Leadership ATI 2016
breach of confidentiality (ch. 3)
-nurses who disclose client information to an unauthorized person can be liable for invasion of privacy, defamation, or slander -*HIPAA rights of pts* >>client is able to obtain a copy of their medical record and to submit requests to amend erroneous or incomplete information >>a requirement for health care and insurance providers to provide written information about how medical information is used and how it is shared with other entities -->permission must be obtained before information is shared >>the pt has the right to privacy and confidentiality
Inhalation Antrhax
-occurs when a person inhales spores that are aerosolized, though it may be transmitted cutaneously as well if they come in direct contact with the spores.
smoothing
-one party attempts to "smooth" the other party, decreasing the emotional component of the conflict -often used to preserve or maintain a peaceful work environment -the focus may be on what is agreed upon, leaving conflict largely unresolved -usually a lose-lose situation
Intentional Torts
- Assault: Conduct that makes someone fearful (Threatening to put an NG tube down a pt. if they don't comply) - Battery: Intentional & wrongful physical conduct that entails injury/offensive touching - False Imprisonment: Restraint of person's liberty of movement by another party who lacks legal authority to carry out restraint (No order from Dr.)
Appropriate Delegation to An Assistive Personnel
Activities of daily living Bathing grooming Dressing toileting ambulating Feeding (without swallowing precautions) Positioning routine tasks Bed making Specimen collection intake and output Vital signs (for stable clients) Ch. 1
Can be delegated to AP (CNA)
Activities of daily living [ADLs]: -Bathing, Grooming, Dressing; -Toileting, Ambulating; -Feeding [*without* swallowing precautions] -Positioning, Bed making; Specimen collection; Intake and output (I&O); Vital signs [on *stable* clients] Can document stuff like vitals
Acute glomerulonephritis
Acute glomerulonephritis is an inflammation of the glomerular capillaries The expected symptoms include hematuria, decreased urine output, and proteinuria Clients should consume a diet low in sodium and restrict fluid intake
Adult day care
Adult day care personnel can provide constant assistance with ADLs while the family member is at work; the client can live at home during the night and evening hours.
what is advocacy?
Advocacy refers to nurses role in supporting clients by ensuring that they are properly informed, that their rights are respected and that they are receiving the proper level of care.
A nurse manager is presenting an in-service about preventing readmission of clients due to complications after joint replacement surgery. Which leadership task is the nurse performing?
Advocacy: The nurse acts as an advocate by promoting and protecting safety for staff and clients by providing information that allows staff to act autonomously.
Diminished facial affect
Affect is the outward representation of a person's internal state of being and is an objective finding A diminished affect could indicate depression, or be seen in clients who have schizophrenia This should be reported, but it is not the priority
acute pancreatitis
After addressing the pain the nurse should: rest the pancreas and reduce secretion of pancreatic enzymes, oral fluids and food are withheld during the acute phase of pancreatitis
Abuse
All healthcare providers are responsible to report any type of abuse.
What type of strategy is being used during collaboration, mediation and negotiation?
All three are conflict resolution strategies
Withdrawing consent
Consent may be withdrawn after it's given clients have the right to change their mind and nurses responsibility is to notify the surgeon if the client verbalizes a desire to stop or delay a medical procedure
Case Management
Coordinates acute care in hosp from adm to d/c to when client is home; makes referrals
role development
Cost-effective way to increase productivity, Training: Providing employees with the knowledge and skills to perform a specific duty of a job, Evaluation of training needs: Ask, Watch,and Education. Global development of employees
A nurse is reviewing a client's health care record and discovers that the client's do-not-resuscitate (DNR) order has expired. The client's condition is not stable. Which of the following actions should the nurse take? A. Assume that the client does not want to be resuscitated, and take no action if she experiences cardiac arrest. B. Write a note on the front of the provider order sheet asking that the DNR order be reordered. C. Anticipate that CPR will be instituted if the client goes into cardiopulmonary arrest. D. Call the provider to determine whether the order should be immediately reinstated.
D
A nurse manager is providing information to the nurses on the unit about ensuring client rights. Which of the following outlines the rights of individuals in health care settings? A. American Nurses Association Code of Ethics B. HIPAA C. Patient Self-Determination Act D. Patient Care Partnership
D
A nurse manager is working with a committee of nurses whose task is to update the policies for new employee orientation. The nurse manager directs the team to collect as much data as possible and recommend several options. Which of the following decision-making styles is being demonstrated by the nurse manager? A. Decisive B. Flexible C. Hierarchical D. Integrative
D
what do you do if a client is refusing surgery and is leaving against medical advise (what is the first thing)
Inform the client about the risks she may encounter by leaving the facility
The client is considered to be a primary source of information
Information obtained directly from the client (client concern) is the most accurate and provides the best information available to the nurse The client is considered to be a primary source of information.
Restraints
Nursing Interventions for restraints Implement non-pharmacological measures such as a distraction, frequent observation, or diversion Prior to application, review manufacturers instructions for correct application. Notify health care provider immediately when restraints are implemented. Remove the restraints and assess client q 2 hrs. Assess neuro vascular and neuro sensory status q 2 hrs. Leave the restraint loose enough to prevent injury. Always tie the restraint loose enough to prevent injury. Always tie the restraint to the bed frame Reassess the need for continued use.
Great Leader
One point to remember about a great leader is that they usually go by their intuition or gut instinct to make their decisions.
Performing range of motion on a client with wrist restraints.
Only one restraint should be removed at a time when performing range of motion on a client with wrist restraints
ABCD's
Open airway= highest priority breathing circulation
Time management of a Nurse
Organize care- What must be done immediately What must be done by specific time What must be done by the end of shift What can be delegated
BUDGETS
PERSONAL=Worked time and benefit time OPERATING=Electricity, maintenance, and supplies CAPITAL BUDGET=Buildings or major equipt
A nurse is planning care for a client who is placed in wrist restraints for behavioral control following a behavior change. What should be the nurses initial action?
Perform a physical assessment and review the current laboratory data. It is important for the nurse to perform a physical examination and review any test results to determine if there is an underlying cause for behavior change. Head injuries causing enter cranial pressure and medication levels not within therapeutic range can cause behavior changes.
5 Phases of the Management Process
Planning Organizing Staffing Directing Controlling
5 major functions of management
Planning, organizing, staffing, directing, and controlling
Lithium carbonate toxicity
Poor coordination is an advanced sypmtome of lithium carbonate toxicity. Mental confusion and coarse tremors are also associated with lithium levels of 1.5-2.0 mEq/L. This is the PRIORITY
nurse receiving report on four clients
Potassium 6.5
Precipitous labor
Precipitous labor is defined as labor that lasts less than 3 hr from the onset of contractions to the time of birth Precipitous labor may result from hypertonic uterine contractions, which may increase the risk for placenta abruption
Predetermined
Predetermined is used to distinguish the characteristic for implementing a new standard of care
Standard
Predetermined level of excellence that serves as a guide for practice. Have distinguishing characteristics: Predetermined, Established by authority, Communicated to and accepted by the people affected by them.
Venous thromboembolism
Wearing elastic stockings or a sequential compression device (SCD) will help prevent another complication, venous thromboembolism To prevent venous thromboembolism, the nurse should also teach leg exercises; encourage fluid intake; observe for redness, swelling, pain, or changes in mental status; and administer prescribed anticoagulants
Chemical Impairment
When confronted the employee is usually defensive and denies allocations, but it is extremely important that the unit manager confront any suspected employee immediately. Most nurses steal drugs from their place of employment
outpatient surgery gave consent
ask the client to explain the procedure that is being performed
staff not answering call light promplty
ask the client to verbalize his expectations
Right person
assess and verify the competency of the health care team member task must be within their scope of practice
Right circumstance
assess the health status and complexity of care required by client match the complexity of care demands to skill level of health care team member
RNs cannot delegate the following activities to unlicensed assistive personnel (UAP)
assessment of clients evaluation of client data nursing judgment client/family education/counseling and evaluation nursing diagnosis/nursing care planning
total client care model
assign a nurse to complete total care of a client
planning daily work priority
assign client care to staff
delegating unit short staffed. wound irrigation
assign procedure to LPN
Functional nursing model
assign specific tasks to staff
process of transferring the authority, accountability, and responsibility of a client care task to soemone else
assigning
Licensed Practical or Vocational Nurses (LPN/VN)
assist in implementing a defined plan of care and to perform procedures according to protocol assessment skills involve collecting data and are directed at differentiating normal from abnormal may reinforce information that has been given to the client by the RN competence to care for physiologically stable clients with predictable conditions the scope of practice for LPN/VNs is not the same in every jurisdiction
Authoritative, democratic or laissez faire? Work output by staff is usually high- good for crisis situations and bureaucratic settings
authoritative
Authoritative, democratic or laissez faire? makes decisions for the group, motivation by coercion
authoritative
Most managers can be categorized into the floowing three styles:
authoritative, democratic, laissez faire
mandated reporter
children or older adult clients who are being abused or neglected
community health clinic communicable diseases. nationally infection disease
chlamydia
List 10 reportable incidents
client injury unanticipated client death malfunction of equipment unanticipated adverse reactions inability to meet client needs unethical, illegal, or incompetent practice client/family complaint about care toxic spills, fires, &/or other environmental emergencies violent behavior by client/family loss of pregnancy
Client role in informed consent
client must: give it voluntarily be competent and of legal age or be emancipated receive sufficient information to make a decision based on an informed understanding of what is expected
no ortho experience
client who had a right above knee amp 24 hr ago
nurse caring for four clients. which priority
client with PVD and absent pulse
client rights understanding of teacing
clients on mental health unit can refuse meds
case management model
collaboration between disciplines to create a multidisciplinary care plan for each client
Right direction/communication
communicate in writing or orally: data that needs to be collected specific tasks expected results/time lines/follow up
advance directive
communicates clients wishes regarding end of life care if client cannot do so 2 components: living will & durable power of attorney
decrease rate of pressure ulcers
compare data from clients records regarding skin integrity
abdominal pain admitted
completing the clients initial admin assessment
Negligence
conduct that falls below the standard of care [e.g., med errors, failure to monitor a client's condition, failure to report changes in client's condition to HCP, falls that occur as result of failure to provide safety to client, failure to check equipment for proper functioning]
implied consent
consent when client with complies with instructions provided by the nurse
Right task
delegate task to appropriate levels of team members based on standards of practice, legal and facility guidelines
Shortness of breath
emergent triage category - implies that a condition exists that poses an immediate threat to life or limb
Transformational leaders
empower followers to assume responsibility for a communal vision, and personal development is a secondary outcome
discharged with post op infection, PICC
ensure that home infusion therapy has been arranged
UTI quality improvement
establish best practice guidelines for reducing the incidence of UTIs
Controlling
evaluation of staff performance and goals; ensure outcomes are being met
poor attendence
explore reasons staff are not attending
Malpractice [aka Professional Negligence]
failure of a person with professional training to act in a reasonable and prudent manner [i.e., using average judgment, foresight, intelligence, and skill that would be expected of a person w/similar training and experience]
client requests pain med. nurse fulfills a promise to return with med in 15 min. nurse demonstrates which ethical principle
fidelity
What should the nurse do if a client's IV infused over 6 hr instead of 8 hr
fill out an incident report
Transactional leaders
focus on immediate problems, maintain status quo, use rewards to motivate followers
deontological theory
focuses on human dignity as an underlying principle
transformation leadership
gives group members responsibilities that will enhance their professional development
what are benchmarks?
goals that are set to determine at what level the outcome indicators should be met (for example a specific percentage)
In an emergency triage crisis...LPN's can care for which clients?
green tag (class III)..these are non-urgent minor injuries
time management skills
groups tasks that are in the same location
Medication Error
has to be reported and incident report filed. You need to report it to the charge nurse or supervisor and they will help you, but it is your responsibility to make sure the report is written and it is reported.
Characteristics of Managers
hold formal position of authority and power possess clinical expertise network with members of the team coach subordinates make decisions about the function of the organization
aggression
hostile or violent behavior or attitudes toward another; readiness to attack or confront. the action of attacking without provocation, especially in beginning a quarrel or war. forceful and sometimes overly assertive pursuit of one's aims and interests.
mental health mechanical restraints
i should request the provider to examine the client within 1 hour of applying mechanical restraints
arguing about restock
i would like for you to approach the ap to resolve the problem
transition to practice
i. Internships ii. Residencies iii. Fellowships
the quality improvement process begins with
identification of standards and outcome indicators based on evidence.
external disaster plan activated
identify stable patients for transfer to surg unit
Restraints
if there is not an order you have to remove them immediately
reflects intrapersonal conflict
im not sure whether i want to apply for unit manager or start a family
Time management
important to help new RN's with time management and encourage them not to leave big tasks to the end of the shift.
