Nursing 115 Comprehensive Study Guide 1

Nursing Diagnosis

Actual, potential, or possible health problem identified by the nurse that is amenable to nursing intervention -analysis of the assessment findings-start -planning how to treat or -not a medical diagnoses

ANA definition

American Nurses Association

Following the completion of a basic program for practical nurses, graduates allowed to take what licensing exam?

PN-NCLEX

Following the completion of a basic program for registered nurses/practical nurses, graduates are allowed to take what licensing exam?

RN-NCLEX - exam for registered nurses /PN-NCLEX - exam for practical nurses

List some certifying organizations in nursing

RNC; CPNP; CFNP

team nursing consists of

RNs LPNs UAPs

When the nurse writes an expected outcome statement in measurable terms. Which is an appropriate example of a correct expected outcome statement?

Client will report pain acuity less than 4 on a scale of 0 to 10 within 1 hour.

Health Perception/Health Management

Compliance with medication Regimen; regular check-ups; not smoking

Describe the Orientation Phase of a nurse-patient relationship

Develop trust Gain respect Assess needs of patient Be an active listener Establish a time line with the patient

Diagnosis

Diagnosis The nurse, after gathering data, analyzes the information to derive meaning. The nurse is involved in which phase of the nursing process

Nursing process step 2

Diagnosis phase

Analytical process for determining a patient's health problems

Diagnostic Reasoning

Nursing diagnosis

a clinical judgement concerning a human response to health conditions/life processes, or vulnerability for that response by an individual, family, or community that a nurse is licensed and competent to treat

Wellness diagnosis

a clinical judgment about an individual, group, or community in transition from a specific level of wellness to a higher level of wellness.

Health promotion nursing diagnosis

a clinical judgment concerning a patient's motivation and desire to increase well-being and actualize human health potential

Illness prevention

Identify risk factors, such as family history assists patients in reducing risk factors Major difference from health promotion is that disease prevention addressees the health problems after the risk factors have been identified

what is critical thinking?

all or part of process of questioning, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity.

What is the significance of the Nurse Licensure Compact state?

allows an RN to have one license (in the state of residence) yet [ractice in other compact states without an additional license; developed to improve the mobility of nurses

What is the significance of the National Licensure Compact state?

allows an RN to have one license (in the state of residency) yet practice in other compact states without an additional license; developed to improve the mobility of nurses

PO

by mouth

integrity is demonstrated by

engaging in consistently ethical behavior; excepting feedback as tool for improving delivery of pt care; maintaining accountability for actions; freely admitting mistakes; following states nurse practice act; never working outside scope of practice

4 stage processes of planning

establish objectives (goals) evaluate present situation, predict future trends and events formulate planning statement (means) convert the plan into an action, statement

5 recommendations for nursing education

established in system of higher education nurses should be highly educated students shouldn't staff hospitals standards for nursing practice should be established students meet minimum qualifications on graduating

morals

established rules of right/wrong (ethics = based on morals)

What are the purposes of professional nursing organizations?

ethical conduct of members, ensure high quality, leadership, meet challenges, professional standards of practice

ANA standards of professional performance

ethics, education, evidence-based practice and research, quality of practice, communication, leadership, collaboration, professional practice evaluation, resources, environmental health (EEEQCLCPRE)

Evaluation

evaluating the nursing actions evaluating the goals evaluating the patients progress

q

every

Daily

every day

During World War 1 and World War 11, the profession of nursing did what?

experienced significant improvement in image as the public became aware of the nurses's roles in saving lives

tertiary care delivered in

hospital' rehab center; extended care center

secondary care delivered in

hospital; outpt surgical center; specialist office

Magnet Recognition

hospitals recognized for excellent nursing care

Significance of critical thinking in nursing

nurses should be able to prioritize and make key decisions

Patient-centered Care

nurses should use the patient's needs, preferences, and values as the central focus when developing the plan of care

Phase III

nursing interventions

Characteristics of the nursing process

o Critical thinking o Clinical reasoning o Clinical judgement o Care Coordination

Chronic illness

patient has to adjust to the demands of the illness and the therapy used to treat the condition

Subjective data

patient's verbal descriptions of their health problems

Name the 6 quality and safety competencies

patienter-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, informatics.

Which makes more money physical therapist or nurses?

phyiscal therapist

primary care delivered in

physicians office; hospital-based clinics; community health center; public health service organizations

developmental stages for adolescents

can think abstractly, participate in healthcare decisions

Negative Feedback System

Tries to return body back to desired state (like a thermostat)

Renin-Angiotensin-Aldosterone System

Triggered by decreased blood flow to the kidneys Kidneys release Renin into the blood Renin reacts with Angiotensinogen to form Angiotensin I ACE (angiotensin converting enzyme) in the lungs converts Angiotensin I to Angiotensin

True or false: Health promotion is free to all who wants it?

True

Hospital is considered a

secondary level of care

Team Nursing

RN is the leader; one who is responsible and delegates to others); Other team members are LPN's and nursing technicians/assistants

social workers

case managers or counselors

nurses can use EBP in clinical practice to improve pt care as they

collaborate w/ other discipilines; assist pt's through system in various roles; ensure open, effective communication & continuity among healthcare team members, pt's, families

Professional Nursing organizations

collective entity of nurse members that has as its purpose enhancement of some element of patient care of the nursing profession

American Association of Colleges of Nursing

collective voice for academic nursing, AACN serves as the catalyst for excellence and innovation in nursing education, research, practice.

4 steps of developing EBP

develop a clinical question; retrieve the evidence; evaluate the evidence; apply the evidence

Which of the following would be an appropriate reason to join a professional nursing organization?

develop leadership skills

Associates Degree Nurse (ADN) (schooling/preparation)

developed by montag, shorter, evening hours

Good Samaritan Laws

encourage healthcare providers to help victims in an emergency. These laws are designed to protect the healthcare worker from potential liability when volunteering his or her skills outside of an employment contract.

What does "licensure by endorsement" mean?

exam and endorsed by other state boards of nursing

Physicians

examine patients, obtain medical histories, order tests, make diagnoses, perform surgery, treat diseases/disorders, and teach preventive health.

5 levels of proficiency through which a nurse progresses in gaining additional clinical experience

novice advanced beginner competent proficient expert

Benner

novice to expert

primary nursing

one nurse responsible for overseeing total care of a number of pt's 24/7

Mexican culture believe sickness is

spiritual

QSEN

stands for Quality and Safety Education for Nurses, a project for preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the health care systems within which they work

Blood components

red blood cells, white blood cells, and platelets

Best way to prevent and promote health is by

rehabilitation: maximum potential and sets goals

what is the academic renewal? when would an applicant time to use it?

removal of failing grade up to two semesters every two years after the greatest given.

coordination and consultation

represent midrange levels of collaboration seeking to maximize the efficiency of resources.

developing conflict competence

resolving conflict requires increased cognitive, emotional, and behavioral skills, confidence, and competence. purposeful development of these skills is also called CONFLICT COMPETENCE.

Diffusion

responsible for moving the respiratory gases from one area to another by concentration gradients

Rehabilitation and long term care

restores the individual or body part to normal or near normal provides care for individuals who require lengthy assistance

What is the most reliable method of obtaining information about professional nursing organizations mission and strategic activities?

reviewing the organizations website

RLQ

right lower quadrant

5 rights of delegation

right task right circumstances right person right direction & communication right supervision

nurse must determine whether pt info is?

fact, interference, judgment, and opinion by evaluating credibility of info sources is an important step.

Negligence

failure to act as a reasonably prudent person would behave in specific circumstances

How is family functioning altered during a members illness

family members must alter their lifestyle and take on some of the role functions of the ill person

Identify the criteria and strategies for successful communication

feedback appropriateness- reply fits the circumstances and matches the message Efficiency- simple, clear words Flexibility- deal with patients questions and feelings Be a good listener Take cultural differences into consideration

optimism

feeling that things will turn out for the best

clot dissolution

fibrinolysis - Allows blood flow to continue

WBC

fight infection. lab valves can tell if you are anemic

What do case managers do?

file insurances, help patients find a home becasue they cannot go home.

secondary prevention

focuses on diagnosis and treatment of disease

primary prevention

focuses on health promotion & illness prevention

Risk Management

focuses on limiting a healthcare agency's financial and legal risk associated with delivery of care, particularly in terms of lawsuits, ideally before incidents occur.

Legal/ethical responsibilities involved in administration of medication?

give according to orders, report, monitor, instruct patient, NO UNLICENSED may administer!!

what are salient cues?

indicate neg. or positive change in pt's health status. Varies from norms of pt population.Indicates a developmental delay.

Characterization of the maintenance stage of the Transtheoretical Model?

individual has changed behavior for more than 6 months

Characterization of the Precontemplation stage of the Transtheoretical Model?

individual has no intention of taking action within the next six months

Patient ex when to ask family for data

infants, critically ill patients, confused or unconscious patients

common signs of abuse of children

infants- bruising can indicate physical abuse,; vomiting, irritability, and lethargy may indicate head injury. older children- unexplained bruises or injuries, injuries that do not match explanations, untreated medical problems. in children and adolescents who report sexual abuse, may exhibit no abnormal findings in exam but cultures may indicate STDs.

Objective data

information from a doctor that is given and observed

nurse

maintain chronological records of it's ital signs and separate logs about medications

Nurses

maintain chronological records of the pt's vital signs & separate logs that show what medications were ordered and when they were administered.

Nurse Administrator

manages patient care and the delivery of specific nursing services within a health care agency

active transport

movement of ions or particles to a level of higher concentration

intuition for problem solving

unconscious awareness of potentially compromising or dangerous situation, aspect of critical thinking, w/ practice, solving problems using rules & anticipatory thinking transforms into ability to use thinking processes, knowledge, intuition almost unconsciously.

Identify the levels of communication

• Verbal - speaking • Non-verbal - Gestures Clothing Posture Facial expressions Tone and volume of voice

Clinical Ladder

•A multi-step program for promotion within the hospital system •Need experience •Need continuing education •Demonstrate clinical competence •Pursue formal education •Become certified in your area of specialty

Clinical manisfestations

↑ respiratory rate/Dyspnea hypoxemia cough purulent/blood tinged/ rust colored sputum fever pleuritic chest discomfort Chills orthopnia

Diffusion (passive transport)

"I'll lead" (Particles). Movements of solutes form an area of higher to lower concentration. Uses energy from constant motion of molecules... the more the molecules - the more movement. The purpose is to equalize the concentration in both areas. ** Solutes move, not the fluid.

protected health information

"Individually identifiable health information" delineates it to further include any form of medium oral, written, or electronic, that identifies the individual (name, address, DOB, social) or for which a reasonable basis exists to believe the information can be used to identify individual.

Purpose of the ANA

- Broad purpose organization - National student nurses association - Improve health standards and availability of health care for all people. - Foster high standards for nursing - Stimulate and promote the professional development of nurses - Advance the economic and general welfare of nurses

What are the purposes of the American Nurses Association (ANA)?

- Broad purpose organization - National student nurses association - Improve health standards and availability of health care for all people. - Foster high standards for nursing - Stimulate and promote the professional development of nurses - Advance the economic and general welfare of nurses

Mary Ann Bickerdyke

- Civil War lay nurse who rallied the soldiers, cleaning up the camps and the soldiers

Glomerular Filtration Rate (GFR)

- Creatinine - Produce of creatine metabolism in the muscle - filtered by kidneys but not absorbed - If GFR drops, first sign of impending renal failure - If our high pressure washer isn't working, it's not going to clean the surface. ->24 hour collection, two 1 hour urine specimens are collected with blood drawn in between

Describe the responsibilities of the following nursing occupation: Faith Community nursing

- Interest in spirituality - Interest in wellness and health promotion - Usually employed by the church - Holistic approach to healing

Describe the functions of the National Student Nurses Association (NSNA)

- Promotes professional growth - Discounts on products - Voice for nursing students - Mentor students - Promote development of skills - Advocate high quality of health care

Describe the functions of the National Student Nurses Association?

- Promotes professional growth - Discounts on products - Voice for nursing students - Mentor students - Promote development of skills - Advocate high quality of health care

The mission and impact of professional organizations

- Provide the opportunity for nursing as a profession to influence: * Nursing practice * Health policy * Healthcare standards

Define morals

- Provides standards of behavior - Established rules of conduct to be used in situations in which a decision about right and wrong must be made - Reflect how individuals or groups behave - Learned over time and are influenced by life experiences - Theories of moral development - Kohlberg

What is the most fundamental human right, which is the foundation for all ethical principles?

- Respect for others - Valuing every aspect of a person's life - Each individual is unique and equal to others - Foundation to all ethical principles

Clot Retraction

- Shrinking of the clot (20-30 mins of injury) - TPA comes and breaks it apart (clot buster)

Describe the responsibilities of the following nursing occupation: Occupational nursing

- Usually are employed by large companies - Provide basic health care services - Provide health education/disease prevention - Provide health screenings - Provide emergency treatment to employees

JCAHO (Joint Commission on Accreditation of Healthcare Organizations)

- accrediting agency for hospitals and nursing homes - inspects every 2 years - enforces gold standard established by CLSI - works with CAP to provide lab accreditation

Assessment of kidneys/Urinary system postoperative

- check urine retention by inspection, palpate and percuss lower abdomen - report less than 30 mL/hr * ↓ urine output may indicate hypovolemia or renal complications

mitral valve prolapse

- closed and gone too far in that direction, causes regurgitation (most common heart valve disorder) - tied to scarlett fever

Examining results

-requires you to have an open mind, keen observation skills, and the ability to exhibit a neutral perspective -is an ongoing process of gathering subjective and objective data from a patient

What is the most fundamental human right, which is the foundation for all ethical principles?

-respect for others -valuing every aspect in a persons life -each individual is unique and equal to others -foundation of all ethical principles

9

.

Interpretation

1. determine presence of abnormal findings 2. recognize that further observations are needed to clarify information 3. begin to identify patient's health problems

Phosphate values

3.0-4.5

Potassium (K) value

3.5-5.0

Urine pH

4.5-8 (average is 6)

What is the minimum score required on the TEAS?

62

Hypermagnesemia

>2.1 mEq/L • Manifestations: Vasodilation, somnolence, lethargy, muscle weakness, ↓ reflexes, ↓ pulse, BP, respirations • Treatment: ↑ fluids, withhold mag food/drugs, admin with calcium (antidote), give Lasix, NaCl or LR IV, dialysis - seen in renal insufficiency, antacids or laxatives containing magnesium, dehydration

What level of education do the majority of RN's who are employed have

ADN program

Groups, Organizations of Nurses, Nurse educators, people who developed or attempted to develop definitions of Nursing

ANA, RCN, ICN, State Legislation, Dorothea Orem, Hildegard Peplau

Do nursing graduates earn an AS or an AA degree?

AS

Perfusion

Ability of cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs

WWII's effect on definition of nursing

Advanced technology, more aware of emotions playing a part

Skin assessment

Assess for skin breakdown, open sores

If Phosphorous is HIGH what will be low and vice versa?

Calcium

Choosing the options for the best patient outcomes on the basis of a patient's condition and the priority of the problem

Clinical Decision Making

atelectasis

Collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide

Assessment findings in bronchitis

Color dusty to cyanotic Recurrent cough and ↑sputum collection Hypoxia Hypercapnia ↑pCO2 respiratory acidosis ↑ hbg ↑respiratory rate exertional dyspnea ↑incidence in heave cigarette smokers digital clubbin Cardiac enlargement leads to right sided heart failure

What organization was created in 1996 as the national accrediting body for baccalaureate and higher degree nursing programs?

Commission of Collegiate Nursing Education (CCNE)

Ongoing, dynamic series of events that involves the transmission of meaning from sender to receiver.

Communication

Which nurse most likely kept records on sanitation and nutrition and their effects on morbidity and mortality?

Florence nightingale

Primary prevention

Immunizations, health promotion education

What is the impact of continuing education of the nursing practice

Informal ways that nurses maintain expertise during their professional careers Some examples are conferences, short courses, workshops

What is the impact of "continuing education" on the nursing practice?

Informal ways that nurses maintain expertise during their professional careers. Conferences, short course, workshops

Dieticians

Manage food service systems; plans menus; teaches special diets.

Coping/stress tolerance

Manner of handling stress; support system

Food's high in Phosphate

Meat Eggs Poultry

O2

Oxygen

Nonmaleficence

Refers to the avoidance of harm or hurt. DO NO HARM.

Pregnancy- child bearing- islamic

Reversible contraception (ie pill, IUDs, condoms) are notforbidden in Islam, but are regarded as undesirable.•Abortion is not permitted, unless there are very strongmedical reasons.•If pregnancy constitutes a serious threat to the life of themother, then an abortion is permissible irrespective of the period of gestation.•Muslims consider fetus after the age of 120 days is aviable baby.•The death of a fetus after 120 days after conceptionwould require a burial - given to the parents for proper burial.•After delivery, the placenta (which is part of the baby)should be offered to the parents for disposal.

Risk nursing diagnosis

Risk for impaired skin integrity

Dorothea Orem's Theory

Self-Care Deficit Theory

Benefits of general post-op nursing care(Positioning)

Semi-fowlers unless contraindicated Side-lying or turn head to prevent aspiration

Homeostasis

The ability to respond and maintain stability during rapid changing conditions

Adaptation

The ability to respond to challenges of physical or psychological homeostasis and the return to a balanced state

When airway resistance increases,

The amount of oxygen delivered to the alveoli decreases

How have "patients' rights" affected health care?

The public has a say in their health care rights and privileges are granted to every hospitalized patient.

Battery

Threat that is carried out

Goldenseal

Vasoconstriction

Data gathered during assessment

alway need to be assessing interview physical assessment lab and diagnostic cultural considertaions

caring interventions

attitude and compassion key to nursing professionalism

what does ask mean as related to nurse professional identity?

attitude skills and knowledge

c/o

complains of

C&S

culture and sensitivity

Data collected during assessment should be

descriptive, concise, complete, no assuming, validated, objective and subjective

arrogance

excessive pride, feeling of superiority (can be extremely dangerous)

Phase II of planning

goals, broad statements derived form problem Outcome: specific expectation that leads to attainment of goal

Which 2 groups are the most vulnerable population

infants, and elderly

What are the physical effects of Liver disease

jaundice vomiting lower back pain

aortic valve stenosis

narrowing of the aortic valve

lb

pound

RLE

right lower extremity

top

topically

Number 1 complaint in the ER is

Pain

Health Care Practices-Mexican

Traditional Medical Practices Traditional medicine in Mexico is based on the Greek belief, brought by the Spaniards, in the four humors: blood, phlegm, black bile and yellow bile. A balance of these is believed to be needed for good health (Reinert). These beliefs were brought over by the Spanish during colonization, and over the years combined with some of the already existing ones to form a belief, which is based on a balance between hot and cold. When someone is sick, it is because they are out of balance, having either too much heat or cold. Correction of this balance is by consumption of foods or herbs of the opposite quality. Hot and cold as far as healing goes, has nothing to do with the actual physical temperature of the food and definitions of this can vary depending on the region in Mexico the individual is from. Awareness of these beliefs is important when prescribing medicine since they too are categorized as hot and cold. For example, penicillin is considered a "hot" medicine and if given for a "hot" disease such as fever it is less likely that the patient will be compliant. Another example is vitamin C which is considered a cold food and therefore inappropriate treatment for a "cold" disease like an upper respiratory tract infection. "Cold" diseases are ones that have invisible symptoms and include earaches, arthritis, stomach cramps and a chest cold. Hot diseases have more visible symptoms and include empacho (indigestion), colico (nausea, vomiting and abdominal cramp), stomach ulcers, fever, headache and sore throat. Since these categories may vary depending on where the patient is from it is often best just to ask if there is any contraindication to taking a medicine according to their beliefs. Supernatural powers are also believed to cause disease. An example of this is "mal de ojo" or the evil eye (see below). With diseases caused by supernatural forces, non-supernatural cures are not believed to be helpful and often have poor compliance. Therefore it is important to point out the natural cause of the disease and why the prescribed treatment will be beneficial. Another common example of a supernatural diseases is susto (fright sickness). The main traditional healer is known as a curanderas and is believed to get her power from God. Less used traditional healers include the Yerberos (herbalists) and Sobadores (masseuses). Curanderas view illness in a religious and social context, and are used more for diseases that have a supernatural cause (Fisherman et al). Traditional diseases Empacho is a form of stomach upset which is believed to be caused by a bolus of undigested food (Fishman et al). This can happen by eating the wrong foods at the wrong time of the day or eating undercooked foods. Symptoms include anorexia, vomiting, diarrhea bloating, indigestion, and constipation. The most common treatment is massaging the stomach or back, pinching the skin of the back and pulling it until it pops. Caida de mollera means sunken fontanel and is believed to be caused by pulling a baby away from the breast or bottle too quickly, having the baby fall to the ground or carrying the baby incorrectly. Symptoms include poor suck, irritability, sunken eyes, vomiting and diarrhea. The treatments include pushing up on the baby's palate with a finger, holding the baby upside down over a pan of water and slapping the bottoms of his feet, and apply a poultice to the fontanel. Susto or fright sickness is caused by a traumatic or frightening experience. Symptoms include lethargy anxiety, depression, insomnia, and irritability. Treatment includes herbal teas, covering the face with a cloth and sprinkling holy water, and spitting a mouthful of water or alcohol into the patients face unexpectedly. Mal ojo or evil eye is caused by a person with a "strong eye" and occurs when someone admires a child without touching them. The cure involves passing an egg over the body and then placing it in a bowl under the child's pillow overnight. If the egg is cooked in the morning then the child had "mal de ojo". Mal puesto is when someone uses witchcraft to put a bad disease on a person. The hex can be placed by a bruja (witch) or someone who knows about witchcraft. Symptoms can be varied and the cure involves prayers, massages, herbs, making crosses on the arms with olive oil and chili powder, and medicinal enemas. Traditional Remedies Problems and Remedies Fever Cold water compresses over the head, neck and groins Tepid baths Alcohol rub or bath Lots of liquids Give teas Remove clothes Cough Herbal teas, especially oregano, cinnamon, eucalyptus, and chamomile (sometimes with honey) Honey and lemon Combination teas of several herbs Diarrhea Rice water Increase clear liquids, no milk or food Herbal teas, especially mint and chamomile Suedro (dehydration solution made of water, sugar, lemon or banana) Vomiting Stop all food and give clear liquids such as rice water, 7-up, water and sugar, pedialyte, and fruit juice Herbal teas, especially mint and chamomile Suedro Conjunctivitis Chamomile drops or wash for the eyes Breast-milk drops in the eyes Wash with warm water Special diet (vegetable soup and fresh fruits, carrot juice, or eliminate flour tortillas, bread and sodas) Skin Rash Apply cornstarch Alcohol rub or bath at night Apply various substances such as baby lotion, water with baking soda amica lemon oatmeal powder, or rub with watermelon shell If due to allergy, change soap, rinse kids' laundry well, or use cotton clothes Frequent daily baths Minor wounds Wash with soap and water Cover with bandage Clean with lemon juice Minor burns Wash with or place in cold water Apply pork lard, cooking oil, or butter Aloe vera Raw onions Apply toothpaste Egg white Cooked beans

3rd level in Maslow's hierarchy of needs

love and belonging

expressed consent

an oral or written agreement

Dx or dx

diagnosis

Health care for the poor

not limited but a plan is set

nurse practitioner

(like a doctor-nurse) treat common and acute illnesses, order and interpret lab tests, counsel/teach pts

Aldosterone antagonists

(potassium sparing diuretics) - Spironolactone - Distal tubule (less effective), antagonizing effects of aldosterone, hold potassium in - less effective than loop, but doesn't get rid of potassium like thiazide *decrease sodium reabsorption, decrease potassium secretion

Four important things the "Nurse Practice Act" does for nursing.

* Defines the practice of nursing * Sets educational qualifications/requirements for licensure * Legal title abbreviations that nurses can use * Provides disciplinary action for licensees

K+ Administration

***NEVER IV PUSH K*** No faster than 20mEq/hr on tele unit PIV or central line is ideal Dilute liquid K in water or fruit juice Give oral K w food DO NOT CRUSH NO TUBE FEED Dig toxicity - Digiband S/S: green/yellow halo, n/v, headache Magnesium and Potassium married, fix one have to fix the other!

BUN (blood urea nitrogen)

*Not the best test b/c we have to wait too long, shows only really bad renal failure - Diet can alter BUN, so should use creatinine - By-product of protein metabolism - Levels may be affected by: protein intake, GI bleed, dehydration - 2/3rds of renal function must be lost before you see an increase in BUN

Magnet Recognition for Nursing

- A program of the American Nurses Credentialing Center, which is a subsidiary of ANA. - Recognizes health care organizations that provide nursing excellence - Provides a vehicle for disseminating successful nursing practices and strategies - Recognizes quality patient care - Recognizes innovations in professional nursing practice - Provides consumers with the ultimate benchmark to measure the quality of care that they can expect to receive.

Benefits of belonging to a professional organization

- Develop leadership skills - Certification - Research Opportunities - Defining practice standards and redefining policies - Legislative lobbying powers - Publications - Health/Life/Malpractice Insurance - Continuing Education

Defining characteristics

-observable assessment cues -supports each problem-focused diagnostic judgement

Fibrin Clot and Blood Coagulation

- Extrinsic Pathway: (15 sec. MAX, initiated by trauma) - Intrinsic Pathway: (1-6 mins) * Fibrin stabilizes clot and keeps it there (hairspray or sealent)

Describe the employment outlook in nursing?

- Hospital employment will grow more slowly than those in the community based sector - More rapid growth will occur in outpatient facilities - Home health positions will increase the fastest of all - Nursing home positions will increase - Nurse practitioners will be in demand

case management nursing

- May work for a hospital or outside agency - Ensure that the patient receives the services they need from the entire health care team - Most useful with high costs/high volume/high risk patients - Follow-up @ home - Assess, plan, facilitate, and advocate

Letter written to nursing students/faculty by the Anne Bavier PhD, RN, FAAN

- NLN states that "doing the right thing is simply how we do business" - Our actions reveal our commitment to telling the truth - Nurses must be guardians of the ethical treatment of patients - Every action and choice is thought to aim at something good

Holistic Nursing

- Nourishes the whole person - Mind Body and Spirit

Describe the responsibilities of nursing managers

- Nurses who are in charge of all activities on their units - Manage patient care - Manage quality improvement - Select and evaluate personnel - Resource manager - Helpful to have a business background

Define "primary nursing"

- One nurse is responsible for the 24-7 care - Provides care of patient form admission to discharge - Assesses patient/plans care while on duty - delegates while off duty - Usually an all RN staff

Primary Nursing

- One nurse is responsible for the 24-7 care - Provides care of patient from admission to discharge - Assesses patient/plans care while on duty - delegates while off duty - Usually an all RN staff

Assessment of GI post operative

- PONV can be reduced side-lying position before raising head of bed -listen for bowel sounds in all 4 quadrants -assess for paralytic ileus, distended abdomen, discomfort, vomiting, no passage of flatus or stool -record color, consistency and amount of NG tube drainage every 8 hours *red drainage= active bleeding * Brown drainage= old bleeding *imbalances include fluid volume deficit, hypokalemia, hyponatremia, hypochloremia, metabolic acidosis - I,A,P,P abdomen

Culturally competent nurse

- Preforms a cultural assessment - Understands the differences in cultures - Interprets patient's behavior correctly - Planning care recognizing cultural influences - Knowledgeable of various cultures - Understanding of attitudes, beliefs, personal space, medications, and effects on illness

Functions of the National Student Nurses Association (SNA)

- Promotes professional growth - Discounts on products - Voice for nursing students - Mentor students - Promote development of skills - Advocate high quality of health care

Patient Rights

- The public wants a say in matters affecting their healthcare - Guarantees certain rights and privileges to every hospitalized patients

Moral development

- Various Theories - Describes how a person deals with moral dilemmas from childhood to adulthood - Kohlbergs theory is utilized in MTC nursing program <9 years: self centered >9 years and adults: conform to expectations of family/groups/society - Independent thinking: defining own moral values (higher intellectual development)

List 4 important things that the "Nurse Practice Act" does for nursing?

-Defines the practical of nursing -sets educational qualifications/requirements for licensure -legal titles/ abbreviations that nurse can use -provides disciplinary action for licenses

List four important things that the "Nurse Practice Act" does for nursing

-Defines the practice of nursing -sets educational qualifications/requirements for licensure -determines the legal titles and abbreviations nurses may use -provides for disciplinary action for licenses

Internal Influences

-Dependence/Independence -Coping Ability -Hardiness/Learned Resourcefulness -Resilience -Spirtuality

Pulse oximetry

-Identifies hemoglobin saturation -sensor can be placed on finger, toe, nose, earlobe, or forehead -can detect desaturation before manifestations (dusky skin, pale mucosa, pale or blue nail beds) occur. -Causes for low readings include: pt movement, hypothermia, decreased peripheral blood flow, ambient light (sunlight, infrared lamps), decreased Hgb, edema, and fingernail polish.

Leukotriene Modifier (Singulair)

-MOA: blocks leukotriene receptor, preventing the inflammatory mediator from stimulating inflammation. Prevent asthma attacks triggered by inflammation or allergens. -S/Es: equal to placebo

Anti-inflammatory/ Corticosteroids (Fluticasone)

-MOA: disrupts all known production pathways of inflammatory mediators. The main purpose is to prevent an asthma attack caused by inflammation or allergies -S/Es: Candida albicans (yeast) infection because of drug reduces local immunity - perform good mouth care & check the mouth daily for lesions or drainage; also, beware if pt has infection or diabetes. Dysphonia, oral thrush, bone loss

What is the most fundamental human right, which is the foundation for all ethical principles?

-Respect for others -valuing every aspect of a persons life -each individual is unique and equal to others -foundation of all ethical principles

List several reasons why the Associate Degree Nursing programs were popular?

-Shorter duration -Evening hours -Part time -Low tuition -Accessibility -Graduates can take the RN-NCLEX

What were the 5 recommendations made by various studies that set the stage for the development of the nursing educational programs that exist today?

-Should be within the system of higher education -Nurses should be highly educated -Students should not be used to staff hospitals -Standards of nursing practice needed to be established -All students need to meet minimum qualifications upon graduation

Ethics

-a term used to reflect what actions an individual should take and may be "co defined" as in the ethical code of profession -"Should" of human behavior -what "Should" be done for people to live together

critical thinking

-ability to make sound decisions -good problem solving skills -reflective thinking-looking back - think on your feet -improves patient outcomes -motivated by patient's needs -decisions are driven by standards and ethics -honors patient values and beliefs -increases efficiency -need a knowledge base

define "nursing diagnosis"

-actual or potential problems that the nurse is capable and licensed to treat -analysis of the assessment findings -not medical diagnoses.

