Nursing Exam 1 Foundations of Nursing

Codes of Ethics for Nursing

-A respect for human dignity, the individual, and provision of nursing care that is not affected by race, religion, lifestyle, or culture -A commitment to continuing education, to maintaining competence, and to contributing to improved practice -The confidential nature of the nurse-patient relationship, outlining behaviors that bring credit to the profession and protect the public

3 basic Stages of patient interview

1. The opening, when rapport is established with the patient 2. The body of the interview, when the necessary questions are presented 3. The closing segment of the interview

Formulating a Plan

A collaborative process among the nurse, the patient, and other health care members

Ethics Committee

A committee formed to consider ethical problems

Child Abuse Prevention and Treatment Act (CAPTA)

A federal law that defines child abuse and neglect as "any recent act, or failure to act, that results in imminent risk of serious harm, death, serious physical or emotional harm, sexual abuse, or exploitation of a child by a parent or caretaker who's responsible for the child's welfare". States that healthcare personnel are required to report child abuse

Nurse Practice Act

A law that defines the scope of nursing practice, and provides for the regulation of the profession by a state board of nursing. Regulates the degree of dependence or independence of a licensed nurse with regard to other nurses, physicians, and health care providers

Patients Rights

A list of rights the patient could expect and responsibilities that the hospital may not violate. Under some legally specified conditions, certain rights may be temporarily suspended, such as in an emergency when the patient is unconscious or unable to communicate or is in danger of injury and cannot protect himself from harm, or to protect the public from harm

Battery

A nurse would be charged with this if they attempt to resuscitate a patient who has a physician's DNR order

Planning

A series of steps by which the nurse and the patient set priorities and goals to eliminate or diminish the identified problems. The goals are stated as specific expected outcomes. The nurse and the patient collaborate and choose specific interventions for each nursing diagnosis. The interventions assist the patient to meet the expected outcomes. The expected outcomes and nursing interventions are listed on the patients nursing care plan

Expected Outcomes

A specific statement of the goal the patient is expected to achieve as a result of nursing intervention. Should be realistic and attainable and should have a defined time line

Scientific Method

A step-by-step process with observable results used by scientists to solve problems

Nursing Process

A way of thinking and acting based on the scientific method. It is a framework for planning, implementing, and evaluating nursing care

Crime

A wrong against society, and imprisonment and/or fines may result if one is convicted.

Adventitious Sounds

Abnormal lung sounds

Signs

Abnormalities that can be verified by repeat examination and are objective data

Ethical Codes

Actions and veliefes approved by a particular group of people

Interventions

Actions taken to improve, maintain or restore health or prevent illness.

Assisted Suicide

Aiding a person (providing the means) to end his life.

Database

All the information gathered about a patient

Sentinel Event

An unexpected patient care even that results in death or serious injury (or risk thereof) to the patient

Five Components of Nursing Process

Assessment (Data Collection) Nursing Diagnosis Planning Implementation Evaluation

Nursing Process

Assessment, Nursing Diagosis, Planning, Implementation, Evaluation

Goal

Broad idea of what is to be achieved through nursing interventions

HIPAA Health Insurance Portability and Accountability Act

Called for the creation of regulations regarding patient privacy and electronic medical records. Failure to comply may lead to civil penalties. Protect the way patient information is conveyed and stored. Also dictates to whom information may be revealed. Rule states that disclosing medical information to family members, close personal friends, or other individuals identified by the patient for involvement in the patient's care is permittied if the patient DOES NOT object.

Implementation

Carrying out the nursing interventions in a systematic way. The nurse carries out the interventions or delegates some of them to an appropriate person. The patient's response to the care given is documented on the patient's chart.

Etiologic Factors

Causes of the problem

Defining Characteristics

Characteristic (signs and symptoms) that must be present for a particular nursing diagnosis to be appropriate for that patient

Founded the American Red Cross

Clara Burton

Assessment

Collecting, organizing, documenting, and validating data about a patient's health status. Assessment data are obtained from the patient, the family, the physician, diagnostic tests, and information about the patient from other health professionals

Administrative Law

Comes from agencies created by the legislature

Inferences

Conclusions made based on observed data

Chart or Medical Record

Confidential. Only Only people directly associated with the care of that patient have legal access. It is the property of the hospital or agency or physician, not the patient. Patient does have right to access and copies may be authorized by the patient to be provided to other agencies. Used to determine the truth of what happened and what was done or not done to a patient during a period of time. Therefore, it always needs to be accurate, pertinent, and timely.

