Study for 1st test

Explain the purpose of a code of ethics.

(a list of written statements describing ideal behavior) The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. The nurse's primary commitment is to the patient, whether an individual, family, group, or community. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. 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. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.

List five benefits that result from client teaching.

) reduced length of stay, (2) cost-effectiveness of health care, (3) better allocation of resources, (4) increased client satisfaction, and (5) decreased readmission rates.

Discuss the three stages and consequences of the general adaptation syndrome.

-Alarm Stage - is the immediate physiologic response to a stressor -Stage of Resistance- the second phase in the general adaptation syndrome, is characterized by physiologic changes designed to restore homeostasis. -State of Exhaustion- is the last phase in the general adaptation syndrome. It occurs when one or more adaptive or resistive mechanisms are no longer able to protect the person experiencing a stressor. Once beneficial mechanisms now become destructive.

List five ethical issues common in nursing practice.

-Telling the truth -Confidentiality -Withholding and withdrawing treatment -Whislte blowing- reporting incompetent or unethical practices -Allocation of scarce resources- e process of deciding how to distribute limited life-saving equipment or procedures among several who could benefit. Such decisions are difficult. In effect, those who receive the resources have a greater chance to live, whereas those who do not may die prematurely. One strategy is "first come, first served." Another is to project what would produce the most good for the most people, although predicting the future is impossible.

Identify four ways to document a plan of care.

-Written by hand -Standardized on printed forms -Computer generated -Based on an agency's written standards or clinical pathways.

Identify the purpose of adaptation and two possible outcomes of unsuccessful adaptation.

Adaptation- (the response of an organism to change) requires the use of self-protective properties and mechanisms for regulating homeostasis. Neurotransmitters mediate homeostatic adaptive responses by coordinating functions of the central nervous system, autonomic nervous system, and endocrine system.

Differentiate task-related touch from affective touch

Affective touch- touching that demonstrates concern or affection Task related touch- personal contact that is required when performing nursing procedures

List at least five characteristics of Anglo-American culture

Aging adults live separately from their children. Status is related to occupation, wealth, and education. Common beliefs are that everyone has the potential for success and that hard work leads to prosperity. Daily bathing and use of a deodorant are standard hygiene practices. Anglo-American women shave the hair from their legs and underarms; most men shave their faces daily. Licensed practitioners provide health care. Drugs and surgery are the traditional forms of medical treatment.

Name the six components in the chain of infection.

An infectious agent A reservoir for growth and reproduction An exit route from the reservoir A means of transmission A portal of entry A susceptible hos

List five steps in the nursing process.

Assessment Diagnosed Planning Implementation Evaluation

Describe four skills that all nurses use in clinical practice.

Assessment Skills Caring Skills Counseling Skills Comforting Skills

Name eight specific types of microorganisms.

Bacteria, Virus, Fungi, Ricketts, Protozoans, Mycoplamas, Helminths. prions

Identify at least five factors that influence choice of educational nursing program.

Career goals Geographic location of schools Costs involved Length of programs Reputation and success of graduates Flexibility in course scheduling Opportunity for part-time versus full-time enrollment Ease of movement into the next level of education

Name at least three techniques for sterilizing equipment.

Chemical sterilization Free flowing steam Dry Heat

List examples of client teaching provided by nurses.

Client teaching generally focuses on combinations of the following subject areas: The plan of care, treatment, and services Safe self-administration of medications The pain assessment process and methods for pain management Directions and practice in using equipment for self-care Dietary instructions Rehabilitation programs Available community resources Plan for medical follow-ups Signs of complications and actions to take

Describe the three domains of learning.

Cognitive- is a style of processing information by listening or reading facts and descriptions Affective domain- is a style of processing information that appeals to a person's feelings, beliefs, or values Psychomotor domain- is a style of processing information that focuses on learning by doing. Box 8-2 lists some activities associated with each learning domain.

Differentiate between social communication and therapeutic verbal communication.

Communication can take place on a social or therapeutic level. Social communication is superficial; it includes common courtesies and exchanges about general topics. Therapeutic communication (using words and gestures to accomplish a particular objective) is extremely important, especially when the nurse is exploring problems with the client or encouraging expression of feelings. Techniques that the nurse may find helpful are described in

Explain psychological adaptation and two possible outcomes.

Coping mechanisms- (unconscious tactics to defend the psyche) to prevent their ego, or reality base, from feeling inadequate Coping strategies- (stress-reduction activities selected consciously) help people to deal with stress-provoking events or situations. They can be therapeutic and nontherapeutic.

List five examples of medical aseptic practices. .

Examples of medical aseptic practices include using antimicrobial agents, performing hand hygiene, wearing hospital garments, confining and containing soiled materials appropriately, and keeping the environment as clean as possible.

Describe the four forms of nonverbal communication

Kenesic- body language paralanguage Proxemics Touch

List at least five ways to demonstrate cultural sensitivity.

Language and communication style Hygiene practices, including feelings about modesty and accepting help from others Special clothing or ornamentation Religion and religious practices Rituals surrounding birth, passage from adolescence to adulthood, illness, and death Family and gender roles, including child-rearing practices and kinship with older adults Proper forms of greeting and showing respect

Describe the difference between negligence and malpractice.

Negligence- (harm that results because a person did not act reasonably) implies that a person acted carelessly. In cases of negligence, a jury decides whether any other prudent person would have acted differently than the defendant, given the same circumstances. Reasonableness is based on the jury's opinion of what constitutes good common sense. fMalpractice- is professional negligence, which differs from simple negligence. It holds professionals to a higher standard of accountability. Rather than being held accountable for acting as an ordinary, reasonable lay person, in a malpractice case the court determines whether a health care worker acted in a manner comparable to that of his or her peers. The plaintiff must prove four elements to win a malpractice lawsuit: duty, breach of duty, causation, and injury

Distinguish between a nursing diagnosis and a collaborative problem.

Nursing Diagnosis- A is a health issue that can be prevented, reduced, resolved, or enhanced through independent nursing measures. It is an exclusive nursing responsibility. Nursing diagnoses are categorized into five groups: actual, risk, possible, syndrome, and wellness Collaborative problem- are physiologic complications that require both nurse- and physician-prescribed interventions. They represent an interdependent domain of nursing practice (Fig. 2-3). The nurse is specifically responsible and accountable for the following: Correlating medical diagnoses or medical treatment measures with the risk for unique complications. Documenting the complications for which clients are at risk. Making pertinent assessments to detect complications. Reporting trends that suggest development of complications. Managing the emerging problem with nurse- and physician-prescribed measures. Evaluating the outcomes. Collaborative problems are identified on a client's plan for care with the abbreviation PC, which stands for potential complication (Table 2-3). Because a collaborative problem requires the nurse to use diagnostic processes, some nursing leaders are proposing the use of the term "collaborative diagnosis" instead

Discuss three age-related categories of learners

Pedagogy- is the science of teaching children or those with cognitive ability comparable to children Androgogy- is the principles of teaching adult learners. Gerogogy- is the unique techniques that enhance learning among older adults

dentify seven uses for medical records.