Discontinuing a care plan

-after determining that patient has met expected outcomes and goals -documentation of a discontinued plan ensures that other nurses will not unnecessarily continue interventions

4 Indicators reflecting a nurse's ability to perform evaluation

-examine the results according to clinical data collected -compare achieved effect with goals and expected outcomes -recognize errors -understand a patient situation, participate in self-reflection, and correct errors

Biographical information

-factual demographic data -admitting office typically collects

Assessment

-first step in nursing process -involves gathering and analyzing information about a patient's health status

-c

.

Creatinine normal range

0.6-1.2 mg/dl

What are the categories of the Multicriteria Screening Process?

1) academic degrees or diplomas. Any relevant work or volunteer experience 2) GPA In relevant coursework 3) CSU transfer pattern 4)life experiences or special circumstances of an applicant 5)language 6) teas

Nursing process (steps)

1. Assessment 2. Nursing diagnosis - analysis 3. Planning 4. Implementation 5. Evaluation ** Assessment phase includes: Gathering information (Subjective data - symptoms/Objective data - signs)

State Board of Nursing (3 functions)

1. Authority to administer the nursing practice act 2. Authority to adopt rules to administer the act 3. Authority to deny, suspend, or revoke a license or to otherwise discipline a licensee or to deny an application for licensure

What are 3 functions of the state boards of nursing?

1. Authority to administer the nursing practice act 2. Authority to adopt rules to administer the act 3. Authority to deny, suspend, or revoke a license or to otherwise discipline a licensee or to deny an application for licensure

List specific strategies that a nurse can use to limit the possibility of legal action.

1. Practice in a safe setting 2. Communicate with other health professionals; open and clear communication - verbal and written 3. Delegate wisely 4. Meet the standard of care - technically competent; keeping up to date; be aware of peer expectation; participate as an equal on the health care team 5. Carry professional liability insurance Promote positive interpersonal relationships

Strategies by the nurse to limit the possibility of legal action

1. Practice in a safe setting 2. Communicate with other health professionals; open and clear communication - verbal and written 3. Delegate wisely 4. Meet the standard of care - technically competent; keeping up to date; be aware of peer expectation; participate as an equal on the health care team 5. Carry professional liability insurance Promote positive interpersonal relationships

Describe Kohlbergs stages of "Moral Reasoning"

1. Pre conventional- individuals is inattentive to the norms of society when responding to moral problems 2. Conventional- characterized by moral decisions that conform to the expectations of ones family, group, or society 3. Post conventional- stage 5 + 6 involves more independent modes of thinking then previous stages. his or her own moral values

Administration of medications - State board of nursing regulations - 1.A (6)

1. The admin of meds is defined as: The act of preparing and giving drugs in accordance with the orders of a licenses physician or dentist as to drug dosage route and frequency; observing recording and reporting desired effects, untoward reactions and side effects of drug therapy; intervening when emergency care is required as a result of drug therapy; appropriately instructing the patient regarding his meds; recognizing accepted prescribing limits and reporting deviations to the prescribing physician or dentist

Components of the Magnet model

1. Transformational leadership 2. Structural empowerment 3. Exemplary professional practice 4. New knowledge, innovation, snd improvements 5. Empirical quality

Steps of Cascade Clotting

1. Vessel Spasm 2. Formation of Platelet Plug 3. Fibrin Clot and Blood Coagulation 4. Clot Retraction 5. Clot Dissolution

what categories of multi-criteria screening process?

1. academic degrees or diplomas any volunteer or work experience. 2. GPA in relevant coursework 3. life experience or social circumstances. 4. proficiency or advanced level coursework another language. 5. TEA's

3 Types of nursing diagnoses

1. problem-focused 2. risk 3. health promotion

Describe the preparation of a bachelor nurse degree

4 year program; part of a 4 year college and universities; BSN programs are needed to provide leadership in administration; public health; and teaching

Describe the preparation of an associate nurse degree

2 year program; part of the technical schools and community colleges; began in 1952; very popular program for various reasons

what are the estimated cost for entering the ADN program?

2,600

What is the estimated cost for a student entering the ADN program?

2600, total 6200

If creatinine is 2x normal, 3x normal, or levels at 10mg/dl or more?

2x = loss of 1/2 of renal function 3x = loss of 3/4 of renal function 10mg/dl or more = loss of 90% of renal function

How many hours of Continuing Education (CE's) does an active RN need to maintain his/license?

30

how many hrs of continuing education does active RN need to maintain his/her Licence?

30 contact urs for every 2 years

what is the minimum required on the teas?

62%

Calcium value

9.0-10.5

Chloride (Cl-) Values

95-108

example of nonmaleficence

A bone marrow tramsplant procedure may offer a chance at a cure, but the process involves periods of suffering, and it may not guarantee a positive outcome. Decisions about the best course of action can be difficult and uncertain precisely because nurses agree to avoid harm at the same time as they commit to promoting benefit

Mary Ann Bickerdyke

A civil war lay nurse who rallied the soldiers, cleaning up the camps and the soldiers

A nursing diagnosis is:

A clinical judgement about individual, family, or community responses to actual and potential health problems or life processes.

Syndrome diagnosis

A clinical judgment concerning a specific cluster of nursing diagnoses that occur together and are best addressed together and through similar interventions.

Health promotion diagnosis

A clinical judgment concerning motivation and desire to increase well-being and to actualize human health potential. These responses are expressed by a readiness to enhance specific health behaviors, and can be used in any health state.

Risk Diagnosis

A clinical judgment concerning the vulnerability of an individual, family, group, or community for developing an undesirable human response to health conditions/life processes. In order to make a risk-focused diagnosis, the following must be present: supported by risk factors that contribute to increased vulnerability

Compassionate fatigue

A combination of physical, emotional and spiritual depletion assocy with caring for patients in significant and emotional pain and physical distress--- secondary trauma

What is the meaning of the evil eye in Mexican culture

A person with a strong eye. Occurs when someone admires a child without touching them. The cure involves passing an egg over the body and placing it in a bowl under the childs pillow. If the egg is cooked in the morning, then the child had mal de ojo (evil eye)

What is the Magnet Recognition Program?

A program of the American Nurses credentialing center, which is a part of the ANA -recognizes health care organizations that provide nursing excellence -provides a vehicle for disseminating successful nursing practices and strategies -recognizes quality patient care -recognizes innovations in professional nursing practice -provides consumers with the ultimate benchmark to measure the quality of care that they can expect to receive

Define tertiary care

A referred doctor specialized consultant care Maybe a long term center

Dorothea Dix

A reformer and pioneer in the movement to treat the insane as mentally ill, beginning in the 1820's, she was responsible for improving conditions in jails, poorhouses and insane asylums throughout the U.S. and Canada. She succeeded in persuading many states to assume responsibility for the care of the mentally ill. She served as the Superintendant of Nurses for the Union Army during the Civil War.

Compassion fatigue

A state of burnout and secondary traumatic stress

What are "advance directives"?

A written statement of a persons wishes regarding medical treatment , often including a living will, end-of-life issues -in SC there are 2 Advanced Directives - health care Power of Attorney -Living will -Other types of advanced directive -Organ Donation -EMS DNR (Do Not Necessitate) order

solutions for uneven distribution of services

ACA; medicare for older adults; medicaid for people w/ lower incomes; children's health insurance program (CHIP); local health dept. & community health centers

List the accrediting agencies that accredit various types of nursing programs

ACEN CNEA

List the accrediting agencies that accredit various types of nursing programs

ACEN (Accreditation Commission for Education in nursing CNEA (NLN Commission for Nursing Education Accredition) CCNE (Commission of Collegiate Nursing Education)

Certified Registered Nurse Anesthetist (CRNA)

AN APRN with advanced education from a nurse anesthesia accredited program. They also provide surgical anesthesia under the guidance and supervision of an anesthesiologist who is a physician with advanced knowledge of surgical anesthesia

Compliance

Ability of the lungs to distend or expand in response to increased intraalveolar pressure

What is the significance of critical thinking in nursing

Ability to make sound decisions Good problem solving skills Reflective thinking- looking back Think on your feet Improves patient outcomes Motivated by patients needs

What is the significance of critical thinking in nursing?

Ability to make sound decisions good problem solving skills reflective thinking- looking back improves patient outcomes motivated by patients needs decisions are driven by standards and ethics honors patient values and beliefs need to know base

Hypercalcemia

Above 10.5 S/S: Anorexia, nausea, fatigue, constipation, polyuria, dehydration, ECG changes N/I: re-hydration, 0.9% NS, loop diuretics Ca chelators Hemodialysis when severe

Hyperphophatemia

Above 4.5 S/S: Convulsion, arrhythmia's, tetany, spasms, stridor N/I:HypoCa common Phosphate binders Renagel, PhosLo, Aluminum based antacids

actual diagnosis

Actual, problem focused. Nursing diagnosis, a clinical judgement concerning an undesirable human response to health conditions/life processes that exists in an individual, family, group or community

Accreditation Commission for Education in Nursing (ACEN)

Accredits all types of nursing programs A recent letter states "the National Advisory Committee on Institutional Quality and Integrity (NACIQI) recommended to the Secretary of Education that ACEN should lose its recognition as an accrediting body

Being attentive to what a person is saying both verbally and nonverbally

Active Listening

inspiration (inhalation)

Active process stimulated by chemical receptors in the aorta

health promotion

Activities aimed at improving health and preventing disease by enabling people to increase control over and improve their health

Describe the role of Nurse Anesthetists

Administer anesthesia for all types of surgeries in various settings

manager

Administration, organization, coordination

What exactly is an Advance Directive?

Advance Directives are legally binding documents that you can sign to specify the kind of treatment you desire or the type you wish to refuse in the event you are unable to express your wishes when medical treatment is deemed necessary by a health care provider. In South Carolina, there are two types of Advance Directives: Living Will and Health Care Power of Attorney.

Fluid Volume Excess: S/S

Adventitious breath sounds Altered electrolytes Anxiety, restlessness BP changes Change in mental status Decreased H&H Dyspnea Edema JVD Oliguria Orthopnea Pleural effusion Pulmonary congestion Wt gain over short period of time

Risk factors that increase complications of surgery

Age over 65 Medications - Antihypertensives, Tricyclic antidepressants, anticoagulants, NSAIDS Medical Hx - Diabetes, Pulmonary, Cardiac, Anemia, Dehydration, Infection, BP, coag Prior surgeries - less than optimal emotional reaction, anesthesia reaction, post op. comp Health Hx - Malnutrition/obesity, drugs, tobacco, ETOH, illicit use Family Hx - Malignant hyperthermia, cancer, bleeding Type of surgery - Airway comp: neck, oral, facial; Pulmonary: chest, high abdomen; Paralytic ileus/thromboembolism: Abdominal

What increases potassium excretion in the kidney?

Aldosterone

Critical thinking

All or part of a process used to evaluate a situation and determine what you should do

Deficient Fluid Volume: S/S

Altered mental status Decreased: BP, pulse pressure, pulse volume Skin turgor Urine output Venous filling Increased: Body temp, pulse rate, urine concentration Sudden wt loss Thirst and weakness

Benefits of general post op (Early ambulation)

Ambulate ASAP Turn side to side every 1 to 2 hours ↓ risk for VTE,DVT. ↑ circulation

What are employment opportunities for community health nurses

Ambulatory clinics Health Departments Hospices Home Clinics Mostly, it becomes and additional role of the nurse

the "Healthy Nurse, Healthy Nation" program is associated with which of the following professional nursing organizations?

American Nurses Association

Tidal Volume (TV)

Amount of air exhaled following a normal inspiration

residual volume

Amount of air left in the alveoli after a full expiration

Certified Nurse-Midwife (CNM)

An APRN who is also educated in midwifery and is certified by the American College of Nurse-Midwifes

Why should nursing schools be accredited

An accredited program voluntarily adheres to standards to protect the quality of education, public safety and the profession itself

Define evidence- based practice

An approach to the delivery of health care that integrates the best evidence of research studies and patient care data with clinical expertise and patient preferences and values Nurses need to be aware of the research that supports specific nursing interventions

Dorothea Dix

An avid reformer of care of the mentally ill. Appointed by president Lincoln as superintendent of women nurses of the army. Created month-long training program for women who wanted to serve.

What are prerequisite courses to the three core science prerequisites courses?

Anatomy 125 Chemistry 143 Math 100 or 89/higher

what are the prerequisite courses to the Three core science prerequisite courses?

Anatomy physiology and microbiology.

aortic valve disorders

Aortic valve stenosis Aortic valve regurgitation

Define "evidence based practice"

Approach to the delivery of health care tat integrates the best evidence of research studies and patient care data with clinical expertise and patient preferences and values

What is the definition of values?

Are freely chosen principles,ideals, or standards held by an individual class or group that give meaning and direction to life.

Distinguish between non nursing certifications and differing nursing degrees

Are nonnursing certifications: Certified nursing aide (CNA) limited in what they can do Certified Medical assistant (CMA) Nurse's aide Home Health Aide (HHA) must be a CNA first ​Medical assistant Different nursing degrees: LVN Licensed vocational nurse (LVN) Associates of science in nursing (ADN) Bachelors of science in nursing (BSN) Masters of science in nursing (MSN) Doctorate degree in nursing (DNP/ Ph.D.)

Values

Are the freely chosen principles, ideals, or standards held by a person or social group that give meaning and direction

Allows expression of feelings and ideas without judging or hurting others

Assertiveness

Steps in Diagnosis

Assess Validate Interpret and analyze the data Look for defining characteristics

The step system 1)

As-needed rapid-acting beta2-agonist (relief inhaler). No daily drugs needed

Musculoskeletal status

Ask about joint replacement and document the exact location of any prothesis. May interfere with surgical positioning

3. A nurse has identified a nursing diagnosis of "Imbalanced nutrition: less than body requirements related to continued weight loss despite adequate intake." During the implementation phase of the nursing process, which activities would be appropriate for the nurse to perform in care of this client

Ask the family to bring in a home-cooked meal. Administer 100 mL of nutritional supplement as ordered at bedtime. Contact a dietician to perform a calorie count.

Six standards of practice

Assessment Diagnosis Outcomes identification Planning Implementation Evaluation

What are the five phases of the nursing processess

Assessment Nursing diagnosis- analysis planning implementation evaluation

Nursing process step 1

Assessment phase

ANA standards of nursing practice

Assessment, diagnosis, outcomes identification, planning, implementation, and evaluation (ADOPIE)

Define Health Promotion

Assists patients to remain healthy Prevent diseases and injuries Detect diseases earlier Promote healthy lifestyles Detection of warning signs Examples: prenatal classes, aerobic classes and smoking cessation classes

Health Promotion

Assists patients to remain healthy prevent diseases and injuries detect diseases earlier promote healthy lifestyles detection of warning signs Examples are: prenatal classes, aerobic classes, and smoking cessation classes

2. The director of nursing (DON) of a major hospital is searching to hire a nurse with a strong technical background to care for patients on a busy surgical unit. The DON is most likely going to hire a nurse prepared at which level of nursing

Associate level

Self directed and independent in accomplishing goals and advocating for others

Autonomy

Which level of educational preparation of registered nurses constitutes the majority of the RN's who are employed?

BSN

A majority of employed nurses are ____ degree nurses

Baccalaureate

3. A student is choosing her educational path and desires a nursing degree that has a track that contains community nursing and leadership, as well as liberal arts. The student would best be suited in which type of program

Baccalaureate program

Neuman

Based on stress and the patient's reaction to the stressor Role of nursing is to stabilize the patient or situation.

What are the techniques that are helpful in responding to patients and others?

Be non-judgemental Observe body language Be an active listener Show empathy Demonstrate caring and compassion Ask open-ended questions Give information Use reflection- method of encouraging patient to think through their problems Silence can be a helpful response

Why will definitions of nursing continue to evolve?

Because it will continue to reflect the profession's evolution over the years.

Which is not one of the "Skills acquisition" stages, identified by Patricia Benner?

Beginner

Intraoperative period

Begins when the patient enters the surgical suite and ends at the time of transfer to the postanesthesia recovery area, same-day surgery unit or ICU.

Preoperative period

Begins when the patient is scheduled for surgery and ends at the time of transfer to the surgical unit.

Which of the following factors contributes the most to premature mortality in the United States?

Behavior

Hypokalemia

Below 3.5 S/S: A: alkalosis S: shallow resp I: irritability C: confusion, diziness W: weakness, fatigue A: arrhythmia's\ L: lethargy T: thready pulse N/I: O2, cardiac monitoring, patient safety falls risk, monitor labs, ECG changes, K supplement, K diuretic

Self-perception/self-concept

Body comfort; Body image;Self esteem

BLE

Bilateral Lower Extremities

Interview and health history

Biographical, past illness, present illness, and reasons for seeking healthcaer

Chronic bronchitis

Bronchitis is an inflammation of the bronchi and bronchioles caused by exposure to irritants, especially cigarette smoke. The irritant triggers inflammation, vasodilation, mucosal edema, congestion, and bronchospasm. Bronchitis affects only the airways, not the alveoli.

key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs

Core Measures

When magnesium is low, what else may be low?

Calcium

Spanish American War Nursing

Call for trained Nurses, catholic women assisted again because shortage of nurses, untrained African American nurses respond, led to development of a permanent Army Nurse Corps and Navy Nurse Corps

Decrease in airway diameter by bronchoconstriction

Can increase airway resistance

accessory muscles of respiration

Can increase lung volume during inspiration

Anxiety assessment

Can ↑ resp. rate., BP, HR, and pulse

In depth self-examination of one's own background, recognizing biases, prejudices, and assumptions about other people

Cultural Awareness

Locus Ceruleus

Central integrating site in the brain stem for ANS response to stress

American Nurses Credentialing Center (ANCC)

Certification of nurses and Magnet credentialing of hospitals and health networks

Means of sending and receiving messages

Channels

Cardiovascular status

Check for hypotension, Listen to heart sounds, Check for VTE, Examine hands and feet for temp, color, peripheral pulses, capillary refill and edema

COPD

Chronic obstructive pulmonary disease is characterized by obstruction caused y emphysema and bronchitis not reversible

without this, it is impossible to advocate for your patient

Communication

List various nursing occupations

Community Health Nursing Hospital-based nursing School Nursing Case Management Nursing Hospice and Palliative Care nursing Occupational Nursing Office-based nursing Military nursing Telehealth nursing Faith Community nursing Informatics nursing Travel nursing Nurse Entrepreneurs

Clinical judgment in nurising

Conclusion or enlightened opinion at which a nurse arrives following a process of observation, reflexes and analysis of observable or available information or data

Describe the role of a Nurse Practitioner

Conduct physical exams; diagnose and treat common and acute illnesses; manage chronic problems; order and interpret lab tests and counsel/teach patients

maintenance

Continuation of desirable actions Intervention: reminders; avoiding slips

team style

Contributor: task oriented Collaborator: big picture Communicator: relationships Challenger: devil's advocate, raises questions

Regulating System

Cooperating mechanisms that act to maintain homeostasis

Benefits of general post op (Breathing)

Cough and deep breath to expand lungs Promote gas exchange, eliminate anesthesia Use incentive spirometer

Commission of Collegiate Nursing Education (CCNE)

Created in 1996 by the American Association of Colleges in Nursing Nationally accrediting body for bachelor and higher degree programs, it began in 1998

The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process

Critical Thinking

Systemic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families, and communities

Cultural Assessment

Health Care Practices-Chinese

Culturally Appropriate Geriatric Care: Treatment Role of the Health Care Provider: The basic concepts of treating patients with respect, compassion, and honesty are still what are most important to patients, regardless of cultural/ethnic background. A better understanding of a person's cultural beliefs can improve patient compliance and the relationship. There may be a conflict with Western concept of patient-physician relationship of partnership vs. the doctor as authority. Patients may hesitate to make direct eye contact, may hesitate to ask questions or voice opinions so as not inconvenience others or appear disrespectful. Physicians are expected to make decisions and give instructions. They must be viewed as trustworthy, caring and willing to help. To put the elder patient at ease, it is important to take a little time to "talk story" before beginning the clinical interview, to address patients with respect (Mr. or Mrs.), and to try to pronounce names correctly. Some elders may feel uncomfortable with physical contact during conversations. Health care providers must be aware of their own stereotypes toward the Chinese and degree of acculturation of their patients. Integration/Awareness of Traditional Chinese Medical Treatments/Beliefs: Many Chinese still believe in traditional Chinese medical treatments, and a total disregard or lack of respect for these beliefs may lead to distrust. Open discussion and flexibility may go a long way in treating the elder Chinese-American patient Examples: Acupuncture: meridians are pathways of energy, or "chi", which lead to various organs. Cupping: using heated bamboo cups to reduce stress, congestion, colds. Herbology: use of plant or animal parts in the treatment of illness and deficiencies and to stimulate the body's "chi". Yin/Yang concept: elders may avoid the cold, and may avoid certain foods considered to be "cold" foods. Meditation/Exercise: often used to help alleviate stress. Cross Cultural Psychopharmocology. Lower doses of psychotropic medications may be needed in Asians, due to lower body weight and differences in metabolism. .Psychotherapy There should be an awareness that Western methods of psychotherapy-may not be received well. Confrontation may make patients uncomfortable, and somatization is common. Advance Directives/End of Life Issues: Many Chinese may be reluctant to discuss these issues due to the belief that if you talk about something bad, it could occur (karma). Resistance toward organ donation may result from the concept of keeping the body whole for the afterlife, and out of respect. Attitudes can change depending on degree of acculturation. Some elders do not want to be a burden to their children. Medical professionals need to use care and be aware of their patient's beliefs in approaching these issues with Chinese elders or their families. It is also important to ask about whether there is an accepted family decision-maker Medications. There is a high rate of non-compliance with Western antihypertensive medications in non-English speaking Chinese with hypertension (Huff & Kline, 1999). Many less acculturated Chinese-Americans may believe that Western medications are too strong and may not take prescribed doses. Elder Chinese-Americans may be at risk for drug interactions due to metabolic factors that alter the metabolism of drugs, and the concurrent use of herbs and other Chinese medications. Access and Utilization Health Care Utilization The degree of utilization is dependent upon acceptance by patient and family, and barriers such as mistrust, money, saving face, and family responsibilities. Additional barriers to the U.S. health system include: lack of language and culturally competent services; geographic; and economic barriers. For example, conservatism with regards to sexual matters may be partially responsible for lower rates of mammograms in older Chinese-American women. In general, the fact that Asians and Pacific Islander Americans are less likely to see a physician may impact on the success of prevention programs, such as smoking cessation and breast cancer screening (Chen, 1994). Use of Long Term Care There may be reluctance to place parents in long-term care facilities out of respect and filial piety. Often a female family member (daughter-in-law or daughter) has the burden of care. Often the decisions regarding placement occur later, when the situation is extremely stressful. In 1990, about 1.4% of Chinese Americans 65+ lived in nursing homes, compared to the overall rate of 5% for all Americans 65+

List 4 important things that the "Nurse Practice Act" does for nursing?

Defines the authority of the State Board of Nursing * Defines the practice of nursing * Sets educational qualifications/requirements for licensure * Legal title abbreviations that nurses can use * Provides disciplinary action for licensees

Responsibilities of Telehealth nursing

Deliver health care to patients through telecommunication technology Use of computers, interactive video linkage, teleconferencing, transmission of patients clinical and lab data

What factors influence illness behavior (internal)

Dependency Ability to cope Ability to manage and maintain control over the situation Resourceful Resilience Spiritual Beliefs

horizontal violence (HV)

Described as aggressive acts committed against a nurse by one or more nursing colleagues.

12

Determine the differences between prerequisite courses and graduation requirements for the Associate Degree Nursing (ADN) program

Examples of justice

Discussions about health insurance, hospital locations and services, organ transplants

Impaired O2 transport

Don't have RBC/hemoglobin need. No O2 issue, can't be delivered. Shortness of breath, dizziness/faint, weakness, fatigue, angina, compensatory mechanisms- tachycardia, palpitations

Setting for communication

Environment

Work of breathing (WOB)

Effort required to expand and contract the lungs

aortic valve characteristics

Either born with this or due to wear and tear. Less common, typically geriatric patients related to scarring of valves.

Use of technology to create ongoing relationships with patients and their health care team

Electronic Communication

Assessment and communication technique that allows nurses to better understand and perceive the emotions of themselves and others

Emotional Intelligence

Mary Breckinridge

Established the Frontier Nursing Service

4th level in Maslow's hierarchy of needs

Esteem (ego)

Nursing process step 5

Evaluation phase

Stressors

Events or environmental agents responsible for initiating the stress response

Knowledge based on research or clinical expertise

Evidence-Based Knowledge

Common causes of Fluid overload

Excessive fluid replacement; Kidney failure (late phase); Heart failure; Long-term corticosteroid therapy; Syndrome of inappropriate antidiuretic hormone (SIADH); Psychiatric disorders with polydipsia; Water intoxication

Define communication

Exchange of thoughts, ideas or information Part of every relationship Primary instrument through changes that occur

Magnesium normal ranges

Expected Range: 1.3-2.1 mEq/L

Sodium normal range

Expected Range: 136-146 mEq/L

Phosphorous normal ranges

Expected Range: 3.0-4.5 mg/dL

What are the purposes of the National League of Nursing?

FOCUS ON NURSING EDUCATION -oldest organization for nurses (since 1893) -advances quality nursing education -concerned with quality nursing for all types of nursing programs -pratical nursing -Associates degree nursing -Baccalaureate degree nursing -master degree nursing NLNAC- accredits nursing programs

One of the purposes of the use of standard formal nursing diagnostic statements is to:

Facilitate understanding of client problems among health care providers.

Negligence

Failure to act as a reasonably prudent person would behave in specific circumstances

Role-relationship

Family roles; work satisfaction

How do we lose fluids in the body?

Feces Sweating Vomiting/Emesis Urine

HyperNa: Hypervolemic response

Fluid Overload Bounding pulse w high BP

Message a receiver receives from the sender

Feedback

Identify the criteria and strategies for successful communication

Feedback Appropriateness- Reply fits the circumstances and matches the messages Efficiency- simple, clear words Flexibility - deal with patients questions and feelings Be a good listener Take cultural differences into consideration

Coltsfoot

Fever, liver toxicity

Evaluation

Final steps decide if goal/outcome was met identify variables that affect achievement, quality of care modification/revision reevaluation

Mary Mahoney

First african american trained nurse

Mary Mahoney

First black trained nurse

Mary Mahoney

First professionally trained African American nurse

Adelaide Nutting

First professor in the nursing world

Mary Adelaide Nutting

First professor of nursing in the world

What contribution did Civil War have to nursing?

First training schools

Rosemare Rizzo Parse's Nursing Paradigm

Goal of nursing is to know the patients' perspective on health and illness; patient's perspective of quality is important. Unitary Man; the patient is in continual communication with the environment and the "lived experience"

Orem's Theory

Focuses on patient's self-care needs

Identify highly valued attributes of a nurse

For someone who has good communication skills, emotionally stable, shows empathy, is flexible, has attention to detail, has good interpersonal skills, has good physical care, is good at problem solving, quick thinker, organized, hard working, honest, and shows respect.

Mildred Montag

Founded ADN education (1952)

Mildred Montag

Founded ADN education in 1952

Lillian Wald

Founded Henry street Settlement and public health nursing

Clara Barton

Founded the American Red Cross

Lillian Ward

Founded the Henry St Settlement and public health nursing

Lillian Wald

Founded the Henry Street settlement and public health nursing

Florence Nightingale

Founder of modern nursing and nursing education

Florence Nightingale

Founder of modern nursing and nursing education. Established training schools for nurses. Upgraded conditions. Hospital reform.

Clara Barton

Founder of the American Red Cross

Who is Clara Barton? What did she do?

Founder of the American Red cross, tended soldiers on the battlefields, cleansing their wounds, meeting their basic needs, and comforting them in death.

Elimination

Frequency of Bowel movements

Patients with COPD, especially emphysema

Frequently use accessory muscles to increase lung volume

Endogenous Stressor

From within

Exogenous Stressor

From without

Teamwork and Collaboration

Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

Regional or Local anesthesia

Gag and cough reflex stays intact. Allows participation and cooperation of patient Less disruption of physical and emotional body functions ↓ chance of sensitivity ↓ intraoperative stress

17

Gain insight to make an informed decision whether to pursue nursing as an educational goal.

what types of data are included under assessment?

Gathering information 1.subjective data---symptoms 2.objectives data--- signs

What types of data are included under assessment

Gathering information Subjective data- symptoms (yourself) Objective data- signs

Alarm

Generalized stimulation of the SNS and HPA axis

Communication-islamic

Given the centrality of the family, consider informingfamily of medical information, and to be involved inthe decision-making process.•Use your right hand for care - as the left hand is usedfor washing after elimination•Good communication - develop and maintain trust•Do not point the soles of the feet to the patient•Consider Ramadan when prescribing/administeringmedication

Teamwork and Collaboration

Goal: Achieve quality patient outcomes by effectively communicating with nurse and interdisciplinary teams having mutual respect & shared decision making New: function effectively with interdisciplinary teams fostering open communication, mutual respect & shared decision making

safety

Goal: Prevent harm, establish culture of safety New: minimize risk of harm to patients/providers through both system effectiveness and individual performance

Informatics

Goal: Use computerized decision support systems to provide care New: use it to communicate, manage knowledge, mitigate error, & support decision making.

Quality Improvement (QI)

Goal: identify gaps between local & best practices New: use data to monitor outcomes of care processes criteria

patient centered care

Goal: patient is in control and full partner; care is based on respect for patients preferences, values, and needs New: asking the patient how they want it to be

Evidence Based practice

Goal: reduce variability in practice so that the best standard of care are implemented guides us in clinical decision making New: integrate best current evidence, clinical expertise, patient preferences & values to deliver optimal health care

Afferent

Goes towards the hypothalamus

Alpha 1

Increased glycogenolysis and smooth muscle contraction (blood vessels) and breakdown of glycogen

Hispanic attributes

Hard working, very devoted parents, supportive high pain tolerance stoic eats lots of beans/rice Belief for illness is the body is out of balance; too much hot or too much cold

LC-NE System

Has afferent pathways to: - the hypothalamus - the limbic system - the hippocampus - the cerebral cortex

Why we should define Nursing

Having an accepted definition of Nursing provides a frame work for Nursing practice

Ginseng

Headache, ↑ BP, ↑ HR, anxiety

Ephedra

Headache, ↑ HR, ↑ BP, anxiety, dry mouth

Difference among populations in the availability, accessibility, and quality of health care services aimed at prevention, treatment, and management of diseases and their complications

Health Care Disparities

Inequality or difference between the health status of a disadvantage group such as people with low incomes and wealth and an advantaged group such as people with high incomes and wealth

Health Disparity

The components of Nursing's meta paradigm are:

Health, Nursing, Environment, and person

rehabilitation and long term care

Help restore the patient to the fullest possible level of function and independence following injury or illness

Post WWII definition of nursing

Helped advance the technologies available to treat people which in turn influenced nursing, health, illness, and nursing care

Isabel Hampton Robb

Helped to form the National League of Nursing and the American Nurses Association

Caregiver

Helping patients maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process. Helping patients and families set realistic goals and to meet those goals

Nursing Entrepreneurs

Highly creative and challenged by risks of starting a new enterprise Identifies a need and creates a service to meet the identified need Self-employed as consultants to hospitals, nursing homes and schools of nursing

Activity-Exercise

Hobbies; Mobility; exercise; activities of daily living

Sigma Theta Tau International

Honor Society of Nursing, is advancing world health and celebrating nursing excellence in scholarship, leadership, and service.