Medication error
incident report has to be written
staff selection
including IOM 80/20 recommendation
individuals who can grant consent for another person
parent of a minor legal guardian court specified representative spouse of closest available individual who has durable power of attorney for HC (emancipated minors can provide for themselves)
incivility
rude or unsociable speech or behavior. an impolite or offensive comment.
What is an important follow up for a patient who is on warfarin?
schedule follow-up tests for PT and INR
non-urgent triage category - client can generally wait for several hours without a significant risk of clinical deterioration
swollen and bruised ankle
nurse role in informed consent
witness ensure the provider gave the necessary info ensure the client understood and is competent have the client sign notify provider if client has more questions or does not understand documenting: reinforcement of info originally given by provider, questions from client were forwarded to provider, use of an interpreter
charge managing conflict...
you always complete your work on time and do a great job.....
Performance Evaluation
your signature on the evaluation only means you have read it. It doesn't mean you agree with what is stated.
Can LPN's collect a sterile specimen from a wound?
yyes
Five Rights of Delegation
✓Right Task ✓Right Circumstances ✓Right Person ✓Right Direction/Communication ✓Right Supervision/Evaluation
PHASES OF MANAGEMENT PROCESS
-Planning -Organzing -Staffing -Directing -Controlling
Management
process of planning, organizing, directing, and coordinating the work within an organization
Delegating
process of transferring the authority and responsibility to another team member to complete a task while retaining the accountability
Assigning
process of transferring the authority, accountability, and responsibility of a client care to another member of the health care team
HIPAA
prohibits disclosing
Situations in which nurses may need to advocate for clients:
End of life decisions Access to health care Protection of client privacy Informed consent Substandard practice
Living will
what are the patient's wishes. Care is provided to keep the patient comfortable. Clarify patients concern's or wishes
team nursing
when assigning a team to care for a group of clients based on client location within the unit
Clients Health Values and Beliefs
Values concerning health may be more important to the nurse than the client. For example: "the client may believe being home for the children is more urgent than the health problem."
AP qualified
review the APs skill competency checklist
What are the rights of a nursing home patient?
right to be treated w/ dignity and respect. Right to refuse medicaitons. right to leave regardless of provider recommendations. right to be fully informed of their health conditions.
bullying
use superior strength or influence to intimidate (someone), typically to force him or her to do what one wants.
Competent nurse
usually been in practice 2-3 years demonstrate increasing levels of skill and proficiency and clinical judgment
participative leadership
*democratic* -serves as a resource person and facilitator and is non-directive -guides staff toward reaching an objective and shares responsibilities with the staff -allows creativity and development of many strategies
Time savers
*document nursing interventions ASAP (accurate and thorough documentation *grouping activities for patients *delegate to other staff when avail *take time to plan care and taking priorities into consideration
Time wasters
*documenting at the end of the shift *making repeated trips to the supply room for equip *reluctant to delegate *not asking for help *socializing with staff during client care time
Laissez-faire
*makes few decisions, little planning *lack of motivation *communication up&down chain of command *work output is low *effective with professional employees
charge nurse orienting new nurse. understands when..
"after i finish with the printout of my assignment i will put it in the shredder
pt has dnr. AP understands when states...
"i will call for the clients nurse to come to the room if i cannot detect a pulse"
Delegatee factors
* Education, training, experience *knowledge and skill to perform task *level of critical thinking required to complete task *ability to communicate with others as it pertains to the task *demonstrated competence *the delegatee's culture *agency policies and procedures
Democratic
* Includes group when decisions are made * Motivates * Communication up&down chain of command * work output is good quality
Characteristics of a good leader
* Initiative * Inspiration * energy * Positive attitude * communication skills * Respect * Problem solving and critical thinking skills
Emotional intelligence in a leader
* insight to emotions of members of the team *understand the perspective of others *encourage constructive criticism, be open to new ideas *multi-task by maintaining focus ***manages emotions and channels them in a positive direction ***refrains from judgment or emotionally charged situations until facts are gathered
Authoritative
* makes decisions for the group * motivates by coercion * communication down the chain of command * work output by staff is high (good for crisis)
delegation/supervision
*5 rights* 1. task 2. circumstance 3. person 4. direction and communication 5. supervision and evaluation -based on individual client needs, facility policies and job descriptions, state NPA, professional standards -consider the individual's education, training, and experience -RNs can delegate to: >>other RNs >>LPNs >>APs
responding to inappropriate delegation
*DO NOT DELEGATE*: -nursing process -client education -tasks that require clinical judgement to LPNs or APs *CONSIDER*: -predictability of outcome -potential for harm -complexity of care -need for problem solving and innovation -level of interaction with the client
5 Rights of delegation
*Task* - Identify what tasks are appropriate to delegate for each specific client; *Circumstance* - Assess health status and complexity of care required by client; *Person* - Assess and verify competency of team member; Communication; Supervision
time management (p. 7)
*WASTERS*: -documenting at end of shift -making repeated trips to the supply room for equipment -providing care as opportunity arises regardless of other responsibilities -missing equipment when preparing to perform a procedure -being reluctant to delegate or underdelegate -not asking for help when needed or truing to procide all client care independently
inappropriate use of restraints
*assualt*: threatening to place a NG tube in a pt who is refusing to eat *battery*: restraining a pt and administering an injection against his wishes *false imprisonment*: using restraints on a competent client to prevent his leaving the health care facility
quality monitoring tools
-
Remove an NG tube ( always very order before removal of the NG tube)
- Discontinuing a NG tube requires a provider order Therefore, confirmation of an order would be a priority before removal of the tubeNasogastric tubes can be used to provide enteral nutrition, to administer medication, and to provide gastric decompression - NG tube requires only clean technique - One purpose of NG tubes is to provide gastric decompression -The NG tube is connected to suction, which is connected to a canister to collect gastric drainage Prior to discontinuing the NG tube, the suction should be turned to the off position to prevent damage to the gastric mucosa during removal of the tube It would be important to turn off the suction - Part of the nursing process is to observe and record the color and amount of gastric drainage
What has to be proved when someone is being charged for Malpractice?
- Duty to client - Duty not carried out - Damage to Client - Cause of damage was due to failure to carry out duty
Board of Nursing has the authority to ...
- Issue and revoke nursing license - Set standards for nursing programs & delineate scope of practice for RN, LPN, and APN
Principles of Prioritization
- Life before limb (hypoglycemia before fracture) - Acute before chronic (new onset of delirium before client with Alzheimer's dementia) - Actual before potential problem (Adm diuretic for HF before ROM exercise for client with CVA) - Listen & don't assume (Accept client's report of pain, even if vitals are stable and client is resting) - Recognize trends & report them (Recognize increase in BP during shift after BP meds given) - Identify med emergencies vs. expected findings (Sudden onset of dyspnea vs. dyspnea during ambulation in client with COPD) - Application of clinical knowledge (Draw blood cultures before adm antibiotic to identify organism) - Make effective use of time by combining activities such as physical assessment with bath - Delegate when necessary
when nurse sees a change in a client's behavior such as
- Meaningless phrases, worry A mixture of words or phrases that lack meaning are characterized by loose association in clients who have schizophrenia It is an indication of disorientation, disorganization, and an alteration in mental cognition This should be the nurse's priority because of the threat to client safety and the safety of others
Unintentional Torts
- Negligence: Failure to provide care that results in damage to others - Malpractice: Improper, illegal or professional negligence that results in damage, injury, or loss
Maslow's Hierarchy of Needs
- Physiological (human survival) - Safety & Security (of body, employment, fam) - Love & Belonging (friends, fam, intimacy) - Self-esteem - Self-actualization
Client's Legal Rights
- Refuse Treatment - Right to Confidentiality - Informed Consent
Audit Process
-*structure audit* - evaluates the setting and resources available to provide care; -*outcome audit* - evaluates results of nursing care provided; -*root cause analysis* - indicated when a sentinel event occurs; -*retrospective audit* - conducted when client is no longer receiving care; -*process indicators* - measure nursing actions that are used to facilitate expected and desired outcomes in clients; -benchmark is set at beginning of process and then compared to the data after collection is completed
SMOOTHING
-1 party attempts to smooth another party by trying to satisfy the other party -Often used to preserve or maintain a peaceful work env -This focus may be on what is agreed upon, leaving conflict largely unresvoled -LOSE LOSE sit
COMPETING/COERCING
-1 party pursues a desired solution at the expense of others -Managers may use this when a quick or unpopular dec must be made -Party who loses something may experince anger, aggrevation, and desire for retibution -WIN-LOSE sit
COOPERATING/ACCOMADATING
-1 party sacrifices something, allowing the other party to get what it wants -Opposite of competing -Original prob may not actually be resolved -Solution may contribute to future conflict -LOSE-WIN sit
Continuity of Care: Referrals for Home Oxygen Therapy
-A referral is a formal request for a service by another care provider. It is made so that the client can access the care identified by the provider or the consultant -The care can be provided in the acute setting or outside the facility -Clients being discharged from health care facilities to their home can still require nursing care -Discharge referrals are based on client needs in relation to actual and potential problems and can be facilitated with the assistance of social services, especially if there is a need for: 1. Specialized equipment (cane, walker, wheelchair, grab bars in bathroom) 2. Specialized therapists (physical, occupational, speech) 3. Care providers (home health nurse, hospice nurse, home health aide) -Knowledge of community and online resources is necessary to appropriately link the client with needed services. Ch. 2
AP
-ADLS: Grooming, bathing, dressing, toileting, ambulating, feeding (without swallowing precautions!!!), positioning, bed making -Specimen collection -I&O -VS on STABLE pts -Assemble pt med records -Maintain safe env -Recognize situations to report to immediate superior -CAN NOT DO DRESSING CHANGES
delegating to AP
-ADLs -bathing -grooming -dressing -toileting -ambulating -feeding without swallowing precautions -positioning -bed making -VS for stable clients -specimen collection -I&O >>follow facility policies and stage practice guidelines
AVODIING/WITHDRAWGIN
-Both parties knowthres conflict but refuse to face it or fix -May be approp for minor confl when 1 part holds more power than other of is issue may worl itself out over time -BC conflict remains, it may surface again at later data and escalate over time -Usually LOSE LOSE sit
If nurse receives an inappropriate assignment
-Bring assignment to attention of charge nurse and negotiate new assignment; -If no resolution is arrived at, take concern up chain of command; -If no satisfactory resolution after reporting to charge nurse, file an unsafe staffing complaint w/the appropriate personnel.
