funds exam 4

what age is testicular cancer more common

20-34

30 ml= _________ - amount of medication prescribed __________ - weight or volume of medication available in units supplied by the pharmacy, May be on label as contents of a tablet or capsule May be the amount of medication dissolved per unit volume of liquid _________- basic unit or quantity of the medication that contains the dose on hand aka 1 tablet or ml on hand formula:_________

2tsp Dose ordered (D) Dose on hand (H) Amount on hand (V) D/H x V

agency specific polices for restraints

A physician order is required, based on face-to-face assessment of client Order must state type of restraint, location, and specific client behaviors, time frame for use Cannot be ordered prn (as needed) Must conduct ongoing assessment Proper documentation including behaviors and condition of body part restrained Restraint must be periodically removed

Before Meal Twice a day Hour At bedtime After Meal Whenever there is a need Every morning, every am Every day, daily Every Hour

AC, ac BID, bid H HS, hs PC, pc prn Qam QD Qh

Factors That Influence Accident/Injury Prevention

Age Developmental Stage Lifestyle Mental Status Basic needs: oxygen, nutrition, temperature Physical hazards: MVA's, poison, falls, fire, disasters, lighting, obstacles, bathroom hazards Transmission of pathogens Pollution

factors that effect bowel elimination

Age Diet Physical activity Psychological factors Personal habits Position during defecation Pain Pregnancy Surgery and anesthesia Medications(pain meds cause constipation, others cause diarrhea) Diagnostic tests

steps for seizure precautions

Assess seizure history, noting frequency, sequence of events Assess for medical or surgical conditions that will lead to seizures Inspect clients environment, prepare bed with padded side rails and head board, bed in lowest position Have an airway, suction apparatus, clean gloves and pillow visible for use

what are some risk reductions for breast cancer

BMI, aerobic activity, lower alcohol, lower fat diet, no smoking

what are typical components of a written record

Black ink; include date, time and signature; no blank spaces

regarding ostomy, what can and cannot be delegated?

Changing the pouch of a new ostomy, or an ostomy with complications, may not be delegated to UAP. Changing the pouch of an established ostomy may be delegated to UAP without a nurse's assistance, following assessment of the patient. Check with state licensing and facility policy and procedure.

what should nursing documents be ____,___,___,___ Every entry should have:_____,___,___

Clear, accurate, accessible, timely date, time, signature.

Prescriber's Role Lasix 10mg, two times a day, by mouth Demerol 75mg, every 4 hours PRN, IM

Client's name, medications name, amount and frequency of the dose, and the route of administration

[nursing diagnosis] ______- related to pain medication use, decreased fluid intake, and decreased mobility as evidenced by no stools for a few days, hypoactive bowel sounds, and a firm, tender abdomen _______ related to malabsorption as evidenced by bloating, cramping, and loose liquid stools _______- related to sphincter dysfunction as evidenced by constant dribbling of soft and liquid feces, inability to recognize the urge to defecate, and fecal staining of underclothing ________: Toileting related to impaired mobility as evidenced by need for assist of one for toileting and restriction of bed rest _______ related to bowel diversion as evidenced by refusal to discuss descending colostomy and disinterest in learning about care of ostomy

Constipation Diarrhea Bowel Incontinence Self-Care Deficit Disturbed Body Image

______: The desired dosage _____: The dosage on hand or on the container _____: The vehicle or the form in which the drug comes (tablet, capsule, liquid)

D H V

[abnormal bowel patterns] ________ is an intestinal disorder that is characterized by an abnormal frequency and fluidity of fecal evacuations. _________, often called "C. diff," is a bacterium that causes diarrhea, hand sanitizer wont work against contagion ________ refers to the loss of ability to voluntarily control fecal and gaseous discharges through the anus [bowel elimination] _________: Infrequent or difficult bowel movements; fewer than three bowel movements per week ________: Occurs when a person's breath is held while bearing down ________: Hard fecal mass in the rectum or colon that the patient is incapable of expelling, leads to nausea/vomiting _________: Production of a mixture of gases in the intestine; byproducts of digestion _________: are swollen and inflamed veins in the anus or lower rectum

Diarrhea Clostridium difficile (C. difficile) Incontinence Constipation Valsalva maneuver Impaction Flatulence Hemorrhoids

______ (electronic medical record) = a record of one episode of care _______ (electronic health record)= longitudinal record of health Government requires EHR for each ______ (as of 2014) Major components: _______,_____,____,____ ________ is integrated in the EHR.

