Chapter 3 Quality, Patient Safety, and Communication, and Record-keeping
Because high oxygen concentrations are used in respiratory care, fire is a real hazard. Even though oxygen is categorized a(n) (blank) gas and does not burn, it greatly speeds up an existing fire
nonflammable
What do you think is the mos common type of injury in health care?
Back injuries are the most common injuries in almost all work settings.
State how to reduce electrical shocks to patients and yourself
Don't roll beds, or other equipment over electrical power cords. report frayed cords take suspect equipment out of use
List the common components of a medical record
Health care records are written pictures of occurrences and situations pertaining to a patient throughout his or her stay in a health care institution. Medical records are the property of the institution. Only those individuals directly caring for the patient may view the patient's medical records.
What is a medical record? Who owns the record? Who is allowed to read it?
Health care records are written pictures of occurrences and situations pertaining to a patient throughout his or her stay in a health care institution. Medical records are the property of the institution. Only those individuals directly caring for the patient may view the patient's medical records.
List two factors you should monitor during patient ambulation. (There is a total of five!)
Level of consciousness, color, breathing, strength, and complaints
On what shift do most injuries, accidents, and patient incidents occur?
Night shift. There are fewer workers overall, workers are less likely to be alert for various reasons, and patients who are sleepy or medicated are more likely to fall.
State how communication can affect patient care.
Status and perception of the problem may result in conflict. The doctor and the nurse are concerned with transporting a critically ill patient as quickly as possible. Some practitioners may perceive their "rank" as higher than other practitioners. Some form of collaboration or compromise or an avoidance strategy is indicated. For example, ask someone else to manually ventilate the patient, or keep manually ventilating and ask someone else to take care of the cords as you leave. Accommodation would be a good strategy here.
You are caring for a patient who is on a mechanical ventilator. You need to transport the patient to radiology for a CT scan. The nurse unplugs the IV pump and pulse oximeter from the back of each unit. The pumps and the pulse oximeter are now running on their battery systems. As you prepare to leave, you notice that the power cords are still plugged into the wall outlets. The physician and the nurse are anxious to get the transport under way. What potential conflict/communication problems exist? How would you deal with them?
Status and perception of the problem may result in conflict. The doctor and the nurse are concerned with transporting a critically ill patient as quickly as possible. Some practitioners may perceive their "rank" as higher than other practitioners. Some form of collaboration or compromise or an avoidance strategy is indicated. For example, ask someone else to manually ventilate the patient, or keep manually ventilating and ask someone else to take care of the cords as you leave. Accommodation would be a good strategy here.
You should begin(blank) as soon as a patient is stable.
ambulation
You must (blank) each treatment, medication, or procedure you provide.
document
Identify the potential physiologic effects that electrical current can have on the body
electrocution macro shocks micro shocks
Everything should have a three-prong plug. The third prong is the neutral wire, or (blank) , which helps prevent electrocution. For this reason, no outside electrical devices are allowed in the hospital unless the medical staff checks them.
ground
Prevent electrical shocks by always (blank) your equipment
grounding
Identify impediments to care and risk in the direct patient environment.
high oxygen concentration electrical equipment
a medical record is a (blank) document
legal
Electrocution can occur in the form of a(n) (blank) shock. This might happen if you are standing on a wet floor and a power cord falls onto the floor. Many power cords are detachable, so this is a potential hazard. Always clean up spills.
macro
A(n) (blank) is a small current that enters the body through external catheters and may cause ventricular fibrillation
micro shock
A small shock, or (blank) shock is a hazard to patients who have pacemakers, ECG leads, and indwelling heart catheters. These shocks may result in ventricular fibrillation and death! This could happen if the (blank) wire gets broken , so don't ever roll beds or other equipment over electrical power cords. Report frayed cords and take suspect equipment out of use.
micro; ground
You can minimize fire hazards by removing flammable materials and ignition sources from areas where (blank) is in use.
oxygen (O2)
List the conditions needed for fire and how to minimize fire hazards
oxygen,combustible material,heat
Describe how to apply good body mechanics and posture to moving patients.
straight spine and use of leg muscles to lift a heavy object
The following are some guidelines for safe ambulation. Number them 1 through 7 in the right order. - Dangle the patient - Sit the patient up - Assist to a standing position - Encourage slow, easy breathing -lower the bed and lock the wheels - move the iv pole close to the patient -provide support while walking
1 Lower the bed and lock the wheels. 2 Move the IV pole close to the patient. 3 Sit them up. 4 Dangle the patient. 5 Assist to a standing position. 6 Encourage slow, easy breathing. 7 Provide support while walking.