Diploma Nurse (schooling/preparation)

Hospital based learning, earliest form of nursing education

Describe the employment outlook for nursing

Hospital employment will grow more slowly than those in a community based sector More rapid growth will occur in outpatient facilities Home health positions will increase the fastest of all Nursing home positions will increase Nurse practitioners will be in demand

What are secondary care services?

Hospital, home health care

Theory of psychological development

How well a person can integrate into a society, how well social skills are

Rosemarie Rizzo Parse's Theory

Human Becoming Theory

Hypernatremia

Hyper: over 145 Causes: excess salt consumption, prolonged diarrhea, or dehydration S/S: F: flushed skin/fever R: restlessness I: increased fluid retention E: edema D: decreased urine output N/I: Monitor VS, I&O, labs, daily weights, neuro checks, Hypotonic fluids, diuretics, Na restriction

Licorice

Hyperkalemia, Hypernatremia

Hyponatremia (Sodium, Na)

Hypo: less than 136 Causes: impaired renal function, fluid loss r/t burns, low ADH secretion, low salt diet, Na loss d/t some diuretics S/S: Cerebral edema Mental status change, Confusion Seizures, Coma Muscle weakness, Nausea, diarrhea N/I: Daily weight, I&O, diuretics, IV therapy, restrict Na

Types of nursing interventions

Independent, dependent, collaborative

What if I have an old health care power of attorney or living will. or signed one in another state?

If you previously signed a living will or health care power of attorney, even in another state, it is probably valid. However, it may be a good idea to sign the most current forms. For example, the current South Carolina living will form covers artificial nutrition and hydration whereas older forms did not.

Nursing process step 4

Implementing phase

action

Implementing plan Intervention: assist with feedback & support

Informed Consent

Implies that the patient has sufficient information to understand: • The nature of and reason for surgery • Who will be performing the surgery and whether others will be present during the procedure (e.g., students) • All available options and the risks associated with each option • The risks associated with the surgical procedure and its potential outcomes and with the use of anesthesia

Diseases such as asthma and tracheal edema

Increase airway resistance

Lasix

Increase sodium excretion, outcome should be weight loss & lab improvements q 8hrs.

Decreased lung compliance, increased airway resistance, and increased use of accessory muscles increase WOB resulting in

Increased energy expenditure. Therefore metabolic rate increases as well as the need for more oxygen

Pender's Health Promotion Model is based on what factors?

Individual characteristics, experiences, and personal factors

Process of drawing conclusion from related pieces of evidence and previous experience with the evidence

Inference

19. A nurse working on a medical unit is caring for a client with anemia. The nurse has a part-time business selling vitamin supplements. The nurse approaches the client, offering to sell the supplements to help "improve your blood." A second nurse overhears the conversation. How should the second nurse address this situation

Inform the nurse that selling supplements to clients is a conflict of interest.

Implementation

Initiation of nursing interventions to achieve goals of the nursing care plan Specify who executed the intervention Specify the intervention

Describe how evidences-based practice is utilized in nursing practice

Injections hand washing donning and doffing PPE nurse staffing pressure ulcer prevention 2 step blood pressure check

What are nursing practices based on the latest research

Injections hand washing donning and doffing of PPE Nurse staffing Pressure ulcer prevention 2 step blood pressure check

What increases sodium in the body?

Insulin

Content of the communication

Message

What is holistic nursing?

NOURISHES THE WHOLE PERSON,THAT IS, THE BODY, MIND,AND SPIRIT.

Malpractice

Negligence in the profession

Includes the five senses and everything that does not involve the spoken or written word

Nonverbal Communication

Respiratory status

Observe posture, resp. rate rhythm and depth, clubbing, cyanosis, adventitious breath sounds

Clinical reasoning

Process of 3 different steps: noticing, interpreting, responding

Ethics

The study of conduct and character

Alpha 2

Renin release

Most fundamental human right

Respect

administrative laws

Responsibilities that may be interpreted and enforced by an agency that has been delegated the power of oversight by the governing legislation.

Foods high in calcium

Sardines, fish bones

Secondary prevention

Screening high risk patients; early detection and treatment

Valerian root

Sedative, tranquilizer, hepatotoxicity

What is objective data

Signs, observable, measurable data, by observation or physical examination

What characteristic is the strongest indicator for health status?

Socioeconomic status

What state agency in SC has the power to issue a nursing license to qualified individuals?

South Carolina Board of Nursing

What is subjective data

Symptoms, what the patient says to you, patients point of view, self support, comes from the patient (self)

What are the purposes of the professional nursing organization?

They offer a supportive way to learn leadership skills, to test ideas, and to follow these ideas to completion

General Anesthesia

Total loss of consciousness. Inhalation or IV Depresses CNS, ↓ pain, no memory of surgery. Better for older & high-risk

Assault

Threat; an attempt to make bodily contact with another person without their consent

BID

Twice a day

Examples of quality imporvement

Use tools such as flowcharts and diagrams to make process of human factors and basic safety design principles and commonly used unsafe practices.

What are the components of the therapeutic use of self

Using one's personality and communication skills to help patients Can be developed by utilizing knowledge and skills Assists in relating effectively with patients/families/peers/ and other health care workers

Wherever sodium goes what follows?

Water

Exhaustion or Recovery

When stress is too much for the body to handle or When the body is able to adapt

Nurse's Responsibility for Informed Consent

Witness and obtain informed consent from the patient but we ARE NOT responsible to explain it to the patient

Actor illness

a disease with an abrupt onset and usually a short course

p

after

AC

before meals

what was Spanish American War's contribution?

development of the army/navy nurse corps

4 major health care services

diagnostic, therapeutic, information, environment

Isabel Hampton Robb

founded American Nurses Association

attitude

mental state involving values, beliefs, feelings, mood

Malpractice

negligence in the profession

Signs

objective

PO or Po

orally or by mouth

after meals

pc

generational cohort

people born in same general time span who share key life experiences

do BSN and ADN students take a different NCLEX?

they take the same

VS

vital signs

Motherwort

↑ Anticoagulation

Impact of illness on family

-role reversal -entire family is affected -increases stress/anxiety -family disruption - anger and guilt -financial difficulties -confusion -values are reassessed -priorities are shifted -working together -may enhanced strengths of individual family members

show reliability and accountability by

follow through on commitments; take responsibility for consequences of one's actions; refuse assignments only if not qualified or not prepared to perform; avoid judging pt's or forcing nurse's own personal beliefs onto pt

possible pitfalls can be avoided by

following ethical practices use available resources know pt's health concerns have sense about pt priorities prioritize care appropriately use questions from clinical decision-making models

child participation in healthcare decisions

for a minor (under age 18), a parent or guardian must give informed consent for medical treatment.

triage emergent (immediate)

for life-threatening issues that requires prompt treatment stabilization of pt's condition is critical

triage nonurgent (minor)

for pt who have minor issues not requiring prompt care often pt can ambulate, is stable some ERs use satellite divisions for pt's w/ nonurgent issues

triage urgent (delayed)

for serious conditions in which delay would not result in life threatening situations

Damages (compensation)

for the plaintiffs loss or injury may include enough money to pay for the plaintiffs medical fees associated with the injury.

failure to observe and take appropriate action

form of malpractice when nurse ignores a patients complaints.

scientific method

formalized, logical, systematic investigative approach most successful in controlled situation, health professionals use modified version for solving problems.

Clara Barton

founded red cross

Florence Nightingale

founder of modern nursing and a reformer of hospital sanitation methods

qid

four times a day

ad lib

freely as desired

Afferent Arterioles "active"

from renal artery

Battery

is defined as willful touching of another individual( or individuals clothes or even something the individual is carrying) that is unwanted, embarrassing, or unwarranted, such as touching done without permission or giving an injection without a patients consent.

Discuss behaviors that exhibit healthy role-modeling in the professional arena

lead by example, always a teacher as a nurse

to support efforts to be effective, efficient

limit distractions, interruptions treat all pt's w/ respect, dignity, necessary attention

liq

liquid

Custodial care

long term care

nonacute urgency level

low urgency factors delay would not neg. affect pt outcomes

preparation

making plans to change Intervention: concrete plan of action

Before beginning patient interview, be prepared by reviewing patient's _______ first.

medical record

National Student Nurses Association

mission is to mentor students preparing for initial licensure as registered nurses, and to convey the standards, ethics, and skills that students will need as responsible and accountable leaders and members of the profession.

obtaining information

nurses should request and record only info pertinent to the health status of patients to whom they are assigned.

intergroup conflict

occurs between teams that are in competition or opposition to one another.

Clotting Cascade

"The orderly, step wise process for stopping bleeding."

list the 5 phases of the "nursing process"

- Assessment - Nursing Diagnosis - analysis - Planning - Implementation - Evaluation

Leukotriene Modifier Xolair

-MOA: drug is an antibody that binds to the IgE receptors on mast cells and basophils, preventing allergens triggering the release of inflammatory mediators. For prevention. -S/Es: small increased risk for anaphylaxis and cancer; injection site reaction, viral infection, URI, h/a, sore throat

What is the most important statutory law affecting nurses in each state?

-Nurse Practice Act

Preoperative lab assessment

-Potassium 3.5-5.0 -Sodium 136-145 -Chloride 98-106 -CO2 23-30 -Glucose 70-110 -Creatinine F 0.5-1.1 -M 0.6-1.2 -BUN 10-20 -PT 11-12.5 -INR 0.7-1.8 -aPTT 30-40 -WBC 5000-10,000 -Hemoglobin 12-16 (18-44 years) -HCT 35-45% (18-44 years)

Membership and involvement of Nursing associations

-Professional nursing organizations -Task forces and work groups -Leadership positions -Liaison activity -Authorship opportunities

Nursing Diagnosis

-Provides the basis for selection of nursing interventions to achieve outcomes for which you, as a nurse, are accountable. A clinical judgement concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community

Collaborative problem

-an actual or potential physiological complication that nurses monitor to detect the onset of changes in a patient's health status -upon development, nurses intervene with personnel from other health care disciplines

Related factor

-an etiological or causative factor for the diagnosis -included in problem-focused nursing diagnosis

nursing process 5 phases

-assessment -nursing diagnoses-analysis -planning -implementation -evaluation

Evaluative measures

-assessment skills and techniques -important to use the right one to accurately identify changes -be detailed and patient specific

Define values

-attitudes, ideals, or beliefs that an individual or group holds to guide their behaviors - expressed in terms of right or wrong -values are freely chosen -indicates what a person considers most important

Evaluation

-final step of the nursing process -crucial in determining whether, after application of the first four steps of the nursing process, a patients condition or well-being improves

Types of assessments

-patient-centered interview -physical examination -periodic assessments

What to do when a goal is not met

-reassess -redefine diagnosis -review goals and expected outcomes -review appropriateness of interventions

2 Approaches in comprehensive assessments

.

characteristics of effective interprofessional collaboration

1. common purpose and goals identified at the outset. 2. clinical competence of each provider. 3. interpersonal competence. 4. humor 5. trust 6. valuing and respecting diverse, complementary knowledge.

Urine osmolality

1.005-1.025

Magnesium values

1.3-2.1

Tertiary care

Acutely ill; terminally ill; long term care; rehabilitation ; and trauma centers.

Norms, values, and traditions passed down through the generations

Culture

Ability to understand and accept another person's reality, accurately perceive feelings, and communicate this understanding

Empathy

Delegation

Empower one to act for another

educator

Explains health concepts & care processes

Responsibilities of Hospital-based nursing

Identifying very sick patients Help stabilize sick patients Prepare them for transport Care for patients who have medical or surgical conditions Care for a variety of patients

12. Nurses apply critical thinking to clinical reasoning and judgment in their nursing practice every day. Which of the following are characteristics of this practice

It is guided by standards, policies and procedures, ethics codes, and laws. It carefully identifies the key problems, issues, and risks involved. It is based on principles of nursing process, problem solving, and the scientific method.

Which organization provides accreditation for health care organizations, such as hospitals?

JCAHO (Joint Commission on the Accreditation of Health Care Organizations)

Loop

Lasix, Demadex *most effective diuretic - exert their effect in the thick ascending loop of henle -reduce absorption of NA, K, CL, and increase elimination of calcium, magnesium - difficult to concentrate urine (looks like water!)

If calcium is LOW what will be low as well?

Magnesium

Foods high in phosphorous

Meats, cheese, egg yolk, dairy products, nuts

Curricula in nursing programs reflect the :

Mission and Philosophy of the school

Mitral Valve Disorders

Mitral valve stenosis Mitral valve regurgitation Mitral valve prolapse

Holistic Nursing

Nursing the whole person, personality, environment, emotions, spirit

Dependent

Orders written by physicians for implantation by the nurse (meds, x-ray, labs)

Define JCAHO

Organization that provides accreditation for health care organizations Hospitals Outpatient clinics nursing homes

Example of health promotion nursing diagnosis

Readiness for enhanced knowledge

person who encodes and delivers a message

Sender

Potassium and what have inverse relationship?

Sodium

What state agency in South Carolina has the power to issue a nursing license to qualified individuals?

South Carolina Board of Nursing

Implementation

The RN implements the identified plan

Nightingale's Theory

The environment was the focus of nursing care

Assessment

The registered nurse collects comprehensive data pertinent to the patient's health or the situation

What are the components of the therapeutic use of self?

Using one's personality and communication skills to help patients Can be developed by utilizing knowledge and skills Assists in relating effectively with patients/families/peers/ and other health care workers

Responsibilities of Occupational Health Nurses

Usually employed by large companies Provide basic health care services Provide health education/disease prevention Provide health screenings Provide emergency treatment to employees

before meals

ac

compassion

awareness of, concern about other individuals' suffering

BUE

bilateral upper extremities

types of abuses of power

bullying; sexual harassment; improper use of authority; intimidation

When correcting potassium what else do you have to correct?

hypomagneseima

LLQ

left lower quadrant

degree centigrade

oC

liability

state of being legally obliged and responsible.

covert conflict

the conflict is not discussed openly.

Standard of care

the minimum level of care accepted to ensure high quality of patient care

Describe the process of "accreditation" of nursing programs. Why should nursing schools be accredited?

•A voluntary review process of educational programs by a professional organization •Compares the educational quality of the program with standards and criteria •An accredited program voluntarily adheres to standards to protect the quality of education, public safety, and the profession itself

What are the techniques that are helpful in responding to patients and others?

•Be non-judgmental •Observe body language •Be and active listener •Show empathy •Demonstrate caring and compassion •Ask open-ended questions •Give information •Use reflection - method of encouraging patient to think through their problems •Silence can be a helpful response

Describe the preparation and practice of the Licensed Practical/Vocational nurse?

•Practical Nurse - typically lasts 12 months; technical workers; limited scope of practice (Vocational schools, Technical schools, and Community Colleges

School Nurse

•Purpose is to enhance the educational process by improving the well-being of the target population, children and adolescents •Counselors •Responsible for seeing that immunizations are current •Educate parents, children and teachers regarding health related issues •Provide routine and emergency care to children and school employees •Safety/accident prevention is a primary concern •Provide routine screenings

List the 5 major elements that have to be present for communication to take place.

•Sender •Message •Receiver •Feedback •Context or setting

List several reasons why the Associate Degree Nursing programs were popular?

•Shorter duration •Evening hours •Part-time •Low tuition •Accessibility •Graduates can take the RN-NCLEX

Assessment findings in Emphysema

↑ CO2 retention (Pink) Minimal cyanosis Purse lip breathing Dyspnea Minimal cough Hyperresonance orthopneic Barrel chest Exertional dyspnea Prolonged expiratory time Anxious Speak in jerky sentences Thin appearance

Dandelion

↑ Lithium and ↑ Potassium concentration, ≠ diuretics

Garlic

↓ BP, inhibit blood clotting, diabetic drugs pontentiation

Black cohosh

↓ HR, ↓ BP, joint pain

Bloodroot

↓HR, impaired vision, intense thirst

Feverfew

≠ blood clotting mechanisms

Virginia Henderson's Nursing Paradigm

"The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery that he would perform unaided if he had the necessary strength, will or knowledge." Maintaining a supportive environment.

Which publication brought national attention to problems with patient safety and quality in health care?

"To Err is Human: Building a Safer Care System"

Osmosis (passive transport)

"You'll lead" (Water). Osmosis is the passage of fluid from an area of high concentration and less solutes to an area of higher solutes and comparatively less fluid/ water concentration through a semipermeable membrane (allow some solutes to pass thru but not others)

intuition

"gut reaction". Part of nurse's knowledge, experience, expertise for understanding w/out conscious use of reasoning.

nurse manager

"head nurse" - in charge of unit, patient care, improving work environment and flow

Kava

(Long Term) Damage to eyes, skin, liver, spinal cord

Define "team nursing"

(RN is the leader; on who is responsible and delegates to others); Other team members are LPN's and nursing technicians/assistants

Patients Bill of Rights

(Rights and privileges to every hospital patient) 1. Considerate and respectful care 2. Understandable information regarding diagnosis, treatment, and prognosis 3. Know the identity of health care member 4. Know the financial implications 5. Make decisions about the plan of care 6. Advance directive 7. Privacy (conversation and records) 8. Review his or her own records and have it explained =, except when restricted by the law 9. Hospital will make a reasonable response to the request of the patient 10. Ask and be informed of business relationships with the hospitals/educational institutions etc. 11. Consent to or decline in research studies 12. Reasonable continuity of care 13. Informed of hospital policies and practices relative to patient care

What is the Magnet Recognition Program?

- A program of the American Nurses Credentialing Center, which is a subsidiary of ANA. - Recognizes health care organizations that provide nursing excellence - Provides a vehicle for disseminating successful nursing practices and strategies - Recognizes quality patient care - Recognizes innovations in professional nursing practice - Provides consumers with the ultimate benchmark to measure the quality of care that they can expect to receive.

What is the Magnet Recognition program?

- A program of the American Nurses Credentialing Center, which is a subsidiary of ANA. - Recognizes health care organizations that provide nursing excellence - Provides a vehicle for disseminating successful nursing practices and strategies - Recognizes quality patient care - Recognizes innovations in professional nursing practice - Provides consumers with the ultimate benchmark to measure the quality of care that they can expect to receive.

Acute vs. Chronic Illness

- Acute Illness: short term, appear suddenly, subside quickly, may not require medical attention (COPD flare up) - Chronic Illness: usually cannot be cured, develop gradually, require continuous medical attention, may be lifelong (COPD)

Formation of Platelet Plug

- Attracted to injury - Von Willebrand Factor (VWF): excreted and drawn to injury **Liver is key in ability to clot

Purpose of ANA (American nurses Association)

- Broad purpose organization - National student nurses association - Improve health standards and availability of health care for all people. - Foster high standards for nursing - Stimulate and promote the professional development of nurses - Advance the economic and general welfare of nurses

What are the purposes of ANA (American nurses Association)?

- Broad purpose organization - Part of National student nurses association - Improve health standards and availability of health care for all people. - Foster high standards for nursing - Stimulate and promote the professional development of nurses - Advance the economic and general welfare of nurses

Dorthea Orem's definition of nursing

- Captures the self care theory on nursing: - Nursing gives direct assistance to a person, as required, because of the person's specific inabilities in self care resulting from a situation of personal health.

Describe the responsibilities of the following nursing occupation: Telehealth nursing

- Deliver health care to patients through telecommunication technology - Use of computers, interactive video linkages, teleconferencing, transmission of patient's clinical and lab data

What are the benefits of belonging to a professional nursing organization?

- Develop leadership skills - Certification - Research Opportunities - Defining practice standards and redefining policies - Legislative lobbying powers - Publications - Health/Life/Malpractice Insurance - Continuing Education

What are the benefits of belonging to a professional organization?

- Develop leadership skills - Certification - Research Opportunities - Defining practice standards and redefining policies - Legislative lobbying powers - Publications - Health/Life/Malpractice Insurance - Continuing Education

Values

- Freely chosen principles and ideas - Gives meaning and direction to a persons life - Abstract representation of what is right or desirable - Values are developed as a culture, society, and individual change - Assists in making day to day choices and decisions - Nurses need to understand their own value system (first step in self awareness, which is important in maintaining a non judgmental approach)

Signs and Symptoms of Anemia

- Impaired O2 transport - Reduction in Red Cell Indices +/or Hgb levels - S&S of the process causing the Anemia

Martha Roger's definition of nursing

- Includes the nursing process in her definition: - Nursing aims to assist people in achieving their maximum health potential. Maintenance and promotion of health, prevention of disease, nursing diagnosis, intervention, and rehabilitation encompass the scope of nursing goals.

Beliefs

- Intellectual acceptance of something as true and correct - Serves as road-map for critical thinking and decision making - Shown through attitude and behaviors - It is important to know and understand ones beliefs - Need to adopt non-judgmental attitudes - Most recent published set of beliefs called the nursing code of ethics by ANA.

Faith Community Nursing

- Interest in spirituality - Interest in wellness and health promotion - Usually employed by the church - Holistic approach to healing

Statutory law affecting nursing in each state

- Law established through formal legislative processes - Nurse Practice Act: defines the authority of the State Board of Nursing * Defines the practice of nursing * Sets educational qualifications/requirements for licensure * Legal title abbreviations that nurses can use * Provides disciplinary action for licensees

Case Management

- May work for a hospital or outside agency - Ensure that the patient receives the services they need from the entire health care team - Most useful with high costs/high volume/high risk patients - Follow-up @ home - Assess, plan, facilitate, and advocate

culturally competent nurse

- Preforms a cultural assessment - Understands the differences in cultures - Interprets patient's behavior correctly - Planning care recognizing cultural influences - Knowledgeable of various cultures - Understanding of attitudes, beliefs, personal space, medications, and effects on illness

Purpose of SNA (student nursing association)

- Promotes professional growth - Discounts on products - Voice for nursing students - Mentor students - Promote development of skills - Advocate high quality of health care

Morals

- Provides standards of behavior - Established rules of conduct to be used in situations in which a decision about right and wrong must be made - Reflect how individuals or groups behave - Learned over time and are influenced by life experiences - Theories of moral development - Kohlberg

Describe the responsibilities of the following nursing occupation: School nursing

- Purpose is to enhance the educational process by improving the well-being of the target population, children and adolescents - Counselors - Responsible for seeing that immunizations are current - Educate parents, children and teachers regarding health related issues - Provide routine and emergency care to children and school employees - Safety/accident prevention is a primary concern - Provide routine screenings

Challenges of Afro-American Nurses in the late 1800-early -mid 1900

- Racial barriers for education - one black nurse was admitted to the New England Hospital for woman and children (1878) Mary Mahoney - Segregated Nursing Schools - First program exclusively for black women was established at the Atlanta Baptist Female seminary in 1886 (Spelman College) - Racial Barriers for military - In 1847 segregation of black nurses ended.

Personal Value System

- Rank ordering of personal values - Influence the behavior of individuals - Learned beliefs that help people choose among difficult alternatives - Vary among individuals - Enable people to resolve conflicts - Nurse must determine if their value system is ethical - Professional ethics outweigh personal ethics in a professional setting

Creatinine

- Reflects GFR - Freely filtered in glomeruli: not absorbed back into blood, not much secreted back into tubules *EXCELLENT TOOL FOR RENAL FUNCTION

Most Fundamental Human Right

- Respect for others - Valuing every aspect of a person's life - Each individual is unique and equal to others - Foundation to all ethical principles

Describe "moral development."

- Various Theories - Describes how a person deals with moral dilemmas from childhood to adulthood - Kohlbergs theory is utilized in MTC nursing program <9 years: self centered >9 years and adults: conform to expectations of family/groups/society - Independent thinking: defining own moral values (higher intellectual development)

Moral Development

- Various Theories - Describes how a person deals with moral dilemmas from childhood to adulthood - Kohlbergs theory is utilized in MTC nursing program <9 years: self centered >9 years and adults: conform to expectations of family/groups/society - Independent thinking: defining own moral values (higher intellectual development)

What is the significance of critical thinking in nursing

- ability to make sound decisions - good problem solving skills - reflective thinking - looking back - think on your feet - improves pt outcomes - motivated by pts needs - decisions are driven by standards and ethics - honors pt values and beliefs - increases efficiency - need a knowledge base

Urinalysis

- clear, amber-colored fluid - 95% water, 5% dissolved solids - no blood, glucose, or proteins *high specific gravity = dehydration *low specific gravity = dec. renal function (can't concentrate urine)

Pulmonary function tests

- evaluate lung function and breathing problems - Tests include lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance and distribution of ventilation -observe patients for dyspnea or bronchospasm after testing

RBC

- fit through capillaries - live for days 120 then the iron in heme is recycled (key to anemia) - carry O2 and exchange for CO2 - four oxygen to one heme. 16 carrying capacity

glomerulus

- high pressure capillary filtration system: between two arterioles - 2 to 3 times higher than other capillaries - high pressure, b/c 25% co goes through these two arteries: Afferent and Efferent

mitral valve stenosis

- narrowing of hearts mitral valve - can make you tired and short of breathe - main cause rheumatic fever

Assessment of Respiratory postoperative

- patent airway and adequate gas exchange -Monitor SP02 -asses rate, rhythm and depth of breathing -listen to lung sounds, check symmetry and chest wall movement

Purposes of a professional nursing organization

- professional standards of practice - Ethical conduct of members - Ensure high quality - Leadership opportunities - Meet present and future challenges

What are the purposes of a professional nursing organization?

- professional standards of practice - Ethical conduct of members - Ensure high quality - Leadership opportunities - Meet present and future challenges

What are the purposes of the professional nursing organizations?

- professional standards of practice - Ethical conduct of members - Ensure high quality - Leadership opportunities - Meet present and future challenges

Assessment of fluid electrolyte and acid base post operative

- record I&O ( Iv's, vomitus, urine, wound drainage, NG tube drainage) - inspect color, moisture of mucous membranes, turgor/texture/tenting of skin, drainage on dressings, sweat

Magazines

- written for public - contains current "news maker" - will occasionally contain article health/disease related - some magazine health/wellness related

What is the most important statutory law affecting nurses in each state?

-"Nursing practice act" -it defines authority of the state board of Nursing

What is the most important statutory law affecting nurses in each state?

-"Nursing practice act"-defines authority of the state board of Nursing

Describe Kolberg's stages of "moral reasoning"

-<9 years: self-centered ->9 years and adults: conform to expectations of family/groups/society

Where are employment opportunities for community health nurses?

-Ambulatory clinics -Health departments -Hospices -Homes -Clinics

Assessment of skin Postoperative

-Assess incision at least every 8 hours for redness, ↑ warmth, swelling, tenderness or pain and type/amount of drainage *serosanguinous drainage beyond 5 days or ↑ in amount might be dehiscence -impaired wound healing can be caused by infection, distention from edema, paralytic ileus, stress at surgical site or other heath problems

What are 3 functions of the state boards of nursing?

-Authority to administer the nursing practice act -authority to adopt rules to administer the act -authority to deny, suspend, or revoke an license or to otherwise discipline a license or to deny an application for licensure

What are the purposes of the American Nurses Association (ANA)?

-Broad purpose organization, -National Student Nurses Association, -improve health standards and availability of health care for all people, -foster high standards of nursing, -stimulate and promote the professional development of nurses, -advance the economic and general welfare of nurses

ICN (International Council of Nurses) Code of Ethics

-Called the international council of nurses code for nurses - 80+ nations - Respect for the life, dignity, and integrity of all people in a manner that is unmindful of nationality, race, creed, color, age, sex, political affiliation, or social status

Describe the 6 steps that are used in ethical decision making

-Clarify the dilemma -Gather additional data -Identify options -Make a decision -Act upon the decision -Evaluate

Asthma

-Disease of lower respiratory tract -Inflammation triggers asthma when allergens bind to specific antibody molecules - Bronchospasm is a narrowing of the bronchial tubes through constriction of the smooth muscle in bronchial wall.

Corticosteroids (Prednisone)

-MOA: not recommended unless asthma symptoms cannot be controlled w/ any other therapy -S/Es: GI ulceration (take drug w/ food), fat redistribution, weight gain, hyperglycemia, risk for infection d/t reduction of all protective inflammatory responses, blood vessels become fragile (avoid activities that lead to injury)

Corticosteroids (Nedocromil)

-MOA: stabilizes the membranes of mast cells and prevents the release of inflammatory mediators. Prevention of asthma triggered by inflammation or allergens. First-line for prevention of moderate asthma -S/Es: bronchospams, cough, h/a

Acute, life threatening complications of general anesthesia

-Malignant hyperthermia (↑ calcium, ↑ potassium, acidosis) manifested by tachycardia, dysrhythmias, muscle rigidity of jaw & upper chest, HTN, tachypnea, mottling, cyanosis, myoglobinuria. ↑ End tidal CO2, ↓ O2 stat, extremely elevated temp of 111.2° F for Hx of reaction give Dantrotene prior to surgery -Overdose of anesthesia can occur if metabolism and excretion are slower than expected. Can occur in older, renal/hepatic patients. Account for height, weight, medical Hx, liver/kidney Fx. -Unrecognized hypoventilation is caused by failure to exchange adequately and can lead to cardiac arrest, brain damage, and death. Use end tidal CO2 monitor and breathing system to detect any break in breathing circuit. -Intubation complications can include broken, injured teeth, caps, swollen lips, vocal cord trauma. Neck injury. ET tube can cause tracheal irritation and edema (sore throat)

Forced Vital Capacity (FVC)

-Maximum amount of air that can be removed from the lungs during forced expiration

How have "patient rights" affected health care?

-Public wants a say in matters affecting their health care -Guarantees certain rights and privileges to every hospitalized patient

guidelines that should be presented prior to treatment

-The diagnosis or condition that requires treatment -The purposes if treatment -What the patient can expect to feel or experience - the intended benefits of treatment -possible risks or negative outcomes of the treatment -advantages or disadvantages of possible alternatives to treatment (including no treatment).

