1451 Exam 1 for real this time

Risks for infection

- Disease - Environment - Inadequate hand washing - Surgery (break in skin) - Indwelling devices (IV, catheter) - Impaired circulation (prevents the body from getting rid of infection)

Current trends in nursing

- EBP -QSEN - Genomics - Nurses moving beyond the bedside - move to community based care

Common chronic and disabling health problems result in issues in regards to...

- Elimination (UTI to sepsis) - Mobility - Skin (cracked or ulsers) - Functional Ability

Joint Commission discharge requirements

- Info on safe, effective use of medications - Safe, effective use of equipment - drug-food interaction info - Techniques or rehab for functional limitations - Access to community resources - when/how to access future treatment - client/caregiver responsibility - hygiene/grooming

Issues in health care delivery

- Nursing shortage - Competency - Quality and safety in health care (Pay for performance, Patient satisfaction) - Magnet Recognition Program (Nursing-sensitive outcomes) - Nursing informatics & technological advancements - Globalization of Health Care (Vulnerable Populations)

21st century influences on nursing

- Obamacare - Emphasis in EBP - Increased chronic disease - Sex/Human Trafficking - Emerging Illnesses - Nursing shortage - Continued drug use/mental illness problems - Informatics - Globalization

National Partnership Priorities

- Patient and family engagement - Population Health - Safety/eliminating errors - Care Coordination - Palliative care for advanced illnesses - Reduce waste/overuse

IOM Nurses need to be transformed by

- Practicing to the full extent of their education and training - Becoming full partners in redesigning the health care system - Improving data collection and the information infrastructure for effective workforce planning and policy making

Levels and settings of care

- Primary Care - Community Care/Retail (minute clinics) - Home Care - Secondary and tertiary care - Long-term acute care (LTAC) - Assisted Living - Rehab - Palliative Care/Hospice - Schools and prisons

Delivery system challenges

- Regulatory Agencies (joint commission, OSHA, Centers for Medicare/Medicaid) - Utilization review - Diagnostic Related Groups - Capitation - Managed Care

breaking the chain port of entry

- Use sterile technique for invasive procedure - Use sharps containers - provide clients with their own personal care items

Social influence 20th century

- Women's Health - Human Rights - Bioterrorism threats - Demographics changes (increase in immigrants, elderly) - Medically underserved - Health care cost increase - Nursing shortage - Increased use of street drugs

Tertiary intention healing

- aka delayed primary intention - type of wound healing where wounds that are left open 3-5 days to allow edema or infection to resolve or exudates to drain and are then closed with sutures, staples or adhesive skin

Discharge planning

- begins the moment a patient is admitted. Crucial due to prospective payment system. Patient must be involved (ID their strengths, limitations, and resources) - Med Rec must be done again at discharge.

Breaking the chain: culprit

- correctly clean and sterilize - educate clients and support persons about methods to clean - cover coughs - wash hands

Breaking the chain host

- maintain skin integrity and mucous membranes - balanced diet - Immunizations

Domain of Nursing

- perspective of a profession - provides the subject, central concepts, values and beliefs, phenomena of interest, and central problems of a discipline - provides both practical and theoretical aspects of the discipline

Challenges to healthcare

- reduce cost while maintaining high level care - Improve access and coverage for more people - Encourage healthy behaviors - Increases in chronic illness - Shorter hospital stays - More people need nursing homes or home care

Disease specific isolation precautions

- use private rooms with special ventilation - cohort clients sick with same disease - gowning to prevent soiling clothes

maturation phase of wound healing

-final phase begins about 3 weeks from injury -may take up to 2 years -collagen is lysed and resynthesized by macrophages, producing storng scar tissue -scar maturation, or remodeling -scar tissue slowly thins and becomes paler

ANA Standards of Nursing Process

1. Assessment 2. Diagnosis 3. Outcomes Identification 4. Planning 5. Implementation 6 Evaluation Nursing process is the foundation of clinical decision making.

