidity, incentive spirometry, and aerosol therapy
Non verbal communication
includes grooming, clothing, gestures, posture, facial expressions, eye contact, tone and volume, and actions -influenced by environment
How do you measure for crutches
includes pt height, distance between crutch pad and axilla, angle of elbow flexion Standing: crutch tips 15cm (6in) to side and 15cm in front of pt's feet. Crutch pads should be 5cm(2 inches which is 2-3 fingertips) under axilla. hand of grip must allow for 15-30 degree flextion
Valsalva maneuver
increases central venous pressure to prevent air entry into the catheter. it is holding your breath and straining
value statement
indicate that the nurse made a judgment, either positive or negative -nurse is operating out of his/her own framework
Spiritual distress
individual cannot achieve their spiritual needs because of their health
Feedback
information given back into the system to determine whether the purpose or end result of the system has been achieved
how to clean injection site
inner to outer in a circular motion using alcohol swap
Technology and talking with other colleagues during care comes off as...
insensitive and makes the patient feel like they are secondary -email: leads to misunderstanding
How should you hold your hands when sterile gloves are completely
interlock fingers and above your waist
piggy back
intermittent med infusion; small (25-250mL) IV bag/bottle that connects to upper Y-port ("piggybacks" on the big IV bag); micro/macrodrip system; bag is set higher than primary infusion bag
Qualitative research data collection methods
interviews, observations, focus groups, questionnaires, field notes, participant journals & diaries, photo elicitation
Key concepts of qualitative research
investigate phenomena, words, NOT stats/numbers, flexible (we can go where the research takes us), data collection and analysis happen at the same time
Active listening:
involves focusing solely on a person and acknowledging feelings in a nonjudgmental manner -best w/o distractions, enriched manner, good eye contact, nodding
Hypertonic IV solution
irritating to the vein; can cause increased risk of heart failure and pulmonary edema
Collaboration:
is a complex process that builds on communication -working jointly with other health care professionals
Evidence-based practice
is an element of critical thinking and a good means of improving clinical judgment.
Delegation: Right task
is it safe? Does it require little supervision?
Communication defintion
is the exchange of thoughts, ideas, or information and is at the heart of all relationships
An important focus of professional nursing education
is to learn how to seek out and critique research findings to implement best practices in one's own nursing practice. Consider: P-I-C-O-T framework
how can altruism influence nursing?
it can devalue autonomy
how is nursing different than other professions?
it has varying levels of preparatory education (can be licensed in 3 ways)
how are gender issues displayed in nursing?
it is female dominated profession and society deems it as "woman's work"
Prejudice definition:
judging a person in advance of knowing him or her -makes acceptance of others difficult
Fidelity
keep promises
How should you hold the sterile bottle when pouring solution?
label UP touching your palm
who was mary ann "mother" bickerdyke?
lay nurse
Open posture:
leaning forward, relaxed, arms uncrossed -reflect what you hear
Nurse managers use...
listening as a tool for dealing with staff members problems and concerns
What should a nurse do if they don't know about the medication that was ordered for their patient?
look it up -NEVER use cluelessness as an excuse -NEVER assume anything you are questioning
Nasal cannula
low flow -1-6 L/min: 24-44% Advantages: -safe and simple -easily tolerated -effective for low concentration -does not impeded eating or drinking -inexpensive DIsadvantages: -unable to use with nasal obstruction -drying mucous membrane -can dislodge easily -can cause skin irritation and nosebleeds
oxygen conserving cannula
low flow -8 L/min: 30-60% ***needed for a patient who requires high O2 concentration than what can be provided via traditional cannula*** -has a built in reservoir located on the nose which allows increase of O2 at a low rate Advantages: -indicate long term O2 use in the home -allows increased O2 concentration and lower flow Disadvantages: -cannula cannot be cleaned -more expensive than standard cannula
What do you have to do once you have picked up the catheter for trach care?
lubricate by testing it in the saline
diagnosis
made after data analysis result of client assessment
How do you remove the syringe after it has been inflated?
maintaining pressure on the plunger
Ethnocentrism
making judgements (usually negative) about another's culture relative to ones own
stereotyping
making prejudgements about patients from different cultures
Unintentional Torts
malpractice or professional negligence
Input
material that enters a system
Social support
means that a person belongs to a social network, feels loved and cared for, and can count on people for assistance.
Evaluation
measures the success or failure of the output
metabolism of a drug
medication is broken down to remove the active chemicals (most metabolism occurs in the liver but the lungs, kidneys, blood, and intestines play a role)
Single medication
medication ordered to be given ONCE at a specified time (ex. pre op)
what was FNS?
midwifery/health education services to poverty-stricken residents in the Appalachian mountains
trough
minimum blood serum concentration of medicine reached just BEFORE the next scheduled dose
Fraud
misrepresenting the facts (self as nurse or procedure)
Nurses have a professional responsibility to
model positive health behaviors in their own lives, practice self-care
what did soldiers from Iraq and Afghanistan return with?
more extensive injuries
what did more extensive injuries call for?
more nurses
Most common cause of HAI's
multidrug-resistant organisms -MRSA -VRE -C. Diff
what is the third level of maslow's hierarchy?
need for love and belonging
what is the second level of maslow's hierarchy?
need for safety and security
what is the fourth level of maslow's hierarchy?
need for self-esteem
Examples of social systems
neighborhoods, schools, churches, professional associations, civic groups, recreational groups
Invasion of Privacy
never agree to secrets, breech, pt confidentiality
Example of contact in the orientation phase
newly diagnosed diabetes patient agrees to work with the nurse to work together on the patient monitoring their glucose levels
Can a NAP administer O2 therapy to a pt with an artificial airway?
no
Can removal of sutures and staples be delegated to a NAP?
no
Can sterile irrigation of a wound be delegated to a NAP?
no
Can you delegate accountability?
no
A single clinician should not make no more than how many attempts for an IV?
no more than 2 attempts
Can completing the nursing assessment during admission be delegated to an NAP?
no, they can prepare the room with equipment needed and gather the patients personal items and collect specimens
Type 2 Error
not rejecting the null hypothesis when in fact the alternative hypothesis is true
When are gloves necessary to where during IV insertion?
not required to locate the vein. only required for the venipuncture
Non judgmental acceptance
nurses acknowledge all patients rights to be who they are and to express their uniqueness
how has the information aspect seen technological developments?
nurses are responsible for data entry and retrieval by using computer based applications
how has biomedical developments changed?
nurses are responsible for monitoring and responding to data that is generated by complex machines/implanted devices
what was a problem within the health care setting with the HIV epidemic?
nurses did not want to care for those patients
Informed Consent
nurses moral obligation to insure pt gives voluntary permission for procedure based on information given by doctor. RN verifies consent was given
what was FNS the first demonstration of?
nurses providing primary health care
Research Era
nurses were on the move to conduct research and to begin developing a specialized body of knowledge
what do the first 3 provisions describe?
nurses' values and commitments
what did this expansion of hospitals mean?
nursing shortage
Theory Era
nursing theory development noted to be the cornerstone of the development of the discipline of nursing
what was the johnson & johnson campaign used to enhance?
nursing's image and improve recruitment
prioritizing nursing process
o Safety o Airway o Breathing o Circulation o Pain
what is a profession?
occupational group with set attitudes and behaviors
What is synergy in regards to systems and subsystems?
occurs when all various subsystems work together to create a result that is not independently achievable
How do you label the edge of the dressin?
on a piece of tape with your initials, gauge, time
How should patient be positioned for wound irrigation?
on their side
Where does the nurse stand if the pt has a weak side?
on their weak side
remove VAD if
on unresolved complications, discontinuation of therapy, or when no longer necessary for plan
open ended questions:
one that causes the patient to answer fully, giving more than a "yes" or "no" answer -useful in data gathering
What should be checked before and after repositioning a pt on mechanical vent
oral cavity suctioning before repositioning and cuff pressure checks after repositioning
After trach suctioning and care are complete
oral hygiene with chlorhexidine and HOB to 30 degrees
What should you do if acute pain occurs with using an IS?
order an analgesic
what do the 8 spokes of miler's wheel of professionalism represent?
other behaviors that have been deemed necessary to maintain or increase nurses' professionalism
Most common site of pressure injuries
over bony prominences
needle length
patient size and weight, type of tissue to be injected (579)
Locus of control
people tend to be influenced by wither an internal or external view of control
Orientation (Introductory phase)
period often describes as "getting to know you" in social settings -Nurse and patient assess each other in this phase -be calm and unhurried -Understanding patients needs and problems -Patient learns the nurses credentials and name ** initial development stage
remission
period when symptoms subside
Deep tissue pressure injury
persistant, nonblanchable, deep red, purple or maroon discoloration
Receiver:
person acquiring the message
Sender:
person sending the message
Hand Hygiene
pg. 244 (Review Check-Off) -soap and water are required for VISIBLY soiled hands or C.diff -Alcohol-based can be used for non-visible germs
Hierarchy is dominated by..
physicians -nurses prefer collaboration interactions
Peplau
pioneer in nursing theory development, first focused on the importance of the nurse-patient relationship
how are nurses viewed in the public image?
polled highest in honesty and ethics
What is the most influential determinant of health (per WHO)?
poverty
side effect
predictable and often unavoidable secondary effects of a medication at a usual therapeutic dose
what distinguishes an occupation from a profession?
preparation and commitment
when continuous infusion of solutions or medications is not necessary, a short peripheral IV line can be locked with what?
preservative free 0.9% sodium chloride
what was developed because of the AIDS/HIV epidemic?
preventive measures (gloves) and protocols for handling blood products
Throughput
processes a system uses to convert material
What is the ANA code of ethics provision 2?
professional boundaries The nurse's primary commitment is to the patient, whether an individual, family, group, or population. When acting within one's role as a professional, the nurse recognizes and maintains boundaries that establish appropriate limits to relationships.
standardization in nursing helps nursing move towards...
professionalism
open system
promotes the exchange of matter, energy, and information with other systems and the environment.
Civil Law
protects rights of individuals in society ensuring fair and equal treatment. (e.g. voting rights, malpractice, negligence)
Criminal Law
protects society as a whole from certain crimes (e.g. theft)
Walkers
provide the most stability and security with a wide base of support
disbelief and denial
psychological defense mechanism that people sometimes use to avoid the anxiety associated with illness
Where does the nurse stand if the patient uses an assistive device?
pt's weak side
People who are NOT candidates for using an IS?
pt's who are unable to follow directions or who are not developmentally or physically able to perform the actions associated with this skill
what is a code of ethnics?
public document reminding nurses and the public of nurses' obligations and responsibilities to patients and others
What does the patient continuously have to wear during trach suctioning and care?
pulse oximeter on finger
after opening first flap of central line kit, what do you do?
put the mask on the patient and put your mask on then apply clean gloves
How often should you rotate a pt to avoid a pressure injury?
q2h
who should you be careful using a yaunker for oropharyngeal suctioning in?
recent head/neck injuries, tonsillectomy bc it increases risk to bleeds
closed-line suction catheter
recommend for pts who cant tolerate PEEP
granulation
red tissue represents the presence of granulation tissue, increase new amount of RBC and wound is concidered healthy
Material support, also called tangible support
refers to financial help, providing material goods and/or services.
Appropriateness:
refers to the correct fit of a reply -it matches the message -How are you? don't go into a lengthy reply -nurse needs to actually know how their patient is
Transmission:
refers to the expression of information, verbal or non verbal -teachers verbal and non verbal expressions when teaching a lesson (message)
Cyberchondria
refers to the propensity of certain people to believe that they suffer from a variety of disease they read about online.
what did the flexner report work to do?
reform standards in medical education
oxygen flowmeter
regulates the flow in liters per minute
What is the ANA code of ethics provision 1?
relationships with colleagues and other ...practices with compassion and respect for the inherent dignity, worth, and unique attribute of EVERY person.
belief
represents intellectual acceptance of something as true or correct
Administering oxygen therapy with a patient having an artificial airway
require constant humidification from either a T-tube(briggs adaptor) or trach collar
ANA Code of Ethics...
requires nurses to be professional nurses with stereotypes
Reflective practice
requires taking tie to focus on their own thoughts, feelings, actions and beliefs
Human Dignity
respect for inherent worth and uniqueness of populations and individuals
What do excessive amount of secretions signs of?
respiratory distress
spiritual nursing care
responsibility that goes beyond calling the chaplain
False Imprisonment
restraints, unjustified retention
What are HAI's?
result from delivery of health services in a health care setting and were not present at the time of admission. -A hospital is one of the most likely settings for acquiring an HAI because staff, patients, and environmental factors support a high population of pathogens that are resistant to antibiotics. -Health care workers transmit many HAIs by direct contact during delivery of care. -Although protecting patients from HAIs is an obvious priority, nurses are also at risk because of contact with infectious materials or exposure to a communicable disease.
Donning/Removing Sterile Gloves
review checkoff
Wet-To-Dry dressing change
review checkoff
pharmacist
reviews, prepares, and dispenses medication
what issue did technical life support raise?
right to die
21% oxygen is
room air (yellow)
what did margaret sanger fight for?
safe contraception/family planning
Never use what to cut the tape to avoid cutting the catheter
scissors
Braden Scale for predicting pressure ulcer risk include
sensory perception, moisture, activity, mobility, nutrition, fiction and shear
Reflection:
serving as a mirror for the patient -understanding and acceptance -encourages patients to think through problems themselves
theory
set of concepts, definitions, relationships and assumptions that project a systematic view of a phenomena components-concepts, definitions, assumptions, phenomenon
Context:
setting in which an interaction occurs - including the mood, relationship between sender and receiver and other factors
Giving information:
sharing knowledge that the recipients are not expected to know -know the difference between providing intro and giving opinions -giving opinions is unhelpful
what is the #1 factor for the shortage of nurses?
shortage of nursing faculty
Routine suctioning on a mechanical ventilator
should be avoided. Only suction if saw-tooth pattern is present in the pressure and flow curves of the vent, increased peak inspiratory pressure, decrease tidal volume, decrease in SpO2
documentation points for central line
site appearance, cleaning solutions used, characteristics of drainage, pt tolerance, time, if a culture was taken
What do you document after insertion of a saline lock?
site of insertion; size, type, legnth of catheter; number of attempts; If IV fluids are running
SBAR
situation background assessment recommendation
documentation points for urinary catheter insertion
size, type of catheter, amount or urine, color and consistency, was a specimen collected, daily care with soap and water
When observing skin around the stoma, faceplate, and ties, what are you looking for?
skin breakdown: drainage, blistering, erythema, discoloration
What are CPAP and BiPAP used for?
sleep apnea,COPD, pulmonary edema, resp. failure, neuromuscular disorders
What is a way to prevent infusion related complications
solutions and medications with an osmolarity greater than 900 mOsm/L are infused through a CVAD. (central vascular access devices
how to check for right dose
some tablets have to be broken in order to administer a portion of a tablet. ONLY break tablets that have been scored by the manufacturer -some hospitals require the pharmacy to split the medications -some tablets have to be crushed. ALWAYS check to see if a tablet can be crushed. unit dose: The ordered dose of medication a patient is to receive at one time. Each tablet or capsule is wrapped in foil or a paper container. Liquid medication is pre-packaged in foil or plastic cups. -QUESTION unusually large or small doses -if calculations are necessary, have another qualified nurse check your calculations -DOUBLE CHECK high risk medications with a second nurse (opioids, insulin, IV digoxin, etc.)
if you are reading this go over everything i left off because i dont feel like adding on to this anymore lol its tooooo much
sowwy
Verbal communication
speech and represents the most obvious aspect of communication -consists of nonverbal communication -develops last in children
what did jessie sleet scales and elizabeth tyler establish?
stillman house
coping
strategies a person uses to assess and manage demands
SBAR is the...
structural way of relating critical information in spoken form -establishes culture of quality, reliability, and patient safety ** safety is key -means that info is clear, complete, concise and structured -most relevant and important data are featured
ethics
studies standards of conduct
Ethics
studies standards of conduct. "What is the nature of good and evil?" Moral principles and values make up a system of ethics. Behavior depends on moral principles and values. Ethics, therefore, underlie the standards of behavior that govern us as individuals and as nurses. Bioethics is a term describing the branch of ethics that deals with biologic issues.
logic
study of proper & improper methods of reasoning
Philosophy
study of the principles underlying conduct, thought, and the nature of the universe
aesthetics
study of what is beautiful
What do you set the the suction and FiO2 at when performing trach suctioning and care?
suction between 100-150 not exceeding 180 and FiO2 at 100%
Abstracts
summary of research
After aspirating for blood return and flushing the line, what are you observing the vein for?
swelling
S/S of DVT
swelling in infected leg, warm to touch, cyanotic skin, pain
sympathy and empathy difference:
sympathy is more into feelings and empathy acknowledges their feelings and emotions but isnt swept along with them
exacerbation
symptoms reappear or worsen
viscous solutions
syrupy: having a relatively high resistance to flow, or having a glutinous consistency and the quality of sticking, or adhering
Nursing research
systematic investigation of phenomena related to improving patient care
Translational research
takes the findings in the laboratories and develops them for use at the bedside. It also takes the findings from clinical research done at the bedside to ask new questions and to direct new research at the bench level.
Need to take a minute from care because of overstimulated emotions
talk to a colleague to assist you or receive you from care
How to draw up medicine from an ampule
tap bottle until fluid moves out of neck -place small gauze around neck of ampule and snap the neck of the ampule quickly and firmly AWAY from body -draw up medication quickly using filter needle long enough to reach bottom of ampule -hold ampule upside down and insert filter needle into center of opening without allowing the needle to touch the rim -aspirate medication into syringe by pulling back on plunger (if you aspirate air bubbles, DO NOT expel air into the ampule) -if syringe has excess fluid, discard in sink
what did the nursing shortage lead to?
team nursing
what has been under rapid development in the medical community?
technology
who was margaret sanger?
tenement nurse in the henry street settlement
Living Will
terminal illness determines which procedure is ok
what did the american civil war show?
that nurses were needed
what did florence nightingale reform?
the Britain Army medical system
What should be done before O2 therapy in a person with an artificial airway?
the airway must be determined to be patent before O2 is administered
Evaluation:
the analysis of received information. -people evaluate the content of their professors lecture
Holistic nursing care nourishes the whole person
the body, mind, and spirit. Eight factors contribute to holistic approach to nursing Nursing is an open system Nursing is the provision of health care services Nursing involves collaborating with patients and their families Nursing is integrally involved with people Nursing care is provided regardless of diagnosis, individual differences, age, beliefs, gender, sexual orientation, or other factors. Nurses require advanced knowledge and skills Nursing requires concern, compassion, respect, and warmth, as well as comprehensive, individualized planning of care, to facilitate patients' growth toward wellness. Nursing links theory and research
what did Nursing's Social Policy Statement: The Essence of the Profession give?
the contemporary definition of nursing
Example of the working phase
the diabetic patient may give the nurse some degree of difficulty in accepting the lifestyle changes that managing diabetes requires
what did the hub of miller's wheel of professionalism represent?
the essential foundation of nursing education
what was florence nightingale?
the first nurse researcher (she wrote everything down)
The decision of whether or not to delegate or assign is based upon what?
the judgment concerning the condition of the patient, the competency of the members of the nursing team, and the degree of supervision that is required of the RN if a task is delegated.
Supra-system
the larger environment outside the system
Standards of care
the legal requirements for nursing practice that describe minimum acceptable nursing care.
implementation
the nurse DID the actual plan that is undertaken communication is essential
The working phase
the nurse and patient address tasks outlines in the orientation phase -patients may exhibit alternating periods of intense effort and resistance to change
What is the ANA code of ethics provision 6?
the nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action
Dependent variable
the outcome variable that is being measured; relies on the independent variable
Population in PICOT
the patient population of interest by age, gender, ethnicity, or disease/health problem.
personal knowing
the person's inner experience of becoming whole, aware and genuine
plan
the plan for the client the nurse WILL set goals for the outcome of the client based on diagnosis of client
Inductive reasoning
the process begins with a particular experience and proceeds to generalizations *Inferences are made that lead to further research
excretion
the process of the medication exiting the body through bowels kidney, liver, exocrine glands, and lungs
nursing process
the process that nurses use to plan care for the client holistic view of the entire person roadmap for the care of the client assessment, nursing diagnosis, plan, implementation, evaluation
Perception:
the selection, organization and interpretation of incoming signals into meaningful messages -people perceive information differently -students in a lecture hall
Interpersonal skills
the skill set that includes communication is referred to as this
what was the flexner report a benchmark for?
the status of occupations
Logic
the study of proper and improper methods of reasoning. "What should our thinking methods be in order to reach true conclusions?"
Aesthetics
the study of what is beautiful. "Why do we find things beautiful?"