EMR EHR person oHealth information oDiagnostic test results oOrder-entry system oDecision support Nursing process

health history for bowel elimination

Elimination pattern Characteristics of stool Routines Use of medications or enemas Presence of bowel diversion Changes in appetite Diet and fluid intake Prior medical history Emotional state Exercise patterns Presence of discomfort Social history Mobility and dexterity

______-introduction of solutions into the rectum and sigmoid colon via the anus. The increase in the volume of fluid rapidly distends the colon and irritates the intestinal mucosa lining, stimulating complete evacuation of the lower intestinal tract. Common uses of enemas _______,______,_______,______,______ Contraindications

Enema •Relief of constipation •Removal of impacted feces •Emptying of the bowel before diagnostic tests or surgery •Beginning a program of bowel training •Instill medications intracranial pressure-glaucoma, prostate surgey

administration of tap enema ____ sims means?____

Explain Pad bed Be prepared Prime Left Sims Lubricate and insert 3-4 inches Release Fluid slowly Withdrawal enema Pt. to hold 15 minutes Record Results lying flat on side

acute care topics

Falls Restraints Side rails Seizures

____stool culture, figure out cause of diarrhea, need PPE for C. diff possibility ___occult=blood in stool, positive occult=positive for blood ____illuminates upper GI for better view ___enema for lower structures, diet needed few days before ____invasive, cant drive 24 hrs after, IV started with numbing spray, might have lots of gas after ____same as EGD but lower, stool needs cleared out before for ____warn patients to drink lots of fluids and that stool will be white blue=

Fecal Specimens Fecal Occult Upper GI Series/Barium Swallow Lower GI Series/Barium Enema Upper Endoscopy (EGD) Colonoscopy barium positive for occult blood in stool

_________Role of U.S. government is to protect the health of the people by ensuring that medications are safe and effective FDA enforces medication laws ______State must conform to federal guidelines Local government regulate use of alcohol and tobacco ________- Establish individual policies to meet federal, state, and local regulations _______-State Nurse Practice Acts define the scope of nurses professional functions and responsibilities

Federal Regulations State and Local Healthcare Institutions Nursing Practice

I PASS the BATON

I-introduction P-patient A-assessment S-situation S-safety concerns the B-background A-actions T-timing O-ownership N-next

national safety goals

Identify Patients Correctly. Two identifiers, eliminate transfusion errors Improve Staff Communication. Report important test in a timely manner Use Medicines Safely. Label medications, reduce harm to patients who take anticoagulation therapy, Medication reconciliation, give a list of patients medication to next provider, and to family before discharge Use Alarms Safely. Make improvements to ensure that alarms on medical equipment are heard and responded to on time. Prevent Infections. Hand hygiene, prevent central-line infections, surgical infections, urinary tract infections, and difficult to treat infections. Identify Patient Safety Risks Identify patients at Risk for Suicide

[Risks at Developmental Stages] Infant, toddler, and preschool-_________ School-age-________ Adolescent-__________ Adult-___________ Older adult_________

Lead poisoning, choking, drowning Head injuries, strangers, improper use of seat belts Risk-taking behaviors, drinking and driving, substance abuse, STD's Risks are related to lifestyle habits-alcohol use, smoking, obesity Effects of multiple medications, chronic diseases, falls

[Individual Risk Factors] _________-Operating machinery, risk takers, stress, anxiety, fatigue, alcohol, or drug abuse ________Muscle weakness, paralysis, poor balance increase risk of falls Immobilization increases risk of emotional and physical hazards ______Cognitive impairments such as dementia, or depression increase risk of injury such as falls or burns ________-make it difficult to call for help ______Some patients are unaware of need to keep medicines and poisonings away from children, and to read expiration dates on food and medicines.