Assessment of patients history

-Use of tobacco, illicit substances -Current use of drugs -General Health -Medical Hx - Decreased immunity, diabetes, pulmonary, hemodynamic, multisystem disease, coagulation, dehydration, infection, BP -Family Hx -Prior experience w/ anesthesia, reactions? -Blood donation - Autologous donations (give up to q 3 days up until 72 hrs prior), bank? -Type of surgery planned, knowledge & understanding -Allergies- Iodine or shellfish allergy? -Psychosocial -Labs

Comprehensive assessment

-a detailed assessment of patient's physical , psychological, social, cultural, and spiritual needs -moves from the general to the specific

What is the significance of the Nurse Licensure Compact State?

-allows a RN or LPN to have one license (in the state of residency) yet practice in other compact state without an additional license; developed to improve the mobility of nurse

Components of nursing health history

-biographical information -chief concern -patient expectations -present illness -health history -family history -psychosocial history -spiritual health -review of symptoms (ROS)

Assessment of Cardiovascular postoperative

-check vitals and heart sounds -rate, rhythm, quality of apical pulse with peripheral pulses -pulse deficit(difference in apical and peripheral) could mean dysrythmias -compare distal pulses ~ pulsations, color, temp, sensation capillary refill= circulation and perfusion

Describe the 6 steps that are used in ethical decision making

-clarify the dilemma -gather additional data -identify options -make a decision -act upon the decision -evaluate

Sources of diagnostic error

-collecting (disorganization and failure to validate) -interpreting (inaccurate cue interpretation) -clustering (premature or incorrect clustering) -labeling (wrong diagnostic label and failure to seek guidance)

Requirements of effective communication

-courtesy -comfort -connection -confirmation

Family history

-data about immediate and blood relatives -if family is not supportive, do not involve

Steps involved in the diagnostic reasoning process

-data clustering -data interpretation -formulating a nursing diagnostic statement

Assessment of neurologic postoperative

-determine orientation to person, place and time - compare baseline status with post operative status -evaluate motor function by asking patient to move each extremity -evaluate return on SNS by gradually elevating patients head and check for hypotension

What are the benefits of belonging to a professional nursing organization?

-develop leadership skills -certification -research opportunities -defining practice standards and redefining polices -legislative lobbying power -publications -health/life/malpractice insurance -continuing education -discounts -networking with peers

What are the benefits of belonging to a professional nursing organization?

-develop leadership skills -certification -research opportunities -defining practice standards and redefining policies -legislative lobbying power -publications -health/life/malpractice insurance -discontinuing education -discounts -networking with peers

What are the purposes of the American Nurses Association (ANA)?

-develops positions relevant to nursing practice, health policy, and social concerns impacting the health of patients and families -broad purpose organization -NSNA= national student nurses association -state nurses association -improve health standards and availability of health care for all people -foster high standards of nursing practice -stimulate and promote the professional development of nurses through continuing education and certification -political activists -develops and oversees the magnet recognition program for nursing -nursing code of ethics -patient safety -"healthy nurse, healthy nation" program -advance the economic and general welfare of nurses

Spiritual history

-difficult to assess quickly -spiritual dimension represents totality of one's being -rituals and religious practices

Documentation

-enter nursing diagnoses on written plan of care or electronic health information record (EHR) -list nursing diagnoses chronologically -place highest-priority nursing diagnosis first (on original care plan)

What are 3 functions of the state boards of nursing?

-executive authority to administer the nursing practice act -Legislative authority to adopt rules to administer the act -Judicial authority to deny, suspend or revoke a license or to otherwise discipline a licenses or to deny an application for licensure

Asthmatic manisfestations

-expiratory wheeze on auscultation, rapid onset, difficult expiration, non productive cough, chest tightness, ↓ O2 saturation -If wheezing stops it's time to get the crash cart & mechanically ventilate pt b/c wheezing indicated gas exchange - when it stops, the airways are completely shut!!

Chief concern

-gather when you initially set an agenda during patient-centered interview -quotations indicate subjective responses -learn chronological history of patient's health problem

Preventing Pneumonia

-have influenza vaccine -avoid crowded public areas during flu season -clean respiration equipment -avoid indoor pollutants -smoking cessation -eat a healthy and balanced diet -drink 3 liters of nonalcoholic fluids

Good Faith Immunity

-healthcare workers are protected in every state when reporting suspected child abuse in good faith even if subsequent investigation does not make a determination of abuse. -know fed and state laws concerning duty to report -report req info to approp gov agency promptly -comply with rep. laws in good faith -follow agency policy -avoid breach of confidentiality report only mandatory info.

Reducing errors in the diagnostic statement

-identify a patient's response -identify a NANDA-I diagnostic statement from a cluster of symptoms (not just one symptom) -identify a treatable related factor or risk factor rather than a clinical sign or chronic problem that is not treatable through nursing intervention -identify a problem caused by the treatment or diagnostic study rather than the treatment or study itself -identify a patient response to the equipment rather than the equipment itself -identify a patient's problem rather than your problems with nursing care -identify a patient problem rather than a nursing intervention -identify a patient problem rather than the goal of care -make professional rather than prejudicial judgment -avoid legally inadvisable statements -identify the problem and etiology to avoid a circular statement -identify only one patient problem in the diagnostic statement

3 Part nursing diagnosis

-includes NANDA-I label, related factor, and defining characteristics -PES (Problem, Etiology, Symptoms)

Psychosocial history

-information about patient's support system -ways patient typically copes with stress

Patient expectations

-information about treatment and prognosis -can affect patient satisfaction (a standard measure of quality for all hospitals)

evidence based practise is utilized in nursing practice

-injections -hand washing -donning and dogging of PPE -nurse staffing -pressure ulcer prevention -2 step blood pressure check

Orientation and setting an agenda phase

-introduce self -explain purpose -focuses on patient's goals, preferences, and concerns -show professionalism and competence (strengthens nurse-patient relationship)

Define "case management nursing"

-may work for a hospital or outside agency -ensure that the patient receives the services they need from the entire health care team -most useful with high costs/high volume/high risk patients -follow-up @ home -assess plan, facilities, and advocate.

cultural influences on illness behavior

-meanings that are attached to the illness -perceptions of treatment -determines if individual seeks help -predicted or expected behaviors

Interview techniques

-observation (non-verbal communication) -open-ended questions (prompts patient to describe a situation in more than one or two words) -leading questions (most risky; may limit the information provided to what a patient thinks you want to know) -back channeling (active listening prompts; encourages patient to give more detail) -probing (encourages a full description) -direct close-ended questions (limits answer to one or two words; allows nurse to acquire specific information)

Pneumonia risk factors

-older patient -no vaccine -smoking -chronic lung disease -altered level of consciousness -poor nutritional status - immunocompromised status - drugs that increase gastric pH -ventilators

What are the purposes of the National League of Nursing?

-oldest organization for nurses (since 1893) -advances quality nursing education -concerned with quality nursing for all types of nursing programs -pratical nursing -Associates degree nursing -Baccalaureate degree nursing -master degree nursing NLNAC- accredits nursing programs

What are the purposes of the National League of nursing?

-oldest organization for nurses (since 1893) -advances quality nursing education -concerned with quality nursing for all types of nursing programs -main purpose is education

Working phase

-open-ended questions -attentive listening -no rushing patient -initial interview is more extensive -ongoing interviews are less extensive (allows update to patient status)

Phases of an interview

-orientation and setting an agenda -working phase (collecting assessment or nursing health history) -terminating an interview

Sources of data

-patient -family and significant others -health care team -medical records -scientific literature -nurse's experience

List specific strategies that a nurse can use to limit the possibility of legal action

-practice in a safe setting -communicate with other health professionals; open and clear communication- verbal and written -Delegate wisely -meet the standard of care- be technically competent; keep up to date; be aware of peer expectations; participate as an equal on the health care team -carry professional liability insurance -Promote positive interpersonal relationships- best strategy

List specific strategies that a nurse can use to limit the possibility of legal action.

-practice in a safe setting -communicate with other health professionals; open and clear communication -delegate wisely -meet the standards of care- technically competent; keeping up to date; be aware of peer expectations; participate as an equal on the health care team -carry professional liability insurance -promote positive interpersonal relationships- best strategy

Present illness

-present symptoms -use PQRST to guide assessment (Provokes, Quality, Radiate, Severity, Time) -presence of concomitant symptoms (other symptoms experienced along with primary symptom)

What are the purposes of the professional nursing organization?

-professional standards of practice -ethical conduct of members -ensure high quality -leadership opportunities -meet present and future challenges

What are the purposes of the professional nursing organizations?

-professional standards of practice -ethical conduct of members -ensure high quality -leadership opportunities -meet present and future challenges

Describe the functions of the National Student Nurses Association

-promotes professional growth -discounts on products -voice for nursing students -mentor students -promote development of skills -advocate high quality health care

Describe the functions of the National Student Nurses Association

-promotes professional growth -discounts on products -voice for nursing students -mentor students -promote development of skills -advocate high quality health care

nurses role on health care team

-provide care -educate -counselor -manager -researcher -collaborator -change agent -entrepreneur -patient advocate

Define morals

-provide standards of behavior -established rules of conduct to be used in situations in which a decision about right and wrong must be made -reflect how individuals or groups behave -learned over times and are influences by life experiences -theories of moral development- Kohleberg

Purposes of standard, formal, nursing diagnostic statements

-provides a precise definition of a patient's responses to health problems -allows nurses to communicate -distinguishes the nurse's role -helps nurses focus on the scope of nursing practice -fosters the development of nursing knowledge -promotes creation of practice guidelines

Health history

-provides holistic view of a patients health care experiences and current health habits -hospitalizations, medication history, allergies, lifestyle patterns (alcohol, tobacco, caffeine, recreational drugs)

Morals

-provides standards of behavior -established rules in situations in which decision about right and wrong must be made -reflect how individuals or groups behave -theories of moral development- Kohlberg

Data documentation

-recording results of nursing health history and physical examination in a clear, concise manner using appropriate terminology (becomes baseline) -be factual and descriptive

Terminating phase

-summarize your discussion -give a clue to an end

The nature of professional nursing organizations

-support and educate nurses -provide a variety of opportunities for nurse members -influence healthcare policy -Advocate for highest quality care possible to the public

Review of systems (ROS)

-systematic approach for collecting subjective information from patients about the presence or absence of health-related issues in each body system -includes physical examination

Developing the nurse-patient relationship

-taking quality time to be with the patient in order to know them as a person -connecting with patient by showing interest in his/her problems -visiting patient at set intervals (rounding)

Bronchoscopy

-the insertion of a tube in the airways -usually as far as the secondary bronchi, for the purposes of biopsy or culture; diagnose & manage pulmonary disease. -This test is most useful to assist w/ cancer staging and removal of secretions that are not cleared w/ normal suctioning procedures. -patient should be NPO 4 to 8 hrs prior. -Laboratory tests that may be required include a complete blood count (CBC), platelet count, prothrombin time, electrolytes, and chest x-ray. -

who is a culturally competent nurse?

-understands the differences in cultures -interprets patient's behavior -planning care recognizing cultural influences -knowledgeable of various cultures -understanding of attitudes, beliefs, personal space, medications, and effects on illness

Motivational interviewing

-used often in counseling -process that addresses a patient's ambivalence (uncertainties) to medically indicated behavior change and supports patients in making health care decisions

Observation of patient behavior

-verbal and nonverbal -includes level of functioning (physical, developmental, psychological, social)

Concept map

-visual representation that allows you to graphically show the connections among a patient's many health problems -first organize assessment data, then identify specific nursing diagnoses, then plan appropriate nursing interventions

Define ethics

-what actions an individual "should" take -what "should" be done for people to live together -process orientated and require a critical analysis

Modifying a care plan

-when patients do not meet goals and outcomes (identify factors that interfere with their achievement)

Formulating a nursing diagnostic statement

-will include a related factor (identified from patient's assessment data) -use diagnostic label (the name of the nursing diagnosis as approved by NANDA-I) -use the language adopted within an agency

-s

.

1

.

1. A licensed practice nurse (LPN) is working as a staff nurse. What role do the LPNs working as staff nurses play

.

10

.

10. The nurse is caring for a client in a critical care unit. The client's cardiac monitor alarms, and the nurse recognizes the rhythm as atrial flutter. What two skills did the nurse use to interpret this cardiac rhythm

.

10.Establishing the criteria for the education and licensure of nurses is a component of:

.

11

.

2 Steps in nursing assessment

.

6. A nurse manager is developing a program for the unit staff to foster critical thinking. Which activity would the nurse manager implement to promote theoretical knowledge

.

6. The nurse is administering immunizations to a group of teens in a county health clinic. The nurse correctly identifies this action as:

.

7. A nurse is assigned the care of a client who has been admitted to the health care facility with high fever. Which nursing skill should be put into practice at the first contact with the client

.

7. A nurse who is not familiar with using automated intravenous (IV) pumps is moving to a unit that unit that uses them frequently. The nurse is anxious about using the device. What is the most appropriate way for the nurse to lessen this anxiety

.

8. A nurse is caring for a client with a hernia. Which of the following statements should the nurse use while counseling the client about his condition

.

8. An older adult client is being admitted to the hospital for treatment of a fractured hip. Which part of the nursing process would the nurse carry out first

.

9. A registered nurse assigns the task of tracheostomy suctioning of a client to the LPN. The LPN informs the nurse that she has never done the procedure practically on a client. What should be the most appropriate response of the registered nurse

.

9. On a particular 12-hour day shift, the nurse-client ratio on a busy floor is lower than usual because a member of the health care team called in sick for the day. Which example shows this nurse practicing with a good sense of legal competence in response to this challenge

.

________ is a vital part of assessment.

.

What are common types of drug errors made in a hospital setting?

.• Wrong drug/IV • Allergy to drug • Wrong drug for patient's disease • Incorrect administration technique • Wrong diluent (solution that mixes with a powdered drug) • Wrong dose • Excessive dose • Insufficient dose • Wrong concentration • Too-rapid IV flow rate • Omitted drug • Wrong patient • Wrong time • Wrong route • Wrong procedure or test • Violation of orders • Wrong label directions • Wrong preparation

Describe the 6 steps that are used in ethical decision making

1. Clarify the dilemma 2. Gather additional data 3. Identify Options 4. Make a decision 5. Act upon the decision 6. Evaluate

Ethical Decision Making (6 steps)

1. Clarify the dilemma 2. Gather additional data 3. Identify Options 4. Make a decision 5. Act upon the decision 6. Evaluate

Rights and privileges to every hospital patient

1. Considerate and respectful care 2. Understandable information regarding diagnosis, treatment, and prognosis 3. Know the identity of health care member 4. Know the financial implications 5. Make decisions about the plan of care 6. Advance directive 7. Privacy (conversation and records) 8. Review his or her own records and have it explained =, except when restricted by the law 9. Hospital will make a reasonable response to the request of the patient 10. Ask and be informed of business relationships with the hospitals/educational institutions etc. 11. Consent to or decline in research studies 12. Reasonable continuity of care 13. Informed of hospital policies and practices relative to patient care

The 7 steps in the resolution of an ethical dilemma:

1. ask the question is this an ethical dilemma. 2. Gather information relevant to the case. 3. Clarify values, distinguish among fact, opinion, and values 4. Verbalize the problem. A clear simple statement of the dilemma is not always easy but it helps to ensure effectiveness in the final plan and facilitates discussion 5. Identify possible courses of action. 6. Negotiate a plan. Negotiation requires a confidence in one's own point of view and a deep respect for the opinions of others. 7. Evaluate the plan over time.

Hypokalemia

< 3.5 mEq/L • Manifestations: ↓contraction, weak pulse, ECG changes, ↓ Respiratory, ↓ peristalsis/bowel sounds, Digozin levels still in normal range but symptoms of Dig toxicity. • Treatment: Potassium supplements, ↓ broccoli, meats, dried fruits, milk, fish; monitor BP, RR, O2, IV potassium ONLY as K-ryders due to cardiac effects -seen in NPO status, excessive use of of non-potassium sparing diuretics, V/D, Alkalosis= ↑ph

Hypomagnesemia

<1.3 mEq/L • Manifestations: Paresthesias, LOC changes, ↑Deep Tendon Reflexes, muscle spasms, seizures, stridor, ↓motility, N/C, dysrhythmias, death • Treatment: ↑ mag foods, supplements, mag sulfate IV - D, crohn's disease, low intake of magnesium, GI sunctioning, alcoholism, intestinal fistulas

Hyponatremia

<136mEq/L • Manifestations: headache, seizure, confusion/lethargy, N/D, ↓BP with hypovolemia; Normal or ↑BPwith hypervolemia (↑H2O, ↓Na or = Na) • Treatment: Increase food intake with Sodium, Administer NaCl(3% or 2%), Assess BP - seen in NG drainage, N/D, laxative use, H2) IV's, SIADH

Hypophosphatemia

<3.0 mg/dL • Manifestations: Weak pulses, muscle weakness/breakdown, ↓bone density/pain, bruising, disorientation, respiratory failure • Treatment: Oral phosphate, ↓ calcium intake - everything will go back to normal -malnutrition, alcohol withdrawal

Hypocalcemia

<9.0 mg/dL • Manifestations: Muscle spasms/twitch/cramps, laryngeal spasms, numbness/tingling in extremities, ↑ peristalsis, D, ↓clot, arrhythmias, positive Trousseau's and Chvostek's, charlie horse • Treatment: Calcium gluconate/Chl (IV), ↑calcium diet, aluminum hydrox, padded siderails, quite environment, monitor for bleeding *If albumin is low, calcium will be low -seen in Acute pancreatitis, D, Hypoparathyroidism, lack of Vitamin D

Hypercalcemia

>10.5 mg/dL • Manifestations: N/V/C, arrhythmias, ↓ Deep Tendon Reflexes, headache, confusion, flank/bone pain, clots • Treatment: Mobilization, ↓ Vitamin D and Calcium intake, protect cardiac monitoring IV or NA, calcium binders *Causes faster clotting times -Hyperparathyroidism, cancer, immobility, increased vitamin D

Hypernatremia

>145 mEq/L • Manifestations: Tachycardia, BP changes, Altered LOC, S&S of dehydration, flushed skin, firm/poor turgor, thirst/oliguria, lethargy, muscle weakness, deep tendon reflexes absent • Treatment: Restrict sodium, loop diuretics, hypotonic solutions (D5W, .225 or .3 NaCL, .45 NaCl) - seen in cardiac or renal failure, hypertension, excessive IV amounts containing NA

Hyperphosphatemia

>4.5mg/dL • Manifestations: No real changes • Treatment: ↑calcium, limited phosphate in diet, Aluminum hydroxide, dialysis - renal failure, large intake of Vit D, phosphate containing laxatives, chemo

Define concept mapping and how it is used in nursing

A concept map care plan is a diagram of patient problems and interventions. An innovative approach to planning and organizing nursing care

What does certification mean to nursing

A credential that has professional but not legal status A certificate is awarded by a professional group as validation of specific qualifications demonstrated by the RN in a defined area of practice

Describe what "certification" mean to nursing? List some of the certifying organizations in nursing.

A credential that has professional but not legal status. RNC, CPNP, CFNP

How is a health care power of attorney different from a durable power of attorney?

A health care power of attorney is a specific form of durable power of attorney that names an agent only to make health care decisions. A durable power of attorney may or may not allow the agent to make health care decisions. It depends on what the document says. The agent may only be able to make decisions about property and financial matters.

Define "Clinical ladder"

A multi-step program for promotion within the hospital system Need experience Need continuing education Demonstrate clinical competence Pursue formal education Become certified in your are of specialty

Define the Test of Essential Academic Skills (TEAS) and identify the cut score needed to gain entrance into the ADN program

A score of 62 or higher TEAS which measures skills in the content area domains of Reading, Mathematics, Science, and English and Language Usage.

Tuberculin Test (Mantoux)

A small amount (0.1 mL) of purified protein derivative (PPD) is given intradermally in the forearm. An area of induration (not just redness) measuring 10 mm or greater in diameter 48-72 hrs after injection indicates EXPOSURE to and infection w/ TB.

Stress (according to Seyle)

A state manifested by symptoms that arise from coordinated activation of the neuroendocrine and immune systems

acute illness

A sudden illness from which a person is expected to recover

Describe accreditation process of nursing programs

A voluntary review process of educational programs by a professional organization Compares the educational quality of the program with standards and criteria

Example of 3 step problem-focused nursing diagnosis

ACUTE PAIN related to TRAUMA OF SURGICAL INCISION as evidenced by GRIMACING, GUARDING BEHAVIOR, AND PATIENT-REPORTED PAIN OF 8. -"Acute pain" = first step and is NANDA-I approved nursing diagnosis -"trauma of surgical incision" = second step and serves as the related factor -"grimacing, guarding behavior, and patient-reported pain as 8" = third step and serves as the defining characteristics

List groups/organizations of nurses/nurse educators/people who have developed or attempted to develop definitions of nursing

ANA,ARCN,ICN

Battery

Act carried out

Define nursing Diagnosis

Actual or potential problems that the nurse is capable and licensed to treat analysis of the assessment findings not medical diagnosis

Types of Nursing Diagnoses

Actual, Risk, Health promotion, Syndrome, Wellness

What organization was created in 1996 as the national accrediting body for baccalaureate and higher degree programs?

American Association of Colleges of Nursing

What are the prerequisites to the ADN program?

Anatomy 125 Physiology 101 *Chemistry 143 *Anatomy 125 Microbiology 101 *Chemistry 143 3 science courses, psychology, communications, sociology and English. The 3 addition courses an ADN student needs to take to fulfill graduation is an activities class, humanities class, and guidance

Communication-Mexican

Buenos días Good morning Buenas tardes Good afternoon Adiós Good bye Perdone, no hablo español. I am sorry I do not speak Spanish Estamos esperando un intérprete We are waiting for an interpreter. Greetings and Displays of Respect Respect is very important in Latin culture. The way in which a doctor and other health workers greet and address a Latino patient may convey respect or disrespect to the patient. In the medical culture, a greeting may serve more purposes than just a salutation or welcoming. Sometimes the greeting serves the purpose of clarifying the patient's identity for the doctor. This can be an important part of avoiding medical errors - making certain that the chart or medical record belongs to the patient at the appointment, and that the chart does not belong to another patient who has a similar name. For instance, a doctor who greets his patient Julio Perez by saying "Hello Julio" may be using the greeting to confirm that the patient is indeed Julio Perez, and not Jaime Perez or Juan Perez who are two of the doctor's other patients. It may seem appropriate to use only the patient's first name in order to confirm identity. However, greeting the patient by using only his/her first name may convey disrespect for the patient. Greeting Julio Perez by saying Hello Señor Perez conveys respect from the doctor to the patient. A recommendation to doctors for greeting their patients in a manner that conveys respect while still avoiding patient identification errors is to use a title and the full name, such as saying Hello Señor Julio Perez. Then, after correct patient identification is established (when it is found that the person matches the chart in hand), continue addressing the patient in the most respectful manner throughout the encounter, such as saying Señor Perez.

Nursing Licensure

By Exam By Endorsement - endorsed by the other State Boards of Nursing Nurse Licensure Compact - allows an RN to have one license (in the state of residence) yet [ractice in other compact states without an additional license; developed to improve the mobility of nurses

Common Abbreviations

C- degrees centrigrade F- degrees fahrenheit ac- before meals pc- after meals ad lib- freely as desired ADL- activities of daily living bid- twice a day tid- three times a day qid- four times a day C ( with a line above it)- with S (with a line above it)- without c/o- complains of cap-capsule DNR- do not resuscitate Dx or dx- diagnosis H & P- history and physical hs- at bedtime or hour of sleep IM- intramuscular IV- intravenous prn- when required, or as often as necessary subcut- subcutaneous stat- immediately TPR- temperature, pulse and respirations TLC- tender loving care VS-vital signs I&O- intake and output O2- oxygen Po or PO- orally or by mouth

Assessment of the older patient preoperatively

Cardiac - ↓ output, HTN, ↓ circulation, Resp - ↓ lung capacity, elasticity, rigidity, Renal - ↓ blood flow, excretion = toxicity, Neuro - Slower reaction, sensory defects, difficulty adjusting to surroundings, ↑ falls, Skin - ↑ risk of infection, less SUBQ fat, Musculoskeletal - ↑ risk of deformity

Define secondary care

Care received after your primary care physician; assists in preventing complications; home health care; counseling/ therapy

4. A nurse is caring for a young victim of a terrorist attack. During the rehabilitative process, the nurse assists the client in bathing and dressing. The role the nurse is engaged in is

Caregiver

National League of Nursing core values?

Caring, Integrity, Diversity, and Excellence

casuistry

Case based reasoning turns away from conventional principles of ethics as a way to swtermine best actions and focuses instead on an intimate understanding of particular situations.

Surfactant

Chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing

Communication model that enhances the linear communication by enabling the sender and receiver to view perceptions, attitudes, and potential reactions of others via a mental picture

Circular Transaction Model

Mary Ann Bickerdyke

Civil War lay nurse who rallied the soldiers, cleaning up the camps and the soldiers

What is a critical factor in meeting the needs of individuals, families, and communities?

Clear communication

Guidelines for goals

Client centered Broad restatement of problem Time limited Mutual Realistic Patient Will

Guidelines or outcomes

Client centered Specific Measurable Time limited Mutual Realistic

Nursing organizations: Clinical, political, and regulatory missions

Clinical: -Connection to special organization ensures up-to-date clinical practice information -Nursing organizations create wide variety of practice and educational resources Political: international and national organizations support work at the state level Regulatory: -Specialty organizations responsibility is to support regulatory efforts in areas of: *healthcare reform *Professional practice

What is one of the biggest reasons that nursing schools can't expand?

Clinicals not enough space

Circulating nurse

Coordinate, oversee and are involved in the patient's nursing care in the OR.

the enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients

Cultural Competency

The motivation and commitment to caring that moves an individual to learn from others, accept the role as a learner, be open to and accepting of cultural differences, and build on cultural similarities

Cultural Desire

Cross-Cultural interactions that provide opportunities to learn about other cultures and develop effective intercultural communication

Cultural Encounters

Sufficient comparative knowledge of diverse groups, including the values, health beliefs, care practices, world view, and bicultural ecology commonly found within each group

Cultural Knowledge

Ability to assess social, cultural, and biophysical factors that influence patient treatment and care

Cultural Skills

What characteristic is a social determinant of health?

Cultural influences

Care that fits the person's valued life patterns and set of meanings.

Culturally Congruent Care

A product of critical thinking that focuses on problem resolution

Decision Making

What are advanced directives?

Decisions regarding life, death, and health care Examples: -living wills -durable power of attorney -DNARs

Effects of Cortisol in the Immune system

Decreases leukocytes at the site of inflammation or wound Lipolysis (lipid break down) Adipose surrounding face and neck

Normal lung values

Determined by age, gender, and height

14

Develop an awareness of avenues that may enhance nursing school success

5

Develop an awareness of the areas of practice for a registered nurse

Describe the preparation of a Diploma Nurse degree

Diploma nurse is a 3 year program; sponsored by and attached to the hospital setting; highly trained and skilled nurses; enrollment has declined for various reason

What are primary care services?

EMS system, emergency room, health department, doctor's offices

Is there anything I need to know about completing the living will or health care power of attorney form?

Each form contains spaces for you to state your wishes about things like whether you want life support and tube feeding. If you do not put your initials in either blank, tube feeding may be provided, depending upon your condition. Be sure to read the form carefully and follow the instructions.

Edema

Edema occurs with right sided heat failure. The volume of blood increases because the right ventricle is too weak. Blood backs up, venous pressure rises. Excess fluid spills from capillaries into interstitial spaces. ↓H&H and serum protein levels seen. Give loop diuretics, response would be weight loss & lab improvements q 8hrs. Specific gravity less than 1.005. Each 1lb gained after first ½ lb = 500mL H2O.

Define Diagnosis and Treatment

Emphasis is the heaviest Primary focus of the medical community Modern technology has helped

Diagnosis and treatment

Emphasis is the heaviest Primary focus of the medical community Modern technology has helped

Discuss the employment outlook for nursing

Employment will grow much faster, about 22% through the year 2016 Hospital employment will grow more slowly, but outpatient facilities will grow the fastest Home-Health positions are expected to grow the fastest of all Assisted-living and nursing home care is an expected are of high growth Advanced practice nurses can expect to be in higher demand Median annual salary for nurses in 2012 was $64,690 ($44190- $95,130)

Purpose of informed consent

Ensure patient safety. It helps protect the patient from any unwanted procedures and protects the surgeon and the facility from lawsuit claims related to unauthorized surgery or uninformed patients. Written record of informed consent is documented on a "consent form" but can also be documented in the surgeon's notes. The consent form documents the patient's consent and signature for the procedure listed.

Potassium normal range

Expected Range: 3.5-5.0 mmol/L

Calcium normal ranges

Expected Range: 9.0-10.5 mg/dL

Surgeon's Responisbility

Explaining the procedure before sedation is given and before surgery is performed.

His or her views about health and illness and its treatment

Explanatory Model

Other types of preparation

External Degree Program- independent study Articulated Program- RN to BSN; RN to Masters; LPN to ADN

What are some of the common causes of communication breakdown

Failure to see the uniqueness of the individual Failure to recognize levels of meaning Use value statements and cliches Give false reassurance Failure to clarify

What are some of the common causes of communication breakdown?

Failure to see the uniqueness of the individual Failure to recognize levels of meaning Use valve statements and clichés Give false reassurance Failure to clarify

Pre-Op teaching

Fears & anxiety Surgical procedure, pre-op routine (NPO, blood draws) Invasive procedures Coughing, turning, deep breathing Incentive Spirometer - When/how to use, how to tell when used correctly Lower extremity exercises Splinting, stockings, compression devices Early ambulation Pain Management

WWII nursing

Great Depression, Graduated Nurses worked minimum wage in hospitals, Army commissioned its Nurses, Segregation ended, further progress towards professionalism, congress appropriated millions for training nurses

Foods high in magnesium

Green leafy vegetables, nuts, legumes

Why should we define nursing?

HAVING AN ACCEPTED DEFINITION OF NURSING PROVIDES A FRAMEWORK FOR NURSING PRACTICE.

Thiazide

HCTZ, Maxzide - a potassium wasting, work on system to pull fluid but only works on distal tubule so not a lot of action. Least aafective, last minute. First line drug fro hypertension, b/c we don't want it to effect BP drastically - prevent NACL absorption

four major categories of health care services

Health Promotion Illness Prevention Diagnosis and Treatment Rehabilitation and Long Term

Describe the 4 major categories of health care services?

Health promotion Illness prevention Diagnosis and treatment Rehabilitation and long term care

What is a governmental initiative that provided a comprehensive set of national goals and objectives for improving the health of all Americans?