Independant variable
the variable that is manipulated; presumed cause
domain
the view or perspective of discipline contains the subject, central concepts, values and beliefs, phenomena of interest, and the central problems of the discipline
"twos steps forward and one step backwards"
the working phase
Types of Advocacy: Four Dimensions of Advocacy
there are four dimensions of advocacy when the nurse is caring for a client.2 Being a client advocate Following through or following up Providing resources Going above and beyond
Boundaries violations occur when..
there is confusion between the needs of the nurse and those of the client
What are the ANA scope of standards?
they are not laws but influence policy development
regarding nursing education, what happened after the civil war?
they looked towards formal educations of nurses
what did 9/11 and hurricane Katrina mean for nurses?
they took on new roles concerning disaster preparation/manmade disasters (bioterrorism) and natural disasters
Secretive behavior of a nurse
thing to watch for.... crossing boundaries
Evaluative beliefs
those in which there is a judgment about good or bad. The belief "Advanced life support for a 90-year-old is immoral" is an example of an evaluative belief.
Descriptive or existential beliefs
those that can be shown to be true or false. An example of a descriptive belief is "The sun will come up tomorrow morning."
Assault
threat to touch w/o consent
peak
time it takes for medication to reach it's highest effective peak concentration
what is the truth about nursing organization's goal?
to change how the world thinks about nursing
when preparing an IV, why do you prime the saline lock?
to remove air so it doesnt enter the patient
where do you hang the drainage bag?
to the bedframe, below the bladder level ***not on the bedrail***
TT
trach tube -can be temporary or permanent -inserted surgically directly into trachea through a small incision in the neck -pts who needed to be intubated longer, have upper airway obstruction secondary to trauma or tumor, or spinal cord injuries
How to apply SCD hose
turn stocking inside out, hold heel, pull through. slide over the pt's calf until sock is completely extended making sure there are no rough ridges. make sure to measure pt's leg when selected sizes. you can also apply powder or cornstarch to legs
what was Nursing's Social Policy Statement: The Essence of the Profession the framework for?
understanding nursing's relationship with society
adverse drug reaction
unintended, undesirable, and often unpredictable effects of a medication
When advancing the suction catheter into the trach, how do you know when to stop advancing?
until patient coughs or resistance is met and then pull back 1cm (1/2 inch)
How far should a catheter be inserted?
until urine has returned and advance another 1-2 inches for a female, and all the way to bifurcation for males
due to the lack of nurses, what were nursing school graduate supplemented with?
untrained women
What is the frequently prescribed timing of using an IS?
up to 30 deep breaths within 30-60 seconds rests between sets of ten
how to apply the transparent dressing
up to the hub (leave connection below the insertion site uncovered)
How do you be assertive?
use a nonthreatening tone, respect others,use direct statements of feeling
Biomedical technology involves the use of complex machines or devices in patient care situations. Because of the highly technological environment in which nurse's work, it is important that nurses.
use human touch and words of reassurance frequently to convey caring
what does a persistent vegetative state and life support mean for a hospital?
use of a lot of their resources
resourcefulness
use of cognitive skills that one uses to adapt to the world around him, often in very creative ways
Astute nurses...
use their communication skills throughout their personal and professional lives
Oxygen Therapy
used in a variety of conditions to treat hypoxia, which is a condition in which there is insufficient oxygen to meet the metabolic demands
Venting:
used to describe the verbal "letting off steam" that occurs when talking about concerns or frustrations -nurse may hear patient talking... can't take it personal
two types of crutches
used to remove weight from one or both legs -axillary crutch: frequently used in pt's of all ages on a short term basis -Lofstrand crutch: has a handgrip and a metal band that fits around a pt's forearm and are useful for pt's with permanent disability
Now medication
used when patient needs a medication quickly but NOT as soon as stat. (you have UP TO 90 minutes to give this drug)
How should you clean the wound if a drain is present?
using circular stroke starting with the area next to the drain and finishing away using a different swab each tie
Efficiency:
using simple, clear words that are timed at a pace suitable to participants -dont just say that your patient will be having an angioplasty... you need to explain to them what it is (this would not be good for a small child though) -ex. physical said a patin had bugs in her bladder and she took it seriously
If vein palpation is necessary after application of chlorhexidine, how would you touch it?
using sterile gloves
what is society's image of nursing like?
varied (sexualized/less intelligent)
VAP
ventilator associated pneumonia -only considered for this after 2 days on vent
Congruent communication
verbal and non verbal aspects match and reinforce each other
evaluation
was the goal met? Yes good no-start over ADPIE
why is it important to improve the recruitment of new nurses?
we have an aging population
Why does it take an older adult longer to achieve target volume when using an incentive spirometer?
weakened respiratory muscles and decreased elastic recoil properties of the lungs affect a patient's ability to cough and deep-breathe.
what did Lillian Wald do?
went into the communities to promote health
Message:
what is actually being said plus applying nonverbal communication
empirical knowing
what is known is accessible through the 5 senses and is based on knowledge that is considered objective, quantifiable and verifiable
Communication begins the moment...
when two people become aware of each others presence -no words can be spoken
How do you dry your hands off after washing them?
wiping from fingers up to wrists and forearms
how do you secure a catheter?
with a stat lock onto pt's thigh
how do you prepare a women for cleaning her vagina before catheter insertion?
with non-dominant hand spread open labia. ***ONCE THIS IS DONE YOU CANNOT CLOSE BACK UNTIL AFTER CATHETER IS INSERTED*** clean from for labia, to near labia fold, then down the center using a different cotton ball
how do you prepare a man for cleaning his penis before catheter insertion?
with nondominant hand, retract foreskin and gently grasp penis at the shaft. hold penis at a right angle to the body. using circular stokes, clean from the meatus out 3 times
How do you clean the stoma?
with qtips working outward 2-4 inches in all directions
When are sutures and staples generally removed?
within 7-14 days after surgery if healing is adequate (retention sutures remain in place for 14-21 days)
Incongruent Communication
words and nonverbal communication do not match -creates confusion in receivers whoa re unsure of what levels of communications they should respond to -unexpressed feelings
translator:
works with written documents
what does the american red cross provide?
worldwide relief
perscriber
writes the order
slough
yellow tissue representing nonviable tissue and in some cases the presence of infection. normally purulent drainage
Can a NAP administer a nasal cannula or mask O2 therapy?
yes
Can applying a transparent dressing be delegated to a NAP?
yes
Can caring for pt's on isolation precautions be delegated to a NAP?
yes
Can oropharyngeal suctioning be delegated to and NAP?
yes
Can the application of SCD's be delegated to a NAP?
yes
Can the skill of promoting early activity and exercise for patients be delegated to a NAP?
yes
Can you delegate responsibility?
yes
do you need goggles for central line cleanse?
yes
how did the vietnam war impact nurses?
young nurses took care of soldiers -on the battlefield -greater responsibilities
Barriers to communication
• Asking too many questions • Providing false reassurance or assurance • Asking "why", it suggests criticism • Interrupting or changing the subject • Using leading or biased questions, "you didn't do that, did you?" • Failing to listen • Offering approval or disapproval • Offering advice • Avoid yes or no questions • Stereotyping- conclusions are influenced based on personal beliefs or biases • Using patronizing language- "you know better than that"
NCBSN guidelines for professional boundaries
• Professional sexual misconduct is an extreme form of boundary violation; includes seductive behavior, sexual demeaning, harassing or reasonably interpreted as sexual by the patient • Boundary violations can result when there is confusion between the nurses needs and those of the patient • Avoid repeated boundary crossings • Avoid personal or business relationships to the patient • Don't discuss personal problems with patient • Don't show favoritism • Don't keep secrets with patient
What is SBAR?
• Situation: The problem - State your name and unit - I am calling about (patient name and room number) - The reason for calling • Background of patient: Brief and to the point - State admission diagnosis and date of admission - State pertinent medical history - Brief synopsis of the up to date treatment • Assessment: Vital signs, O2 sat, pn, mental status - What you found, what you think • Recommendation: What you want to happen or think should happen
what is the difference between an indwelling catheter and straight?
♣ The difference lies in the inflation of a balloon to keep the indwelling catheter in place and the presence of a closed drainage system. - Single lumens are used for intermittent/straight catheters. One time bladder emptying. Made of rubber (softer, more flexible) or PVC. - Double-lumen catheters are used for indwelling catheters and provide one lumen for urinary drainage and a second lumen to inflate a balloon that keeps the catheter in place. Made of latex or silicone. ***Size 14-16 Fr to minimize infection and trauma. ***An indwelling catheter is attached to a urinary drainage bag to collect the continuous flow of urine. Always hang the bag below the level of the bladder on the bed frame or a chair so urine drains down, out of the bladder
Code of Ethics
"STANDARDIZATION" Guiding Principals for all members of a profession to uphold when questions arise -1950 created by ANA
Definition of nursing
"The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge."
How does WHO define health?
"a state of complete physical, mental and social well-being and not merely the absense of disease or infirmity"
WHO definition of health
"a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity"
DNR
"do not resuscitate." means CPR cannot be used if the persons heart and breathing stops
how has the knowledge aspect undergone technological development
"technology of the mind" -use of computer systems to transform info and knowledge and generate new knowledge (expert systems)
what was her definition of nursing?
"unique body of knowledge"
(Q.) A nurse is caring for a client who is 24 hr postoperative following an inguinal hernia repair. The client is tolerating clear liquids well, has active bowel sounds, and is expressing a desire for "real food." The nurse tells the client that she will call the surgeon and ask. The surgeon hears the nurse's report and prescribes a full liquid diet. The nurse used which of the following levels of critical thinking?
(A.) Basic (B.) Commitment (C.) Complex (D.) Integrity A. At the basic level, thinking is concrete and based on a set of rules, such as obtaining the prescription for diet progression.
Trade name of a drug
(Also called brand name) is used to market the medication; has a symbol at the upper right of the name (tm)
IM
(Intramuscular) injection into muscle
Isolation Precautions
(This may lead to loneliness or changes in self-concept or body image. Know cultural views and preferences of your patients. When a patient from another culture requires isolation, use caution to be sure that the patient and family understand the therapeutic purpose of isolation.) -PPE required (gown, goggles, mask, gloves) -leave equipment in the room
IV
(injection or infusion) injection into vein
ID
(intradurmal) injection just under the epidermis
SubQ
(subcutaneous) injection into tissues just under the dermis of the skin
Advancing the Profession Through the Use of Research
*BSN-prepared nurse* --Read, interpret, and evaluate research for use in supporting their evidence-based nursing practice --Identify nursing problems that need to be investigated --Participate in the implementation of scientific studies --Help disseminate research-based knowledge by sharing useful research findings with colleagues
California Nurse Practice Act
*Defines the "Standards of Care" -Details state specific regulations -Defines scope of nursing practice (what you can and cannot do as a nurse) -Defines medical vs nursing care (e.g. giving a medications without order) -Sets education and licensure requirements
Advancing the Profession Through the Use of Research
*Master's degree-prepared nurse* --Ready to replicate studies that have been previously conducted --Some nurses are better prepared to conduct research.
why was licensure needed?
*to protect the public* from people with no education on nursing
Rules for injecting insulin
- 3/16 inch needles for insulin are associated with less pain, adequate control of glucose, and minimal leakage of medication. If using a 3/16 inch needle, administer at a 90 degree angle. - Use insulin syringe - Use upper arm, abdomen, thigh, buttocks, - Rotate sites within anatomical area - Do not aspirate - ***Do not rub site after injection*** -Pinch skin to give injection -Check glucose levels before injections
Obtaining a midstrem urine specimen
- After patient initiates urine stream into toilet or bedpan, have him pass urine specimen container into stream and collect 90 to 120 mL of urine - While continuing to hold labia apart, patient initiates urine stream into toilet or bedpan; after stream is achieved, pass specimen container into stream and collect 90 to 120 mL of urine - Initial stream flushes out resident microorganisms that accumulate at urethral meatus and prevents transfer into specimen - Remove specimen container before flow of urine stops and before releasing labia or penis. Patient finishes voiding into bedpan or toilet. Offer to help with personal hygiene as appropriate.
Prescriptive Theories
- Also called microtheories, practice theories, or situation specific theories - Address nursing interventions for a phenomenon - Predict consequence of a specific nursing intervention - Test the validity & predictability or a nursing intervention - Least complex - Narrow in scope Example - Infant bonding or oncology pain management.
CONCEPT 1: Person
- An open system with human needs - Human needs - required for a person's well-being - Maslow's 5 needs
preventing catheter related UTI's
- Aseptic insertion of urinary catheters - Limiting the use of indwelling catheters to essential conditions and removing them as soon as medically indicated. Examples of appropriate indications for catheterization include acute urinary retention, accurate intake and output measurement in critically ill patients, perioperative preparation for select surgeries, healing of open sacral or perineal wounds in incontinent patients, patients requiring prolonged bedrest, and comfort for end-of-life care - Using the smallest catheter possible - Daily cleansing of the urethral meatus with soap and water or perineal cleanser - Maintaining a closed urinary drainage system - Maintaining a free flow of urine through the catheter - Avoiding urethral trauma by securing a catheter - Antiseptics applied to the urinary meatus are not effective and should not be applied - Antiseptic solutions placed in drainage bags and complex urinary drainage systems have not been found to be effective
Cultural systems
- Astute nurses realize that integration of a patient's cultural health beliefs into planning patient-centered care can make a strong impact on that patient's desire and ability to improve his or her health.
Systems Theory
- Closed ** Does not interact with environment ** E.g. chemical reaction in test tube - Open ** Interacts with the environment ** Information exchanged between system and environment ** In an Open System factors that change the environment, will also change the system...e.g. the internal & external environment that have an effect on a person.
Three Categories of Beliefs
- Descriptive or existential beliefs - Evaluative beliefs - Prescriptive (encouraged) and proscriptive (prohibited) beliefs
Descriptive Theories
- First level of theory development ** Determines what will be the phenomenon studied. - Describe a phenomenon & speculate on why it occurs & describe the consequences ** Observe ** Name concepts ** Name properties ** Name dimensions - Does not explain the interrelationships among the concepts Example - explains assessment of a patient thru various stages thru growth and development
Social systems
- Individuals are influenced by the social system - include: family, neighborhood, school, churches, professional associations, civic groups, and recreational groups - Social support - emotional support, companionship, informational support, and material support
Four components for effective lifestyle change
- Information - Skill development - Skill enhancement through guided practice and feedback - Creating social supports for change
Components of Systems
- Input, throughput, output, evaluation, and feedback - subsystems
Subcutaneous injection rules
- Insulin syringe ONLY for insulin - TB syringe for other medications to be given subcutaneous - Usually 25g - 5/8 inch if to be inserted at 45 degree angle (if you can grasp 1 inch of tissue) -1/2 inch if to be inserted at 90 degree angle (if you can grasp 2 inches of tissue) - 3/16 inch needles for insulin are associated with less pain, adequate control of glucose, and minimal leakage of medication. If using a 3/16 inch needle, administer at a 90 degree angle. -Small amounts-0.5-1.5 mL
Middle Range Theories
- More limited in scope - Less abstract - Address a specific phenomenon - Reflect practice - Comprised of relatively concrete concepts - May be tested Example - 1. Mishel's theories about uncertainty in illness, may help a nurse to assist patients in coping with cancer.
bladder scan machine
- Noninvasive device that creates an ultrasound image of the bladder for measuring the volume of urine in the bladder. The device makes calculations to report accurate urine volumes, especially lower volumes - To assess bladder volume whenever inadequate bladder emptying is suspected such as after the removal of indwelling urinary catheters, in the evaluation of new-onset incontinence, and after urologic surgery - Most common use for the bladder scan is to measure postvoid residual (PVR), the volume of urine in the bladder after a normal voiding. ***To obtain the most reliable reading, measure PVR within 10 minutes of voiding. A volume less than 50 mL is considered normal.****** Two or more PVR measurements greater than 100 mL require further investigation.*** If a bladder scanner is not available, obtain a PVR by measuring urine emptied from the bladder after a straight catheterization
Foundation of nursing
- Person - Health - Environment
The Competent Nurse
- Practices ethically -Attains knowledge and competency that reflects current nursing practice - Integrates evidence and research findings into practice - communicates effectively - Demonstrates leadership in the professional practice setting -Collaborates with health care consumers, family & others -Evaluates his/her own nursing practice in relation to professional practice standards, etc. -Uses appropriate resources to plan and provide nursing care services that are safe, effective and financially responsible -Practices in an environmentally safe & healthy manner
Suprapubic catheter
- Urinary drainage tube inserted surgically into the bladder through the abdominal wall above the symphysis pubis - Catheter may be sutured to the skin, secured with an adhesive material, or retained in the bladder with a fluid-filled balloon similar to an indwelling catheter. - Placed when there is blockage of the urethra (e.g., enlarged prostate, urethral stricture, after urologic surgery) and in situations when a long-term urethral catheter causes irritation or discomfort or interferes with sexual functioning
Rules for heparin and Lovenox injections
- Use abdomen (2" on right or left of umbilicus) - ***Do not expel air bubble (Lovenox)*** - Do not aspirate - Do not rub site after injection -***pinch skin and remain pinching until after injection***
Obtaining a urine specimen from a closed system
- Use syringe without needle to remove urine - ***Clamp catheter for 10-15 minutes*** so you can obtain specimen from catheter and NOT THE BAG - Apply clean gloves and ***clean port for 15 seconds*** with disinfectant wipe and allow to dry - Attach needleless Luer-Lock system and ***withdraw 3 mL for culture or 20 mL for routine urinalysis*** - Transfer urine from syringe into CLEAN urine container for routine urinalysis or STERILE urine container for culture - Place lid on urine container - Unclamp catheter and allow urine to flow into drainage bag Place label on container, **NOT LID**
Individuals, as open systems, also endeavor to maintain balance between external and internal forces.
- When balance is achieved, the person is healthy or is resistant to illness. - If adaptation is unsuccessful, disequilibrium may occur, setting the stage for the development of illness or disease.
foundation of nursing: environment
- affects well-being - physical (air, water, etc) - nonphysical (family, culture, social structures)
How to check for right patient
- before administering medications to a patient, you need to use AT LEAST 2 patient identifiers (pt name, birthday, id number) -NEVER use the room number as a pt identification -compare the MAR with the patient's identification band (at bedside)
Defining health
- best viewed as continuum - health status varies day by day - influence by variety of factors
what is maslow's hierarchy of need?
- common to all humans - five levels
Family
- defined as the patient defines family and do not necessarily involve "blood relatives."
Poverty
- diminished access to health care for a variety of reasons. - Lack of money means inadequate nutrition and lack of basic health care, adversely affecting the health status of all family members. - Food insecurity and hunger; poor transportation, inability to pay mortgage or rent, and inability to pay for utilities such as natural gas, water, and electricity
Homeostasis
- dynamic balance achieved by effectively functioning open systems. - attained by coordinated responses of organ systems that automatically compensate for environmental changes.
what are the 5 branches of philosophy
- epistemology - logic - aesthetics - ethics - politics - metaphysics
Health belief model
- evaluation of one's vulnerability to a condition and seriousness of that condition - evaluation of how effective health maintenance behavior might be - presence of a trigger event that precipitates health maintenance behavior
examples of suprasystem
- family - culture - community
Values
- freely chosen principles, ideals, or standards held by an individual, class, or group that give meaning and direction to life. - abstract representation of what is right, worthwhile, or desirable.
Bandura's percieved self-efficacy
- high belief in self-efficacy leads to efforts to change - low percieved self-efficacy leads to lack of change
4 necessary components of bandura's theory
- information - skill development - skill enhancement through guided practice/feedback - creating social supports for change
Professional Relationships
- interactions are planned and purposeful - limited in time with termination date - goal directed - problem solving - nonjudgmental acceptance - outcome is improved health status of patient
healthy people 2020
- introduced every 10 years - national initiative to improve health of nation - 26 leading health indicators - organized into 12 topic areas
what is the most basic level of maslow's hierarchy?
- needed for physiologic survival - food, oxygen, rest, activity, shelter, sexual expression
Social Relationships
- not time limited - not necessarily goal directed - outcome is pleasure for both parties
Foundation of nursing: Health
- on a continuum - dynamic - holistic - affected by beliefs & behaviors
Belief
- represents the intellectual acceptance of something as true or correct. - exhibited through attitudes and behaviors. - Nonjudgmental attitude - effort to convey neither approval nor disapproval of patients' beliefs and respects each person's right to his or her beliefs - Differences in beliefs that directly affect nursing Blood transfusion Vaccinations
what is the highest level of maslow's hierarchy?
- self actualization - Self-actualized people have realized their maximum potential. They use their talents, skills, and abilities to the fullest extent and are true to their own nature. - Do not stay in state of self-actualization. May have "peak experiences"
Belief systems
- serve to guide thinking and decision-making
Family system
- the way the family functions with and within the environment and the dynamics between various members of the family - Most direct environmental influence on a person.
