LEADING AND MANAGING, Taylor Ch. 14: Assessing, Taylor Ch. 16: Outcome Identification and Planning, Taylor Ch. 18: Evaluating, Taylor Ch. 8: Communication, Taylor Ch. 19: Documenting and Reporting, Taylor Ch. 17: Implementing, Taylor Ch. 13: Blended...
Physical, mental, and emotional state
The degree to which people are physically comfortable and mentally and emotionally free to engage in interactions also influences communication
Planning:
The development of patient centered goals to prevent, reduce, or eliminate problems and identify nursing interventions that will assist in meeting these goals. Contains expected changes in the patient health status or in patient behaviors.
Physical Assessment:
The examination of the patient for objective data that may better define the patient's condition and help the nurse plan care.
Compliance
The extent to which a patient's behavior coincides with the clinical advice, implying the health care provider is viewed as the authority and the patient passively follows recommendations, a paternalistic attitude toward patients
Adherence
The extent to which a person's behavior corresponds with the agreed upon recommendations from a health care provider
Facial Expressions
The face is the most expressive part of the body
Written materials
The first consideration with printed material is availability. Many brochures, fact sheets, and pamphlets are available at no cost from online sources
Caring:
The human mode of being. -Is the essence of nursing and the moral imperative that guides nursing praxis (education, practice, and research).
Electronic communication
The internet and a variety of social websites provide new and challenging opportunities for nurses to communicate and collaborate with other health care providers. Ct signs authorization permitting email communication
Process Evaulation:
The nature and sequence of activities carried out by nurses implementing the nursing process.
Maslow believes that what needs should be met first:
The need for air, food, fluid or sleep must be met first
When evaluating patient outcome achievement :
The nurse identifies factors that contribute to the patients ability to achieve expected outcomes and when necessary modifies the care plan.
Review of Systems (ROS):
The nursing physical assessment involves the examination of all body systems in a systemic manner, commonly using a head-to-toe format.
Clinical Inquiry
The ongoing process of questioning and evaluating practice and advancing informed practice.
Expiration
The passive phase of ventilation, movement of air out of the lungs
Patient care summary:
The patient care summary contains an overview of valuable patient information such as documentation, lab and test results, orders, and medications
(Box 26-3) Positions for Physical Assessment: Lithotomy
The patient is in the dorsal recumbent position with the buttocks at the edge of the examining table and the heels in stirrups. *It is used to assess female genitalia and rectum.*
(Box 26-3) Positions for Physical Assessment: Knee-Chest
The patient kneels, with the body at a 90-degree angle to the hips, back straight, arms above the head. *It is used to assess the anus and rectum*
(Box 26-3) Positions for Physical Assessment: Prone
The patient lies flat on the abdomen with the head turned to one side. *It is used to assess the hip joint and the posterior thorax*
(Box 26-3) Positions for Physical Assessment: Supine
The patient lies flat on the back with legs extended and knees slightly flexed. It facilitates abdominal muscle relaxation and is used to assess vital signs and the head, neck, anterior thorax, lungs, heart, breasts, abdomen, extremities, and peripheral pulses.
(Box 26-3) Positions for Physical Assessment: Dorsal Recumbent
The patient lies on back with legs separated, knees flexed, and soles of the feet on the bed. It is used to assess the head, neck, anterior thorax, lungs, heart, breasts, extremities, and peripheral pulses. It *should not be used* for abdominal assessment because it causes contraction of the abdominal muscles.
(Box 26-3) Positions for Physical Assessment: Sims Position
The patient lies on either side with lower arm below the body and the upper arm flexed at the shoulder and elbow. Both knees are flexed, with the upper leg more acutely flexed. *It is used to assess the rectum or.*
Financial resources
The patient may be unable to afford to follow a new treatment regimen. If needed, refer patients and families to community based support groups and funding sources
(Box 26-3) Positions for Physical Assessment: Sitting
The patient may sit in a chair or on the side of the bed or examining table, or remain in bed with the head elevated. It allows visualization of the upper body, facilitates full lung expansion, and is used to assess vital signs and the head, neck, anterior and posterior thorax, lungs, heart, breasts and upper extremities.
(Box 26-3) Positions for Physical Assessment: Standing
The patient stands erect. This position *should not be used* for patients who are weak, dizzy, or prone to fall. It is used to assess posture, balance, and gait (while walking upright).
Medication Administration Record (MAR):
The patients medication record must include documentation of all medications administered to the patient, the nurse administering the drug, and, for some medications, the reason the drug was administered and it effectiveness.
The nurse is concerned with?
The patients response to health and illness and the patients ability to meet the basic needs.
Precordium
The portion of the body over the heart and lower thorax, encompassing the aortic, pulmonic, tricuspid, and apical areas, and Erb's point.
Purposes of Patient records:
The primary purpose is to help health care professionals from different disciplines (who interact with the patient at different times) communicate with one another.
Communication:
The primary purpose of the patient record is too help care professionals from different disciplines communicate with each other. Communication fosters continuity of care.
Bedside report:
The trend today is towered a standardized , stream-lined shift report system at the bedside. Vital elements of the bedside report include 1.) The oncoming and outgoing nurse seeing the patient together. 2.) Reviewing medication records and health care providers and nursing orders. 3.) establishing patient goals for the next shift.
Posture
The way a person holds the body carries nonverbal messages. People in good health and with a positive attitude usually hold their bodies in good alignment. Depressed or tired people are more likely to slouch
HOW CAN MENTORS AND PRECEPTORS HELP ME
There are two aspects to consider as you get ready to become a leader and manager. - The first part consists of developing self. The second part is a combination of developing self and developing others: mentorship and preceptorship. *mentor* is someone more experienced who provides career development assistance, such as coaching, sponsoring advancement, providing challenging assignments, protecting protégés from adversity, and promoting positive visibility. Mentors *provide guidance* to new students or recent graduates as they continue in the profession. They offer a constructive example as a role model to novices. Mentors can also *fulfill psychosocial roles*, such as personal support, friendship, acceptance, role modeling, and counseling. You should always *use sound judgment* when following the advice of others. *Do not blindly engage* in behaviors or actions because others are engaging in them *preceptors*:A preceptor is an experienced nurse who provides practical teaching and guidance for a student or new employee Ex: the nurse you follow in clinical settings - the mentor relationship is voluntary - in many instances the preceptor will become your mentor - mentoring and precepting are part of your professional abilities as the ANA standard of nursing
Making nursing assessments:
They do not duplicate medical assessments.
Positive reinforcement
To affirm the efforts of patients who have mastered new knowledge, attitudes, or skills. Reinforcement may be as simple as a few words of acknowledgement
Purpose of Evaluation
To allow the patient's achievement of expected outcomes to direct future nurse-patient interactions.
The purpose of Implementing
To assist the patient in achieving desired health goals, promote wellness, prevent diseases and illness, and facilitate coping with altered functioning
Confer:
To consult with someone to exchange ideas or seek information, advice, or instructions. A nurse may consult with another nurse, such as when a primary care nurse consults with a nurse clinical specialist about a particular patients care.
Why are records reviewed?:
To evaluate the quality of care patients have received and the compliance of the nurses providing that care.
Purpose of teaching and counseling
To help patients and families develop the self care abilities(knowledge, attitude, skills) they need to maximize their functioning and quality of life (or to have a dignified death)
Because nursing is concerned with the patients response to health and illness, the care plan is supportive of the nursing's broad aims. which are:
To promote wellness Prevent disease and illness Promote recovery Facilitate coping with altered functioning
TRANSFORMATIONAL THEORIES
Transformational leaders aspire to meet the self-actualization needs of their followers. People need a sense of purpose and vision that goes beyond good interpersonal relationships or the reward for a job well done - empower others and create a supportive environment - followers become motivated to go beyond their self interests
Non-verbal
Transmission of information without the use of words. It often helps nurses to understand subtle and hidden meanings in what the patient is saying verbally.
Acuity records:
Twenty-four hour reports are increasingly used in conjunction with acuity reports, with which nurses rank patients condition and need for nursing assistance or intervention.
Intellectual Skills
Use of cognitive abilities involves knowing and understanding basic sciences, materials, before carrying out nursing activities.
Expected Outcome
Used to refer to the more specific measurable criteria used to evaluate the extent to which a goal has been met.
Gestures
Using various parts of the body can carry numerous messages. Often used extensively when two people speaking in different languages attempt to communicate with each other
Learning
The process by which a person acquires or increases knowledge or changes behavior in a measurable way as a result of the experience
Communication
The process of exchanging information and generating and transmitting meanings between two or more people. It is the foundation of society and the most primary aspect of a nurse patient interaction. Requires at least 2 people
Consultation :
The process of inviting another professional to evaluate a patient and make recommendation to you about the patients treatment.
Progress notes purpose:
The purpose is to inform caregivers of the proress a patient is making toward achieving expected outcomes.
"Read-back":
The recipient reads back the message as he or she heard and interpreted it.
Clinical Judgment:
The result of critical thinking or clinical reasoning- the conclusion, decision, or opinion you make.
Working Phase of the Helping Relationship
Usually the longest phase of the relationship. The nurse works together with the patient to meet the patient's physical and psychosocial needs. Interaction is the essence of the working phase. Nurse patient interactions that occur at this time are purposeful in that they are designed to ensure achievement of health goals or objectives that were mutually agreed upon. The nursing roles of teacher and counselor are performed primarily during this phase. These roles involve motivating the patient to learn and to implement health promotion activites
(Box 26-5) Assessing for Melanoma
Warning signs: ABCDEs A = Asymmetry B = Border C = Color D = Diameter E = Evolving
Social media
Web based technologies that allow users to create, share, and participate in dialogue in virtual communities and networks. Health care facility policies often do not address employee use of social media when not at work, but disclosing information that violates the privacy and confidentiality of patients or professional standards, and posting defamatory remarks about an employer, supervisor, coworker, or patient has serious consequences for nurses.
Web based instruction and technology
Websites appropriate to the patient's disease process, wellness interests, or health promotion focus can be valuable teaching and learning resources. Access to the internet is common, and many websites can support instruction
Therapeutic Relationship:
When the relationship between the carer and the person who is being cared for is focused on promoting or restoring health and well-being of the person being cared for in the relationship.
Human-to-Human Relationship Model:
Which defined nursing as an interpersonal process whereby the professional nurse practitioner assists an individual, family, or community to prevent or cope with the experience of illness and suffering and, if necessary, to find meaning in these experiences. -Developed by Travelbee (1971) an early nurse theorist
Confidentiality
Which patient information is to be treated should be established with the patient
Dullness
With medium pitch and intensity heard over the liver
Collaborative problems
"certain physiologic complications that nurses monitor to detect onset or changes in status. Nurses manage collaborative problems using physician-prescribed and nurse interventions to minimize the complications of the event. -treatments initiated by other providers and carried out by a nurse.
Independent Actions:
(Nurse-Initiated) carrying out nurse prescribed orders that are written on nursing care plan. Nurses held legally held accountable for actions. *Things the MD will NOT tell you to do!!
Dependent Actions:
(Physician-Initiated) involves carrying out physician orders regarding medications, Treatments, Activity, or Diet. Nurses are held accountable for their actions.
adventitious breath sounds
(added, abnormal sounds) are not normally heard in the lungs and result from air moving through moisture, mucus, or narrowed airways. Also result from sudden opening of collapsed alveoli.
RECOGNIZING RESISTANCE
*Active resistance* can take the form of *aggressive actions or outright refusals to comply,* negative communications designed to demean the idea or the person who suggested it, quoting existing rules that make the change difficult to implement, or organizing others to resist the change. *Passive resistance* involves *avoidance*, such as canceling meetings to discuss implementing the change; *being "too busy*" to implement the change; or agreeing to the change, but citing numerous barriers to it.
ENHANCING EXPERTISE
*Actively participate* in interdisciplinary team conferences, client-centered conferences, and clinical or governance committees on your unit. *Enhance your expertise* by attending continuing education activities. This might include local, regional, national, and international conferences sponsored by nursing organizations. *Participate in nursing research projects* or use evidence-based practice guidelines, current nursing journals, and books to make decisions regarding your nursing practice. *Discuss with colleagues* how to handle a difficult clinical situation and observe the practices of experienced nurses or other providers. Do not be afraid to ask questions. *Continue your education* by earning additional degrees and certifications in nursing. Although you have just begun your nursing career, it is not too early to begin thinking of ways to become empowered.
Steps of implementation
*Always asses FIRST -Reassess each patient, ensure prompt attention is paid to emerging problems. -Remain alert to subtle cues - Perform and competently - Each NSG intervention should have scientific rationale = know why you are doing that skill
DIRECT AND INDIRECT CARE THAT MAY BE DELGATED TO A NAP
*Direct Client Care Activities* Assisting with activities of daily living: feeding, drinking, ambulating, grooming, toileting, dressing Assisting with socializing Taking vital signs *Indirect Client Care Activities* Providing a clean, safe environment Providing transport for noncritical clients Assisting with stocking nursing units Providing messenger and delivery services Making beds Ordering supplies
CHALLENGES TO BEING AN EFFECTIVE LEADER
*ECONOMIC CLIMATE OF HEALTHCARE* - *Resources are scarce:* how much do we spend on services how wil services be produced how should be or can we distribute healthcare *Resources have alternative uses* - if we choose to spend in one area that will eliminate the allocation of those same resources *Individuals want different things or have different preferences:* - some people choose alternative treatment modalities instead of traditional healthcare like acupuncture or herbal therapy *NURSING LABOR MARKET* From now until 2030, the population aged 65 and older will double. The questions are - (1) whether there will be enough nurses available to fill those jobs, - (2) even if nurses are available, whether it will be economically feasible for organizations to hire as many as they need. - *The Affordable Care Act* has increased the demand for advanced practice registered nurse practitioners. changes will likely demand that the RN lead and manage personnel delivering client care while maintaining fiscal responsibility
EMOTIONAL INTELLIGENCE THEORY (EI)
*Empathy*—Able to make emotional connections with others. *Self-awareness*—Recognize and understand their own emotions. *Self-management*—Control their personal emotions. *Relationship management*—Use self-emotions to successfully interact with and manage others. Ability to build trust, respect, and cooperation within the team (Sadri, 2012). *Social awareness*—Accurately assess and respond to the emotions of others. Ability to listen and accurately interpret unspoken emotions
SOURCES OF EMPOWERMENT
*Empowerment* is a psychological state: a feeling that one has been given the power to solve problems, take initiatives, and exercise autonomy *KEY POINT: Given these definitions, it is possible to be powerful and yet not feel empowered. Power refers to action, and empowerment refers to feelings. Both are of interest to nursing leaders and managers.* Feeling empowered includes - *Self-determination*: Feeling free to decide how to do your work - *Meaning*: Caring about your work, enjoying it, and taking it seriously - *Competence*: Confidence in your ability to do your work well - *Impact*: Feeling that people listen to your ideas, that you can make a difference you will feel empowerment in settings that: 1) manageable, reasonable work assignments; (2) reward, recognition, and appreciation for a job well done; and (3) fair, consistent treatment of all staff.