Healthy people 2020

Lobelia

Hearing & vision problems

Common causes of Dehydration

Hemorrhage; Vomiting; Diarrhea; Profuse salivation; Fistulas; Ileostomy; Profuse diaphoresis; Burns; Severe wounds; Long-term nothing-by-mouth (NPO) status; Diuretic therapy; GI suction; Hyperventilation; Renal failure (early phase); Diabetes insipidus; Difficulty swallowing; Impaired thirst; Unconsciousness; Fever; Impaired motor function

Hyperkalemia (potassium, K)

Higher than 5.0 S/S: M: muscle cramps U: urine abnormalities R: resp distress D: decreased cardiac activity E: EKG changes R: reflexes, hyper N/I: Monitor cardiac, pt safety falls risk, stop K infusion, Kayexalate, insulin, calcium gluconate and glucose, hemo-dialysis, AVOID SALT SUBSTITUTES

Nettle

Hypokalemia

Review the Florence Nightingale Pledge

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully, I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.

Florence Nightingale Pledge

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous. and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare or those committed to my care.

common steps in making decisions

ID situation or problem list all possible alternatives & info about situation compare, evaluate pros & cons of each alternative select best option to try put it into action evaluate success

Sister Callista Roy's Nursing Paradigm

Identification of areas where there is not adaption and intervene; helping the patient to adapt. Cognator/regulator; internal and external environment.

Jean Watson's nursing paradigm

Identified CARE as essential nursing knowledge and something to be learned. Understanding the meaning of health for the patient; outcome of holistic care.Creating a healing, holistic, positive environment; nursing is promoting, restoring health, preventing illness

Define Illness Prevention

Identify risk factors, such as family history Assists patients in reducing risk factors Major difference from health promotion is that disease addresses the major problem after the risk factors have been identified

Responsibilities of Community Health Nurses

Improve the overall health of communities by planning and implementing health programs delivering care for individuals with chronic health problems Provide education programs in health maintenance, disease prevention, nutrition and child care Immunization clinics and health screenings and work with teachers, parents, physicians and community leaders toward a healthier community

Neuroendocrine Responses during Stress

Increased communication = between neurological and endocrine systems Cerebral Cortex = cognition and increased alertness Limbic System = emotional center Thalamus = Sorts out sensory input Hypothalamus = coordinates responses from the endocrine system and ANS Pituitary Gland = secretes TSH (goal: secretion of T3 and T4, both of which are necessary for metabolism regulation in every cell of the body) and ACTH (goal: secretion of adrenal hormones) Reticular Activating System (RAS) = increases mental alertness, skeletal muscle tone; responsible for circadian rhythm

Beta 2

Increased hepatic gluconeogenesis, glycogenolysis, and muscular glycogenolysis

evidence based practice

Integration of clinical expertise, best current evidence, and client values to provide high quality services reflecting the interests, values, needs, and choices of the individual patient

The ANA is the professional organization that publishes Nursing's Scope and Standards of Practice. How would you explain the purpose of this population?

Intends to improve health and well-being of people through standards-based nursing practice

Responsibilities of Faith Community Nursing

Interest in spirituality interest in wellness and health promotion Usually employed by the church Holistic approach to healing

ICN definition

International Council of Nurses

One-on-one communication with another person

Interpersonal Communication

Hildegarde Peplau's Theory

Interpersonal Relationships

Factors within both the sender and the receiver that influence communication

Interpersonal Variables

All belong simultaneously to multiple social groups within changing social and political contexts

Intersectionality

Self-Talk

Intrapersonal Communication

Nursing diagnosis

Involves making an educated judgement about the patients condition

How does ones "personal value system" affect nursing practice and how a nurse responds to ethical dilemmas?

It can affect nursing practice by what she believes and it may cause her to not want to do a procedure that is granted. The workplace that she works at may allow abortions but she does not agree so that will cause conflict within the practice. The nurse may respond to an ethical dilemma by not practicing what should be practiced because what they believe/ culture/ or educational level.

4. Which statements about the nursing process are accurate

It is important for providing individualized care to each client. It is an orderly way of solving client problems. It helps to emphasize the client's active role in making decisions.

Discuss benefits and barriers in the nursing profession

It is stable, always learning, good beneifits. and barriers, can be desrespected, doctors can be unprofessional, can make mistakes that can be detramental.

Which organization provides accreditation for health care organizations, such as hospitals?

JCAHO- Joint Commission on the Accreditation of Health Care Organizations

Military Nursing

Job Description Nurses are a part of a special military program called the Nurse Corps. They help care for military personnel and dependents that are in need of medical treatment. They may work in hospitals, clinics or in the field. Responsibilities The responsibilities vary. Their duties include giving medications, charting stats and performing patient assessments. They work with other help-care professionals to assist with the direct care of patients.

Describe the responsibilities of the following nursing occupation: Office-Based nursing

Job Description: 1) Cares for and treats patients in medical office, as directed by physician: Prepares patient for and assists with examinations. 2) Administers injections and medications, dresses wounds and incisions, interprets physician's instructions to patients, assists with emergency and minor surgery, and performs related tasks as directed. 3) Maintains records of vital statistics and other pertinent data of patient. 4) Cleans and sterilizes instruments and equipment, and maintains stock of supplies. 5) May conduct specified laboratory tests. 6) May record and develop electrocardiograms. 7) May act as receptionist, perform secretarial duties, and prepare monthly statements

physical therapist

Job: assess and plan for client to increase musculoskeletal functions, esp of lower extremities, to maintain mobility; direct care of physical therapy assistants Refer to when: ex- following a hip replacement, a client requires assistance learning to ambulate and regain strength

occupational therapist

Job: assess and plan for the client to regain ADLs, esp motor skills of the upper extremities; direct care of occupational therapy assistants Refer to when: ex- client has difficulties using an eating utensil with dominate hand following a stroke

Where should I keep my health care power of attorney or living will?

Keep the original in a safe place where your family members can get it. You also should give a copy to as many of the following people as your are comfortable with: your family members, your doctor, your lawyer, your minister or priest, or your agent. Do not put you only copy o these documents in your safe deposit box.

Hildegarde Peplau's Nursing Paradigm

Knowledge;nursing different from medicine; strong, wouldn't make changes to her book by adding a doctor's name to it. Effect of interpersonal communication/presence, individualized care.

Workplace bullying

Lateral Violence

Efferent

Leads away from the hypothalamus

Advance Directives

Legal documents that indicate the wishes of adult individuals in regards to end of life issues In SC there are 2 advanced directives 1. Health Care Power of Attorney 2. Living Will Other types of advanced directives 1. Organ donation EMS DNR (do not resuscitate) order

Advanced Directives

Legal documents that indicate the wishes of adult individuals in regards to end of life issues In SC there are 2 advanced directives 1. Health Care Power of Attorney 2. Living Will Other types of advanced directives 1. Organ donation EMS DNR (do not resuscitate) order

What are "advance directives?"

Legal documents that indicate the wishes of adult individuals in regards to end of life issues In SC there are 2 advanced directives 1. Health Care Power of Attorney 2. Living Will Other types of advanced directives 1. Organ donation EMS DNR (do not resuscitate) order

competency

Legal presumption that a person can make decisions for him or herself unless proven otherwise.

Hypomagnesemia

Less than 1.3 S/S: leg/foot cramping Tremors Hyperactive, deep tendon reflexes Tetany Cardiac dysrhythmias Difficulty swallowing Constipation N/I: Correct HypoCa Stop loop diuretics, streptomycin, gentamycin Mg sulfate IV Deep tendon reflexes hourly Oral Mg causes diarrhea = increases Mg loss

Hypocalcemia

Less than 9.0 S/S: C: convulsions A: arrhythmia's T: tetany (positive Trosseau/Chvostek sign) S: stridor/spasms N/I: seizure precautions, bleeding precautions, muscle relaxants, aluminum hydroxide and vitamin D increase absorption

Loop of Henle

Like a pipe under your sink (right and left don't matter, think and think does) - Thin side: think like a paper towel (reabsorbs water, not particles) - Thick side: absorbs particles

The founder of public health Nursing in the US was?

Lillian Wald

Ability of an organization and its staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences

Linguistic Competence

Nursing Paradigm

Links person, health, environment/situation, and nursing

Boneset

Liver toxicity, Resp, Mental changes

Diuretics

Loop, Thiazide, Aldosterone antagonists

Purposes of the National League of Nursing

Main Purpose - Education - Oldest organization for nurses since 1893 - Advances quality nursing education - Concerned with quality nursing for all types of nursing programs - NLNAC - accredits nursing programs

What are the purposes of the National League of Nursing?

Main Purpose - Education - Oldest organization for nurses since 1893 - Advances quality nursing education - Concerned with quality nursing for all types of nursing programs - NLNAC - accredits nursing programs

What are the purposes of the National League of Nursing? (NLN)

Main Purpose - Education - Oldest organization for nurses since 1893 - Advances quality nursing education - Concerned with quality nursing for all types of nursing programs - NLNAC - accredits nursing programs

Describe each of these terms and state how each is related to nursing practice: malpractice, negligence, assault and battery, delegation, informed consent, and confidentiality?

Malpractice - Negligence in the profession Negligence - Failure to act as a reasonably prudent person would behave in specific circumstances Assault - Threat; an attempt to make bodily contact with another person without their consent Battery - The act carried out. Delegation - Empower one to act for another Informed Consent - Voluntary; individual must be competent and have the capacity to understand. Patient must be given enough information understand; full knowledge authorization by the patient for care treatment or procedures. Must include the risks benefits, side effects, costs, alternatives (do not need consent if it is life threatening) Confidentiality - Protection of private information HIPPA

Describe each of these terms and state how each is related to nursing practice: Malpractice, Negligence, Assault and Battery, Delegation, Informed consent, and Confidentiality?

Malpractice: negligence in the profession Negligence: failure to act as a reasonable prudent person would behave in specific circumstances Assault: threat, attempt to make bodily contact with another person without their consent Battery: act carried out Delegation: empower one to act for another Informed Consent: voluntarily; individual must be competent and have the capacity to understand; patient must be given enough information to understand; full knowing authorization by the patient for care/treatment/procedures-must include risks/benefits/side effects/costs/alternatives (DO NOT NEED THIS IF LIFE THREATENTING) Confidentiality: protection of private information

More likely to have poor health outcomes and die at an early age because of a complex interaction between individual genetics and behaviors; public and health policy; community and environmental factors; and quality of health care

Marginalize Group

The clinical Nurse leader(CNL) is a nurse prepared at what level and receives what type of degree

Master of science degree

Define Case management Nursing

May work for a hospital or outside agency Ensure that the patient receives the services they need from the entire health care team Most useful with high costs/high volume/high risk patients Follow-up at home Assess, plan,facilitate and advocate

How does an individuals culture influence their illness behavior

Meanings that are attached to the illness Perceptions of treatment Determines if individual seeks help predicted or expected behaviors

How does an individual's culture influence his/her illness behavior?

Meanings that are attached to the illness perceptions of treatment determines if individual seeks help predicted or expected behaviors

ABG's

Measure oxygenation, base excess/deficit, blood ph, PCO2, pO2, O2 saturation - remove oxygen for 20 mins prior to get accurate measure. -monitor VS and gag reflex has returned. Monitor for bleeding, infection or hypoxemia

Foods high in potassium

Meats, fish, dried fruits, milk, vegetables, salt substitutes

A broad term that refers to all factors that influence communication

Metacommunication

Define the Nursing Process

Method used by nursing to solve patient problems

Nursing process (define)

Method used by nursing to solve patient problems

Eustress

Mild, brief, controlled stress (Good Stress)

Side effects Bronchodilators

Most common side effects are cough with mucus, respiratory issues, headache, throat irritation, runny nose, S.O.B., sneezing, stuffy nose, tightness in the chest

Diet and Nutrition-Islamic

Most cultures share the belief that there is a critical relationship between food and health. Food is almost always used as the first line of treatment for some illnesses such as soups for the common cold and some food types are highly valued as preventative and curative for a variety of illnesses. For centuries, many Muslims have maintained a steadfast belief that black seed has medicinal properties that can cure all illnesses if eaten or distilled properly. It is narrated by hadith that the Holy Prophet (AS) said: "Use the black seed because it has a relief of all diseases, but death (A. N. Muhaimin, personal communication, November 28, 2009; Islamic Bulletin, 1999; Al-'Ani, 1985, p. 274)." That belief has spurred Muslim medical scientists and nutritionists to use black seed in a search for cures to such diseases as cancer and respiratory diseases. Muslims are also less likely to drink milk and consume foods that are fortified with vitamin D because of traditional food preferences or lactose intolerance, which increases their risk factor of having vitamin D deficiency. Another highly valued practice related to food is abstinence from oral sustenance, also viewed as having healing properties by Muslims. Although Muslims practice several optional fasts, the most commonly known fast is the obligatory fast of Ramadan, which is mandated in the Holy Qur'an and should be assumed by every able-bodied male and female beginning by puberty, the formal age for adulthood in Islam. However, Muslim children typically begin fasting in solidarity with their families at around seven to nine years of age. The fast of Ramadan requires abstinence from all oral intake from 1 hour before dawn to sunset, unless an illness might be worsened or harm might befall an unborn fetus if a pregnant woman fasts. Women are not permitted to fast while menstruating, but they must make up the missed days during the succeeding year. Although there are many benefits associated with fasting, there are also associated risks. An example provided by Anwar Muhaimin, President of Quba, Inc (Personal communication, November 28, 2009), a Muslim community in Philadelphia, PA was that during a blood drive sponsored by his community in 2006, the hemoglobin level was so low in 20 out of 50 men and women who fasted the month of Ramadan and came to donate blood. Since that time, he recommends that pregnant women who fast are sure about their health before assuming the fast of Ramadan. His advice was essential for their compliance

Technique that holds promise for encouraging patients to share their thoughts, beliefs, fears, and concerns with the aim of changing their behavior

Motivational Interviewing

National Council of State Boards of Nursing (NCSBN)

NCSBN is a not-for-profit organization through which boards of nursing act and counsel together on matters of common interest and concern affecting public safety and welfare, including the development of nursing licensure examinations.

How did the post-World War II influence the definitions of nursing?

NURSING IS A SIGNIFICANT, THERAPEUTIC, INTERPERSONAL PROCESS, NURSING IS AN EDUCATIVE INSTRUMENT THAT AIMS TO PROMOTE FORWARD MOVEMENT OF PERSONALITY IN THE DIRECTION OF CREATIVE

What is the official, professional, accrediting organization for Associate Degree Nursing programs?

National League for Nursing Accreditation Commission (NLNAC)

What is the official professional organization for accrediting nursing programs?

National League for Nursing Accrediting Commission

Examples of infomatics

Navigate an electronic health record, protect confidentiality of protected health information in electronic health records

Betty Neuman's Theory

Neuman Systems Model

NLN Commission for Nursing Education Accreditation (CNEA)

Newly formed (2015) accrediting commission. Accredits all types of nursing programs

Termination

No longer tempted to revert to past behavior Intervention: acknowledge success

What techniques are helpful in responding to patients and others

Non-judgmental Observe body language Be an active listener Show empathy Demonstrate caring and compassion Ask open-ended questions Give information Use reflection- method of encouraging a patient to think through their problems Silence can be a helpful response

Mary Breckenridge

Nurse midwife who founded frontier nursing service

Mary Breckenridge

Nurse midwife who founded the Frontier Nursing Service

Case management nursing

Nurse who oversees patients long term care plans. Patients typically have medical conditions that are chronic or complicated in nature

Key members of the Health Care Team

Nurses Physicians Dietitian Pharmacists Lap Personnel Radiology Personnel Respiratory therapists Social workers Physical Therapists Occupational Therapists Administrative Support- unit secretary

Identify the key members of the interdisciplinary health care team and explain what each one contributes

Nurses physicians dieticians pharmacists lab personnel radiology personnel respiratory therapists social workers physical therapists occupational therapists administrative support- unit secretary

what was WWI's contribution?

Nurses given military rank & authority to care for patients

At the time the nurse practitioner role was introduced :

Nurses in advanced practice roles found it necessary to develop skills in political activism to fight for changes in legislation

What are the benefits of belonging to a professional nursing organization?

Nurses join organizations to network with colleagues, to pursue continuing education and certification opportunities, to stay informed on professional issues, to develop leadership skills, to influence health policy and to work collectively for job security

Madeline Leininger's Nursing Paradigm

Nurses need knowledge of cultural differences and similarities; specialist nurses are needed who can consult on other cultures health beliefs and values. Culture is environment-external and internal.

Evidence based practice utilization in nursing practice

Nurses need to be up-to-date on information and also should be aware of different cultures

Quality improvement

Nurses should be involved in the continual monitoring of patient data to determine areas for process improvement

Safety

Nurses should ensure patient safety by providing patient care in accordance with organizational policies

Evidence-Based practice

Nurses should use evidence-based data in conjunction with patient preferences and values to implement the plan of care

Informatics

Nurses should use technology as available to support the safe implementation of patient care

Teamwork and collaboration

Nurses should work as part of a team to effectively execute the patient-driven plan of care

Describe the responsibilities of nurse managers

Nurses who are in charge of all activities in their units Manage patient care Manage quality improvement Select and evaluate personnel Resource manager Helpful to have a business background

Collaborative

Nursing actions that require shared action by individuals from another discipline

Dorothea Orem's Nursing Paradigm

Nursing does for patients what they can't do for themselves, due to self-care deficits form illness and injury. Evaluates impact of illness/injury on psychological, physical developmental and social needs

ICN definition of nursing

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles

ANA Code of Ethics

Nursing profession informing society of principles/rules by which nurses function More emphasis is placed on patients right ANA Code for Nurses (code of ethics) -respect for human dignity -patients right to privacy -safeuards the patient and the public -Assumes responsibility and accountability -Maintains competence -Good Judgement/clinical decision-making -Professional development -Assists the profession in approving standards of nursing - High quality nursing care -Maintains integrity -Collaborates with other health care team members

Vitals

Obtain a complete set of vitals signs for baseline levels

Dehydration

Occurs when fluid intake/retention is less than what is needed to meet body needs. It results in fluid volume deficit. It can also occur without loss of H2O, whatever shifts from plasma into interstitial. For each degree over 98.6° F, 500 mL is lost. Specific gravity is greater than 1.030 and color is dark amber. Type of replacement prescribed depends on the specific patient. Important to monitor pulse rate, quality, and urine output.

Morals/Ethics

Often used interchangeably=Sometimes difficult to define and distinguish between the two

Which population will grow substantially by 2030 and require nurses to have specialized knowledge of their care?

Older adults

Assessment of Older adult client (F&E)

Older adults are at risk for most electrolyte imbalances as a result of age-related organ changes, especially a reduction of kidney function. Older adults have less total body water than younger adults and therefore are more at risk for fluid imbalances. They are more likely to be taking drugs that affect fluid or electrolyte balance.

Which of the following professional nursing organizations has a primary mission of supporting a clinical nursing role function?

Oncology nursing society

Define Primary Nursing

One nurse is responsible for 24/7 care Provides care of patient form admission to discharge Assesses patients/plans care while on duty- delegates while off duty Usually an all RN staff

Formal and informal system of advantages and disadvantages tied to our memberships in social groups, such as those at work, school, and in families

Oppression

List the three phases of the Nurse-Patient relationship

Orientation phase "getting to know the patient" Working phase "tackle the tasks identified in orientation phase" Termination phase "activities that end the relationship in a therapeutic manner

Describe the three phases of the nurse-patient relationship

Orientation phase- "getting to know the patient" Working phase- "tackle the tasks identified in orientation phase" Termination phase- "activities that end the relationship in a therapeutic manner"

3 phases of nursing relationship

Orientation, working, termination

Neurologic status

Overal mental status, level of conciousness, orientation and ability to follow commands. check for motor and sensory deficits

Following the completion of a basic program for practical nurses, graduates are allowed to take what licensing exam?

PN-NCLEX

expiration (exhalation)

Passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work

What factors influence illness behavior (external)

Past experience culture

Describe the Working phase of a nurse-patient relationship

Patience Self-awareness Maturity

6 different QSEN nursing competencies

Patient centered care, Teamwork & collaboration, evidenced- based practice, quality improvement, safety, Infomatics

Define Primary Care

Patients immediate doctor; where they are entered the first time into the system

High risk health behaviors for the Chinese

Patterns of Health Risks There is little specific data regarding the health status of Chinese-Americans. Prior to 1985, studies suggested a lower risk for death and disease in Asians and Pacific Islanders as a whole. However, newer studies see a trend towards poorer health status for this group in general, especially among those that live in poverty. The myth of the "Model Minority"(that all Asians are affluent and healthy) is misleading, as large segments are living in poverty, lack insurance, and do not access health care. Role of Western Society on Health Status The degree to which immigrants have adopted the culture and behaviors of Western society has impacted their health status in many cases. Comparisons of illness patterns show an increased rate of cancer of the breast, colon, and prostate in Chinese Americans when compared to Chinese living in mainland China and Hong Kong and Singapore. Specific Diseases Depression. Chinese-American women aged 65+ have three times the suicide rate of white women in the U.S. Among women aged 75+, the rate is seven times that of white women. With regard to suicide method, Chinese-American women tend to hang themselves, men tend to use medications. The majority of Chinese suicide victims are foreign born. Chinese-American elders are less likely to communicate the intent to commit suicide. Depression in Chinese-American elders is under-diagnosed and under-treated Alcoholism: drinking in Asians is lower than the national average, but may be underestimated in some groups of immigrants. Chinese-Americans born in the U.S. consume more alcohol than immigrant Chinese Dementia. Vascular dementia is prevalent among Chinese-American elders, possibly more prevalent than Alzheimer's disease in this group Infectious Disease Hepatitis B. There is a higher prevalence of Hepatitis B among Chinese-Americans, and hence, a higher prevalence of Hepatitis B-associated liver cancer. Hepatitis B infection is present in 80% of liver cancer cases Tuberculosis. As a group, Asian and Pacific Islanders have a higher incidence of tuberculosis. In 1990, this incidence was ten times that of the general U.S. population. Cancer. Cancer rates vary with age, acculturation and location. Some of these differences may represent the influence of environment, such as diet and health habits, and therefore may be modifiable. Liver Cancer. Chinese-Americans have highest rate of liver cancer among all U.S. ethnic and racial populations. In the Chinese, it is associated with Hepatitis B. In whites, liver cancer is primarily associated with alcohol. Nasopharyngeal Cancer. Chinese-Americans have the highest rates in the U.S. Rates vary among Chinese living in mainland China, the U.S., Hong Kong and Singapore. Breast Cancer: higher in Chinese-American immigrants than in Chinese living in Asia. Breast cancer is the most commonly diagnosed cancer in Chinese females living in the US. Factors such as the use of estrogens, nulliparity, fewer births, older age of first birth and obesity may be responsible for rate differences in various countries. Chinese women are less likely to receive mammograms than white women. Prostate Cancer. The rate of prostate cancer increases sharply with age, and the rate of prostate cancer among Chinese-Americans is three to five times higher than Chinese living in Asia. Colon Cancer. The variable rates among Chinese living in various countries suggest diet related and other environmental risk factors. The rates are higher among U.S. and Hong Kong Chinese than in mainland China. Lung Cancer. These rates vary widely. The highest rates are in Chinese living in Hong Kong and Singapore, followed by mainland China, and then the US. This probably reflects the rate of smoking in the various areas. Smoking. The rates of smoking in the U.S. as a whole have been declining. The average for U.S. adults is 30%. The rate of smoking in Chinese-American males is estimated at 28%. In some states, the rate of smoking among Chinese-American males is greater than in whites. Chinese-American women currently have low rates of smoking, but are being targeted by tobacco advertising. Smoking among Chinese-American women is greater than in their Asian counterparts Cardiovascular Disease. There is a tendency towards an increasing incidence of cardiovascular disease and hypertension in elderly Chinese-Americans Diabetes Mellitus. There is a trend towards increasing rates Genetic Diseases. Thalassemia and Glucose-6-dehydrogenase deficiency is high in Chinese-Americans.

uninsured

People who are without health insurance coverage

respiratory therapists

Perform therapeutic procedures involving patient respiration

Characteristics of a culturally competent nurse

Performs a cultural assessment Understands the difference in cultures Interprets patients behavior correctly Planning care recognizing cultural influences Knowledgeable of various cultures Understanding of attitudes, beliefs, personal space, medications and effects on illness

Calcium and what have an inverse relationship?

Phosphorous

If calcium is HIGH what will be low?

Phosphorous is LOW

St. John's wort

Photosensititivy, antidepressant

Surgeon

Physician who assumes responsibility for the surgical procedure and any surgical judgments about the patient.

Hildegard Peplau

Pioneer in nursing theory

Unit Secretary

Places physician's orders, answers phone calls, pages other specialists/doctors, and organizes the patient's paperwork

Nursing interventions

Planned strategies based on scientific rationale, devised by the nurse to assist the patient in meeting the patient outcomes

Nursing process step 3

Planning phase

Describe the termination phase of a nurse-patient relationship

Positive and negative feelings Summarize the gains that the patient has made View relationship as an opportunity to grow and change in a positive caring manner

Electrolyte Lab Values

Potassium (K): 3.5-5.0 Magnesium (Mg): 1.3-2.1 Calcium (Ca): 9.0-10.5 Phosphorous (P): 3.0-4.5 Sodium (Na): 136-145

Senna

Potentiation of digoxin

What electrolyte is most abundant in ICF?

Pottasium

Describe the preparation and practice of the Licensed Practical/Vocational nurse?

Practical Nurse - typically lasts 12 months; technical workers; limited scope of practice (Vocational schools, Technical schools, and Community Colleges)

Describe the preparation of a Diploma nurse, Associate Degree Nurse, and the Baccalaureate Degree nurse?

Practical Nurse- Typically lasts 12 months; technical workers; limited scope of practice (vocational schools, technical schools, and community colleges) Diploma Nurse- 3 year program; sponsored by and attached to the hospital; highly training and skilled nurses; enrollment has declined for various reasons Associate Degree Nurse- 2 year program; part of the technical schools and community colleges; began in 1952; very popular for various reasons Baccalaureate Degree Nurse- 4 year program; part of 4 year colleges and universities; BSN programs are needed to provide leadership in administration; public health; and teaching

Professional Responsibilities of Nurses

Practice Nursing under the direction of the standards of Care Quality improvement which includes record review Research- participant Education- preceptor to new nurses Management- head nurses or nurse managers

Responsibility of nurses in military

Practice in peacetime and wartime settings Broader responsibilities and scope of practice than civilian nurses Must have BSN for active duty Travel and change are integral to military nursing, nurses must be flexible All military nurses may be called on for active wartime duty anywhere in the world

Five professional responsibilities of professional nurses

Practice nursing under the direction of standards of care quality improvement which includes record review Research- participant Education- Preceptor to new nurse Management- head nurse or nurse managers

Describe 5 professional responsibilities of professional nurses

Practice nursing under the direction of the Standards of Care Quality improvement which includes record review research- Participant Education- Preceptor to new nurses Management- head nurses or nurse managers

Pregnancy and childbearing practices- Chinese

Pregnancy is considered a normal but also an expected stage for married women. During the early phase of pregnancy, Chinese women are encouraged to take it easy, rest, avoid heavy work, and eat well in order to ensure a healthy pregnancy and subsequently a healthy baby. Even though the Chinese are diverse in their background and country of origin, one traditional belief that has not changed much was the value of a son over a daughter. In Mainland China, the "One Child Only" policy combined with today modern technology have led numbers of expectant mothers to terminate their pregnancy when the fetus is a female. During pregnancy, women are advised to avoid various activities and follow certain food regiments and practices. For example, pregnant women are strongly discouraged from carrying heavy load or engaging in strenuous work during the first trimester for fear of miscarriages. Superstition- It was believed that expectant mothers should avoid using sharp objects, knives or scissors on their bed. Failing to heed this advice can result in cleft lip babies. Women are also not to tape or post any things on the wall of their bed. This could cause unwanted birthmarks on babies' faces. Sexual intercourse is acceptable during the course of pregnancy. However, most couple would abstain during the first trimester for fear of miscarriages. As for food regiments, women are advised not to eat "cold food" such as mung beans, bean sprout, banana or watermelon during the first trimester to reduce a risk of miscarriage. Some Chinese also believe that in order to prevent babies from developing rashes, women were to avoid eating shell seafood such as crabs, shrimps or clams. Some women also supplement herbal drink during the first trimester to safeguard the pregnancy and a different type of herb toward the end of third trimester as a means to get rid of the toxins in the womb, and expectantly, to ensure themselves a healthy baby. As Chinese women living in North America become more acculturated with Western culture, conventional prenatal care with intake of prenatal vitamins are increasingly accepted as a norm. Women will seek OB care, undergo blood draw and comply with routine OB visits. Illegitimate pregnancy (pregnancy outside of marriage) is considered shameful and dishonorable to the families especially to the woman's side. Women do not discuss abortion openly but will seek this medical service when in need. Child Birth Women want to eat to get the energy before going through the labor. Western culture, however, discourages eating for fear a full stomach will induce nausea/vomit especially during active labor phase. This has been a common complaint for Chinese women. Many did not understand why they were not allowed to eat and thought the hospital policy is too strict. When asked for a drink of water, women were offered ice chips instead of warm water that they prefer. Most Chinese women will endure the thirst for fear the cold water from ice chip will upset their internal hot/cold balance and subsequently increase their risk of developing arthritis in old age. Traditionally, men do not play a major role during deliveries. Husband/expectant fathers usually remain outside of labor room till the baby is born. Female family members/relatives such as mother, mother-in-law, aunts or sisters provide much of needed support during this time. This tradition is slowly evolving as extended family members/relatives are not readily available and nuclear families are becoming more prevalent. Younger and more western acculturated couples will want to attend childbirth classes. Expectant fathers are more willing/wanting to stay in labor room with their wives to provide support and serve as labor coaches. Postpartum Practices Chinese women believe strongly in postpartum practices. Caring for oneself immediately after childbirth is very crucial in restoring women's health to pre-pregnant condition. There are wide regimens of self-care and special food intake during postpartum period. A period of care right after the delivery ranging from one to three months is known as the "sitting month". Depending on regional differences, there are variances in regiments and practices associated with sitting month. During the sitting month, women are to abstain from taking a bath, washing their hair, exposing themselves to cold water, cold temperature environment and wind, drinking ice water or eating "cold" food (i.e. uncooked vegetables, salads or fruits). The reasons for these restrictions are based on the beliefs that women are undergoing a cold stage right after the delivery due to loss of blood. In order to restore the energy, women need to consume food that are considered "hot" (i.e. hot water, soups, ginger, wine and food that are high in protein) and avoid exposing themselves to cold air, cold water or wind. Western providers and health care members who are unfamiliar with sitting month have a difficulty time in understanding the Chinese women who just gave birth. In Western culture, cold drinks such as milk, orange juices, ice water and cold food such as salad, cold sandwiches, tomato based sauce dishes and deserts such as Jell-O, fruits and ice cream are routinely offered to women during their inpatient stay. In contrast, for Chinese women these are the types of food that their mothers, women friends and relatives have advised avoiding as much as possible. Women who had Caesarian section would want to avoid not only "cold" food but also beef or seafood. Beef and seafood are believed to prolong the healing process. It is not unusual for hospital staff to find the food served left untouched. Inpatient women preferred to have their food brought in from home. For women who have an episiotomy, nurses will advise women to use ice packs to reduce swelling and inflammation. Young Chinese women who have been exposed to Western culture will heed the advice and adopt the practice. For the majority of Chinese women, however, the practice is considered contradictory to their Chinese health belief. Traditionally, women should avoid using anything cold for fear that cold compress will increase their risk of incontinence, headache, backache and/or arthritis in old age.