Permanent health record, Occasionally, medical records also are used to investigate quality of care in a health agency, demonstrate compliance with national accreditation standards, promote reimbursement from insurance companies, facilitate health education and research, and provide evidence during malpractice lawsuits.

Name three levels of prevention that apply to reducing or managing stress-related disorders.

Primary prevention- involves eliminating the potential for illness before it occurs. An example is teaching principles of nutrition and methods to maintain normal weight and blood pressure to adolescents. Secondary prevention- includes screening for risk factors and providing a means for early diagnosis of disease. An example is regularly measuring the blood pressure of a client with a family history of hypertension. Tertiary prevention- minimizes the consequences of a disorder through aggressive rehabilitation or appropriate management of the disease. An example is frequently turning, positioning, and exercising a client who has had a stroke to help restore functional ability.

Discuss the shortage of nurses and methods to reduce the crisis.

SHORTAGE : Increased aging population requiring health care Disappointing salaries for nurses with longevity employment Job dissatisfaction as a result of stress and the unrelenting rigor of working in health care Heavier workloads and sicker clients Publicity about mandatory overtime Downsizing nursing staff from dwindling revenues and managed care policies Negative stereotypes for traditionally female occupations like nursing The federal government has addressed the shortage of nurses by approving the American Recovery and Reinvestment Act in 2009. This legislation authorizes the following: Loan repayment programs and scholarships for nursing students Funding for public service announcements to encourage more people to enter nursing Career ladder programs to facilitate advancement to higher levels of nursing practice Establishment of nurse retention and client safety enhancement grants Grants to incorporate gerontology into nursing curricula Loan repayment programs for nursing students who agree to teach after graduation

Differentiate between source-oriented and problem-oriented records.

Source oriented records- (records organized according to the source of documented information). This type of record contains separate forms on which physicians, nurses, dietitians, physical therapists, and other health care providers make entries about their own specific activities in relation to the client's care Problem oriented records- (records organized according to the client's health problems). In contrast to source-oriented records that contain numerous locations for information, problem-oriented records contain four major components: the database, the problem list, the plan of care, and the progress notes

Define stress and list factors that affect the stress response

Stress- is the physiologic and behavioral responses to disequilibrium. It has physical, emotional, and cognitive effects

Describe two types of ethical theories.

Teology- is ethical decision making based on final outcomes. It is also known as utilitarianism because the ultimate ethical test for any decision is based on what is best for the most people. Stated from a different perspective, teleologists believe "the end justifies the means. Deontology- is ethical decision making based on duty or moral obligations. It proposes that the outcome is not the primary issue; rather, decisions must be based on the morality of the act itself. In other words, certain actions are always right or wrong regardless of circumstancesis ethical decision making based on duty or moral obligations. It proposes that the outcome is not the primary issue; rather, decisions must be based on the morality of the act itself. In other words, certain actions are always right or wrong regardless of circumstances

Identify four sources of assessment data.

The primary source of information is the client. Secondary sources include the client's family, reports, test results, information in current and past medical records, and discussions with other health care workers.

Name six types of laws

The six categories of laws are constitutional, statutory, administrative, common, criminal, and civil

Name three ways that nurses used their skills in the early history of US nursing.

They offered their services to fight yellow fever, typhoid, malaria, and dysentery during the Spanish-American War. They replenished the nursing staff in military hospitals during World Wars I and II (Fig. 1-3). They worked alongside physicians in Mobile Army Surgical Hospitals (MASH) during the Korean War, acquiring knowledge about trauma care that later would help reduce the mortality rate of US soldiers in Vietnam. More recently, nurses again answered the call during the conflicts in Iraq and Afghanistan. Whenever and Whenever and wherever there has been a need, nurses have put their own lives on the line.

Describe four characteristics of culturally sensitive care.

To provide culturally sensitive care, nurses must become skilled at managing language differences, understanding biologic and physiologic variations, promoting health education that will reduce prevalent diseases, and respecting alternative health beliefs or practices.

Explain the difference between intentional and unintentional torts.

Unintentional tort- result in an injury, although the person responsible did not mean to cause harm. The two types of unintentional torts involve allegations of negligence and malpractice. are lawsuits in which a plaintiff charges that a defendant committed a deliberately aggressive act. Examples include assault, battery, false imprisonment, invasion of privacy, and defamation. Intentional Tort -are lawsuits in which a plaintiff charges that a defendant committed a deliberately aggressive act. Examples include assault, battery, false imprisonment, invasion of privacy, and defamation.

Discuss the difference between values and beliefs, and list health beliefs common among Americans.

Values- are ideals that a person feels are important (eg, knowledge, wealth, financial security, marital fidelity, health Beliefs- are concepts that a person holds to be true. Beliefs and values guide a person's actions. Both health values and beliefs demonstrate or affirm what is personally significant. When a person values health, he or she takes actions to preserve it.

Describe seven characteristics of the nursing process

Within the legal scope of nursing 2. Planned 3. Based on knowledge 4. Client Centered 5. Goal Directed 6.Prioritized 7. Dynamic Within the legal scope of nursing. Most state nurse practice acts define nursing as an independent problem-solving role that involves the diagnosis and treatment of human responses to actual or potential health problems. Based on knowledge. The ability to identify and resolve client problems requires critical thinking , which is a process of objective reasoning or analyzing facts to reach a valid conclusion. Critical thinking enables nurses to determine which problems necessitate collaboration with the physician and which fall within the independent domain of nursing. Critical thinking helps nurses select appropriate evidence-based nursing interventions for achieving predictable outcomes. Planned. The steps of the nursing process are organized and systematic. One step leads to the next in an orderly fashion. Client-centered. The nursing process makes it easier to formulate a comprehensive and unique plan of care for each client. Clients are expected, whenever possible, to actively participate in their care. Goal-directed. The nursing process involves a united effort between the client and the nursing team to achieve desired outcomes. Prioritized. The nursing process provides a focused way to resolve the problems that represent the greatest threat to health. Dynamic. Because the health status of any client is constantly changing, the nursing process acts like a continuous loop. Evaluation, the last step in the nursing process, involves data collection, beginning the process again.

Describe the process of concept mapping as an alternative learning strategy for student clinical experiences.

also known as care mapping) is a method of organizing information in graphic or pictorial form. This strategy promotes learning by having the student gather data from the client and medical record or a written case study, select significant information, and organize related concepts on a one- or two-page working document. Various formats used include a spider diagram with a central theme such as the client's medical diagnosis, a hierarchy moving from general to specific, or a flow chart (Fig. 2-6). With additional knowledge, students draw lines or arrows to link or correlate relationships within the map. Organizing the data then facilitates identifying nursing diagnoses, setting goals and expected outcomes, and evaluating the results of the care provided.

Explain why US culture is described as being anglicized (or English based).

because it evolved primarily from its early English settlers.

Define the term ethics.

ethics -moral or philosophical principles direct actions as being either right or wrong.