Assessment

Consists of gathering information about patients and their needs using a variety of methods. These are an ongoing process. You will continue to gather data about the patient each time there is an encounter

Interview

Conversation where facts are obtained

Subjective Data

Data obtained from the patient verbally. Example: I have a headache, i'm nauseated, The sharp pain is in my hip, i've been feeling really blue lately, i've been lonely since my husband died, i'm tired all the time, i'm afraid i have cancer

Symptoms

Data the patient has said are occuring that can't be verified by examination and are subjective data

Nursing Diagnosis

Defines the patient's response to an illness

Nurse Practice Act

Designed to protect the public, and they define the legal scope of practice.

Critical Thinking

Directed, purposeful, mental activity by which ideas are evaluated, plans are constructed, and desired outcomes are decided.

Liability Insurance

Does not provide protection from being sued, but it protects the livelihood and assets of a nurse should the nurse get sued. If a nurse is sued, it pays for the expense of a lawyer to defend the nurse and pays any award won by the plaintiff up to the limits of the policy. May also pay for attorney costs and related costs if the nurse is subjected to a review by the state board of nursing

Patient Input

During the planning state, this results in more success with the plan of care

4 Elements that must be present in Malpractice

Duty, breach of duty, causation, and injury. If one is not present, the nurse is not guilty

Lordosis

Exaggerated lumbar curve (lower back)

Knee chest

Face down, knees bent up to chest

Negligence

Failing to do something a reasonably prudent (sensible and careful) person would do, or doing something a reasonably prudent person would NOT do

Edema

Fluid in the tissues (swelling)

LAMA (Leave against Medical Advice)

Form used by a hospital or facility when a patient does not accept the physicians recommendation for hospitalization, and leaves the agency. This form documents that the reasons for continuing hospitalization or treatment, and risks of leaving without treatment have been explained to the patient. If the patient refuses, that is noted and witnessed

Long Tern Goal

Goals that take weeks or months to achieve. Often relate to rehabilitation

International Center for Safety of The Joint Commission

Have developed goals to promote specific improvements in patient safety. The goals attempt to provide evidence-based and expert-based solutions to areas that have been problematic in terms of patient safety

Student Nurses

Held to the same standards as a licensed nurse. Legally responsible for her own actions or inaction, and may schools reqire carrying malpractice insurance. Need to know the nurse practice act and it's definition of nursing in the state in which they are practicing and not exceed the scope of practice for their state. it is not legal to do something beyond the scope of practice for their state. It is not legal to do something beyond the scope of nursing practice just because someone told them they were to do so

Critical Thinking

Improves the outcomes of the problem-solving process

kyphosis

Increased curve in the thoracic area (hunchback)

Nursing Diagnosis

Indicates the patient's actual health status or the risk of a problem developing, the causitive or related factors, and specific defining characteristics(signs and symptoms)

Objective data

Information obtained through the senses and hands-on physical examination. Example: Temperature 101.4F, bruise on right hip, eyes downcast flat effect, Only one visitor seen in room all day, Pathology report states tissue is adenosarcoma

Nursing Art vs. Science

Initially, nursing was an art- it consisted of certain acts of care skillfully, with intuition and creativity. Over time, a scientific base was combined with the art of nursing. From this body of knowledge, the nurse can choose interventions that are most likely to produce desired outcomes for the patient

Tremors

Involuntary fine movement of the body or limbs

Critical THinking

Involves a variety of skills. Effective reading, writing, attentitive listenting, and effected communicating are the foundation skills

Percussion

Involves light, quick tapping on the body surface to produce sounds. Used primarily over the chest and abdomen to determine the size, location, and density of the organs that lie within.

Priority Setting

Involves placing nursing diagnoses or nursing interventions in order of importance

Continuing Education

It is necessary for nurses to continue their education about changes in health care practice, pharmacology, and technology in order to practice safely. Nurses may stay current by attending programs provided by their employer, through participation in their professional organization, by attending workshops, seminars, or presentations on health care topics, by readin professional nursing journals, by formal continuing education in colleges, or by corresponding courses

Nurses Responsiblity

It is the nurses responsibilty to explain the reason why a particular drug or treatment is important. However, if the patient still refuses, the nurse should obtain a release from liability because the treatment is not done or the drug is not taken

Confidential

Kept private.