MED TIMES
-Ok to give 30 min early
Legal Rights and Responsibility: Priority action to take when Floating Units
-Orient to the unit -Inform Manager about capabilities -Remain Positive -Care for patients -Ask questions/guidance from charge nurse Ch. 3
QUANTITATIVE
-Phenomenology
Coordinating Client Care: Case Management Approach
-Case management is the coordination of care provided by an interprofessional team from the time a client starts receiving care until she no longer receives services. Principles of Case Management: -Case management focuses on managed care of the client through collaboration of the health care team in acute and post acute settings -The goal of case management is to avoid fragmentation of care and control cost -A case manager collaborates with the interprofessional health care team during the assessment of a client's needs and subsequent care planning, and follows up by monitoring the achievement of desired client outcomes within established time parameters. -A case manager can be a nurse, social worker, or other designated health care professional. A case manager's role and knowledge expectations are extensive. Therefore, case managers are required to have advanced practice degrees or advanced training in this area -Case manager nurses do not usually provide direct client care -Case managers usually oversee a caseload of clients who have similar disorders or treatment regimens -Case managers in the community coordinate resources and services for clients whose care is based in a residential setting -A critical or clinical pathway or care map can be used to support the implementation of clinical guidelines and protocols. These tools are usually based on cost and length of stay parameters mandated by prospective payment systems such as Medicare and insurance companies Nursing Roles: -Coordinating care, particularly for clients who have complex health care needs -Facilitating continuity of care -Improving efficiency of care and utilization of resources -Enhancing quality of care provided -Limiting unnecessary costs and lengthy stays -Advocating for the client and family Ch. 2
Nurse should include the following in an incident report
-Client's name and hospital number, and date, time, and location of incident; -Factual description of incident and injuries incurred -avoid assumptions as to cause of incident; -Names of any witnesses to incident and any client or witness comments regarding incident; -Corrective actions that were taken, including notification of HCP and any referrals; -Name and dose of any meds or ID number of any equipment involved in incident
Informed consent - provider must give the client:
-Complete description of treatment/procedure; -Description of professionals who will be performing/participating in the treatment; -Description of potential harm, pain, and/or discomfort that might occur; -Options for other treatments; -Right to refuse treatment; -Risk involved if client chooses no treatment
Referrals: Priority Nursing Action for Discharge
-Continuity of care is desired as clients move from one: -Level of care to another, such as from the ICU to a medical unit -Facility to another, such as from an acute care facility to a skilled facility -Unit/department to another, such as from the PACU to the post surgical unit -Nurses are responsible for facilitating continuity of care and coordinating care through documentation, reporting, and collaboration -A formal, written plan of care enhances coordination of care between nurses, interprofessional team members, and providers. Ch. 2
Safety & Infection Control: Needle Stick Safety Procedures
-Dependent on policy per hospital or employer -Always fill out incident report -Prophylactic testing/treatment ch. 5
COMPROMISING/NEGOTIATING
-Each party gives something up -To consider this a WIN/LOSE WIN/LOSe sit, both parties must give up something equally imp -If 1 party give up more than the other, it can become a WIN-LOSE sit
Legal Rights and Responsibility: Mandatory Reporting of STI's
-Ensure appropriate medical treatment of diseases (tuberculosis). -Monitor for common‑source outbreaks (foodborne: hepatitis A) -Plan and evaluate control and prevention plans (immunizations for preventable diseases) -Identify outbreaks and epidemics -Determine public health priorities based on trends -Educate the community on prevention and treatment of these diseases Ch. 3
urgent triage category - implies that the client should be treated quickly
-High fever and productive cough (possibly new onset pneumonia); -possible fractured tibia
Quality Improvement: Strategies for Cost Containment
-Infection control is extremely important to prevent cross-contamination of communicable organisms and health care-associated infections -Staff education on infection prevention and control is a responsibility of the nurse -Facility policies and procedures should serve as a resource for proper implementation of infection prevention and control -Clients suspected of or known to have a communicable disease should be placed in the appropriate form of isolation -The nurse should ensure that appropriate equipment is available and that isolation procedures are properly carried out by all health care team members -Use of standard precautions by all members of the health care team should be enforced. Employees who are allergic to latex should have non-latex gloves (e.g., nitrile or vinyl) made available to them. A latex-free environment is provided for clients who have a latex allergy. Many facilities avoid the use of latex products unless there is no other alternative -Hand hygiene facilities, as well as hand sanitizer, must be readily accessible to employees in client care areas -Sturdy, moisture-resistant bags (usually red) should be used for soiled items, and the bags should be tied securely with a knot at the top. Double-bagging is not cost-effective and is unnecessary unless the outside of a bag becomes contaminated. Ch. 4
QUANTITATIVE
-Meta analysis -Experimental study -Secondary analysis
Can be delegated to LPN
-Monitoring client findings; -Reinforcement of client teaching; -Trach care; -Suctioning; -Checking NG tube patency; -Admin of enteral feedings; -Insertion of urinary catheter; -Med admin [excluding IV meds]
Delegated to LPN?
-Monitoring client findings; -Reinforcement of client teaching; -Trach care; -Suctioning; -Checking NG tube patency; -Admin of enteral feedings; -Insertion of urinary catheter; -Med admin [excluding IV meds]
TB
-Neg pressure -particulate (HEPA) masks -Airborne precautions
Coordinating Client Care Roles: Roles and Responsibilities of the Interdisciplinary Team
-Nurse‑provider collaboration should be fostered to create a climate of mutual respect and collaborative practice -Collaboration occurs among different levels of nurses and nurses with different areas of expertise -Collaboration should also occur between the interprofessional team, the client, and the client's family/significant others when an interprofessional plan of care is being developed -Collaboration is a form of conflict resolution that results in a win‑win solution for both the client and health care team Ch. 2
NG Intubation and Enteral Feedings: Administering an Intermittent Tube Feeding
-Prepare the formula and a 60‑mL syringe -Remove the plunger from the syringe -Hold the tubing above the instillation site -Open the stopcock on the tubing, and insert the barrel of the syringe with the end up -Fill the syringe with 40 to 50 mL formula -If using a feeding bag, fill the bag with the total amount of formula for one feeding, and hang it to drain via gravity until empty (about 30 to 45 min) -If using a syringe, hold it high enough for the formula to empty gradually via gravity -Continue to refill the syringe until the amount for the feeding is instilled.Follow with at least 30 mL tap water to flush the tube and prevent clogging Ch. 54(Fundamentals)
Right supervision - delegating nurse must
-Provide supervision, either directly or indirectly (by assigning supervision to another licensed nurse); -Provide clear directions and understandable expectations; -Monitor performance; -Provide feedback; -Intervene if necessary; -Evaluate client to determine if client outcomes met; -Identify needs for quality improvement activities and/or additional resources
INFORMED CONSENT
-RN must witness signature -CAN provide clarification to info already given by MD -CANNOT provide NEW info
ORGAN DONATION
-Regualted by state and fed laws -RN must present option of organ donation to all fams
Handiling Damaged Equipment
-Safe use of equipment refers to appropriate operation of health care-related equipment by trained staff. Equipment-related injuries can occur as a result of malfunction, disrepair, or mishandling of mechanical equipment -Nurses must ensure that they have the competence necessary to use equipment for tasks that fall within their scope of practice. Nurses should use equipment only after receiving sufficient instruction -Equipment should be regularly inspected by the engineering or maintenance department and by the user prior to use. Faulty equipment (frayed cords, disrepair) can start a fire or cause an electrical shock and should be removed from use and reported immediately per agency policy Ch. 4
CANNOT CONSENT
-Schitzophrenia -15 yr old -Dementia OK: BAL .05
LPNS
-Scope of practice determined by RN practice acts, which vary state to state -Monitor pt findings (as input by RN) -Reinforcement of pt teaching from a standard care plan -Contributes to care plan -Adminsteres IVPB meds -Monitors IV fluids -Trach care -Suctioning -Checking NG tube patency -Admin of enteral feedings -Insertion of urinary catheter -Med admin (excluding IV meds in many states)
ANA CODE OF ETHICS
-Sets guidelines to use when providing pt care -Outlines RN resp to pt and profession of nursing -Assists the RN in making ethical decisions
right person
-assess and verify competency of the health care team member >>within scope of practice and necessary competence and training -continual performance reviews right: delegate a LPN to adminster enteral to a client who has a head injury wrong: delegate an AP to adminster enteral feedings to a client who has a head injury
right circumstance
-assess health status and complexity of care required by the client -match the complexity of care demands to the skill level of the health care team -consider workload right circustance: delegate to AP to measure VS on stable pt wrong: delegate AP to measure VS on pt who is post-op and received naloxone to reverse respiratory depression
referral for home oxygen therapy (ch. 2)
-begin discharge planning upon the client's admission -evaluate the client/family competencies in relation to home care prior to discharge -involve the client and family in care planning -discharge referrals are based on client needs in relation to actual and potential problems and can be facilitated with the assistance of social services, especially if there is a need for: >>specialized equipment: -->cane, walker, wheelchair, grab bars in bathroom >>specialized therapies
when a nurse receives an unsafe assignment
-bring the assignment to the attention of the scheduling/charge nurse and negotiate a new assignment -if unresolved take it up chain of command -file a written protest to the assignment >>assignment despite objection >>document of practice situations -failure to accept the assignment without following the proper channels can be considered client abandonment
right direction/communication
-data that needs to be collected -method and time line for reporting (when to report concerns/findings right: delegate an AP to assist in room X with (something very specific) before X amount of time wrong: delegate an AP to assist with (something nonspecific) in room x
right supervision/evaluation
-directly or indirectly -clear directions and expectations -monitor performance -provide feedback -intervene if necessary -evaluate and identify needs for quality improvement activities right: delegate the ambulation of the client and provide positive feedback to the AP after completion of task wrong: delegate the ambulation of a client to an AP without supervision to determine the need for intervntion and failing to provide feedback to the AP
time savers (p. 7)
-documenting throughout shift -group activities -estimate time needed and plan accordingly -plan non-essential tasks -delegate -complete one task before beginning a second
Client's rights in a healthcare setting per the American Hospital Association's Patient Care Partnership
-high quality of care; -protection of client privacy; -involvement in care; -help when leaving hospital (preparation for discharge); -help w/billing and filing insurance claims
Clients rights?
-high quality of care; -protection of client privacy; -involvement in care; -help when leaving hospital (preparation for discharge); -help w/billing and filing insurance claims
delegating to LPN
-monitoring client findings as input for the RNs ongoing assessment of the client -reinforcing client teaching from a standardized care plan -performing tracheostomy care and suction -perform uncomplicated wound care -checking NG tube patency -administering enteral feedings -inserting urinary catheter -administering medications >>not IV meds
INTENTIONAL TORTS
1. ASSAULT=Makes another person fearful and aprpehensive; threatening to place NG tube in pt refusing to eat 2. BATTERY=Intentional and wrongful physical contact w person that involves injury or offensive contact (restraining pt and giving injection against his wishes) 3. FALSE IMPRISON=Use restraints in pt to prevent him from leaving
*components of privacy rule*
-only healthcare team members directly responsible for the client's care are allowed access to the patients records. >>nurses may not share information with other clients or staff not involved in the patient care -clients have a right to read and obtain a copy fo their medical record, and agency policy should be followed when the client requests to read or have a copy of the record -no part of the client record can be copied except for authorized exchange of documents between health care institutions >>transfer from a hospital to an extended care facility >>exchange of documents between a general practitioner and a specialist during a consult -client records must be kept in a secure area to prevent inappropriate access to information -client information may not be disclosed to unauthorized individuals, including family members who request it and individuals who call on the phone >>many hospitals use a code system in which information is only disclosed to individuals who can provide the code >>nurses should ask any individual inquiring about a client's health status for the code and disclose information only when that code is -communication should only take place in a private setting where it can not be overheard by unauthorized people >>change of shift reports are to be done at the bedside as long as the patient does not have a roommate and no unsolicited visitors are present >>*DO NOT* use: -->walking rounds or taped rounds
client's rights
-right to be respectful, considerate, and competent care -right to participate fully in the decision-making process -right to accept, refuse, or request modification in the plan of care
Botulism toxin
-symptoms: ptosis, dysphagia, descending paralysis, difficulty breathing. -Botulinum toxin can be absorbed through the GI or respiratory tract, but not through the skin. it is highly toxic.
What happens if you have a medication error that causes hypotension? What do you do?
-take vitals -make sure the client calls for assistance before getting out of bed. -notify the provider -complete an incident report -notify risk manager
Pneumonic plauge
-usually presents with fever, weakness and rapid on set pneumonia with shortness of breath, cough, chest pain, and sometimes bloody sputum. Nausea and abdominal pain may occur. Without early intervention, pneumonic plague will usually cause respiratory failure, shock, and rapid death.