(Box 26-4) Geriatric Depression Scale (GDS)
*How you felt over the last week. Yes or No* 1. Are you basically satisfied with your life? 2. Have you dropped many of your activities and interests? 3. Do you feel that your life is empty? 4. Do you often get bored? 5. Are you in good spirits most of the time? 6. Are you afraid that something bad is going to happen to you? 7. Do you feel happy most of the time? 8. Do you often feel helpless? 9. Do you prefer to stay at home, rather than going out and doing things? 10. Do you feel that you have more problems with memory than most? 11. Do you think it is a wonderful time to be alive now? 12. Do you feel worthless the way you are now? 13. Do you feel full of energy? 14. Do you feel that your situation is hopeless? 15. Do you think that most people are better off than you are? Score 1 point = "no" to questions 1, 5, 7, 11, and 13 Score 1 point = "yes" to other questions Total score of 5 or more = possible depression and warrants further assessment
LOWERING RESISTANCE
*KEY POINT: A change that is welcomed by one group may be strongly resisted by another group. Resistance to change is affected by the leadership approach and the type of organizational structure.* *COMMANDING CHANGE* - first issue the command - dictating change may sometimes be necessary - people may resist this through: Passive resistance can undermine the change. High motivational levels are necessary to make the change successful. People can refuse to implement the change without negative consequences. *SHARING INFORMATION* - effective way to reduce uncertainty and ease transition - you should communicate changes in your plans to the appropriate people *REFUTING CURRENTLY HELD BELIEFS*: - provide evidence that the actions or beliefs are inadequate, incorrect or inefficient *PROVIDING PSYCHOLOGICAL SAFETY* - if a chance will threaten a basic human need then reducing that threat can lower resistance - this leaves people more comfortable about the change
WHAT IS LEADERSHIP:
*KEY POINT: The essence of leadership is the ability to influence other people and motivate action toward a common goal. * Three tasks: - *Set direction* (i.e., help people develop vision, a mission, goals, and purpose). - *Build commitment* (i.e., help people develop motivation, team spirit, and teamwork; inspire others to act). - *Confront challenges* that arise from innovation, change, and turbulence
MENTOR AND MENTEE RESPONSIBILITIES
*MENTOR*: Demonstrate excellent communication and listening skills. Be sensitive to the needs of nurses, clients, and the workplace. Encourage excellence in others. Share and provide counsel. Exhibit good decision-making skills. Demonstrate an understanding of power and politics. Demonstrate trustworthiness. *MENTEE RESPONSIBILITIES* Demonstrate eagerness to learn. Participate actively in the relationship by keeping all appointments and commitments. Seek feedback and use it to modify behaviors. Demonstrate flexibility and an ability to change. Be open in the relationship with the mentor. Demonstrate an ability to move toward independence. Evaluate choices and outcomes
CONFLICT OCCUR AT ALL LEVELS
*On the individual level*, they can occur between two people working together on a classroom or clinical project, between two people in different departments, or even between a staff member and a client or a client's family member. *On the group level*, conflict can occur between two or more teams, departments, or professional groups (e.g., nurses and case managers may conflict over who is responsible for discharge planning). *On the organizational level*, conflicts can occur between two or more hospitals, health agencies, or community organizations.
(Box 26-2) Patient health Questionnaire
*Over the last two weeks, how often have you been botehred by the following?* 1. Little interest or pleasure in doing things 2. Feeling down, depressed, or hopeless 3. Trouble falling or staying asleep, or sleeping too much 4. Feeling tired or having little energy 5. Poor appetite or overeating 6. Feeling bad about yourself-or that you are a failure or have let yourself or family down 7. Trouble concentrating on things, such as reading the newspaper or watching television 8. Moving or speaking so slowly that other people could have noticed. Or the opposite- being so fidgety or restless that you have been moving around a lot more than usual. 9. Thoughts that you would be better off dead or hurting yourself in some way. Major depressive syndrome if: 5 or more "more than half days" checked off #1 or #2 were positive or checked "more than half days" Other depressive disorders if: 2, 3, or 4 were checked "more than half days" #1 or #2 were positive or checked "more than half days"
SOAP format:
*S*ubjective data (statements made by patient or family, describes their perception of the problem) *O*bjective data (measurable data from interventions and staff observation) *A*ssessment (or nursing diagnosis analysis of subjective and objective data) *P*lan (of action, nurse develops in response to nursing diagnosis) *I*mplementation (action taken) *E*valuation of Intervention (response to care) *R*eassessment of patient's needs (care plan revision) Used to organize entries in the progress notes of the POMR. Varients of the SOAP format include SOAPE, SOAPIE, and SOAPIER.
MANAGEMENT THEORIES
*SCIENTIFIC MANAGEMENT* - Given a properly designed task and sufficient incentive to get the work done, workers would be more productive because repetition promotes efficiency - in healthcare the equivalent would be to pay for the number of tasks completed *HUMAN RELATIONS CASED MANAGEMENT* Theory X: a manager needs to use strict rules, constant supervision, and the threat of punishment to create industrious, conscientious workers - similar to scientific management Theory Y: manager emphasizes guidance over control, development rather than close supervision, and reward over punishment. - staff mortal should be high, and provide an atmosphere where they can do their best work SERVANT LEADERSHIP - applies more to supervisors and administrators than nurses - improves the way each employee is treated and provides employees with what they need to provide good quality care - the servant leadership will put the employee first
CONFLICT RESOLUTION
*STEP 1: IDENTIFY THE PROBLEM OR ISSUE* - easy to identify the issue sometimes - sometimes the discussion and exploration of the issues are necessary - people may be vague of real concern, and there may be emotional involvement that may cloud judgement *STEP 2: GENERATE POSSIBLE SOLUTIONS* - begin process of trying to find creative new solutions - some solutions that were previously working may not work now -encourage people to find innovative solutions *STEP 3: EVALUATE SUGGESTED SOLUTIONS* - judge the suggestions on its merits not its source - use an open minded objective evaluation of each suggestion *STEP 4: CHOOSE THE BEST SOLUTION* - one that ill give best results and least negative effects *STEP 5: IMPLEMENT THE SOLUTION CHOSEN* - it is important to give the solution time to work *STEP 6: IS THE PROBLEM RESOLVED* - if the problem isn resolved look at why the chosen solution did not work - resume the process with even greater attention to detail
DELEGATING
- *Assess and diagnose*. You must assess each client's needs before assigning the client to particular team member. - *Plan goals and interventions*. Set client-specific goals and identify the interventions required to achieve these goals. Mentally identify which staff member is best suited for the task or activities before delegating helps to prevent problems later. - *Implement*. Next, determine which personnel have the knowledge and skills to care for the client and assign the tasks to the appropriate person. - *Evaluate*. You are still accountable to oversee care and ensure client care needs have been met. Establish timelines for feedback during the day - use the five rights of delegation - the manager should look at the mix or personnel before delegating - look at the education level of the staff before delegating
SOURCES OF POWER
- *Positional/legitimate*: A person's authority is derived from her location in the organization's hierarchy. The person at the top has the most power. - *Referent*: Informal power created through relationships with people within the organization. Power is acquired through the person's ability to influence and gain other's respect. - *Reward*: The ability of an individual to control or allocate incentives (e.g., promotion, salary increases, recognition, or other benefits). - *Expertise*: "Knowledge is power" ( The person's expertise and analytical skills are deemed critical to the organization. *Coercion*: The power to control others through threats or discipline. The person has the authority to enforce standards, policies, and procedures. *MANAGERS*: - have reward power and they can use coercion to provide structure - they can evaluate and fire people *CLIENTS* - they may seem powerless - can either reward healthcare workers by praising them or causing discomfort by complaining ' *REGISTERED NURSES* - have expert. legitimate and coercion power - delegate to LPN or NAP - essential to healthcare operation and and ensure others are perfuming their roles - they have the power or information or expertise *ASSISTANTS AND TECHNICIANS*: - have both expertise and coercive powers - the organization would grind to a halt without it
INFORMATIONAL RESPONSIBILITIES
- *Spokesperson*. Nurse managers relay information from administration to staff members and speak with administration on behalf of staff members. - *Monitor*. Nurse managers monitor the activities of their units or departments (e.g., the number of clients seen, length of stay), as well as the staff (e.g., absenteeism) and the budget (e.g., money spent). - *Public Relations*. Nurse managers share information with clients, staff members, and employers, for example, regarding new developments in healthcare and policy changes
DECISIONAL ACTIVITES
- Employee evaluation, including conducting formal performance appraisals - Resource allocation (e.g., budgeting and how to use available funds wisely) - Hiring and terminating employees - Planning for future changes (e.g., in budgets or client populations) - Job analysis and redesign (e. g., improve efficiency) - Unit-based decisions (e.g., staffing policies, space utilization, interdisciplinary collaboration)
INFORMAL NEGOTIATION
- If problem solving does not resolve the conflict you may have to go on the next step, informal negotiation *Clarify the situation in your own mind*- look at what you are trying to achieve *Set the stage*- confront the two parties, make direct statement designed for open communication *Conduct the negotiation* *Continue with offers and counteroffers* *Agree on the resolution of the conflict*: conflict can stimulate people to learn more about one another and how to work together effectively Resolution can improve relationships and productivity
COMPONENTS OF TIME MANAGEMENT
- Pritottize - Question effectiveness, efficiency, efficacy - Recheck - Practice Self reliance: identify the tasks that are within your control - Treat yourself to a break when you can *KEY POINT: Above all, remember that you may be the most important person in the life of your patient during the time you are with him or her—a very big responsibility, but one you will meet with honor and courage.*
SHARING EXPERTISE
- communicate what you've learned to other students and later to your colleagues in nursing - inform and demonstrate to your instructors and supervisors that you have enhanced your competence - share with clients as well - can publicate wosmthing
MANAGING CHNAGE: THE COMFORT ZONE
- first stage of change is called *unfreezing* when you go out of your comfort zone
SETTING YOUR OWN GOALS
- get an overview of the situation - set goals - figure out priorities - create both short term goals and long term goals *Short-term goals* are those you wish to accomplish within the near future (e.g., organizing your day to participate in a study group). *Long-term goals* are those you wish to complete in the future.
IMPLEMENTING THE CHANGE
- look at the purpose of the change - is change necessary - is change technically correct - will the change work - is there a better way to - some unfreezing strategies you are ready to make a change that have been planned so carefully *Magnitude of the Change*. Is this a major change that affects almost everything people do, or is it a minor one with little impact on what people do every day? *Complexity of the Change*. Is this a difficult change to make? Does it require much new knowledge or skills or both? How long will it take for people to acquire the necessary knowledge and/or skills? *Pace of the Change*. How urgent is this change? Can it be done gradually, or must it be implemented all at once? *Stress Level of Those Involved*. What is the current stress level of the people involved in this change? Is this the only change that is taking place, or is it just one of many changes taking place? How stressful are these changes? How can I help people keep their stress levels within tolerable bounds?
TIME MANAGEMENT
- management accepts very few excuses for tardiness - timesheet and schedules are part of nurses lives -
TRANSACTIONAL THEORIES
- people are motivated by reward and punishment and that they work best within a clear chain of command and structured environment - the employer employee relationship
WHAT ARE POWER AND EMPOWERMENT:
- people who have the most authority in an organization do not have all the power, people at the bottom will also have power *Power* is the ability of a person to get things done and is created through both formal and informal systems - can either facilitate growth or it can create stagnation (positive or negative_
RESISTANCE OF CHANGE
- resistance to change and unfreezing will come from three major sources : - technical concerns, psychosocial needs, and threats to a person's position and power - you will first look at Maslows hierarchy of needs, the basic needs must be met before a person is motivated to go to higher needs
INTEGRATING THE CHANGE
- the last step after the change is made, make sure everyone has moved - Is the change well integrated into everyday operations? - Are people comfortable with it now? - Is it well accepted and perceived as valuable? If not, why not? What can be done to increase acceptance? - Is there any residual resistance that could still undermine full integration of the change?
WHAT ARE CONCERNS ABOUT DELEGATING?
- there are personal risk to their license if they delegate inapporpriately - The courts have usually ruled that nurses are not liable for the negligence of other workers, provided that the nurse delegated appropriately. *KEY POINT: Nurses have also expressed concern over the effects of delegation on the quality of client care. When you delegate, you control the delegation. You decide to whom and what you will delegate. Remember you must ensure that the delegation process results in quality client care.*
COMMUNICATING
- use active listening to pick up all levels of communication - important to effective manage client care - use trust and sincerity,people will be more lily to ask question if you have this. promotes growth and employee satisfaction - *Reinforces constructive behavior.* Positive feedback lets people know which behaviors are most productive and encourages them to continue the behaviors. - *Discourages unproductive behavior*. Constructive feedback prompts the person to correct inappropriate behavior. -*Provides recognition* Praise is an excellent motivator.