Medical Diagnosis

Labels "the illness"

Statutes

Laws that may be either civil or criminal.

Good Samaritan Law

Laws that protect a healthcare professional from liability if she stops to provide aid in an emergency

Litigation

Lawsuit

Prone position

Laying on Stomach

Supine position

Laying on back

Apprenticeship

Learning by doing

Release

Legal form used to excuse one party from liability

Standards of Care

Legally, the LPN is responsible for their own actions under the nurse practice act and according to the standards of care that are approved by the profession

Auscultation

Listening to the sounds produced in the body with the aid of a stethoscope. Used to take blood pressure readings, listen to the lungs, and assess heart sounds and bowel sounds

Inspection

Looking

Bronchovesicular Sounds

Lung sounds heard over the central chest or back. Normally equal in length during inspiration and expiration and have no pause between them

Discrimination

Making a decision or treating a person based on a class or group to which he belongs, such as race, religion, or sex, rather than on his or her individual qualities

Protective Devices

May be mechanical, such as locks, rails, belts, or garments that prevent a person from getting out of a room, bet, or chair, or they may be chemical drugs such as sedatives or tranquilizers that sedate the patient that he is unable to move about. A PHYSICIAN ORDER IS NECESSARY FOR ANY PROTECTIVE DEVICE, MECHANICAL OR CHEMICAL. The inappropriate use of devices can lead to charges of false imprisonment.

Euthanasia

Mercy killing. the act of ending another person's life, with or without the person's consent, to end actual or potential suffering. IT IS ILLEGAL IN ALL STATES

Priority

More important than something else at the time

Critical Thinking

Necessary to make reliable observations regarding health status and to draw sound conclusions from the data obtained

Malpractice

Negligence by a professional person. Person doesn't act according to professional standards of care as a reasonably prudent professional would. In nursing ___________________ a reasonably prudent person is a similarly educated, licensed, and experienced nurse. Example: a nurse did not check the patient's vital signs and condition after surgery, and the patient was hemmorhaging, and the patient went into shock and died

Negligence

Not reporting another professional's misconduct

Physiologic needs

Number one priority. Circulation. Airway Always comes first!

Evidence Based Practice (Nursing)

Nursing practice based on validated research

Invasion of Privacy

Occurs when there has been a violation of the confidential and priveleged nature of a professional relationship. Occurs when unauthorized persons learn of the patient's history, condition, or treatment from the professional caregiver.The only exception is that nurse's are required by law in most states to report information regarding child or elder abuse, sexual abuse, or violent acts that may be crimes (stabs or gunshot wounds)

Preferred Provider Organizations PPO's

Offer a discount on fees in return for a large pool of potential patients. Allows insurance companies to keep their premium rates lower and in turn makes insurance coverage of employees less expensive for employers

Incident (Occurrence) Reports

Often used to document what happened, the facts about the incident, and who was involved or witnessed. Tool used by the risk management department. Useful because it allows the facility to note dangerous patterns, or if a change in the appearance of a medication might have been a factor in several recent similar medication errors. Generally not filed as part of the patient's chart. No reference to the report is made in the patients chart

Lithotomy position

On back with feet in stirrups, knees relaxed

Dorsal Recumbent position

On back with knees bent

Where not to take a blood pressure

On the arm containing a dialysis shunt or on the side where a mastectomy and lymph node dissection have occured.

Emancipated Minor

One who has established independence by moving away from parents or through service in the armed forces, marriage, or pregnancy, is considered capable of signing a consent

Patient Advocate

One who speaks for and protects the rights of the patient

Slander

Oral form of defamation. Example: Two nurses are overheard talking about a physician in a way that holds the physician up to ridicule or contempt

DNR

Orders written by a physician when the patient is indicated to be allowed to die if he or she stops breathing or his or her heart stops. In this situation, no CPR would be started.

Nursing Process

Organized, deliberate, systematic way to deliver nursing care. Provides a way to implement caregiving, and it combines the art and science of nursing

OSHA

Passed in 1970 to improve the work environment in areas that affected workers health or safety. it includes regulations for handling infectious or toxic materials, radiation safeguards, and the use of electrical equipment

Consent

Permission given by the patient or his legal representative. Also known as releases and are legal documents that record the patients permission to perform a treatment or surgery, or to give information to insurance companies or other health care providers. If the patient has any questions, they should be satisfactorily answered before the patient signs. It is important to determine that proper consent has been obtained both legally and ethically. Failure to obtain a valid informed consent may lead to charges of assault and battery, or invasion of privacy.