TYPES OF LAWS AND COURTS
1. CRIMINAL LAW -Felony-Major -Misdemenaor-Minor 2. CIVIL LAWS TORT LAW: 1. UNINTENTIONAL TORTL=Negligence, malplactice 2. QUASI-INTENTAIONAL=Breach of confidentiality, defamation of char 3. INTENTIONAL TORT=Assault (threat), battery (touch), false imprisonment
For the purposes of organ donation, the Uniform Determination of Death Act (UDDA) states that death is determined by one of two criteria:
1) An irreversible cessation of circulatory and respiratory functions; 2) Irreversible cessation of all functions of the entire brain, including the brain stem
TRIAGE
1. EMERGENCY=CLASS 1=Highest priority!!!! Who have life threat inj but high poss of survival once stable 2. URGEN=CLASS II=Second hightest-to pt who have minor inj that are not yet life threatening and usually can wait 45-60 min for tx 3. NONURGENT=CLASS III=To pt who have minor inj and not life threat and do NOT need immed attn 4. EXPECTANT=CLASS IV=LOWEST priority-given to those NOT EXPECTED TO LIVE and allowed to DIE NATURALLy-Comfort measures will be given but restorative measures will not
TEAM
1. FORMING=Get to know; ledaer defines tasks for team and offers directoin 2. STORMING=Conflict arises, and team mem begin to express polarized viewe -Team est rules, and members begin to take on various roles 3. NORMING=Team est rule; members show respect for on eanother and begin to accomplish some of tasks 4. PERFORMING=Team focuses on accomplishmen tof task
client who is experiencing a seizure 1- Note time and call for help: 2- Calling for help will initiate additional team members to assist and is essential for client safety 3- Position client safely: 4- Loosen restrictive clothing 5- Reorient and reassure client 6- Determining precipitating trigger
1- Note time and call for help: When a client experiences a seizure, noting the time is essential because it allows for accurate documentation that may aid the provider in caring for the client 2- Calling for help will initiate additional team members to assist and is essential for client safety The nurse should remain with the client during this time 3- Position client safely: - If the client is standing or sitting, assist the client to the floor and protect the head - If the client is in the bed, remove pillows and raise side rails Clearing the area promotes client safety Turning the client to the side is essential to allow secretions to drain from the mouth and to prevent aspiration or choking
client who is experiencing a seizure
1- Note time and call for help: 2- Calling for help will initiate additional team members to assist and is essential for client safety 3- Position client safely 4- Loosen restrictive clothing 5- Reorient and reassure client 6- Determining precipitating trigger
Steps in providing educational programs
1. Identify and Respond 2. Analyze 3. Research 4. Plan 5. Implement 6. Evaluate
conflict
1. Internal or external discord that results from differences in ideas, values, or feelings between two or more people. 2. Can occur when there are differences in economic and professional values and with competition among professionals 3. Other sources: scarce resources, restructuring and poorly defined role expectations 4. Conflict can produce growth or destruction depending on how it is managed 5. Some level of conflict in an organization is desirable; optimum level unknown
the hiring process
1. Interviewing 2. Selection 3.Placement 4. Indoctrination (Display 15.6, p. 355) a. Planned guided adjustment of an employee to the organization and the work environment
PRIORITIZATION PRINCIPLES
1. LIFE BEFORE LIMB EX: Shock over pt w limb inj 2. ACUTE BEFORE CHRONIC 3. ACTUAL BEFORE POTENTIAL 4. MASLOWS: SELSP 5. EMERGENCIES VS. EXPECTED FINDINGS
A nurse discovers that a client was administered an antihypertensive medication in error. Number the following actions in the appropriate sequence that the nurse should follow. A. Call the client's provider. B. Monitor the client's vital signs. C. Notify the risk manager. D. Complete an incident report. E. Instruct the client to remain in bed until further notice.
1. Monitor the client's vital signs. 2. Instruct the client to remain in bed until further notice. 3. Call the client's provider. 4. Complete an incident report. 5. Notify the risk manager.
NURSE STAGES
1. NOVICE=Student or new grad 2. ADVANCED BEGINNER=Most New RNs 3. COMPETENT=2-3 yrs experience 4. PROFICIENT=Signif amt of experience; holistic care 5. EXPERT=Do not need to rely on rules
CAN NOT DELEGATE
1. NURSING PROCESS 2. PT EDUCATION 3. TASKS THAT REQUIRE RN JUDGEMENT
Maslow's Hierarchy
1. Physiological (food, water, warmth, rest) 2. Safety (security) 3. Love/Belonging (intimate relationships, friends) 4. Esteem (prestige and feeling of accomplishment) 5. Self actualization (achieving one's full potential, including creative activities)
change strategies
1. Rational-empirical strategies 2. Normative-reeducative strategies 3. Power-coercive strategies
Career development
1. Reduces employee attrition 2. Provides equal employment opportunity 3. Improves use of personnel 4. Improves quality of work life 5. Improves competitiveness of the organization 6. Avoids obsolescence/builds new skills 7. Promotes EBP!!!!!
5 RIGHTS OF DELEGATION
1. TASK=What task should be delegated 2. CIRCUMSTANCE=Under what circumstances 3. PERSON=To whom 4. DIRECTION/COMMUNICATOIN=What info should be communicated 5. RIGHT SUPERVISOIN/EVAL=How to supervise/evaluate`
time wasters
1. Technology - find balance 2. Socializing a. Don't make self overly accessible b. Interrupt to encourage directness c. Avoid promoting socialization d. Be brief e. Schedule long-winded pests 3. Paper-work Overload 4. Poor filing system
Quality control: know the steps
1. The criterion or standard is determined. 2. Information is collected to determine whether the standard has been met. 3. Educational or corrective action is taken if the criterion has not been met.
creating a motivating climate
1. Understand employee values 2. Devise a reward system that is consistent 3. Recognize each worker as uniquely motivated and act on those differences 4. Generational differences 5. Positive reinforcement 6. Consistency 7. Predictable and spontaneous
ORDER OF GENERATIONS
1. VETERAN 1925-1942 2. BABY BOOMER 1943-1960 3. GENERATION X 1961-1980 4. GENERATION Y 1981-2000
Factors that influence healthcare planning
1. Value vs. volume 2. Revenue Management vs Cost Management 3. Physician Integration 4. Population Health 5. Illness care vs. Wellness care 6. Complementary and Alternative medicine 7. Intraprofessional collaboration 8. Patient centered care 9. EHR - portability of health information 10. Expert networks 11. Robotics 12. Biomechatronics 13. Biometrics 14. Point of Care Testing 15. Home Care (Telehealth) 16. Internet 17. Increased demand for RNs 18. Aging workforce 19. Improving economy 20. Nursing Education
A nurse receives a change-of-shift report at 0700 for an assigned caseload of clients. Number the following clients in the order in which they should be seen. A client who has been receiving a blood transfusion since 0400 A client who has an every 4 hr PRN analgesic prescription and who last received pain medication at 0430 A client who is scheduled for a colonoscopy at 1130 and whose informed consent needs to be verified A client who needs rapid onset insulin before the breakfast trays arrive A client who is being discharged today and needs reinforcement of teaching regarding dressing changes.
1. client who has been receiving a blood transfusion since 0400 2. A client who needs rapid onset of insulin before the breakfast trays arrive 3. a client who has an every 4 hr PRN analgesic prescription and who last received pain medication at 0430 4. a client who is scheduled for a colonoscopy at 1130 and whose informed consent needs to be verified 5. a client who is being discharged today and needs reinforcement of teaching regarding dressing changes
5 stages of nursing ability
Novice Nurse Advanced Beginner Competent Nurse Proficient Nurse Expert Nurse
Primary Nursing
Nurse is focused on bedside care and is involved in planning goal-directed, individualized care. Care managed by single professional and can enhance client-nurse relationship.
An assistive personnel (AP) reports that a client's finger-stick blood glucose reading 30 min before lunch is 58 mg/dL. The client's morning finger-stick blood glucose was 285 mg/dL. The client is asymptomatic for hypoglycemia, and his next dose of insulin is scheduled to be administered at this time. Which of the following actions should the nurse take first? A. Recalibrate the glucometer, and recheck the client's blood glucose. B. Have the laboratory draw a stat serum glucose. C. Inform the AP to give the client 120 mL of orange juice. D. Administer insulin as prescribed.
A
Nurses First Responsibility
Nurses first responsibility if to their patients, which sometimes puts you in the middle of a conflict between what the patient wants and what the physician feels is best.
A client is brought back to the unit after a total hip arthroplasty. The client is confused, is moving his leg into positions that could dislocate the new hip joint, and he repeatedly attempts to get out of bed. Which of the following actions should the nurse take? (Select all that apply.) A. Apply arm and leg restraints immediately. B. Get an order from the provider. C. Have a family member sign the consent for restraints. D. Use a square knot to secure the restraints to the bed frame. E. Ensure that only one finger can be inserted between the restraint and the client
A B C
Medical Treatment Plan
The priorities for treating health problems must be congruent with treatment by other health professionals. A high priority for the client is to become ambulatory can assume a lower priority when the doctor calls for extended bed rest.
CONT'D
3. STATE LAWS=Nursing pracitce reg by state law. Each board of RN ahs rules reg and stand that vary FEDERAL REGS=Hippa, ADA, etc.
Benchmarking
The process of measuring products, practices, and services against best-performing organizations.
A nurse manager is explaining the use of incident reports to a group of nurses in an orientation program. Which of the following statements should the nurse manager include? (Select all that apply.) A. A description of the incident should be documented in the client's health care record. B. Incident reports should not be shared with the client. C. Incident reports include a description of the incident and actions taken. D. A copy of the incident report should be placed in the client's health care record. E. The risk management department investigates the incident.
A B C E
A nurse manager is providing information about the audit process to members of the nursing team. Which of the following statements should the nurse manager include? (Select all that apply.) A. A structure audit evaluates the setting and resources available to provide care. B. An outcome audit evaluates the results of the nursing care provided. C. A root cause analysis is indicated when a sentinel event occurs. D. Retrospective audits are conducted while the client is receiving care. E. After data collection is completed, it is compared to a benchmark
A B C E
ADVANCE DIRECTIVE
=Doc in which pt who is competent is able to express wished re: future acceptable health care (including the desire for extraordinary lifesaving measures: CPR, intubation, and artificial hydration or nut) -Able to designate another person to make dec when the pt becomes physically or mentally unable to do so
MALPRACTICE
=Failure to act in reasonable and prudent manner
DURABLE POA
=Legal doc that desgnates another person to make health care dec for pt when pt becomes unable to make dec independently
LIVING WILL
=Legal doc that instructs health care providers and fam members about what, if any, life-sustaining tx an individual wants if at some time the ind is unable to make dec
NEGLIGENCE
=Omission to do something that a reasonable person would do OR =Doing something that a resonable person would NOT do -Standard of pro practice is developed by prof. organizations
SUPERVISING
=Process of directing, monitoring, and evaluating the performance of tasks by another team member of the health care team -RNs resp for supervision of pt care tasks delegated to AP adn LPNS also knowsn as UAP and LVN
DELEGATING
=Process of tranferring auth and resp to another team member to complete a task while retaining accountability
ASSIGNING
=Process of transferring auth, accountability, and resp of pt care to another member of the health care tea
A nurse is hired to replace a staff member who has resigned. After working on the unit for several weeks, the nurse notices that the unit manager does not intervene when there is conflict between team members, even when it escalates. Which of the following conflict resolution strategies is the unit manager demonstrating? A. Avoidance B. Smoothing C. Cooperating D. Negotiating
A
A nurse is preparing to initiate IV therapy for a client who has a prescription for morphine 10 mg IV bolus. Using time management principles, which of the following actions should the nurse take first? A. Mentally envision the procedure when collecting supplies. B. Enter the room and perform hand hygiene. C. Eject excessive medication from the prefilled syringe D. Explain the procedure to the client
A
A nurse witnesses an assistive personnel (AP) under her supervision reprimanding a client for not using the urinal properly. The AP threatens to put a diaper on the client if he does not use the urinal more carefully next time. Which of the following torts is the AP committing? A. Assault B. Battery C. False imprisonment D. Invasion of privacy
A
An RN on a medical-surgical unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the LPN? A. Obtaining vital signs for a client who is 2 hr postprocedure following a cardiac catheterization B. Administering a unit of packed red blood cells (RBCs) C. Instructing a client in the performance of wound care D. Developing a plan of care for a newly admitted client
A
A nurse is observing a newly licensed nurse and an assistive personnel (AP) pull a client up in bed using a drawsheet. Which of the following actions by the newly licensed nurse indicates a need for further education? A. The nurse spreads his legs apart. B. The nurse uses his body weight to counter the client's weight. C. The nurse's feet are facing inward, toward the center of the bed. D. The nurse uses the muscles in his arms to lift the client off the bed using the drawsheet.
C
A nurse manger is observing the actions of a nurse she is supervising. Which of the following actions by the nurse requires the nurse manager to intervene? (Select all that apply.) A. Reviewing the health care record of a client assigned to another nurse B. Making a copy of a client's most current laboratory results for the provider during rounds C. Providing information about a client's condition to hospital clergy D. Discussing a client's condition over the phone with an individual who has provided the client's information code E. Participating in walking rounds that involve the exchange of client-related information outside clients' rooms
A B C E
A nurse on a sixth-floor medical surgical unit is advised that a severe weather alert code has been activated. Which of the following actions should the nurse take? (Select all that apply.) A. Draw window shades and close drapes as protection against shattering glass. B. Move beds of nonambulatory clients away from windows. C. Relocate ambulatory clients into the hallways. D. Use the elevators to move clients to lower levels. E. Turn the radio on for severe weather warnings
A B C E
A home health nurse is assessing the safety of a client's home. Which of the following factors may increase the client's risk for falls? (Select all that apply.) A. History of a previous fall B. Reduced vision C. Impaired memory D. Takes rosuvastatin (Crestor) E. Wears house slippers F. Kyphosis
A B C E F
A nurse manager is developing an orientation plan for newly licensed nurses. Which of the following should the manger include in the plan? (Select all that apply.) A. Skill proficiency B. Assignment to a preceptor C. Budgetary principles D. Computerized charting E. Socialization into unit culture F. Facility policies and procedures
A B D E F
A nurse is serving as a preceptor to a newly licensed nurse and is explaining the role of the nurse as advocate. Which of the following situations illustrates the advocacy role? (Select all that apply.) A. Verifying that a client understands what is done during a cardiac catheterization B. Discussing treatment options for a terminal diagnosis C. Informing members of the health care team that a client has do-not-resuscitate status D. Reporting that a health team member on the previous shift did not provide care as prescribed E. Assisting a client to make a decision about his care based on the nurse's recommendations
A C D
A nurse is participating in an interprofessional conference for a client who has a recent C6 spinal cord injury. The client worked as a construction worker prior to his injury. Which of the following members of the interprofessional team should also participate in planning care for this client? (Select all that apply). A. Physical therapy B. Speech therapy C. Occupational therapist D. Psychologist E. Vocational counselor
A C D E
Behavioral assessment
A behavioral assessment should be done prior to releasing a restring to determine the need to protect the client from self harm or the staff from being harmed.