American Nurses Association

Premier organization representing the interest of the nation's 3.6 million registered nurses. Advances the nursing profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public. FOREFRONT OF IMPROVING THE QUALITY OF HEALTH CARE FOR ALL

Florence Nightingale

Prepared the environment for the patient to heal. Dependent of good care; vulnerable. Disease as reparative; health prevents disease. She believed the environment needs to change so the body can heal its

Home Health Practices- Islamic

Preservation of life overrides all matters presented in this seminar.•Islam places the onus of practising religionon the individual.•Cleanliness is part of Islamic faith.•Strong emphasis is placed on the virtues of visiting the sick.•Where choice exists, medicines containingalcohol/pork derivates should NOT be used Same sex health professional as the patient whenever possible. Unnecessary touching between non-related people of the opposite sex should be avoided.•For female patients, there is an overriding objective of modesty and privacy. In some cases, a close familymember of the same sex may assist in the washing of the sick person.•A beard is considered a very important religioussymbol to the Muslim male patient. Like any other patient, permission must be obtained to shave any partof the beard, which should be done by a manImpact of Religion and Culture on Accessing and Using Healthcare Muslims are one of the largest and most unique cultures in America, but few healthcare clinicians possess adequate knowledge and experience to interact appropriately with the various aggregate ethnic subgroups that make up Muslim culture. The majority of Muslims descend from generations of people who passed their traditional self-healing practices down to subsequent generations through family and community stories. These stories can provide clinicians with a realistic glimpse into cultural practices that reinforce and strengthen health habits associated with specific ethnic groups within Muslim culture (Ben-David & Amit, 1999, ¶ 7). Though generally thought of in terms of its application to politics and worship, culture of Islam is really a way of living that covers every aspect of a Muslim's daily life including marriage, birth, burial rites at death, health and most social discourse. Western healthcare practitioners often mistakenly limit the culture of the Muslims to the mores of the people from the Arabian Gulf, which will limit their reception and the effectiveness of any treatment options or interventions devised. Cultural beliefs about getting sick, getting better and staying healthy are intertwined and enmeshed with the religion of Islam through language and centuries of social exchange based on the ethnic subcultures and the regions from which the Muslims' originated. For instance, almost all Muslims believe that no practice considered authentic by the majority can ever be erroneous. Healthcare personnel should be cautious about assumptions in providing Muslims care, the most prudent course of action is to start with principles that are common to all Muslims regardless of their ethnicity or country of origin and then build upon those commonly shared values by exploring ethnically specific traditions. Exploring the Shared Values of Muslim Cultural Traditions How Muslims view and seek healthcare can be clustered around several cultural themes, but the one that they refer to most often which confronts healthcare professional who try to intervene in their lifestyle choices is qadr or destiny. When viewed from a Western perspective, qadr is considered fatalistic. However, the Muslim considers this belief a defining idea about the power of man versus the power of God. Through qadr, the Muslim understands that after one has done everything possible, if circumstances do not lead to a desired outcome, then that outcome was not ordained by God who knows best about all things. Such a belief seems contradictory for a people who value education in order to improve and better manage individual and community life. However, for every principle in Muslim culture there is a balancing principle that seeks to establish and reinforce, centrist living and thinking, as the prescription for maintaining health and facilitating healing. For qadr, the balance is individual responsibility to strive to achieve the best possible outcome in all that is undertaken. A saying goes, if you knew you would die tomorrow and intended to plant a tree, plant the tree.

Betty Neuman's Nursing Paradigm

Prevention as intervention; holistic assessment; stabilization of person. Internal and external environments; remove noxious stimuli

Levels of care

Primary Secondary Tertiary

PES

Problem (NANDA) Etiology (cause) Defining characters (AMB)

Hypervolemic

Problem: Increase ECF (extracellular fluid). Causes: Edema forming - CHF, cirrhosis, kidney disease

Hypovolemic

Problem: water loss to lesser amount of Na loss. Causes: Diarrhea, vomiting, diuretic use, sweating

Foods high in Sodium

Processed or preserved foods, canned foods, cured meat, cheese and junk food.

Role of Cortisol in Stress Response

Promotes Glucogenesis in liver Suppresses the immune system Ensures glucose is available

Florence Nightingale's Definition of Nursing

Proper use of fresh air, light, warmth, cleanliness, quiet, and proper selection and administration of diet - All at the least expense of the patient

Advocate

Protecting your patient's human and legal rights and providing assistance in asserting these rights if the need arises (Ie. providing information to help a patient decide whether or not to accept a treatment)

Confidentiality

Protection of private information HIPPA

advocate

Protects patients human & legal rights

Nurses Role on the Health Care Team

Provide Care Educate Counselor Manager Researcher Collaborator Change agent Entrepreneur Patient Advocate

Describe the various roles of the nurse on the health care team

Provide care educate counselor manager researcher collaborator change agent entrepreneur patient advocate

Describe the role of Clinical Nurse Specialists

Provide care in specialty areas, educator; consultant; develop quality assurance procedures

Describe the role of Nurse Midwifes

Provide prenatal and gynecological care to normal, healthy women, deliver babies, and follow up with postpartum care

Define Long term Care

Provides care for individuals who require lengthy assistance

Living will

Provides specific instructions about what medical treatment the client chooses to omit or refuse in the event that the pt is unable to make those decisions.

What are three additional courses an ADN student needs to take to fulfill graduation requirements?

Psychology 101/141 Sociology 101/102/125/154/156 or Anthropology 102 Communications 100, 102, or 110 Activities Humanities Guidance course

What type of well being does a "healthy nurse" address by maintaining healthy work interactions with co-workers?

Psychosocial

Compliance decreases in diseases such as

Pulmonary edema, interstitial and pleural fibrosis, and congenital or traumatic structural abnormalities like kyphosis or fractured ribs

Foods high in Magnesium

Pumpkin / squash seeds roasted Brazil nuts Grains and beans Spinach

Responsibilities of School nursing

Purpose is to enhance the educational process by improving the well-being of the target population, children and adolescents Counselors Responsible for seeing that immunizations are current Education parents, children and teachers regarding health related issues Provide routine and emergency care to children and school employees Safety/accident prevention is a primary concern Provide routine screenings

Sleep-rest

Quality of sleep;energy

What is the definition of beliefs?

REPRESENTS THE INTELLECTUAL ACCEPTANCE OF SOMETHING AS TRUE OR CORRECT.

Define Team Nursing

RN is the leader; who is responsible and delegates to pthers Other team members are LPN's and nursing technicians/assistants

Following the completion of a basic program for registered nurses, graduates are allowed to take what licensing exam?

RN-NCLEX

2 major challenges did African American Nurses face in 1800's-1900's

Racial Barriers for Education and Military Segregated Nursing Schools

HypoNa: Hypovolemia response

Rapid fluid loss Rapid, weak, thready pulse Orthostatic hypo-tension Dizziness

Martha Roger's Nursing Paradigm

Reasons for being here is to care for others. Person-environment as one; universe is our environment; astronaut

patient centered care

Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs.

Brown Report (1948)

Recommended vocational education for practical nurses and recommended that education for RN's be in an institution of higher learning

Various roles of the nurse on the health care team

Record medical history and symptoms, collaborate, advocate, monitor and record, administer medications, operate medical equipment, and perform diagnostic tests

Potassium rich foods

Red tomato sauce White potatoes Citrus fruit, cantaloupe Bananas Meats, Fish

Vessel Spasm

Reduces blood flow, Turns leaky sink off! - Prostaglandin: released from platelets - Serotonin: causes local vasoconstriction - Endothelin: cause local vasoconstriction

motivates one person to communicate with another

Referent

responsibility in nursing

Refers to a willingness to respect one's professional obligation and to follow through. We are held to perform our tasks, as well as oversee those who we delegate tasks to.

Justice

Refers to fairness.

Autonomy

Refers to freedom from external control. Also is an essential element of nursing that involves the initiation of independent nursing interventions without medical orders.

mandatory reporting

Refers to legal requirement to report an act, event or situation that is designated by state or local law as a reportable event

Beneficence

Refers to taking positive actions to help others. This principle is fundamental to the practice of nursing and medicine. The agreement to act with this implies that the best interests of the patient remain more important than your self-interest.

Turning over a subject in the mind and thinking about it seriously

Reflection

Responsibilities of Hospice and Palliative Care nursing

Reflects a holistic philosophy of care Promote and improve the patients quality of life through the relief of suffering along the course of the illness

Conscious Sedation

Reflexes remain intact Patent airway respond to verbal commands

Control Systems

Regulate cellular functions, physical, and physiological adaptation in order to maintain the body's internal environment. Also regulate's life processes and behaviours

Erythropoietin

Regulates the differentiation of red blood cells in bone marrow

Tertiary prevention

Rehabilitation from an illness or injury

What are tertiary care services?

Rehabilitation, trauma centers, hospice

Define Rehabilitation

Rehabilitation: patient meets goals, has milestones

Value-belief

Religious affiliation; spiritual practices; meaning of life

Community-based care for TB

Remind patient that the disease is usually no longer contagious after drugs have been taken for 2 to 3 consecutive weeks and clinical improvement is seen; however, he/she must continue with the prescribed drugs for 6 months or longer as prescribed. Directly observed therapy (DOT), in which the nurse or other HCP watches the patient swallow the drugs, may be indicated in some situations. This contributes to more Tx successes, fewer relapses, and less drug resistance.

17. A registered nurse (RN) and licensed practical nurse (LPN) are administering medications on the neurologic floor. The LPN prepares to administer phenytoin to a client with a history of seizures. The LPN walks into the room and hands the medication to a nursing assistant. The LPN asks the nursing assistant to give the client the medication after completing the client's morning care. What should the registered nurse do

Remind the LPN that it is the LPN's duty to administer the medications.

Belief

Represents the intellectual acceptance of something as true or correct

Nursing profession characteristics

Requires an extended & ongoing education Requires a body of knowledge Provides a specific service Has autonomy Incorporates a code of ethics

Example of Fidelity

Returning to see the patient when you said you would, making sure you keep a routine to help with their pain like you said you would

Why is it important for nursing to have a "code of ethics"?

Rights and responsibilities of nurses related to people, practice, society, co-workers, and the profession.

Example of risk nursing diagnosis

Risk for infection

How is family functioning altered during a member's illness?

Role reversal entire family is affected increases stress/anxiety family disruption anger and guilt financial difficulties confusion values are reassessed priorities are shifted working together may enhanced strengths of individual family members

What is the illness impact on family functioning

Role reversal Entire family if affected increases stress/anxiety family disruption anger and guilt financial difficulties confusion values are reassessed priorities are shifted working together may enhance strengths of individual family members

Sister Callista Roy's Theory

Roy adaptation Model

What state agency in South Carolina has the power to issue a nursing license to qualified individuals?

SC State Board of Nursing

Body shifts into "Fight or Flight" mode Cerebral Cortex-increased attention and arousal Cardiovascular-increased heart rate and rate of contractions Dilated pupils GI(Gastrointestinal)-irritable bowel, decreased digestion Pulmonary-increased respiration Muscular-contraction of skeletal muscle Immune System-suppression Genitourinary-kidneys renin angiotensin Integumentary-decreased blood flow to the skin Endocrine System CNS-increased blood flow to the brain

SNS Stimulation Symptomology

Other jobs of nursing/ student nursing

SR reports, plan, implement, and evaluate/teach

13. Nurses make decisions in their practice every day. Which of the following are potential errors in this decision-making process

Select all that apply. Avoiding information contrary to one's opinion Selecting alternatives to maintain status quo

List the 5 major elements that have to be present for communication to take place.

Sender Message Receiver Feedback Context or setting

What are the five elements of communication that must exist

Sender message receiver feedback context or setting

Positive Feedback System

Senses change and tries to enhance it (like temp in a car

Distress

Severe, uncontrolled stress (Bad Stress)

Signs and Symptoms of the process causing anemia

Severity- Acute vs. Chronic

Sexuality-Reproductive

Sexual functioning; pregnancy and birth experiences

List several reasons why the associate nursing degree programs are popular

Shorter duration Evening hours Part-time Low tuition Accessibility Graduates can take the RN-NCLEX

Recommendations for the Development of Nursing Educational Programs

Should be within the system of higher education Nurses should be highly educated Students should not be used to staff hospitals Standards of nursing practice needed to be established All students need to meet minimum qualifications upon graduation

Which organization has its mission the advancement of global health and improving the health of people world-wide?

Sigma Theta Tau, International

What requires patient identification before surgery?

Site specifics such as right,left or bilateral

Interaction that occurs when a small number of people meet

Small Group Communication

Why is it important for nursing to have a "code of ethics"?

So that they are able to perform and be a caregiver no matter the circumstances even if they do not believe in something they have to follow the rules which is the code of ethics. Ethical codes shape professional self regulation, seeing guidelines to the members of the profession, who then meet their responsibility as trustworthy, qualifies, and accountable caregivers

In the Chinese culture, why should women not have sharp objects in their bed

So they baby is not born with cleft lip/palate

The conditions in which people are born, grow, live, work and age shaped by the distribution of money, power, and resources at global, national, and local levels

Social Determinants of Health

What electrolyte is most abundant in the ECF?

Sodium

Sputum culture for TB

Sputum culture confirms the diagnosis. Enhanced TB cultures and automated mycobacterial cultures require 1-4 weeks to determine a (+) or (-) result. After drugs are started, sputum samples are obtained again to determine therapy effectiveness. Cultures are usually negative after 3 months of Tx.

American Nurses Association Position statement (1965)

Stated that those licensed to practice nursing should be educationally prepared in institutions of higher education

What is the most important statutory law affecting nurses in each state?

Statutory Law: - Law established through formal legislative processes - Nurse Practice Act:

Generalizations that are made about individuals without further assessment

Stereotypes

CRF (Corticotropin Releasing Factor

Stimulates endocrine response Secreted by the hypothalamus Induces the secretion of ACTH from the anterior pituitary gland

Beta 1

Stimulation of lipolysis, increased heart rate, and increased force of contraction

Goldmark Report(1923)

Studied the field of nursing education and recommended minimal education standards

Administration of medications - State board of nursing regulations - 1.A (7)

Subject to the rights of licensed physicians and dentists under their respective medical and dental practice acts, the administration of medications is recognized as the responsibility of a registered nurse or a licensed practical nurse as prescribed by the licensed physician or dentist . After June 30th, 1985 unlicensed nursing personnel shall not administer medications

Who is allowed to administer medication under SC nursing practice act?

Subject to the rights of licensed physicians and dentists under their respective medical and dental practice acts, the administration of medications is recognized as the responsibility of a registered nurse or a licensed practical nurse as prescribed by the licensed physician or dentist . After June 30th, 1985 unlicensed nursing personnel shall not administer medications

Nutritional status

Surgery increases metabolic rate and deletes potassium, vitamin C, and B vitamins. In older adults Indications of poor or nutritional status: brittle nails, muscle wasting, dry or flaky skin, decreased skin turgor, hair changes, orthostatic hypotension, decreased serum protein levels and abnormal electrolyte values.

SNS Endocrine System Immune System Psychoneuroimmunologic Regulation Psychological Neurological

Systems involved in stress

TB

TB is a highly communicable disease caused by M. tuberculosis. The organism is transmitted via aerosolization (airborne route). When a person w/ active TB coughs, laughs, sneezes, whistles, or sings, droplets becomes airborne and may be inhaled by others.

Roles of a nurse

Teach other nurses Hold other nurses accountable for their actions promote policies best practices promoting procedures

History of BCG vaccine

The BCG vaccine contains attenuated tubercle bacilli and is used in many countries to produce increased resistance to TB. Anyone who has received BCG vaccine within the previous 10 years will have a positive skin test that can complicate interpretation. Usually the size of the skin response decreases each year after BCG vaccination. These pts should be evaluated for TB w/ a chest x-ray.

Diagnosis

The RN analyzes the assessment data to determine the diagnoses or issues

Education

The RN attains knowledge and competency that reflects current nursing practice

Collaboration

The RN collaborates with health care consumer, family, and others in the conduct of nursing practice

Communication

The RN communicates effectively in all areas of practice

Quality of practice

The RN contributes to quality nursing practice

Planning

The RN develops a plan that prescribes strategies and alternatives to attain expected outcomes.

Professional practice evaluation

The RN evaluates her or his own nursing practice in relation to professional practice standards, guidelines, relevant statues, rules, and regulations

Evaluation

The RN evaluates progress toward attainment of outcomes

Outcomes Identification

The RN identifies expected outcomes for a plan individualized to the patient or the situation.

Evidence-Based practice & Research

The RN integrates evidence and research findings into practice

Ethics

The RN practices ethics

Environmental health

The RN practices in an environmentally safe and healthy manner

Resources

The RN uses appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible

Leadership

The Rn demonstrates leadership in the professional practice setting and the profession

SC Board of Nursing Position Statement: Assisting with Medication

The SC nurse practice act defines the practice of nursing to include the administration of medications. The admin of meds is defined as "the acts of preparing and giving drugs in accordance with the orders of a licensed physician or dentist as to drugs, dosage, route, and frequency; observing recording and reporting desired effects , untoward reactions and side effects of drug therapy; intervening when emergency care is required as a result of drug therapy.

How are a Health Care Power of Attorney and a Living Will different?

The agent named in a health care power of attorney can make the decisions about your healthcare. A living will only tells the doctor what to do if you are permanently unconscious or if you are terminally ill and close to death. A health care power of attorney is not limited to these situations. A living will affects life support only in certain circumstances. A living will only tells the doctor what to do if you are permanently unconscious or if you are terminally ill and close to death. A health care power of attorney is not limited to these situations. Permanently unconscious means that you are in a persistent vegetative state in which your body functions, but your mind does not. This is different from a coma, because a person in a coma usually wakes up, but a permanently unconscious person does not. A living will can only say what treatment you don't want. In a health care power of attorney you can say what treatment you do want, as well as what you do not want. With a living will, you must decide what should be done in the future, without knowing exactly what the circumstances will be when the decision is put into effect. "With a health care power of attorney, the agent can make decisions when the need arises, and will know what the circumstances are. An Ombudsman as designated by the State Ombudsman, Office of the Governor, 1 must be a witness if you sign a living will when you are in a hospital or nursing home. An Ombudsman does not have to be a witness if you sign a health care power of attorney in a hospital or nursing home.

I want to be allowed to die a natural death and not be kept alive by medical treatment, heroic measures, or artificial means. How can I make sure this happens?

The best way to be sure you are allowed to die a natural death is to sign a health care power of attorney that states the circumstances in which you would not want treatment. In the South Carolina form, you should specify your wishes in items (6) and seven (7). You may not have a person that you can trust to carry out your desire for a natural death. If not, a living will can insure that you are allowed to die a natural death. However, it will only do so if you are permanently unconscious or terminally ill and close to death.

Steady State Conditions

The body automatically attempts to adjust and resist change

Resistance

The body selects the most effective and economic channels of defense

Nursing process

The client's plan of care is created by the nurse using which guideline for nursing practice

Burnout

The condition that occurs when perceived demands out weight perceived resources. State of physical and mental exhaustion.

Constancy

The goal of homeostasis

Airway resistance

The increase in pressure that occurs as the diameter of the airways decreases from mouth/nose to alveoli

Anesthesiologist monitors:

The level of anesthesia (i.e., by using a peripheral nerve stimulator or electroencephalogram [EEG] bispectral analysis) • Cardiopulmonary function (using electrocardiographic [ECG] monitoring, pulse oximetry, end-tidal carbon dioxide monitoring, arterial blood gases [ABGs], and hemodynamic monitoring via arterial lines and/or pulmonary artery catheters) • Capnography (monitors ventilation for non-intubated patients) • Vital signs • Intake and output

In the examples listed below, which nurse is acting to avoid a data collection error?

The nurse assessing the edema in a client's lower leg in unsure of its severity and asks a co-worker to check it with him or her.

Imogene King's Nursing Paradigm

The nursing process is dynamic, emphasis, on communication by nurses to help patients make positive adaptation. Environment provides input to the person, internal and external; conditions to adapt and reach goals.

ANA nursing definition

The protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations

Responsibilities of Informatics Nurses

The science and practice (integrating) nurses, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide)

What is the most important statutory law affecting nurses in each state?

The states nurse practice act (defines and controls nursing)

Hildegard Peplau

Theory of Interpersonal Relations

Martha Roger's Theory

Theory of Unitary Human Beings

Leininger's

Theory of cultural care diversity and universality, social structure.

Imogene King's Theory

Theory of goal attainment

Jean Watson's theory

Theory of transpersonal Caring or Theory of human caring

Specific responses that encourage the expression of feelings and ideas and convey acceptance and respect

Therapeutic Communication

Communication-Chinese

There are seven major groups of Chinese dialects that are differentiated on the basis of phonological features, vocabularies and grammar. The major dialects groups are: Baifanghua (known as Mandarin), Wu, Yue (known as Cantonese), Min, Kejia (known ass Hakka), Xiang, and Gan. Mandarin is the largest dialect group that many native Chinese speak. The non- Mandarin groups are also called the Southern dialects.

Accountability for nurses

To be answerable to ones self and others for ones own actions

Scope and Standards of Practice

To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards-based practice

Describe the responsibilities of the following nursing occupation: Informatics nursing

To prepare, educate and provide technical support to nursing staff when a new computer system is integrated into the healthcare workflow. Nurse informaticists might also work to develop healthcare technology systems by customizing computer programs for best use within their particular healthcare setting. Other nurse informaticists work as liaisons between nursing and information technology (IT) staffs or specialize in nursing informatics research.

Diagnosis and treatment

Traditional goal of medicine; assess symptoms, conduct diagnostic tests, generate formal diagnoses, plan and implement treatment regimens Modern technology allows for refined diagnostic methods

physical therapists

Trained and licensed individuals who help people with muscle, nerve, joint, or bone diseases to overcome their disabilities as much as possible.

In-service education

Training provided by a health care agency or institution. Held in the institutionE and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution. (Ie. Mandatory Ed)

Culture that is universal

Transcultural Nursing

Madeline Leininger's Theory

Transcultural Theory of Diversity and Universality

Describe the preparation of a practical nurse degree

Typically last 12 months; technical workers; limited scope of practice (vocational schools, technical schools and community college)

Describe the preparation and practice of licensed practical/vocational nurse

Typically last 12 months; technical workers; limited scope of practice (vocational schools, technical schools, and community college)

Hypophosphatemia

Under 3.0 S/S: confusion, seizure, memory loss, lethargy, difficulty speaking, weak respiration's, joint stiffness N/I: Oral replacement Na phos/ K phos Vit D, IV P when <1mg assess hand grips, strength, and respiration's

What are the characteristics of a culturally competent nurse?

Understands the differences in cultures interprets patient's behaviors correctly planning care recognizing cultural influences knowledgeable of various cultures understanding of attitudes, beliefs, personal space, medications, and effects on illness

Virginia Henderson's Theory

Unique Needs Theory

Continuing Education

Updates your knowledge about the latest research and practice developments, helps you to specialize in a particular area of practice and teaches you new skills and techniques (Ie. Learning how to use a new hoyer lift)

Name all renal function tests

Urinalysis (UA), BUN (Blood urine nitrogen), Creatine, Glomerular-Filtration Rate

Quality Improvement

Use data to monitor the outcome of care processes and use methods to design and test changes to continuously improve the quality and safety of health care systems

Rationale ex.

Use incentive spirometer 10 x per hour while awake • Helps to aid in gas exchange and prevent alveolar collapse and move secretions to larger airway passages from excretion

Infomatics

Use information and technology to communicate, manage knowledge, mitigate error, and support decision making

Professional behaviors of nurses

Utilizes standard precautions Utilizes professional vocabulary Non-judgmental in acceptance of patients avoids imposing own personal beliefs on others respects patients differing views is competent in care Provides quality nursing care to patient, family, and community is organized plans and sets goals views patients holistically recognizes subtle changes sets priorities with ease effective in time management Takes initiative in resolving conflict situations Aware of and uses available resources Confident eager to try out new skills Enjoys learning and performing in clinical settings participates in professional organization demonstrates pride in role and shares with others demonstrates critical problem-solving skills demonstrates collegiality by sharing with, supporting, assisting and counseling other nurses and nursing students treats others with respect (knocks before entering patients room) Stands up for personal and professional standards- does what is right honest, forthright, and does not participate in gossip or rumor takes responsibility for actions works in partnership with others for the benefit of patient keeps knowledge and skills up to date communicate effectively with a variety of professional an unlicensed personnel

During assessment, a patients clavicles may elevate which can indicate

Ventilatory fatigue, air hunger, or decreased lung expansion

Spoken or written word

Verbal Communication

What are the levels of communication

Verbal- speaking Non-verbal -gestures -clothing -posture -facial expression -tone and volume of voice

Roy

Views the patient as an Adaptive system

Cognitive-Perceptual

Vision;hearing;pain

Physical assessment/clinical manisfestations

Vitals Anxiety Cardiovascular status Respiratory status Kidney function Nuerological status Musculoskeletal status Nutritional status (Older adult) Skin assessment

What vitamin would the muslim culture be lacking

Vitamin D, because of no milk/dairy

What deficiency do they have in their diets?

Vitamin D-lack pork and dairy

Informed Consent

Voluntary; individual must be competent and have the capacity to understand. Patient must be given enough information understand; full knowledge authorization by the patient for care treatment or procedures. Must include the risks benefits, side effects, costs, alternatives (do not need consent if it is life threatening)

Assessment of older adult (F&E) cont'd

Weight loss ½ lb per day is fluid loss. Confusion is common amongst adults and is first indication of fluid imbalance. ECG changes BP, flattened neck veins when raised above heart, tenting, neuro, kidney (output), ↑ RR Edema - Check for bounding pulse, JVD, reduced urine output q 2 hrs, skin.

Define ethics

What actions an individual should take What should be done for people to live together Bible code of ethics (10 commandments) Process orientated and require a critical analysis Bioethics - application of ethical theories and principles to problems in health care Ethical Delimmas Ethical decision-making ANA Nursing Code Of ethics ICN (International Council of Nurses) Code of Ethics

Ethics

What actions an individual should take What should be done for people to live together Bible code of ethics (10 commandments) Process orientated and require a critical analysis Bioethics - application of ethical theories and principles to problems in health care Ethical Delimmas Ethical decision-making ANA Nursing Code Of ethics ICN (International Council of Nurses) Code of Ethics

Alarm Resistance Exhaustion or Recovery

What are the 3 stages of GAS?

what questions do you ask during reflection?

What did or did not work? What could have been done differently to achieve better outcomes? What was done well? What necessary resources were available?

Primary nursing

When a patient is managed for a while 24 hours by one nurse who directs and coordinates other personnel; schedules everything and cares for that specific patient for the remainder of the shift

Adult Health Care Consent

When a patient is unable to give instructions about his/ her care and hasn't used any form of Advance Directive, the law specifies who can make such decisions: 1. Guardian appointed by Probate Court 2. Person given authority by the patient in some other legal way 3. Spouse (unless divorced or legally separated) 4. Parent or adult child of patient 5. Adult sibling, grandparent or adult grandchild of patient 6. Other blood relatives believed to have close personal relationship to patient.

How does one's "personal value system" affect nursing practice and how a nurse responds to ethical dilemmas?

When a situation comes up where your personal values and professional values conflict. In this case the professional values have to out-weight the personal values.

What does "licensure" mean to the nursing graduate?

When the graduate successfully completes the licensing exam, they may legally practice nursing in their own state

Hydrostatic pressure

When the pressure inside a capillary is greater than the pressure in the surrounding interstitial space, fluids and solutes inside the capillary are forced in the interstitial space and vice versa

What is academic renewal? When would be an appropriate time to use it?

When you have received D, F, or NP The student has completed at MJC or another accredited college, since the work to be removed was completed, at least 15 semest​er units with at least a 3.0 GPA, 30 semeste​r units with at least a 2.5 GPA, or 45 semeste​r units with at least a 2.0 GPA.

General-general systemic reaction Adaptation-response to a stressor Syndrome-physical manifestations that coordinate and depend on each other

Why is it called GAS?

Holding area nurse

Work in operating suites that have a presurgical holding area next to the main OR.

Responsibilities of office-based nursing

Work in tandem with physicians, NPs and their patients Performing health assessments Reviewing Medications Drawing blood Giving immunizations Administering medications Providing Health teaching Communicating with patients, families, employers, pharmacists and hospital admissions offices

Describe the process of collaboration and how it is used in the health care setting

Working jointly with other professionals Respect for each ones knowledge and abilities Willingness to work together Supportive organization/workplace A process in which outcomes are positive for all involved The nurse-physician collaboration in the most problematic Collaboration of nurses with unlicensed assistant personnel affects the quality of care to patients; sometimes mutual respect and cooperation is missing

Describe the process of collaboration and how it is used in the health care setting

Working jointly with other professionals Respect for each one's knowledge and abilities Willingness to work together Supportive organization/workplace A process in which outcomes are positive for all involved The nurse-physician collaboration is the most problematic Collaboration of nurses with unlicensed assistive personnel affects the quality of care to patients; sometimes mutual respect and cooperation is missing

Nurse educator

Works primarily in schools of nursing, staff development departments of health care agencies and patient education departments

The way people tend to look out upon the world or universe to form a picture or value stance about life and the world around them

World View

Nursing Journals

Written for nurses - Offer latest information - Research results - Journal for every specialty - usually word "nursing" in the title

Are there forms for living wills and health care powers of attorney in South Carolina?

Yes The South Carolina legislature has approved forms for both a living will and a health care power of attorney. The living will form that the legislature approved is called a Declaration of a Desire for a Natural Death. You may be able to get these forms from the person who gave you this brochure.