Competent

Person who is legally fit mentally and emotionally

Data

Pieces of Information on a specific topic

Cues

Pieces of data or information that influence decisions

False Imprisonment

Preventing a person from leaving, or restricting his movements in the facility. When a patient wants to leave the hospital against the advice of the physician , a release to leave "against medical advice" is used.

Dilemma

Problem or conflict

Invasive Procedure

Procedures that require entry into the body

Scoliosis

Pronounced lateral curve of the spine

Practical Nurses

Provide direct patient care under the supervision of a registered nurse, physician, or dentist

Reciprocity

Recognition of one state's nursing license by another state.

Patient Care Partnership

Recognizes that patients do not lose their civil rights when they are hospitalized

Whistle-blowing

Reporting illegal or unethical actions

Liability

Responsibility

Assessment of Basic Needs

Rest and Activity Nutrition, fluid and electrolytes Safety and security Hygiene and grooming Oxygenation and circulation needs Psychosocial and learning Elimination

Ethical Dilemmas

Result when people hold different views on issues. Ethics committees can provide an interdisciplinary approach to solving these

Judicial Law

Results when a law or court decision is challenged in the courts and the judge affirms or reverses the decision

Laws

Rules of conduct that are established by our government

Ethics

Rules of conduct that have been agreed on by a particular group. Based on the consensus of the group that these rules are believed to be morally right or proper for that group

Ethical Principles

Rules of right and wrong from an ethical point of view

Palpation

Sench of touch performed with the hand and uses touch to feel various parts of the body. Can be used to detect the size, shape, and position of parts of the body and the texture. Used to ascertain the presence of muscle spasm or ridgity, pain, swelling, or presence of a growth, skin temperature, turgor, and presence of edema

Olfaction

Sense of smell. used to identify characteristic smells associated with specific problems. A sweetish odor to the breat can indicate diabetic acidosis, alcohol on the breath can provide a clue to the patient's lethargy or irrationality. mouth odor may indicate periodontal disease or poor oral hygiene

Prudent

Sensible and Careful

SBAR

Situation, Background, Assessment, Recommendation. A strategy that reduces the likelihood of critical patient details being lost

Vesicular Sounds

Soft, rustling sounds heard in the periphery of the lung fields. Longer on inspiration than expiration and ther eis no pause between them

Advance Directive

Sometimes called a living will. It's a consent that has been constructed before the need arises. It spells out a patients wishes regarding surgery as well as diagnostic and therapeutic treatments.

Safety Problems

Take priority after physiologic needs

Psychosocial needs

Take priority after safety problems. Every nurse must

Accountability

Taking responsibility for ones actions. Means asking for assistance when unsure, performing nursing tasks in the sage and prescribed manner, reporting and documenting assessments and interventions, and evaluating the care given and the patients response to that care. means all of the above plus a commitment to continuing education to stay current and knowledgeable.

Battery

The actual physical contat that has been refused or that is carried out against the person's will. Example: Holding down a patient and giving them an injection they have refused

Delegation

The assignment of duties to another licensed person

Assignment

The assignment of duties which can be done by an unlicensed person, such as a nursing assistant

Nursing Diagnosis

The process by which the assessment data are sorted and analyzed so that specific actual and potential health problems are identified. The factors contributing to the problems are considered and specific nursing diagnoses are chosen for the patients care plan

Assault

The threat to harm another or even to threaten to touch another person without the person's permission. Example: Threating to hold down a patient to give them an injection they have refused.

