PNC Midterm
Which statement by the nurse indicates an understanding of the case manager's role?
"Coordinates care for the patient" "Guides patients through the health care delivery process" "Assists patient in achieving goals effectively and efficiently." "Collaborates with the health care team"
The nurse is using assertive communication skills to express self rights when stating:
"I am responsible for what I say"
The nurse must start an IV for a toddler in the emergency department. The toddler is accompanied by a parent. The parent asks the nurse, "Can I stay with my child and comfort him?" Which response by the nurse is best?
"Yes, it would be helpful for you to stay and comfort your child."
EBP: Components of Central line-associated blood stream infections prevention
-Education about CLABSI prevention (cleanse hands, line care q8 hrs, assess daily need, bathe with chg, scrub the hub, inclusive education) -Hand Hygiene -Barrier Precautions -Chlorhexidine skin antisepsis -Disinfection caps -Change dressing every 7 days using an aseptic technique (more frequently if soiled, damp, or loose) -Remove unnecessary catheters -Change administration sets for continuous infusions no more frequently than every 4 days, but at least every 7 days. -If blood or blood products or fat emulsions are administered change tubing every 24 hours. -If propofol is administered, change tubing every 6-12 hours or when the vial is changed
EBP: Prevention of hospital-acquired CDI
-Hand hygiene -Contact precautions -Bleach for terminal cleaning -Private rooms
EBP: Triggers for surgical site infections
-Inappropriate use of prophylactic antibiotics -Inappropriate hair removal -Uncontrolled post-op serum glucose -Unable to maintain normothermia post-op
EBP: Nurse researcher describing evidence-based practice
-Increases capability to deliver nursing treatments that are effective -Research findings and Evidence-Based Practice should be connected. -Make way for newly discovered therapies and procedures -Staying current will help nurses develop in their careers and provide better patient care. -Filling the knowledge gap in nursing and altering how people react to nursing care.
Clients at risk for pressure ulcers:
-Obese -Post op -Elderly -Impaired mobility -Altered mental status
When to implement fall risk assessment:
-Patient with unsteady gait -Older adults -Patient taking any sedatives, benzodiazepines, anti-anxiety, opioid, ect.
Care of a client with HIGH fall risk:
-Re-orient patient to environment, place, time, and person as needed -Consider placing the patient in a room closest to the nurse's station -Apply corresponding colored wristband/socks on the patient to notify nurses of patient fall risk -Assure patient supervision and assistance when having to ambulate or use the restroom -Notify the attending physician that the patient is at high risk for falls by documenting in the patient's chart and discussing the plan of care associated with patients cognitive function, gait and medications.
Essential elements of pressure ulcer prevention
-Reposition patients every 2 hrs -Ensure pt skin is clean and dry -Moisturize pt skin -Inspect pt skin daily -Making sure sheets are wrinkle free
EBP: Components of sepsis bundle
3-hour Bundle: This is the recommendation to be performed within the 3 hours that sepsis is suspected to have maximum results 1. Obtain a blood culture before antibiotics 2. Obtain a lactate level 3. Administer broad-spectrum antibiotics 4. Administer 30mL/kg of fluids for hypotension 6-hour Bundle "Sepsis Critical": This contains all of the therapeutic interventions that must be met within 6 hours after presenting with septic shock: 1. Apply Vasopressors (Dopamine or Norepinephrine)- for hypotension that does not resolve to initial fluid resuscitation to maintain the MAP >65 mmHg 2. Remeasure lactate if initially > 4mol/L 3. Reassess volume status and tissue perfusion 4. Measure CVP (central venous pressure) 5. Measure ScVO2 (central venous oxygen saturation)
Roles of the Case Manager
A case manager is responsible for ensuring that clients receive fiscally sound, appropriate care in the best setting. Part of the case manager's duties includes identifying which services a client will require post-discharge, locating providers of these services, and coordinating visits from these providers. In this scenario, the home health nurse is assuming the role of the case manager. Although the client requires education, the home health nurse's primary role is not that of a health educator. Similarly, although case managers often engage in client advocacy and health promotion activities, these tasks account for just a portion of the nurse's duties in this scenario.