Describe microorganisms

living animals or plants visible only through a microscope, are commonly called "microbes" or "germs." What they lack in size, they make up for in numbers. Microorganisms are present everywhere: in the air, soil, and water, and on and within virtually everything and everyone.

List at least five principles that form the basis of the nurse-client relationship.

nderlying Principles A therapeutic nurse-client relationship is more likely to develop when the nurse treats each client as a unique person and respects the client's feelings. The nurse strives to promote the client's physical, emotional, social, and spiritual well-being, and encourages the client to participate in problem solving and decision making.

Discuss the concept of asepsis.

refers to those practices that decrease or eliminate infectious agents, their reservoirs, and vehicles for transmission. It is the major method for controlling infection. Health care professionals use medical and surgical asepsis to accomplish this goal.

List at least five factors that affect oral communication

(1) attention and concentration; (2) language compatibility; (3) verbal skills; (4) hearing and visual acuity; (5) motor functions involving the throat, tongue, and teeth; (6) sensory distractions; (7) interpersonal attitudes; (8) literacy; and (9) cultural similaritie

Identify three reasons as to why a nurse should obtain professional liability insurance.

(a contract between a person or corporation and a company willing to provide legal services and financial assistance when the policyholder is involved in a malpractice lawsuit) is necessary for all nurses. Although many agencies have liability insurance with an umbrella clause that includes its employees, nurses should obtain their own personal liability insurance. The advantage is that a nurse involved in a lawsuit will have a separate attorney working on his or her sole behalf. Because the damages sought in malpractice lawsuits are so costly, attorneys hired by health care facilities sometimes are more committed to defending the facility against liability and negative publicity, rather than defending an employed nurse whom they also are being paid to represent. Student nurses are held accountable for their actions during clinical practice and should also carry liability insurance. Liability insurance is available through the National Federation for Licensed Practical Nurses, the National Student Nurses' Association, the American Nurses Association (ANA), and other private insurance companies.

Cite examples of biologic defense mechanisms.

(anatomic or physiologic methods that stop microorganisms from causing an infectious disorder) often prevent them from producing infections. The two types of biologic defense mechanisms are mechanical and chemical. Mechanical defense mechanisms are physical barriers that prevent microorganisms from entering the body or that expel them before they multiply. Examples include intact skin and mucous membranes, reflexes such as sneezing and coughing, and infection-fighting blood cells called "phagocytes" or "macrophages."

Differentiate between data base, focus, and functional assessments.

-Database Assessment- (initial information about the client's physical, emotional, social, and spiritual health) is lengthy and comprehensive. The nurse obtains data base information during the admission interview and physical examination -Focus Assessment- is information that provides more details about specific problems and expands the original database. Focus assessments generally are repeated frequently or on a scheduled basis to determine trends in a client's condition and responses to therapeutic interventions - Functional Assaessment- is a comprehensive evaluation of a client's physical strengths and weaknesses in areas such as (1) the performance of activities of daily living (see Box 2-3 for an example that relates to bathing), (2) cognitive abilities, and (3) social functioning. The results of the functional assessment help formulate an individualized plan for care that identifies specific interventions for achieving the maximum possible functioning to ensure a better quality of life.

List five ways that a nurse's professional liability can be mitigated in the case of a lawsuit.

-Good Samaritan Laws- which provide legal immunity to passersby who provide emergency first aid to victims of accidents. -Statue of Limitations- (designated time within which a person can file a lawsuit). The length varies among states and generally is calculated from when the incident occurred. - Assumption of risk -Documentation -Risk Management(the process of identifying and reducing the costs of anticipated losses) is a concept originally developed by insurance companies. -Incident Report -Anecdotal Report (personal, handwritten account of an incident) is not recorded on any official form, nor is it filed with administrative records.

Define illness and terms used to describe illness.

-Illness (a state of discomfort) results when disease, deterioration, or injury impairs a person's health. - Several terms are used commonly when referring to illnesses: morbidity and mortality; acute, chronic, and terminal; primary and secondary; remission and exacerbation; and hereditary, congenital, and idiopathic.

Identify two national health goals targeted for the year 2020.

-Increase the proportion of people with health insurance -In the health professions, allied and associated health professions, and nursing increase the proportion of all degrees awarded to members of underrepresented racial and ethnic groups -Increase the proportion of health and wellness, and treatment programs and facilities that provide full access for people with disabilities -Reduce the number of new cases of cancer as well as the illness, disability, and death caused by cancer -Reduce infections caused by key food-borne pathogens -Improve the visual and hearing health nationally through prevention, early detection, treatment, and rehabilitation

List three parts of a nursing diagnostic statement.

-Name of the health-related issue or problem as identified in the NANDA list -Etiology (its cause) -Signs and symptoms

Differentiate primary, secondary, tertiary, and extended care.

-Primary care - (health services provided by the first health care professional or agency a person contacts) usually is given by a family practice physician, nurse practitioner, or physician's assistant in an office or clinic. Cost-conscious health care reforms advocate the provision of primary care by advanced practice nurses. -Secondary care- (health services to which primary caregivers refer clients for consultation and additional testing) is the referral of a client to a cardiac catheterization laboratory. -Tertiary care- (health services provided at hospitals or medical centers where complex technology and specialists are available) may require that a client travels some distance from home. The growing trend is to provide as many secondary and tertiary care services as possible on an outpatient basis or to require no more than 24 hours of inpatient care. -Extended care- (services that meet the health needs of clients who no longer require acute hospital care) includes rehabilitation, skilled nursing care in a person's home or a nursing home, and hospice care for dying clients. Extended care is an important component of the health care system because it allows earlier discharge from secondary and tertiary care agencies and reduces the overall expense of health care.

Name the four phases of a fever.

A fever generally progresses through four distinct phases: Prodromal phase: The client has nonspecific symptoms just before the temperature rises. Onset or invasion phase: Obvious mechanisms for increasing body temperature, such as shivering, develop. Stationary phase: The fever is sustained. Resolution or defervescence phase: The temperature returns to normal (Fig. 12-11).

Identify four common psychosocial responses when clients are admitted to a health agency.

Anxiety Fear Decisional conflict Situational low self-esteem Powerlessness Social isolation Ineffective self-health managment

Name and explain six ethical principles that apply to health care.

Beneficience - means "doing good" or acting for another's benefit. To do good, an ethical person prevents or removes any potentially harmful factor - Nonmaleficence- means "doing no harm" or avoiding an action that deliberately harms a person. Sometimes, however, "harm" is necessary to promote "good. -Autonomy- refers to a competent person's right to make his or her own choices without intimidation or influence. For a person to make a decision, he or she must have all relevant information, including treatment options in language he or she understands. -Veracity means the duty to be honest and avoid deceiving or misleading a client. -Fidelity- means being faithful to work-related commitments and obligations -Justice- mandates that clients be treated impartially without discrimination according to age, gender, race, religion, socioeconomic status, weight, marital status, or sexual orientation. In other words, everyone should have equal distribution of goods and services. -

Name three pieces of equipment for assessing blood pressure. Describe the five phases of Korotkoff sounds. Identify three alternative techniques for assessing blood pressure.