3 steps in Orem Nursing Process

1. Determine why a patient needs care 2. Design a nursing system and plan the delivery of care 3. Management of nursing systems - planning, initiating, and controlling nursing actions

Chain of infection

1. Infection agent or pathogen 2. Reservoir or source for growth 3. Portal of exit 4. Mode of transmission 5. Portal of entry 6. Susceptible host

NCSBN (National Council of State Boards of Nursing) 9 areas where nursing practice should be improved

1. Medication Errors 2. Clearly communicating patient data and clinical assessment. 3. Attentiveness/surveillance of patients 4. Clinical reasoning and judgement 5. Prevention of errors and complications 6. Interpretation of authorized provider orders 7. Interventions carried out in a timely manner 8. Professional Responsibility 9. Mandatory Reporting

5 competencies for QSEN

1. Provide Patient Centered Care 2. Teamwork and Collaboration 3. Implement EBP 4. Use quality improvement in patient care 5. Use informatics in patient care

ANA 10 Standards of Professional Performance

1. Quality of practice 2. Education 3. Professional Practice Evaluation 4. Collegiality 5. Collaboration 6. Ethics 7. EBP and Research 8. Resource utilization 9. Leadership 10. Environmental Health

5 keys of the nursing profession

1. Requires an extended education 2. Has a theoretical body of knowledge 3. Provides a specific services 4. Members have autonomy 5. The profession has a code of ethics and practice

Maslow's Hierarchy of Needs

1. physiological 2. safety 3. love/belonging 4. esteem 5. self-actualization

ANA Standards of Professional Performance

10 standards - provide a method to assure patients that they are receiving high-quality care and that measure are in place to determine if nurses meet the standards of care.

Pre-albumin

15-36 mg/dL

Functional Independence Measure (FIM)

18-item, 7-level scale that assesses severity of disability in performing basic life activities

serum albumin

3.5-5.5 g/dL Used to detect protein malnutrition

communicable disease

A disease that can be spread from one person or species to another.

Managed Care

A health insurance plan that contracts with health care providers and medical facilities to provide care for members at reduced costs. Predetermined capitated payment for each patient enrolled in the program. (HMO or PPO - you have a network)

What is health?

A state of being that people define in relation to their own values, personality, and lifestyle

Standard precautions

A strict form of infection control that is based on the assumption that all blood and other body fluids are infectious.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Accrediting agency for over 20,000 healthcare organizations and programs in the country.

School Age children

Activities like riding bike and sports can begin to cause safety issues

Wound Contamination/Infection

An exposed wound is always contaminated but not always infected! Contamination—presence of organisms without infection Infection—pathogenic organisms grow and spread, cannot be controlled by body's immune defenses

hemoglobin

An iron-containing protein in red blood cells that reversibly binds oxygen.

Continuing Care

Assisted living, respite care, adult day care centers, hospice

Healthy People 2020 Goals

Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. 10 year national goals

Sanguineous

Bloody drainage, has RBC's

Dehiscence

Bursting open of a wound, especially a surgical abdominal wound

Home Care

Care provided in a person's home to assist him or her with activities of daily living. Focuses on patient and family independence

EBP

Collecting the best evidence, evaluating the evidence, and integrating the evidence

Nursing Today

Continues to be an integration of art and science. The patient is the center of your practice.

Secondary Care

Detecting disease early, asymptomatic, conducts screenings or tests (outpatient, ER, Med Surg)

Bloodborne pathogens

Disease-causing microorganisms carried in the body by blood or body fluids, such as hepatitis and HIV. Enters the body through direct contact with broken skin and contaminated sharps.

health care needs are influenced by

Economic, social and cultural variables of a specific time in history

Mary Mahoney

First professionally trained African American nurse. Challenged perception of discrimination in nursing.

Florence Nightingale: Notes on Nursing

First to focus on infection control, sanitary situation, and quiet environment

Stage IV

Full-thickness tissue loss with exposed bone, muscle, or tendon

Agency fires

Happen in the healhcare facility frequently. Protect the patient, report the fire, contain the fire, extinguish the fire

IOM National Patient Safety Goals

Health care organizations must address high risk issues: - Med errors - Proper ID of patients - Fall reduction - pressure ulcer prevention - Infection control - Communication - CAUTI - CLABSI

Nursing Prioritization

High Priority - Immediate threat to patient survival or safety Intermediate Priority - non-emergent, non-life threatening Low Priority - actual or potential problems may or may not be related to patient's illness or disease. ABC then safety

Morse Fall Scale

History of fall give you 25 points. Fall risk at 40.

Infection process (can be up to 2 weeks)

Incubation period prodromal stage (symptoms begin to appear) Illness stage

phases of would healing

Inflammatory process (release of histamine) Hemostasis and formation of platelet plug phagocytosis granulation tissue

Developmental level infant/toddler

Injuries #1 cause of death

National Patient Safety Goals (NPSGs)

Joint Commission publishes each year. List practices that can keep people safe. (ID patients correctly, improve communication, use meds safely, prevent infection, ID patient safety risks, prevent mistakes in surgery)

Seizure precautions (hospital)

Keep the patient safe. Patients usually have a physical collapse at first so mitigating the fall. Maintain oxygenation, Pad the bed, prepare oral suction

ANA provides

Legal Framework for Nursing

Nursing Paradigm

Links person, health, environment/situation, and nursing

behavioral restraints

MD must be present, documentation Q15, order must be re-written every 4 hours, vitals monitored

Contact

MRS Wee - Multidrug resistant organisms - RSV - Skin Infection - Wound infection - Enteric infections (c. diff) - Eye infections

Healthcare risk factors

Med errors (about 60% of mistakes) Chemical use Falls (on their way to the bathroom) Equipment-related

Primary Care

Most cost effective - health promotion. Preventing the disease or health problem.