Change Agent
A change agent organizes and prepare available resources when change is going to occur and informs the staff nurse of the change and education needed, this statement is characteristic of a change agent A change agent plans ahead for education when a major change occurs A change agent is knowledgeable of available resources to meet the needs of change for the staff nurses A change agent is an excellent communicator when change is impending
first-degree ankle sprain
A first-degree sprain requires rest, ice, compression, and elevation (RICE) -The client should rest the ankle, but immobilization is not necessary for a first-degree sprain Initially, the client may need to avoid weight bearing -Elevate ankle above the level of the heart is correct In order to reduce inflammation as a result of the sprain, the client should elevate the ankle above the level of the heart to promote venous return and decrease edema For example, the nurse should position the client on the bed with the client's foot propped up on one or two pillows to elevate the ankle above the heart Immediately after the injury, the nurse should reinforce to the client to rest, ice, compress, and elevate the ankle Heat may be applied After 48 hr, but the client should not apply heat During the initial 48 hr of injury. Wrap ankle with an elasticized compression bandage Application of an elasticized compression bandage for a few days following the injury is necessary to reduce swelling and provide joint support Compression also can help with pain relief and is facilitated by wrapping an elasticized compression bandage around the injured extremity
A major complication of total hip replacement
A major complication of total hip replacement is subluxation (partial dislocation) or total dislocation In addition to preventing adduction, the client should avoid flexing the hips more than 90°, not 60° The nurse should use diagrams or demonstrate correct positioning to help reinforce this information prior to the surgical procedure
What can be delegated to AP?
ADLs!! vitals on stable pt
What kind of incidents need to be reported
Accidental omission of prescribed therapies, circumstances that led to injury, client falls, medication administration errors, needle stick injuries
A nurse is participating in a quality improvement study of a procedure frequently performed on the unit. Which of the following will provide the most relevant information regarding the efficacy of the procedure? A. Frequency with which procedure is performed B. Client satisfaction with performance of procedure C. Incidence of complications related to procedure D. Accurate documentation of how procedure was performed
C
Who can give tracheostomy care?
An RN may delegate the task of performing tracheostomy suctioning for a client who is stable or whose tracheostomy is not new to the LPN. This task is within their scope of practice.
Analyzing
Analysis/diagnosis is the portion of the nursing process where the nurse uses critical thinking skills to identify the client's health status or problems, interpret data, reach a nursing judgment about the client's health status and coping mechanisms, and provide direction for nursing care.
Low Priority
Arises from NORMAL developmental needs or that requires only minimal nursing support.
Assessment
Assessment is the portion of the nursing process where the nurse uses critical thinking skills to collect subjective and objective data about the client to help plan the appropriate interventions.
Leadership styles
Authoritative - makes decision for the group; Democratic - includes group when decisions are made; Laissez-faire - makes very few decisions and does little planning
Which style of management is the best for emergency situations?
Autocratic
Which style of management makes decisions for staff without their input?
Autocratic
3 Management Styles
Autocratic Laissez-Faire Democratic
Risk for injury when working with clients who have a history of anger and aggression
Avoid wearing necklaces during client care is correct Know the layout of the facility is Provide immediate verbal feedback for escalating behavior Providing immediate verbal feedback for escalating behavior is an effective de-escalation technique
A community experiences an outbreak of meningitis, and hospital beds are urgently needed. Which of the following clients should the nurse recommend for discharge? A. 58-year-old man admitted this morning with angina and a history of a coronary artery bypass grafting (CABG) 1 year ago B. 50-year-old adult with type 2 diabetes mellitus being admitted for rotator cuff surgery C. 70-year-old adult admitted yesterday with pneumonia and dehydration D. 65-year-old woman who fell and broke her hip and is scheduled for total hip replacement tomorrow
B
A newly licensed nurse is preparing to insert an IV catheter in a client. Which of the following sources should the nurse use to review the procedure and the standard at which it should be performed? A. Web site B. Institutional policy and procedure manual C. More experienced nurse D. State nurse practice act
B
A nurse on a telemetry unit is caring for a client who was admitted 2 hr ago and has chest pain. The client becomes angry and tells the nurse that there is nothing wrong with him and that he is going home immediately. The nurse should base her actions on which of the following? (Select all that apply.) A. The nurse should notify the risk manager immediately. B. In the event the client leaves the hospital without a discharge order, the nurse should document that the client left the facility "against medical advice" (AMA). C. It is the nurse's responsibility to explain to the client the risks involved if he chooses to leave. D. Most facilities have a form that clients are asked to sign if they leave the facility prior to discharge. E. A nurse who tries to prevent a client from leaving the hospital may be faced with legal charges.
B C D E
A nurse is preparing to transfer an older adult client who is 72 hr postoperative from a surgical procedure to a long-term care facility. Which of the following should the nurse include in the transfer report? (Select all that apply). A. Type of anesthesia used B. The client's advance directives status C. The client's vital signs on day of admission D. The client's medical diagnosis E. Need for special equipment
B D E
A nurse who has just assumed the role of unit manger is examining her skills in interprofessional collaboration. Which of the following actions support interprofessional collaboration? (Select all that apply.) A. Use aggressive communication when addressing the team. B. Recognize the knowledge and skills of each member of the team. C. Ensure that a nurse is assigned to serve as the group facilitator for all interdisciplinary meetings. D. Encourage the client and family to participate in the team meeting. E. Support team member requests for referral.
B D E
staff education
Benefits: Employee competence and productivity are unit level issues and Socialization is a unit level issue Difficulties: Role ambiguity between education staff and manager, Limited accountability for quality and outcomes of activities and Lack of cost-effective evaluation Overcoming: Clear communication and follow up - understanding of accountability, Input from nursing unit if education is not administered by nursing, Educational advisory committe, and Track cost and benefit of each program
nursing turnover
Benefits: Fresh thinking and Reduces groupthink Costs: Human resources, Recruitment fees, Use of travel nurses/agency nurses, Overtime, Lost productivity and Training time and expense
budgeting
Budget - financial plan including estimated expenses and income for a period of time. Types: a. Fixed expenses - do not vary with volume b. Variable expenses - vary with volume c. Controllable expenses - controlled by manager d. Non-controllable expenses - no control by manager i. Additional Budget Terminology Display 10.2,p. 206-207
A nurse has received a performance appraisal from the unit manager. Which of the following actions by the unit manager requires intervention? A. The evaluation was conducted in the unit manager's office. B. Data that was collected for the previous 12 months was presented. C. Verbal concerns provided by a staff member were incorporated into the data. D. The nurse was asked to review the performance appraisal tool and complete a self-evaluation.
C
A nurse is caring for a client who is being prepared for surgery. The client hands the nurse information about advance directives and states, "Here, I don't need this. I am too young to worry about life-sustaining measures and what I want done for me." Which of the following actions should the nurse take? A. Return the papers to the admitting department with a note stating that the client does not wish to address the issue at this time. B. Explain to the client that you never know what can happen during surgery and that he should fill the papers out "just in case." C. Contact a client representative to talk with the client and offer additional information about the purpose of advance directives. D. Inform the client that surgery cannot be conducted unless he completes the advance directives forms.
C
Advance directives
The purpose of advance directives is to communicate a client's wishes regarding end-of-life care should the client become unable to do so. The Patient Self-Determination Act (PSDA) requires that all clients admitted to a health care facility be asked if they have advance directives
A toddler is being treated in the emergency department following a head contusion from a fall. History reveals the toddler lives at home with only her mother. The provider's discharge instructions include waking the child up every hour during the night to assess for indications of a possible head injury. In which of the following situations should the nurse intervene and attempt to prevent discharge? A. The mother states she does not have insurance or money for a follow-up visit. B. The child states her head hurts and she wants to go home. C. The nurse smells alcohol on the mother's breath. D. The mother verbalizes fear about taking the child home and requests she be kept overnight.
C
An LPN ending her shift reports to the RN that a newly hired assistive personnel has not calculated the intake and output for several clients. Which of the following actions should the RN take? A. Complete an incident report. B. Delegate this task to the LPN. C. Ask the AP if assistance is needed to complete the I&O records. D. Notify the nurse manager
C
An individual approaches the door of the maternal newborn unit, states that he is the uncle of a newborn, and asks to be admitted to the unit. Which of the following actions should the nurse take? A. Admit the individual after he provides the mother's full name and the date and time of the infant's birth. B. Call security to remove the individual from the area. C. Instruct the individual to obtain the access code from the family and then return. D. Call a Code Pink because the man could be attempting to abduct the infant
C
An older adult client who is on fall precautions is found lying on the floor of his hospital room. Which of the following actions is most appropriate for the nurse to take first? A. Call the client's provider. B. Ask a staff member for assistance getting the client back in bed. C. Inspect the client for injuries. D. Ask the client why he got out of bed without assistance.
C
A staff nurse is reviewing the hospital's fire safety policies and procedures with newly hired assistive personnel. The nurse is describing what to do when there is a fire in a client's trash can. Which of the following statements should the nurse include? (Select all that apply.) A. The first step is to pull the alarm. B. Use a Class C fire extinguisher to put out the fire. C. Instruct ambulatory clients to evacuate to a safe place. D. Pull the pin on the fire extinguisher prior to use. E. Close all doors.
C D E
nursing shortage
Caused By: Changes in reimbursements, Quality and safety movement and National and local economics Typically a nursing shortage increases with robust economy, decreases with receding economy
Cellulitis
Cellulitis is a generalized infection in deep connective tissue with staphylococcus or streptococcus It is usually a localized inflammation that may enlarge rapidly if not treated Expected findings include redness, warmth, edema, tenderness, and pain This client will require pain management and antibiotics
Centralized vs Decentralized Staffing
Centralized: Decisions made by personnel in central staffing office/center; Staff clerk carries out activity but RN oversees Decentralized: Decision-making moved to level of staff; Based on theory that more is achieved when employees are involved and empowered.
Example: A nurse is teaching a client who is at risk for iron-deficiency anemia about optimizing her dietary intake of iron. The nurse should explain that which of the following sources of iron is easiest for the body to absorb?
Chicken
An assisted-living facility
Clients have to be able to perform ADLs to be in an assisted living situation.
Which type of power has the ability to inflict aversive outcomes or punishment?
Coercive
HIPAA
Communication, Confidentiality and HIPAA 1. Legitimate professional need to know 2. Meaningful use HIPPA violation to tell someone where another patient is if they do not have authorization to know this information. Be careful where you are talking about patients and who might overhear you say something.
DEC MAKING
DECISIVE=Min, one option FLEXIBLE=Limited, several option HIERARCHIAL=Large, one option INTEGRATIVE=Large, several option
Defamation
Defamation is a false communication or a careless disregard for the truth that causes damage to someone's reputation, either in writing (libel) or verbally (slander). An assault occurs when a person puts another person in fear of a harmful or an offensive contact. Negligence involves the actions of professionals that fall below the standard of care for a specific professional group.
Critical Thinking
Definition: "the mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion." More complex than problem solving or decision making. Involves higher-order reasoning and evaluation. Includes both a cognitive and affective component: Insight, Intuition, Empathy, Willingness to take action
Which style of management does the manager allow staff to participate in making decisions/unit changes?
Democratic
Which style of management is the most time consuming?
Democratic
Which style of management puts emphasis on teamwork?
