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