Airborne

My chicken has TB - Measles - Chicken Pox - Herpes - TB Influenza

Urine and blood culture

Normally sterile, if microorganism is present = infection

Risk factors for HAI

Number of health care employees with direct contact with the patient Types and numbers of invasive procedures Therapy received (keeping equipment clean) Length of hospitalization

Restraints

Nurse can apply restraints but needs an order within 1-2 hours, orders re-written every 24 hours, evaluated by a physician within 8 hours, document every 2 hours, start with least restrictive restraint, assess vitals hourly

Clara Barton

Nurse during the Civil War; founder of the American Red Cross

Early 20th Century

Nurses expanded and advanced practice roles were established.

Restorative Care

Nursing care that is planned to promote residents health and regain as much of their independence as possible. Home care, rehab, extended care. Requires multidisciplinary approach

Who enforces NAP laws?

Ohio Board of Nursing

American Nurses Credentialing Center (ANCC)

Organization created by the ANA to provide certification for nurses in various specialties. 14 forces of magnetism.

PICOT

P= Population I = Intervention of interest C = Comparison of interest O = Outcome T = Time

Discharge AMA

Patient must sign a form releasing the hospital and physician from any responsibility. Patient has the right to terminate healthcare, but the nurse has an obligation to discuss the possible outcomes of this decision.

Diagnostic Related Groups (DRGs)

Payment system that determines how much Medicare pays the hospital. A predetermined amount of $$ for a treatment. Due to managed care, the number of days a patient can be hospitalized is limited based on DRG's upon admission.

Components of a theory

Phenomenon Concepts Definitions Assumptions

State Boards of Nursing

Protect the public, weed out unsafe nurses and students.

A safe environment

Reduces the transmission of pathogens

Nutrition and safety

Safe storage, refrigeration and prep. Good handwashing and clean prep area are essential. Hep C can be transmitted from feces to food.

Braden Scale

Scale to assess risk for pressure ulcer. sensory perception, moisture, activity, mobility, nutrition, friction and shear. Lower the score, greater the risk

Dorthea Orem

Self Care Deficit theory

Verbal orders/telephone orders

Should only be done in an emergency. Have another person on the line to verify orders.

Droplet

Spiderman - Sepsis, scarlet fever, strep - Parvovirus, Pertussis, Pneumonia - Influenza - Diptheria - Epiglottis - Rubella - Mumps, Meningitis, - AN - Adenovirus

QSEN (Quality and Safety Education for Nurses)

Sponsered by the Robert Wood Johnson Foundation. An initiative to respond to the reports about safety and quality of patient care by the IOM.

ANA regulates

State Boards of Nursing

Capitation

System of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided; reimbursement to the hospital on a per-member/per-month basis to cover costs for the members of the plan.

Preventing home fires

Teach fire safety, keep emergency numbers by phone, have an evac plan for the family, working smoke alarms and extinguishers

The Nursing Process

The common thread uniting different types of nurses who work in varied areas. The essential core of practice for the RN to deliver patient-centered, holistic care.

evisceration

The displacement of organs outside of the body.

Magnet recognition

The hospital has clinical promotion systems and research and evidence-based practice programs; nurses have professional autonomy over their practice.

hematocrit

The percent of the volume of whole blood that is composed of red blood cells as determined by separation of red blood cells from the plasma usually by centrifugation.

proliferation phase

The second phase of wound healing, in which new tissue forms, closing off the wound.

Use of theory

Theory guides research which then guides practice

occupational therapy

Therapy based on engagement in meaningful activities of daily life (as self-care skills, education, work, or social interaction) especially to enable or encourage participation in such activities despite impairments or limitations in physical or mental functioning

Oxygen and safety

Too little and we die. Carbon monoxide triggers us to breathe so people with COPD cannot be put on too much oxygen or they don't breathe.

Nursing Delegation

Transferring the authority to perform a selected nursing task in a selected situation. Requires knowing which skills are transferable. Nurse is still responsible for the outcome.