Blood pressure most often is measured with a sphymomanometer (a device for measuring blood pressure), an inflatable cuff, and a stethoscope. Phase I sounds may disappear briefly before they become reestablished, especially in older adults and in clients with high blood pressure or peripheral arterial disease. An (a period during which sound disappears) can range as much as 40 mm Hg. Failure to identify the first sound preceding an auscultatory gap results in an inaccurate blood pressure assessment from undermeasurement of the systolic pressure. Consequently, many clients with hypertension may be unidentified and thus, undiagnosed and untreated. Phase II is characterized by a change from tapping sounds to swishing sounds. At this time, the diameter of the artery is widening, allowing more arterial blood flow. Phase III is characterized by a change to loud and distinct sounds described as crisp knocking sounds. During this phase, blood flows relatively freely through the artery once more. Phase IV sounds are muffled and have a blowing quality. The sound change results from a loss in the transmission of pressure from the deflating cuff to the artery. The point at which the sound becomes muffled is considered the first diastolic pressure measurement. It is generally preferred when documenting blood pressure measurements in children. Phase V is the point at which the last sound is heard, or the second diastolic pressure measurement. This is considered the best reflection of adult diastolic pressure because phase IV is often 7 to 10 mm Hg higher than direct diastolic pressure measurements. When recording adult blood pressure measurements, the pressures at phases I and V are used. They can measure blood pressure by palpation or by using a Doppler stethoscope.

Explain how art, science, and nursing theory have been incorporated into contemporary nursing practice.

Contemporary nursing practice has added another dimension: science. The English word "science" comes from the Latin word scio, which means, "to know." A science (body of knowledge unique to a particular subject) develops from observing and studying the relationship of one phenomenon to another. By developing an accumulating body of unique scientific knowledge, it is now possible to predict which nursing interventions are most likely to produce desired outcomes, a process referred to as evidence based practice

Differentiate culture, race, and ethnicity.

Culture- values, beliefs, and practices of a particular group; (2) incubation of microorganisms -Ethics- bond or kinship a person feels with his or her country of birth or place of ancestral origin -Race - (biologic variations) is a term used to categorize people with genetically shared physical characteristics. Some examples include skin color, eye shape, and hair texture.

Name and explain at least four terms used to describe abnormal breathing characteristics.

Dyspnea- (difficult or labored breathing) is almost always accompanied by a rapid respiratory rate as clients work to improve the efficiency of their breathing. C Orthopnea- (breathing facilitated by sitting up or standing) occurs in clients with dyspnea who find it easier to breathe this way. Apnea- (the absence of breathing) is life threatening if it lasts more than 4 to 6 minutes. Prolonged apnea leads to brain damage or death. Brief periods of apnea lower oxygen levels in the blood and can trigger serious abnormal cardiac rhythms hyperventilation- (rapid or deep breathing or both

Identify the two scales used to measure temperature.

Farheinheit and Celsius

Give two reasons for using an infrared tympanic thermometer when body temperature is subnormal.

First, other clinical thermometers do not have the capacity to measure temperatures in hypothermic ranges. Second, the blood flow in the mouth, rectum, or axillae generally is so reduced that measurements taken from these sites are inaccurate.

Discuss five patterns that nurses use to administer client care.

Functional Nursing- a pattern in which each nurse is assigned specific tasks -Case Method- a pattern in which each nurse is assigned specific tasks - Team nursing- a pattern in which nursing personnel divide the clients into groups and complete their care together) is organized and directed by a nurse called "the team leader." -Primary Nursing - h the admitting nurse assumes responsibility for planning client care and evaluating the client's progress), the primary nurse may delegate the client's care to someone else in his or her absence but is consulted when new problems develop or the plan of care requires modifications. -Nursing managed care -a pattern in which a nurse manager plans the nursing care of clients based on their type of case or medical diagnosis

List examples of current trends affecting nursing and health care.

Health Care The most underserved health care populations include older adults, ethnic minorities, and the poor, who delay seeking early treatment because they cannot afford it. The number of uninsured rose from 37 million in 1995 to 41.2 million in 2002. This figure now exceeds 50 million in 2009. Medicare and Medicaid benefits are being modified and reduced. Chronic illness is the major health problem. Disease and injury prevention and health promotion are priorities. Medicine tends to focus on high technology, which improves outcomes for a select few. Hospitals are downsizing and hiring unlicensed personnel to perform procedures once in the exclusive domain of licensed nurses for cost containment. There are fewer primary care physicians in rural areas. Changes in reimbursement practices have created a shift in decision making from hospitals, nurses, and physicians to insurance companies. Health care costs continue to increase despite (cost-containment strategies used to plan and coordinate a client's care to avoid delays, unnecessary services, or overuse of expensive resources). (strategy for controlling health care costs by paying a fixed amount per member) encourages health providers to limit tests and services to increase profits. Hospitals, practitioners, and health insurance companies are being required to measure, monitor, and manage quality of care. Nursing Enrollments and numbers of graduates from LPN/LVN and RN educational programs are not keeping pace with projected shortages. More licensed nurses are earning master's and doctoral degrees. There continues to be a shortage of nurses in various health care settings because of decreased enrollments, retirement, attrition, and cost-containment measures. Hospital employment is decreasing. Client-to-nurse ratios in employment settings are higher. More high-acuity clients are in previously nonacute settings such as long-term and intermediate health care facilities. Job opportunities have expanded to outpatient services, home health care, hospice programs, and community health, and mental health agencies.

Identify the authoritative bases that mandate client teaching.

Health teaching is a mandated nursing activity. State nurse practice acts require health teaching, and The Joint Commission (2010) has made it a criterion for accreditation.

Identify two beliefs about the body and mind based on the concept of holism.

Holism is the foundation of two commonly held beliefs: (1) both the mind and the body directly influence humans, and (2) the relationship between the mind and the body can potentially sustain health as well as cause illness. Consequently, it is helpful to understand how the mind perceives information and makes adaptive responses. Both physical and psychological mechanisms of perception and adaptation are discussed later in this chapter.

Explain homeostasis and list categories of stressors that affect homeostasis.

Homeostasis- is a relatively stable state of physiologic equilibrium; it literally means "staying the same." Although it sounds contradictory, staying the same requires constant physiologic activity. The body maintains constancy by adjusting and readjusting in response to changes in the internal and external environment that foster disequilibrium. Stressors- Prematurity, Aging, Injury,Infection, Malnutrition Obesity, Surgery, Pain, Fever, Fatigue, Pollution Fear, Powerlessness, Jealousy, Rivalry, Bitterness, Hatred Insecurity, Gender, racial, age discrimination, Isolation, Abandonment, Poverty, Conflict in relationships Political instability, Denial of human rights,Threats to safety Illiteracy, Infertility, Guilt, Doubt, Hopelessness Pressure to join, abandon, or change religions Religious discrimination

List four types of educational programs that prepare students for beginning levels of nursing practice.