A nurse has been assigned the following patients. Which patient is a priority to assess first?
A patient with pneumonia and O2 saturation of 88%
A student nurse is studying clinical judgment theories and is working with Tanner's Model of Clinical Judgment. The student nurse can generalize the process as
A reflective process where the nurse notices, interprets, responds and reflects in action
After accidentally providing food to a client who is NPO for surgery, the nurse reports the error to the healthcare provider and follows hospital policy for managing the error. Which characteristic is demonstrated by the actions of this nurse?
Accountability
Components of a professional identity in nursing include which attributes?
Accountability Advocacy Autonomy Competence
Professional Values
Altruism is a concern for the welfare and well-being of others. In practice, altruism is reflected in the nurse's concern for the welfare of patients, other nurses, and other healthcare providers. Autonomy is the right to self-determination. Professional practice reflects autonomy when the nurse respects patients' rights to make decisions about their healthcare. Human dignity refers to the inherent worth and uniqueness of individuals and populations. The nurse who values and respects all patients and colleagues show respect for human dignity. Integrity is acting in accordance with an appropriate code of ethics and accepted standards of practice. Integrity is reflected in professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession. Social justice refers to the upholding of justice, or what is fair, on a social scale. Nurses act in accordance with social justice by treating all patients equally without regard to economic status, ethnicity, age, gender, religion, citizenship, disability, or sexual orientation.
What resources are available to professional nurses to help resolve ethical dilemmas?
American Nurses Association (ANA) Code of ethics for Nurses
Which of the following demonstrates that further teaching is required to prevent an infection related to being catheterized? Select all that apply
An elderly female carries her urinary drainage bag like a purse under her arm as she ambulates As a patient is being transferred in a wheelchair, he places the drainage bag in his lap The NAP places a patient drainage bag on a lowered side rail or on the floor.
The charge nurse is determining which activities to delegate to the nursing assistant. Which of the following would not be appropriate for the charge nurse to delegate to the nursing assistant?
Assessing a patient's lung sounds
EBP: Infection modes for catheterized client
Bacteria enter the urinary tract during insertion, through the catheter lumen itself, or via contact between the outside of the catheter and the urethra. 66% of CAUTI's are due to bacterial entrance via the catheter-urethral interface. The remainder of CAUTI's is associated with bacterial contamination due to manipulation of the catheter and drainage system.
EBP: Basic of Clostridium Difficile (CDI)
Bacteria that can cause a disruption to individual GI system when there is abnormal balance of the organism and causes: -Diarrhea -Fever -Stomach tenderness -Loss of appetite -Nausea
A home health nurse is planning care for an adult client who is being discharged from the hospital after experiencing complications of diabetes mellitus. The client requires an extensive dressing change twice per day, help with activities of daily living, and comprehensive education. To ensure these needs are met, the nurse is coordinating home visits from aides and therapists. Which role is the nurse assuming by coordinating this client's care?
Case manager
Client being discharged to Rehab
Case manager responsible for coordinating, implementing, and evaluating patient care -From pre-admission through discharge or transfer and recuperation -Referred to as discharge planners Involves multidisciplinary teams that assume collab responsibility
A nurse works in the operating room (OR) as a circulator. Which actions should the nurse perform to help prevent surgical-site infections? Select all that apply:
Close the OR doors at all times during a surgical case Minimize traffic in the OR Monitor the sterile field at all times Immediately discard any object that becomes contaminated
The nurse interprets assertive behavior as:
Direct
Ethical and Legal Practice: Withholding food and fluids
During the dying process, patients exhibit decreased oral intake, progressive fluid deficits, and progressive accumulation of drugs. These changes can worsen existing symptoms or create new ones; these, in turn, lead to further declines in oral intake. Research consistently suggests that, when this occurs, it is more harmful to administer nutrition and fluids to the patient than it is to withhold them. As a result, nurses in this situation are morally obligated to withhold nutrition and fluids—or any treatment.