Democratic
Early symptoms of hypoglycemia
Early symptoms of hypoglycemia include sweating, irritability, anxiety, tachycardia, and hunger Late symptoms include weakness, fatigue, confusion, and seizures. TIRED is an acronym for early signs: tachycardia, irritability, restlessness, extreme hunger, and diaphoresis.
A nurse is caring for a client who is requesting to go to the bathroom immediately after an uncomplicated vaginal birth. What is an appropriate assessment for the nurse to make.
Evaluate the side effects of analgesia used during labor. The effects of narcotic analgesia as well as epidural or general anesthesia should be evaluated to prevent falls. The client should be able to raise her legs, flex her knees, and lift her butt off the bed. Sensation to the feet and legs should be present with no tingling. Often, it will take several hours for the anesthetic affects to disappear.
Evaluation
Evaluation is the portion of the nursing process where the nurse uses critical thinking skills to determine whether application of the nursing process and implementation of the treatment plan have resulted in an improvement in the client's status.
Clients reviewing their records
Every client has the right to review personal medical records clients usually do not have the medical knowledge to understand and interpret everything in their charts it is best for clients to review their charts with the healthcare team member
strategic planning process
Examines purpose, mission, philosophy and goals in the context of its external environment - SWOT Analysis and Balanced Scorecard Management Process: 1. Clearly defined purpose 2. Establish consistent, realistic goals and objectives 3. Identify stakeholders 4. Communicate goals and objectives 5. Sense of ownership 6. Strategies for goal achievement 7. Effective use of resources 8. Method of measuring progress 9. Informed change as needed 10. Consensus about organizational direction
The individual nurse is struggling to make a personal or professional decision, which is an example of intrapersonal conflict
Example: Nurse Jones is deciding between going to a professional meeting or attending a play
The nurse who is threatened by another nurse may be experiencing bullying, this is an example of interpersonal conflict Interpersonal conflict arises from differing goals and value system
Example: Nurse Lee is professionally threatened by Nurse Doe
The nurses conflicting among themselves to make a client care decision is an example of intrapersonal conflict
Example: Nurses on the day and night shift are conflicting regarding who should do client daily weights.
The nurses throughout an organization conflicting about length of shifts is an example of intergroup conflict
Example: Nurses throughout the hospital disagree on having 8-hour shifts or 12-hour shifts
Which type of power is based on expertise or knowledge?
Expert
FROM COMPREHENSIVE
FROM COMPREHENSIVE
When is informed consent not needed?
In general, there are two situations in which informed consent of an adult client is not needed. One is when an emergency is present and delaying treatment for the purpose of obtaining informed consent would result in injury or death to the client. The second is when the client waives the right to give informed consent. Option 1 will delay emergency treatment, and option 2 is inappropriate. Although option 4 may be pursued, it is not the best action.
Transactional Leader
Focuses on management tasks. Is a caretaker. Uses trade-offs to meet goals. Does not identify shared values. Examines causes. Uses contingency reward
Iron
Food sources of iron fall into two categories: 1- heme iron (from lean red meat, poultry, and fish) 2- nonheme iron (from fruit, vegetables, grains, and dried peas and beans) The body more easily absorbs heme iron
Love & Belonging Needs (3)
Giving and receiving affection, attaining a place in a group, and maintaining the feeling of belonging.
Medium Priority
Health threatening problems - acute illness, decreased coping, & can result in delayed development or destructive physical/emotional changes.
Advocacy
Helping others to grow and self-actualize. Nurses must advocate for: Themselves, Their clients, Their subordinates, Their profession. Goals of the Advocate: To inform, To enhance autonomy, To respect the decisions of others.
Physiologic Needs (1)
Needs such as air, food, water, shelter, rest, sleep, activity, and temperature maintenance are crucial for SURVIVAL.
Hospice care
Hospice care is only appropriate for ac client who has at terminal illness who has less than a 6-month life expectancy.
communication - individual, group and organizational
INDIVIDUAL: 1. Assertive communication- Use of "I" statements, Verbal and nonverbal message are congruent, Conveying a message that insists on being heard AND Respectful of the receiver 2. Passive communication - Silence when the person has a message 3. Aggressive communication - Direct and hostile 4. Passive-aggressive communication - Aggressive message delivered in a passive way GROUP: Forming - Relationships formed, expectations defined, directions given. Storming - Competition and attempts to establish individual identities. Norming - Establish rules and design work. Performing - Work gets done. Termination or closure ORGANIZATIONAL: 1. Assess organizational communication 2. Understand structure and who will be affected by decisions: Formal networks AND Informal networks 3. Communication is a two way channel 4. Must be clear, simple and precise 5. Seek feedback regarding accurate reception of message 6. Use multiple communication methods for important messages 7. Don't overwhelm people with unnecessary information
Transformational leader
Identifies common values. Is committed. Inspires others with vision. Has long-term vision. Looks at effects. Empowers others
AMA
If a patient leaves AMA one of the best things you can do is make sure they have a follow-up appointment. This way you are hoping they will continue getting care and the services they need.
placental
If a precipitous labor results in emergency birth without the provider attending, the placenta can be left in place until the provider arrives The nurse should never tug on the cord Signs of placental separation include a slight gush of dark blood, lengthening of the cord, and change in the shape of the uterus.
What happens if a nurse questions a HCP prescription?
If the HCP writes a prescription that requires clarification, the nurse's responsibility is to contact the HCP. If there is no resolution regarding the prescription because the HCP cannot be located or because the prescription remains as it was written after talking with the HCP, the nurse should contact the nurse manager or nursing supervisor for further clarification as to what the next step should be. Under no circumstances should the nurse proceed to carry out the prescription until obtaining clarification.
first-degree ankle sprain
If the client reports throbbing, discomfort, or the wrap is too tight, the nurse should remove and rewrap the bandage with less stretch The nurse should begin from the distal point of the extremity (toes) and move toward the proximal point (up the leg) in order to promote venous return Apply intermittent cold compress to the ankle for the first 24-48 hr Cold is used for the first 24-48 hr For a client who has a muscle sprain, an ice bag is an ideal nonpharmacological intervention to prevent edema formation as well as to anesthetize the body part Cold provides short-term pain relief and also limits swelling by reducing blood flow to the injured area through vasoconstriction The nurse should reinforce to the client not to apply ice directly to the skin or leave ice on the ankle for more than 20 min at a time Longer exposure can damage the skin and even potentially result in frostbite
Consent
If you are having a patient sign a pre-op form. You are only witnessing that they signed the form, NOT that they understand the procedure. If the patient makes a statement about the procedure that is incorrect, it is then YOUR responsibility to call the physician and have he/she come explain it.
Treatment for alcohol withdrawal
Illusions present the greatest safety risk to the client and are therefore the priority finding Findings: - Increased heart rate is a finding that can occur during alcohol withdrawal - Diaphoresis is a finding that can occur during alcohol withdrawal - Vitamin deficiency is a finding that can occur during alcohol withdrawal - Give vitamin B12
Third-degree sprains
Immobilization is indicated for 4 to 6 weeks in or when severe ligament damage occurs As a result of a third-degree sprain, arthroscopic surgery may be necessary
Is it appropriate for a nurse manager to assign LPN's to initiate care to class II (yellow tag) patients?
No - Class II clients require treatment within 30min - 2 hours. These patients also need an initial assessment which is not with an LPN's scope of practice. LPN's are allowed to provide care for class III (green tag) patients who have non-urgent and minor injuries.
Intermittent feeding NG Tube feeding
Intermittent feeding may be done by using a large barrel syringe or feeding bag The steps in administering intermittent NG tube feedings include the following: 1- Have the formula and a 60-mL syringe prepared 2- Remove the plunger from the syringe 3- Hold the tubing above the instillation site 3- Open the stopcock on the tubing, and insert the barrel of the syringe with the end up 4- Fill the syringe with 40 to 50 mL of formula 5- If using a feeding bag, fill the bag with the total amount of formula prescribed for one feeding, and hang it to drain via gravity until empty (about 30 min) 6- If using a syringe, hold it high enough for the formula to empty gradually via gravity 7-Continue to refill the syringe until the amount prescribed for the feeding is instilled 8-Flush with tap water after infusion is complete 9-Clamp the NG tube once the feeding and flushing are complete
Client's Priorities
Involves client prioritizing care and planning enhances cooperation. For example, an older client may not regard turning and repositioning in bed as important, preferring to be undisturbed. The nurse is aware of complications of bed rest (muscle weakness & pressure ulcers.) Inform client & carry out interventions
What is risk management
Is a planned method to identify, analyze, and evaluate risks, followed by a plan for reducing the frequency of accident and injuries.
Laissez-faire
Is permissive, with little or no control. Motivates by support when requested by the group or individuals. Provides little or no direction. Uses upward and downward communication between members of the group. Disperses decision making throughout the group. Places emphasis on the group. Does not criticize
NG Tube
It is appropriate to flush the tubing with tap water The stomach is not considered sterile, so tap water is acceptable Typically, the tubing is flushed with 30 to 60 mL of tap water (or as prescribed) following each feeding and after administering medications to prevent clogging When an NG tube is used for decompression, the client is at risk for electrolyte imbalance Irrigation may be necessary if the tip of the tubing rests against the stomach wall or if the tube is blocked with thick secretions
JCAHO
Joint Commision on Accreditation of Healthcare Organizations - defines quality improvement as an approach to the continuous study & improvement of the process of providing health care services to meet the needs of clients and others
6 Essential Components of Leadership
Knowledge Self-Awareness Communication Energy Goals Action
What CAN LPN's do?
LPNs may reinforce teaching, give PO meds, and perform some higher level skills like dressing changes or suctioning, but should not be assigned the care of unstable patients.
Which style of management allows staff to work out conflicts on their own?
Laissez-faire
Which type of power is based on one's position?
Legitimate
Democratic
Less control is maintained. Economic and ego awards are used to motivate. Others are directed through suggestions and guidance. Communication flows up and down. Decision making involves others. Emphasis is on "we" rather than "I" and "you". Criticism is constructive
High Priority
Life threatening problems - loss of respiratory or cardiac function.
living will
Living wills, also known as natural death acts in some states, are required to be in writing and signed by the client. The client's signature must be witnessed by specified individuals or notarized. Laws and guidelines regarding living wills vary from state to state, and it is the responsibility of the nurse to know the laws. Many states prohibit any employee, including the nurse of a facility where the client is receiving care, from being a witness.
LEADERSHIP ATI
MUST KNOWS
Time Management Pinciples
Making optimal use of available time: Prioritizing duties, Managing and controlling crises, Reducing stress and Balancing work and personal life
failure of a person with professional training to act in a reasonable and prudent manner [i.e., using average judgment, foresight, intelligence, and skill that would be expected of a person w/similar training and experience]
Malpractice
Maternal complications
Maternal complications associated with a precipitous labor can include: uterine rupture, lacerations of the birth canal, and postpartum hemorrhage Applying perineal pressure as the fetal head is crowning may decrease maternal tearing and injury
Examples of when an incident report should be filed
Med errors; Procedure/treatment errors; Equipment-related injuries/errors; Needlestick injuries; Client falls/injuries; Visitor/volunteer injuries; Threat made to client or staff; Loss of property (dentures, jewelry, personal wheelchair); Discovery that a preop client has eaten breakfast
Functional Nursing
Model of care that is task-focused, not client focused. Tasks are divided, with one nurse assuming responsibilities for specific tasks. (Ex. one nurse in charge of meds, one doing shift assignments) Problem: Absence of holistic care + communication is not always clear
Monitor for shortening of the affected leg with Hip arthoplasty
Monitoring for shortening of the affected leg is a nursing action that identifies dislocation Signs of dislocation include shortening of the extremity pain and external rotation of the extremity These findings should be reported immediately The nurse should check neurovascular status, which includes pain, pallor, pulse, paresthesia, paralysis, and pressure
Ethical Dilemas
Most difficult. Being forced to choose between two or more undesirable alternatives
NCHPPD
NCH/PPD = Nursing hours worked in 24 hours/ patient census
do you ever chart in advance
NO! don't ever chart in advance
Self Esteem Needs (4)
Needs self esteem (feelings of independence, competence, & self respect) and esteem from others (recognition, respect, and appreciation.)
NG Tube
Prior to administering an intermittent gastric tube feeding, the stomach should be checked for residual volume When gastric residual exceeds 100 mL (10 mL for intestinal placement), the nurse should do the following: - Withhold the feeding - Notify the provider -Maintain semi-Fowler's position -Recheck residual in 1 hr or as prescribed -Before the first feeding, placement should be confirmed with an x-ray Thereafter, placement should be checked by aspirating gastric secretions and checking the pH Aspirate gently to collect gastric contents and observe the color, test pH (4 or less is expected) Note: - Injecting air into the tube and listening over the abdomen is not an acceptable practice.