Lifestyle Impaired Mobility Sensory or Communication Impairment Language barrier Lack of Safety Awareness

reducing exposure to radiation:______

Limit the time spent near the source Make the distance from the source as great as possible (6 feet) Use shielding devices such as lead aprons Staff regularly working near radiation wear devices that track accumulative exposure.

two types of inhalers what should you include:____,____,___

Metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) Client assessment and instruction, Use of spacer Determination of doses in canister

alternatives to restraints

Orient client and families to environment Provide companionship and supervision; use trained sitters Offer divisional activities Assign confused patients to room near nursing station Use de-escalating, time-out, when managing aggressive behaviors Promote relaxation and normal sleep patterns Attend to toileting, food, and liquid needs Evaluate all medications patient is receiving

[bowel diversions] ______ refers to the surgically created opening in the gastrointestinal, urinary, or respiratory organs, which is exited onto the skin. The ______is the actual protuberance of the organ through the skin. A ______ is surgically created when a portion of the colon (large intestine) or the rectum is removed and the remaining colon is brought through the abdominal wall. if ascending colon has stoma____ if transverse____ if sigmoid___

Ostomy stoma colostomy right sided tumor need bag may need bag

[Risks in the Healthcare Agency] Medical Errors. ________Accidents other than falls in which the patient is the primary reason for the accident (seizure, fire setting, self-inflicted cuts _______Accidents caused by health care providers (medication and fluid errors, improper performance of procedures such as dressing changes, catheterization) _________accidents that are equipment relates result from the malfunction, disrepair, or misuse of equipment or from an electrical hazard

Patient-Inherent Accidents. Procedure-Related Accidents Equipment-Related Accidents.

pros of EHR cons

Permit Computerized Provider Order Entry (CPOE) Can offer decision support Enhance communication Provide cost savings Increase delivery of guideline-based care Increase productivity Decrease errors and storage space Allow multiple simultaneous users Support administrative processes Permit Computerized Provider Order Entry (CPOE) Can offer decision support Enhance communication Provide cost savings Increase delivery of guideline-based care Increase productivity Decrease errors and storage space Allow multiple simultaneous users Support administrative processes

steps if seizure occurs

Position client safely: If client is sitting or standing, guide client to floor and protect head by cradling in lap or placing pillow under head Clear surrounding area of furniture If client is in bed, raise side rails, add padding, and put bed in lowest position If possible, turn on side, with head flexed slightly forward Do not retrain or place anything in mouth unless needed for airway Stay with client, observing sequence and timing of seizure activity After seizure, explain what happened and answer questions Assist client to comfortable position with padded side rails up and bed lowest position Place call light in reach and provide quiet nonstimulating environment Inform physician and document occurrence

seizure precautions

Protecting the client from traumatic injury Positioning the client for adequate ventilation, and oral secretions Providing privacy Support following a seizure

purpose of nasal gastric tubes-designed to put thing in and take things out, should be open not clamped

Pull Gastric Secretions Out Decompress Bowel Provide Nutrition Medication Route

for fires:_____

R- Rescue and remove all patients in immediate danger. A- Activate the alarm. Always do this before attempting to extinguish even a minor fire. C- Confine the fire by closing doors and windows and turning off oxygen and electrical equipment. E- Extinguish the fire using an appropriate extinguisher

when are restraints necessary

Reduce the risk of injury to others by clients such as disruptive or agitated behavior Reduce risk for injury from falling Prevent interruption of therapy such as NG, IV, Foley catheter Prevent the confused or combative client from removing life support equipment such as wrist restraints for patient on a ventilator for serious complications

[types of enema] _____-safest, exerts same osmotic pressure as fluids in interstitial space surrounding bowel ______- creates intestinal irritation to stimulate peristalsis, only pure castile soap is safe ______- hypotonic, escapes into interstitial spaces, volume stimulates defecation-never repeat-fluid overload _______-exerts osmotic pressure that pulls out of interstitial space, colon fills with fluid and distention causes defecation-low volume needed _______- lubricates the rectum and colon _______- enemas containing medications such as antibiotics or Kayexalate for high K+ levels ______- solution is administered and then drained to promote peristalsis and passing of flatus

Saline Soapsuds Tap water Hypertonic Oil retention Medicated Free flow

fall prevention

Side rails Locks on beds and wheelchairs Safety bars on toilets Call lights in reach Bedside items within reach Rubber tips on assistive devices Proper transfers Nonskid footwear

[SBAR} What is happening at the current time? What are the circumstances leading up to this situation? What does the nurse think the problem is? What should we do to correct the problem?

Situation Background Assessment Recommendation

________ established by health organization, Should agree with The Joint Commission's standards, Accessible only by authorized personnel American Nurses Association (ANA) Principles-____________________

Standards accessibility, accuracy, relevance, auditability, thoughtfulness, timeliness, and retrievability.