Hospital based Associate degree Bachelors Degree Masters degree

Identify at least four factors that nurses assess before teaching clients.

Literacy Sensorydeficits Cultural diffe focus & conentration

Name one historical event that led to the demise of nursing in England before the time of Florence Nightingale.

In England, the character and quality of nursing care changed dramatically when religious groups were exiled to Western Europe during the schism between King Henry VIII and the Catholic Church. The management of parochial hospitals and the ill within them fell to the state. Hospitals became poorhouses, which some characterized more accurately as "pest houses." The English state recruited the hospital labor force from the ranks of criminals, widows, and orphans, who repaid the Crown for their meager food and shelter by tending to the unfortunate sick. An example of the menial requirements for employment appears in Box 1-1. Generally, nursing attendants were ignorant, uncouth, and apathetic to the needs of their charges. Without supervision, they rarely performed even minimal duties. Infections, pressure sores, and malnutrition were a testimony to their neglect.

Explain the purpose and applications associated with the Health Insurance Portability and Accountability Act (HIPAA).

In an effort to limit casual access to the identity of clients and health information, HIPAA legislation has created several changes that affect the workplace. Some examples of these regulations include the following: The names of clients on charts can no longer be visible to the public. Clipboards must obscure identifiable names of clients and private information about them. Whiteboards must be free of information linking a client with a diagnosis, procedure, or treatment. Computer screens must be oriented away from public view; flat screen monitors are recommended because they are more difficult to read at obtuse angles. Conversations regarding clients must take place in private places where they cannot be overheard. This has led to a trend of providing private rooms for all hospitalized clients so that personal health information cannot be overheard by someone else sharing the room. Facsimile (fax) machines, filing cabinets, and medical records must be located in areas off-limits to the public. A cover sheet and a statement indicating that faxed data contain confidential information must accompany electronically transmitted information. Light boxes for examining X-rays or other diagnostic scans on which the client's name appears must be in private areas. Documentation must be kept of people who have accessed a client's record. ongress enacted the first HIPAA legislation to protect the rights of US citizens to retain their health insurance when changing employment.

Identify the three phases of the nurse-client relationship.

Introductory phase- (the period of getting acquainted Working phase- (period during which tasks are performed) involves mutually planning the client's care and implementing the plan. Termination phase- (the period when the relationship comes to an end) occurs when the nurse and client agree that the client's immediate health problems have improved

List at least five situations in which affective touch may be appropriate

Lonely Uncomfortable Near death Anxious, insecure, or frightened Disoriented Disfigured Semiconscious or comatose Visually impaired Sensory deprived

List four methods to control escalating health care costs.

Managed care organization- (MCOs) (private insurers who carefully plan and closely supervise the distribution of their clients' health care services) control costs of health care and focus on prevention as the best way to manage costs using the following techniques: Using health care resources efficiently Bargaining with providers for quality care at reasonable costs Monitoring and managing fiscal and client outcomes Preventing illness through screening and health promotion activities Providing client education to decrease the risk for disease Minimizing the number of hospitalizations of clients with chronic illness Health maintenance organization - (HMOs) are corporations that charge preset, fixed, or yearly fees in exchange for providing health care for their members. Preferred provider organizations- PPOs) are agents for health insurance companies that control health care costs on the basis of competition. PPOs create a network of a community's physicians who are willing to discount their fees for service in exchange for a steady supply of referred clients. Capitation- , a payment system in which a preset fee per member is paid to a health care provider (usually a hospital or hospital system) regardless of whether the member requires services. Capitation provides an incentive to providers to control tests and services as a means of making a profit. If members do not receive costly care, the provider makes money.

Discuss why it is important to use only approved abbreviations when charting

Many abbreviations have common meanings; however, nurses cannot assume that all abbreviations are interpreted the same universally. Some may have one meaning in one locale or agency but may mean something different or be unfamiliar in another. To avoid confusion among caregivers and misinterpretation if the chart is subpoenaed as legal evidence, each agency provides a written or computerized list of approved abbreviations and their meanings.

Discuss the physiologic data that can be inferred from a blood pressure assessment.

Measuring the blood pressure helps to assess the efficiency of the circulatory system. Blood pressure measurements reflect (1) the ability of the arteries to stretch, (2) the volume of circulating blood, and (3) the amount of resistance the heart must overcome when it pumps blood.

Name two programs that help finance health care for the aged, disabled, and poor.

Medicaid-(services that meet the health needs of clients who no longer require acute hospital care) includes rehabilitation, skilled nursing care in a person's home or a nursing home, and hospice care for dying clients. Extended care is an important component of the health care system because it allows earlier discharge from secondary and tertiary care agencies and reduces the overall expense of health care. Medicare- (a federal program that finances health care costs of persons aged 65 years and older, permanently disabled workers of any age and their dependents, and those with end-stage renal disease) is funded primarily through withholdings from an employed person's income.

Differentiate between medical and surgical asepsis.

Medical Asepsis- means those practices that confine or reduce the numbers of microorganisms. Also called clean technique, it involves measures that interfere with the chain of infection in various ways. The following principles underlie medical asepsis: Microorganisms exist everywhere except on sterilized equipment. Frequent hand hygiene and maintaining intact skin are the best methods for reducing the transmission of microorganisms. Blood, body fluids, cells, and tissues are considered major reservoirs of microorganisms. Personal protective equipment such as gloves, gowns, masks, goggles, and hair and shoe covers serve as a barrier to microbial transmission. A clean environment reduces microorganisms. Certain areas—the floor, toilets, and the insides of sinks—are more contaminated than others. Cleaning should be done from cleaner to dirtier areas. Surgical asepsis- surgical asepsis: measures that render supplies and equipment totally free of microorganisms

List six components generally found in any client's medical record

NAME OF FORM CONTENT Fact sheet Provides information such as the client's name, date of birth, address, phone number, religion, insurer, admitting physician, admitting diagnosis, person to contact in case of emergency, and emergency phone number Advance directive Provides instructions about the client's choices for care should he or she be unable to make decisions later History and physical examination Contains the physician's review of the client's current and past health problems, results of a body system examination, medical diagnosis, and tentative plan for treatment Physician's orders Identifies laboratory and diagnostic tests, diet, activity, medications, intravenous fluids, and clinical procedures (instructions for changing a dressing, inserting tubes, and so forth) on a day-by-day basis Physician's or multidisciplinary progress notes Describes the client's ongoing status and response to the current plan of care, and potential modifications in the plan Nursing admission database Documents information concerning the client's health patterns and initial physical assessment findings Nursing or multidisciplinary plan of care Identifies client problems, goals, and directions for care based on an analysis of collected data Graphic sheet Displays trends in the client's vital signs, weight, and daily summary of fluid intake and output Daily nursing assessment and flow sheet Indicates focused physical assessment findings by individual nurses during each 24-hour period and the routine care that was provided Nursing notes Provides narrative details of subjective and objective data, nursing actions, response of the client, outcomes of communication with other health care personnel, or the client's family Medication administration record Identifies the drug name, date, time, route, and frequency of drug administration as well as the name of the nurse who administered each medication Laboratory and diagnostic reports Contains the results of tests in a sequential order Discharge plan Indicates the information, skills, and referral services that the client may need before being released from the agency's care Teaching summary Identifies content that was taught, evidence of the client's learning, and need for repetition or reinforcement

Describe the rationale for setting priorities.