Airborne precautions require:
Private room Masks and respiratory protection Negative pressure airflow exchange in the room of at least 6 to 12 exchanges per hour. Examples: Measles, varicella, Turburculosis
Contact precautions
Private room w/ same pts Gloves and gowns worn ex. Respiratory syncytial virus (RSV), wound infections (MRSA), herpes simplex, impetigo, scabies,active herpes simplex lesions
Droplet precautions require:
Private room with other clients with same disease Masks ex.: Pneumonia, Influenza,rubella, mumps, meningococcal pneumonia
Nursing interventions for radiation seeds
Private room, sign on door (radiation exposure), Visitors can't stay more than 30 min and must stay 6 ft away, wear badge that records amt of radiation exposure
staffing mandates
Pro's: Protect patients and nurses, Increase patient safety, Improved patient outcomes Con's: Band-aid cure for quality of care issues caused by nursing shortage, Numbers ≠ quality, Don't account for acuity, Costs keep employers from responding to market forces and innovations
Resources Available to the Nurse & Client
Problems may be given lower priority if money, equipment, or personnel are scare. LTC facilities have less resources than hospitals. An unemployed client may refuse dental treatment.
client who is experiencing a seizure
Provide client privacy during this time 4- Loosen restrictive clothing 5- Reorient and reassure client Continue to monitor the seizure (type of seizure; parts of body affected; loss of consciousness; presence of lip smacking, mastication, or grimacing; rolling of eyes; presence of incontinence; presence of apnea) Some clients may be confused As the client is regaining consciousness, the nurse should reorient the client, explain what happened, and provide reassurance to minimize anxiety 6- Determining precipitating trigger Client safety is the priority when caring for a client during a seizure episode
the goals of healthcare reform
Provide universal access to healthcare for Americans Control the rising costs of healthcare Regulate the private insurance industry through things like state-based private exchanges - an online marketplace that brings together state-approved insurance plans from multiple companies so consumers can shop for individual insurance plans Improve the quality of healthcare Make healthcare choices more consumer friendly and easier to understand.
interviewing
Purpose is Determination of applicant's suitability for the position, Applicant determines if they want to work for the organization and Maintaining respect and goodwill regardless of the outcome. Types of interviews: Unstructured, Semi-structured, Structured
5 rights of delegation
RIGHT task RIGHT circumstance RIGHT person RIGHT direction and communication RIGHT supervision and evaluation
admissions can only be performed by
RN's
Team Nursing
RN, LPN, and AP work together on large group of clients. Nurses may not be assigned same clients everyday.
What CAN NOT be delegated by the RN?
RNs cannot delegate the nursing process, client education, or tasks that require nursing judgment to LPNs.
Which type of power is based on attractive characteristics?
Referent
Remember the steps in the Nursing Process - A Delicious PIE
Remember the steps in the Nursing Process - A Delicious PIE A = Assessment D = Diagnosis P = Planning I = Implementation E = Evaluation
frayed cord of infusion pump. take which action
Report the pump...
A charge nurse observes an LPN chatting sociable you with peers, learns that the LPN left the unit without communicating the absence, and received reports from clients about lack of care by the LPN. What is an appropriate action by the charge nurse?
Review the LPNs assignment in relation to other nurses on the unit. Reviewing the LPNs assigned activities allows the charge nurse to see the delegated task from the perspective of the LPN, and is the appropriate action at this time.
Which type of power has the ability to control resources?
Reward
5 types of power
Reward Coercive Legitimate Referent Expert
5 rights of delegating
Right task, right circumstance, right person, right communication, and the right supervision
The RN has assigned an LPN to perform routine wound irrigation, is this appropriate?
Routine wound irrigation is in an LPN's scope of practice..in addition LPN's can reinforce teaching, but the initial teaching must be completed by the RN. FYI. LPNS can administer enteral feedings.
adverse effects after a new med. which communication tool for complication
SBAR
Safety & Security Needs (2)
Safety need has both physical and psychological aspects. Person needs be safe in both relationships & physical environment.
sanguineous
Sanguineous drainage is bright red and indicates active bleeding
When to seek assistance from the charge nurse
Seek assistance from the charge nurse when client care may require emergency medical interventions that are outside of the nurse's scope of practice
client who is experiencing a seizure
Seizure precautions include placing the bed in the lowest position, ensuring oxygen and suctioning equipment are available, and placing a saline lock (especially if the client is at risk for a generalized tonic-clonic seizure) The practice of padding the side rails is currently controversial Side rails are rarely the source of significant injury, Padded side rails may embarrass the client and family, and could be considered a restraint Therefore, the agency policy regarding this practice must be followed After reorienting the client and ensuring a return to stable vital signs, the nurse should determine whether the client experienced an aura, which can possibly indicate the origin of the seizure in the brain Determining a trigger that precipitated the seizure will assist the client in preventing recurring episodes and manage the disorder
serosanguineous
Serosanguineous drainage is pink (light red), watery, and a mixture of serum and blood
emergent triage category - implies that a condition exists that poses an immediate threat to life or limb
Shortness of breath
Incident reports:
Should be completed as soon as possible and within 24 hr of the incident; Are are not shared with client, nor is it acknowledged to client that one was completed; -Are not placed nor mentioned in client's health care record [However, a description of the incident itself should be documented factually in client's record]; -Include an objective description of incident and actions taken to safeguard client, and assessment and treatment of any injuries sustained; Are forwarded to the risk mgmt department, possibly after being reviewed by the nurse manager
Urgency of the Health Problem
Situations that affect the integrity of the client, that is, those that have a negative or destructive effect on the client, have high priority. Drug abuse, radical alteration of self concept are examples.
Soy Milk
Soy milk is the best choice for this client because soy milk is lactose-free.
Delegation
Strategies for Successful Delegation: 1. Plan ahead 2. Match the task to the education and skill level of the person 3. Select capable people 4. Communicate goals clearly 5. Empower the delegate 6. Set deadlines and monitor progress 7. Monitor the role and provide guidance 8. Evaluate performance 9. Reward accomplishment
Authoritarian
Strong control is maintained over the work group. Others are motivated by coercion. Others are directed with commands. Communication flows downward. Decision making does not involve others. Emphasis is on difference in status ("I" and "you"). Criticism is punitive
What does informed consent imply?
That the client has all the information necessary to decide on treatment. It is the client's agreement for the health care team to proceed with the specified treatment based on awareness of risks, benefits, other treatment options, and the expected outcomes of refusing the treatment.
Ethical Practice: Understanding Nursing Code of Ethics
The American Nurses Association Code of Ethics for Nurses (2001) and the International Council of Nurses' Code of Ethics for Nurses (2006) are commonly used by professional nurses. The Code of Ethics for Licensed Practical/Vocational Nurses issued by the National Association for Practical Nurse Education and Services also serves as a set of standards for Nursing Practice. Codes of ethics are available at the organizations'website Ch. 3
A nurse is asked to assist in a continuous quality improvement program to reduce the number of medication errors. The nurse should recognize that which strategy is appropriate?
The purpose of quality improvement is to evaluate outcomes of care based on standards. Once a problem is identified data is collected and analyzed before trying to fix the problem.
what is the PSDA?
The Patient Self-Determination Act (PSDA) stipulates that on admission to a health care facility, all clients must be informed of their right to accept or refuse care. Competent adults have the right to refuse treatment, including the right to leave a health care facility. The Patient Self-Determination Act (PSDA) requires that all clients admitted to a health care facility be asked if they have advance directives.
Planning
The actual writing of an expected outcome is done in the planning phase of the nursing care plan. During panning, the nurse establishes goals and outcomes for the client and selects the interventions that will help achieve those goals and outcomes. Planning also involves setting care priorities.
Types of leadership
The autocratic leader is focused, maintains strong control, makes decisions, and addresses all problems. The autocrat dominates the group and commands, rather than seeks suggestions or input. In this situation, the manager addresses a problem (quality improvement) with the staff, designs a plan without input, and wants all problems reported directly back to her. A situational leader will use a combination of styles, depending on the needs of the group and the tasks to be achieved. The situational leader would work with the group to validate that the information that the leader gained as a new employee was accurate and that a problem existed. Then, the leader would take the time to get to know the group and determine which approach to change (if needed) would work best according to the needs of the group and the nature and substance of the change that was required. A democratic leader is participative and would likely meet with each staff person individually to determine the staff member's perception of the problem. The democratic leader would also speak with the staff about any issues and ask the staff for input with developing a plan. A laissez-faire leader is passive and nondirective. The laissez-faire leader would state what the problem was and inform the staff that the staff needed to come up with a plan to "fix it."
Maslows Hierarchy of Needs
Used by nurses to set priorities. Basic needs like, air, food, and water receive higher priority than the need for security or activity. Growth needs - self esteem, are not perceived as basic. Nursing diagnosis such as ineffective airway clearance and impaired gas exchange take priority over anxiety or ineffective coping.
Managed Care
Uses select group of providers who agree to predetermined payment before care is given; Goal is control cost of health care
ETHICAL PRINCIPLES
VIDELITY=Be faithful; keep promises NONMALEFICIENCE=Not to do hard VERACITY=Tell the truth
Right supervision/evaluation
The delegating nurse must: * provide supervision (directly or indirectly) * provide clear direction and expectations *monitor performance *provide feedback *intervene if necessary *evaluate client and determine if outcomes were met
Positioning with Ng feeding
The head of the bed should be positioned at a minimum of 30° elevation to prevent aspiration from reflux during feedings The greatest risk to a client receiving enteral feedings is injury from aspiration Therefore, the priority nursing action before initiating an enteral feeding is to determine proper placement of the tube and maintain the client in semi-Fowler's position during the feeding - If aspiration of formula is suspected, the first action the nurse should take is to stop the feeding Other actions should include the following: Turn the client to the side Suction the airway Provide oxygen if indicated Monitor the client's vital signs for elevated temperature Auscultate breath sounds for increased congestion Notify the provider Obtain a chest x-ray
What does an incident report contain?
The incident report should contain the client's name, age, and diagnosis. The report should contain a factual description of the incident, any injuries experienced by those involved, and the outcome of the situation
Self-Actualization (5)
The innate need to develop one's maximum potential and realize one's abilities and qualities.
The most effective way to recognize someone's abilities and contributions is through direct, immediate feedback. Direct communication of both positive and negative feedback fosters teamwork
The most effective way to recognize someone's abilities and contributions is through direct, immediate feedback. Direct communication of both positive and negative feedback fosters teamwork
precipitous labor include ( rapid labor)
The most important intervention is preventing injury to the infant during the delivery Fetal complications from precipitous labor include hypoxia caused by decreased periods of uterine relaxation between contraction A change in pressure from a rapid delivery of the fetal head may cause neurologic damage (increased intracranial pressure and dural/subdural tearing) Rapid birth also may cause maternal injury, such as vaginal or perineal lacerations
Hip arthroplasty
The nurse should implement foam wedge between legs to prevent dislocation Because the muscle surrounding the hip joint has been cut to expose and replace the diseased joint clients are at risk for hip dislocation Proper body alignment after total hip arthroplasty includes keeping the affected leg slightly abducted A major complication of total hip arthroplasty is subluxation (partial dislocation) or total dislocation In some facilities, abduction devices such as foam wedges and pillows are placed between legs Adduction of the hip should be avoided to prevent dislocation.
Which strategy for the nurse use to assist in a continuous quality improvement program to reduce the number of medication errors?
The nurse should review the information that led up to each medication error. The purpose of quality improvement is to evaluate outcomes of care based on standards once the problem is identified data should be collected and analyzed before trying to fix the problem.
Libel
The nurse who is libel uses untrue written communication
Slander
The nurse who slanders uses the spoken word to harm another professional's reputation
Battery
The nurse who uses battery touches a client without permission, which may cause embarrassment or injury
Negligence
The nurse's conduct displayed negligence, which is providing client care below the standard of care and placing the client at risk for harm.
The responsibility for the delivery of quality care rests with the staff member who directly provides the care Individuals have the greatest impact on the perceived quality of care provided to a specific client in any health care organization
The responsibility for the delivery of quality care rests with the staff member who directly provides the care Individuals have the greatest impact on the perceived quality of care provided to a specific client in any health care organization
Study of Ethics
The systematic study of what a person's conduct and actions should be with regard to self, other human beings, and the environment. A system of moral conduct and principles that guide a person's actions. The study of what a person's life and relationships should be.