WIN WIN RESOLUTIONS
- work together and more effectively - people who lose are likely to feel bad so they might put their energy to win the next one - a tie may just be a stalemate, the problem is sill there and nobody has gained anything - older adults are more likely to choose the deferral option when presented with low and high level conflict scenarios, both groups will defer decision in high level conflict scenarios
HOW WILL LEADERSHIP GROW IN MY NURSING CAREER
- you will being working more as a member of the team - expected to work with clients family and the healthcare team - prioritize intervetniosn - go to community agencies and networks its groups
ORGANIZING YOUR WORK
- you will need to learn how to handle the workload of caring for five or six clients *TIME INVENTORY* - start to see how much time you spend on things - helps identify time wasters *ENERGY USE* - work on most difficult tasks when you have the most energy - analyze work to see which tasks are fixed and which you can manipulate to match your energy *LISTS AND SCHEDULES* - make a to do list and see how much time this will require *DAILY WORKSHEET* - create reminders of when various tasks need to be done without some type of schedule you are more likely to drift though a day or shift from one activity to another without an organized fashion - this wil divide the day into segments *SAY NO* - take control to avoid time wasters - tell people no when you can't do something *DELEGATE* *DO NOT MULTITASK*: finish one task and then move to the next *STREAMLINE YOUR WORK* - work smarter not harder - gather materials for all clients at one time - perform physical assessment while giving a bath - if a client does not look right don't ignore instincts - prevention is always a good idea -when you set time aside for a task you should finish it - do not allow interruptions while you are completing any tasks *PLAN AHEAD* - organize patients supplies for he day
Magnesium
-1.3-2.3 mEq/L -metabolism of carbohydrates and proteins, vital actions involving enzymes
Sodium
-135-145 mEq/L -controls and regulates volume of body fluids
Phosphate
-2.5-4.5 mg/dL -involved in important chemical reactions in the body, cell division, and hereditary traits, bone and teeth formation
Bicarbonate
-25-29 mEq/L -body's primary buffer system
Potassium
-3.5-5.0 mEq/L -chief regulator of cellular enzyme activity and water content
Calcium
-4.5-5.1 mg/dL -nerve impulse, blood clotting, muscle contraction, b12 absorption, major component of bones and teeth
Chloride
-97-107 mEq/L -maintains osmotic pressure in blood, produces hydrochloric acid
The ANA standards identify the following characteristics of effective documentation:
-Accessible; accurate, relevant, and consistent; -Auditable: clear, concise, and complete; -Legible/readable (particularly in terms of the resolution and related qualities of EHR content as it is displayed on the screens of various devices); -Thoughtful; timely, contemporaneous, and sequential; -Reflective of the nursing process; and -Retrievable on a permanent basis in a nursing specific manner.
Risk factors for imbalances..
-Acute and chronic illnesses -abnormal losses of body fluids -burns -trauma -surgery -therapies that may disrupt fluid and electrolyte balances.
Factors affecting patient learning
-Age and developmental level -Family support networks -Financial resources -Cultural influences -Language deficits -Literacy level
Base
-Alkali -substance that can accept or trap H+ ions, such as bicarbonate ion.
Auscultation
-Auscultate from the apex to the base, comparing each side while listening to a complete respiratory cycle -Have the client breathe slowly through an open mouth to eliminate any falsely abnormal sounds -If abnormal breath sounds are detected, have the client cough and listen again for at least two complete respiratory cycles is the act of listening with a stethoscope to sounds produced within the body. It is performed by placing the stethoscope diaphragm or bell against the body part being assessed.
Precautions for oxygen administration
-Avoid open flames in patient's room -Place no smoking signs in conspicuous places -Check to see electrical equipment in room is in good working order -Avoid wearing and using synthetic fabrics (builds up static electricity) -Avoid using oils in the area (ignite spontaneously in oxygen)
Promoting compliance
-Be certain instructions are understandable and support patient goals -Include patient and family as partners in process -Utilize interactive teaching strategies -Develop interpersonal relationships with patients and their families
Key points to effective communication
-Be sincere and honest. -Avoid too much detail and stick to the basics. -Ask for questions. -Be a cheerleader for the patient. -Use simple vocabulary. -Vary the tone of voice. -Keep content clear. -Listen and do not interrupt.
Potential errors in decision making:
-Bias -Failure to consider the whole situation -Impatience
Complete Blood Count
-CBC -determines the total number of red blood cells and values for hemoglobin and hematocrit.
Serum electrolytesm blood urea nitrogen, and creatinine levels
-CMP -determines plasma levels of certain electrolytes such as sodium, potassium, chloride, and bicarbonate ion. -BUN (blood urea nitrogen) and creatinine can provide information related to the fluid status and the renal function of the patient.
Central venous access devices
-CVADS -integral component of patient care in acute, ambulatory, and subacute care settings, as well as in the home and long-term care facilities. -provide access for a variety of IV fluids, medications, blood products, and TPN solutions and allow a means for hemodynamic monitoring and blood sampling.
Body has 3 buffer systems...
-Carbonic acid-sodium bicarbonate buffer system (most commonly used) -phosphate buffer system -protein buffer system
Sample teaching strategies
-Cognitive domain: lecture, panel, discovery, written materials -Affective domain: role modeling, discussion, audiovisual materials -Psychomotor domain: demonstration, discovery, printed materials
Four types of outcomes:
-Cognitive: increase in patient knowledge -Psychomotor: patient's achievement of new skills -Affective: changes in patient values, beliefs, and attitudes -Physiologic: physical changes in the patient
Time-Lapsed assessment:
-Compares patients current status to baseline data obtained earlier -Reassess health status and make necessary revisions in plan of care -Collects data about current health status of client
Assessment involves:
-Data collection -Data validation -Pattern identification of division
Promoting proper breathing
-Deep breathing -Using incentive spirometry -Pursed lip breathing -Abdominal or diaphragmatic breathing
The Mechanics of Charting:
-Describe what you see -Be specific -Be prompt -Be clear -Be concise -Be consistent *** Describe observed behavior instead of an interpretation of the behavior. Use direct quotes Record all relevant information Respect confidentiality Recording charting errors
Pattern Identification or division; Data clustering:
-Determine what data is relevant -Determine which pattern or division should the data be grouped -Form a composite of similar pieces of data that represents a sequence of behavior over a period of time. -Fill gaps by reassessing
Methods of Documentation:
-Electronic Health Records (EHRs) -Personal Health Records (PHRs) -Health Information Exchange (HIE)
Nurses work in partnership with patients and family to:
-Establish priorities -Identify and write expected patient outcomes -Select evidence-based nursing interventions -Communicate the nursing care plan
Documentation:
-Facilitate quality -Evidence-based care -Serve as financial and legal record -Help in clinical research -Support decision analysis Is a written or electronic legal record of all pertinent interactions with the patient: assessing, diagnosing, planning, implementing, and evaluating.
Considerations for successful patient teaching
-Forming contractual agreements -Considering time constraints -Scheduling -Group vs. individual teaching -Formal vs. informal teaching -Manipulating the physical environment
Focused Assessment:
-Gathered during the INITIAL ASSESSMENT -Health problems surface but routinely part of ongoing data collection -Focuses on a specific problem
Teaching outcomes
-High-level wellness and related self-care practices -Disease prevention or early detection -Quick recovery from trauma or illness with minimal or no complications -Enhanced ability to adjust to developmental life changes and acute, chronic, and terminal illness -Family acceptance of lifestyle necessitated by illness or disability
Vascular access devices
-IV catheters fall into 3 main categories: peripheral venous catheters, midline catheters, and central venous devices
Teaching plans for older adults
-Identify learning barriers (hearing/vision) -Allow extra time ( they may be a bit slower) -Plan short teaching sessions (repetition) -Accommodate for sensory deficits (hearing aid/glasses) -Reduce environmental distractions (TV, phone, guests)
Problems collecting data
-Inappropriate organization of the database -Omission of pertinent data -Inclusion of irrelevant or duplicate data -Misinterpreted data -Failure to establish rapport and partnership with patient. -Recording an interpretation of data rather than observed behavior. -Failure to update the database.
Comprehensive Assessment:
-Includes all aspects of patients health -This is gathered during initial contact.
Formats of Nursing Documentation:
-Initial nursing assessment -Care plan; Client care summary -Critical collaborative pathways -Progress notes -Flowsheets and Graphic records -Medication record -Acuity record -Discharge and Transfer summary -Long-term care documentation
Physical assessment
-Inspect chest for shape and contour -Is chest rise and fall symmetrical -Is skin intact, dry, and of normal temperature and color -Any scars- when and how did they occur -Observe respirations for one full minute
Factors essential to normal functioning of the respiratory
-Integrity of the airway system to transport air to and from lungs -properly functioning alveolar system in lungs -Oxygenate venous blood -Remove carbon dioxide from blood -Properly functioning cardiovascular and hematological system -Carry nutrients and wastes to and from body cells
Signs of respiratory distress
-Intercostal retractions -Subcostal retractions -Supraclavicular retractions -Head bobbing -Nasal flaring
Respiratory functioning in the older adult
-Kyphosis contributes to appearance of leaning forward -Barrel chest deformity may result in increased anteroposterior diameter -Tissues and airways become more rigid; diaphragm moves less efficiently -Older adults have an increased risk for disease, especially pneumonia
Common Reasons for Noncompliance
-Lack of family support -Lack of understanding about the benefits of compliance -Low value attached to outcomes or related interventions -Adverse physical or emotional effects of treatment -Inability to afford treatment -Limited access to treatment
Teaching strategies
-Lecture -Discussion -Panel discussion -Demonstration -Discovery -Role playing -Audiovisual materials -Printed materials -Programmed instruction -Web-based instruction and technology
Purposes of Medical Records:
-Legal document -Documentation of care -Communication among HCT -Quality evaluation and quality assurance -Baseline for future care/planning for staffing -Reimbursement for services and equipment -Credentialing, regulation, and Legislation -Research of trends
Factors affecting respiratory functioning
-Levels of health- illnesses -Developmental considerations -Medications -Lifestyle -Environment
Respiratory activity in the infant
-Lungs are transformed form fluid filled structures to air filled organs -The infants chest is small, airways are short, and aspiration is a potential problem -Respiratory rate is rapid and respiratory activity is primarily abdominal
Aims of teaching
-Maintaining and promoting health -Preventing illness -Restoring health -Facilitating coping
Guidelines to patient counseling
-Make everyone feel comfortable in the situation and surroundings. -Counseling may be formal or informal. -Use interpersonal skills of warmth, friendliness, openness, and empathy. -Caring is fundamental in the counseling role.
Guides to facilitate clinical reasoning when prioritizing patient problems:
-Maslows hierarchy of needs -Patient preference -Anticipation of future problems
Oxygen delivery systems
-Nasal cannula -Nasopharyngeal catheter -Simple face mask -Partial rebreather mask -Nonrebreather mask -Venturi mask -Oxygen tent
Upper airway components
-Nose -Pharynx -Larynx -Epiglottis
Components of Medical Record:
-Nurses notes -Admission sheets -Physician orders -Physician progress record -Pt history and PE -Pt care -Graphic sheets -Medication sheets -Lab reports -X-Ray reports -Other reports -Flow Sheets -Operating reports -I&O records -Physician notes -Discharge summary
Types of Nursing Care:
-Nursing care related to basic human needs -Nursing care related to nursing diagnoses/problems -Nursing care related to medical and interdisciplinary care plan
Personal Attributes of a Professional Nurse:
-Open-mindeness (humility) -A professional sense of value of the person -Self-Awareness and knowledge of your own beliefs and values -A sense of personal responsibility for your actions -Motivation to do what you do to the best of your ability because you care about the well-being if those entrusted to your care. -Leadership skills -Bravery to question the "System"
Peripheral venous catheters
-Over-the-needle catheters -most common type -placed in the peripheral vein
Transport of respiratory gases
-Oxygen i carried in the body via plasma and red blood cells -Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin -Hemoglobin also carries carbon dioxide in the form of carboxyhemoglobin -Internal respiration between the circulating blood and tissue cells must occur
Palpation
-Palpate trachea, it should not be deviated from the center of the trachea -Thoracic excursion -Tactile fremitus -Subcutaneous emphysema (subcutaneous crepitation) uses the sense of touch. The hands and fingers are sensitive tools that can assess temperature, trugor, texture, and moisture, as well as vibrations within the body (such as the heart) and shape or structures within the body (e.g. the bones).
Risk factors for Imbalances
-Pathophysiology underlying acute and chronic illnesses -Abnormal losses of body fluid -burns -trauma -surgery -therapies that disrupt fluid and electrolyte balancs
Emergency assessment:
-Physiologic or psychologic crisis -Identifying life-threatening problem -Gather data about a life-threatening problem
Developing Technical Competencies:
-Practice a skills until necessary to perform it. -Take time to familiarize yourself with new equipment. -Identify nurses who are technical experts and ask for advice. -Never be ashamed to ask for help
Focus of patient education
-Preparation for receiving care -Preparation before discharge from health care facility -Documentation of patient education activity
Nursing interventions
-Promoting and controlling coughing -Performing chest physiotherapy -Suctioning the airway -Use of medication -Supplemental oxygen -Managing chest tubes -Using artificial airways -Clearing obstructed airway -Administering CPR
Your nursing assessment should be:
-Purposeful -Prioritized -Complete -Systematic -Factual and accurate -Relevant -Recorded in a standard manner
Hyrdrostatic pressure
-Pushing force -when the hydrostatic pressure inside the capillary exceeds the surrounding interstitial space, fluids and solutes are forced out of the capillary wall into the interstitial space.