Foundation of nursing: person
- unique, adaptable - open system with subsystems - influences by genetics and environment - motivated by needs - seeks homeostasis
Financial Support for Nursing Research
--National Institute of Nursing Research --National Institutes of Health --Nursing associations like: ---American Nurses Foundation ---Sigma Theta Tau International Honor Society of Nursing
Relationship of Research to Theory and Practice
--Research develops solutions that can be used with confidence in different situations. --Nursing research generates interest in further studies. --Clinical studies have made a difference in patient care. --Nursing research findings affect the health care system. --Nursing research enhances the status of nursing as a profession.
Positional ways to prevent pressure ulcers
-30-degree lateral position -pillow bridging
Simple face mask
-6-12 L/min: 35-50% Advantages: -useful for short periods of time such as patient transportation Disadvantages: -contradicted in patients who retain CO2 -may feel claustrophobia -therapy interrupted with eating or drinking -increased risk to aspirate
What is Nursing?
-A Profession & A Discipline -Profession—calling or occupation, especially one that is learned, scientific or artistic -Discipline—Art & Science
A problem may be amenable to being addressed by research if:
-A conceptual framework exists or can be constructed from previous research. The problem fits logically and aligns with what is already known. -Based on related research findings published in professional, peer-reviewed journals or is supported by similar ongoing research in other settings -Carefully designed. The results will be applicable in similar situations or will generate hypotheses for further research and testing.
Notice of rights
-A hospital must protect and promote each patient's rights. -A hospital must inform each patient whenever possible or, when appropriate, the patient's representative, of the patient's rights in advance of furnishing or discontinuing patient care. -The hospital must have a process for prompt resolution of patient grievances and must inform each patient about whom to contact to file a grievance
TJC safety goals
-Accredits health care organizations -Committed to improving patient safety -Established National Patient Safety Goals -Medication safety has been a consistent National Safety Goal for ex. *Identify patients correctly *improve communication among caregivers *verbal or telephone orders require "read-back" *standardize a list of abbreviations, acronyms, symbols, and dose that can NOT be used *safety use of medications *identify look alike list *label all medications and medication containers prior to procedure *communicate patients complete medical list *encourage patients to be active int heir own care
Examples of tasks delegated to a CNA (certified assistant)
-Activities of daily lining (ADLs): Bathing, Grooming, Dressing, Toileting, Ambulating, Feeding (without swallowing precautions), positioning, bedmaking -Specimen collection (non-sterile) -Intake and output -Vital signs (on stable clients)
Binders
-Binders are bandages made of large pieces of material specially designed to fit a specific body part. -Breast binders are not used often in current practice. Sports bras are preferred for breast support after certain surgeries. -An abdominal binder supports large abdominal incisions that are vulnerable to tension or stress as a patient moves or coughs. The binder also lessens pain in postoperative patients. -Abdominal binders provide a noninvasive intervention for enhancing recovery of walk performance, controlling pain, and improving patient's experience following major abdominal surgery. -Binders support underlying muscles and large incisions, lessening muscle stress which assists a patient to move more freely without additional discomfort. -can be delegated
Grand Theories
-Broadest in scope - Most complex - Non-specific & comprised of relatively abstract concepts - Generally cannot be tested - Provides broad & abstract views about nursing Example - 1. Neuman Systems Model about client responses, environmental factors and nursing actions is a foundation for nursing practice, education and research.
What databases contain searchable Scientific Literature
-CINAHL: Cumulative Index of Nursing and Allied Health Literature. Includes studies in nursing, allied health, and biomedicine Cochrane Database of Systematic -Cochrane Collaboration. Includes completed reviews: Full text of regularly updated systematic reviews prepared by the and protocols. -PubMed: Health science library at the National Library of Medicine. Offers free access to journal articles. -MEDLINE: US National Library of Medicine; bibliographical database that contains more than 22 million references to journal articles in the life sciences with a concentration in biomedicine -EMBASE: Biomedical and pharmaceutical studies and abstracts and articles from biomedical, drug, and medical device conferences -Psyc INFO: Interprofessional biographical resources in psychology and the behavioral and social sciences -National Guidelines Clearinghouse: Public resource for evidence-based clinical practice guidelines. Available through the Agency for Healthcare Research and Quality; contains structured abstracts (summaries) about clinical guidelines and their development; also includes condensed version of guidelines for viewing
Review of the literature - covers all relevant research and supporting documents
-Classics and literature published within 5 years -Internet and disciplined, organized searches of established databases
Identification of a researchable problem
-Clinical situations -Literature -Theories
Nursing Core Concepts
-Communication -collaboration -Curiosity -Competence -Care -Cure
ANA definition of Nursing
-Diagnosis and treatment of human responses to actual or potential health problems. (1980) -Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations. (2003)
The discipline of Nursing
-Disciplines are distinctions between bodies of knowledge -Discipline perspective expressed in theories or conceptual frameworks. -Theories built on concepts Most important are called metaparadigm concepts
Advancing the Profession Through the Use of Research
-Doctor of philosophy or other doctoral decrees nurse -More favorably positioned to receive research funding than are nurses without doctorates -Only nurses with PhDs may receive funding from the NIH, although other funding sources are open to nurses with other doctoral degrees.
Nursing Roles
-Educator -Patient education -Formal educator role -Politician -Consultant -Counselor -Researcher—Consumer of research -Evidence based practice -Client Advocate
classifications of medicine
-Effect on a body system -Symptoms the medication relieves -Medication's desired effect
Hydrocolloid dressing
-Elastomeric, adhesive, and gelling agents -absorb and hydrate -form gel that promotes a moist environment, facilitates autolytic and enzymatic debridement
SLU Conceptual Framework: Environment
-External factors: -Surround or interact with client Influence development & behavior -Client adapts by changing self or by changing environment -May include: individuals, families, communities, physical surroundings, settings, milieu, social/political -Health care system
Polyurethane foam dressing
-Foamed polymer sheets with small open cells that hold wound exudate away from the wound bed -Protect wound surface while maintaining a moist, insulated environment -not appropriate if the wound is tunneling because the dressing expands which can enlarge the tunnel
Nursing Theories Define
-Goal of Nursing -Client -Role of Nurse -Source of client difficulty -Intervention focus -Modes of intervention -Consequences
The Scientific method has limitations when applied to phenomena of interest to nursing
-Health care settings are not comparable with laboratories. -Human beings are far more than collections of parts that can be dissected and subjected to examination or experimentation. -The claim for objectivity (freedom from bias)
Formulation of the research question or hypothesis
-Hypothesis - educated or informed speculation as to what the outcome will be *The researcher defines the variables.
2017 Hospital National Patient Safety Goals
-Identify patient correctly -Improve staff communication -Use medications safely -Use alarms safely -Prevent infection -Identify patient safety risks -Prevent mistakes in surgery
Example of a PICOT
-In abdominal surgery patients (P), does epidural analgesia (I) compared to patient-controlled analgesia (C)affect pain severity(O) in the first 48 hours after surgery (T)? -Is an adult patient's (P) blood pressure more accurate (O) while measuring with the patient's legs crossed (I) versus the patient's feet flat on the floor (C)?
SLU Conceptual Framework : Person
-Individual, family, group, community -Family—set of relationships that client defines as family -May have legal/ biological ties -Group—assembly of people who meet over time for a specified reason -Community—social group which may share geographic boundaries. Interact because of common interests to meet needs in larger society -Adaptive system -Interacting with environment -Goals -Meet basic needs -Maximize function -Progress toward self-actualization -Integrated whole with 4 dimensions
Female and Male needle lengths
-Less than 130 pounds 5/8 to 1 inch -130-152 pounds 1 inch -153-200 pounds 1-1 ½ inches -200+ pounds 1-1 ½ inches
In which three states were the first training schools for nursing practice opened?
-London was the first -New York, Connecticut, and Massachusetts
Delegation: Right circumstance
-Long term vs. acute vs home health? -Knowledge and skill of delegatee -Verification of clinical competence -Stability of patient's condition -Availability of resources (including human)
The goal of IV therapy
-Maintain or prevent fluid and electrolyte imbalances -Administer medications -Replenish blood volume -Assist in pain management
Examples of LPN (licensed) delegated tasks
-Monitoring client findings as input to the RN's ongoing assessment -Reinforcement of client teaching from standard care plan -Insertion of urinary catheter -Medication administration (IV meds?)
What are the guidelines for administering controlled substances
-NEVER waste controlled substances into the sharps container -store in a locked, secure cabinet -MUST be counted frequently -used controlled substance inventory record each time one is used -if you are giving a partial dose, a second nurse HAS TO WITNESS you throw out the rest -report any discrepancies -document administration of controlled substance
American Nurse Association (ANA)
-National Professional Nursing organization for the US -Foster high standards of professional practice
Formal Role Expectations
-Nurse Practice Act -Define nursing -Address scope and expectation of practice -State specific
What can RN's NOT delegate to an NAP?
-Nursing Process: Assessment, Diagnosis, Planning, and Evaluation -Patient Education: (LPNs may reinforce education) -Tasks that require clinical judgment and critical thinking
Financing of Health Care
-Payment usually comes from a variety of sources -Government programs: -Medicare—3 Parts Over 65, Workers with permanent disabilities -Part A—hospital, home, hospice care, all recipients have -Part B—voluntary—outpatient and physician services -Part D—voluntary—prescription drugs -Medicaid -VA -Prospective payment system -Diagnosis related groups (DRG): Classification system that determines payment
6 LEVELS of care in the HC system
-Preventative -Primary care -Secondary care -Tertiary care -Restorative care -Continuing care -Intensity of nursing services in different settings will vary
Scope Of Nursing
-Promoting health and wellness -Preventing illness -Restoring health . providing direct care to ill person . performing diagnostic procedures . consulting with other health professionals . teaching about recovery activities . rehabilitating patients to optimal functional level - Caring for the dying
Critical Thinking in Nursing
-Purposeful, goal directed thinking for clinical decision-making -Goal is to make decisions that enhance client safety & well-being
How to draw up medication from a vial
-Remove cap - If already used wipe surface with alcohol swab and allow it to dry -Take cap off needle and draw back equal to the desired amount of medication - check to see if you need to use filter needle. -With vial on flat surface insert tip of needle through center of rubber seal -Inject air -Invert vial while holding syringe and plunger; Withdraw medication (keep tip of needle in fluid). -Allow air pressure to gradually fill syringe. -When desired volume is obtained. Move needle in vial's air space and tap any bubble out and eject any remaining air. -Remove needle (or needleless vial access device) -Hold syringe at eye level, at 90 degree angle to ensure correct volume w/ no bubbles -If bubbles persist, tap barrel then draw back slightly, then push forward expelling bubbles but no fluid - recheck volume. -If using a powdered medication: inject diluent into vial and then roll in palms to mix - continue as liquid medication
Five rights of delegation
-Right direction/communication -Right supervision -Right circumstances -Right task -Right person
What personal factors aided Florence Nightingale to be considered the founder of nursing?
-She went against her parents wishes and decided to go to college -In her work, she writes about health, illness, and the nurse's role in caring for patients -She focused on the relationship between patients and their environment -She also focused on the little things for patients- clean bed, water and food, sunlight, etc.
SLU Conceptual Framework: Health
-State of complete physical, mental and social well-being -Dynamic state of being that fluctuates along a continuum from high level wellness to death. -Absence of illness -Can be stable or fluctuating -Internal variables -Genetic influences -Health habits -Age/ Developmental state -Emotional factors -Spiritual factors -External factors: Family variables, Socioeconomic factors, Cultural background -Client strives for integrity
National Institute of Nursing Research (NINR)
-Support basic, clinical, and translational research to build scientific foundation for clinical practice -Prevent disease and disability -Manage and eliminate symptoms caused by illness -Enhance palliative and end-of-life care -Train the next generation of scientists (NINR, 2015)
What is the difference between a suture and a staple
-Sutures are threads of wire or other materials used to sew body tissues together. They are available in different sizes and may be absorbent or nonabsorbent. They are placed within tissue layers in deep wounds and superficially as the final means for wound closure. -Staples are stainless-steel wire. The location of the incision sometimes restricts their use because there must be adequate distance between the skin and structures that lie below the skin, including bone and vascular structures. The cosmetic result is not always as desirable as that obtained with finer suture material. Staples do provide ample strength. Removal requires a sterile staple extractor and aseptic technique.
Implementation
-The RN implements the identified plan. -Coordination of care, health teaching & health promotion
Factors that Influence Decision Making in Nursing
-The nature of nursing practice -The health care system -The patient -Legal and ethical principles
Restraint or seclusion
-The patient has the right to be free from physical or mental abuse and corporal punishment. -The patient has the right to be free from restraints or seclusion of any form that is not medically necessary or is used by staff as a means of coercion, discipline, convenience, or retaliation. A restraint is any manual method or physical or mechanical device, material, or equipment attached or adjacent to the patient's body that he or she cannot easily remove that restricts freedom of movement or normal access to one's body. A drug used as a restraint is a medication used to control behavior or to restrict the patient's freedom of movement and is not a standard treatment for the patient's medical or psychiatric condition. Seclusion is the involuntary confinement of a patient alone to a room or area from which the patient is physically prevented from leaving. -A restraint or seclusion can be used only if needed to improve the patient's well-being and if less restrictive interventions have been determined to be ineffective. -Use of a restraint or seclusion must be selected only when other less restrictive measures have been found to be ineffective to protect the patient or others from harm and in accordance with the order of a physician or other licensed independent practitioner. -This order must never be written as a standing order or on an as-needed basis (i.e., prn). The order must be followed by consultation with the patient's treating physician as soon as possible, if someone other than the patient's treating physician or health care provider ordered the restraint or seclusion. Use of a restraint or seclusion must be: -In accordance with a written modification to the patient's plan of care. -Implemented in the least restrictive manner possible. -In accordance with safe and appropriate restraining techniques. -Ended at the earliest possible time. -The condition of the restrained or secluded patient must be assessed, monitored, and reevaluated continually. -All staff who have direct patient contact must have ongoing education and training in the proper and safe use of restraints and seclusion.
Exercise of rights
-The patient has the right to participate in the development and implementation of his or her plan of care. -The patient or his or her representative has the right to make informed decisions regarding his or her care. -The patient's rights include being informed of his or her health status, involved in care planning and treatment, and able to request or refuse treatment. This right must not be construed as a mechanism to demand the provision of treatment or services deemed medically unnecessary or inappropriate -The patient has the right to formulate advance directives and to have hospital staff and practitioners who provide care in the hospital comply with these directives. -The patient has the right to have a family member or representative of his or her choice and his or her own health care provider notified promptly of his or her admission to the hospital.
Privacy and safety
-The patient has the right to personal privacy. -The patient has the right to receive care in a safe setting. -The patient has the right to be free from all forms of abuse or harassment.
Confidentiality of patient record
-The patient has the right to the confidentiality of his or her clinical records. -The patient has the right to access within a reasonable time frame information contained in his or her clinical records.
Peak Flowmeter
-The peak expiratory flow rate (PEFR) measurement is the maximum flow that a patient forces out during one quick, forced expiration, measured in liters -Use these measurements as an objective indicator of a patient's current status or the effectiveness of treatment. -Normal peak expiratory flow rate (PEFR) values vary according to a person's age, gender, and size. -Decreased PEFR may indicate the need for further interventions such as increased doses of bronchodilators or anti-inflammatory medications. -Patients with asthma perform PEFR measures in the home to monitor the status of their airways. -Health care providers usually recommend that patients measure their PEFR during the following times: every morning, before taking asthma medicines, during asthma symptoms or an asthma attack, after taking medicine for an asthma attack, and at other times recommended by their health care provider. *Pt's with asthma should measure PERF at the same time each day -Green indicates 80-100%, Yellow indicates 50-90%, Red indicates < 50%
What is an appropriate delegation?
-The transfer of responsibility for the performance of a task from one individual to another while retaining accountability and authority for the outcome -The individual receiving the assignment is responsible for the performance of the task The individual delegating the task retains accountability for the outcome.
Research builds nursing knowledge but it can be expensive
-To receive funding, nurses must do research that interests others, has demonstrated significance, and has support from reviewers. -Research that is not based on or is not related to previous work may have inadvertent violations of human participants' rights. -Institutional review board (IRB) approval
Intradermal injection rules
-Tuberculin (TB) syringe -25-27 gauge -1/8 to 5/8 inch in length -Insert at 5-15 degrees -Small amounts 0.01-0.1mL in adults
how to check for right time
-Understand the difference between every x-amount of hours and x-amount of times a day -STAT medications are to be given immediately -you have 30 minutes before and after a prescribed time to administer time CRUCIAL medication -you have 1-2 hours before the scheduled time with NON-CRUCIAL medications -ALWAYS use your clinical judgement for as needed medications
Health care workers with chipped nail polish or long or artificial nails have high numbers of bacteria on their fingertips; therefore the CDC recommends:
-Using only neutral colored, nonchip polish. -Wearing gloves over artificial nails. -Keeping natural nails less than ¼ inch long. -Allowing extra time for hand washing to scrub nails.
PRN medications
-a medication ordered to be given ONLY when the patient requests it -usually has a minimum interval set for the time of administration (always use clinical judgement)
resilience
-adapt successfully despite challenges or threats to their way of life or routines -children tend to have a lot of resilience
when should you release the tourniquet?
-after advancing the catheter and before attaching the saline lock
Intradermal uses/reactions
-allergy tests -tb skin tests If a bleb does not appear, or if the site bleeds after needle withdrawal, the medication may have entered subcutaneous tissues. In this situation skin test results will not be valid.
How to check for right drug
-an order is REQUIRED before admission of a drug -compare prescriber's order with the MAR when new MARs are written or when patients transfer from one unit or one health care setting to another -compare the label on the medication with the MAR 3 TIMES: *When removing the medication from the supply drawer *When placing the medication in the cup or syringe *Before administering the medication to the patient
while performing the venipuncture, what should you remember to do?
-anchor the vein w/o touching cleansed site -inserts ONC with bevel up at 10-30 degree angle directly parallel to the vein
s/s of acute hypoxia
-anxiety, behavior changes -increased pulse rate -dizziness -fatigue -dyspnea -pulse ox less than 90% -decreased lung sounds -pallor, cyanotic
INS standards for reducing intravascular infections
-assess the site for redness, tenderness, swelling, drainage through dressing (at least every 4 hours) -change dressing immediately to assess, clean, and disinfect the site of drainage -perform hand hygiene -perform dressing changes frequently based on the catheter and dressing Short-peripheral catheters: change if dressing is damp, loose, visibly soiled, blood, or at least every 5-7 days CVAD: at least every 5-7 days for TMS dressing at at least every 2 days for gauze dressing that covers catheter -use appropriate antiseptic techniques before venipuncture and when performing skin antisepsis -allowing skin antiseptic to fully dry before dressing placement -using catheter stabilization device -using vigorous scrubbing mechanisms when disinfecting -change needless connectors ever 96 hours -change admin sets
spirituality
-belief in a higher power, interconnectedness among living beings, and an awareness of life's purpose and meaning -differs from religion in that religion is a codified ay of organizing rituals and spirituality is a larger concept
Standing medication
-carry out until the health care provider cancels it by another order or until a prescribed number of days elapse. indicates a final day or number of doses (Policies for abrupt discontinue)
What do you document after trach suctioning and care?
-characteristics of secretions, trach size, pt tolerance, respiratory findings, appearance of stoma and skin,
acute illness
-characterized by severe symptoms that are relatively short-lived -symptoms appear suddenly, progress steadily, and subside quickly
Oxygen hoods
-commonly used in pediatric setting for children with airway inflammation, croup, or respiratory tract infections or people with head trauma -give high concentrations of humidified O2
Ampule
-contain single doss of injectables of medication in liquid form -available in sizes 1-10mL or more -made out of glass with constricted, prescored neck (a color ring around the neck indicates where it has been prescored) -aspirate with a filter needle to avoid glass breakage in syringe -DO NOT use the filter needle to administer the medication
indications for cuff inflation
-continuous positive airway pressure -PEEP -inability to meet vent or O2 requirements with cuff down -feeding tube -GERD -hernia -during/after meals -impaired swallowing
Suture removal rules
-cut as close to the skin as possible AWAY from the knot -never pull exposed surface of suture below the epidermis -never snip both ends of the suture
What are the state nurse practice acts?
-defined as the scope of practice in each state -protected by the public -law that regulates the practice of nursing: to have a nursing licensure and pass the NCLEX-RN exam in order to practice. (RN, LPN, APN) -establishes the Alabama Board of Nursing (ABON) and gives the board authority over nursing practice. They have the right to give and take away nursing liscense
What are internal influences on illness behavior?
-dependence/independence needs -coping ability -hardiness -learned resourcefulness -resilience -spirituality
chronic illness
-develops gradually, requires ongoing medical attention -may continue for the duration of the individual's life
Problems associated with CPAP and BiPAP
-discomfort, psychological, risks to skin integrity, hypercapnia, gastric distention, noise
ways to prevent needlestick injuries
-dispose into sharps container -do not recap -immediately dispose of needles -maintain sharps log -attend educational offerings about bloodborne pathogens and follow recommendations
Tablets you should avoid crushing
-do not crush enteric coated tablets -do not crush long-acting tablets -do not open sealed capsules -do not crush contents of capsules -do not crush sublingual medications (SL) medications can be given if the patient is (NPO)
What are the rules about trach ties?