Not all clients' problems can be resolved in a brief time. Therefore, it is important to determine which problems require the most immediate attention. This is done by setting priorities. Prioritization involves ranking, from those that are most serious or immediate to those of lesser importance. There is more than one way to determine priorities. One method nurses frequently use is Maslow's Hierarchy of Human Needs (see Chap. 4). Problems interfering with physiologic needs have priority over those affecting other levels of needs

Describe at least five ways in which early US training schools deviated from those established under the direction of Florence Nightingale.

NIGHTINGALE SCHOOLS US TRAINING SCHOOLS • Training schools were affiliated with a few select hospitals. • Any hospital, rural or urban, could establish a training school. • Training hospitals relied on employees to provide client care. • Students staffed the hospital. • Education costs were borne by students or endowed from the Nightingale Trust Fund. • Students worked without pay in return for training, which usually consisted of chores. • Training of nurses provided no financial advantages to the hospital. • Hospitals profited by eliminating the need to pay employees. • Class schedules were planned separately from practical experiences. • No formal classes were held; training was an outcome of work. • Curricular content was uniform. • Curricular content was unplanned and varied according to current cases. • A previously trained nurse provided formal instruction, focusing on nursing care. • Instruction was usually informal, at the bedside, and from a physician's perspective. • The number of clinical hours during training was restricted. • Students were expected to work 12 hours a day and to live in or adjacent to the hospital in case they were needed unexpectedly. • At the end of training, graduates became paid employees or were hired to train others. • At the end of training, students were discharged and new students took their places. Most graduates sought private-duty positions.

Identify four reforms for which Florence Nightingale is responsible.

Nightingale changed the negative image of nursing to a positive one. She is credited with the following: Training women for future work Selecting only those with upstanding characters as potential nurses Improving sanitary conditions for the sick and injured Significantly reducing the death rate of British soldiers Providing classroom education and clinical teaching Advocating that nursing education should be lifelong

State three reasons that support the need for continuing education in nursing.

Nightingale is credited with having said, "to stand still is to move backwards." No basic program provides all the knowledge and skills needed for a lifetime career. Current advances in technology make previous methods of practice obsolete. Assuming responsibility for self-learning demonstrates personal accountability. To ensure the public's confidence, nurses must demonstrate evidence of current competence. Practicing according to current nursing standards helps to ensure that care is legally safe. Renewal of state licensure often is contingent on evidence of continuing education.

Discuss the evolution of definitions of nursing.

Nightingale is credited with the earliest modern definition: "putting individuals in the best possible condition for nature to restore and preserve health." One such authority was Virginia Henderson (1897 to 1996). Her definition, adopted by the International Council of Nurses, broadened the description of nursing to include health promotion, not just illness care. As stated in 1966: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 could 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. Henderson proposed that nursing is more than carrying out medical orders. It involves a special relationship and service between the nurse and the client (and his or her family). According to Henderson, the nurse acts as a temporary proxy, meeting the client's health needs with knowledge and skills that neither the client nor family members can provide. In Nursing's Social Policy Statement, 3rd edition (2010), the American Nurses Association (ANA) defines nursing as follows: Protection, promotion, and optimization of health and abilities Prevention of illness and injury Alleviation of suffering through the diagnosis and treatment of human response Advocacy in the care of individuals, families, communities, and populations

Differentiate between nonpathogens and pathogens, resident and transient microorganisms, and aerobic and anaerobic microorganisms.

Nonpathogen- nonpathogens, or normal flora (harmless, beneficial microorganisms) Pathogens- (microorganisms that cause illness) resident microorganisms: generally nonpathogens that are constantly present on the skin pathogens picked up during brief contact with contaminated reservoir transient microorgANISm- pathogens picked up during brief contact with contaminated reservoirs Aerobic- require oxygen to live, Anaerobic- whereas exist without oxygen; this difference demonstrates how varied these life-forms have become.

Discuss the purpose of nurse practice acts and the role of the state board of nursing.

Nurse practice act-(statute that legally defines the unique role of the nurse and differentiates it from that of other health care practitioners, such as physicians) is one example of a statutory law (Box 3-1). Although each state's nurse practice act is unique, all generally contain common elements: They define the scope of nursing practice. They establish the limits to that practice. They identify the titles that nurses may use, such as licensed practical nurse (LPN), licensed vocational nurse (LVN), or registered nurse (RN). They authorize a BOARD OF NURSING to oversee nursing practice. They determine what constitutes grounds for disciplinary action.- The state board of nursing is an example of an administrative agency that enforces Administrative law. Each state's board of nursing (regulatory agency for managing the provisions of a state's nurse practice act) has a primary responsibility to protect the public receiving nursing care within the state. Some activities of the state's board of nursing include (1) reviewing and approving nursing education programs in the state, (2) establishing criteria for licensing nurses, (3) overseeing procedures for nurse licensing examinations, (4) issuing and transferring nursing licenses, (5) investigating allegations against nurses licensed in that state, and (6) disciplining nurses who violate legal and ethical standards. The state's board of nursing is responsible for suspending and revoking licenses and reviewing applications asking for reciprocity (licensure based on evidence of having met licensing criteria in another state). A license in one state does not give a person a right to automatic licensure in another.

Describe the current role expectations for clients.

Nurses now encourage and expect people for whom they care to become actively involved, communicate, question, assist in planning their care, and retain as much independence as possible

List four aspects of documentation required in the medical records of all clients cared for in acute settings.

Nurses or those to whom they delegate client care are responsible for documenting: Assessment dataa Client care needs Routine care such as hygiene measures Safety precautions that have been used Nursing interventions described in the care plan Medical treatments prescribed by the physician Outcomes of treatment and nursing interventions Client activity Medication administration Percentage of food consumed at each meal Visits or consults by physicians or other health professionals Reasons for contacting the physician and the outcome of the communication Transportation to other departments, like the radiography department, for specialized care or diagnostic tests, and time of return Client teaching and discharge instructions Referrals to other health care agencies

List four temperature assessment sites and indicate the sites considered the closest to core temperature.

Oral- The oral site, or mouth, is convenient. It generally measures temperatures 0.8° to 1.0°F (0.5° to 0.6°C) below the core temperature 98.6º 37.0º . Rectal equivalent- A rectal temperature differs only about 0.2°F (0.1°C) from the core temperature. 99.5º 37.5º Axillary equivalent- The axilla, or underarm, is an alternative site for assessing body temperature. Temperature measurements from this site are generally 1°F (0.6°C) lower than those obtained at the oral site and reflect shell rather than core temperature (except in newborns 97.5º 36.4º Tympanic membrane 99.5º 37.5º Temporal artery 99.4º 37.4º

List four major steps involved in the admission process

Preparing room, safety of valuables , initial assesment, orient

Differentiate between shell and core body temperature.