Gas exchange
-Refers to the intake of oxygen and release of carbon dioxide -Made possible by respiration and perfusion
Sounds heard upon percussion of chest wall
-Resonance -Hyperresonance -Flatness -Dullness -Tympany
Five Rights of Delegation
-Right task -Right circumstance -Right person -Right direction/communication -Right supervision/evaluation
Planning includes:
-Setting priorities (determine order of care) -Establishing expected outcomes (goal writing) -Selecting nursing interventions -Communicating the plan of care *These steps should result in prioritized nursing care.
Respiratory activity in the child
-Some subcutaneous fat is deposited on the chest wall making landmarks less prominent -Eustachian tubes, bronchi, and bronchioles are elongated and less angular -By end of late childhood, the immune system protects from most infections
Documentation of the teaching learning process
-Summary of the learning need -The plan -The implementation of the plan -Evaluation results
Process of ventilation
-The diaphragm contracts and descends, lengthening the thoracic cavity. -The external intercostal muscles contract, lifting the ribs upward and outward. -The sternum is pushed forward, enlarging the chest from front to back -Increased lung volume and decreased intrapulmonic pressure allow air to move from an area of greater pressure (outside lungs) to lesser pressure (inside lungs). -The relaxation of these structures results in expiration.
Lower airway (tracheobronchial tree) components
-Trachea -Right and left main stem bronchi -Segmental bronchi -Terminal bronchioles
Breath sounds
-Vesicular -Bronchial -Bronchovesicular
Cardiovascular system
-Vital for exchange of gases -Composed of the heart and the blood vessels
Abnormal (adventitious) lung sounds
-Wheezes -Rhonchi -Crackles or rales (cRAckLES) -Stridor -Friction rub
3 learning domains
-cognitive -psychomotor -affective
Midline peripheral catheters
-inserted peripherally, normally just above or below the antecubital fossa into the proximal basilica or cephalic veins. -longer (greater than 3in) than peripheral venous catheters, and the distal tip terminates in the basilic, cephalic, or brachial vein, at or below the axillary level and distal to the shoulder.
Group identity
-members value and "own" the aims of the group; aims are clearly articulated
Colloid osmotic pressure
-pulling force -plasma proteins, particularly albumin, concentrated in the intravascular space or plasma facilitate this reabsorption.
Alfaro-LeFevre (2014) concerns that are central to role as a nurse
-recognizing safety and infection-transmission risks and addressing these immediately. -identifying human responses-how problems, s/s, and treatment regimens. -anticipating possible complications and taking steps to prevent them -initiating urgent interventions.
Body fluids
-transports nutrients to cells and wastes from cells -transports hormones, enzymes, blood platelets, and red and white blood cells -facilitate cellular metabolism and proper cellular chemical functioning. -act as a solvent for electrolytes and nonelectrolytes -help maintain normal body temperature -facilitate digestion and promote elimination -act as a tissue lubricant
Maslows hierarchy of needs:
1) Physiological Needs (food, water, sex, etc) 2) Safety Needs (security of body, employment, morality, family, health, property) 3) Love and Belonging Needs (friendship, family, sexual intimacy) 4) Self-Esteem Needs )self-esteem, confidence, achievement, respect of others) 5) Self-actualization Needs (morality, creativity, spontaneity, problem-solving, lack of prejudice, acceptance of facts)
problem-oriented medical record (POMR)Components: problem-oriented medical record (POMR):
1. Data base - Problem list - Plan of care - Progress notes (SOAP) 2.Another type of paper record used in some health facilities, organized around a patients problems rather then around sources of information. All members chart on the same forms. Advantage: entire HCT works together in identifying a list of patient problems and contributes collaboratively to plan of care. Progress notes clearly focus on patients problems.
Providing culturally competent patient education
1. Develop an understanding of the patient's culture 2. Work with multicultural team 3. Be aware of personal assumptions, biases, and prejudices 4. Understand the core cultural values of the patient or group 5. Develop written material in native language of the patient 6. Use testimonials of persons with same cultural background as the patient
4 steps of data interpretation and analysis
1. Recognizing significant data 2. Recognizing patterns or clusters 3. Identifying strengths and problems 4. Identifying potential complications Reaching conclusions
Obtaining feedback about learning
1. Reinforcing and celebrating learning 2. Evaluating teaching 3. Revising the plan
Purposes of diagnosing
1. identify how a person, group, or community responds to actual or potential health and life processes 2. identify factors that contribute to or cause health problems 3. identify resources or strengths that the person, group, or community can draw on to prevent or resolve problems.
Predict, prevent, manage and promote (PPMP) Alfaro
1. in the presence of known problems , predict the most common and most dangerous complications and take immediate action to (A) prevent them, and (B) manage them in case they cannot be prevented. 2. Whether problems are present or not, look for evidence of risk factors. If you identify risk factors, you aim to reduce or control them, therby preventing the problems themselves. 3. in all situations, ensure that safety and learning needs are met, and promote optimum function and independence.
The six factors that nurses use to select nursing interventions:
1.) Desired patient outcomes 2.) Characteristics of the nursing diagnosis 3.) Research base for the intervention 4.) Feasibility for doing the intervention 5.) Acceptability to the patient 6.) Capability of the nurse
Three possible judgments (RN) :
1.) Goals completely met discontinue plan of care. 2.) Goals partially met, continue or revise plan of care. 3.) Goal unmet, revise or discontinue plan of care.
Five classics elements of evaluations
1.) Identifying evaluation criteria and standards 2.) Collecting data to determine whether these criteria and standards are meet. 3.) Interpreting and understanding findings 4.) Documenting your judgement 5.) Terminating / continuing, or modifying the plan
Three possible judgments (LPN) :
1.) Intervention effective, continue nursing intervention 2.) Intervention Partially Effective, revise or discontinue nursing intervention 3.)Discontinue nursing intervention, give supportive statement for each judgment (Evaluates patients response to intervention)
Developing critical thinking:
1.) Purpose of Thinking 2.) Adequacy of Knowledge 3.) Potential Problems 4.) Helpful Resources 5.) Critique of Judgment/Decision
LPN's role:
1.) RN - Evaluates goals 2.) LPN - Evaluates patients response ( was intervention effective, partially, or not at all?)
Reasons for ineffective care plans or Interventions:
1.) Severe illness of patient 2.) Non-Supportive family 3.)uncooperative patient 4.) ill-prepared nurse 5.) Unknowledgeable nurse 6.) Distracted nurse
Collective data:
1.) Systematic data gathering process 2.) Subjective and objective 3.) Judges patients behavioral responses to nsg interventions
Source-Oriented Record Components: Source-oriented record:
1.-Admissions sheet/Assessment -Graphic sheet -Activity flow sheet -Nurses notes -Medication sheets -Medical history and PE sheet -Physician order and progress sheet -Miscellaneous forms 2.Paper format in which each health care group keeps data on its own separate form. Sections of the record are designated for nurses, health-care workers, laboratory, x-ray personnel, and so on. Notations are entered chronologically, with the most recent entry being nearest the front of the record. These notes are kept in a chronological order.; most recent near the front. Disadvantage: fragmented record of care. Difficult to trace overall care.
Hypernatremia Hyponatremia
1.Surplus of sodium in ECF -exceeds 145 mEq/L 2.-sodium deficit -less than 135 mEq/L
Hyperphosphatemia Hypophosphatemia
1.above-normal concentrations of phosphorus -exceeds 2.6 mEq/L 2.below-normal concentration of phosphorus in the ECF -Less than 1.8 mEq/L
Hyperchloremia Hypochloremia
1.above-normal level chloride in ECF -exceeds 106 mEq/L 2.below-normal level of chloride in ECF -less than 96 mEq/L
Causes of Hypophosphatemia Causes of Hyperphosphatemia
1.administration of calories to malnourished patients, alcohol withdrawal, diabetic ketoacidosis, hyperventilation, insulin release, absorption problems and diuretic use. 2. impaired kidney excretion and hypoparathyroidism.
Hypocalcemia Hypercalcemia
1.calcium deficit -less than 4.5 mg/dL 2.excess of calcium in ECF -Exceeds 5.1 mg/dL
Fluid volume deficit (FVD) Fluid volume excess (FVE)
1.caused by loss of both water and solutes in the same proportion from the ECF space. -AKA hypovolemia 2.excessive retention of water and sodium in ECF in near-equal proportions. -AKA hypervolemia
Acidosis Alkalosis
1.condition characterized by an excess of H ions or loss of base ions (bicarbonate) in ECF in which the pH falls below 7.35 2.occurs when there is a lack of H ions or a gain of basic (bicarbonate) and the pH exceeds 7.45.
Hyperkalemia Hypokalemia
1.excess of potassium in ECF -exceeds mEq/L 2.potassium deficit in ECF -less than mEq/L
Hypertonic solution Hypotonic solution
1.greater osmolarity than plasma -water moves out of the cells and is drawn into the intravascular compartment, causing the cells to shrink. 2.less osmolarity than plasma -hypotonic solution in the intravascular space moves out of the intravascular space and into intracellular fluid, causing cells to swell and possible burst.
Causes of Hypocalcemia Causes of Hypercalcemia
1.inadequate of calcium intake, impaired calcium absorption, and excessive calcium loss. 2.cancer and hypothroidism
Causes of Hyponatremia Causes of hypernatremia
1.loss of sodium or a gain of water -vomiting, diarrhea, fistulas, sweating, or as a result of taking diuretics. 2.excess of water loss or an overall excess of sodium, fluid deprivation, lack of fluid consumption , diarrhea, excess insensible water loss
Hypermagnesemia Hypomagnesemia
1.magnesium exceeds in the ECF -exceeds 2.5 mEq/L 2.magnesium deficit in the ECF -less than 1.5 mEq/L
Causes of Hypomagnesemia Causes of Hypermagnesemia
1.nasogastric suction, diarrhea, withdrawal from alcohol, administration of tube feedings or parenteral nutrition, sepsis, or burns. 2.renal failure, excessive magnesium intake
Respiratory alkalosis Respiratory acidosis
1.primary deficit of carbonic acid in the ECF. -result of alveolar hyperventilation, breathing that is faster and deeper, and the consequent increase in the elimination of CO2. 2.primary excess of carbonic acid in the ECF
Metabolic acidosis or nonrespiratory acidosis Metabolic alkalosis or nonrespiratory alkalosis
1.proportionate deficit of bicarbonate in ECF. 2.excess of HCO3, a decrease in H+ ions, or both, in the ECF
Causes of Hypochloremia Causes of Hyperchloremia
1.severe vomiting and diarrhea, drainage of gastric fluid, metabolic alkalosis, diuretic therapy and burns. 2.metabolic acidosis, head trauma, increased perspiration, excess adrenocortical hormone production, and decreased glomerular filtration.
Informal teaching Formal teaching
1.unplanned teaching sessions dealing with the patient's immediate learning needs and concerns 2.planned teaching done to fulfill learner outcomes
Causes of Hypokalemia Causes of Hyperkalemia
1.vomiting, gastric suction, alkalosis, diarrhea, or as a result of the use of diuretics. 2.renal failure, hypoaldosteronism, or the use of certain medications such as potassium, chloride, heparin, ACE inhibators, NSAIDS.
Osmosis Osmolarity
1.water passes from an area of lesser solute concentration and more water to an area of greater solute concentration and less water until equilibrium is established. 2.concentration of particles in a solution, pulling power.
(Box 26-6) Normal Heart Sounds
1st heart sound = S1, is when the *mitral* and *tricuspid valve close* and corresponds to the onset of ventricular contraction. 2nd heart sound = S2, is when the *aortic* and *pulmonic valves close.* Termination of systole, and corresponds to the onset of ventricular diastole. Ventricular Systole = QRS- T wave Diastole = End of T- Beginning QRS
Body fluid compartments
2 compartments-intracellular and extracellular fluid
Age and development
3 critical developmental areas to consider when developing a teaching plan are the patient's -physical maturation and abilities -psychosocial development -cognitive capacity -emotional maturity -moral and spiritual development
Variations in fluid content
50%-60% of the body's weight can occur.
Gait
A bouncy, purposeful walk usually carries a message of well-being. A less purposeful, shuffling one often means the person is sad or discouraged.
Dispositional traits
A characteristic or customary way of behaving. Nurses who consistently demonstrate warmth and friendliness; openness and rapport; empathy, honesty, authenticity, and trust; caring; and competence are well disposed to communicate effectively
Graphic record:
A form used to record specific patient variables such as pulse, respiratory rate, blood pressure readings, body temperature, weight, fluid intake and output, bowel movements, and other patient characteristics.
Medical Record:
A legal document that provides a written record of the patients problems or conditions, treatments, and teaching received, as well as the clients reaction to the care. also documents discharge teaching and planning.
A nurse coach establishes
A partnership with a patient and uses discovery to identify the patient's personal goals and agenda in a way that will result in change rather than using teaching and education strategies directed by the nurse as the expert
Interview:
A planned communication.
Language
A prescribed way of using words so that people can share information effectively. Includes a common definition of words and a method of arranging the words in a certain order.
Discovery
A problem or situation is presented to the patient or group of patients, who are then guided to discover the solution or approach. This is a good method for teaching problem solving techniques and independent thinking
Nursing Process:
A systemic method that directs the nurse, with the patients participation, to accomplish the following: 1.) Assess the patient to determine the need for nursing care. 2.) Determine nursing diagnoses for actual and potential health problems. 3.) Identify expected outcomes and plan care. 4.) Implement the care. 5.) Evaluate the results.
Critical thinking:
A systemic way to form and shape one's thinking.
Nurses perform Evaluation:
A thorough systemic review of the effectiveness of nursing interventions and determination of whether or not patient goals have been achieved.
Initial Nursing assessment:
A typical electronic form used to record the initial database obtained from the nursing history and physical assessment
(Box 26-1) Type of Assessment: Abdomen
Abdomen color, moisture, lesions, wounds, bowel sounds, tenderness, distention, pain/discomfort, ability to eat, elimination pattern and urine characteristics, bowel elimination and stool characteristics.