-do not remove the old ties until the new ties are in place -make sure it fits 1 finger loosely or 2 fingers tightly to avoid cutting off the carotid artery -double knot
How do you correctly document medicine administration?
-document administration of medications as soon as they are given but NEVER before -document patients response (ex. pain scale) -orders MUST include: *patients name *date of the order *name of medication *medication dosage *route *frequency
Subcutaneous injection sites
-dorso-lateral: 3 finger widths above elbow (acromion process something like that lol) -abdominal: 2 inches around belly button, don't go higher than the coastal margins, don't go below pelvis, don't go past anther posterior iliac spine -anterior thigh: (same as vastus laterals)
drug dependence
-drug dependence can be physical or psychological. -psychological dependence is exhibited by patients having an emotional desire for a drug to maintain an effect. Physical dependence is a physiological adaptation to a medication that manifests itself by an intense physical disturbance when the medication is withdrawn
ET tube
-endotracheal tubes inserted into the nares(nasotracheal) or mouth (most common-oral ET) -cuff inflated to prevent dislodging
Stereotypes are based on..
-ethnicity -gender -nationality -political affiliation
Airborne Precautions
-examples are pt's with chicken pox and TB -require negative pressure rooms -required to wear a mask that filters small particles
Droplet precautions
-examples are pt's with diphtheria, pneumonia, mumps, pertussis -private room or cohort pt's -mask required within 3 ft of contact with pt and during transport
What are professional characteristics?
-extensive education -theoretical body of knowledge -specific service -autonomy in decision making -code of ethics
how do you prevent medical errors?
-follow the six rights of medication administration. -only prepare medications for one patient at a time. -be sure to read labels at least 3 times (comparing MAR with label): When removing medication from storage, before taking to patient's room, before giving medication. -use at least two patient identifiers every time you administer medications (e.g., patient name, birthday, hospital number) whenever administering a medication. -do not allow any other activity to interrupt administration of medication to a patient (e.g., phone call, pager, discussion with other staff). -double-check all calculations and other high-risk medication administration processes (e.g., patient-controlled analgesia) and verify with another nurse. -do not interpret illegible handwriting; clarify with the health care provider. -question unusually large or small doses. -document all medications as soon as they are given. -when you have made or discovered an error, reflect on what went wrong and ask how you could have prevented it. Complete an occurrence report per agency policy. -evaluate the context or situation in which a medication error occurred. This helps to determine if nurses have the necessary resources for safe medication administration. -when repeated medication errors occur within a work area, identify and analyze the factors that may have caused the errors and take corrective action. -when repeated medication errors occur within a work area, identify and analyze the factors that may have caused the errors and take corrective action. -attend in-service programs on the medications you commonly administer. -ensure that you are well rested when caring for patients. Nurses make more errors when they are tired (Murphy and While, 2012). -involve and educate patients when administering medications. Address patients' concerns about medications before administering them (e.g., concerns about their appearance or side effects). -follow established agency policies and procedures when using technology to administer medications (e.g., automated medication dispensing system [AMDS] and bar-code scanning).
signs of a UTI
-frequency -pain with urination -odor urine cloudy urine
Intramuscular needle/syringe rules
-generally use a 3mL syringe -20-25g for aqueous solutions -18-21g for viscous solutions -insert at a 90 degree angle, stretching the skin -1mL-3mL volume most common -give deep in muscle -***ASPIRATE for blood before administering EXCEPT for vaccines (CDC)*** -inject slowly -Z-track technique
rules for insulin
-gently roll all cloudy insulin preparations in palms of hands -always draw the fast acting insulin first so it doesn't contaminate with the longer lasting insulins' -NEVER mix insulin glargine (Lantus) or insulin detemir (Levemir) with any other types of insulin.
Hydrogel dressing
-glycerin or water based -promotes moist wound healing and autolysis -nonadherent with absorptive properties (less painful to remove) -cooling/soothing properties
Care bundle for ventilator-associated pneumonia
-good hand hygiene -head of bed at 30-45 degrees -prophylaxis for deep vein thrombosis -oral care with chlorohexidine every 12 hours and general care every 2 hours -complete subglottal suctioning to decrease secretions -provide motility through turning and repositioning every 2 hours
The key components to central line bundle
-hand hygiene -maximal sterile barrier precautions with insertion -chlorhexidine gluconate skin asepsis -optimal catheter site selection avoiding the femeral artery -necessary of daily review of the condition
Ventri mask
-high flow -24-50% -good for COPD pt's Advantages: -provides specific amount of O2 with humidity added -administers low, constant Disadvantages: may irritate skin -cant use when eating
high flow nasal cannula
-high flow -adjustable FiO2 and flow up to 60 L/ml Advantage: can be used on children and adults Disadvantage: risk for infection -used in neonates alot and adults with acute respiratory failure
Common risk factors that include conditions that influence virchow's triad
-hyper-coagulability -venous wall abnormalities -blood flow stasis (all these contribute to developing a DVT)
People on mechanical ventilators report
-impaired body image -fear caused by loss of control -disconnection from reality
What type of pt's are more susceptible to acquiring a pressure injury?
-incontinent -immobile -pt's with loss of sensory and perception -pt's who are malnourished -anemia -age -heavy sedation and anesthesia -fever -circulatory changes -dehydration -hx of pressure ulcers
Unexpected outcomes: pt experiences skin irritation
-increase humidification -provide skin care. ***do not use petroleum based gel around oxygen because it is falmmable***
Intradermal sites
-inner forearm and upper back are ideal locations -since a lot of these medications are potent, you inject them into the dermis (where blood supply is reduced and drug absorption occurs slowly)
Safety guidlines regarding oxygen therapy
-know the patients normal vital signs and pulse ox -document if a pt smokes -know a patients hemoglobin value and past current arterial blood gas -have suction equipment ready -keep oxygen delivery systems 5 feet away from any heat source -oxygen supports combustion but it WONT explode -avoid using items that can spark -reminder that oxygen is a medication
partial non rebreather (also called mask with reservoir bag)
-low flow ***bag should always remain partially inflated to avoid the patient breathing in CO2)*** -10-15 L/min: 60-90% Advantages: -used short term -delivers increased FiO2 -easily dehumidifies O2 -doesn't dry mucus membranes Disadvantages: -hot and confining -causes skin irritation -interferes with eating -bag may twist or deflate
toxic effects
-medication accumulates in the blood because of impaired metabolism or excretion or when too high of a dose of medication is given -excess medication can have lethal effects to your patient. Many drugs have antidotes to treat toxicity.
medication tolerance
-medication tolerance is a decreased physiological response that occurs after repeated administration of a medication -usually noted when patients take the same medication for long periods of time and require higher doses to produce the desired therapeutic effect. It sometimes takes months for tolerance to occur
z-track method
-minimize local skin irritation by sealing off medication in muscle tissue -give medication deep into muscle -pull skin 1-1/2 inches laterally -holding skin, insert needle and inject slowly -leave in place for 10 seconds -withdraw needle and release skin
depression and grief
-most common mood disorder that occurs with illness -ability to work is altered, daily activities modified, sense of well-being and freedom from pain lost
Low flow devices
-nasal cannula -simple face mask -nonrebreather/partial nonrebreather
Benefits of having a TT over an ET
-need for deeper sedation -shorter ventilation weaning time -shorter ICU hospital stay
CVAD devices
-nontunneled: days to several weeks, located in subclavical or jugular veins,not surgically placed its done at the bedside held in place with sutures -external tunneled: considered permanent, chest region, surgery required held in place by a dacron cuff coated in antimicrobial solution, 2-3 weeks scar tissue forms -implanted venous ports: considered permanent, in chest abdomen, forearm, requires surgery and attatched to a reservoir located within the subcutaneous pocket, access needle through skin -PICC: lasts as long as they can until complications occur, inserted in anticubital fossa until reaches the Vena Cava. not surgically placed done at bedside, held in place with sutures and engineering devices
What contributes to a nurse making an administration of medicine error
-nurses not familiar with medication -failure to recheck medication BEFORE administration -workload -miscommunication about VERBAL orders -clinician miscommunication -distraction!
medication interactions
-occurs when a medication modifies the action of another medication. Medication interactions may result in an increase of decrease in the therapeutic effect of each medication -common problem with older adults who take a variety of medications and who have multiple physicians.
Idiosyncratic effect
-occurs when patients overreact or underreact to a medication or have reactions different from normal. -Predicting idiosyncratic reactions is impossible. The example in the book describes giving Ativan (anti-anxiety drug) to an elderly adult causing agitation and delirium.
How does the TJC require a nurse to take orders?
-only authorized staff receive and record verbal or telephone orders -READ BACK ALL ORDERS to health care provider -write "vo" indication verbal order and "to" for telephone order including the date, time, name of pt, complete order, and signature of nurse and heath care provider -health care provider co signs within 24 hours -follow agency policies ***-nursing students MAY NOT receive verbal or phone orders***
absorption
-passage of medication molecules into the blood from the site of administration -administration route, blood flow to administration site, body surface area, and lipid solubility of a medication
What are external influences on illness behavior?
-past experiences -culture -communication patterns -personal space norms -role expectations -values -reaction to prescribed medications -ethnocentrism
acceptance and participation
-patient has acknowledged reality of illness and amy be ready to participate in decisions about treatment
irritability and anger
-patient may get irritable as ability to function declines, may lead to depression -anger may be directed at specific people or general
pediatric considerations for IV therapy
-perform venipuncture somewhere other than in their room -use four scalp veins or in a baby the foot -smallest gauge possible
attempting to gain control
-person may consult health care provider or use over the counter medications, folk practices, or home remedies -aware they are ill and express some concern or fear about the outcome
List of "never events"
-pressure ulcers/ bedsores -falls -medication errors -CAUTI's -retained objects -VAP
ways to prevent infection during insertion of a needle
-prevent contaminating the solution and needle -prepare skin -reduce the transfer of organisms
distributive
-process of transporting a drug to the site of action (most medications bind to albumin for transport) -circulation, cell membrane permeability, and protein binding
Alginate dressing
-promotes autolysis, granulation, epithelization -calcium alginate material (seaweed) -form a get over wound to contain exudate -You can safely pack deep tracking wounds with calcium-sodium alginate preparation, which allows easy removal with little risk for retained dressing deep in the wound cavity.
IV check off
-review check off-
med admin checkoff
-review check off-
Trach Suctioning and care checkoff
-review checkoff-
Six patient rights for administering medication
-right patient -right drug -right dose -right route -right time -right documentation
What do you teach the pt about an IV?
-s/s of phlebitis, inflammation, infiltration -if fluid slows down or stops running or if they see blood in the tubing -protect IV when showering or moving
After donning PPE when performing trach suctioning, what would you asses for?
-signs of upper and lower airway obstruction (adventitious lung sounds, crackles, non productive cough, drooling, restlessness, vomitious in the mouth -signs and symptoms of hypoxia or hypercapnia (increased HR and BP, decrease pulse ox, confusion, lethargy, decrease LOC, lack of concentration etc...)
Vial
-single OR multi-use -plastic OR glass with a rubber seal on top -after opening a single dose vial, discard it -once multi-use vial is used on a patient, it must remain being used ONLY ON THAT SAME PATIENT -when using multi-vial, write the date of use and dose on label -verify how long an open multi-use vial can be used -if vial has 2 chambers, push on the upper chamber to mix
principles for fostering venous distention
-stoke vein from distal to proximal -apply warmth to vasodilate -place extremity in dependent position
Developing trust
-straight forward, non defensive manner -follow through on promises -withhold judgments about patents and their situations -listen carefully to your own responses -congruence (equal) between verbal and nonverbal communication
how to check for right route
-the prescriber's order MUST designate route of administration -if route isn't specified, consult with the prescriber immediately -you may use your clinic judgement to recommend a route; however, you may not change the route on your own
therapeutic range
-the range of drug dosages which can treat disease effectively without having toxic effects -allows you to provide patient teaching and accurately evaluate desired effects
allergic reaction
-unpredictable responses to medications. Allergic responses range from mild to severe. -Mild allergic symptoms (urticaria or hives, eczema or rash, pruritis (itching) and rhinitis (runny nose). Severe or anaphylactic reactions are: sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, severe wheezing and shortness of breath. Anaphylaxis is potentially fatal.
principles for selecting a vein
-use most distal site -nondominant arm if possible -select large, soft, spongy/bouncy vein -Avoid: areas with pain, infection, or wound -Avoid: arm with paralysis (previous CVA), mastectomy, or dialysis graft -Avoid flexion sites: antecubital and wrist -Avoid: bruised areas, hardened veins, or areas with viable venous valves
geriatric considerations for IV therapy
-use smallest gauge possible -avoid the back of the hand or dominant arm
Intramuscular injection sites
-ventrogluteal: heel of hand on the greater trochanter, thumb towards the pelvis/pubic area, pointer finger on the anterior superior iliac spine, middle finger on iliac crest. (1 ½ adult, ½ to 1 inch child) -deltoid: 3 finger widths below the acromion process which is 2.5-5 cm (1-2 inches) below (1-1 ½ adult, ½ to 1 inch child) -vastas lateralis: 3 finger widths above knee, 3 finger widths below the greater trochanter (5/8 to 1 inch adult, 5/8 to 1 inch child) -dorsogluteal: NOT RECOMMENDED to avoid hitting sciatic nerve
How many inches above insertion site should pressure be applied?
1 1/4 inch (3 cm)
If you are unsterile, what is the only place of a sterile field you can touch?
1 inch border
Clara Barton
1. "Angel of the Battlefield" 2. Founded the American Red Cross 3. Traveled to Virginia, at the scene of the battlefield set up a makeshift field hospital (cared for the wounded & dying) 4. Campaign to provide relief for the soldiers.
What are the 6 steps of EBP?
1. Ask a clinical question 2. Collect the most-relevant and best evidence 3. Critically appraise the evidence you gather 4. Apply or integrate evidence along with your clinical expertise, patient preferences, and values in making a practice decision or change 5. Evaluate the practice decision or change 6. Communicate your results
According to Jean Watson what are the top Ten derived from Nursing Literature?
1. Attentive 2. Listening 3. Comforting 4. Honesty 5. Patience 6. Responsibility 7. Providing information so patients can make an informed decision 8. Touch 9. Sensitivity 10. Great responsibility to mold our children into responsible adults
3 Levels of Critical Thinking
1. Basic critical thinking 2. Complex critical thinking 3. Commitment
First 3 American Training Schools for Nurses
1. Bellevue Training School for Nurses in New York City 2. Connecticut Training School for Nurses in New Haven 3. Boston Training School for Nurses at Massachusetts General Hospital in Boston
14 Activities for Client Assistance The nurse's role is to assist sick or healthy individuals in meeting these basic needs:
1. Breathe normally. 2. Eat and drink adequately. 3. Eliminate body wastes. 4. Move and maintain desirable postures. 5. Sleep and rest. 6. Select suitable clothes-dress and undress. 7. Maintain body temperature within normal range by adjusting clothing and modifying environment. 8. Keep the body clean and well groomed and protect the integument. 9. Avoid dangers in the environment and avoid injuring others. 10. Communicate with others in expressing emotions, needs, fears, or opinions. 11. Worship according to one's faith. 12. Work in such a way that there is a sense of accomplishment. 13. Play or participate in various forms of recreation. 14. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.
Three Steps in Valuing
1. Choosing is the cognitive (intellectual) aspect of valuing. 2. Prizing is the affective (emotional) aspect of valuing. 3. Acting is the kinesthetic (behavioral) aspect of valuing.
4 Elements of Malpractice
1. Duty to Act 2. Breech of Duty 3. Cause and Effect 4. Harm Occurred
Jean Watson 10 Carative Factors
1. Humanistic-altruistic system of values 2. Faith-Hope 3. Sensitivity to self and others 4. Developing helping-trusting, caring relationship 5. Expressing positive and negative feelings and emotions 6. Creative, individualized, problem-solving caring process 7. Transpersonal teaching-learning 8. Supportive, protective, and/or corrective, mental, physical, societal, and spiritual environment 9. Human needs assistance 10. Existential phenomenological and spiritual forces
Steps in Research Process
1. Identification of a re-searchable problem 2. Review of the literature 3. Formulation of the research question or hypothesis 4. Design of the study 5. Implementation of the study 6. Drawing conclusions based on findings 7. Discussion and/or clinical implications 8. Dissemination of findings
A few examples of changes in nursing practice stimulated by research include the following:
1. Improved care of patients with skin breakdown from pressure ulcers 2. Decreasing light and noise in critical care units to prevent sleep deprivation 3. Using caps on newborns to decrease heat loss and stabilize body temperature 4. Positioning patients after chest surgery to facilitate respiration 5. Scheduling pain medication more frequently after surgery 6. Preoperative teaching to facilitate postoperative recovery
What are the attributes of interpretivist perspective (clinical Judgment)?
1. Involves a holistic view of the patient situation 2. Is a process orientation (circular process) 3. Requires reasoning and the interpretation of data
Components of Critical Thinking
1. Knowledge 2. Experience 3. Competencies 4. Attitudes 5. Standards
Dorothea L. Dix
1. Long time advocate for the mentally ill 2. Superintendent of Women Nurses of the Union Army
Patients rights provided for by CMS
1. Notice of rights 2. Exercise of rights 3. Privacy and Safety 4. Confidentiality of pt record 5. Restraint or seclusion
Clinical Judgment Process
1. Noticing 2. Interpreting 3. Responding 4. Reflecting
Benners Stages of Nursing Proficiency
1. Novice 2. Advanced beginner period 3. Competent Practitioner 4. Proficient Practitioner 5. Expert Practitioner
Florence Nighingale
1. Organizing & Cleaning the hospital & providing care for the wounded British soldiers in Turkey during the Crimean War. 2. Founded the first training school for Nurses at St. Thomas Hospital in London (1860) 3. Famous Publication: Notes on Nursing; What It Is and What It Is Not. (Mastering a unique body of knowledge was required of those wishing to practice professional nursing)
What are the basic concepts of nursing?
1. Person -An open system with human needs -Each person is unique with varying social, cultural backgrounds -Motivated by needs Influenced by genetics and the environment 2. Health -It is a continuum that varies on a day-to-day basis depending on changing factors and influences -It is dynamic and holistic (interrelationship of all parts that make up a whole person) -Affected by health beliefs and behaviors -Healthy people 2020 focuses on increasing the quality of health and increasing life span 3. Environment -Circumstances, influences, and conditions that surround and affect individuals, communities, and families -Can be either physical (water and air) or nonphysical (family, culture, social structures) -Can be either small (individual) or large (the universe) -Environment can either promote or interfere with homeostasis
Watson's carative factors include all the following
1. Practicing loving-kindness and equanimity within context of caring consciousness. 2. Being authentically present and enabling, and sustaining the deep belief system and subjective life world of self and one-being cared for. 3. Cultivating one's own spiritual practices and transpersonal self, going beyond ego self. 4. Developing and sustaining a helping-trusting, authentic caring relationship. 5. Being present to, and supportive of the expression of positive and negative feelings. 6. Creatively using self and all ways of knowing as part of the caring process; engaging in artistry of caring-healing practices. 7. Engaging in genuine teaching-learning experience that attends to wholeness and meaning, attempting to stay within other's frame of reference. 8. Creating healing environment at all levels, whereby wholeness, beauty, comfort, dignity, and peace are potentiated. 9. Assisting with basic needs, with an intentional caring consciousness, administering 'human care essentials,' which potentiate alignment of mind-body-spirit, wholeness in all aspects of care. 10. Opening and attending to mysterious dimensions of one's life-death; soul care for self and the one-being-cared for; "allowing and being open to miracles."
Name the 2 Major focuses for nurses regarding Legal implications.
1. Protect your clients' rights 2. Protect yourself from legal liability
Mary Ann "Mother" Bickerdyke
1. Sent to Western front to investigate the situation in the hospital camp at Cairo Illinois, found appalling conditions
Clinical Judgment - Scope
1. Standards - Based approach 2. Evidence - Based practice 3. Interpretivist perspective
Sallie Thompkins
1. Superintendent of Hospital 2. Established a private hospital in Richmond Virginia, commissioned a "Captain of Cavalry, unassigned" by Confederate President Jefferson Davis 3. Only woman in the Confederacy to hold military rank
What are the 5 ways to protect yourself legally when you are a nurse
1. Understand the state's laws impacting nursing practice. 2. Follow the rules and regulations in your stat's nurse practice act. 3. Deliver safe, competent nursing care. 4. Develop and use critical thinking skills. 5. Education.