Shell - warmth at the skin surface core temperature: warmth at the center of the body

Discuss appropriate circumstances for short-term and long-term goals.

Short-Term Goals Nurses use short-term goals (outcomes achievable in a few days to 1 week) more often in acute care settings because most hospital stays are no longer than 1 week. Short-term goals have the following characteristics (Box 2-7): Developed from the problem portion of the diagnostic statement Client-centered, reflecting what the client will accomplish, not the nurse Measurable, identifying specific criteria that provide evidence of goal achievement Realistic, to avoid setting unattainable goals, which can be self-defeating and frustrating Accompanied by a target date for accomplishment, the predicted time when the goal will be met; identifying a target date establishes a time line for evaluation. Long-Term Goals Nurses generally identify Components of Short-Term Goals Nursing Diagnostic Statement Constipation related to decreased fluid intake, lack of dietary fiber, and lack of exercise as manifested by no normal bowel movement for the past 3 days, abdominal cramping, and straining to pass stool Short-Term Goal The client will _____________ client-centered have a bowel movement ___________ identifies measurable criteria that reflect the problem portion of the diagnostic statement in 2 days (specify date) _________ identifies a target date for achievement within a realistic time frame

Describe three levels of care that nursing homes provide.

Skilled Nursing Facility- provides 24-hour nursing care under the direction of a registered nurse. The facility is reimbursed for the care of clients who require specific technical nursing skills. To qualify for skilled care, the client must be referred by a physician and must require daily skilled nursing care. The following are examples of common procedures that qualify: Care for a pressure ulcer Enteral feedings or intravenous fluids Bowel or bladder retraining Injectable medications Sterile dressing changes Tracheostomy care Intermediate Care Facility- This type of agency provides health-related care and services to people who, because of their mental or physical condition, require institutional care but not 24-hour nursing care. Clients who require intermediate care may need supervision because they tend to wander or are confused. They need assistance with oral medications, bathing, dressing, toileting, and mobility. Basic care facility- (an agency that provides extended custodial care). The emphasis is on providing shelter, food, and laundry services in a group setting. These clients assume much responsibility for their own activities of daily living such as hygiene and dressing, preparing for sleep, and joining others for meals. Intermediate and basic care may be provided at a skilled nursing facility but usually in separate wings.

Discuss factors that interfere with perceiving others as individuals.

Stereotyping (fixed attitudes about all people who share a common characteristic) develop with regard to age, gender, race, sexual preference, or ethnicity. Because stereotypes are preconceived ideas usually unsupported by facts, they tend to be neither real nor accurate. In fact, they can be dangerous because they interfere with accepting others as unique individuals.

Differentiate between sympathetic and parasympathetic adaptive responses.

Sympathetic nervous system- When a situation occurs that the mind perceives as dangerous, the sympathetic nervous system prepares the body for a flight or fight response. It accelerates the physiologic functions that ensure survival through enhanced strength or rapid escape. The person becomes active, aroused, and emotionally charged. Parasympathetic - The parasympathetic nervous system restores equilibrium after danger is no longer apparent. It does so by inhibiting the physiologic stimulation created by its counterpart, the sympathetic nervous system. The parasympathetic nervous system, however, does not produce an opposite reaction for every sympathetic effec

Explain the difference between systolic and diastolic blood pressure.

Systolic- pressure within the arterial system when the heart contracts) is higher than Diastolic- (pressure within the arterial system when the heart relaxes and fills with blood).

Name four types of clinical thermometers.

TYPE ADVANTAGES DISADVANTAGES Electronic Faster than glass Accurate No sterilization or disinfection needed Easy to use Expensive Recharging is necessary Probe needs to be held by the client or nurse Interference with simultaneously taking the client's pulse while holding the probe with one hand and unit in the other Infrared (tympanic) Fast Convenient Close approximation of core temperature Less invasive Accuracy unaffected by eating, drinking, or breathing Sanitary Expensive in comparison with others Battery recharging is necessary Accuracy is affected by improper placement and probe size Actual ear and core temperature ranges are slightly different from oral, rectal, and axillary sites Tip requires cleaning with a paper tissue or alcohol swab Extreme hot or cold environmental temperatures may affect electronics No sterilization or disinfection is required Infrared (temporal artery) Closest approximate of core temperature Most sanitary Most convenient for clients Records within 2 seconds Initial cost is similar to other types of electronic and tympanic membrane thermometers Probe covers are not needed; decreases volume of disposal waste Can be used over the femoral artery or lateral thoracic artery if the temporal artery is inaccessible due to bandaging or trauma User error if the thermometer is moved too quickly across the skin Hair, clothing, or bandages between the probe and the skin can result in falsely high readings Infrared probe requires cleaning between uses with an alcohol prep pad and dry swab Chemical Inexpensive Safe; nonbreakable Sanitary Temperature registers in approximately 45 seconds to 3 minutes Resets in 30 seconds Cleans easily in hot soapy water Easily used by untrained people Varying measurements at different body sites depending on blood flow and room temperature Digital Inexpensive Safe; no glass to break or potential mercury spill Memory displays last temperature Fast; records in 1-3 minutes Audible signal during or after assessment Automatic shut-off to prolong battery Battery life of 200 hours Water resistant, which facilitates cleaning Large, lighted numerical display for ease of reading Requires a battery (1.55 V) Accuracy of 0.2ºF compared with glass thermometer at 95-102.2ºF Accuracy is 0.4ºF compared with glass thermometer at <95 or >102.2ºF Glass Inexpensive Small Portable Breakable Difficult to read Cleaning necessary before use by another client Cannot sterilize using heat Time-consuming Accuracy affected by eating, drinking, smoking, talking, mouth breathing, stool in rectum, vasoconstriction of skin and mucous membranes Porous; possible inaccuracy from mercury evaporation High risk for injury if broken during use Environmental pollution from mercury is possible if not properly disposed

List four physiologic components measured during an assessment of vital signs.

Temperature, Blood pressure, respiration and pulse rate

List at least four signs or symptoms that accompany a fever.

The following are common signs and symptoms associated with a fever: Pinkish, red (flushed) skin that is warm to the touch Restlessness or, in others, excessive sleepiness Irritability Poor appetite Glassy eyes and a sensitivity to light Increased perspiration Headache Above-normal pulse and respiratory rates Disorientation and confusion (when the temperature is very high) Convulsions in infants and children (when the temperature is very high) Fever blisters around the nose or lips in clients who harbor the herpes simplex virus

List at least four signs and symptoms that accompany subnormal body temperature.