Selecting Nursing Interventions:
Activities that will most likely promote or produce the desired outcome or objective or goal. Includes referrals and reinforcement of patient teaching.
The development of patient centered goals does this:
Affords the nurse, the patient, family, and SO an opportunity to formulate a mutually agreed upon plan of action aimed at resolving patients problem.
Health Information Exchange (HIE):
Allows doctors, nurses, pharmacists, other health care providers, and patients to appropriately access and securely share a patient's vital medical information electronically—improving the speed, quality, safety, and cost of patient care -Stimulates consumer education and involvement -Increases communication between providers -Provides feedback for research -Facilitates deployment of emerging technology and services
Open ended question or comment
Allows the patient a wide range of possible responses. It allows patients to express what they understand to be true, yet is specific enough to prevent digressing from the issue at hand. It encourages free verbalization
Diaphoresis
An excessive amount of perspiration, such as when the entire skin is moist.
Patient outcome:
An expected conclusion to a patient health problem, or in the event of a wellness diagnosis, an expected conclusion to a patient's health expectation.
(Box 26-5) Assessing for Melanoma: Evolving
Any change- in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching, or crusting-points to danger.
Nursing intervention
Any treatment based upon clinical judgement and knowledge that a nurse performs to enhance patient/client outcomes.
Developing Interpersonal Competencies:
Are essential to the practice of thoughtful person-centered practice. Involves promoting the dignity and respect of patients as people and establishing a caring relationship.
Criteria:
Are measurable qualities, attributes, or characteristics that identify skills, knowledge, or health status.
Quality - assurance program
Are special programs the promote excellence in nursing. these programs enable nursing to be accountable to society for the quality of nursing care.
Standards:
Are the levels of performance accepted by and expected of nursing staff or other health team member.
Indirect care interventions
Are treatments performed away from the patient but on behalf of the patient or group of patient's. interventions include nursing actions for managing patient's environment and interdisciplinary collaboration.
Collaborative pathways (Critical pathways or core maps):
Are used in the case management model. The collaborative pathway specifies the care [plan linked to expected outcomes along a timeline
Protocols
Are written plans that detail the nursing activities to be executed in specific situations.
Family support networks
Assess the family's function and style by talking with them and observing how the patient and family interact
ADPIE
Assessing Diagnosing Planning Implementing Evaluating
Language deficits
Be sure to identify barriers and develop strategies to address them, clearly communicating this in the nursing care plan. Do not assume that a family member is adequately translating information critical to the patient's learning
Historical Documentation:
Because all entries on records are dated, the record has value as a historical document. Years later, information concerning a patient's past health care might be pertinent.
(Box 26-1) Type of Assessment: Safety
Bed position, call bell location, appropriate emergency equipment, assistive devices, fall risk/ hazards.
(Box 26-1) Type of Assessment: Psychosocial
Behavior and affect
Programmed instrution
Books or booklets are prepared so that learners can use them independently of a teacher. Self paced strategy
Cope model
C - creativity O - optimism P - planning E - expert information
Impaired verbal communication
Can affect every aspect of a person's life. may be defined as decreased, delayed, or absent ability to receive, process, transmit, and or use a system of symbols
Silence
Can be used appropriately, allowing the patient to gather his or her thoughts and to proceed at his or her own pace to initiate a conversation or to continue speaking. Periods of silence during a conversation often carry important nonverbal messages. A silence between two people might indicate complete understanding of each other, that both of them are thinking, or that they are angry with each other
Ongoing Planning:
Carried out by a nurse who interacts with the patient.
(Box 26-1) Type of Assessment: Chest
Chest color, moisture, lesions, wounds, quality of respirations, heart sounds, lung sounds, cough, sputum.
Decision Making:
Choosing from options. Have consequences.
Standards for Critical Thinking:
Clear, precise, specific, accurate, relevant, plausible, consistent, logical, deep, broad, complete, significant, adequate (for the purpose), and fair.
Nursing Interventions describe:
Communicate to the entire nursing staff and healthcare team, the specific nursing care to be implemented for the patient.
Environment
Communication happens best when the environment facilitates an easy exchange of needed information. The environment most conductive to communication is one that is calm and nonthreatening. The goal is to minimize distractions and ensure privacy
Valuesa
Communication is influenced by the way people value themselves, one another, and the purpose of any human interaction
Eye contact
Communication often begins with it. Some view this as the nonverbal communication that reveals a persons true nature.
(Box 26-7) Components of a Neurovascular Assessment: Peripheral Pulses
Comparison between affected and unaffected limb is important. Assess the consistency of arterial blood flow (pulse presence, rate, quality) to and past the affected area. Assess capillary refill, especially in patients whose pulses cannot be palpated due to casts or bandages and in nonverbal patients.
(Box 26-7) Components of a Neurovascular Assessment: Pallor (perfusion)
Comparison between affected and unaffected limb is important. assess color and temperature of the extremity. Pale skin, decreased tone , or white color may indicate poor arterial perfusion. Cyanosis may indicate venous stasis. Coolness or decreased temperature may indicate decreased arterial supply. Compare distal to proximal temperature variation in affected limb. Assess capillary refill.
(Box 26-7) Components of a Neurovascular Assessment: Pressure
Comparison between the affected and unaffected limb is important. Affected area may become taut and firm to the touch, with surrounding skin appearing shiny. The feeling of tightness or pressure may be present.
CUS
Concerned Uncomfortable Unsafe (this is a safety issue)
Lower airway (tracheobronchial tree) functions
Conduction of air, mucocillary clearance, and the production of pulmonary surfactant
Nursing care related to nursing diagnoses/problems:
Contains outcomes and nursing interventions for every nursing diagnoses/problem, as well as a place to note the patient's response to care.
Effective communication techniques
Critical component is the nurse's ability to be an effective communicator
Negative reinforcement
Criticism or punishment- is generally ineffective, undesirable behavior is usually best ignored
Sounds
Crying, moaning, gasping, and sighing are oral but nonverbal forms of communication
Electronic Health Record (EHR):
Data can be distributed among many caregivers in a standardized format, allowing them to compare and uniformly evaluate patient progress easily. -Increase efficiency and cost savings -Increases patient participation -Improves coordination of care -Improves quality and convince to patient
Evaluation:
Defined as the judgement of the effectiveness of nursing care to meet patient goals.
Demonstration and return demonstration
Demonstration of techniques, procedures, exercies, and the use of special equipment, combined with a lecture and discussion, is an effective strategy
Types of Nursing Actions:
Dependent Actions Independent Actions
Affective Outcomes:
Describes changes in patient values, beliefs, and attitudes.
Cognitive Outcomes:
Describes increases in patient knowledge or intellectual behaviors.
Psychomotor Outcomes:
Describes patient's achievement of new skills.
The primary purpose of the outcome identification and planning step is to:
Design a plan of care with and for the patient that, once implemented results in the prevention, reduction, or resolution of patient health problems and attainment of the patients health expectations as identified in the patient outcomes.
Flatness
Detected over bone or heavy muscle
Collecting evaluative data:
Determines whether or not the patient has meet the desired outcomes.
Patient record include:
Diagnostic and therapeutic orders. Anyone reviewing the chart can find all diagnostic studies ordered for the patient since admission, the results of these studies, and related orders for care.
Helping relationship vs social relationship
Difference is important. Helping relationships contain many of the qualities of a social relationship; they have in common the components of care, concern, trust, and growth. Helping relationships are professional relationships
Intuitive Problem Solving:
Direct understanding of a situation based on a background of experience, knowledge, and skill that makes expert decision making possible.
Long term care documentation:
Documentation in long-term care settings is specified by the Resident Assessment Instrument (RAI), which helps staff gather definitive information on a resident's strengths and needs and addresses these in an individualized plan of care.
PIE charting:
Documentation system that does not develop a separate care plan. The care plan is incorporated into the progress notes in which problems are identified by number, worked up using the problem.
Flow sheets:
Documentation tools used to record routine aspects of nursing care.
Care Planning:
Each health care professional working with the patient has access to the patients baseline and ongoing data and can see how the patient is responding to the treatment plan from day to day.
Preventing illness
Educational intervention related to illness prevention, a major theme in health teaching and counseling, takes many forms.
Leadership
Effective style of leadership meets desired aims
Person-centered care:
Emerged 30 years ago as a return to holistic roots of health care.
Problem-Oriented Record:
Emphasizes the patient and his or her health problems. The care plan is developed based on the identified problem.
Standing Orders
Empower the nurse to initiate actions that ordinarily require the order or supervision of a health care provider.
Outcome evaluation:
Evaluation that focuses on measurable changes in the health status of the patient or the end results of nursing care.
Motivational interviewing
Evidence-based counseling approach that involves discussing feelings and incentives with the patient
Verbal
Exchange of information using words, including both the spoken and written word.
Conversation skills
Exchange of verbal communication, is a social interaction. As social beings, humans learn as children how to converse with others. -control the tone of your voice -be knowledgeable about the topic of conversation -be flexible -be clear and concise -avoid words that might have different interpretations -be truthful -keep an open mind -take advantage of available opportunites
Long term counseling
Extends over a prolonged period. A patient might need the counsel of the nurse at daily, weekly, or monthly intervals
(Box 26-7) Components of a Neurovascular Assessment: Pain
Extreme pain, especially on passive motion, is a significant sign of probable neurovascular impairment in an extremity. Subjective and Objective assessments should be included. Opioid analgesia is unlikely to relieve the pain.
(Box 26-1) Type of Assessment: Head, Eyes, Ears, Nose
Eyes, pupils, mouth, carotid arteries, swallowing, throat, neck, facial color, moisture, lesions, wounds, glasses, hearing aid, ability to hear conversation, ability to see.
The physical chart is:
Facility property and patients may request a copy from medical records office.
When interpreting and summarizing findings consider:
Factors that influence outcome achievements.
Blocks to communication
Failure to verbalize clearly and compassionately, however, blocks effective communication. recognition of the patient as a human being, listening carefully, and avoiding nontherapeutic statements help the nurse to provide optimal, compassionate patient care
Nursing Interventions Classification (NIC)
First comprehensive, validated list of nursing interventions applicable to all settings that can be used by nurses in multiple specialties and facilitates the work of identifying appropriate interventions.
Nursing Assessments:
Focus on the patient's response to health problems or functional disability.
Role playing
Gives the learner a chance to experience, relive, or anticipate an event. You explain a scenario and allow the patient to play out the scene with you or with one or more other learners
An acid releases H+ as follows:
H2CO3------>H+ + HCo3-
A base traps H+ as follows:
HCO3 + H+ -----> H2CO3
Stridor
Harsh, shrill, or creaking noise, heard on inspiration, caused by air moving through a narrowed upper airway (croup, RSV, or foreign body)
Characteristics of the helping relationship
Has at least the following three basic characteristics: Dynamic Purposeful and time limited The person providing the assistance is professionally accountable for the outcomes of the relationship and the means used to attain them
(Box 26-5) Assessing for Melanoma: Color
Having a variety of colors is another warning signal. A number of different shades of brown, tan, or black could appear. A melanoma may also become red, white, or blue.
Education:
Health care professionals and students reading a patients record can learn a great deal about clinical manifestations of particular health problems , effective treatment modalities, and factors that affect patient goal achievement.
Nurses work with?
Healthy and ill patients in both institutional and community settings.
Sources of Data: the family and significant others
Helpful when the patient is a child or has limited capacity to share information with the nurse.
Bronghial
High pitched and longer, heard primarily over trachea
Tympany
High pitched, loud, drum like sound produced over the stomach
Patterns of interaction
Honest, direct communication flows freely; members support, praise, and critique one another
QUALITIES OF AN EFFECTIVE MANAGER:
INTERPERSONAL ACTIVITEIS - *Networking*. Managers must clearly articulate nurses' roles in and value to the institution. - *Conflict negotiation and resolution*. For example, conflict may arise on a unit over work schedules, especially on holidays. - *Advocacy*. Managers must advocate for and support staff to upper level management. - *Employee development*. This includes providing for continuing learning and upgrading employees' skills. - *Rewards and punishments*. Examples include salary increases, time off, and praise. - *Coaching*. The goal is to help the employee do a better job through learning. Some managers use a directive approach ("Let me show you how to do this"). Others use a nondirective approach ("How do you think we can improve our outcomes?").
Orientation Phase of the Helping Relationship
Ideally begins between the nurse and patient during the data gathering part of the nursing process. It can also be initiated at other times during the nurse patient relationship. in this phase, the tone and guidelines for the relationship are established. you and the patient meet and learn to identify each other by name. It is especially important to introduce yourself to the patient
Nursing History:
Identifies the patient's health status, strengths, health problems, health risks, and need for nursing care. The nurse may also perform a nursing physical examination to collect data.
5.) Critique of Judgment/ Decisions:
Identify alternative judgments or decisions, weigh the merits of each and reach a conclusion.
1.)Purpose of Thinking:
Identify the purpose or goal of your thinking.
(Box 26-5) Assessing for Melanoma: Asymmetry
If a line is drawn through a mole, the two halves will not match.
Piaget's theory
If you understand how children and adolescents develop learning abilities, you can use this knowledge when teaching patients.
Verbal Orders:
In most facilities the only circumstance that the attending physician, nurse practitioner, or house officer may issue orders verbally is in an medical emergency when the physician or nurse practitioner is present but finds it impossible, owing to the emergency situation, to write the order.
Nursing diagnosis should be ranked:
In order of importance
Evaluating:
Incorporating evaluative statements in the care plan clearly communicates the message that nursing care is never complete until achievement of patient outcomes is evaluated.
Who has considerably more total body fluid and ECF than adults
Infants -infants are more prone to fluid volume deficits
Nursing Variables
Influence the implementation of the care plan, includes the level of expertise, creativity (ability to match patient needs with specific nursing strategies), willingness to provide care in available time.