The commonly used OTN catheter includes
1. a metal sylet to pierce the skin 2. a catheter made of silicon, polyurethane, ploy chloride, teflon that remains in vein
Conflict resolution skills:
1. acknowledge conflict 2. Recognize and affirm task issues while redirecting 3. Facilitate debate over task issues 4. Promote expression 5. Explore alternative positions 6. Willing to change your position on an issue 7. Share power 8. Stay focused
how did she reform the Britain Army?
1. asked why soldiers were dying 2. realized a clean environment was better
Generations in nursing:
1. baby boomers 2. Generation X 3. Generation Y (millenials) 4. Net generation (digital age)
what does the affordable care act (ACA) provide?
1. bans lifetime coverage limits for extreme conditions 2. young adult coverage up to age 26 3. cannot prevent coverage to children under 19 w preexisting conditions 4. coverage of preventative services 5. right to appeal coverage decisions 6. choice of primary care providers
what were the 6 points the flexner report made?
1. basically intellectual 2. based on body of knowledge that is learned/refined through research 3. practical and theoretical 4. taught through professional education 5. well developed group consciousness 6. practitioners are motivated by altruism
what were requirements for early nursing school applicants based on?
1. be female 2. good breeding 3. submission to authority 4. sensitive 5. intelligence
what were the first 3 nursing training schools?
1. bellevue training school for nurses (NY) 2. Connecticut training school for nurses 3. boston training school for nurses
what are these 8 spokes?
1. competence and continuing education 2. adherence to code of ethics 3. participation in professional organizations 4. publication and communication 5. orientation toward community services 6. theory and research development & utilization 7. self regulation and autonomy
what are 2 internal conflicts that serve as barriers to professionalism in nursing?
1. differences in education levels 2. proliferation of organizations that compete for nurses' membership
who were nursing leaders that emerged during the american civil war?
1. dorothea dix 2. sojourner truth 3. harriet tubman 4. mary ann "mother" bickerdyke 5. clara barton 6. phoebe pember
what are the 4 types of technological developments we've seen?
1. genetics 2. biomedical 3. information 4. knowledge
how have genetics seen technological developments?
1. genomics 2. pharmacogenetics
Full attention guidelines:
1. give your full attention 2. interrupted by a call that you must take them you must go into the hall 3. adopt a courteous tone in email and voicemail messages regardless of how rushed you are ** dont resort to :).... reword your letter/ email 4. avoid use of jargon 5. keep messages short 6. when leaving # in voicemail, make sure to enunciate 7. when receiving a message... read, listen and evaluate the entire message before reacting
Bacas 5 ways in which self-disclosure becomes problematic
1. if the nurse problems or needs becomes problematic 2. if disclosure by the nurse becomes a common, rather than rare, event during interactions with a patient 3. when the discloser is unrelated to the patients problems or experiences 4. if it takes more than a very short time during an interaction 5. the nurse discloses personal info even if its clear that the patient is confused by the interactions
what nursing leaders emerged during the chicago world's fair
1. isabel hampton robb 2. lavinia lloyd dock 3. bedford fenwick 4. florence nightingale
Swanson's 5 caring processes germane to nursing practice:
1. knowing 2. being with 3. doing for 4. enabling 5. maintain belief
who was harriet tubman?
1. leader of underground railroad 2. acted as a nurse
what are 3 external conflicts that serve as barriers to professionalism in nursing?
1. nurses can now provide services that were formerly part of medical practice by physicians 2. legal scope of nursing is protected through lobbying and legislation 3. nurses have to strive for cooperation with other medical disciplines
Three therapeutic nurse patient relationship
1. orientation 2. working 3. termination
why is there a frequent nursing shortage?
1. people leave nursing because they aren't satisfied 2. not good hours 3. *not enough $*
what does a profession consist of?
1. prolonged education 2. work involves mental creativity 3. values and beliefs are important 4. workers are autonomous 5. unlikely to change profession
Key component for effective interprofessional collaboration
1. respect for other collaborators 2. confidence in own knowledge 3. willingness to learn 4. cooperative spirit 5. Belief in common purpose 6. Value contributions 7. Willingness to negotiate 8. Excellent communication skills 9. Self-awareness 10. Tolerance of differing opinions 11. Not threatened by conflict 12. Knowledge of ones own limits
what does collegiality include?
1. supportive and healthy work environments 2. cooperation 3. recognition of interdependence among members of the nursing profession
Principles for determining professional boundaries
1. the nurse is responsible for maintain and coming up with boundaries 2. the nurse should work within the zone of helpfulness 3. the nurse should examine any boundary crossing 4. care setting, community influences, client needs, and the nature of therapy affect the delineation of the boundaries 5. actions that overstep established boundaries to meet the needs of the nurse are violating 6. the nurse should avoid dual relationships 7. posttermination relationships are complex because the client may need additional services
Tasks of the orientation phase
1. the patient will have developed enough trust in the nurse to continue to participate in the relationship 2. the patient and nurse will see each other as individuals 3. the patents perception of major problems and needs will have been identified 4. approximate length of the relationship will have been estimated and the nurse and patient work together
what does an occupation consist of?
1. training on job 2. manual labor 3. decisions guided by trial and error 4. workers are supervised 5. material reward is the main source of motivation
who was dorothea dix?
1. union superintendent of women nurses 2. champion for mental health
what did richard hall's 5 points include?
1. use of profession organization as a primary point of reference 2. belief in the value of public service 3. belief in self-regulation 4. commitment to a profession that goes beyond economic incentives 5. sense of autonomy in practice
what are the 8 characteristics of the nursing profession?
1. vital to humanity and welfare of society 2. special body of knowledge enlarges over time 3. services involve intellectual activities 4. education in institutions of higher learning 5. practitioners relatively independent 6. motivated by service and importance of work 7. code of ethics to guide practice 8. organization supports high practice standards
After venipuncture when you observe for blood return, how far do you advance the needle?
1/8-1/4 inch
US census bureau estimates more than ___% people living in US are foreign more
11%
Recommendations for short peripheral catheter selection
14, 16, 18 gauge: used in trauma, surgery, rapid blood transfusions, rapid fluid replacement 20 gauge: continuous or intermittent infusions in adults, blood transfusions 22-24gauge: continuous or intermittent infusions in adults, neonates,elderly; admision of blood or blood product in adults, children, elderly
How long should you lather and apply friction to your hands for when washing hands?
15 seconds
How long should it take to withdraw the catheter after intermittent suctioning?
15 seconds rotating it back and forth and encouraging pt to cough
in what year did the American Nurses Association form?
1896
in what year was the International Council of Nurses (ICN) formed?
1899
when did standardization of nursing through licensure begin?
1903
in what year was the National Association for Colored Graduate Nurses formed?
1908
in what year were african american students admitted into he ANA?
1916
Total patient care
1:1 ratio nurse:patient. One nurse providing the majority of the care of the patient. One person guides and manages care (provides continuity).
When introducing a cleaning solution to irrigate a wound using a syringe or catheter, how far away should the tip be from the wound?
2.5cm (1 inch)
Graduate Education Era
21 nursing doctoral programs existed in 1970
How much soap should be applied when washing hands?
3-5ml
A nurse compares patient compliance after an interactive video instruction compared to usual verbal instructions among patients with a new diagnosis of diabetes mellitus. The study design most likely describes:
3. Modified experimental studies are designed to avoid unethical and inappropriate denial of care. In this case, the nurse provides appropriate teaching to the patients. It however, compares two different strategies to conduct patient teaching.
When should you apply an anesthetic when inserting an IV?
30 min before
What percentage of medication errors are related to administration?
37%
NLNAC "National League for Nursing Accreditation Commission"
4 councils of ADN, Diploma, BSN, & MSN/Doctoral programs.
How often do you perform mouth care on a pt with mechanical vent?
4 times a day use with toothbrush with chlorehexidine twice daily
How far above the select in site should you apply the tourniquet?
4-6 inches above site
How often do you hyperventilate the pt white performing trach care?
5-6 breaths over 30 seconds
What is the range recommended time to be intubated?
7-10 days to as long as 21 days
the nursing code of ethics consists of how many provisions?
9 provisions and interpretations
Ludwig von Bertalanffy (1936): General Systems Theory
A common framework for studying several similar disciplines would allow scientists and scholars to organize and communicate findings, making it easier to build on the work of others
Nursing Social Policy
A contract with society; the nature of the social contract between the members of the nursing profession and society. Obligation to those who receive nursing care. "Essence of Nursings Professionalism"
Generic name of a drug
A manufacturer who first develops a medication provides it; it is the name listed in the official publications such as United States Pharmacopeia (USP)
What is basic critical thinking?
A novice/student nurse thinks concretely based on the rules.
Mary Breckinridge
A nurse, and midwife, established the Kentucky Committee for Mothers and Babies, later known as the FNS (Frontier Nursing Service).m
Ethics
A set of moral principles that may be held by a society, a group or an individual.
Nursing theory definition
A set of related ideas/concepts to help find meaning of a phenomenon; a framework for our practice. Nursing theory separates you from other educated practicing nurses.
Goldmark Report
A study of Nursing education that advocated the establishment of collegiate schools of nursing rather than hospital-based diploma programs, and establishment of programs in rural midwifery.
Hypothesis
A testable prediction of the link between two variables.
Complimentary medicine
A treatment used in addition to the standard of care that compliments the standard of care.
VAD
A venous access device (VAD) is inserted into a vein Can be peripheral or central venous access devices, depending on where the final tip resides
Accreditation
A voluntary review process of educational programs or service agencies by professional organizations
The nurse admits to the unit a 4-year-old child who is experiencing separation anxiety from her parents. What age-appropriate behavior related to separation anxiety might this child exhibit? A. Having difficulty sleeping B. Throwing items C. Screaming at the nurse D. Urinating in bed
A. Having difficulty sleeping Rationale: This is the only age-appropriate behavior. The other behaviors may be seen as well; however, a 4-year-old child should not be exhibiting these.
Which vaccination is recommended for health care providers to reduce the risk of disease from exposure to bloodborne pathogens? A. Hepatitis B B. Influenza C. Pertussis D. Tetanus
A. Hep B Rationale: Hepatitis B is transmitted through direct and indirect contact with blood- and serum-derived fluids. Pertussis has a respiratory transmission through droplets. Tetanus typically enters the body through a wound contaminated with soil or feces, and influenza has a respiratory transmission.
What would the nurse expect to observe as evidence of healing in a patient with a deep burn? A. Scar tissue near the wound B. Edges of wound healing lost C. Necrotic tissue in the center of the wound D. Purulent drainage at the midline
A. Scar tissue near the wound Rationale: This is an example of second intention healing. Connective tissue develops, which supports new capillaries. This form of healing results in the formation of scar tissue to close the wound. Surrounding skin moves toward the center of the wound in an effort to close the defect.
Do not EVER massage redness areas because doing so may cause additional tissue trauma A. True B. False
A. True
Never cut a gauze pad to fit around TT A. True B. False
A. True
Can high-flow nasal cannula may be used in place of a noninvasive positive pressure vent in some patients with acute respiratory failure? A. True B. False
A. True EBP
When hands are not visibly soiled or contaminated with blood or body fluids, the nurse may use an alcohol-based hand rub to perform hand hygiene. A. True B. False
A. True Rationale: Alcohol-based hand sanitizers have been shown to reduce infection in a variety of settings from intensive care units to long-term care facilities. Alcohol-based rinses or gels containing emollients cause substantially less skin irritation and dryness than plain or antimicrobial soaps.
A patient receiving NIPPV via full face mask should **NEVER** be restrained A. true B. false
A. true
In the outpatient setting, education regarding activity and exersize CANNOT be delegated to a NAP A. True B. False
A. true
Primary and secondary continuous administration sets used to administer solutions other than lipid, blood, or blood products should be changed no more often than every 96 hours A. True B> False
A. true
You should auscultate the lungs before and after trach suctioning? A. true B. false
A. true
What type of patients do you use standard precautions in?
ALL pt's regardless of risk or presumed infection status
Copious amount of drainage is a lot or a little?
ALOT
how is the image of nursing changing?
ANA works to get rid of bad representation of nurses
What should be done after applying tourniquet
ASSESS RADIAL PULSE!!!
When removing dressing, how should the dressing be turned?
AWAY from the patient so they do not see what is on it
Autonomy
Ability to self-rule Right of self-determination Make decisions independently Cannot work if a patient is in a coma, mentally unable to make their own decision, developmentally delayed, incompetent, or under the influence.
Dissemination of findings
Abstracts
Goals of collaboration
Achieve high-quality patient care and satisfaction Prevent redundancies, deficits, and errors Enhance continuity across the continuum of care Provide research-based, high-quality, cost-effective care that is driven by expected outcomes Promote mutual respect and communication among nurse, patient, and caregiver Provide opportunities to solve issues and problems Provide a full-range of expertise through each of the team members
Sister Callista Roy
Adaptation Theory Client is an adaptive system Goal of nursing (in illness and health) is to assist the client in adapting to changes in the following: Physiologic needs Self-concept Role function Interdependent relations Roy—1979 Identify types of demands placed on client, assess adaptation to demands, and help client adapt This adaptation model is based on the physiological, psychological, sociological, and dependenceindependence adaptive modes
Types of Advocacy: Educating Providers and Others
Advocacy in this situation involves educating healthcare providers so that they are able to provide appropriate care to their clients
What is applied after staples/sutures are removed?
After sutures/staples are removed, the nurse applies Steri-Strips over the incision to provide support. The strips loosen over time (5 to 7 days) and can be removed when half of the strip is no longer attached to the skin.
A patient's susceptibility to an infection include...
Age, nutritional status, stress, disease processes, and forms of medical therapy place patients at risk.
What association defines nursing as "the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations."?
American Nurses Association
Which nursing organization issued the Code of Ethics for Nursing
American Nurses Association
What is the ANA?
American Nurses Association (ANA)
Evidence-Based Practice
An approach to the delivery of healthcare that integrates the
Phenomenon
An aspect of reality that can be observed or experienced. Phenomena can be sensed, it is real e.g. a patient's response (for example to stress which causes the blood sugar to increase) or response to a treatment. It is "the thing" that gets you started or thinking.
Articulation
An educational mobility system providing for direct movement from a program at one level of nursing education to another without significant loss of credit
Communication (definition)
An interaction between two or more persons that involves the exchange of information between a sender and a receiver. It involves the expression of emotions, ideas, and thoughts through verbal and non-verbal signals.
Alternative medicine
An option that happens for someone in place of a standard of care option.
Clara Barton
Angel of the Battlefield Delivered aid to soldiers of both the North and the South She established the Red Cross
Patient education definition
Any set of planned, educational activities designed to improve patients' health behaviors, health status, or both
Ethnography
Asks descriptive and interpretative questions about a culture and cultural behavior (behavior, artifacts, speech)
Grounded Theory
Asks process questions to create a theory Start with phenomenon, gather info, interview experts, create theory about phenomenon.
Intentional Tort Examples (6)
Assault, battery, defamation of character, fraud, invasion of privacy, false imprisonment
Skills the nurse must develop in order to be an effective advocate include:
Assertiveness A recognition that the rights and values of clients and families must take precedence when they conflict with those of healthcare providers An awareness that conflicts may arise over issues that require consultation, confrontation, or negotiation between the nurse and administrative personnel, or between the nurse and healthcare provider The ability to work with community agencies and lay practitioners An understanding that advocacy may require political action, such as communicating a client's healthcare needs to government and other officials who have the authority to do something about these needs.
Health Belief Model
Assesses the likelihood of a person acting in response to a health threat and changing their behavior What is the patient's perception of the illness?
Critical thinking and the nursing process
Assessment Analysis/data collection Planning Implementation Evaluation
The Education Process
Assessment Planning Implementation Evaluation
What is the difference between assigning, delegating, and supervising?
Assigning - transferring the authority, accountability, and responsibility of client care to another Delegating - transferring the authority and responsibility to another team member to complete a task, while retaining the accountability Supervising - directing, monitoring, and evaluating the performance of tasks by another. RNs are responsible for supervising delegated tasks to an LPN or AP
Neuman—1972 (Potter , Patricia A. . Fundamentals of Nursing (With Media), 7th Edition. Mosby, 032008. p. 49). <vbk:978032304828M#outline(4.7.1)>
Assist individuals, families, and groups in attaining and maintaining maximal level of total wellness by purposeful interventions Stress reduction is goal of systems model of nursing practice. Nursing actions are in primary, secondary, or tertiary level of prevention System Model
Subjective knowledge
Authority was internalized and a new sense of self emerged Focusing on defining nursing and developing theories
Four ethical principles
Autonomy Beneficence Non-maleficence Justice
When receiving report at change of shift, the nurse is told that the patient's IV infiltrated earlier in the day and the patient is at grade 2 on the phlebitis scale. What symptoms should the nurse expect to see when assessing this patient's infiltrated IV site? (Select all that apply.) A. Purulent drainage B. Edema C. Erythema D. Streak formation
B,C Purulent drainage is associated with a grade 4 phlebitis, and streak formation is associated with a grade 3 phlebitis.
You should remove an initial surgical dressing for direct wound inspection prior to the health care provider's order for removal A. True B. False
B. False
The task of completing vital signs among admission can be delegated to an NAP? A. True B. False
B. False Do not delegate admission vital signs, because a nurse must conduct the baseline assessment. The nurse can delegate some tasks to nursing assistive personnel (NAP), such as preparing the patient's room and collecting specimens; however, the actual assessment must be performed by the nurse.
A nursing assistive personnel (NAP) arrives to assist the nurse with a dressing change by opening sterile packages. The NAP states that she does not need to perform hand hygiene before assisting the nurse because she is not going to touch the patient. Is the NAP correct? A. True B. False
B. False Rationale: The nursing assistive personnel (NAP) is incorrect in saying that hand hygiene does not need to be performed before she assists the nurse. Although she may not touch the patient, she is still participating in patient care. Hand hygiene is performed by all caregivers.
You should always apply suctioning during insertion of a suction catheter into a trach? A. True B.False
B. False ***NEVER DO THIS***
You should apply tape over the TSM dressing A. True B. False
B. False NEVER DO THIS
When is the use of an alginate dressing contraindicated? A. Full-thickness wounds B. Necrotic, dry wounds C. Hip donor sites D. Draining wounds
B. Necrotic, dry wounds Rationale: Alginates are highly absorbent, nonwoven material that forms a gel when exposed to wound drainage. They work best on wounds that have drainage.
ADN is popular, but we are moving towards...
BSN (for profession)
What do assess for before and after you administer medication?
Before: -medical history -allergies (drug and food) -condition of patient (is it safe?) -patient knowledge (do they know/ understand what you are about to administer After: -allergic reaction to drug -body's reaction to medication
Assumptions
Beliefs about the phenomena that one must accept as true to accept the theory to be true. Assumptions can be the normal range of responses expected during stress for example. It is usually common knowledge.
who studied nursing's status as a profession?
Bixler and Bixler
Silent Knowledge
Blind obedience to medical authority Following orders because that is what the physician said to do, little attempt to develop theory
Types of Advocacy: Professional & Public Domains
Both individual nurses and professional organizations have many opportunities to: Speak publically for the health, welfare, and safety of their clients Take steps to protect client rights Inform the public about issues and concerns through articles and other media Lobby their congressional representatives on behalf of better health care for all people Run for political office
Stillman House
Branch of the Henry Street Settlement serving "colored people"
Descriptive statistics
Brief, descriptive numbers that summarize a sample of data. (measures of central tendency, standard deviation, variability)
An RN on a medical-surgical unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the LPN? A. Obtaining vital signs for a client who is 2 hr. post-procedure following a cardiac catheterization B. Administering a unit of packed red blood cells (RBCs) C. Instructing a client in the performance of wound care D. Developing a plan of care for a newly admitted client.
C. Because it is reinforcing client teaching from the standard care plan
Which of the following examples is correct technique for a nurse to use in removing intermittent sutures? A. Pinch the surrounding skin with a forceps. B. Snip both ends of the suture at the same time. C. Place gauze a few inches from the suture line. D. Cut the skin around the wound with the scissors.
C. Place gauze a few inches from the suture line. Rationale: Gauze serves as a receptacle for removed sutures. Placement of scissors and forceps is very important. Avoid pinching the skin around the wound when lifting up the suture. Likewise, avoid cutting the skin around the wound by accident when snipping the suture. Never snip both ends of a suture; there will be no way to remove the part of the suture situated below the surface.
An 82-year-old man with a rotator cuff tear is not a candidate for surgery. Which of the following exercises can the nurse teach the patient to do to assist with range of motion? A. Lift 15-pound weights, raising the arm slowly to shoulder height. B. Perform 5-count sets of push-ups 3 times daily. C. Reach to the bedside table to lift a book. D. Perform household chores of changing overhead lightbulbs.
C. Reach to the bedside table to lift a book. Rationale: Reaching sideways to a bedside table is performing ROM activity without putting more stress on the shoulder.
A 52-year-old male just underwent a cardiac catheterization, and bleeding at the insertion site is noted. What action should the nurse take? A. Apply a colloid dressing. B. Coat the area with petroleum jelly. C. Secure a pressure bandage. D. Inject vitamin K at the site.