The following are common signs and symptoms associated with hypothermia: Shivering until body temperature is extremely low Pale, cool, and puffy skin Impaired muscle coordination Listlessness Slow pulse and respiratory rates Irregular heart rhythm Decreased ability to think coherently and use good judgment Diminished ability to feel pain or other sensations

Identify two contributing factors to the increased demand for home health care

The number of clients who receive home health care continues to rise, partly as an outcome of limitations imposed by Medicare and insurance companies on the number of hospital and nursing home days for which they reimburse care. Another factor is the growing number of chronically ill older adults in the population in need of assistance.

Give at least five examples of therapeutic and nontherapeutic communication techniques

Therapeutic- Broad opening Relieves tension before getting to the real purpose of the interaction "Wonderful weather we're having." Giving information Provides facts "Your surgery is scheduled at noon." Direct questioning Acquires specific information "Do you have any allergies?" Open-ended questioning Encourages the client to elaborate "How are you feeling?" Reflecting Confirms that the nurse is following the conversation Client: "I haven't been sleeping well." Nurse: "You haven't been sleeping well." Paraphrasing Restates what the client has said to demonstrate listening Client: "After every meal, I feel like I will throw up." Sharing perceptions Shows empathy for the client's feelings "You seem depressed." Clarifying Avoids miAvoids misinterpretation "I don't quite understand what you're asking." Confronting Calls attention to manipulation, inconsistencies, or lack of responsibility "You're concerned about your weight loss, but you didn't eat any breakfast." Summarizing Reviews information that has been discussed "You've asked me to check on increasing your pain medication and getting your diet changed." Silence Allows time for considering how to proceed or arouses the client's anxiety to the point that it stimulates more verbalization Nontherapeutic- Giving False Reassurance, cliches, Giving approval or disapproval, demanding

Name the most commonly used site for pulse assessment and three other assessment techniques that may be used.

These pulse sites are collectively called "peripheral pulses" because they are distant from the heart. Of all the peripheral pulses, the radial artery, located on the inner (thumb) side of the wrist, is the site most often used for pulse assessment. Three alternative assessment techniques can be used instead of or in addition to the assessment of a peripheral pulse. These techniques include counting the apical heart rate, obtaining an apical-radial rate, and using a Doppler ultrasound device over a peripheral artery.

Identify at least three principles of surgical asepsis.

They preserve sterility by touching one sterile item with another that is sterile. Once a sterile item touches something that is not sterile, it is considered contaminated. Any partially unwrapped sterile package is considered contaminated. If there is a question about the sterility of an item, it is considered unsterile. The longer the time since sterilization, the more likely it is that the item is no longer sterile. A commercially packaged sterile item is not considered sterile past its recommended expiration date. Once a sterile item is opened or uncovered, it is only a matter of time before it becomes contaminated. The outer 1-in. margin of a sterile area is considered a zone of contamination. A sterile wrapper, if it becomes wet, wicks microorganisms from its supporting surface, causing contamination. Any opened sterile item or sterile area is considered contaminated if it is left unattended. Coughing, sneezing, or excessive talking over a sterile field causes contamination. Reaching across an area that contains sterile equipment has a high potential for causing contamination and is therefore avoided. Sterile items that

Describe the nursing activities helpful to the care of clients prone to stress and approaches for preventing, reducing, or eliminating a stress response.

To enhance adaptation, people experiencing stress may adopt techniques from the following categories: alternative thinking, alternative behaviors, and alternative lifestyles. p. 69 p. 70 Table 5-5 Interventions for Stress Management INTERVENTION EXPLANATION Modeling Promotes the ability to learn an adaptive response by exposing a person to someone who demonstrates a positive attitude or behavior Progressive relaxation Eases tense muscles by clearing the mind of stressful thoughts and focusing on consciously relaxing specific muscle groups Imagery Uses the mind to visualize calming, pleasurable, and positive experiences Biofeedback Alters autonomic nervous system functions by responding to electronically displayed physiologic data Yoga Reduces physical and emotional tension through postural changes, muscular stretching, and focused concentration Meditation and prayer Reduces physiologic activation by placing one's trust in a higher power Placebo effect Alters a negative physiologic response through the power of suggestion

Describe how the World Health Organization (WHO) defines health.

as "a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.

Discuss three outcomes that result from an evaluation.

both the nurse and the client can speculate on what activities need to be discontinued, added, or changed.

Name four roles that nurses perform in nurse-client relationships.

caregiver, educator, collaborator, and delegator. Caregiver- is one who performs health-related activities that a sick person cannot perform independently Educator- (one who provides information) is a necessity in today's complex health care arena Collaborator- (one who works with others to achieve a common goal Delegator- (one who assigns a task to someone), he or she must know what tasks are legal and appropriate for particular health care workers to perform.

Discuss the difference between fever and hyperthermia.

fever- (a body temperature that exceeds 99.3°F [37.4°C]) is a common indication of illness hyperthermia- (excessively high core temperature) describes a state in which the temperature exceeds 105.8°F (40.6°C). At this level, the person is at extremely high risk for brain damage or death from complications associated with increased metabolic demands.

Identify five levels of human needs.

five levels of human needs (factors that motivate behavior). He grouped the needs in tiers, or a sequential hierarchy (Fig. 4-3), according to their significance: physiologic (first level), safety and security (second level), love and belonging (third level), esteem and self-esteem (fourth level), and self-actualization (fifth level).

List the steps involved in the discharge process.

generally consists of discharge planning, obtaining a written medical order, completing discharge instructions, notifying the business office, helping the client leave the agency, writing a summary of the client's condition at discharge, and requesting that the room be cleaned.

Describe the information that is documented in a plan of care

identify the what, when, where, and how for performing nursing interventions. They provide specific instructions so that all health team members understand exactly what to do for the clien

Define nosocomial infection.

infections acquired while a person is receiving care in a health care agency).

Discuss at least five characteristics unique to older adult learners

motivated by goal crisis learner undergoign degenerative changes respond to frequent feedback Experiental learning

Identify six methods of charting

narrative notes, SOAP charting, focus charting, PIE charting, charting by exception, and computerized charting.

Identify three characteristics noted when assessing a client's pulse.

pulse rate- (the number of peripheral pulsations palpated in 1 minute) is counted by compressing a superficial artery against an underlying bone with the tips of the fingers. pulse rhythm- (the pattern of the pulsations and the pauses between them) is normally regular. That is, the beats and the pauses occur similarly throughout the time the pulse is palpated pulse volume- (the quality of pulsations felt) is usually related to the amount of blood pumped with each heartbeat, or the force of the heart's contraction

Define the term "subculture" and list four major subcultures in the United States.

subculture- (unique cultural groups that coexist within the dominant culture) exist in the United States. In addition to Anglo-Americans, there are also African Americans, Latinos, Asian Americans, and Native Americans

Explain the concept of holism.

the sum of physical, emotional, social, and spiritual health) determines how "whole" or well a person feels. Any change in one component, positive or negative, automatically creates repercussions in the others

Explain the difference between transferring clients and referring clients.

transfer- (discharging a client from one unit or agency and admitting him or her to another without going home in the interim) may occur when a client's condition improves or worsens. Referral- is the process of sending someone to another person or agency for special services. Referrals generally are made to private practitioners or community agencies.