Values

The worth or importance of an action or belief to an individual

Percussion

Thumping

Lesions

Tissue damage or abnormality

Goals of the Nursing process

To explore patient's health status, identify actual or potential healthcare problems, determine desired outcomes, deliver specific nursing interventions to solve the problems and promote health, and evaluate care given to determine whether outcomes have been achieved

Goals of Nursing

To promote wellness, to prevent illness, to facilitate coping, to restore health

Implementation

To put into action

Palpation

Touching

Sexual Harrassment

Unwelcome sexual advances, requests for sexual favors, an other verbal or physical conduct of a sexual nature

Ophthalmoscope

Used to check the eyes

Tort

Violation of Civil Law

NAPNES (National Association for Practical Nurse Education and Service

Was formed to standardize practical nurse education and to establish licensure criteria for graduates

Defamation

When one person makes remarks about another person that are untrue, and the remarks damage that other person's reputation

Critical Thinking

With this, factors can be weighd, problems skillfully solved, and good decisions made a majority of the time

Aseptically

Without introducing infectious material

Libel

Written form of defamation. Example: A letter or newspaper article quotation that states that a person is incompetent or dishonest.

Critical Thinking

a directed, purposeful, mental activity by which ideas are created and evaluated, plans are constructed, and desired outcomes are decided

Health Maintenance Organizations

a type of group practice, enroll patients for a set fee per month. They provide a limited network of physicians, hospitals, and other health care providers from which to choose. One goal is to keep patients healthy and out of the hospital

Basic Principles for Priority Setting

a.Consider what will happen if the task is not done on time b.Priorities constantly change because patient needs and conditions change frequently. c.Must be flexible and frequently reorder tasks. d.Reconsider work organization plan at least ever two hours during a shift, reprioritizing as needed e.Physiologic needs for basic survival take precedence. The airway ALWAYS comes first f.After physiologic needs, safety problems take priority g.After these two, psychosocial needs of love and belonging, self esteem, and self actualization are given attention h.Every nurse must attempt to look at each patient holistically, keeping psychosocial needs in mind while working on physical problems

Steps in the Problem Solving Process

a.Define the problem clearly b.Consider all possible alternatives as solutions to the problem c.Consider the possible outcomes for each alternative d.Predict the likelihood of the outcome occurring e.Choose the alternative with the best chance of success that has the fewest undesirable outcomes

Practice Settings for LPN

a.Hospitals- Restorative care is provided to ill or injured patients b.Extended Care Facilities-Facilities for intermediate or long-term care where personal care and skilled care is provided for those requiring rehabilitation or custodial care c.Physician's Office- Ambulatory patients receive preventative care or treatment of an illness or injury d.Ambulatory Clinics- Ambulatory patients come for preventative care or treatment of an illness or injury; often treatment by specialty groups is available on site e.Renal Dialysis Clinics- Patients with kidney failure receive renal dialysis treatments f.Hospices- Supportive treatment is provided for patients who are terminally ill g.Home Health Agencies- In-home care is provided to patients by nurses who visit the home

Evaluation

assessing the patient's response to the nursing interventions. The responses are compared with the expected outcomes to see to what extent the outcomes have been achieved. The entire care plan is reassessed in this phase, and any changes needed are made.

Implied consent

assumed when in a life threatening emergency, consent cannot be obtained from the patient or the family.May be obtained by telephone it is witness by two persons who hear the consent of the family member

Diagnosis Related Groups

created by medicare in 1983 as an attempt to contain healthcare costs. system means that a hospital recieves a set amount of money for a patient who is hospitalized with a certain diagnosis

Turgor

elasticity

Short term goal

goals that are achievable within 7 to 10 day or before discharge

Nystagmus

jerky movements

Sims Position

laying on side

LPN and Assessment Data Collection

often asked to assist with the task and participate in carrying out the plan by continuing to collect data

Nursing competence

possessing the suitable skill, knowledge, and experience necessary to provide adequate nursing care. FIRST AND MOST IMPORTANT IS COMPETENT AND WELL-DOCUMENTED NURSING CARE. POTENTIAL LAWSUITS MAY BE AVOIDED BY EARLY IDENTIFICATION OF DISSATISFIED PATIENTS.

Privilege

premission to do something that is usually not permitted in other circumstances

Integrated Delivery Network

set of providers and services organized to deliver coordinated care to promote wellness, care for illness, and promote rehabilitation

Scope of Practice

the definition of nursing for LPN's and may include definitions for advanced practice . T

Capitated Cost

they are paid a set fee for every patient enrolled in the network each year

Otoscope

used to check the ears

Glasgow Coma Scale

used to score the neurologic check and to quantify the neurologic condition of the patient

Analysis

used to sort and group assessment data so that nursing diagnoses can be chosen and priorities can be set

Chart Review

useful for gathering information for the nursing database and for obtaining information for a student assignment