C. Secure a pressure bandage pressure bandages are essential for stopping the flow of blood and promotes clotting at the site until definitive action can be taken to stop the source
A 49-year-old woman is recovering from a pressure injury on her left hip. The patient refuses lunch and tells the nurse that she fasts at lunchtime as part of her weight loss plan. How should the nurse respond to this patient? A. The nurse should explain to the patient that fasting is against the hospital policy . B. The nurse should scold the patient for her choice of diet. C. The nurse should inform the patient that fasting will hinder her healing progress. D. The nurse should respect the patient's choice and not say anything.
C. The nurse should inform the patient that fasting will hinder her healing progress. Rationale: Adequate nutrition helps to prevent and treat pressure ulcers. A diet high in protein with enough calories, vitamins, and minerals helps maintain normal tissue status and promotes healing. With tissue injury, the body needs more calories for healing; nutrient deficiencies may result in impaired or delayed healing.
Tort
CIVIL wrong doing against person or property
Who are considered assistive personnels? (NAP)
CNA or CMA Monitor Techs Dialysis Techs Phlebotomists Orderlies/House Attendants Nursing Students
Adaptation Model
Callista Roy
What are the 6 C,s in nursing?
Care Compassion Competence Courage Commitment
What is caring in the nursing profession?
Care is what is done; caring is the act of doing
Roles of the nurse
Caregiver Communicator Collaborator Educator Manager Leader Advocate Researcher & Innovator
List the roles of a nurse:
Caregiver, communicator, teacher, client advocate, change agent, leader, manager, case manager, and research consumer
Jean Watson's Definition: Caring as a.....
Caring as a science -Encompasses the humanitarian, human science orientation, human caring processes, phenomena, and experiences -Art and science -Being-in-relation -It's clinical, empirical, philosophical, ethical, ways of knowing, exploration
Battery
Carrying out threat
Mary Adelaide
Chaired the National Committee on Nursing
Affective learning
Changes in attitudes, values, and feeling with regards to the new information received.
Types of Theories
Classified by level (Grand or Middle range of abstraction) and by Goal (Describe or Predict)
Formal Socialization
Classroom lectures, assignments, laboratory experience, and new vocabulary.
Delegation: Right direction/communication
Clear, concise, correct, and complete initial and ongoing directions. (Include time, expectations, follow-up communication etc.)
In order to determine the advocacy needs of the client, the nurse must assess the following
Client's ability to cooperate and make decisions Reliability of information provided by the client, especially if the client exhibits impairment of cognitive function or mental instability Client's medical history and family situation
According to Roy's adaptation theory, which subsystem responds through four cognitive responds through four cognitive-emotive channels (perceptual and information processing, learning, judgment, and emotion)?
Cognator Subsystem
Critical Thinking (definition)
Cognitive process for analyzing knowledge
Components of critical thinking - Competence
Cognitive processes nurse uses to make nursing judgement
Domains of learning
Cognitive, Psychomotor, Affective
Lavinia Dock
Colleague of Lillian Wald; provided services through visiting nurses and clinics that cared for well babies, treated minor illnesses, prevented disease transmission, and provided health education to the neighborhood.
Mixed Methods
Combination of qualitative and quantitative
Definitions
Communicates the general meanings of the concepts involved. The definitions describe it, e.g. a patient with diabetes reacting by refusing to give up regular sodas.
C in PICOT
Comparison (current) intervention What is the usual standard of care or current intervention used now? THE CURRENT STATUS QUO
What is used to prevent DVT's?
Compression (elastic) stockings Sequential compression devices (SCDs) pump blood into deep veins, thus removing pooled blood and preventing venous stasis. Another venous plexus foot pump promotes circulation by mimicking the natural action of walking.
Nursing theory associated terms
Concepts - words or phrases used to create boundaries or structure for phenomenon Assumptions - relationships between two items. Kinda like a hypothesis for the links between the concepts Propositions - your definitive statement that describes the statement between those two items
The Research Process
Conceptualize the problem Design the study Implement the design Analyze/Interpret the data Use the results
Reliable
Consistently accurate
Ways to stay current and aware of new evidence:
Continuing education courses, professional conferences, journals, and membership in professional organizations
Which of the following items of information must be provided during the admission process? (Select all that apply.) A. General consent form to treatment B. Patient rights C. advance directives D. HIPAA E. Health Insurance options
Correct answer: A, B, C, D Rationale: All of these are to be provided to the patient at the time of admission. The nurse is responsible for ensuring that the patient receives the information in a format that he or she can understand. Except for information on health insurance options, the nurse will ensure that all other information is provided and documented appropriately.
Lillian Wald
Created the Henry Street settlement Pioneered the concept of "public health nursing" for poor people Henry Street nurses provided care at public schools
Barriers to communication
Cultural, gender, generational, or personality differences Stress or excessive fatigue Deficiencies in skill Work environment is not conducive Organizational/hierarchy culture Differences in jargon Professional rivalry or excessive authority gradients Disruptive behavior: outbursts of anger or profanity, physical acts or on the opposite end excessive courtesy Differing values and expectations Varying qualifications and status Complexity of care requiring rapid decision making
The concept of advocacy is related to most of the other concepts part 2
Culture and diversity: The culture and diversity of each client must be taken into consideration when providing care. The professional nurse must ensure that the client is able to maintain their choices. Healthcare systems: The complexities of the healthcare system are difficult to maneuver even for the well-educated client. The professional nurse can assist the client to maneuver within the system.
Dr. Google" and influence of the Internet
Cyberchondria literally means "online concern about health"
The patient tells the nurse she will not cooperate this evening with the physical therapist to perform exercises because she was in pain the entire time during exercise last evening. What question should the nurse ask the patient? A. Do you like the therapist who was assigned to you? B. Why are you trying to be difficult tonight? C. Have you ever liked to exercise in the past? D. Did you receive pain medication before exercise?
D. Did you receive pain medication before exercise? Pain may reduce a patient's motivation to perform isometric exercises. Pain relief before attempts at exercise may enhance the patient's participation; it may be appropriate to medicate the patient 30 to 60 minutes before exercise.
Implementation of the study
Data Collections and Data Analysis
Quality enhancement strategies (data collection, coding & analysis, presentation)
Data collection: prolonged engagement and observation, data and method triangulation, audit trails (explain how and when researchers gathered data), member checking Coding and analysis: investigator triangulation, peer review & debriefing, inquiry audits (expert in field critiques your data to make sure it is accurate) Presentation: researcher credibility, thick and contextualized description (direct quotes from participants!)
chemical name of a drug
Describes the composition and molecular structures; rarely used in clinical practice
Jane A. Delano
Director of Nursing in the American Red Cross.
What should you do if a patient refuses medication you are about to administer?
Discard it, don't return to chart, all patients have the right to refuse medications.
Non-maleficence
Do no harm Inflicting the least amount of harm for a beneficial outcome
Communication
Does not involve simply being able to talk, but to listen and engage with another person nonverbally
Learning Theories
Domains of Learning Andragogy Health Belief Model Social Learning Theory
Order in which you don and remove PPE
Donning: gown, mask, goggles, gloves Removing: gloves, goggles, gown, mask
Self-care Deficit Theory of Nursing
Dorothea Orem
maintaining homeostasis (internal stability).
Dynamic balance within and between subsystems, systems, and supra-systems helps create and maintain homeostasis (internal stability).
What is best evidence?
EVIDENCE-up to date information from relevant, valid research -BEST evidence is comes from well designed, systematically conducted research studies Other sources (non-research): -General literature review -Quality improvement data -Risk management data -Infection control data -Chart reviews -Clinician's expertise
Based on the nurse's assessment of the client, advocacy interventions may include:
Educating clients and their families about their legal rights Monitoring treatment planning and delivery of service for the abuse of client rights Evaluating policies and procedures regarding infringement of client rights Ensuring that clients have the necessary information to make an informed decision or give informed consent Questioning other healthcare professionals when they provide care that is based on stereotypic ideas rather than on assessment of the individual client's needs Speaking out for safe practice conditions when threatened by budget cutbacks
Curriculum Era
Efforts to understand the nature of the knowledge needed for the practice of nursing was emphasized on curricular content
Concepts
Elements of a phenomenon that are necessary to understand the phenomenon. Concepts is the glossary of terms that is used to describe the phenomena. Examples of concepts might be stressors, defense mechanisms, ideas that the patient have that make them respond in a particular way.
Types of Advocacy: Enabling
Enabling is defined as "facilitating the other's passage through life transitions and unfamiliar events."1 Enabling includes: Coaching Informing Explaining Assisting Guiding Focusing Validating
Nightingale's Theory
Environmental theory - manipulating the environment to assist in patients recovery Highlighted holistic care with spiritual dimensions 13 Canons are central to her theory
The concept of advocacy is related to most of the other concepts
Ethics: The role of the advocate is to uphold ethics in all situations. Legal issues: All clients have the right to expect competent nursing practice. The professional nurse will ensure that all clients receive this care. Professional behaviors: Nurses hold the public's trust as professionals. One of the roles of the professional nurse is to advocate for the client through professional behaviors
What is EBP?
Evidence based practice is a problem-solving approach to clinical practice that combines the best available evidence in combination with a clinician's expertise, patient preferences and values, and available health care resources in making decisions about patient care
Design of the study
Experimental, Non-experimental, and True experimental
How to explain the fluid that accumulates under the dressing to a patient
Explain the need to change dressing if edges loosen; explain that fluid under dressing is not "pus"; it is the result of normal interaction of body fluids with the dressing
T/F: A nurse with a nonjudgmental attitude makes every effort to convey approval and no disapproval of patients' beliefs ad respects each person's right to his or her beliefs.
FALSE. you should show NEITHER approval or disapproval
What do you do in the event of a medication error?
FIRST, assure safety of the patient and asses them -notify the physician ASAP! -report the incident to the appropriate person in the health care institution -prepare a written incident report (usually within 24 hours) ***-DO NOT REFER TO THE INCIDENT REPORT IN THE NURSES' NOTES!!!!*** -Report ALL errors including the ones that do not result in obvious harm
Nightingale—1860 (Potter , Patricia A. . Fundamentals of Nursing (With Media), 7th Edition. Mosby, 032008. p. 49). <vbk:978032304828M#outline(4.7.1)>
Facilitate "the body's reparative processes" by manipulating client's environment Nurse manipulates client's environment to include appropriate noise, nutrition, hygiene, light, comfort, socialization, and hope. Environmental Theory
Justice
Fair distribution of benefits and burdens Distribution of scarce healthcare resources Equal treatment, equal care
Justice
Fairness
Type 1 Error
False Positive saying you dont have disease but test says that you do (eg Prgnancy Test)
T/F: Only 50% of longevity can be attributed to clinical care
False only 15-20%!!
how many inches do you lubricate the catheter?
Female: 1-2 inches Male: 5-7 inches
Mary Mahoney
First African American Graduate Nurse
Mary Eliza Mahoney
First African American professionally educated nurse.
Linda Richards
First trained nurse in the US
Linda Richards
First trained nurse in the United States
Notes on Nursing: What it is, What it is not was written by
Florence Nightingale
what was the henry street settlement?
Form of nursing in the community that helped sick immigrants
National League for Nursing (NLN)
Foster development and improvement of nursing services and education
Bedford Fenwick
Founded international council of nurses ICN
Lillian Wald
Founded of the Henry Street Settlement, obtained financial assistance from private sources and began the first formalized public health nursing practice.
Isabel Hampton Robb
Founded the group that eventually became the American Nurses Association (ANA)
Indications of poor health literacy
Frequently missed appointments Failure to complete medical forms Unable to name medications or explain their purpose/dosing Identifying pills by looking at them, not reading the label Unable to provide a coherent, sequential medical history Lack of follow-through on tests or referrals Repeatedly using statements like, "I forgot my reading glasses," "I'll read this when I get home," "I'm too tired to read it now."
Martha Franklin
Gathered the National Association of Colored Graduate Nurses NACGN
What are the requirements to be a profession nurse?
Graduate with an rn and then take the NCLEX-RN which will make you a licensed RN and you can start practicing
Isabel Hampton Robb
Graduated from Bellevue Hospital Training school Superintendent of nurses at the Illinois Training School for Nurses at Cook County Hospital in Chicago 1st grading policy in nursing school
what did the early 1980s mark the recognition of?
HIV (human immunodeficiency virus)
Flow- oriented incentive spirometry
Have one or more plastic chambers with freely movable, colored balls. As a patient inhales slowly, the balls are elevated to a premarked area.
Isotonic IV solution
Have same osmolality as body fluids; can cause increased risk for fluid overload
CONCEPT 3
Health : A continuum
HIPAA
Health Insurance Portability and Accountability Act
HIPAA
Health Insurance Portability and Accountability Act (record keeping, technology, patient privacy, etc.) Law that requires medical professionals to keep personal patient information private. Our federal law that states you HAVE to keep patient health information private, and health insurance companies cannot turn you down based off of preexisting conditions.
external locus of control
Health is externally controlled. Belief that health is determined by outside factors.
internal locus of control
Health is internally controlled. Belief that health is controlled by what they themselves do
3 types of canes
Helps maintain balance by widening base of support -standard crook: provides the least support and is used by pt's who require minimal assistance to walk. It has a half circle handle, to hook over chairs -tripod cane: has three legs -quad cane: has four legs for wide base support
"Nursing is therapeutic interpersonal process". This definition was stated by:
Hildegard Peplau
She uses the concept of human as she emphasizes individuality and the dynamic nature of the nurse-patient relationship. For her, humans in need are the focus of nursing practice. Who is she?
Hildegard Peplau. Her book established one of the first widely accepted nursing theories, which was based on the premise that the patient and the nurse's relationship should be the center of attention, rather than simply the patient themselves.
Developmental Theories
Human growth and development is an orderly predictive process that begins with conception and continues through death.
What do you do after each suction pass?
Hyperventilate with ambu bag
Social Learning Theory
If a person thinks they are capable of change, they will try to do so. Change is dependent upon the person's belief that they are capable of change and that the change will have a desirable outcome.
What happens if you detect signs of suture line separation while trying to remove them?
If there is any sign of suture line separation during the removal process, the remaining sutures/staples are left in place, and a description is documented and reported to the health care provider.
Henry Street Settlement
Immigrants coming from the Northeast. Poverty stricken and overcrowded primitive living conditions in inner city tenements became a target for infectious diseases.
Theory of Goal Attainment
Imogene King
Healthcare Collaboration definition
Implies working jointly with other professionals, all of whom are respected for their unique knowledge and abilities, to improve a patient's health status or to solve an organizational problem.
Goals of nursing informatics
Improve the health of populations, communities, families, and individuals by optimizing information management and communication. Connect the art of nursing to the science of nursing Support information management across all nursing specialties
Elizabeth Fry
In 1840, Elizabeth Fry founded the Protestant Sisters of Charity in response to the pleas of British Social Reformers
Human Error
Inadvertent Action (slip, lapse, mistake)
Procedural knowledge
Includes both separate and connected knowledge. Difficulty attaching theory to practice
Termination phase
Includes those activities that enable the patient and the nurse to end the relationship in a therapeutic manner
Affordable Care Act "Health Care Reform"
Includes: Banning lifetime coverage limits for extreme medical conditions, young adult coverage to age 26, prevention of coverage denial to children under 19 with preexisting conditions, coverage of preventive services, right to appeal coverage decisions, choice of primary care providers
what epidemic swept the US in 1917?
Influenza epidemic with WW1 (nurses responded to both needs)
Constructed knowledge
Integration of different types of knowledge (intuition, reason, and self-knowledge) Shift from grand theories to middle and practice theories
Interdisciplinary Theories
Interdisciplinary theories provide a systematic view of a phenomena, relevant to the discipline being looked at. E.g. Maslow's hierarchy of basic human needs.
Hildegard Peplau
Interpersonal Relations in Nursing Nursing's role is to decrease anxiety by converting it into constructive actions. Therapeutic milieu (environment - quiet, soothing colors, etc.) Acknowledged the connection between anxiety and hereditary. Peplau—1952 Develop interaction between nurse and client (Peplau, 1952) Nursing is a significant, therapeutic, interpersonal process (Peplau, 1952). Nurses participate in structuring health care systems to facilitate interpersonal relationships.
I in PICOT
Intervention of Interest: the new one you are considering. Which intervention are you interested in using in practice?
Clinical Judgment (definition)
Is "an interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient's responses"
Developing self-awareness
Is basic to effective interpersonal relationships and is especially important in the nurse patient relationship
Evaluating resources/nursing informatics
Is it a reliable source? Is the information on that website correct?
Clinical Reasoning (Definition)
Is the cognitive process by which a nurse reaches a clinical judgment
who founded the ANA?
Isabel Hampton Robb
ANA Nursing's Social Policy Statement: The Essence of the Profession
It sets forth several underlying values and assumptions: - Humans manifest an essential unity of mind, body, and spirit. - Human experience is contextually and culturally defined. - Health and illness are human experiences. The presence of illness does not preclude health, nor does optimal health preclude illness.*** - The interaction between the nurse and patient occurs within the context of the values and beliefs of the patient and the nurse. - Public policy and the health care delivery system influence the health and well-being of society and professional nursing.
How should an Incentive Spirometry be used?
It should be used in combination with other pulmonary maneuvers such as deep breathing and coughing, early mobilization of the patient, and directed coughing. instruct pt to take slow, deep breaths like pulling a straw. inhalation raises ball or piston to targeted area. Remove mouth piece at point of maximum inhalation and hold breath for 3 seconds
Which theorist designed the 10 carrative factors?
Jean Watson
In 2002 which major American corporation partnered with nursing to design a media campaign to promote the image of nursing?
Johnson and Johnson → aim was to enhance the view of nursing and increase recruitment
Developing Clinical Judgment
Knowledge of deep understanding Learning to recognize patterns Apply concepts to nursing practice Skillful responding Reflective practice Narrative, written, and spoken
Virginia Henderson
Known for her definition of nursing ** "assisting the individual, sick or well in the performance of those activities that will contribute to health, recovery, or a peaceful death and that the individual would perform unaided if he or she had the necessary strength, will, or knowledge. And to do this in a way as to help him gain independence as rapidly as possible." Nurses care for patients until they can care for themselves. Henderson—1955 Work independently with other health care workers, assisting client in gaining independence as quickly as possible; to help client gain lacking strength Nurses help client to perform Henderson's 14 basic needs.
Florence Nightingale
Laid down the foundation for nursing as a profession. Crimean War- men died from disease not injury Created a clean, bright, happy environment for soldiers Lady with the Lamp Environmental Model- physical environment
Andragogy
Learner-focused education for people of all ages
Received knowledge
Learning through listening to others Borrowing theories from other disciplines (sociology, education, medicine)
Standards of Care
Legal requirements for the minimum acceptable nursing care
Leininger's Theory
Leininger's Cultural Diversity and Universality Theory Knowing and understanding different cultures with respect to nursing and health-illness caring practices, beliefs and values with the goal to provide meaningful and effective nursing care services to people according to their culture, values, and health-illness context. ***3 Modalities to provide culturally congruent/competent nursing care: Preservation or maintenance Accommodation or negotiation Repatterning or restructuring
Evidence Hierarchy
Level 1: Clinical Practice Guideline based on evidence drawn from a comprehensive review and rating of available research studies and systematic reviews. Level 2: Systematic reviews including integrated literature reviews and meta-analysis of experimental research studies Level 3: Single experimentally designed research studies Level 4: Systematic reviews including integrated literature reviews, meta-analysis, and metasynthesis of non-experimental/qualitative research studies. Level 5: Single non-experimental or qualitative research studies. Level 6: Non-research driven expert opinion or committee reports.
Delegation: Right person
License, certification and role description; strengths, experience, competence?
who founded the henry street settlement?
Lillian Wald
Facilitating factors of communication
Listen carefully and reflect back a summary of the patient's concerns Use terms and vocabulary appropriate for the patient Call the patient by his or her preferred name Use respectful and professional language Ask the patient what he or she needs and responds promptly Provide helpful information Solicit feedback from the patient Employ humor as appropriate Provide words of comfort when appropriate
Core communication skills! (with patients)
Listening - SOLER Exploring - using facilitators, clarifying, paraphrasing, assessing nonverbal cues Understanding - know when to ask open or closed ended questions Comforting/Supporting - trust, hope, validation, humor, touch, silence, empathy
who came up with the 8 characteristics of the nursing profession?
Lucie Kelly
Transcultural Model of Nursing was proposed by:
Madeleine Leininger
Cultural Care Diversity & Universality Theory
Madeline Leininger
Who defined Culture as the learned, shared and transmitted values, beliefs, norms, and life-ways of a group that guides their thinking, decisions, and actions in patterned ways?
Madeline Leininger
who supplied trained nurses to the US army hospitals and founded the army school of nurses?
Mary Adelaid Nutting
Who established the frontier nursing service (FNS)?