EBP

Translating the evidence and applying it to clinical decision making. Using best evidence to make patient-care decisions

transmission-based precautions

Used in addition to standard precautions. Airborne, droplet, and contact

QI

Using systematic, data-guided approach to improve processes or outcomes

Skin infections

VCHIPS - Varicella Zoster - Cutaneous dipheria - Herpes Simplex - Impetigo - Pediculosis - Scabies and Staph

Tertiary Care

When a defect is permanent or irreversible. Minimizing negative outcomes and preventing further complications. (ICU)

Joint Commission

Working to create a culture of safety in all healthcare settings. Evaluations every 3 years.

Common skin problems

Xerosis (dry skin) Pruritus (itching) Sunburn Urticaria (hives)

Standards of Nursing Practice Definitions

a desired and achievable level of performance against which a nurse's actual performance can be compared. They direct and maintain safe and clinically competent nursing practice

Centers for Medicare and Medicaid Services (CMS)

a federal agency within the U.S. Department of Health and Human Services that is responsible for Medicare and Medicaid, among many other responsibilities. Biggest payer. Set many prices

Infection is the invasion of

a susceptible host by pathogens or microorganisms, resulting in disease.

Grand theory

a theory designed to describe and explain all aspects of a given phenomenon

Respite Care

a type of care provided for caregivers of homebound ill, disabled, or elderly patients (assess for caregiver burnout)

Skilled nursing facility

a type of nursing home that provides the most intensive nursing care available outside of a hospital

Prescriptive theory

address nursing interventions for a phenomenon, guide practice change, and predict the consequences of a specific nursing intervention

collect culture before...

administering antibiotics

National League for Nursing (NLN)

advances excellence in nursing education to prepare nurses to meet the needs of a diverse population in a changing health care environment (looks @ nursing school curriculums)

Influencing Factors

age, gender, health status, developmental status, social economics, sociocultural, family history.

Fire evacuation process

ambulatory patients and visitors first, patients requiring some assistance next, most critical to be moved last

Phenomenon

an aspect of reality that people consciously sense or experience

concepts

an idea, simple or complex and related to an object or event that comes from individual perceptual experiences

arterial ulcer

an open wound on the lower legs or feet caused by poor arterial blood flow. full thickness, punched out look. lower extremities are cool to the touch. Usually on the foot

Breaking portal of entry

avoid talking, coughing, or sneezing over open wound cover mouth and nose when sneezing or coughing

Adolescents

believe themselves to be industructable so they display risky behavior.

breaking reservoir

change dressings when wet or soiled dispose of linens properly dispose of urine and feces appropriately ensure fluid containers are covered or capped empty suction and drainage bottles end of each shift

wound cleaning

clean from wound out

medical asepsis

clean technique; involves procedures and practices that reduce the number and transfer of pathogens

definitions

communicate the general meaning of a concept

Chronic and disabling health problems

complications account for majority of deaths. Accidents are leading cause of death among young and middle-aged adults

#1 symptom of infection in older adults

confusion. Their temp is usually lower so not a good indicator

Pneumonia that develops over 6 months after hospitalization

considered HAI

Purulent

containing pus, thick and opaque

Nursing theory

contains a set of concepts, definitions, and assumptions that explain a phenomenon

Descriptive theory

developed to understand and explain human processes and responses in health and illness

Med/surg restraings

doc has 1 hour to write order, documentation every 2 hours, release and re-evaluate usage Q2

pressure ulcer with necrosis

don't stage the ulcer, just say necrosis

serous

drainage that is clear, watery, thin. Probably not infected

3 layers of skin

epidermis, dermis, subcutaneous

systemic infection

fever, increased HR and RR, malaise, nausea, vomiting, loss of appetite, enlarged lymph nodes, confusion

vocational therapist

find meaningful training education or employment after discharge. What can you do with your disability

Exudates

fluid, cells, and other substances (pus) that filter from cells or capillaries ooze into lesions or areas of inflammation

Reservoir factors

food, human tissue, Oxygen, water, temperature, PH, light

Exogenus infection

from microorganisms outside the individual

Stage III

full thickness tissue loss with visible fat

Research

generate new knowledge or validate existing knowldge based on a theory

Most important technique to control transmission of infection

handwashing

gram stain of wound, sputum, and throat

if WBC and microorganism = infection

Leukocytosis

increase in the number of white blood cells (over 11,000)

Community acquired infection

infection acquired in the community, not in a hospital (pneumonia or chicken pox)

septicemia

infection in the blood

stage I

intact skin with non-blanching redness

Increase of specific type of WBC's

left shift = increase in neutrophils

Individual risk factors

lifestyle impaired mobility sensory or communication impairment lack of safety awareness