Describe how to ambulate a patient and the potential benefits of ambulation.
1 Lower the bed and lock the wheels. 2 Move the IV pole close to the patient. 3 Sit them up. 4 Dangle the patient. 5 Assist to a standing position. 6 Encourage slow, easy breathing. 7 Provide support while walking. Portable O2 source: E cylinder or liquid. Color, breathing (rate, pattern, use of accessory muscles), strength, patient complaints (shortness of breath). A pulse oximeter might be useful in evaluating adequacy of oxygenation. Benefits: helps maintain normal body function reduce length of hospital stay avoid bed sores avoids atelectasis (low lung volumes)
identify key statistics related to the incidence and origins of hospital fires.
1980 12,000 hospital fires 2010, 6240 hospital 50% reduction because of education and enforcement of strict fire codes
List four factors that influence the communication process.
A. Attitude B. Culture C. Self-concepts D. Feelings E. Prior experiences
List the factors associated with the communication process
A. Attitude B. Culture C. Self-concepts D. Feelings E. Prior experiences
Describe two problems associated with immobility and two benefits of ambulation
A. Bed rest promotes atelectasis, can cause bed sores. B. Ambulation reduces length of stay, maintains normal body functions.
State one legal and one practical essential aspect of record keeping
A. Legal: No documentation means that no care was given. B. Practical: Briefness (using standard terms)
State the legal and practical obligations involved in record keeping
A. Legal: No documentation means that no care was given. B. Practical: Briefness (using standard terms)
List three risks that are common among patients receiving respiratory care.
A. Patient movement and ambulation B. Electrical hazards C. Fire hazards
Describe how to recognize and help resolve interpersonal or organizational sources of conflict.
A. Poor communication: Supervisor not willing to accept different points of view for dealing with a difficult patient. B. Structural problems: Conflict increases in larger organizations. C. Personal behavior: Personalities, attitudes, and behavior traits. D. Role conflict: Clinical supervisor trying to manage staff and students at the same time.
Name four sources of conflict in healthcare organizations. Give an example of each.
A. Poor communication: Supervisor not willing to accept different points of view for dealing with a difficult patient. B. Structural problems: Conflict increases in larger organizations. C. Personal behavior: Personalities, attitudes, and behavior traits. D. Role conflict: Clinical supervisor trying to manage staff and students at the same time.
The text lists five ways to improve your effectiveness as a sender of messages. Describe two of these that apply to you. Give examples of situations where you communicated well (or not!) I need to improve in
A. Share information instead of telling. B. Relate to people instead of controlling. C. Value disagreement as much as agreement. D. Eliminate threatening behavior. E. Use effective nonverbal communication. Students are expected to elaborate on two of these areas! You will find considerable additional information that can be used for discussion.
Describe how to improve your communication effectiveness.
A. Share information instead of telling. B. Relate to people instead of controlling. C. Value disagreement as much as agreement. D. Eliminate threatening behavior. E. Use effective nonverbal communication. Students are expected to elaborate on two of these areas! You will find considerable additional information that can be used for discussion. conflict
A respiratory therapist has completed SOAP charting in the progress notes following a bronchodilator treatment. While signing the chart form, she notices that the wrong amount for the medication has been entered. Which of the following actions should be done at this time? 1. Draw one line through the error 2. Notify the physician of the error 3. Write "Error" and initial 4 Recopy the progress notes. A. 1 and 2 B. 1 and 3 C. 2 and 4 D. 3 and 4
B. 1 and 3
Describe how to maintain a problem-oriented medical record.