Mary Breckinridge
Valid
Measures what is supposed to measure
What is Medical Asepsis and Sterile Technique?
Medical Asepsis: clean technique that reduces organisms and prevents the transfer of them as well -HAND HYGEINE!!!, barrier techniques, routine environment cleaning Sterile Technique: eliminates pathogenic organisms used in surgery or other invasive procedures
Historical Development of Nursing Practice
Military: Florence Nightingale Advocated fresh air, cleanliness, nutrition, hydration -American Civil War World War I, II, Vietnam Values—submission to authority, conformity
Components of critical thinking - attitudes
Mindsets that affect how a nurse approaches a problem
Components of critical thinking- Standards
Model for comparing care to determine acceptability, excellence, and appropriateness
Patricia Benner
Model of skill acquisition in nursing Five stages of skill acquisition: - Novice - Advanced Beginner - Competent - Proficient - Expert Frequently used by administration in nursing evaluations and in preceptor programs. Also Primacy of Caring with Wrubel. An example of using Benner's caring theory in the work place would be to assign a mentor to new employees. Benner and Wrubel—1989 Focus on client's need for caring as a means of coping with stressors of illness Caring is central to the essence of nursing. Caring creates the possibilities for coping and enables possibilities for connecting with and concern for others
Harriet Tubman
Moses Underground Railroad operated leading over 300 slaves to freedom
Mary Ann Ball
Mother Bickerdyke Served in the Civil War Ignored rank, protocol, and allegiance-rebel, union, black soldiers all received the same attention Risked enemy fire
What should you NEVER do with needle caps?
NEVER RE-CAP
Some of the "do not use" abbreviation list
NEVER USE: -ug -cc -u -iu -q.d. -q.o.d. -mso4 -mgso4 -trailing zero -lacking a leading zero -@ -> -< -qn -sq -hs (etc. there is more just go review the list)
During trach care, where should you NEVER hold the inner cannula while drying it?
NEVER hold over the sterile field
what did these nurses form?
National League for Nursing (NLN)
Qualitative research
Naturalistic inquiry or interpretivism- relies on data collection techniques, like narrative interviews or participant observation.
Which of the following theory has used "General Systems Theory" as a framework for its development?
Neuman's Model
Healthcare disparities
Not receiving adequate care because on your ethnicity/culture.
What is Complex critical thinking?
Nurse begins to express autonomy by analyzing and examining data to determine the best alternative.
Types of Advocacy: Empowerment
Nurses advocate for clients in order to protect their rights and empower them to participate in making informed healthcare decisions.
Types of Advocacy: Illegal, Immoral, or Unethical Activities of Professionals.
Nurses have a legal responsibility to report other professionals suspected of engaging in illegal, immoral, or unethical activities by following established procedures at the facility of employment.
Henderson's Theory
Nursing Need Theory - basic needs Florence Nightingale of the 20th Century Best known for her definition of nursing Highlighted the art of nursing and empathetic understanding 14 Basic Needs - Nursing Need Theory. There are fourteen needs of every patient ***First theorist to really look at the psychological needs of patients.
Components of critical thinking - knowledge
Nursing education, use of Evidence Based practice, continuing education courses, advanced degrees and certifications
What should you post on the wall when someone is on O2 therapy?
O2 in use sign
Occupation vs Career
Occupation: one's job or employment; an activity that keeps a person busy. Career: a course of professional life or employment that affords the individual opportunities for personal advancement, progress, or achievement
Phoebe Pember
One of the earliest to be placed in charge of the hospital
O in PICOT
Outcome What results do you wish to achieve or observe as a result of the intervention? What are you looking to change/measure? (ex. change in patient behavior, physical finding, or patient perception)
Delegation: Right Supervision
Oversee assigned/delegated tasks (Huddles/checkpoints - solicit team members opinion; credit team for accomplishments
Statistical significance
P < 0.05 to be statistically significant! (means STRONG relationship between the two variables, so we reject the null hypothesis)
How to form a PICOT statement?
P: patient, population, or problem I: intervention or issue of interest C: comparison with the intervention O: Outcome (measurable) T: Time (an optional component of a clinical question)
as a result of working on the battlefields during the vietnam war what did nurses suffer from?
PTSD
What is a systematic review?
Panel of experts reviews all of the evidence from RCTs and summarizes the data! A meta-analysis adds statistical analysis combining all data from the studies.
Requirements for the working stage:
Patience, self-awareness, and maturity
Dissemination of Findings
Peer Review process
Concept of adaptation
People admitted in hospitals and removed from their usual environments commonly become anxious.
Metaparadigm concepts in nursing
Person, health, environment, nursing
Value
Personal belief/idea
Types of qualitative research
Phenomenology Ethnography Grounded Theory Historical Case Study Narrative
Components of a Theory
Phenomenon Concepts Definitions Assumptions
Branches of Philosophy
Philosophy is the study of the principles underlying conduct, thought, and the nature of the universe.
POLST
Physicians Order Life Sustaining Treatment Contains a summary of patient's choices bout the nature and extent of life-sustaining procedures
Maslow's Hierarchy of Needs
Physiologic needs - food, oxygen, rest, activity, shelter, and sexual expression Physical and psychological safety and security - reasonably predictable environment with which one has some familiarity and relative freedom from fear and chaos Love and belonging - close intimate relations, social relations, a place in the social structure Self-esteem - need to feel self-worth, self-respect, and self-reliance Self actualization - realized maximum potential
Career Management
Planned logical progression of one's professional life that includes defined goals and objectives and a plan for achievement.
PICOT format
Population Intervention Comparison Outcome Time
Women who cared for others, but who had no formal education, often called themselves "practical nurses"
Practical Nursing Graduate in one year and was created due to the nursing shortages during WWII
Applied science
Practical application of scientific theory and laws - also known as clinical science
Prescriptive (encouraged) and proscriptive (prohibited) beliefs
Prescriptive (encouraged) and proscriptive (prohibited) beliefs are those in which certain actions are judged to be desirable or undesirable. Prescriptive "Every citizen of voting age should vote in every election" Proscriptive "People should not have sex outside of marriage" These two types of beliefs are closely related to values.
The Social Security Act (SSA)
President Roosevelt's plan to bring the nation out of the Depression, enhanced the practice of public health nursing. One of its purposes was to strengthen public health services and to provide medical care for crippled children and the blind.
Missouri Nurse Practice Act
Professional nursing", the performance for compensation of any act which requires substantial specialized education, judgment and skill based on knowledge and application of principles derived from the biological, physical, social and nursing sciences. . .
How a Nurse is Socialized into the Profession
Professional socialization requires students to internalize new knowledge, skills, attitudes, behaviors, values, and ethical standards into their own professional identities.
What is the ANA code of ethics provision 3?
Promotes, advocates for, and strives to protect the health, safety, and rights of the patient This means: -Participate in review and development of policies -Reporting errors and near misses per facility policy (whether you or other made error) -Disclosing errors to patients -Use the Chain of Command
The nurse may need to advocate for clients in the following areas:
Promoting health, such as by ensuring good nutrition, suggesting immunizations, and helping with stress management Ensuring safety, such as by assessing for abuse and neglect, preventing accidents, and being aware of community resources Participating on committees and task forces in the healthcare agency or community Collaborating with care teams in hospitals, rehabilitation centers, and nursing care settings
Abdellah—1960 (Potter , Patricia A. . Fundamentals of Nursing (With Media), 7th Edition. Mosby, 032008. p. 49). <vbk:978032304828M#outline(4.7.1)>
Provide service to individuals, families, and society; to be kind and caring but also intelligent, competent, and technically well prepared to provide this service This theory involves Abdellah's 21 nursing problems
Hill-Burton Act
Provided funds to construct hospitals and leading to a surge in the growth of new facilities. This rapid expansion in the number of hospital beds resulted in an acute shortage of nurses and increasingly difficult working conditions.
Jessie Sleet Scales
Publication "A Successful Experiment". Training at Providence Hospital in Chicago (hospital exclusively for colored people) was hired as a district nurse on a trail basis.
Examples of Basic, Clinical, and Traditional science are
Pure Science, Applied Science, and Translational Science
Participant sampling in qualitative research
Purposive/Purposeful Sample Convenience/Volunteer Sample Network/Snowballing Sample
How often should you check nasal cannula/mask?
Q8h by agent policy and keep humidification container filled at all times
Ethnography, Phenomenology, and grounded theory are other types of
Qualitative research
What is commonly used in social sciences where measurement of phenomena may not be possible?
Qualitative research
After the final hyperventilation, what should you remember to put back on the pt?
REPLACE O2!!!!!!!
Professional and Legal Regulation of Nursing Practice
RN Credentialing -Licensure *Need license to practice nursing *Specific education requirements and NCLEX Exam *License may be revoked w/ due process -Certification *State and national certification programs -Specialty or advanced practice practioner
Who can delegate to NAP's?
RN's and LPN's (know your state policy in regards to delegations)
A nurse who helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health
RN?
Bias
Refers to systematic distortion of a finding from data, often resulting from a problem with the sample.
Dorthea Lynde Dix
Reformer of mental hospitals Superintendent of nurses for Union Army Formed an army of Nursing Corps
Data collection instruments
Reliable and Valid
Historical Development of Nursing Practice
Religion : Values—self denial, devotion to duty, hard work Angel of Mercy
Examples of client advocacy include:
Representing the client's needs and wishes to other healthcare professionals. Helping clients exercise their rights.
Dignity
Respect for the intrinsic worth of each person without respect to age, race, religion, medical condition, etc.
Autonomy
Right to self determination
Law is:
Rule of conduct enforced by the government.
What should you do if your patient starts to question the medication you are about to administer?
STOP and access the patients concerns
Data Saturation
Sampling until no new information is obtained and redundancy is achieved
General Critical Thinking
Scientific method Problem-solving Decision-making Diagnostic reasoning and inference Clinical decision - making; collaboration
Philosophy of Nursing
Seeks to understand the truth, to provide a description of nursing, to propose an understanding of explanation, to examine prediction, to critically relate theories, models and scientific systems and to fully explore free will
Dorothea Orem
Self Care Deficit Theory Self care A learned, goal-oriented activity directed toward the self in the interest of maintaining life, health, development, and well-being. Nursing care is needed when a patient is unable to fulfill biological, psychological, developmental, or social needs. Using this theory, the nurse might determine that the patient with diabetes is unable to safely draw up her own insulin dose and teach the daughter to do that part for the patient (after determining that the patient can safely give her own injection, maintaining as much independence as possible). Home Health nurses teach patient self-care in the home. The goal of nursing is to increase the patient's ability to independently meet their self-care needs. Orem—1971 Care for and help client attain total self-care Nursing care is necessary when the client is unable to fulfill biological, psychological, developmental, or social needs
Orem's Theory
Self-care deficit theory This theory assumes that all individuals have self-care needs and that they have the right and ability to meet these needs themselves, except when their ability is in some way compromised. Compromised of THREE related theories Theory of Self-Care: describes why and how people care for themselves and that nursing is required when people are unable to perform self-care as a result of limitations Theory of Self-Care Deficit: describes and explains why people can be helped through nursing Theory of Nursing Systems: describes and explains relationships that must exist and be maintained for nursing to occur
process of communication
Sender Encoding Message Receiver Decoder
How do you perform a wound assesment?
Should be done on a schedule basis to determine if the wound is moving towards healing A thorough wound assessment will include the identification of the type of wound healing, primary secondary or tertiary intention, the type of tissue in the wound base; these parameters will be used to base the proper wound intervention. The healing process proceeds in a series of events, generally described as phases. In a full-thickness wound, the phases are hemostasis animation, proliferation, and remodeling [Review Box 40-1 with the students: Phases of Wound Healing (Full-Thickness Wounds).] Parameters include:Location, type of wound, extent of tissue involvement, type and percentage of wound base, wound size, wound exudate, presence of odor, periwound area, and pain
Stages of Nursing Theory Development
Silent Knowledge Received Knowledge Subjective Knowledge Procedural Knowledge Constructed Knowledge
4 Stages of Cognitive Development in the Nursing Profession
Stage 1: Unilateral Dependence Stage 2: Negative/Independence Stage 3: Dependence/Mutuality Stage 4: Interdependence
Pressure Injury stages
Stage 1: non-blanchable erythma of intact skin Stage 2: partial thickness skin loss with exposed dermis. wound bed is pink and moist Stage 3: full thickness skin loss in which adipose and granulation tissue is visible Stage 4: full thickness and tissue loss with exposed palpable fascia, muscle, tendon, or bone. slough and eshcar may be visible
Quantitative Research
Standardized experimental designs with hypothesis, measurable variables and outcomes, and statistical analysis.
Regulatory Law
State/Federal administrative agencies, like the State Board of Nursing, sets legal rules and regulations (e.g. Nurse Practice Act)
Data Analysis Plan
Statistics and designing the data analysis, and Qualitative analysis
unexpected outcomes: infiltration
Stop infusion and remove catheter at first site. elevate the extremity, avoid pressure
Cognitive learning
Storing and recalling new information in the brain. Factual knowledge.
Watson's carative factors include all the following, EXCEPT:
Strengthening flexible lines of defense
Feedback, Appropriateness, Efficiency, Flexibility
Successful communciation
Pure Science
Summarizes and explains the universe without regard for whether the information is immediately useful - new knowledge
Madeline Leininger
Sunrise Model Nursing is synonymous with caring The goal of applying Leininger's theory in nursing practice is to provide culturally congruent care to persons of diverse populations. Integrating the patient's cultural norms into care of the patient. Leininger—1978 Provide care consistent with nursing's emerging science and knowledge with caring as central focus With this transcultural care theory, caring is the central and unifying domain for nursing knowledge and practice.
Scientific Method
Systematic way of thinking
T/F: The dynamic balance within and between subsystems, the system, and the suprasystem helps create and maintain homeostasis
T
T/F: When a person's needs are not met, homeostasis is threatened.
T
Safety measures to take when picking out a medication with look alike/sound alike characteristics as that of another medication
TJC publishes a book with a list of these! -use the generic AND trade name to verify correct drug -include the purpose of the medication on prescription -draw attention to their dissimilarities (using tall-man or mixed letters approved by the FDA for the ISMP)
5 rights of delegation
Task Circumstance Person (delegated TO) Communication/Direction Supervision
Susie King Taylor
Teaching soldiers (Black & White) how to read and write.
Current Nursing Trends
The Gender Gap Cultural & Ethnic Diversity Access to Health Care Incivility Violence in the Workplace Mental Health Needs Global Aging Regulation & Reform Nursing Supply and Demand Consumerism Complementary and Alternative Approaches Technological Changes Disaster Preparedness Research Needs
What is the ANA code of ethics provision 7?
The Nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards of development, and the generation of both nursing and health policy."
IOM
The Quality of Health Care in America Committee of the Institute of Medicine (IOM) concluded that it is not acceptable for patients to be harmed by the health care system that is supposed to offer healing and comfort--a system that promises, "First, do no harm." prevention of medical errors
Diagnosis
The RN analyzes the assessment data in determining diagnoses or issues.
Assessment
The RN collects comprehensive data pertinent to the patient's health or the situation.
Planning
The RN develops a plan that prescribes strategies and alternatives to attain expected outcomes.
Evaluation
The RN evaluates progress toward attainment of outcomes.
Outcome Identification
The RN identifies expected outcomes for a plan individualized to the patient or the situation.
Generalizability
The ability to apply study results from the sample to the population (can only happen when an experimental study is truly randomized)
Psychomotor learning
The ability to demonstrate a new skills/techniques indicating that a physical skill has been learned.
Health literacy
The ability to read, understand, and act on health information
Critical Thinking definition
The ability to think in a systematic and logical manner, solve problems, make decisions, and establish priorities in the clinical setting, and the competent use of thinking skills, ability to make sound clinical judgments, and safe decisions.
When selecting a VAD (venous access device)
The choice of VADs can be overwhelming because there are a variety of sizes, number of lumens, and materials used to manufacture the devices. When selecting the appropriate VAD, consider a patient's prescribed therapy; length of treatment; duration the device remains in place; vascular characteristics; and patient's age, co-morbidities, history of infusion therapy, preference for VAD location, and resources available to care for the device.
Values Basic to Client Advocacy
The client is a holistic, autonomous being who has the right to make choices and decisions. The client has the right to expect a nurse-client relationship that is based on shared respect, trust, collaboration in solving problems related to health and healthcare needs, and consideration of his or her thoughts and feelings. The nurse has the responsibility to ensure the client has access to healthcare services that meet health needs.
Fidelity
The duty to keep promises, follow through on actions
Veracity
The duty to tell the truth, do not intentionally deceive or mislead
What is commitment?
The expert level of knowledge nurse expects to make choices without help from others and fully assumes the responsibility for those choices.
Margaret Sanger
The face of the battle for safe contraception and family planning for women.
Malpractice
The failure of a professional to use such care as a reasonably prudent member of the profession would use under similar circumstances that leads to harm.
Julie O. Flikke
The first nurse to be promoted to the rank of colonel in the US Army
IOM
The institute of Medicine
Informed consent
The legal obligation of a provider to disclose necessary information at a level that the person can understand so they can make an informed decision.
What is the ANA code of ethics provision 8
The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.
What is the ANA code of ethics provision 4
The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care
What is the ANA code of ethics provision 9?
The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
Define Nursing
The protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.
Nursing Informatics definition
The retrieval, management, and processing of data, information, knowledge, and wisdom relevant to nursing
Which of the following statements is related to Florence Nightingale?
The role of nursing is to facilitate "the body's reparative processes" by manipulating client's environment.
Ethics
The study of ideal human behavior and ideal ways of being; distinguishing between right and wrong, good and bad as they exist along a continuum and as they relate to the well-being of and the relationships among beings. The process of deciding what is right or wrong and what actions should be taken in certain circumstances.
CONCEPT 2: Environment
The supra-system in which a person lives in. - The environment can either promote or interfere with homeostasis and well-being of individuals.
Peplaus theory
The therapeutic use of self -helpful with relating effectively to patients, patents' families and other health care professionals
Classic Definition Of Nursing
The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health, its recovery, or a peaceful death that the client would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help the client gain independence as rapidly as possible. (Henderson, 1966)
Martha Rogers
Theory of Unitary Man The person is an irreducible whole and cannot be broken down into parts. Human beings are dynamic energy fields and are in constant exchange with environmental energy fields. Checking in with your own feelings prior to taking care of another is an example, e.g. taking a deep breath prior to entering a patient's room who is dying. Rogers—1970 Maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through "humanistic science of nursing" "Unitary man" evolves along life process. Client continuously changes and coexists with the environment.
Linking Theory to Practice
Theory provides a framework for research - Research builds nursing knowledge used in practice - Practice leads to more research question and thus more theories
Benner's Theory
Theory that suggests you acquire the knowledge and skills as you socialize to the nursing profession Novice to expert
What is a theory and a Concept for Nursing?
Theory: A group of related concepts, definitions, and statements that describe certain views of the nursing --phenomena -Peplau's theory of interpersonal relationships -Focuses on the patient understanding their illness Theories in nursing focus on these four major concepts: 1. Person 2. Environment 3. Health 4. Nursing
Boundaries
They get blurred and relationships become social, not professional - problem in long term care facilities (hospice/palliative)
T in PICOT
Time: specifies the time it takes for the intervention to achieve the outcome. What amount of time is needed for an intervention to achieve an outcome? HOW LONG would it take to see results of that change?
Typical Research Article Format
Title & Abstract Introduction/Background Literature Review Method Results/Findings Discussion Conclusion/Summary
Beneficence
To do good Nurses take actions to benefit patients and facilitate their well-being
Chain of infection
Transmission, Portal of entry, Host susceptibility, infectious agent, reservoir, portal of exit
Jean Watson
Transpersonal caring Purpose of nursing - Promoting health - Restoring health - Preventing illness Believes that health is associated with the degree of congruence between the self as perceived and self as experienced Watson—1979 Promote health, restore client to health, and prevent illness Involves the philosophy and science of caring. Caring is an interpersonal process comprising interventions to meet human needs
T/F: 70% of the variance in individuals' health is explained by socioeconomic and environmental determinants
True! (per public health 2030)
True or False. At the onset of the American Civil War there were no professional nurses.
True.
True or False. Until the last months of 1861 & early 1862 Confederate Hospitals were staffed by female volunteers or wounded soldiers.
True.
Attributes of a Critical Thinker
Truth seeker Open-minded Analytical Systematical Self-confident Inquisitive Mature/Integrity Humility
Phenomenology
Understanding people's everyday lived experience Asks meaning questions (meaning behind living through a hurricane, having breast cancer, etc.)
Informal Socialization
Unplanned observations participating in a student nurse association, hearing nurses discuss patient care.