Types of orders _____-Until prescriber cancels _____ orders-As needed ______-one time Stat orders-right away Telephone/verbal orders Electronic orders

Standing orders prn Single orders

[distibution systems] _______-On-hand for emergencies ______-Cart with 24 hour supply ________-Agencies within are networked

Stock supply Unit dose Computer controlled/Pyxis

for skin medications:____,___,____

Use of gloves or applicators Preparation of skin Thickness of application

applying restraints

Use quick-release tie Insert two fingers under secured restraint Assess proper placement, skin integrity, pulses, temperature, color, and sensation of the restrained body part at least every 2 hours Remove every 2 hours Call light in reach, bed lowest position locked, with bed alarm on

Often limited to emergency situations If needed, must be taken by an RN who: oRepeats the order verbatim oEnters order into paper or electronic system oDocuments it as a verbal/phone order oIncludes date, time, physician's name, and RN signature Most facility policies require the physician to cosign a verbal or telephone order within a defined time period

Verbal and Telephone Orders

nurse should work closely with ____if possible Soap is not needed when cleaning the stoma; ________only should be used. There is lack of evidence on optimal pouch wear times, but changing when not necessary can cause _____ damage. It is imperative to take into account the _______factors of a person with an ostomy, when caring for the ostomy appliances. Use of ostomy skin tools and ostomy quality of life tools assists nurses in promoting ______

WOCN-ostomy nurse warm water skin psychological and coping self-esteem

for ear instillation: ________,________

Warming of solution, Straightening of canal for children and adults

U for unit IU for international unit QD, QOD, QID Trailing zero MS04, MgSO4, MS u for micrograms H.S. for half-strength or bedtime TIW for three times a week DC for discharge cc for cubic centimeter AS, AD, AU OS, OD, OU

Write "unit Write international unit Write daily, or every other day, or four times a day Never write a zero by itself after a decimal point (2.0 mg-wrong), always use a zero before a decimal point (0.25 mg-right) Write morphine sulfate, or magnesium sulfate Write mcg Write out half-strength of bedtime Write 3 times weekly Write discharge Write ml for milliliter Write left ear, right ear or both ears Left eye, right eye, or both eyes

_____self initiated action taken to promote wellness, recovery, and rehabilitation

adherence

What are the positions for awareness? what palpation approach should be used for breast exams what is the most common quadrant for breast cancer

arms relaxed at sides, hands on hips, arms raised above head, bending forward systemic, circular or spokeswheel URQ

_____patient gets 250ml every 2 hrs, has feeding bag ____nurse only flushes patient, need to check residual which experience diarrhea more?

bolus feeding pump tube feeding

Gastrointestinal system main functions: ________,_______,_________ what is the order of assessment for GI where would you palpate? where would you percuss

breakdown, absorption, and elimination inspect, auscultate, palpate, percuss abdomen and rectum start over costoverterbral angle (kidneys)

BSE=___ BSA=___ what should you inspect for? what should you inspect the nipples and areolas for?

breast self exam breast self awareness contour, skin,symmetry, size, shape, color variation, lums, masses flattening, retraction,dimpling, drainage, bruising, excoriations, MOBILITY size, shape, color, texture, lesions, discharge

______drugs that are considered to have either limited medical use or high potential for abuse and addiction Five groups(____) based on medical usefulness and potential for abuse Example: a ____narcotic has high abuse potential ***Locked drawer, counts

controlled substances I,II,III,IV,V schedule I

____-slow flow of fluid if patient is ___ _____-remover of enema?

cramping prime

Every note in a medical record must include a _________,______,______. Medical record entries cannot be _________ The __________ is the legal documentation of care provided to a patient.

date, time, and signature with credentials altered or obliterated. medical record

special considerations: Infants and children-________ Older adults:______

dont cooperate, dont want it Polypharmacy, Self-prescribing, Over-the-counter medications, Misuse, Noncompliance

_____-semirigid, curved tubes with a cuff at the distal end, needed for airway obstruction over ten days

endotracheal tubes

____Has resulted in death, injuries, fractions, lacerations, and falls Use side rail netting or covers, protective padding, and or antiskid mats to prevent mattress from being pushed to one side

entrapment

Local effects-_____,_____ Transdermal disk-_____,____ Work for ______ Always write _______on patch

estrogen, xylocaine nitro, pain control 24 hours-7days date and time

The real-time process of passing patient-specific information from one caregiver to another or among interdisciplinary team members to ensure continuity of care and patient safety is often called a _________

handoff

alternative medication routes: NG, Nasoduodenal/nasojejunal, Gastrostomy, Jejunostomy, you should always raise:____and check ____for NG hold medication if residual is____ you should ____NG meds

head of bed residual >120ml crush, mix in lukewarm water, put in syringe, flush after completeing