Briefness (using standard terms)
Describe the two patient identifier systems
Name and Birthday probably
The physician orders ambulation for a patient who is receiving oxygen. The nurse asks you to assist. The patient is in bed wearing a nasal cannula running at 2L/min After 5 minutes of walking, you notice that the patient is breathing at a rate of 24 breaths/min and using his accessory muscles of ventilation. His skin appears sweaty, and he is exhaling through pursed lips What observations are important to note in this situation? What action would you take?
Color, breathing (rate, pattern, use of accessory muscles), strength, patient complaints (shortness of breath). A pulse oximeter might be useful in evaluating adequacy of oxygenation
A patient with asthma has orders for albuterol by medication nebulizer every 2 hours. During the shift, the patient improves, and the order is changed to every 4 hours. In regard to the new frequency, what action should you take? 1. Note the change in your charting 2. Inform the registered nurse of the order. 3. Frequency will change during your shift. A. 1 and 2 B. 1 and 3 C. 2 and 3 D. 1,2, and 3
D. 1, 2, and 3 The new order must be noted in the chart for legal and reimbursement purposes. You should communicate with the RN regarding the patient's care plan. The supervisor will need to know about the change in order to plan workload scheduling.
A patient's heart rate increases from 88 to 134 beats/min following a breathing treatment. After reassuring the patient, the respiratory therapist should A. Discontinue the therapy B. reduce the dosage of the medication C. Place the patient on oxygen D. notify the physician
D. Notify the physician. Even if the RT could discontinue with a protocol, the MD needs to know about the problem.
What is the main reason you should use good body mechanics?
Minimizes the likelihood of injuries.
Explain Plan-Do Study-Act Cycle
Plan - determine strategy (aim, duration, data collection & team). Do - collect data & record observations. Study - analyze results & derive conclusions. Act - change process for improvement, plan next cycle.
The physician orders ambulation for a patient who is receiving oxygen. The nurse asks you to assist. The patient is in bed wearing a nasal cannula running at 2L/min What equipment will you need before you try to walk this patient?
Portable O2 source: E cylinder or liquid.
S - Meaning - Example O - meaning -example A -meaning -example P -meaning -example
S - Meaning:Subjective - Example: "My chest hurts when I breathe." O - meaning: Objective -example:Awake, alert, and oriented. HR 98, RR 25, BP 118/80. Bronchial breath sounds in right lower lobe A -meaning:Assessment -example: Pneumonia continues. P -meaning: Plan -example: Postural drainage and percussion every 4 hr.
You are caring for a patient who is on a mechanical ventilator. You need to transport the patient to radiology for a CT scan. The nurse unplugs the IV pump and pulse oximeter from the back of each unit. The pumps and the pulse oximeter are now running on their battery systems. As you prepare to leave, you notice that the power cords are still plugged into the wall outlets. The physician and the nurse are anxious to get the transport under way. Describe the actions you would take if you encountered this situation.
Take time to unplug the power cords from the wall. Cords plugged into the wall but disconnected from the IV pump or pulse oximeter represent a significant electrocution hazard.
In fact, oxygen is necessary for fires to exist. For a fire to start, you also need (blank) material, and heat Remove any of these three, and the fire will go out. You make sure that ignition sources such as (blank) are not allowed when oxygen is in use. Most hospitals will call "Code Red" if a fire exists, and you must respond. One of the respiratory therapist's responsibilities in fire is to shut off the zone to the affected area if the fire is near a patient using oxygen.
combustible, cigarettes
(blank) skills play a key role in your ability to achieve desired patient outcomes.
communication
accommodating, avoiding, collaborating, competing, and compromising are basic strategies for handling(blank)
conflict
Health Care settings are filled with electrical equipment. The flow of electricity is called (blank)
current
Write definitions of key terms associated with electricity, including voltage, current, and resistance
voltage- what makes electrical charge move current-flow of electricity resistance-force working against electrical movement