YOU HAVE THE RIGHT TO MAKE HEALTH CARE DECISIONS THAT AFFECT YOU

You have the right to make all decisions about the health care you receive. If you do not want certain treatments, you have the right to tell your doctor, either orally or in writing, you do not want them. If you want to refuse treatment, but you do not have someone to name as your agent, you can sign a living will. Most patients can express their wishes to their doctor, but some who are badly injured, unconscious or very ill cannot. People need to know your wishes about health care in case you become unable to speak effectively for yourself. You can express your wishes in a health care power of attorney or living will. In a living will, you tell your doctor that you do not want to receive certain treatment. In a health care power of attorney, you name an agent who will tell the doctor what treatment should or should not be provided. The decision to sign a health care power of attorney or living will is very personal and very important. This pamphlet answers some frequently asked questions about health care powers of attorney and living wills. These documents will be followed only if you are unable, due to illness or injury to make decision for yourself. While you are pregnant, however, these documents will not cause life support to be withheld. If you do not have a living will or health care power of attorney that tells what you want done, you do not know what decisions will be made or who will make them. Decisions may be made by certain relatives designated by South Carolina law, by a person appointed by the court, or by the court itself. The best way to make sure your wishes are followed is to state your wishes .in a health care power of attorney, or sometimes, a living will. If you want to refuse treatment but you do not have someone to name as your agent, you can sign a living will. If you have questions about signing a health care power of attorney or living will, you should talk to your doctor, your minister, priest, rabbi, or other religious counselor, or your attorney. Finally, it is very important that you discuss your feeling about life support with your family. A health care power of attorney also should be discussed with the people you intend to name as your agent and alternate agents to make sure that they are willing to serve. It is also important to make sure that your agents know your wishes.

Who should I appoint as my agent? What if my agent cannot serve?

You should appoint a person you trust and who knows how you feel about health care. You also should name at least one alternate, who will make decisions if you agent is unable or unwilling to make these decisions. You should talk to the people you choose as your agent and alternate agents to be sure they are willing to serve. Also, they should know how you feel about health care.

Which documents should I sign if I want to be treated with all available life-sustaining procedures?

You should sign a Health Care Power of Attorney and not a living will. The South Carolina Health Care Power of Attorney form allows you to say either that you do or that you do not want life sustaining treatment. A living will only allows you to say that you do not want life sustaining procedures.

Describe the responsibilities of the following nursing occupation: Travel nursing

______________ nurses _____________ locally or nationally to work on short-term assignments, and are employed by a travel-nursing agency. Travel-nursing agencies offer qualified nurses to hospitals and clinics to help supplement current nursing staff.

Risk nursing diagnosis

a clinical judgement concerning the vulnerability of an individual, family, group, or community for DEVELOPING an undesirable human response to health conditions/life processes

Collaborating

a cooperative approach; gaining insight to the perspectives of others can lead to creative problem solving.

Nursing process

a critical thinking five-step process that professional nurses use to apply the best available evidence to caregiving and promoting human functions and responses to health and illness; a form of scientific reasoning

Breech of Duty

a deviation from the standard of care owed to the patient.

concept mapping

a diagram of patient problems and interventions. An innovative approach to planning and organizing nursing care.

dietician

a health care professional who has training in nutrition and diet planning

Healthcare advance directive

a legal document executed by an individual that expresses that individuals desires regarding medical treatment that may be used if and when the individual is no longer able to communicate his or her preferences directly.

duty

a legally enforceable obligation to adhere to a particular standard of care.

Chronic disease, such as diabetes, cancer, and heart disease, account for the majority of the deaths in the United States. A chronic disease is:

a long-lasting disease that typically remains with an individual from onset to the end of life and lasts longer than 3 months

social worker

a mental health professional who counsels patients and provides a link between the patient and the treatment center

A philosophy of nursing is like ____

a mission statement

primary nursing

a model of patient care delivery whereby one registered nurse functions autonomously as the patient's main nurse throughout the entire hospital stay

Data clustering

a set of cues; the signs or symptoms gathered during assessment

Data cluster

a set of signs or symptoms that you group together in a logical way

Respiratory Therapist

a specially trained technician who administers, among other treatments, inhalation therapy to patients with lung disease.

Compact State

a state you can nurse in (Licensure by Endorsement) because you passed the NCLEX

Concept mapping

a way to visualize, communicate, brainstorm, problem solve, collaborate, and manage information

what is intellect?

ability to think, understand, and reason. helps to differentiate facts from opinions, approach situations objectively, and clarify concepts.

responsibility

accountability for their actions that includes the obligation to answer for an act done and to repair any injury one may have caused.

concepts related to evidence-based practice

accountability; clinical decision making; health, wellness, & illness; legal issues; professional behaviors; quality improvement

growth and safety promoted by

accurate self-assessment of strength, weakness; acceptance of feedback from others

Battery

act carried out

reflection

action of retrospectively making sense of occurrences, experiences, situations, or decisions & learning from them.

Independent

actions that a nurse is permitted to perform independently

Approaches to teaching and learning in nursing education that are best include those that promote:

active learning

ADL

activities of daily living

Types of nursing diagnosis

actual nursing diagnosis risk wellness

Holistic Nursing

addresses and treats the mind-body-spirit of the patient

integrity

adherence to moral and ethical code

concepts related to managing care

advocacy clinical decision making communication ethics healthcare systems teaching & learning

What main purpose do all professional organizations serve regardless of discipline?

advocate collectively for their members and other constituents.

PC

after meals

Licensure

allows a nurse the legal privilege to practice nursing as defined in the states NPA.

Nurse Licensure Compact

allows an RN to have one license (in the state of residence) yet [ractice in other compact states without an additional license; developed to improve the mobility of nurses

what is creativity?

allows nurse to take what can be seen in mind, make it tangible. finding unique solutions to unique problems when traditional interventions are ineffective.

Clinical Nurse Specialist (CNS)

an APRN who is an expert clinician in a specialized area of practice. The specialty may be identified by a population(geriatrics), a setting (critical care), a disease specialty (diabetes), a type of care (rehabilitation) or a type of problem (pain)

do nursing graduates earn an AS or an AA?

an AS.

Interview

an approach for gathering subjective and objective data from a patient through an organized conversation

evidence-based practice

an approach to the delivery of health care that integrates the best evidence of research studies and patient care data with clinical expertise and patient preferences and values

Compromising

an approach with both parties are partially satisfied; compromising, at the very least, addresses rather than avoids the issue.

competing

an assertive power oriented approach, competing can be seen as self centered or as defending one position on behalf of a patient.

accommodating

an attempt to satisfy the concerns of others as a whole neglecting the self; accommodation works best when one individual or group is less interested in the issue than the other.

A lack of goal achievement can result from ______.

an error in nursing judgement or failure to follow each step of the nursing process

Causation

an injury must have resulted as a direct result of the professionals breach of duty.

Hand-off

an interactive process of passing patient-specific information from one caregiver to another for ensuring patient-centered care and patient safety

chronic illness

an on-going illness, slow or gradual in onset; it has no known cure; it can be controlled and complications prevented with proper treatment

Lab personnel

anybody that works in the lab

Lab personnel

anybody who works in the lab

Define bioethics

application of ethical theories and principles to problems in healthcare

Values

are attitudes, ideals, or beliefs that an individual or group holds and uses to guide behavior

statutory laws

are made by the legislative branches of government, including the U.S. Congress, state legislatures, and city and county governments. (ex. nursing laws)

PRN

as needed

prn

as needed

Kidney function

assess for urinary frequency, dysuria, nocturia, oliguria. Kidney impairment decreases excretion of anesthetics.

tasks that can not be delegated to UAPs

assessment interpreting data making a nursing diagnosis creating a nursing care plan evaluating care effectiveness care of invasive lines admin. parenteral meds inserting NG tubes pt education performing triage giving telephone advice

Components of the nursing process

assessment, nursing diagnosis, planning, implementation, evaluation

18. A nurse and a nursing assistant are caring for a group of adolescents. Which task could the nurse safely delegate to the nursing assistant

assisting an adolescent diagnosed with paraplegia with a meal

Secondary care

assists in preventing complications; treat temporary dysfunction( usually in the hospital or home health care); also includes evaluation of long term and chronic care patients for treatment changes; and providing counseling and therapy that are not available in the primary care setting.

secondary care

assists in preventing complications; treat temporary dysfunction( usually in the hospital or home health care); also includes evaluation of long term and chronic care patients for treatment changes; and providing counseling and therapy that are not available in the primary care setting.

paternalism in pregnancy

assumes that the provider knows best, will make best decisions

The NCLEX-RN examination for registered nurse licensure is the same in every state. The primary purpose of Licensure is to?

assure that a nurse is minimally safe to practice.

The ANA defines healthy sleep as:

at least 7 hours of daily comfortable and restorative sleep

abuse of power

attempt to use one's position or authority to shame, control, demean, humiliate, or denigrate another person to gain emotional, psychologic, or physical advantage

What does ASK mean as related to a nurse's professional identity?

attitude, skills, and knowledge

principles of management

authority; accountability; responsibility; mng resources; enhancing employee performance; mng conflict; mng time

(CCNE)- Commission on Collegiate Nursing Education

autonomous accrediting agency, contributing to the improvement of the public's health

implied consent

based on patients action. (when pt cooperate when taking vital signs are expressing implied consent.)

triage ID priorities for implementing care

based on severity and urgency of pt's condition

pessimism

belief that situation is always bad, may worsen (can be dangerous)

types of unprofessional behaviors

belittling; neg. or disparaging nonverbal messages; constant criticism; elitism about experience, education, or practice area; undermining activities or causing unnecessary disruptions; emotional outbursts

inductive-reasoning

bottom-up approach, nurse observes specific behaviors, symptoms. develops general conclusion by putting together significant specific cues.

when nurse feels conflict between assigned tasks & nurse's beliefs or values

bring conflict to supervisor's attention, discuss reasonably; employer may allow nurse to opt out; nurse should anticipate such conflicts, report them to employer as soon as possible

Purposes of ANA?

broad; focus on political, improvement of working conditions, supporting nurse registration

Cholinergic Antagonists (Ipratropium)

bronchodilation by inhibiting the parasympathetic NS, allowing the sympathetic system to dominate, releasing norepinephrine that activates beta2 receptors. Purpose is for both rescue and prevention asthma. Not as good as SABA but can replace SABA if pts cannot tolerate S/Es of beta2 agonists

symptoms of elder abuse

bruises, lacerations, fractures, open wounds, and untreated injuries in various stages of healing. Dehydration malnutrition, and poor personal hygiene.

developmental stages for toddlers & preschoolers

can't reason out implications of care but need explanations in language they can understand, play therapy to understand healthcare

health literacy

capacity to obtain, communicate, process, understand basic health info and services to make appropriate health decisions

cap

capsule

Side effects Cholinergics

causes mouth dryness and throat irritation - teach pt to drink at least 4 L of fluid daily unless on fluid restriction; blurred vision, eye pain, h/a, nausea, palpitations, tremors, inability to sleep - these are systemic symptoms of overdose that require intervention and that pt should REPORT

Foreseeability

certain events may reasonably be expected to cause specific results.

reflection can

change a situation that is obscure, uncertain, and disturbing into one that is clear, understandable, and settled.

urgency of interventions affected by

change in pt's condition deterioration of pt's health status complexities of pt's condition

humanistic leadership

characterized by emphasis on individuals' dignity, self-worth

schools and educational settings

children with special needs, children who are medically fragile, and children with acute or chronic conditions may require long and short term interprofessional care from nurses, teachers, school administrators or counselors, mental health specialists, physical therapist, occupational therapists, speech/language therapists, physicians and others.

Mary Ann Bickerdyke

civil war lay nurse

Chinese believe that women should avoid sharp objects because of

cleft lip

Concept map

cluster of more than one nursing diagnosis usually top 3 priority nursing diagnosis

once recognized, salient clues can be?

clustered to look for a pattern

clinical judgment

combines critical thinking abilities, evaluative decision making, nursing experience to determine appropriate responses to pt's complex situations.

Identify state requirements to maintain an active practice as a registered nurse

complete 30 hours of education every 2 years including renewala fees

while in nursing school stay long enough at end of shift to

complete work or hand it off properly; facilitate smooth transition between shifts; ensure that work in progress is not left for others to finish; never rush out the door at the end of the shift that might mean leaving a pt, coworker, visitor hanging

Nursing health history

comprehensive history gathered during an initial or early contact with patient

informatics nurse

computers, more like researching the nursing profession/how to improve it as a whole

interpersonal conflict

conflict that occurs between two or more individuals. It can arise from differences in goals or personalities, competition, or concern about territory, control, or loss.

clinical judgement

consists of informed opinions and decisions based on empirical knowledge and experience

Critically anticipate

continuously think about what the data tells you and decide if more data is needed

nurses act as pt advocate by

conveying pt's wishes to members of healthcare team; communicating w/ pt's family; encouraging pt to express his/her wishes

managed care

cost-effective, high-quality care; designed to improve outcomes for groups of pt's; health maintenance organizations(HMOs); prefrerred provider organizations (PPOs),

15. What is a systematic way to form and shape one's thinking

critical thinking

experienced nurses use

critical thinking, experiences, knowledge, skills, current nursing research evidence to make decisions.

When selecting a nursing diagnosis, consider your patient's ________.

cultural diversity. (values, beliefs, health practices, ethnicity, gender)

how do pt's differ

cultural rituals spiritual practices routines of daily living some of pt's individual practices have time constraints

What are the characteristics of a culturally competent nurse

culturally aware, knowledgable, skillful, encountering, desiring

Civil Law

deals with the rights and duties of private individuals or citizens and is most often enforced through law suits.

what can nurses turn to when they do not have enough clinical experience or knowledge, skills, or imagination to make decisions

decision trees, protocols available for many aspects of nursing, models of decision making w/ steps in how to use cognitive process to choose among alternatives.

Deontology

defines actions as right or wrong on the basis of their right making characteristics such as fidelity to promises truthfulness and justice. DOES NOT LOOK AT THE CONSEQUENCES OF THE ACTION

Criminal Law

defines conduct that is harmful to another individual or to society as a whole and that may be punishable by fines or imprisonment.

A nurse interviewed and conducted a physical examination of a patient. Among the assessment data the nurse gathered were an increased respiratory rate, the patient reporting difficulty breathing while lying flat, and pursed-lip breathing. This data set is an example of:

defining characteristics

what does critical thinking involve?

deliberation, nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, evaluating factual and belief-based info.

team nursing

delivery of individualized nursing care to a group of pt's, led by professional nurse

Problem-focused nursing diagnosis

describes a clinical judgement concerning an undesirable human response to a health condition/life process that EXISTS in an individual, family, or community

define "concept mapping care plan" and how is it used in nursing

diagram of patient problems and interventions. Planning and organizing

Muslim religion/culture is related to

diet

What is an example of a preventable health behavior?

dietary habits that include saturated fat intake

generational gap

differences between generations

Continued life support measures that are not viewed by the nurse to be in the best interest of the patient can be a source of:

distress

Prolonged use of the accessory muscle

does NOT promote effective ventilation and causes fatigue

levels of competence reflect 4 progressive changes thinking process

each builds on previous one critical thinking skills mastered, decision making becomes routine

Purposes of National League of Nursing?

education

qualities that affect pt's perception of nursing care

effectiveness: doing the right things. efficiency: doing things right

Delegation

empower one to act for another

Legal issues in nursing

encompass the rights, responsibilities, and scope of nursing practice as defined by state nurse practice acts and nursing practice as defined by state nurse practice acts and as legislated through criminal and civil laws.

debriefing during reflection

encourage reflective learning. Helps transfer book knowledge to practice application in complex situations.

What does "licensure by endorsement" mean?

endorsed by the other State Boards of Nursing

communicator

essential for all nursing roles and activities

Community College Education for Nursing (Montag) (1959

established the validity of the ADN (2 year nursing) program as adequate preparation for nursing practice.

Vietnam War nursing

establishment of medicare/medicaid, era of specialty care, emergence of the Nurse practitioner, rapid influx of medical knowledge and technology.

Pneumonia

excess of fluid in the lungs resulting from an inflammatory process. The inflammation is triggered by many infectious organisms and by inhalation of irritating agents. The inflammation occurs in the interstitial spaces, the alveoli, and often the bronchioles

3 functions of State Board of Nursing?

executive, judicial, legislative

Educator

explaining concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self care activities

Adelaide Nutting

first professor in the nursing world

Mary Adelaide Nutting

first professor of nursing

Peplau's Theory

focuses on interpersonal relations between the nurse, the patient, and the patient's family and developing the nurse-patient relationship

functional nursing method

focuses on jobs to be completed as part of pt-care task-oriented approach requires clearly defined job descriptions procedures, policies, lines of communication

guidelines for successful delegation

follow state nurse practice act & facility's policies & procedures delegate only tasks for which you have both accountability, responsibility follow delegation process & key behaviors for delegating accept delegation only when you clearly understand the task, time frame, reporting requirements, other expectations confront your fears about delegation & recognize which are realistic, which are not

3 discrete steps to accessing healthcare

gaining entry into healthcare system; getting access to sites of care where pt can receive needed services; finding providers w/ whom pt can communicate, develop trusting relationship, have individual needs met

What are the legal and ethical responsibilities involved with the administration of medications?

give drug in accordance to orders: drug, dosage, route, frequency as well as observing recording, and reporting desired effects, untoward reactions, and side effects and intervening when neccesary

mitral vale disorders characteristics

gonna affect left side of the heart- most amount of pressure. most common in women.

From the 1950's through the 1970's, which of the following were most influential in advancing nursing knowledge?

graduate education

what are three additional courses and ADN students needs to take?

guidance Humanities and activities.

underinsured

having inadequate insurance coverage

HOB

head of bed

4 major categories of health care services

health promotion, illness prevention, diagnoses/treatment, rehab/long-term

Mitral valve regurgitation

hearts mitral valve doesn't close tightly, allowing blood flow backward in your heart

Isabel Hampton Robb

helped form the National League of Nursing and the ANA

prioritizing care

helps nurses mng time, establish order for completing responsibilities and care, for a single pt or group of pt's

caregiver

helps patients maintain and regain health

to initiate case mngmnt, specific pt diagnosises selected

high-volume cases (occur frequently) high-cost cases high-risk cases(pt's or case types w/ complications, stay in critical care unit >2 days or need ventilatory support

imminent death urgency level

highest urgency action takes priority over everything else nurse must act immediately to prevent further deterioration, threat to life

Tertiary Care

highly complex care and therapy services from practitioners in a hospital or overnight facility, long term care

H&P

history and physical

case mngrs in other settings

hospital based community based insurance companies, some large employers

Diet and nutrition for the Chinese

http://ethnomed.org/clinical/nutrition/chinese_food_cultural_profile

illness prevention

identification of risk factors such as a family history of hypertension or diabetes and assisting of clients to reduce the effects of risk factors on their health.

What is the purpose of having a "registry in North Carolina (1903)?

identify nurses who had been trained

Planning

identifying goals for your patient

Platelets

if you have a low count of this then, it will cause anemia * help body form clots to stop bleeding

Majority of funding in hospitals is spent on

illness, treatment, diagnosis

STAT

immediately

stat

immediately

Actual nursing diagnosis

impaired skin integrity, injury on leg, losing weight

consent in emergency

in most states, the law assumes an individuals consent to medical treatment when the individual is in imminent danger of loss of life or limb and enable to give informed consent.

what can result from infrequent assessments

inaccurate or incomplete data in shift report

incivility in workplace

incivility or disruptive behavior in the workplace can play out in many forms including: aggression, bullying, and violence.

privacy

includes the right of individuals to keep their personal information from being disclosed. it's up to individual when, where, and whom knows info.

what happens when you have frequent absences

increases workload; stresses other employees; decrease productivity; create delays & inconveniences for coworkers; create potential for delaying pt's diagnosis, treatment, or discharge; create potential for late delivery of supplies if paperwork not filed on time; coworkers may have to work overtime to compensate for delays

high-quality healthcare beyond reach of many because

individuals who work for small employers; unemployed; underemployed; self-employed; poor; members of underserved minorities

disclosing information

information obtained from the pt should be disclosed only to individuals who are directly involved in providing that patients healthcare.

Cue

information that you obtain through use of the senses

20. A client is scheduled to undergo an exploratory laparoscopy. The registered nurse (RN) asks the licensed practical nurse (LPN) to prepare the client for surgery. The RN must confirm that the LPN has specialized training before delegating which task

initiating I.V. therapy, as ordered

I&O

intake and output

what skills are needed for critical thinking?

intellect, creativity, inquiry, reasoning, reflection, and intuition.

ID

intradermal

IM

intramuscular

IV

intravenous

14. An experienced ICU nurse is mentoring a student. The nurse tells the student, "I think something is going wrong with your patient." What type of clinical decision making is the experienced nurse demonstrating

intuitive thinking

tertiary care

involves complicated diagnostic or therapeutic procedures

information exchange

involves planned communication, but decision making is unilateral, involving little if any collegiality.

Tort

is a civil wrong committed against an individual or an individuals property. (can be intentional or unintentional.

It is the position of the SC Board of Nursing that administration of medication

is a critical nursing function based on the understanding of pharmacotherapeutics, biochemistry, and pathophysiology. In settings where nurses are employed to provide nursing care to clients, the regulations preclude the licensed nurse from delegating administration of medications to unlicensed assistive personnel.

Patient Self-Determination Act

is a federal law requiring healthcare institutions that receive federal funding to do following: 1. at time of admission give patients a written summary of healthcare decision mkkng rights. 2. the facilities policies with respect to recognizing ADs. 3. ask pts whether they have an AD and document the ADs existence in the medical record. 4. educate staff and community about ADs. 5. ensure that the individuals know that the facility never discriminates on the basis of whether or not the o.j individual has an AD.

controlled substances act (CSA)

is a federal law that requires drugs to be classified an the basis of the substances medical use, potential for abuse, and safety risks.

Credentialing

is a formal identification of professionals who meet predetermined standards of professional skill or competence.

workplace bullying

is a longterm behavior lasting a minimum of 6 months and plays out in form of verbal attacks, refusal to help or assist others, speaking nagatively or taunting.

nurse practice act (NPA)

is a series of state statues that define the scope of practice, standards for education programs, licensure requirements, and grounds for disciplinary actions.

mindsight

is a term that describes being self aware of ones triggers to stress that can result in conflict, and purposefully "retraining" the brain to respond differently.

crime

is an act prohibited by statue or by common law principles. (usually considered against state than individual).

incident report

is an agency record of an accident or incident that occurred within the agency. designated to collect adequate info to assist personnel in preventing future incidents or occurrences.

Negligence

is conduct that deviates from what a reasonable person would do in a particular circumstance.

Evaluation

is crucial to deciding whether a patients condition or well being improves after interventions have been implemented. Evaluations determine if expected outcomes are met not if nursing interventions were completed.

collaboration

is defined as two or more individuals working toward a common goal by combining their skills, knowledge, and resources while avoiding duplication of effort.

interorganizational conflict

is most commonly considered to involve competition between two organizations that exist within one market.

verbal abuse

is professional settings Is defined as malicious, repeated, harmful mistreatment of an individual with whom one works, regardless of whether that individual is an equal, a superior, or a subordinate.

questions to consider before delegating

is task w/in scope of practice?, have pt's needs been assessed?, is task consistent w/ recommended criteria for delegation?, does delegation have appropriate training, skills, knowledge to perform the task safely using current standards of practice?, are organizational policies, procedures, protocols available for the task?, is adequate supervision available?

Assault

is the action of creating an apprehension of offensive, insulting, or physically injurious touching. can occur without individual being touched.

whistleblowing

is the disclosure of an employer's unsafe or illegal practices and/or policies by an employee. one who reports such practices is called a whistleblower.

Medical Diagnosis

is the identification of a disease process or condition based on an evaluation of physical signs, symptoms, history and diagnostic tests and procedures.

questions to consider in choosing between alternatives

is there always just "one best alternative? can consideration always be given to every alternative? is there always time to gather info about all alternatives & consequences, think about them one at a time?

The advantage to concept mapping

its central focus is on a patient rather than the disease or health alteration

Physical effects of liver disease

jaundice, vomiting, lower back pain

Organization that provides accreditation for health care organizations such as hospitals

joint commission

In chinese culture, young people don't like to tell old people about illness because

karma

when talking about accountability the nurse must

learn to operate new equipment before it is put in general use; maintain evidence-based practice that is current on latest findings; seek help from peers, mentors, instructors to learn new skills, techniques

clinical reasoning

learned skill that novice nurses must practice. ability to reflect on previous situations and decisions, evaluate their effectiveness.

LLE

left lower extremity

LUE

left upper extremity

LUQ

left upper quadrant

key components of nurse's commitment to behaving professionally

looking and acting like a professional; acting autonomously; demonstrating commitment to nursing

Communicator

making sure everyone understands what is going on, that everyone is on the same page

acute urgency level

med. priority low potential for pt's condition to become life threatening if interventions not completed in short time interventions can be scheduled when time constraints of higher-priority interventions allow

critical urgency level

med.-high urgency urgent need to respond to physical or psychologic problems in short amount of time potential for pt's condition to become life threatening if intervention delayed quick recognition, rapid response required to prevent worsening of problem

Accredited Nursing Programs have demonstrated to external accrediting organizations that they:

meet professional nursing education standards

query

merely a question.

Nursing Process

method used by nurses to plan and deliver nursing care to the resident

define the "nursing process"

method used by nursing to solve patient problems

mL

milliliter

causes of conflict

miscommunication, inaccurate information, mistrust, ambiguous role expectations, ineffective leadership, and resistance to change.

in healthcare basis for organizing formed by

mission, formal organizational structures, delivery systems, job descriptions, skill mix, staffing patterns

key features for collaboration

mutual respect, trust, effective communication skills, giving and receiving feedback, decision making, and conflict management.

developmental stages of infants

need to be comforted, feel secure throughout process

malpractice

negligence of a nursing professional

Do BSN and ADN students take a different NCLEX?

no

is intuition recommended for new nurses or nursing students?

no because, usually lack of knowledge base and clinical experience on which to make valid judgement.

Precontemplation

no intention of changing behavior Intervention: increase awareness

Civil War Nursing

no organized system to care for the sick; lay nurses (who were not formally educated) provided care for military personnel; nursing consisted of feeding, bathing, fixing bandages, sewing, sweeping; no support from physicians. Led to the 1st training schools for Nursing

urgency levels

nonacute: low urgency factor acute: medium priority critical Imminent death

obstacles to delegation

nonsupportive environment; delegator insecurity; an unwilling delegate

appearance is a form of

nonverbal communication, evokes response from others

NPO

nothing by mouth (nil per os)

4 features of tanner's clinical judgment model

noticing interpreting responding reflecting

Unintentional assessment

noticing cues that are important without planning to do so

5 stages of progression

novice; advanced beginner; competent; proficient; expert

Intermediate care

nurse may be responsible for 3 or more patients

Mary Breckenridge

nurse midwife who founded the Frontier Nursing Service

Most important statutory law affecting nurses in each state?

nurse practice act (have license)

Interdisciplinary health care team

nurses are advocates for patients, report to pharmacists, social workers, respiratory therapists

advocating for confidentiality

nurses are professionally obligated not only to avoid participating in discussions of patients outside communications directly related to providing care but also curb others from participation.

time is a considered factor

nurses have only limited time to mkae clinical judgments, perform interventions. multiple objectives to be completed during shift. time mngmnt helps nurse ensure that necessary activities are complete.

Pitfalls of prioritization

nurses may not know all pitfalls prioritizing w/out assessment poor time mngmnt not involving pt's in their care inappropriate delegation doing the easiest task first

Implementation

nursing actions or interventions to meet the goals

ANA's definition of nursing

nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering throughout the diagnosis and treatment of Human Response, and advocacy in the care of individuals

WWI nursing

nursing recruiting effort to recruit young women into Nursing Schools, Advocated Collegiate schools of Nursing rather than hospital based, Army Nursing School created, nurses gained military rank.

Objective data

observations or measurements of a patients health status

helpful assessment data before taking taking action

observe for cues about pace, emotions of staff already working on unit. after getting info from shift report, making quick safety check of pt's. become aware of any pt's at risk. ask about complexity of pt problems. ask about special safety concerns for pt's. note routine responsibilities & interventions that have time constraints. know how many & what level of nursing staff available for task delegation. note presence of necessary resources on unit. ask about pt preferences.

parallel functioning

occurs when communication may be more coordinated, but each professional has separate interventions and a separate plan of care.

Conflict

occurs when diverse interests about significant issues or concerns among individuals, groups, or organizations prevents progressive problem solving or when emotional opposition creates discord and stifles effective communication.

parallel communication

occurs when each professional communicates with the patient independently and asks the same or similar questions.

mutual respect

occurs when two or more individuals show or feel honor or esteem toward one another.

intrapersonal conflict

occurs within individual, is stress or tension that results from real or perceived pressure generated by incompatible expectations or goals.

HIPPA (Health Insurance Portability and Accountability Act)

of 1996 was enacted by Congress to minimize the exclusion of preexisting conditions as a barrier to healthcare insurance, designate special rights for individuals who lose other health coverage, and eliminate medical underwriting in group plans. includes privacy rule which creates national standard for disclosure of private health information.

mutual recognition model

of the nurse licensure allows a nurse to have a single license that confers the privilege to practice in other states that are part of the nurse licensure compact.

The Nightingale School of Nursing at St.Thomas Hospital differed chiefly from earlier forms of nursing education because it:

offered a set of curriculum that, coupled with classes in theory, with clinical experiences

different generational styles can lead to what workplace conflicts

older nurses may consider younger nurses arrogant, lacking commitment, having "slacker" attitude, unprofessional in appearance. Younger nurses may see selves as self-reliant, not arrogant and see older nurses as unwilling to become technologically competent.

emanicipated minor

one who is no longer under parental control and manages his or her own financial affairs

Throughout antiquity, prior to the modern era, the safest nursing care was provided in:

one's own home by one's relative

Diet and nutrition

ood is often used to cure illness as will be discussed later (Gonzalez-Swafford). Here we list some foods as they are categorized for healing. Cold Foods Hot Foods Beans Aromatic Beverages Corn products Chili Dairy products Expensive Meats (beef, water fowl, fish, mutton) Citrus Wheat products Tropical Fruits Inexpensive Meats (goat, chicken, rabbit)

ability to set priorities is a critical thinking skill

optimize nurse's time & productivity bu categorizing tasks in order based on significance and urgency

North American Nursing Diagnosis Association International (NANDA-I)

organization developing standard, formal, nursing diagnostic statements

contingency plan helps

organization prepare for unplanned events

What should be the most important factor to consider when deciding which professional organization to join?

organizational mission and your career objectives

key elements of case mngmnt

organizes pt care by diagnosis-related groups collaboration of all members of healthcare team ID of expected pt outcomes w/in specific time frame use of principles of continuous quality improvement, variance analysis promotion of professional practice promotion of cost-effective care successful in disability mngmnt home care, ambulatory setting conductive to case mngmnt

strategic planning describes

overall purpose, desired results of organization & describes how results will be achieved

external influences

past experiences and culture

Primary care

patient first enters the health care system( doctor's office; EMS system; emergency room; health department ; clinics; etc); also includes emergency care; health maintenance; long term and chronic care; and treatment of temporary dysfunction.

skilled nursing, rehabilitation, and long term care

patients admitted to these facilities often require care from multiple disciplines, including nursing; medical, physical, occupational, speech/language, or respiratory therapy; social services; and mental health or psychiatric services .

team nursing

pattern in which nursing personnel divide the clients into groups and complete their care together

radiology therapist

perform diagnostic imaging and other tech responsibilities

PPE

personal protective equipment

What factors influence illness behaviors

personality, chronic pain, family influences, cultural inflluences

Data included under assessment

physical exams, patients health history, obtaining patients family history, general observation, patient interaction is most critical here

Wellness Dimensions

physical, emotional, intellectual, social, spiritual and environment

elder mistreatment types

physical, emotional, verbal, and sexual. also include: neglect and financial abuse

1st level in Maslow's hierarchy of needs

physiological needs things needed for survival

Hildegard Peplau

pioneer in nursing theory

Concern of the lack of nursing representation on health;thcare governing boards led ANA and several other organizations to propose which initiative?

placing 10,000 additional nurses on boards by 2020

setting priorities include

planning a day in advance determining which activities must be completed at expected time.