Decision Analysis:
Information from record review often provides the data needed by administrative strategic planners to *identify needs* as well as the means and *strategies most likely to address these needs*. Record review might reveal both *underused and overused services, patients with prolonged stays who require special assistance, and financial information about which services generate revenue compared with those that cost the institution or agency money*.
Minimum data set:
Information that must be collected from every patient and uses a assessment form to organize or cluster this data.
A nurse wants to always look for what pieces a paper in patients chart:
Informed consent and DNR
Warmth and friendliness
Initiation of a helping relationship depends on the nurse's ability to begin the orientation phase successfully. By maintaining qualities of warmth and friendliness throughout the helping relationship, you will convey continuous acceptance of the patient and interest in discussing the patient's feelings and concern
(Box 26-8) Teaching Breast self-Awareness
Instruct patients to contact heath care provider for any of teh following changes in their breasts: - Lumps - Change in size of shape - Skin irritation such as redness, thickening, dimpling of skin - Pain or redness of a nipple - Nipple discharge other than breast milk - Swelling
Crackles or rales (cRAckLES)
Intermittent sounds occurring when air moves through fluid in the airway. Heard on inspiration and expiration. Classified as fine, medium, or coarse
Prerequisite skills
Interpersonal ( how well you interact with others) Technical ( Competency Skills) Intellectual ( Critical thinking)
Levels of communication
Intrapersonal, interpersonal, small group, and organizational
Using nursing observations
Involve both seeing and interpreting, are especially useful for validating information. Observing the patient's behavior helps validate the nurse's suspicion that the patient is fearful and the patient's assertion of being unconcerned appears to be a cover up for truer feelings
Developing Cognitive Competencies:
Involves Critical Thinking
Panel discussion
Involves a presentation of information by two or more people
Discussion
Involves a two way exchange of information, ideas, and feelings between the teacher and learners. It is an effective method when used by a nurse who is comfortable with leading a group and knowledgeable about group processes
interpersonal skills
Involves believing, behaving, and relating. the ability to work with others to accomplish a goal. Also involves conducting oneself in a professional manner.
Creative Thinking:
Involves imagination, intuition, and spontaneity, factors that underpin the art of nursing.
Trial-and-Error Problem Solving:
Involves testing any number of solutions until one is found that works for that particular problem.
Hand of communication SBAR
Involves the process of accurate presentation and acceptance of patient related information from one caregiver to another caregiver or team. Hand of communication occurs between nurses and other departments
Patient records:
Is a compilation of a patients health information (PHI). Each health care institution or facility has policies that specify the nurses documentation responsibilities.
Outcome and Assessment Information Set (OASIS)
Is a group of data elements that : 1.) represents core items of a comprehensive assessment for a adult home care patient. 2.) Form the basis for measuring patient outcomes for purpose of outcome based quality improvement.
Thoughtful practice:
Is a nursing practice that is considerate and compassionate. -A thoughtful nurse always keeps the person at the center of caregiving in order to promote the humanity, dignity, and well-being of the patient.
Patient-Centered Assessment Method (PCAM):
Is a tool health care practitioners can use to assess patient complexity using the social determinants of health; these determinants may explain why some patients engage and respond well in managing their health while others with the same or similar health conditions do not experience the same outcomes.
Direct care intervention
Is a treatment performed through interaction with the patients. includes both physiologic and psychosocial nursing actions and include both the "laying on of hands" actions and those that are more supportive and counseling in nature.
Nursing process for patient and caregiver teaching
Is approached most effectively using the steps of the nursing process. The teaching learning process and the nursing process are interdependent
Berlo (1960)
Is credited with the classic description of the communication process, which involves a source (encoder), message, channel, and receiver (decoder). This communication process is initiated based on a stimulus, in this case a patient need that must be addressed.
The role of a nurse coach
Is evolving and should not be confused with that of a preceptor or mentor. Explores the patient's readiness for coaching, designs the structure of a coaching session, supports the achievement of the patient's desired goals, and with the patient determines how to evaluate the attainment of patient goals
Humor
Is increasingly valued as both an interpersonal skill for the nurse and a healing strategy for patients. Laughter releases excess physical and psychological energy and reduces stress, anxiety, worry, and frustration. Humor, like other interpersonal competencies, is a learned skill
Phases of the helping relationship
Is ordinarily described as having three phases: 1: the orientation 2: working phase 3: termination
Group dynamics
Is studied when determining the effectiveness or ineffectiveness of a group. Involves how individual group members relate to one another during the process of working toward group goals. Effective groups have members who are mutually respectful
Health literacy
Is the ability to obtain, read, understand, and act on health information. These skills include performing internet searches, reading health prevention pamphlets, measuring medication doses, and understanding and complying with verbal or written health care instructions
Sources of Data: the patient
Is the primary and usually the best source of information. Data from patients with limited mental or communication capacities such as young children or older adults with dementia cannot be relied on as accurate. -Learn to avoid the mistake of too quickly judging that a family member is better source of information than the patient.
Occurrence Charting (variance charting):
Is the unexpected event, the cause of the event, actions taken in response to the event, and discharge planning, when appropriate.
Patient Care Plan:
Is the written guide that directs the efforts of the nursing team working with the patient to meet his or her health goals.
Focus charting:
Is to bring the focus of care back to the patient and the patients concerns. Instead of a problem list or list of nursing or medical diagnosis, a focus column is used that incorporate many aspects of a patient and patient care.
QSEN (Quality and Safety Education for Nurses):
Is to meet the challenge of preparing future nurses who will have the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the healthcare systems within which they work.
Scheduling
It is better to plan shorter, more frequent teaching sessions than one or two longer sessions. Short sessions allow patients to digest the new material and prevent them from becoming too tired or uncomfortable because of a health problem
Privacy
It might not always be possible to carry on conversations alone with the patient in a room, but every effort should be made to provide privacy and to prevent conversations from being overheard by others. Sometimes merely drawing the curtains around the bed in a hospital or long term care facility or sitting in a corner of the waiting room or lounge can provide the sense of privacy that is so important in most interactions
2.)Adequacy of Knowledge:
Judge whether the knowledge you have is accurate, complete , factual, timely, and relevant.
SITUATIONAL THEORIES
KEY POINT: Adaptability is the key to the situational approach (1) understand all of the factors that affect a particular group of people in a particular environment, and (2) vary the type of leadership to meet the needs of the rapidly changing situations
Report to Family member and SO
Keeping the family and SO updated about the patients condition and progress toward goal achievement.
Components of a NANDA
Label, definition, defining characteristics, related factors.
3.)Potential Problems:
Learn to "Flag" and remedy pitfalls to sound reasoning.
Psychomotor learning
Learning a physical skill involving the integration of mental and muscular activity
Optimal pacing
Let the patient know at the beginning of the interaction if time is limited so that the patient does not feel that you are rushing because of a lack of concern or personal interest
(Box 26-1) Type of Assessment: Mental status
Level of Consciousness, orientation to person, place, and time; speech.
Resonance
Loud, hollow low pitched sound heard over normal lungs
Hyperresonance
Loud, low booming sound heard over emphysematous lungs
Vesicular
Low pitched soft sound during expiration heard over most of lungs
Rhonchi
Low pitched, snoring noises, heard on inspiration and expiration, as air passes through or around secretions. may clear with coughing
Anatomy of the lungs
Main organs of respiration The right lung has three lobes; left lung has two -Cilia -Alveoli -Surfactant -Pleura
Personal health record (PHR):
Manage their health care via computer. Thier records contain the persons medical history, including diagnoses, symptoms, and medication. -Two Type: Standalone = Patient fills in own information, may decide to share with others. Tethered = Linked to a health care organizations EHR, data accessed through secure portal
General physical appearance
Many illnesses cause at least some alterations in general physical appearance. Observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care or therapy
Audiovisual materials
Materials such as computer programs, online courses, technology driven learning tools, presentations using presentation tools such as powerpoint or prezi, films, TV programs, flip charts, posters, and diagrams are popular and effective teaching strategies when combined with a lecture or discussion
(Box 26-7) Components of a Neurovascular Assessment: Paresthesia (Sensation)
May be the first symptom of changes in sensory nerves to appear. Numbness, tingling, or "pins and needles" sensations may be reported. Evaluate the areas above and below the affected area.
Bronghovesicular
Medium pitch and sound during expiration, heard over the major bronchi
Channel
Medium the sender has selected to send the message
(Box 26-5) Assessing for Melanoma: Diameter
Melanomas usually are larger in diameter than the size of the eraser on your pencil (1/4 in or 6 mm), but they may sometimes be smaller when first detected.
Responsibility
Members feel strong sense of responsibility for group outcomes
Cohesiveness
Members generally trust and like one another and are loyal to the group; high commitment; high degree of cooperation
Biological sex
Men and women often have differing communication styles and may give different interpretations to the same conversation. Girls generally play with best friends and use language to seek confirmation, minimize differences, and establish or reinforce intimacy, boys use language to establish their independence and to negotiate status activities
Short-Term:
Met in a matter of a few days. (week to month)
Questions that probe for information
Might cut off communication. Patients who are made to feel as though they are receiving the third degree become resentful, usually stop talking, and try to avoid further conversation
Learning readiness
Motivation for learning, willingness to engage in the teaching learning process, and support system contribute to readiness to learn
(Box 26-1) Type of Assessment: Actiity
Movement and ambulation, ability to move in bed, ability to get out of bed, ability to walk and distance, gait.
Wheezes
Musical sounds heard on expiration and inspiration as air passes through airways constricted by swelling, secretions, or tumors. Classified as sibilant or sonorous
Receiver (decoder)
Must translate and interpret the message sent and received. Through the translation of the message, the receiver must then make a decision about an accurate response
Progress notes:
Notes written to inform caregivers of the progress a patient is making toward achieving expected outcomes.
Measure goal attainment:
Nurse forms comprehensive picture of behavioral responses to nsg interventions.
Collaborative Interventions:
Nurses also carry out treatments initiated by other providers such as pharmacists, respiratory therapists, or physician assistants.
Research founding
Nurses concerned about improving the quality of nursing care use research findings to enhance their nursing practice.
Evaluative statement:
Nurses make and documents a judgment summarizing the findings. This is a two part evaluative statement that includes a decision about how well the outcome was met, along with patient data and behaviors that support this decision.
Transfer and Discharge Reports:
Nurses report a summary of a patients condition and care when transferring patients from one unit, institution, or facilities to another, and when discharging patients.
Carrying out the plan of care
Nurses use specialized abilities to: 1.) Determine the patients new or continuing need for nursing assistance 2.) Promote self-care 3.) Assist the patient to achieve valued health outcomes
Factors promoting effective communication within the helping relationship
Nurses who are competent, honest, skilled communicators are viewed as effective and compassionate caregivers. This focus on helping relationships is a critical component of what nurses do and plays a vital role in promoting healing, enhancing safety, and improving clinical outcomes
Dignosing:
Nursing Diagnoses are recorded in the Assessment/Diagnosis column in prioritized list beginning with the top-priority diagnosis.
Current standards of care
Nursing actions for implementing the care plan must be consistent with standards of practice.
Blended Competencies:
Nursing actions require all four competencies. -Nurses aim to design and manage each patients care scientifically, holistically, and creatively. to do so successfully nurses need many competencies. *Cognitive *Technical *Interpersonal *Ethical/Legal
Empathy
Objective understanding of the way in which a patient sees his or her situation, identifying with the way another person feels, putting yourself in another persons circumstances, and imagining what it would be like to share that person's feelings. Sympathy shifts the emphasis from the patient to the nurse as the nurse shares feelings and personal concerns and projects them onto the patient. Employing sympathy rather than empathy limits the nurse's ability to focus objectively on the patient's needs
Objective Data:
Observable and measurable data that can be seen, heard, or felt by someone other than the person experiencing them. Observed by one person can be verified by another person observing the same patient. -Temperature reading -Rashes -Data can be obtained by the senses or by measuring devices or equipment, lab studies, radiologic tests, and diagnostics.
Interpersonal communication
Occurs between two or more people with a goal to exchange messages
Small group communication
Occurs when nurses interact with two or more people. To be functional, members of the small group must communicate to achieve their goal
Nonadherence or noncompliance
Occurs when patients are resistant to following a predetermined health care regimen (nonadherence) or patients do not follow a predetermined regimen (noncompliance)
Organizational communication
Occurs when people and groups within an organizations communicate to achieve established goals
Termination phase of the helping relationship
Occurs when the conclusion of the initial agreement is acknowledged. This might happen at change of shift time, when the patient is discharged, or when a nurse takes vacation or employment elsewhere. Emotions are associated with the termination of a helping relationship. If the goals have been met, there is often regret about ending a satisfying relationship, even though a sense of accomplishment persists.
Restoring health
Once a patient is ill, teaching and counseling focus on developing self care practices that promote recovery
Openness and respect
One key factor to effective communication is to be open, accepting, frank, respectful, and without prejudice
Structure evaluation:
Or audit focuses on the environment in which care is provided.
Intravascular fluid
Or plasma -liquid component of the blood
Partial pressure of carbon dioxide
PaCO2
Partial pressure for oxygen
PaO2
Long-Term:
Patient hopes to ultimately achieve but are not usually accompanied during hospitalization.
Legal Documentation:
Patient records are legal documentation that might be used as evidence in court proceedings.One in four malpractice suits are decided on the basis pf the patients records. Documentation plays an important role in implicating or absolving health care practitioners charged with improper care.
Reimbursement:
Patient records are used to demonstrate to payers (insurance companies) that patients and received the intensity and quality of care for which reimbursement is being sought.
Patient care plan records:
Patient records must communicate the patients problems or diagnose; related goal, outcomes, and interventions; and progress of resolution of the problems. The nursing care plan may be wrote separately or incorporated into a multidisciplinary plan.