When an unusual and unexpected event involving a patient, visitor, or staff member occurs, an ________is completed. oExamples: fall, medication error, equipment malfunction oFactual only, objective, nonjudgmental The purpose of this report is to document the details of the incident immediately to ensure accuracy. Not part of the medical record

incident reports

Every hospital must have an Emergency Response Plan that addresses how to care for a sudden ______ of patients.

influx

____Medications used to wash out a body cavity delivered with a stream of solution: sterile water, saline, or antiseptic

irrigation

what areas to we assess for GI for objective info?

mouth, abdomen, rectum

order of gastrointestinal track

mouth, esophagus, stomach, small intestine, large intestine, anus, defecation

_______-The traditional method, Time-consuming and lengthy Problem-oriented medical record (POMR)____________

narrative oProvides a framework for documentation oDatabase oProblem list oCare plan oProgress notes oCharting for entire team in same section of record

Scope of Adherence: _________

non-adherence › partial adherence: intentional › partial adherence: non-intentional › total adherence

the GI tract is___ what position should the patient be in for insertion? what should you measure from? what tube is placed by nurses?___, by physician?___

nonsterile high fowler measure from tip of nose to ear lobe to xiphoid process NG, PEG

what does documentation include? Purpose = facilitation of information flow to support continuity, quality, and safety of care Goal: to describe facts clearly and concisely to improve communication

oDescribes the patient oDescribes the patient's health oDescribes care and services provided oIncludes dates of care

The amount to administer is always expressed in the same unit as the amount __________

on hand

for rectal suppositories:____

place patient on left side for enemas

Every 2 hours Every 4 hours Every 6 hours Every 8 hours 4 times a day Every other Day Give immediately 3 times a day

q2h q4h q6h q8h QID, qid QOD, qod STAT TID, tid

________Human, mechanical, and/or physical device that is used without the client's permission to restrict his or her freedom of movement.

restraint

____Help increase a client's mobility and or stability when in bed or when moving bed to chair Help prevent unconscious client from falling out of bed full side rails= ___

side rails restaint

what is linked to constipation? what age can you control defecation? what do you give someone for diarrhea

stress, depression, 2 ammodium, amodum

physical assessment

¥Ability to swallow ¥Gastrointestinal mobility ¥Adequate Muscle mass ¥Adequate Venous Access ¥Vital Signs ¥Body System assessment-ex bronchodilators

Client's Rights

¥Information ¥Refusal ¥Careful assessment ¥Informed consent ¥Safe administration ¥Supportive therapy ¥No unnecessary medications

assessment

¥Medication history ¥Allergies and intolerances ¥Medical History ¥Pregnancy and lactation status ¥Medication record (MAR) ¥Diet and Fluid Orders ¥Laboratory Values ¥Physical assessment

6 rights

¥Right medication ¥Right dose ¥Right client ¥Right route ¥Right time ¥Right documentation

when changing ostomy bag it is critical to:____,____,____,____,___

•Maintain skin integrity •Assess stoma healing and integrity •Prevent odors •Promote comfort •Maintain or increase self-esteem and dignity

•The goals for patients with elimination problems are structured around maintaining normal elimination patterns, returning to previous levels of function, and preventing associated risks. •Goals related to reestablishing normal bowel function and prevention of further complications include: _________________

•Patient will pass soft stools daily during hospitalization. •Patient will defecate formed stools within 24 hours. •Episodes of bowel incontinence will decrease within 48 hours after starting a toileting program. •Patient will care for self after toileting within 2 days. •Patient will participate in personal colostomy care during hospitalization.

nursing interventions:_________

•Promote regular elimination patterns •Educate on preventive screening •Diet education •Daily Weights •Encourage exercise Bedpans and commodes

insertion of NG

•Will be taught in LRC •Equipment-NG, flexiflow •High Fowlers •Measure •Add lubricant •Insert- have pt. swallow •Check placement •Tape •X-Ray