Ethical and Legal Practice: Substance abuse pregnant client refusing HIV testing
Fetal protection laws complicated the ethics of healthcare during pregnancy. Broad interpretation of these laws led to questions about the mother's right to accept or decline certain tests and treatments during pregnancy *** forcing or coercing a patient to have a procedure that the patient has refused is unlawful and can result in legal consequences for the nurse
Ethical and Legal Practice: Impact of risk management on ethical dilemmas
Identify a range of actions with potential outcomes. -What are the pros? What are the cons? -If you choose to participate in the study group and then inform the instructor? -If you choose to participate and not tell the instructor? -If you choose not to participate and not tell the instructor? -If you choose not to participate and to tell the instructor? Decide on a course of action and carry it out. -What are you going to decide? -On what do you base your decision? -What does your decision tell others about you and your values? -Does your decision predict future decisions/actions? Evaluate/reevaluate the consequences of your decision/action. -What tools would you use to evaluate your decision/action after the fact? -How would you determine what effect your decision/action had on others?
A client has been hospitalized after an automobile accident. A full leg cast was applied in the emergency room. The MOST important reason for the nurse to elevate the casted leg is to:
Improve venous return
Ethical and Legal Practice: HIPAA and the client with STI
In keeping with the principle of autonomy, nurses are obligated to respect patients' privacy and confidentiality. Privacy is both a legal and an ethical mandate. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes standards that protect the confidentiality, integrity, and availability of data and standards defining appropriate disclosures of identifiable health information and patient rights protection
A case manager assembles a team of healthcare professionals, including a client's primary healthcare provider, physical therapist, and social worker, for the purpose of collaborative discharge planning and decision making. Which type of team did the case manager assemble?
Interdisciplinary team
Identify contributing factors to pressure ulcer formation. (Select all that apply)
Malnutrition Decreased sensory perception/mobility Excessive sweating
A nurse is caring for a Latino patient. The nurse is aware of the importance of cultural competency and providing the patient with culturally competent care. What can be done to enhance communication with this patient?
Obtain an interpreter if needed
Ethical and Legal Practice: Adolescent cancer patient wanting to stop treatment
Parents or guardians must consent to medical treatment for adolescents under the age of 18 unless -the adolescent has been emancipated -resides in a state that recognizes mature minors -is seeking specific types of treatment recognized by state law such as birth control prenatal care diagnosis and treatment of sexually transmitted infections
A nurse is assigned to care for five patients. The nurse is concerned about the ability to care for this many patients. The nurse needs to
Prioritize the needs of the patients and determine the sickest patient
"A sense of oneself that is influenced by characteristics, norms, and values of the nursing discipline, resulting in an individual thinking, acting and feeling like a nurse."
Professional identify
A nurse is working with a nurse aide to care for a group of patients. Which of the following activities would be inappropriate to delegate to the nurse aide?
Providing discharge instructions to a patient
Which skill is foundational for a nursing students participation in the evidence-based practice process?
Read and understand a research article
The nurse is receiving a phone order from a healthcare provider. How will the nurse make sure that the provider's order is received without error?
Repeat the order, write the order verbatim, and read it back to the provider
In a private NP clinic, a patient presents with trichomonas. State law requires reporting of STDs to the public health department. The patient asks that NP not to report it because her husband works in the public health department. How should this be managed by the NP?
Report it to public health as required by law If state law requires reporting of the STD, it should be reported. Patient names or other identifying data are not part of the reporting process, so the NP's patient should not worry about being identified and associated with this finding.
EBP: Definition of Sepsis
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is a subset of sepsis in which the underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.
Four components of care are recommended for all patients to prevent or reduce the risk of CAUTI
Step 1: Avoid unnecessary urinary catheters Step 2: Insert urinary catheters using aseptic technique Step 3: Maintain urinary catheters based on recommended guidelines Step 4: reveiw urinary catheter necessity daily and removed promptly
EBP: Components of Ventilator-Associated Pneumonia Bundle
Steps of the select Bundles: 1. Elevation of the Head of the Bed 2. Daily Sedative Interruption and Daily Assessment of Readiness to Extubate 3. Peptic Ulcer Disease (PUD) Prophylaxis 4. Deep Venous Thrombosis (DVT) Prophylaxis 5. Daily Oral Care with Chlorhexidine
A 64-year-old patient had a right hemisphere stroke and a recent fall. His wife stated that he has a history of high blood pressure, which is controlled by an antihypertensive and a diuretic. Currently, he exhibits left-sided neglect and problems with spatial and perceptual abilities and is impulsive. He has a moderate left-sided weakness that requires the assistance of two and the use of a gait belt to transfer to a chair. He currently has an intravenous (IV) line and a urinary catheter in place. Which factors increase his fall risk at this time? (Select all that apply.)