Caring
Patients quickly sense whether they are merely a task to be performed, or a person of worth who is both cared about and cared for
Honesty, authenticity, and trust
Patients should be able to trust that nurses are who they say they are, and that they can be trusted to do everything within their level of expertise to secure the resources and to help meet the patient needs
Space and territoriality
People are most comfortable in areas they consider their own. We generally feel relief when we come home, take our shoes and professional clothes off, and relax. This urge to maintain an exclusive right to certain space is termed territoriality. Proxemics is the study of distance zones between people during communication. Each person has a sense of how much personal or private space is needed and what distance between people is optimum
Initial Planning:
Performed by the nurse with the admission nursing history and the physical assessment.
Intial Assessment:
Performed shortly after the patient is admitted to the health care facility or service.
COMMON STRATEGIES TO INCREASE PSYCHOLOGICAL SAFETY AND REDCUE RESISTANCE TO CHANGE
Point out similarities between old and new procedures. Suggest ways in which the change can provide new opportunities and challenges. Allow time for learning and practice of any new procedures, if possible, before a change is implemented. Recognize the competence and skill of the people involved. Involve as many people as possible in both the design and implementation of the change. Express approval of people's concern for providing the best care possible. Express the value of each individual's and group's contributions in general and to the proposed change. Provide a climate of trust and acceptance in which mistakes can be made without negative consequences for individuals. If possible, provide assurance that no one will lose his or her position because of the change. Provide opportunities for people to express their feelings and ask questions about the proposed change.
Agency Policy:
Policy dictates who is responsible for charting, order that forms appear, frequency of documentation, process for author identification, approved abbreviations and how to correct errors.
Touch
Powerful means of communication with multiple meanings. It can connect people; provide affirmation, reassurance, and stimulation; decrease loneliness; increase self esteem; and share warmth, intimacy, approval, and emotional support. Touch can be a powerful therapeutic tool when used at the right time. Anxiety or discomfort might result, however, when a patient does not understand the meaning of a tactile gesture or when the patient simply dislikes being touched. It is the most highly developed sense at birth. Physical closeness between the patient and the nurse is essential and inevitable. Tactile sense has been studied seriously as a form of nonverbal communication only since the 1960s. It is a personal behavior and means different things to different people.
Sources of Data: the patient record
Prepared by many different members of the healthcare team provides information essential to comprehensive nursing care. Reviewing the patients record should be done before first contact with the patient. -It lists age, sex, occupation, religious preference, next of kin, and financial status. This information is record by various healthcare professionals.
Standard Care Plan:
Prepared care plans that identify the nursing diagnoses, outcomes, and related nursing interventions COMMON to specific population or health.
Lecture
Presentation of information by a teacher to a learner. To be more effective, lectures can include question and answer periods and collaboration with the learner
Sources of information
Primary: patient Secondary: medical records, patient's family
Purposeful Rounding:
Proactive, systematic nurse driven, evidence based intervention that helps nurses anticipate and address patients needs. Although nurses may struggle to reorganize their day to permit hourly rounding it is difficult to dismiss the growing body of research that suggests effective, purposeful rounding, can promote patient safety, encourage team communication, and improve staff ability to provide efficient patient care.
Parts of Nursing Diagnoses statements
Problem, Etiology, Defining characteristics
Decision making
Problems are identified, appropriate method of decision making is used; decision is implemented and followed through; group commitment to decision is high
Consultation:
Process in which two or more individuals with varying degrees of experience and expertise deliberate about a problem and its solution.
Patient education
Process of influencing the patient's behavior to effect changes in knowledge, attitudes, and skills needed to maintain and improve health
Referral:
Process of sending or guiding someone to another source for assistance.
Narrative notes:
Progress notes written in a source oriented record that address routine care, normal findings, and patient problems identified in the plan of care.
Closed question or comment
Provides the receiver with limited choices of possible responses and might often be answered by yes or no. Closed questions are used to gather specific information from a patient and to allow the nurse and patient to focus on a particular area.
Cultural influences
Providing care and education to patients from many different cultural and ethnic backgrounds
Interviewing techniques
Purpose is to obtain accurate and thorough information. All interview should begin with an explanation of the purpose. During the interview, you'll use techniques to obtain needed information while remaining flexible in approach
Data collection:
Purpose: to gather information and establish database. -begins the minute the patient enters the healthcare facility. -Nurse collects to determine needs -This forms the baseline that will be used for future comparison of the patients illness/disease process.
The aim of all nursing evaluation:
Quality nursing care that aids patient Outcome Achievement.
4.)Helpful Resources:
Recognize limits and seek help to remedy their deficiencies.
Nursing care related to medical and interdisciplinary care plan:
Records current medical orders for diagnostic studies and treatment and specified related nursing care.
Sociocultural differences
Refers to the common lifestyles, languages, behavior patterns, traditions, and beliefs that are learned and passed from one generation to the next. The first step toward cultural competence requires becoming aware of your own personal cultural beliefs and identifying prejudices or attitudes that could affect interactions with persons different from you or be a barrier to good communication
Research:
Researchers may study patient records,hoping to learn how best to recognize or treat identified health problems from the study of similar cases. The aim is to promote evidence based practice in nursing and quality health care.
Friction rub
Rubbing or grating sound when an inflamed pleura rubs against the chest wall. Heard on inspiration and expiration
Developing Ethical/Legal competencies:
Securing the patients well-being.
Intrapersonal communication
Self talk, is communication within a person. This communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions with the patient and family
Validating question or comment
Serves to validate what the nurse believes he or she has heard or observed
Time constraints
Set priorities in order to teach essential content throroughly. Less important content can be taught last so that the more important learner outcomes can be met within the time available
Implementing:
Sets of nursing orders that describe specific nursing interventions are written for each patient outcome. Evidence - based nursing actions planned in the previous stepped carried out.
Quick Priority Assessments (QPAs):
Short, focused, prioritized assessments you do to gain the most important information you need to have first.
Charting by exception (CBE):
Shorthand documentation method that makes use of well-defined standards of practice; only significant findings or "exceptions" to these standards are documented in narrative notes. Benefits of this approach include less time needed for charting, a greater emphasis on significant data, easy retrieval of significant data, timely bedside charting standardized assessment, greater interdisciplinary communication, better tracking of important patient responses, and lower cost.
Nursing Interventions should be:
Should be specific Should have a frequency should be easily understood should not be confusing complete description of what and when the observations are to be made and what and when interventions are performed.
Nursing Care related to basic human needs:
Should concisely communicate to caregivers the data about the patient's usual health habits and patterns, obtained during the nursing history, that are need to direct daily care.
SBAR
Situation Background Assessment Recommendation Provides a consistent method for hand off communication that is clear, structured, and easy to use. This technique was originally developed by the U.S. Navy to accurately transmit critical information, and later adapted by Kaiser Permanente
Types of counseling
Situational, developmental, or motivational, short or long term
Listening skills
Skill that involves both hearing and interpreting what the other says. It requires attention and concentration to sort out, evaluate, and validate clues to better understand the true meaning of what is being said. -sit when communicating with a patient -be alert and relaxed and take sufficient time so that the patient feels at ease during the conversation -keep the conversation as natural as possible -maintain eye contact with the patient if culturally appropriate
Competence
Skilled in all aspects of basic nursing and can meet their patients health care needs through their technical, cognitive, interpersonal, and ethical/ legal skills
Referrals
Sometimes a patient needs specialized counseling from a nurse with advanced training or from other health care professionals. In these cases, offer to refer the patient to the appropriate professional
Power
Sources of power are recognized and used appropriately; needs or interests of those with little power are considered
Facility policies:
Specific policies regarding patient care. Healthcare team members are expected to keep its confidentiality. Identifies which personnel are responsible for recording on each form in the record. Such forms may also describe the order in which the forms are to appear in the record.
Cliche
Stereotyped, trite, or pat answer. Most health care clichés suggest that there is no cause for anxiety or concern, or they offer false assurance. Another type of cliché makes a sweeping generalization that does not necessarily apply to a specific patient. It also tends to cut off communications and makes people feel as though they are insignificant
Roles and responsibilies
Stereotyping a person according to occupation, however, can be misleading and should be avoided
Assessing:
Student records the assessment data that led to the determination of each diagnosis in the assessment/diagnosis column.
Scientific Problem Solving:
Systematic, seven-step problem-solving process that involves: (1) problem identification, (2) data collection, (3) hypothesis formulation, (4) plan of action, (5) hypothesis testing, (6) interpretation of results, and (7) evaluation resulting in conclusion or revision of the study. -Mostly used in a controlled laboratory setting.
Teaching acronym
T - Tune into the patient. E - Edit patient information. A - Act on every teaching moment. C - Clarify often. H - Honor the patient as partner in the education process.
LEADERSHIP THEORIES
TRAIT THEORIES : - intelligence, initiative, self-confidence, high self-esteem, emotional stability, willingness to take risks, and ability to tolerate the consequences of taking risks *POINT: Although leadership may come more naturally to some than to others, almost anyone can gain the necessary knowledge and skills to be a leader in certain areas.* BEHAVIORAL THEORIES: *Authoritarian Leadership*: - efficient way for high productivity and group needing a lot of direction *authoritarian leader* gives direction, makes the final decisions, and bears most of the responsibility for the outcomes DEMOCRATIC: Also called a participative leader, the - *democratic leader* shares the planning, decision making, and responsibility for outcomes with other members of the group. - guidance rather than control, high quality - less efficient, more flexible LAISSEZ_FAIRE - permissive or non directive leadership - gives followers control in the decision making process *laissez-faire leader* has a relatively inactive style and intervenes only when goals have not been met or a problem arises - little feedback and support, best for mature skilled workers
Medical assessments:
Target data pointing to pathologic conditions
Andragogy
Teaching of adults. Focuses on specific problem or need and on the immediate application of new material. Adult learners must believe that they need to learn before they become willing to learn
Pedagogy
Teaching of children and adolescents
Telephone Reports:
Telephones and Telemedicine equipment can link health care professionals immediately and enable nurses to receive and give critical information about patients in a timely fashion.
(Box 26-1) Type of Assessment: Vital Signs
Temperature, Pulse, Respiration, Blood Pressure, Oxygenation Saturation, Pain assessment.
Evaluation review:
That the patient has mad little or no progress to outcome achievement, the nurse needs to reevaluate each proceeding step of the nursing process to try to identify the contributing factors cause problems with the care plan.
Feedback
That the receiver has understood the intended message
(Box 26-7) Components of a Neurovascular Assessment: Paralysis (Movement)
The ability of the patient to move the extremity distal to the injury. Paralysis of an extremity may be the result of prolonged nerve compression or irreversible muscle damage.
Validation:
The act of confirming or verifying. the purpose is to keep data free from error, bias, and misinterpretation as possible.
(Box 26-5) Assessing for Melanoma: Border
The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.
Critical (or Collaborative) Pathways
The case management plan is detailed, standardized care plan that developed for a patient population with a designated diagnosis or procedure.
Observation:
The conscious and deliberate use of five senses to gather data.
Patient versus task focus
You're asleep right now and did not highlight anything under this section
cyanosis
a bluish or grayish discoloration of the skin in response to inadequate oxygenation.
Physical Assessment
a collection of objective data that provides information about changes in the patient's body systems
Health History
a collection of subjective information that provides information about the patient's health status
Minimum Data Set (MDS)
a common set of screening, clinical, and functional status elements that form the foundation of the comprehensive assessment of all residents in long term care facilities certified to participate in Medicare or Medicaid.
surfactant
a detergent like phospholipid that reduces surface tension between moist membranes of the alveoli, preventing collapse.
Contractual agreement
a pact between two people setting out mutually agreed-on goals. Contracts between nurses and patients are common in many health care settings. The contracts are usually informal and not legally binding
Source (encoder)
a person or group who initiates or begins the communication process
Nurse coach
a registered nurse who integrates coaching competencies into any setting or specialty area of practice to facilitate a process of change or development that assists individuals or groups to realize their potential
Assertive behavior
ability to stand up for oneself and others using open, honest, and direct communication. The focus is on the issue and not the person. Assertive behaviors, which are one hallmark of professional nursing relationships, are very different from aggressive
GI tract
absorbs water and nutrients that enter the body through this route
Edema
accumulation of fluid in the interstitial space
Nursing diagnoses
actual or potential health problems that can be prevented or resolved by independent nursing intervention.
Clarifying question or comment
allows the nurse to gain an understanding of a patient's comment. When used properly, this technique can prevent possible misconceptions that could lead to an inappropriate nursing diagnosis
Quality Improvement (QI)
also known as continuous quality improvement (CQI) or total quality management (TQM) consists of systematic and continuous actions that lead to measurable improvement in health care service and health statuses of targeted patient groups. The US Department of Health and Human Services, Health Resources and Services Administration (HRSA), identifies four key principle of QI - Focus on systems and processes - Focus on patients - Focus on being part of the team - Focus on use of the data
hypoxia
an inadequate amount of oxygen is available to cells.
Horizontal violence
anger and aggressive behavior between nurses or nurse-to-nurse hostility. Also referred to as bullying
Lesions
are areas of diseased or injured tissue such as bruises, scratches, cuts, burns, insect bites, and wounds (breaks in continuity of skin).
bronchovesicular breath sounds
are heard over the mainstem bronchus and are moderate blowing sounds, with inspiration equal to expiration.
Petechiae
are small hemorrhagic spots caused by capillary bleeding.
vesicular breath sounds
are soft, low-pitched, whispering sounds, heard over most of the lung fields, with sound on inspiration being longer than expiration.
Respiratory acidosis and alkalosis occur...
as a result of respiratory disturbances
alveoli
at the end of each terminal bronchiole there are small clusters of air sacs. *the site of gas exchange*
Ions
atom or molecule carrying an electrical charge.
lungs are located:
base of diaphragm to apex or first rib
the airway
begins at nose and ends at terminal bronchioles, is the passage way for transport and exchange of oxygen and carbon dioxide.