Renin-Angiotensin-Aldosterone Mechanism (RAAS)

plays important role in regulation of blood pressure

Wellness nursing diagnosis

potential for enhanced coping

advocacy

practice of expressing, defending pt's needs

Phase 1 of planning

prioritization ABCs first client needs and values mallow's hierarchy of needs

Planning

prioritization of nursing diagnoses, formulation of goals/outcomes, and selection of nursing interventions ABCs

Ventilation

process of moving gases into and out of the lungs

formation

process that facilitates transformation from layperson to professional nurse

How does one's "personal value system" affect nursing practice?

professional ethics outweigh personal ethics in a professional setting.

elder care centers and services

programs such as programs of All-inclusive care for the elderly (PACE) offers services for older adults on an inpatient or outpatient basis as appropriate. services include: medically necessary services, respite care for caregivers, transportation to medical or social services appt, and mental health care.

Quality improvement

promote quality, procedures, and policies

The National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA)

promotes excellence and integrity in nursing education globally through an accreditation process that respects the diversity of program mission, curricula, students, and faculty; emphasizes a culture of continuous quality improvement; and influences the preparation of a caring and competent nursing workforce

National League for Nursing (NLN)

promotes excellence in nursing education to build a strong and diverse nursing workforce to advance health of our nation and the global community

16. Which of the following interpersonal skills is essential to the practice of nursing

promoting the dignity and respect of patients and people

Utilitarianism

proposes that the value of something is determined by its usefulness. MAIN EMPHESIS LOOKS AT THE OUTCOME

Confidentiality

protection of private information

clinical nurse specialist

provide care in specialty areas, educate, (pts and students)

Diagnostic and laboratory data

provide further explanation of alterations or problems identified during health history and physical examination

What does JCAHO do?

provides accredition of hospitals provides accredition of outpatient clinics provides accredition of nursing homes

Nurse Practioner (NP)

provides health care to a group of patients usually in an outpatient, ambulatory care or community based setting

assertive community treatment (ACT)

provides mental health and support services in the community for individuals with serious mental illness, such as schizophrenia or bipolar disorder, to promote optimal functioning at home and within community.

continually gaining knowledge is central to

providing high-quality care, maintaining pt safety

when utilizing time mngmnt take into account specific considerations like

pt health preferences change in pt's condition unexpected occurrences appropriate delegation of tasks

example of pt advocacy essential for pt's in vulnerable population

pt's w/ disabilities or mental health diagnosis

what what is one of the biggest reasons that nursing schools can't expand?

qualified applicants are being rejected.

Radiology personnel

radiology techs to perform diagnostic imaging and other tech responsibilities

ROM

range of motion

Leadership Styles: Laissez-faire

recognition of group's need for autonomy; hands-off approach: less directive, more permissive than other styles; leader assumes that group is internally motivated; group members may work at cross purposes because of lack of cooperation, coordination; most effective for groups whose members have personal, professional maturity

choosing among alternatives

recognizes significant cues that form patterns, mentally rehearses choices, every decision-making process helps nurse improve decision-making skills, adds to clinical experience.

low levels of health literacy lead to

reduced ability to interpret health messages; limited ability to take meds correctly; lower likelihood of receiving preventive care; increased hospitalization; higher use of emergency care

Tertiary specialty care is care that is

referred by a specialist

Accountability

refers to the ability to answer for one's actions. You ensure that your professional actions are explainable to your patients and your employer (Ie. Mt carmel administrating lethal doses of fentanyl being breaking news)

Fidelity

refers to the agreement to keep promises

Confidentiality

refers to the assurance the patient has that private info will not be disclosed without his or her consent.

informed consent

refers to the patients legal and ethical rights to be informed of, and give or refuse permission for, any healthcare procedure or treatment.

5. Self-evaluation is a method that nurses use to promote their own development, and to grow in confidence in their nursing roles. This process is referred to as:

reflective practice.

insubordination

refusal to complete task as assigned

leadership styles; bureaucratic

relies on organization's rules, policies, procedures to direct group's work efforts; group members often dissatisfied w/ leader's inflexibility, impersonal relations w/ them

12 rights of med administration

right med right patient right time right route right dose right documentation right patient education right assessment right reason right response right reactions right to refuse

RUE

right upper extremity

RUQ

right upper quadrant

2nd level in Maslow's hierarchy of needs

safety

Inquiry

search for knowledge or facts. examining objective info to gain clarification,find solutions to problems.

The primary reason why educated nurses first joined to form the precursor to the American Nurses Association was to:

secure the passage of nurse licensure legislation in each of the states in the US

Avoiding

seen as an uncooperative or a preference to avoid addressing the conflict; however, avoidance can be a helpful approach when more info is needed or when issue just is not worth risking further conflict or loss of opportunity or consideration.

consumerism in pregnancy

sees healthcare provider as service provider, transferring essential info so women & insurance provider can make informed decision, but little interaction

What 2 major challenges did african-american nurses face in 1800's and early 1900s?

segregated education, military racial barriers

5th level in Maslow's hierarchy of needs

self-actualization

nurses employ effectiveness, efficiency by

setting priorities managing time delegating to staff

factors to consider when prioritizing care

setting priorities of care when demands exceed time available prioritizing care does not in itself result in nurses being more productive in given time periods multitasking, learning to perform some actions faster may improve effectiveness efficiency but should never compromise pt safety

mutualism in pregnancy

shared decision making by women and provider. gives dr her preferences, expectations, previous knowledge. provider molds info as it relates to the individual woman. pt & provider together discuss scenarios & options, arrive at mutual decision.

Bronchodilator-

short acting(Albuterol)- provide rapid but short-term relief. These inhaled drugs are most useful when an attack begins or as premedication when the patient is about to begin an activity that is likely to induce an attack. Long acting( Salmeterol)- causes bronchodilation by relaxing bronchiolar smooth muscle through binding to and activating pulmonary beta2 receptors. Onset of action is slow w/ a long duration. Primary uses is prevention of an asthma attack (NOT for prn or to abort attack

Nursing self-care interventions

short breaks a priority quality time to refresh,reenergize, take care of body functions (food, drink, toilet) a few quiet minutes to break-up intensity of work environment, relieves stress

Define Acute illnessess

short term appear suddenly subside quickly may not require medical attention

Acute illnesses

short term; appear suddenly; subside quickly; may not require medical attention; examples: common cold, acute appendicitis.

when caring for multiple pt's setting priorities is determined by

significance of interventions for each pt time constraints require more organization, focus consideration of pathophysiology of pt's

collaboration

skill in working as a team member; improves quality of care delivered to pt

How does an individuals culture influence his illness behaviors

some cultures don't like to be touched or show body parts

pharmacist

specialist in drug therapy and dispensing drugs

what was the Vietnam War's contribution?

specialization, medical knowledge, physician's assistant

Pharmacists

specially trained and licensed professionals who specialize in the preparation and dispensation of drugs

features of critical pathways

specific medical diagnosis expected length of stay pt ID data appropriate time frames for interventions pt outcomes interventions presented in modality groups means to easily ID variances, determined whether outcomes met

nurse must verify that UAP understands

specific task to be done for each pt when each task is to be done expected outcome for each task a specific task that can be delegated to 1 UAP may be inappropriate for different UAP a task that is appropriate for UAP to perfrom for one pt may be inappropriate for another pt

4 things Nurse Practice Act does

spells out discipline, defines practice, sets minimum education requirements, determines legal titles (rn, pn, lpn)

Philosophy of Nursing

statement of beliefs about nursing that demonstrate our values, used to make decisions, ethic issues, critical thinking

Nursing diagnosis

statement that describes the client's actual or potential response to a health problem the nurse is licensed to treat

What are outcomes?

statements of progressive, step-by-step physical, emotional, or behavioral responses that a patient needs to accomplish to achieve the goals of care

subcut

subcutaneous

Symptoms

subjective

Validate _______ information at a later time with _______ information.

subjective, objective

SL

sublingual (under the tongue)

law

sum total of the rules and regulations by which a society is governed. made at federal, state, and local levels to reflect the ever changing needs and expectations of a society.

elements essential to successful implementation of case mngmnt

support by key members of the organization qualified nurse case mngr collaborative practice teams high quality mngmt system established critical pathways

susp

suspension (small particles suspended in liquid)

tasks that may be delegated to UAPs

taking VS measuring & recording of I&O's pt transfers and ambulations postmortem care bathing feeding gastrostomy feedings in established systems attending to safety weighing suctioning chronic tracheostomies

nurses may advocate by

talking w/ local legislators; writing to politicians; engaging in discussions in neighborhoods, social groups; participating in national discussions through professional organizations

The biggest thing a nursing student will do is

teach

what was WWII's contribution?

technology, professionalism, end of segregation

TPR

temperature, pulse, respiration

developmental stages for school-aged children

tend to be concrete thinkers, benefit from simple explanations, hands-on exploration of equipment, helping care provider as appropriate

TLC

tender loving care

The first nurse practice acts passed in the US were?

the "permissive" laws that allowed only nurses who were trained to use the title "Registered Nurse"

What act specifies that only individuals involved in a patient's care can access medical records?

the Health Insurance Portability and Accountability Act (HIPAA)

Licensure by Endorsement

the ability to be a nurse in a select group of states because you passed the NCLEX

Confidentiality

the act of holding information in confidence, not to be released to unauthorized individuals

What are the nursing laws in South Carolina regarding the administration of medications by licensed versus unlicensed personnel?

the administration of medications is recognized as the responsibility of a registered nurse or a licensed practical nurse as prescribed by the licensed physician or dentist . After June 30th, 1985 unlicensed nursing personnel shall not administer medications

Bioethics

the application of ethical theories and principles to moral issues or problems in health care What should be done using knowledge of biology or what is learned/ correct

health literacy

the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health

Validation (of assessment data)

the comparison of data with another source to determine data accuracy (clarifies vague or unclear data)

Assessment involves __________.

the continuous interpretation of information

Intentional assessment

the deliberate collection of data through physical examination or interviewing

Risk factors

the environmental, physiological, psychological, genetic, or chemical elements that place a person at risk for a health problem

Values

the ideas, beliefs, and attitudes about what is important that help guide the way you live

Medical diagnosis

the identification of a disease condition based on a specific evaluation of physical signs and symptoms, a patient's medical history, and the results of diagnostic tests and procedures

nolo contendere

the individual neither admits or denies that he or she has committed the crime but agrees to punishment as if guilty.

overt conflict

the individuals or group members who are in conflict address the conflict openly.

What is the danger associated with nurses not being adequately represented nationally and internationally in healthcare discussions?

the interests of nurses and the role they play in patient care will not be represented

discovery

the legal process of obtaining information before a trail.

statute of limitations

the limit to the amount of time than can pass between recognition of harm and bringing of a suit.

durable power of attorney for health care

the patient may designate another individual usually family, significant other, or close personal friend as healthcare surrogate or healthcare proxy and give that individual power to make healthcare decisions on behalf of pt if the pt is unable to do so.

delegator

the person who assigns the task and retains accountability for outcome

delegate

the person who assumes responsibility

Code of Ethics for Nurses

the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients.

define "clinical judgment in nursing"

the process by which the nurse decides on data to be collected about a client

conflict resolution

the process of ending a conflict through cooperation and problem solving

GFR definition

the rate the kidneys are working

standards of care

the skills and learning common to their profession including nursing process.

purpose of ongoing assessment

the sooner a condition change is discovered & addressed, the more quickly the team can intervene, and prevent further deterioration

What is the definition of the "philosophy of nursing?"

the study of the principles underlying conduct,thought, and the nature of the universe

Emphysema

the two major changes that occur are loss of lung elasticity and hyperinflation of the lung. An increased amount of air becomes trapped in the lungs. Causes of air trapping are loss of elastic recoil in the alveolar walls, overstretching and enlargement of the alveoli into air filled spaces called bullae, and collapse of small airways (bronchioles). Hyperinflated lungs flatten the diaphragm.

The SC Board of Nursing recognizes that

there are settings and circumstances where individuals must take medications to maintain their health status where the regularly scheduled presence of a nurse is not required. Often these individuals may need assistance with taking their medications. Assisting an individual to take medication may include the acts of reminding the individual of the time to take the medication; opening the container that is properly labeled; or assisting the individual to place the medication in the mouth or properly apply the medication. In these settings, the defined caregiver (surrogate family member) may assist the individual with taking the medication. The Nurse Practice Act currently contains an exemption to the licensing requirement for gratuitous nursing provided by friends and family members of an individual and for the incidental care of the sick by domestic servants or persons primarily employed as housekeepers as long as they do not practice nursing according to this chapter.

contemplation

thinking about change Intervention: motivate; tip the balance

Assault

threat; attempt to make bodily contact with another person without their consent

TID

three times a day

tid

three times a day

Baccalaureate Nurse (schooling/preparation)

through university, emphasis on scientific/academic more than hands-on experience, you learn leadership, care, nursing science, communication

Describe a nurse's primary role in society

to be professional, role model, teacher, supporter, care taker, and advocate.

What is the intent of evaluation?

to determine if the know problems have remained the same, improved, worsened, or otherwise changed

What is the aim of self management?

to minimize the impact of chronic disease or sudden acute illness on physical health status and functioning and to enable people to cope with the psychological effects of an illness

Fetal protection laws

to protect both mothers and fetuses and punish individuals who harm them.

Florence Nightingale's definition of Nursing

to put the patient in the best condition for nature to act upon him

Efferent Arterioles

to the peritubular capillary vessels

deductive-reasoning

top-down approach, starts w/ general ideas, observations, or principles. analyzes them to develop specific predictions.

Classic Leadership Theories

trait based; behavior based; autocratic (authoritarian) style; democratic style; situational; charismatic; transactional; transformational; contemporary leadership theories; servant leadership

delegation

transference of responsibility & authority for an activity to a competent individual

What is a critical issue for the future of nursing practice?

translating findings from research into improved patient care outcomes

Secondary traumatic stress

trauma that health care providers experience when witnessing and caring for others suffering trauma

Tertiary Care

trauma, long term, terminal illness

what is trial and error

trying a solution, seeing whether it works, reflecting on result, trying another solution if 1st one was not successful

bid

twice a day

Nurses most often face which type of workplace violence?

type 11, involving a customer, client, or patient

pitfalls

unforeseen situations that may have neg. consequences for nurses, results in pt harm.

false imprisonment

unjustified detention of a person without legal warrant to confine person.

ineffective delegation

unnecessary duplication; underdelegation; reverse delegation; overdelegation

co-management and referral

upper levels of collaboration; providers retain responsibility and accountability for their own aspects of care and clients are directed to other providers when the problem is beyond the initial provider's expertise

clinical decision making

used in a clinical setting to evaluate the situation and select the best actions to employ and meet the desired outcome or goal

interdisciplinary

used to denote that paraprofessionals or others (patients or family members) are also included.

priority

using judgment to discern which among competing alternatives should be addressed immediately

Define chronic illnesses

usually cannon be cured develop gradually requires continuous medical attention may be lifelong

Chronic Illness

usually cannot be cured develop gradually require continuous medical attention may be lifelong examples:

interprofessional

usually refers to professionals from various disciplines along with support staff, the patient, and family - anyone who is working together for benefit of patient.

After subjective and objective data are gathered you need to

validate info with other source, cluster info and identify patterns, document data

types of decisions made during process of solving problems

value decisions, time mngmnt decisions, scheduling decisions, and priority decisions.

4 generations of american workforce

veteran (born 1925-1944) baby boomer (1945-1960) Gen X (1961-1980) Millennial (1981-2000)

informed consent

voluntarily; individual must be competent and have the capacity to understand; patient must be given enough information to understand; full knowing authorization by the patient for care/treatments/ procedures- must include risks/benefits/ side effects/ costs/alternatives (Do not need informed consent if life threatened)

Subjective data

what the patient says

ethics

what you SHOULD do

primary care

when pt first enters healthcare system (Hospitals, EMT, Clinic)

pm

when required, or as often as necessary

Team nursing

where planning and coordination of care for a patient are shared by a team of nurses and is normally led by a charge nurse. Usually consists of about 4-6 nurses and takes care of 15-25 patients

Data interpretation

while focusing on patterns of defining characteristics, compare a patient's pattern of data with information that is consistent with normal, healthy patterns

c

with

-s

without

s

without

barriers to EBP

work sched., workload demands; pt preferences that might conflict; lack of access to technology to find evidence when needed; limited knowledge of skills for finding, evaluating evidence; lack of experience, confidence in developing strategies to promote EBP; lack of support from supervisors or agency personnel

nurses must be aware & participate in discussions affecting allocation of resources in

workplace; communities; and at a federal level

Variances

wrong medication, wrong dose, wrong time or omissions.

Inference

your judgement or interpretation of cues

degree Fahrenheit

°F

Define "clinical ladder"

• A multi-step program for promotion within the hospital system • Need experience • Need continuing education • Demonstrate clinical competence • Pursue formal education • Become certified in your area of specialty

Step system 3)

• As-needed rapid-acting beta2-agonist (relief inhaler). • In addition, daily Tx involves the use of one of these four options: o Low-dose ICS and long acting beta2-agonist o Medium-dose or high-dose ICS o Low-dose ICS and leukotriene modifier o Low-dose ICS and sustained released theophylline

Step system 2)

• As-needed rapid-acting beta2-agonist (relief inhaler). • In addition, daily Tx involves the use of one of these two options: o Low-dose ICS (inhaled corticosteroid) o Leukotriene modifier

Step system 4)

• As-needed rapid-acting beta2-agonist (relief inhaler). • In addition, daily Tx involves the use of the Step 3 option that provided the best degree of control and was well tolerated along with one or more of these two options: o Medium-dose or high-dose ICS and long acting beta2-agonist o Leukotriene modifier and sustained-release theophylline

Step system 5)

• As-needed rapid-acting beta2-agonist (relief inhaler). • In addition, daily Tx involves the use of the Step 4 options that provided the best degree of control and was well tolerated along with either of these two options: o Oral glucocorticosteroid o Anti-IgE treatment

How calcium is absorbed and what is it associated with.

• Calcium is intake by your diet. Milk and dairy products - 800-1000mg/day • Functions: Increases skeletal muscle contraction, increases cardiac muscle contraction, regulates nerve impulse transmissions, Assists in blood clotting, Provides bone strength and density • Phosphorus inversely follows calcium

Common Medication Errors (sources) Part 2

• Coined names • Multidose vials • Defective packaging • Similar packaging • Lack of dose limits • Similar drug names • Borrowing medications from a multiple-dose cart • Dangerous abbreviations (OD & QD for once daily) • Lack of interdisciplinary team review of medication errors • Unnecessary use of IVs, catheters, and nasogastric tubes • Lack of dosage check for high-risk drugs and pediatric patients' medications

Common Medication Errors (sources) Part 1

• Human knowledge • Chaotic work environment • Unauthorized floor stocks • Using floor stock medications • Not following policies • Verbal orders • Human performance • Lack of personnel • IV solutions that are not premixed • Unnecessary use of medications • Lack of dose verification process • Math errors • Typographical mistakes • Poor handwriting • Acronyms

What factors influence illness behaviors?

• Internal influences o Dependency o Ability to cope o Ability to manage and maintain control over the situation o Resourceful o Resilience o Spiritual beliefs • External influences o Past experiences o Culture

hypertrophic cardiomyopathy

• Issue with Diastole • Really thick left ventricular muscle (big heart muscle) = not good pump • "left ventricular hypertrophy", but small right side. Diastolic problem because we have too small of a chamber to be filled (same amount of blood that needs to come in, but too small a bucket) • Septum, also thickens

dilated cardiomyopathy

• Issue with Systole (squeeze) • Ventricular chamber being bigger (usually left ventricular) • Issue becomes with the muscle becoming really thin and deteriorating

Restrictive Cardiomyopathy

• Issue with diastole • Loss of flexibility of muscle • Still get a good squeeze, but not a good relaxation due to a lack of flexibility

Edema: where can it be located, how evaluated, what causes it.

• Located: May be life threatening - brain, lung, larynx. Beneath skin and in the cavities of the body, which causes severe pain. • How evaluated: Daily weights, Measure girth of effected limb- same location - same time of day each day., Visual inspection , Finger pressure to determine if pitting edema - graded 1+ to 4+ • Causes:

Hyperkalemia

• Manifestations: Bradycardia, hypotension, cardiac arrest, muscle twitching/cramps, parasthesias, ↑ bowel sounds, N/D • Treatment: Insulin will give you some time, must give oral glucose; K+ restricted diet, Kayexalate, Sodium Bicarb, Calcium gluconate, β2 agonist, Dialysis - seen in dehydration, renal failure, acidosis, cellular/tissue damage, hemolysis of the specimen

Difference of water in the body of males and females

• Men have more H2O than women. • Men are 60% of water • Women have 60%, because we typically have more fat. • After age 60, water content drops to 45%

Teachings about TB

• Nursing interventions focus on pt teaching for drug therapy adherence and infection control. • Strict adherence to the prescribed drug regiment is crucial for suppressing the disease. Teach pt to take each drug regularly, exactly as prescribed, for as long as it is prescribed. • TB drugs may cause the pt to have nausea. Teach pt to prevent nausea by taking the daily dose at bedtime. Antiemetics may also prevent this problem. Instruct pt about the need for a well-balanced diet to promote healing. An increased intake of foods that are rich in iron, protein, and vitamins C & B is recommended -three sputum cultures are negative, the patient is no longer infectious and may return to former employment. Remind him or her to avoid exposure to any inhalation irritants b/c they can cause further lung damage.

Relationship of phosphate and calcium

• Phosphate inversely flows calcium. • Calcium (decreased) = PTH (decreased) = Phosphate (increased) • Calcium (increased) = PTH (increased) = Phosphate (decreased)

professional responsibilities of nurses

• Practice nursing under the direction of the Standards of Care • Quality improvement which includes record review • Research - participant • Education - preceptor to new nurses • Management - head nurses or nurse managers

Primary Care

• Prenatal and well-baby care • Nutrition counseling • Family planning • Exercise classes patient first enters the health care system

Circulating nurse responsibilites

• Protects the patient's privacy • Ensures the patient's safety • Monitors traffic in the room • Assesses the amount of urine and blood loss • Reports findings to the surgeon and anesthesia provider • Ensures that the surgical team maintain sterile technique and a sterile field • Anticipates the patient's and surgical team's needs, providing supplies and equipment • Communicates information about the patient's status to family members during long or unique procedures • Documents care, events, interventions, and findings

Professional Responsibility - Nursing Code of Ethics

• The Code of professional conduct (NMC, 2002) states that a nurse is personally accountable for their practice. Being accountable means being responsible for something or to someone. It also states that you must promote a health care environment conducive to safe, therapeutic and ethical practice whilst working within a team. Being competent means possessing the skills and abilities required for lawful, safe and effective professional practice without direct supervision. • The Scope of professional practice (UKCC, 1992) is based firmly on the Code, emphasizing that professional practice occurs in a context of continual change and development. It points out that practice must be sensitive, responsive and relevant to the needs of the individual patients. Our nursing role takes on countless responsibilities, centered on the patient wherein we are promoting a safe environment, working within our professional boundaries and maintain knowledge of our limitations. • The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. • The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy. • The nurse is responsible and accountable for individual nursing practice and ......... an obligation to provide optimum patient care.

Why is it important for nursing to have a "code of ethics?"

• The Code of professional conduct (NMC, 2002) states that a nurse is personally accountable for their practice. Being accountable means being responsible for something or to someone. It also states that you must promote a health care environment conductive to safe, therapeutic and ethical practice whilst working within a team. Being competent means possessing the skills and abilities required for lawful, safe and effective professional practice without direct supervision.

Occupational Nurse

• Usually are employed by large companies • Provide basic health care services • Provide health education/disease prevention • Provide health screenings • Provide emergency treatment to employees

Types of Medication Errors

• Wrong drug/IV • Allergy to drug • Wrong drug for patient's disease • Incorrect administration technique • Wrong diluent (solution that mixes with a powdered drug) • Wrong dose • Excessive dose • Insufficient dose • Wrong concentration • Too-rapid IV flow rate • Omitted drug • Wrong patient • Wrong time • Wrong route • Wrong procedure or test • Violation of orders • Wrong label directions • Wrong preparation

Diploma Program

•1900 - 432 hospital owned/operated schools •Programs ranged from 6 months to 2 years in length •Awarded Diploma upon graduation •Primary reason for school was to staff hospitals, not education of student nurses •"Diploma Program" was, and still is, term for hospital-based nursing education

Describe the preparation of the Diploma nurse, Associate Degree Nurse, and the Baccalaureate Degree Nurse?

•Diploma Nurse - 3 year program; sponsored by and attached to the hospital setting; highly trained and skilled nurses; enrollment has declined for various reasons •Associate Degree Nurse - 2 year program; part of the technical schools and community colleges; began in 1952; very popular program for various reasons •Baccalaureate Degree Nurse - 4 year program; part of 4 year colleges and universities; BSN programs are needed to provide leadership in administration; public health; and teaching

Define communication

•Exchange of thoughts, ideas, or information •Part of every relationship •Primary instrument through change occurs

Identify the criteria and strategies for successful communication

•Feedback •Appropriateness - Reply fits the circumstances and matches the messages •Efficiency - simple, clear words •Flexibility - deal with patient's questions and feelings •Be a good listener •Take cultural differences into consideration

What is the impact of "continuing education" on the nursing practice?

•Informal ways that nurses maintain expertise during their professional careers •Conferences, short courses, workshops, etc. are examples

Describe the roles of Advanced Practice Nurses (i.e. Nurse Practitioners, Certified Nurse Midwives, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists).

•Nurse Practitioners - conduct physical exams; diagnose and treat common and acute illnesses; manage chronic problems; order and interpret lab tests; and counsel/teach patients •Clinical Nurse Specialists - provide care in specialty areas; educator; consultant; develop quality assurance procedures •Nurse Midwives - provide prenatal and gynecological care to normal, healthy women; deliver babies; and follow up with postpartum care •Nurse Anesthetists - administer anesthesia for all types of surgeries in various settings

evidence-based practice

clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences

Nurse Researcher

conducts evidenced based practice and research to improve nursing care and further define and expand the scope of nursing practice

Assessment

-gathering information -subjective data-symptoms -objective data-signs

2 Types of data

1. subjective 2. objective

Sodium values

136-145

Henderson Theory

14 basic needs of the whole person

Describe the process of "accreditation" of nursing programs. Why should nursing schools be accredited?

A voluntary review process of educational programs by a professional organization. Compares the educational quality of the program with standards and criteria. An accredited program voluntarily adheres to standards to protect the quality of education, public safety, and the profession itself

Malpractice

is conduct that deviates from the standard of practice dictated by a profession.

Who is Florence Nightingale?

she recorded deaths and their causes during the Crimean War and promoted infection control processes. Also known as the lady with the lamp.

Define the educational background required to become a registered nurse

Anatomy 125 Physiology 101 Microbiology 10 English 101, English 100 Psychology 141 Sociology 101 or 102 or 125 or 150 or 154 or 156 or Anthropology 102. . . . . 3 Communication Studies 100 or 102 or 110 Activities Humanities Guidance course Required Nursing Courses First Semester Nurse 270 Nursing Process: Pharmacology 2 Nurse 271 Nursing Process: Fundamentals 6.5 Second Semester Nurse 272 Nursing Process: Geriatrics 1.0 Nurse 273 Nursing Process: Maternal-Child 6.5 Third Semester Nurse 274 Nursing Process: Mental Health 3 Nurse 275 Nursing Process: Medical-Surgical. 7 Fourth Semester Nurse 278 Nursing Process: Advanced Medical-Surgical.

what are the prerequisites to the ADN program?

Anatomy physiology micro and sociology

Anesthesia

Anesthesia provides partial/total loss of consciousness and sensation depending on the type used. Metabolized by liver, excreted by kidneys.

Secondary Care

counseling/therapy, preventing treatment complication (followup to primary)

To conduct an accurate and complete assessment, consider a patient's _________.

cultural background (avoid making stereotypes)

Nutritional-Metabolic

Height/weight; condition of skin

Hawthorne

Hypotension

DNR

do not resuscitate

What if I change my mind after I have signed a living will or health care power of attorney?

You may revoke (cancel) your living will or health care power of attorney any time. The forms contain instructions for doing so. You must tell your doctor and anyone else who has a copy, that you have changed your mind and you want to revoke your living will or health care power of attorney.

What are the requirements for signing a living will?

You must be eighteen years old to sign a living will. Two persons must witness your signing the living will form. A notary public must also sign the living will form. If you sign a living will while you are a patient in a hospital or a resident in a nursing home. a representative, as designated by State Ombudsman, Office of the Governor1 must witness your signing. There are certain people who cannot sign the document. The living will form tells you who cannot be witnesses. You should read the living will form carefully to be sure your witnesses are qualified.

drsg

dressing

steps to be followed for every situation involving delegation

assessment & planning communication surveillance & supervision evaluation & feedback

5 phases that organize the problem-solving process

assessment, nursing diagnosis, planning, implementation, evaluation

hs

at bedtime or hours of sleep

BR

bed rest

Professional Roles

caregiver, educator, manager, advocate, communicator

Watson

caring

Certification

defines the credentialing process by which nongovernmental agency or association recognizes the professional competence of an individual who has met certain predetermined qualifications specified by the agency or association.