Adult risks

lifestyle based (alcohol, stress, etc)

Droplet precautions

mask, gown, gloves. Particles greater than 5u

WBC differential

measure of the percentage of different types of white blood cells present in the blood

erythrocyte sedimentation rate (ESR)

measures time it takes for erythrocytes to settle to the bottom of a test tube (marker to show something is inflamed)

Preventing skin breakdown

mitigate incontinence, turn every 2 hours, ID at risk patients with Braden scale and nutrition assessment

skin breakdown caused by

moisture, pressure, poor nutrition, prolonged immobilization, infection

Middle Range Theory

narrower in focus and makes connections between grand theories and nursing practice

granulation tissue

new tissue that is pink/red in color and composed of fibroblasts and small blood vessels that fill an open wound when it starts to heal

Defenses against infection

normal flora, body system defenses, inflammation

Inflammatory phase of wound healing

occurs immediately after injury and lasts up to 4 days. blood clot and scab form.

Stage II

partial thickness skin loss involving epidermis, dermis, or both - skin is broken

older adult

physiological change (eye sight, sense, hearing)

restraint alternatives

place in closely supervised area, position bed in lowest position, bed alarm, place personal items close to the bed, try soothing techniques

tissue ischemia

point at which tissues receive insufficient oxygen and perfusion

Never Events

preventable errors, which may include falls, urinary tract infections from improper use of catheters, and pressure ulcers

contact precautions

private room, gown and gloves for everyone in the room

Airborne precautions

private, negative pressure room mask (N95 respirator for TB) Gown and gloves particles smaller than 5u

Iatrogenic infection

produced by treatment or from a procedure

International Council of Nurses (ICN)

promoting national associations of nurses, improving standards of nursing practice, seeking a higher status for nurses, and providing an international power base for nurses.

breaking mode of transmission

proper hand hygiene Clean stethoscope wear gloves Wear PPE when appropriate

adult day care centers

provide a variety of health and social services to specific patient populations who live alone or with family in the community. Medicare covers care for Alzheimer's patients but not for non-medical custodial care.

Skin barrier function

provides physical barrier that regulates water loss and prevents against injuries from external environment. damage to the barrier can result in dehydration, infection or inflamation

hyperemia

redness of the skin due to increased blood flow

signs/symptoms of localized infection

redness, swelling, pain or tenderness (release of histamines), presence of exudates, warmth, loss of use of affected part

Sanitizer vs. handwashing

sanitizing more effective since people are not washing hands well. However, sanitizer is not effective against c-diff spores

Extended Care Facility (LTACHS)

services that meet the health needs of clients who no longer require acute hospital care. Bridges the gap between levels of care in hospital and home.

pruritus

severe itching

asymptomatic

showing no symptoms of disease

QSEN

stands for Quality and Safety Education for Nurses, a project for preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the health care systems within which they work

Nurse Practice Act

statute in each state and territory that regulates the practice of nursing (4723 in Ohio)

Major sites for infection

surgical or traumatic wounds, urinary and respiratory tracts, bloodstream

assumptions

taken for granted statements that explain the nature of the concepts, definitions, purpose, relationships and structure of a theory

surgical asepsis

techniques used to destroy all pathogenic organisms, also called sterile technique

instrumental activities of daily living (IADLs)

the activities of daily living needed for independent living (housekeeping, cooking, grocery shopping)

Orem's Self Care Agency

the individual's ability to perform self-care activities. 2 agents - the patient and the caregiver

Scope of Nursing Practice

the range of roles, functions, responsibilities and activities which a registered nurse is educated, competent, and has authority to perform.

Primary intention healing

tissue surfaces are approximated (closed) and there is minimal or no tissue loss, formation of minimal granulation tissue and scarring

Rehab

to restore patients to their fullest physical, mental, social, vocation, and economic potential. Maximize the Patient's new reality.

Physical therapy

treatment to prevent disability or to restore functioning through the use of exercise

When to assess skin

upon admission, during routine physician visit, change in pt condition, upon every position change, transferring from one unit to another

venus stasis ulcer

usually appear on lower leg/ankle, shallow, superficial and have an irregular shape.

Colonization

when the microorganism invades the host, multiplies, but does not cause infection

symptomatic

when the pathogen causes clinical signs and symptoms

Endogenous infection

when the patient's flora becomes altered and an overgrowth results

secondary intention healing

wound in which the tissue surfaces are not approximated and there is extensive tissue loss; formation of excessive granulation tissue and scarring