Discharge Planning:
best carried out by the nurse who has worked closely with the patient and family, possibly in conjunction with a nurse or social worker with a broad knowledge of existing community resources.
Sensible losses
can be measured and include fluid lost during urination, defecation and wounds.
Insensible losses
cannot be measured or seen and and include fluid lost from evaporation through the skin and as water vapor from the lungs during respiration
Bilevel Positive Airway Pressure
changes the airway pressure while the patient breathes in and out. This is a ventilation and a respiration problem
Affective
changing attitudes, values, and feelings
Wellness diagnoses
clinical judgments about a person, group, or community in transition from a specific level of wellness to a higher level of wellness. -often more applicable in nursing settings that deal primarily with healthy patients.
Risk nursing diagnoses
clinical judgments that a person, family, or community is more vulnerable to develop the problem than others in the same or similar situation.
Syndrome nursing diagnoses
comprise a cluster of actual or risk nursing diagnoses that are predicted to be present because of a certain event or situation.
focused health assessment
conducted to assess a specific problem
hypoventilation
decreased depth and rate of air movement into the lungs
ischemia
decreased oxygen supply to the heart caused by insufficient blood supply.
Problem
describe the health state or health problem of the patient as clearly and concisely as possible. -identifies what is unhealthy about the patient and what the patient would like to change in his or her health status.
Arterial blood gases
determine the adequacy of oxygenation and ventilation, as well as in the assessment and treatment of acid-base imbalance.
dyspnea
difficulty breathing
Third-space fluid shift
distributional shift of body fluids into the transcellular compartment, such as the pleural, peritoneal (ascites), or pericardial areas; joint cavities; the bowel; or an excess accumulation of fluid in the interstitial space.
Rapport builders
feeling of mutual trust experienced by people in a satisfactory relationship. Facilitates open communication
Extracellular fluid (ECF)
fluid outside the cells -accounting for about 30% of the total body water or 20% of the adults body weight -includes 2 major areas, the intravascular and interstitial compartments
Intracellular fluid (ICF)
fluid within the cells -constituting about 70% of the total body water or 40% of the adult's body weight.
Nursing diagnosis
focus on unhealthy responses to health and illness, describe problems treated by nurses within the scope of independent nursing practice.
Short term counseling
focuses on the immediate problem or concern of the patient or family. It can be a relatively minor concern or a major crisis, but in any case, it needs immediate attention
Reporting Care:
giving an account of what has been seen, heard, done, or considered; can be written, oral, or computer based communication to others.
bronchial breath sounds
heard over the larynx and trachea are high-pitched, harsh "blowing" sounds, with sound on expiration being longer than inspiration.
Adrenal glands
help the body conserve sodium, save chloride and water and excrete potassium
Venturi Mask
high flow 4-6 L/min = 24-40%
Medical diagnosis
identify disease, describe problems for which the physician directs the primary treatment
Carbonic acid-sodium bicarbonate buffer system
important for acid-base balance and is the most important buffer system of the body -system buffers as much as 90% of the H+ if ECF. -lungs help by regulating the production of carbonic acid resulting from the combination of carbon dioxide and water.
Database:
includes all pertinent patient information collected by the nurse and other healthcare professionals.
Affective learning
includes changes in attitudes, values, and feelings
atelectasis
incomplete expansion or the collapse of alveoli
Thyroid gland
increases the blood flow in the body and increases renal circulation
Subjective Data:
information perceived only by the affected person. this includes the patients feelings, and statements about his/her health problems. -ALWAYS supplied by the patient, but not always valid -obtained through a patient interview and is best record with direct quotes from the patient.
Nervous system
inhibits and stimulates mechanisms influencing fluid balance
SA
initiates a transmission of an electrical impulse. known as teh pacemaker.
hypoxemia
insufficient amount of oxygen in teh blood
Fluid imbalances...
involve either the volume or distribution of water or electrolytes
respiration
involves gas exchange between the atmospheric air in the alveoli and blood in the capillaries
Reflective question or comment
involves repeating what the person has said or describing the person's feelings
Cognitive learning
involves the storing and recalling of new knowledge in the brain
Ecchymosis
is a collection of blood in the subcutaneous tissues, causing purplish discoloration.
Body Mass Index (BMI)
is a ratio of your weight to your height. Is used as an initial assessment of nutritional status, and is an indicator of obesity or malnutrition.
angina
is a temporary imbalance between the amount of oxygen needed by the heart and the amount delivered to the heart muscles causing chest pain or discomfort
Incident report (Variance Report):
is a tool used by health care facilities to document the occurrence of anything out of the ordinary that result in, or has the potential to result in, harm to a patient, employee, or visitor.
Emergency Health Assessment
is a type of rapid focused assessment conducted when addressing life threatening or unstable situation.
jaundice
is a yellowing color of the skin resulting from elevated amounts of bilirubin in the blood.
Comprehensive heath assessment
is broad and includes a complete health assessment. usually conducted when a patient first enters the health care setting with information providing a baseline for comparing later assessment.
Change of shift report:
is given by a primary nurse to the nurse replacing him or her, or by the charge nurse to the nurse who assumes responsibility for continuing care of the patient. - ID information (name, room#, current diagnosis) - Current appraisal of health status - Changes in medical conditions (results of pertinent diagnostic tests) - Patients response to therapy - Patient progress in terms of diagnosis and goals set - Current orders - Nursing diagnosis - Physician orders - Summary of newly admitted patients - Discharge/transfers
Percussion
is the act of striking one object against another to produce sound. The finger tips are used to tap the body over body tissues to produce vibrations and sound waves.
internal respiration
is the exchange of oxygen and carbon dioxide between circulating blood and the tissue cells. and abnormality in the bloods components affect internal respiration
Turgor
is the fullness or elasticity of the skin. Usually assessed on the sternum or under the clavicle by lifting a fold of skin with the thumb and first finger.
waist circumference
is the measurement around a patient at the level of the umbilicus and is a good indicator of abdominal fat.
diffusion
is the movement of gas or particles from areas of higher pressure or concentration to lower pressure or concentration.
Inspection
is the process of performing deliberate, purposeful observations in a systemic manner.
Psychomotor
learning a physical skill
Factors influencing communication
level of development; gender; sociocultural differences; roles and responsibilities; space and territoriality; physical, mental, and emotional state; and environment.
Solvents
liquids that hold a substance in solution -water is the primary solvent in body
Dehydration
loss of or deprivation of water from the body or tissus
Nasal Cannula
low flow 1-2 L/min = 24-28% 3-5 L/min = 32-40% 6 L/min = 44% high flow maximum flow of 60 L/min 10 L/min = 65% 15 L/min = 90%
Nonrebreather Mask
low flow 10-15 L/min = 80-95%
Simple Mask
low flow 5-8 L/min = 40-60% (5 L/min is the minimum setting)
Partial Rebreather Mask
low flow 8-11 L/min = 50-75%
Common causes of Hypervolmia
malfunction of the kidneys, casing inability to excrete the excesses, and failure of the heart to function as a pump, resulting in accumulation of fluid in the lungs and dependent parts of the body.
what are the airways lined with
mucus; to trap debris, particles and cells. Helps to protect against irritation and infection.
Kidneys
normally filter 170 L of plasma and excrete 15 L of urine -output of 30 mL per hour
Acid-base imbalance
occur when the carbonic acid or bicarbonate levels become disproportionate.
Ongoing partial health assessment
or followup assessment, is one that is conducted at regular intervals (e.g. at the beginning of each home health visit or each hospital shift) during the care of a patient.
Pallor
or paleness of the skin, often results from a decrease in the amount of circulating blood or hemoglobin, causing inadequate oxygenation of the body tissues
activities of daily living (ADLs)
or self-care activities. Eating, bathing, dressing, and toileting are examples.
instrumental activities of daily living (IADLs)
or those needed for independent living. Housekeeping, meal preparation, management of finances, and transportation are examples.
Diuretics
patient's with fluid, electrolyte, and acid-base imbalances are often prescribed medications as part of a therapeutic regimen
(Box 26-1) Type of Assessment: Therapeutic devices
peripheral and central venous access devices, supplemental oxygen setting, pacemaker, cardiac monitor, urinary catheters, gastric tubes, chest tubes, dressings, braces, slings.
Etiology
physiologic, psychological, sociologic, spiritual, and environmental factors believed to be related to the problem as either a cause or a contributing factor. -identifies the factors that maintain the unhealthy patient state and prevent the desired change.
Cation
positive charge
Nursing care rounds:
procedures in which a group of nurses visit selected patients individually, at each patient's bedside. The purpose of nursing care rounds is to gather information to help plan nursing care, to evaluate the nursing care patients have received and to provide with a opportunity to discuss their care with those administering it.
Active transport
process that requires energy for the movement of substances through a cell membrane, against the concentration gradient, from an area of lesser solute concentration to an area of higher solute concentration. -ATP
Continuous Positive Airway Pressure
provides continuous mild air pressure to keep airways open. this is just a ventilation problem.
Cardiovascular system
pumps and carries nutrients and water in body.
pulmonary ventilation
refers to the movement of air into and out of the lungs.
Lungs
regulate oxygen and carbon dioxide levels of the blood
Parathyroid glands
regulate the level of calcium in ECF
Actual Nursing diagnoses
represents problems that have been validated by the presence of major defining characteristics. -Has 4 types: label, definition, defining characteristics, related factor.
sputum
respiratory secretion expelled by coughing or clearing the throat
Capillary filtration
results from the force of blood "pushing" against the walls of the capillaries.
incivility
rude, disruptive, intimidating, and undesirable behavior directed at another person. Includes failing to act when action is warranted. Considered by some as a precursor to bullying
Primary organs of homeostasis
see next slide
Fluid is lost from the body through...
sensible and insensible losses.
review of systems
series of questions about all body systems that helps to reveal concerns or problems as part of health history
Discharge and transfer summary:
should be written that concisely summarizes the reason for treatment, significant findings, the procedures performed and treatment rendered, the patient's condition on discharge or transfer, and any specific pertinent instructions given to the patient and family
(Box 26-1) Type of Assessment: Upper and Lower Extremities
skin, color, pulses, temperature, tenderness, edema, capillary refill, strength, sensation, range of motion, lesions, wounds.
Major cations in the body fluid are...
sodium, potassium, calcium, hydrogen, and magnesium ions
Isotonic solution
solution that has about the same concentration of particles, or osmolarity
Aggressive behavior
standing up for one's rights in a negative manner that violates the rights of others. Can be verbal or physical. It is communication that is marked by tension and anger, and inhibits the formation of good relationships and collaboration. Characteristics include using an angry tone of voice, making accusations, and demonstrating belligerence and intolerance. It is rude and threatening
Possible nursing diagnoses
statements describing a suspected problem for which additional data are needed.
Pituitary glands
stores and releases ADH
Cognitive
storing and recalling of new knowledge in the brain
Defining characteristics
subjective and objective data that signal the existence of the actual or possible health problem are the third component of the nursing diagnoses.
Acid
substance containing H+ that can be liberated or released, such as carbonic acid.
Buffer
substance that prevents body fluids from becoming overly acidic or alkaline
Electrolytes
substances that are capable of breaking into particles called ions.
Solutes
substances that are dissolved in a solution
Diffusion
tendency of solutes to move freely throughout a solvent -moves from an area of higher concentration to an area of lower concentration.
Technical skills
the ability to perform both simply and complex nursing procedures/treatment. Requires nurse to perform competently and safely.
Inspiration
the active phase of ventilation, involves movements of muscles and the thorax to bring air into the lungs
Message
the actual communication product from the source
Metabolic or nonrespiratory disturbance alters...
the bicarbonate level in the ECF.
lung compliance
the ease with which the lungs can be inflated. affects lung volume. the ability of the lungs to adequately fill with air during inhalations achieved by normal elasticity of lung tissue, aide by surfactant.
The primary benefit of nursing diagnosis for the patient is....
the individualization of patient care.
Counseling
the interpersonal process of helping patients make decisions that promote their overall well-being. Focuses on improving coping abilities, reinforcing healthy behaviors, fostering positive interactions, or preventing illness and disability. The interpersonal skills of warmth, friendliness, openness, and empathy are necessary for successful counseling. Provides the resources and support that patients need to participate actively in self care and to facilitate their coping with their circumstances
Resources
the most elaborate care plan cannot be fully effective without adequate staff, equipment, and supplies.
Evaluating
the nurse and patient together measure how well the patient has achieved the outcomes specified in the plan of care
perfusion
the process by which oxygenated capillary blood passes through body tissues
oxygenation
the process of providing life-sustaining oxygen to the body's cells
stroke volume
the quantity of blood forced out of the left ventricle with each contraction
air way resistance
the result of and impediment or obstruction that air meets as it moves through the air way. any process that changes the bronchial diameter or width.
The more obese a person is...
the smaller the person's percentage of total body water is compared with body weight
bronchodilator
to open narrowed airways
Ethical and Legal guide to practice
to practice good nursing you need to be knowledgeable in laws and regulations that affect health care and ethical dimensions of clinical practice.
Directing question or comment
used to obtain more information about a topic brought up earlier in the interview or to introduce a new aspect of a current topic
Sequencing question or comment
used to place events in a chronological order or to investigate a possible cause and effect relationship between events
Positive Airway Pressure (PAP)
uses mild air pressure to keep airways open. is used during sleep apnea.
Clinical Reasoning:
usually refers to ways of thinking about patient care issues ( determining , preventing, and managing patient problems).
upper airway function
warm, filter, and humidify inspired air
heart failure
when a person is unable to pump a sufficient blood supply, resulting in inadequate perfusion and oxygenation of tissues
cilia
which are microscopic hair-like projections propel trapped material and accompanying mucus towards the upper air way so they can be removed by coughing