Why do nurse case managers use critical pathways in the planning of patient care?
They are used to implement evidence-based strategies for patients with a common diagnosis to promote cost-effective care.
What CAN AP's do?
They can take vital signs, perform ADLs and range of motion exercises. They can also give enemas, obtain urine specimens, and perform blood glucose monitoring. They cannot perform higher level skills unless they have special certificates.
What is required for a patient to sign their own informed consent
They must be a competent adult who is capable for understanding the information and must be fully able to communicate in return with the provider (an interpretor must be available in a language barrier situation)
Paternalism
Type of relationship between clients and a healthcare provider in which the healthcare providers believe they know what is best for the client
DNR
Unless a "do not resuscitate" (DNR) or "allow natural death" (AND) order is written, the nurse initiates cardiopulmonary resuscitation (CPR) when the client has no pulse or respirations. The written order for a DNR or AND must be placed in the client's medical record. The provider consults the client and the family prior to administering a DNR or AND.
What do you do if a prescription is unclear
Whenever a prescription is unclear or the dose is questionable, the nurse should contact the provider for clarification
Is collaboration a win-win solution
YES -It is a form of conflict resolution resulting in a win-win for both pt and health care team
Can a nurse witness a client's signature on a living will?
Yep
When can't a client give informed consent
a client can't give informed consent under the influence of narcotics
Collaboration is ____
a conflict resolution strategy
what is an indicator of the need of home health care
a new health care problem that requires continued teaching and hands on care is an indicator for home health care
Patients who have restraints must have
a provider prescription in the medical record for the restraints
group roles
a. Initiator b. Information seeker c. Information giver d. Opinion seeker e. Elaborator f. Coordinator g. Orienter h. Evaluator i. Energizer j. Procedural technician k. Recorder
Leadership
ability to inspire others to achieve a desired outcome
AP delegation
activities of daily living (ADLs) -bathing -grooming -dressing -toileting -ambulating -feeding (without swallowing precautions) -positioning -bed making specimen collection intake and output (I&O) vital sign (on stable clients)
four clients who's priority
adult client femur fracture SOB
nurse planning DC for stroke. which intervention
advise client to install grab bars in her bathroom at home
joint repacement surgery
advocacy
palliative care
aims to keep the client comfortable without aggressive therapy. It is focused on managing symptoms, not on curing the disease.
discharging in an emergency
ambulatory clients requiring minimal care go first clients requiring assistance are next clients who are unstable or require nursing care should not be discharged
COPD receiving oxygen
an office chair oxygen tank on floor throw rug over vinyl
ER perfomring triage after MVC
arm contusions and asym thoracic movement
Unlicensed Assistive Personnel (UAP)
because they are unlicensed, they have no scope of practice in general, nursing tasks that may be delegated include non-invasive and non-sterile treatments assist in a variety of direct client care activities or tasks, e.g., bathing, transferring, ambulating, feeding, toileting, and obtaining measurements (vital signs, height, weight, intake and output, blood glucose levels) perform indirect activities such as housekeeping, transporting people and stocking supplies
tubal ligation, uncertain
discuss the clients feelings about the procedure
when a professional provides expert advise in a particular area & determines what treatment or services are needed it is called a _________
consultation
Client w/terminal illness scheduled to be discharged to nursing home states that he wants to go home to die
contact case manager!
Client w/terminal illness scheduled to be discharged to nursing home states that he wants to go home to die
contact the case manager first
The four skills necessary for nurses to provide nursing care in an efficient and safe manner: (4)
critical thinking, decision making, prioritization, and time management
Authoritative, democratic or laissez faire? includes the group when decisions are made, motivation by supporting staff achievements
democratic
Authoritative, democratic or laissez faire? work output by the staff is usually of good quality- good when cooperation and collaboration is necessary
democratic
Which is the most effective management style?
democratic
laissez-faire
demonstrates a non-productive approach -exerts little or no leadership and control -
committee for discharge
determine goals and objectives
autocratic
direct and issues commands necessary for *emergency situations* -makes decisions idependently and then notifies the staff of the decisions made -maintains a high degree of control over the staff and allows little freedom of staff members
moral leadership
involves honesty and fairness under any circumstances
Priority Setting
is the process of establishing a preferential sequence for addressing nursing diagnoses and interventions. The nurse and client begin planning by deciding which nursing diagnosis requires attention first, second, and so on.
nurse has arrived late
issue informal verbal give nurse formal suspend without pay terminate employement
Why should a nurse report a postoperative patient who has a urine output of 20 ml/hr?
it is important to report because the patient is at risk for acute kidney injury
Patient has question about a procedure
it is your responsibility to inform physician.
Authoritative, democratic or laissez faire? makes very few decisions and does little planning, motivation largely the responsibility of individual staff members
laissez faire
Authoritative, democratic or laissez faire? work output is low unless an informal leader evolves from teh group
laissez faire
Which style of management does the manager not participate in, rather they delegate to the staff to solve the problem?
laissez-faire
the ability of an individual to influence the behavior of others
leadership
clinical pathway following hip arthroplasty
length of clients stay
breast cancer otions
lets talk about benefits of each
long term facility transferring to acute care facility. include what info in paper work
list of current medications
Expert nurse
make decisions at an advanced level of intuition and analytical ability
getting work done through others
management
delegate to ap
measuring I&O
What are examples of things that require an incident report?
medication errors, procedure/treatment errors, equipment-related injuries/errors, needlestix, client falls/injuries, visitor injuries, threat made to client or staff, loss of property (dentures...)
change of shift 4 clients
miss graves needs pain reassed
LPN delegation
monitoring client findings (as input to the RN's ongoing assessment of the client) reinforcement of client teaching from a standard car plan tracheostomy care suctioning checking nasogastric tube patency administration of enteral feeding insertion of a urinary catheter medication administration (exlcuidng intravenous medications in several states)
cancer and vomits blood
mop the floors with a bleach solution
Advanced beginner
most new nurses function at this level practice independently and make some clinical judgment begin to rely on prior experience to make practice decisions
barries to change
needs to be Expected and Factors influencing: a. Personal values b. Educational levels c. Sociocultural background d. Experience with change e. Risk taking propensity/Life history
conduct that falls below the standard of care [e.g., med errors, failure to monitor a client's condition, failure to report changes in client's condition to HCP, falls that occur as result of failure to provide safety to client, failure to check equipment for proper functioning]
negligence
what are examples of unintentional torts?
negligence (didn't implement safety precautions) or malpractice (medication error)
swollen and bruised ankle
non-urgent triage category - client can generally wait for several hours without a significant risk of clinical deterioration
Incident report
notify charge nurse/supervisor, write report, does not go in the patients chart.
potassium 3.2, been paging provider for 1hr to report. which intervention next
notify nursing supervisor
VAP
notify quality improvement team
what to observe when you have an interpreter and are talking with a client
observe the client's nonverbal behavior during the session with an interpreter
morning lab results, exhibit
obtain a cap blood glucose reading
difficulty buttoning her clothes
occupational therapy
what do you document
only document objective findings
caring following stem cell
place clients in positive pressure airflow rooms
planning care for client who has dementia
placing client in a room near the nurses station
the five major management functions are:
planning, organizing, staffing, directing, controlling
a patient who has been vomiting x 3 days is at highest risk for
potassium imbalance
Supervising
process of directing, monitoring, and evaluating the performance of task by another member of the health care team. RN supervise AP's and PN's
restraints to combative
quick release tie to secure restraint
safe use of wheelchair
raise footplates before transferring
employees that are resistant to change
realize that if the nurse who must implement the change are not invested in the change process, resistance to change is likely. -problematic when the change is unplanned or imposed by outside forces -resistant staff nurse has likely rejected the change for reasons such as habit, fear of the unknown, and lack of time to learn something new -a meeting between the nurse manager and the staff nurse will allow an open forum for the staff nurse to verbalize the reasons for reluctance to adopt the new policy
informed consent prior to
receiving moderate sedation
2 hr postop following chole
recheck the clients BP
when a formal request for a special service by another care provider so the client can access special care identified it is called a _______
referral
staff looking atEMR for celeb
remind staff this is a breach of confidentiality
right task
repetitive, requires little supervision, and relatively noninvasive right task: AP to assist pt with bedpan and pneumonia wrong task: delegate AP to administer a nebilizer to a pt with pneumonia
urgent care nurse pain assessment not to policy. take which action
report this issue to the nurse manager
Not able to contact physician
report to supervisor after 30 minutes.
Chlamydia should be
reported to state health department
An assertive approach..
required that the nurse manager take some direct action to help resolve the situation. -Assertive behavior involved discusing a situation directly with the person(s) involved.
Delegation involves
responsibility: an obligation to accomplish a task accountability: accepting ownership for the results or lack of authority: right to act or empower over others
New IV pumps are being delivered to a MedSurg floor which type of training should the charge nurse use to best evaluate staff competency?
return demonstration is the best way to measure appropriate use of the new equipment
manager confronts a nurse with smell of alcohol on her breath. which action to take?
set up formal meeting within 24 hr
reporting information to the provider (ch. 2)
should be fostered to create a climate of mutual respect and collaborative practice *-assessment data integral to changes in client status -recommendations for changes in the plan of care -clarification of prescriptions* *Qualities*: -good communication -assertiveness -conflict negotiation skills -leadership skills -professional presence -decision-making and critical thinking
informed consent
signed component by a competent adult
Proficient nurse
significant amount of experience
this is a conflict resolution strategy where one party attempts to ____ another party by trying to satisfy the other party. Often used to maintain or preserve a peaceful work environment.
smoothing
charge nurse supervising several clients which require intervention
studen tnurse photocopying...
Novice nurse
students or newly licensed nurses who have minimal clinical experience
assign AP which task
suction a clients trach
right direction of communication
tell me what time the client in 205 voids for the first time after cath removal
charge nurse delegates task to RN and then finds out an error was made that could cause the client harm
the RN performing the task remains accountable for his actions; the charge nurse is accountable for supervision, follow-up, intervention to safeguard client, and any corrective action
Staffing
the acquisition of adequate staff
Planning
the decisions regarding what needs to be done, how it will be done, and who is going to do it
Directing
the leadership role assumed by a manager; influences and motivates staff
accountability
the nurse answers for personal actions
sterile dressing change
the nurse places the sterile package with the top flap opening away from her
confidentiality
the nurse protects the privacy of the client and her health care information
how should the nurse contribute to the development of a new policy
the nurse should collect data from peer reviewed journals or evidence based practice
Unfreezing stage of change
the nurse should communicate to staff about the need for change during the unfreezing stage of change
18 yr old rhabdomyosarcoma
the nurse states i can gather info about palliative care
advocacy
the nurse supports the client in the decisions she makes about her own health care
responsibility
the nurse upholds obligations
Organizing
the organizational structure that determines the lines of authority, channels of communication, and where decisions are made
veracity
the principle of veracity refers to telling the truth. This situation describes the nurse truthfully informing the client about the diagnosis.
Staff education
the quality of client care provided is directly related to the education and level of competency of health care providers
Decision-making styles: *Hierarchical*
the team uses a large amount of data and generates one option
Decision-making styles: *integrative*
the team uses a large amount of data and generates several options
Decision-making styles: *flexible*
the team uses a limited amount of data and generates several options
Decision-making styles: *decisive*
the team uses a minimum amount of data and generates one option
a client who has developed slurred speech should be assessed first because...
this may indicate a CVA--which means that this pt is unstable and should be assesssed first
advance directives
this means i have outlines my wishes for med treatments
compartment syndrome
tingling, numbness, pallor, paresthesia, and pain.
unionization
to organize into a labor union; bring into or incorporate in a labor union. Current conditions in health care invite unionization.
continuous quality improvement (CQI) program
to review the events leading up to each medication administration error The purpose of CQI is to evaluate outcomes of care based on standards of practice In CQI, once a problem is identified, data collection and analysis should take place before intervening to fix the problem Evaluation consists of reviewing the events leading up to the errors
this type of leader focuses on immediate problems, maintaining the status quo and using rewards to motivate followers
transactional leader
this type of leader empowers folowers to assume responsibility for a communal vision, and personal development is a secondary outcome
transformational leader
smoke from wastebasket
transported client to hallway
True/false. A family member of a client can have the living will overturned in some cases.
true..family members have the right to question the mental capacity at the time a living will was completed
-High fever and productive cough (possibly new onset pneumonia); -possible fractured tibia
urgent-should be treated quickly