Volume oriented incentive spirometry
Use a bellows that a patient must raise to a predetermined volume by inhaling slowly. The advantage of the volume-oriented is that a patient can achieve a known inspiratory volume and measure it with each breath
King—1971 (Potter , Patricia A. . Fundamentals of Nursing (With Media), 7th Edition. Mosby, 032008. p. 49). <vbk:978032304828M#outline(4.7.1)>
Use communication to help client reestablish positive adaptation to environment Nursing is a dynamic interpersonal process between nurse, client, and health care system Goal Attainment Theory
Inferential statistics
Used to make inferences ABOUT THE POPULATION based on sample data; make inferences about the hypotheses and interpret the findings.
Certification
Validation of specific qualifications demonstrated by a registered nurse in a defined area of practice.
forms of verbal/nonverbal communication
Verbal -Vocabulary -Denotative or Connotative Meaning -Pacing -Intonation: tone of voice -Clarity and Brevity -Timing and Relevance Nonverbal -Personal Appearance -Posture and Gait -Facial Expression -Eye Contact -Gestures -Sounds -Personal Space
"The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible" This definition of nursing was given by
Virginia Henderson
Definition of Nursing
Virginia Henderson
Watson's Theory
Watson's Philosophy and Theory of Transpersonal Caring Goal is to help persons attain a higher level of harmony within the mind-body-spirit Goal pursued through transpersonal caring guided by 10 caritas processes Carative factors provide guidelines for the nurse-patient interactions Theory is more about being than doing ***Her theory - CARING is the most important thing in nursing.
Nurse scope of practice
What you can and cannot do as a nurse
What would you draw up first if you were to need both a multi-dose vial and ampule into the same syringe?
When mixing meds from a vial and an ampule, prepare meds in vial first - then withdraw meds from ampule using same syringe and filter needle. When mixing two vials- do not contaminate one med with another -ensure that final dose is accurate Steps: a.) Prepare medication from vial first b.) Determine on syringe scale what the combined volume of meds should be - always use filter needle. c.) Prepare medication from ampule d.) Withdraw filter needle from ampule, and verify fluid level in syringe - change filter needle to appropriate needle or needleless device - keep caped until administration.
Team nursing
When there are multiple different healthcare professionals (CNP, LPN, RN, CNA) taking care of a large group of patients. All about communication.
Social Justice
Working to ensure equality in treatment and access
Nursing had demonstrated its ability both to provide care to the war wounded and to respond effectively to the influenza epidemic at home, by the end of which war?
World War I
Cadet Nurse Corps.
World War II, nations military didn't have enough nurses. The military and collegiate programs formed an alliance to train student nurses.
Mary Adelaide Nutting
World's first nursing professor Entered nursing school at Johns Hopkins Hospital school of Nursing Superintendent of Hopkins
Does the health promotion model uses illness prevention and health promotion as a basic Framework
Yes . That is the definition of a Health Promotion Model
Can a nurse say "no" to an assignment?
Yes... if assignment is unsafe for patients -Talk with charge nurse -Take up the Chain of Command -Document Practice Situation and file with Administration -Failure to follow the steps above may result in a charge of patient abandonment - reportable to the BON
Lypoatrophy
a breakdown of subcutaneous fat at the site of the insulin injection. It usually occurs after several injections at the same site.
Framework
a brief explanation of a theory or those portions of a theory to be tested in a study
Lypohypertrophy
a build up of subcutaneous fat tissue at the site where insulin has been injected continuously.
Phenomena
a fact, occurrence or circumstance observed or observable something that is remarkable or extraordinary
Companionship
a form of support that gives the supported person a sense of belonging and provides people with whom to share social activities
Most common way for pt to become infected with an HAI?
a health care provider's hands
Scant amount of fluid is a lot or a little?
a little
Pressure Injury
a localized area of injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear (a never event)
paradigm
a model that explains the linkages of science, philosophy and theory accepted and applied by the discipline
Non verbal communication is...
a more reliable expression of feeling
Privacy
a person's right to be and to have their information left alone and kept private
Rusch
a pioneer communications theorist
Deductive reasoning
a process in which conclusions are drawn by logical inference from given premises. It proceeds from the general case to the specific. *Valid rather than true
Regression definition
a psychological device the occurs as a reaction to stress and that often proceeds positive changes in behavior
Feedback:
a response to a message
Peer Review Process
a review panel evaluates appropriateness and accuracy and recommends revision, publication, or rejection
Autonomy
ability to make ones own decisions
Hemovac
accommodates up to 500ml/24hr of fluid record: amount of drainage, I&O
CCNE "Commission on Collegiate Nursing Education"
accreditation for BSN, MSN, & Doctoral programs.
Socialization
acquiring the knowledge and skills that are characteristic to your profession
Integrity
acting in accordance with appropriate code of ethics and accepted standards of practice
Reckless Behavior
action that is KNOWINGLY putting themselves and others at harms way
prescriptive theories
address nursing interventions and predict their consequences
middle range theories
address specific phenomena and reflect practice
after tugging on catheter, what should you do?
advance catheter slightly
When advancing catheter to the hub, what should you make sure you dont do?
advance needle/stylet with it
Informational support
advice and guidance, the sharing of useful information.
who did elizabeth tyler work with?
african american patients in the henry street settlement
in early nursing, who was discriminated against?
african-americans, jewish applicants, and males
Contract
agreement, whether formalized in writing or informally agreed on
in 1923, states required exams for licensure. What was the problem with these tests?
all states had different tests
Patient center care has been proposed to..
alleviate vulnerabilities experienced by the patient is central to patient centered care in acute care settings
Therapeutic engagement is the key process in...
alleviating vulnerabilities and one of the mechanisms
what did the 1898 war trigger?
an epidemic of typhoid fever
what was the stillman house?
an extension of the henry street settlement that took care of african americans
model
an idea that explains by using symbolic and physical visualization
who was appointed the head of hospital corps to recruit nurses?
anita m. mcgee
false reassurance
another communication pitfall. -rather say... lets talk about your concerns
Time critical medications
antibiotics, anticonvulsants, anticoagulants, insulin, immunosuppressive agents
apply pressure on insertion site longer if patient is taking what kind of drug
anticoagulant
Nonrebreather mask
applied as a normal mask that contains one way valves with reservoir; exhaled air does not enter reservoir bag. Can be combined with nasal cannula to provide higher inspired oxygen concentration
Unexpexted outcomes: inflamation of trach stoma or pressure area around TT
apply hydrocolloid or transparent dressing just under the stoma
how do you prepare items in catheter kit once sterile?
apply the betadine on cotton swabs, then add lubricant onto tray, then attach water filled syringe. remove plastic wrap from catheter tip
Stereotypes and Prejudices...
are irrational and illogical beliefs
Stereotypes
are simplistic, distorted images used to describe or characterize groups -they result in prejudices and negative attitudes through cultural and social interactions
politics
area of philosophy that deals with regulation & control of people living in society
what do the last 3 provisions address?
aspects of duties beyond individual patient encounters
What should you always do before donning sterile gloves?
assess pt for latex allergy
after removing old dressing (tegaderm) what do you do?
assess the site and surrounding skin again this time DO NOT TOUCH. if a culture is needed now is the time to get it
When performing central line care, what should you do first?
assess the site through the dressing by looking and palpating for signs of complications
parts to the nursing process
assess, diagnose, plan, implement, evaluate
How do you assess for pressure injuries on a dark-pigmented person?
assessment of temperature, edema, change in sensation, and change in tissue consistency is compared to surrounding skin. localized area may be purple-ish instead of red
how do you place the inner cannula back in?
at 9o'clock or 3o'clock ending at 6o'clock
empathy:
awareness of, sensitivity to, and identification with the feelings of another person -if nurses have had similar experiences, empathy is possible "i know exactly how you feel" is not usually helpful
How should you hold your gloved thumb to avoid touching the skin when donning gloves?
away from your body (hitch hike)
How do you selected a needle size?
based on weight, age, gender, condition, drug, site volume
Flexibility:
bases messages o the immediate situation rather than preconceived expectations -nurse walks into who is prepared to talk about the patients diabetes and finds them crying. They have to be flexile to show compassion to the patient -dog bite example
what is the patient instructed to do as a catheter is inserted?
bear down like they are voiding and take a deep breath and ***EXHALE DURING INSERTION***
why was the National Association for Colored Graduate Nurses formed?
because black nurses were not allowed in the ANA
why was there a shortage of primary care physicians?
because doctors worked towards specialized care...intensive care, psych, NICU, cardiology
The process of the termination phase...
begins in the orientation phase when participants estimate the length of time it will take to accomplish the desired outcomes
Reflective practice also involves...
being self-aware. Look past your own negative or positive responses to particular patients
cultural conditioning
belief that all people are basically alike and share their values and beliefs
where do you place your sterile field and drape when inserting a urinary catheter?
between pt's legs
the smaller the gauge, the ________ the needle
bigger
eschar
black or brown tissue present with full thickness destruction, necrotic or desiccated tissue
what was a problem that came about in regards to care during the civil war?
black soldiers could not be taken care of by white women
How do you place the ABD pad over the wound dressing?
blue stripe up
stress
both a response to illness and an important factor in the development of illness
Receiving gifts
both the agency's policy on gifts and your clinical faculty should also be consulted -even if you're not allowed accept a gift from families, you should acknowledge their thoughtfulness
what do the second 3 provisions address?
boundaries of duty and loyalty
ethical knowing
branch of philosophy that focuses on matters of obligation and morality
Esthetics
branch of philosophy that focuses on the critical analysis of art and beauty
Failing to recognize levels of meaning is a cause of...
breakdown -ex. its getting hot in here.... nurse and patent conversation is getting uncomfortable
Failing to see the uniqueness of each individual is a common cause of...
breakdown -preconceived ideas, prejudices, and stereotypes
grand theories
broad and complex
Philosophy
broad, connected statements about beliefs and values presents the general meaning of nursing and nursing phenomena through reasoning and logical presentation of ideas usually in the format of belief statements Potential to guide thinking and behavior
advocacy
can be defined as protecting by expressing and defending the cause of another. Thes ANA key concept. Client advocacy is a primary role of the nurse.
Hypotonic IV solution
can exacerbate a hypotensive state
The nursing process
can only begin after the nurse and patient establish establish their initial therapeutic nurse-patient relationship
Crossing professional boundaries...
can result in role confusion, risking harm to both the patient and nurse
How to measure for canes
cane should extend from greater trochanter of the hip to the floor. allow a 15-30 degree elbow flexion. should be comfortable in palm of hand
what did hospitals funded by the Hill-Burton Act have to do?
care for ALL patients
Case manager nursing
case manager (an RN) coordinates a person's care from admission through discharge and into the home setting; development of patient care plans to coordinate and provide care for complicated cases in a cost-effective manner.
removal of catheter documentation
catheter tip, how much fluid came back into the syringe, color and consistency of urine, patient tolerance
When using any bottle like saline or medicines, what should you do before using it?
check expiration date
Priestly
chemist and theologian, philosopher, educator and political theorist -communication is highly valued in healthcare
modeling
children learn how to act as an ill person by observing their parents or other adults and how they respond to major and minor illnesses
What is the perferred skin antiseptic for IV?
chlorhexidine, wait 30 seconds for it to dry; scrub vertically, horizontal, and circular; DO NOT TOUCH SITE after use
At Risk Behavior
choosing to do something that unintentionally imposes a CHANCE for harm. potential for harm is increased
what is the inner cannula in the trach tube used to do?
clean mucus off
using clean gloves, what do you do first during urinary catheter checkoff
clean perineal area with soap and water
before drawing medication from a vial, you should always
clean the top off
How to clean an intact suture line
cleans from least contaminated to most contaminated area -one stroke down the side -one stroke down the other side -one stroke down the middle (use different gauze every time) pat to dry
Evidence Based Practice
clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences
Jackson-Pratt
collects fluid in the range of 100 to 200 ml/24hr record: amount of drainage, I&O
Emotional support
comes in the form of concern for, affection, love, caring, encouragement, and conveying a sense of value to the person being supported
caregiver stress
common in families of patients with prolonged, progressive illnesses
who was jessie sleet scales?
community nurse that served african american patients with TB
Metaparadigm
comprises the most global and abstract central concepts that identify the phenomena of the discipline Nursing is comprised of: person, health, environment, nursing
Altruism
concern for welfare and well being of others
Altruism
concerned for others welfare
compassion fatigue
condition in which one experiences loss of physical energy, burn out, accident proneness, emotional breakdowns, apathy, indifference, poor judgement, and disinterest in being introspective
Translational research
conduit between bench research and bedside research*
who was phoebe pember?
confederate hospital matron
Metaphysics
consideration of the ultimate nature of existence, reality, human experience, and the universe. "What is the meaning of life?" and explore the fundamental nature of all reality.
metaphysics
consideration of ultimate nature of existence, reality, human experience, and the universe
Somatic language
consists of crying, reddening of the skin; fast shallow, breathing; facial expressions and jerking of the limbs -mothers know the difference between their childs cry -decreases with maturity
Action language
consists of reaching out, pointing, crawling toward a desired object, or closing the lips and turning the head when undesired food is offered -can be without sound
Key concepts of quantitative research
control, randomization, manipulation,
Acceptance
conveys neither approval nor disproval of patients and their personal beliefs, habits, expressions of feelings or lifestyles
what did war do?
create a need for nurses
what did the nursing shortage prompt for?
creation of associate degree in nursing (ADN) programs
For ET tubes what should you always check?
cuff pressure (should be no lower than 20cm and no higher than 25H2O)
assessment
data collection-subjective- what the client says/objective- nurses take on what the client says data analysis- actual/potential
how do you prepare the label for central line?
date time and initials
What do you write on the label that goes on the side of the taped ABD pad?
date, time, initials
Politics
deals with the regulation and control of people living in society. The study the conditions of society and suggest recommendations for improving these conditions. "What makes good governments?"
Epistemology
deals with the theory of knowledge itself. It attempts to determine how we can know whether our beliefs about the world are true.
Epistemology
deals with theory of knowledge itself
what did florence nightingale try to do?
define nursing
Clinical Decision Making
defined as strategies used to understand the significance of data, identify real and potential patient problems and choose the best actions to achieve desired outcomes.
gauge
depends on viscosity of medication/amount of medication (579)
2 types of statistical tests
descriptive and inferential
Non-experimental design
descriptive or exploratory research like surveys, descriptive comparisons, evaluation studies, and historical documentary research, etc.
National Council of State Boards of Nursing (NCSBN)
detailed the subject of professional boundaries
unexpected outcomes: phlebitis
determine the cause, remove, and consider addition sites for IV insertion
Experimental design
determines the effect of an intervention or compares the responses of participants to two or more differing treatments
Underinvolvment and overinvolvment can be..
detrimental to the nurse and patient
what did this need for nurses set the stage for?
development of: 1. army nurse corps (1901) 2. navy nurse corps (1908)
A nursing philosophy should provide________ & promote _____
direction & promote effectiveness
people with unclear values lack
direction, persistence, decision making skills THUS, nurses must have clear values
how do you remove the IV catheter?
directly parallel to the vein, elevation before complete removal leads to hematomas
High flow devices
discourage entraining room air, which dilutes the inspired oxygen concentration -ventri mask -nebulizer -blender -high flow nasal cannula
what does war breed?
disease
what are nurses like in society?
diverse and global society
If hair removal is needed, how should you remove it?
do NOT use a razor, use clippers
Beneficence
do good for others
Non-maleficence
do no harm
How should you adjust your sterile gloves after donning?
do not adjust until both gloves are on. Only adjust fingers, NEVER adjust the cuffs
unexpected outcomes: IV catheter becomes occluded
do not flush
closed system
does not interact with other systems or with the surrounding environment.
Crime
doing something wrong against person or property (misdemeanor or felony)
why is there a shortage of nursing faculty?
don't make enough money as a faculty member
how do you position pt for insertion of an urinary catheter
dorsal recumbent with legs slightly bent
Nightingale pledge
dressed personal boundary questions
Transparent film
dressings are appropriate for prophylaxis on high-risk intact skin (e.g., high-friction areas), superficial wounds with minimal or no exudate, and eschar-covered wounds when autolysis is indicated and safe.
What do you apply ontop of a wound that has been freshly packed with damp gauze?
dry 4 x 4's and an ABD pad
What is the ANA code of ethics provision 5
duties to self and others -INTEGRITY is an aspect of wholeness of character and is primarily a self-concern of the individual nurse. -Nurses have a responsibility to remain consistent with both their personal and professional values
When donning sterile gloves, you take your non-dominant hand to touch which part of the glove?
edge of the cuff
what did team nursing result in?
efficient but fragmented care
what are electronically medical records trying to do?
eliminate error
Helpful responding techniques:
empathy, open-ended questions, giving information, reflection, silence
Failure to maintain professional boundaries with a patient is an offense reportable to your....
employer and/or your state board of nursing and violates nursing code of ethics
What should you do if a patient cant hold their breath for 3 seconds using an IS?
encourage them to do their best and try to extend the duration of breath holding. allow them to rest between breaths to prevent hyperventilation and fatigue
Output
end result or product of the system
How should a patient be sitting while using an IS?
erect (high fowlers)
what did Nursing: Scope and Standards of Practice, 2nd edition outline?
expectations of the professional role of practice
negligence
failure to use a degree of care that a prudent, ordinary person would use under the same/similar circumstances
What would do if the pt ambulating began to fall?
fall with them. Let them slide down your knee"
who was sojourner truth?
famous abolitionist
descriptive theories
first level of theory development
what did the NLN administer in 1950?
first nationwide State Board Test Pool Examination
Nurse Training School of Women's Hospital of Philadelphia
first permanent training school of nursing in the U.S.
nurse
first reviews the order, then administers the medication, finally monitor the pt
what did she found?
first training schools (anyone could be a nurse before)
How do you clean the centrel line site?
first with alcohol going in a rainbow pattern not cleaning over same spot twice. then vigorously clean with chloroprep for a minimum of 30 seconds and allow to dry. apply biopatch and tegaderm after
what did richard hall make?
five point model of a profession
who was the founder of modern nursing?
florence nightingale
for negative pressure displacement devices
flush, clamp catheter, then disconnect syringe
for positive pressure displacement devices
flush, disconnect syringe, then clamp catheter
Quality Improvement
focuses on improvement of health care-related processes, systems, satisfactions, and cost outcomes.
Nursing research
focuses on patients' responses amenable to nursing care All research must be rigorously planned, carefully implemented, and analyzed meticulously.
What can a displaced mask do?
force the pt's jaw inward obstructing the airway
Hotel-Dieu
founded by the Augustinian Sisters in Paris in 651 AD
who was clara barton?
founder of the american red cross
value
freely chosen principles, ideals, standards held by an individual, class or group that give meaning and direction to life
regarding licensure, what happened in 1947?
fully mandated licensure (started in NY)
what did the Hill-Burton Act (1946) provide?
funds to construct hospitals across the country
Factors influencing perception, evaluation, and transmission
gender, age, culture of sender and receiver; interest and mood of both parties; value, clarity and length of message; the presence or absence of feedback; and the context all are powerful influences -needs, values, self concepts, sensory and intellectual abilities or deficit and sociocultural conditioning
When removing tape from the skin, how should it be pulled?
gently TOWARD the wound/suture line
How do you fill a wound with dressing?
gently packed (gauze has been "fluffed") filling the wound and avoiding the periwound area
Stat medication
give a single dose of medications IMMEDIATELY and ONLY ONCE (used in emergencies)
How do you remove gloves?
glove to glove and then skin to skin away from other people and downward towards the trashcan
what is the goal to improve recording and access of medical information?
go paperless
Silence:
good for emotions and growing communication relationships -sitting quietly with patients who just found out bad news
during WWII what was done to increase the number of nurses?
government gave money to nursing education
what is team nursing?
group of patients cared for by a group of caregivers
Defamation of Character -Slander -Libel
harming ones character by -Slander:oral or spoken -Libel:written
The nursing profession is responsible for improving its own image. The most effective avenue for changing the image of nursing is to:
have nurses appear and behave? professionally and explain what nurses do in each patient interaction
what do medicare and medicade (1965) ensure?
health care for the elderly, poor, and disabled
"sea change"
help physicians and nurses collaborate more effectively
EID
help regulate flow of IV ml/hr
Focusing on evidence of effective interventions
helps prevent nursing practice from deteriorating into routine or traditional care.
wound healing process
hemostasis: clotting factors activate inflammation: allowing plasma and blood cells to leak into the wound, noted as edema, exudate, erythema. Leukocytes arrive proliferation: new granulation tissue is formed, collagen is synthesized, reduced size of wound maturation: collagen is remolded to become stronger and provide tensile strength to the wound pg.1013
Florence Nightingale is often credited as being the first nurse researcher. This designation is based on:
her use of data on the morbidity and mortality of soldiers in hospitals in Scutari
what was the henry street settlement the start of?
home visiting nurses
Traditional nurse patient relationship
hospitalized patents are acutely ill, nurses workloads have increased, and the time nurses spend with patients may be limited
who delineated characteristics that indicate an occupation is moving toward professional status?
houle