Takes antihypertensive and diuretics Hx of recent fall Neglect, spatial and perceptual abilities, impulsive Requires assistance with activity, unsteady gait IV line, urinary catheter
Assessing clients factors for fall risk:
The Morse Fall Scale (MFS) is used to assess all in-patients for fall risk: - Hx of falling -Secondary diagnosis -Ambulatory aid -IV/Heparin lock -Steady gait -Mental status If the score is >45, a colored bracelet/sock will be applied to patient indicating their fall risk status
EBP: Interventions to prevent surgical site infection
The four components of SSI prevention include the appropriate use of prophylactic antibiotics, appropriate hair removal, controlled postoperative serum glucose in cardiac surgery, and immediate postoperative normothermia. Preoperative Measures: -Administer antimicrobial prophylaxis in accordance with evidence-based standards and guidelines. -Identify and treat any remote infections before elective operation. -Do not remove hair at the operative site unless it will interfere with the operation; do not use razors. Intraoperative Measures: -Maintain operating room traffic. -Maintain surgical wound dressing -Control blood glucose levels during the immediate postoperative period. -Practice Strict Surgical Asepsis Postoperative Measures: -Feedback on surgeon-specific infection rates -Discontinue antibiotics within 24 hrs after the surgery end time
EBP: Impact of nursing research on nursing practice
The medical field is constantly improving and changing methods with new research coming out to allow for the best possible outcomes for patients. Research shows that alcohol based products are effective and convenient to use to kill non-spore forming organisms. C. diff being a spore forming organism means that the use of alcohol based products does not kill or remove the bacteria. Study shows that the reduction of C. diff was significantly more effective when using soap and water compared to using only the alcohol based Products. Nursing research shows that the use of gloves when caring for patients with C. diff, especially when handling any bodily secretions are shown to reduce the number of CDIs in the hospital setting. Although, using bleach to clean can damage equipment and affect individual health while using the cleaning product (such as respiratory problems) Overtime, it has been proven through research that using bleach products to clean a patient's room who had C. diff can reduce the rate of CDIs.
A charge nurse is making assignments for the shift and notes that a client from a different culture was recently admitted and will require a thorough admission assessment during the upcoming shift. Which generation of nurse is likely to be the most culturally sensitive and thus the best choice for this client assignment?
The millennial nurse
Clinical Decision Making and Concepts associated with starting CPR:
The nurse's clinical decision to initiate cardiopulmonary resuscitation (CPR) immediately can help restore circulation to major organs, including the brain and the heart. Nurse critical decision making addresses the patinets actual or potential risk for compromised airway that may lead to respiratory arrest and alteration in the body's acid-base balance.
Identify prevention strategies for pressure ulcers. (select all that apply)
Use a moisture barrier ointment, applied after each incontinent episode When the patient is in the side-lying position in bed, use the 30-degree lateral position Place the patient on a pressure-reducing support surface Oral supplements should be instituted if the patient is found to be undernourished
Professionalism: Generations
Veteran generation --> value hard work and respect authority Baby boomer --> vaule teamwork Generation X nurses --> value self-reliance Millennial nurses --> value achievement In the workplace, a veteran nurse might say, "Do it because I say so," and a baby-boomer nurse might say, "Lets get together and reach a consensus about how to do it." The generation X staff nurses might say they will do it themselves, and the millennial nurses might not care who does it as long as the work gts done.
Dr. Jones asks you to give a medication to one of the patients, and you know the patient is allergic to it. When you point this out, Dr. Jones says, "Give the medication or I'll report this to your supervisor." What is the best assertive response?
Walk away and ignore Dr. Jones
Ethical dilemma with the withdrawal of life support in ICU
When people are ill, they may be unable to assert their rights as they would if they were healthy. When this happens, nurses have an ethical responsibility to advocate on behalf of the patient based on what the patient would want.
