Unit One Leadership Study Guide
Define the HIPPA Laws
· Clients have the right to privacy and confidentiality in relation to their health care information and medical recommendations. · The security and privacy rules of the Health Insurance Portability and Accountability Act (HIPAA) were enacted to protect the confidentiality of health care information and to give the client the right to control the release of information. Specific rights provided by the legislation include the following: o The rights of clients to obtain a copy of their medical record and to submit requests to amend erroneous or incomplete information o A requirement for health care and insurance providers to provide written information about how medical information is used and how it is shared with other entities (permission must be obtained before information is shared) o The rights of clients to privacy and confidentiality · The Privacy Rule of HIPAA requires that nurses protect all written and verbal communication about clients.
Describe what action(s) may constitute Malpractice in the nursing profession? (pg. 38,47)
· Common actions leading to malpractice suits: o Failure to assess a client appropriately. o Failure to report changes in client status to the appropriate personnel. o Failure to document in the patient record. o Falsifying documentation or attempting to alter the patient record. o Failure to report a coworker's negligence or poor practice. o Failure to provide appropriate education to patients and families. o Violation of an internal or external standard of practice. · Professional negligence issues that prompt most malpractice suits include failure to do the following: o Follow either professional or facility established standards of care o Use equipment in a responsible and knowledgeable manner o Communicate effectively and thoroughly with the client o Document care that was provided
Discuss the mechanism of action, indications for use, nursing considerations, adverse/side effects and client teaching/education for the following medications: digoxin
· Digoxin o Mechanism of action: -Increases the force of myocardial contraction. -Prolongs refractory period of the AV node. -Decreases conduction through the SA and AV nodes. o Indications: -Heart failure. -Atrial fibrillation and atrial flutter (slows ventricular rate). -Paroxysmal atrial tachycardia. o Nursing considerations: -Monitor apical pulse for 1 min before administering. Withhold dose and notify health care professional if pulse rate is <60 bpm in an adult, <70 bpm in a child, or <90 bpm in an infant. Notify provider promptly of any significant changes in rate, rhythm, or quality of pulse. -Monitor BP in patients receiving IV digoxin. -Monitor ECG during IV administration and 6 hr after each dose. Notify HCP if bradycardia or new arrhythmias occur. -Observe IV site for redness or infiltration; extravasation can lead to tissue irritation and sloughing. -Monitor I&O and daily weights. Assess for peripheral edema and auscultate lungs for rales/crackles throughout therapy. -Before administering initial loading dose, determine whether patient has taken any digoxin in the preceding 2-3 wk. -Evaluate serum electrolyte levels (potassium, magnesium, and calcium) and renal and hepatic function periodically during therapy. o Adverse/side effects: -CV: ARRHYTHMIAS, bradycardia, ECG changes, AV block, SA block -EENT: blurred vision, yellow or green vision -GI: anorexia, nausea, vomiting, diarrhea -Hemat: thrombocytopenia -Metabolic: electrolyte imbalances with acute digoxin toxicity -Neuro: fatigue, headache, weakness. o Client teaching/education: -Instruct patient to take medication as directed, at same time each day. Teach parents/caregivers of infants and children how to measure medication. Take missed doses within 12 hr of scheduled dose or omit. Do not double doses. Consult health care professional if doses for 2 or more days are missed. Do not discontinue medication without consulting health care professional. -Teach patient to take pulse and to contact health care professional before taking medication if pulse rate is <60 or >100. -Pedi: Teach parents or caregivers that changes in heart rate, especially bradycardia, are among the first signs of digoxin toxicity in infants and children. Instruct parents or caregivers in apical heart rate assessment and ask them to notify health care professional if heart rate is outside of range set by health care professional before administering the next scheduled dose. -Review S&S of dig toxicity with patient and family. Advise patient to notify health care professional immediately if these or symptoms of HF occur. Inform patient that these symptoms may be mistaken for those of colds or flu -Instruct patient to keep digoxin tablets in their original container and not to mix in pill boxes with other medications; may look similar to and may be mistaken for other medications. -Advise patient that sharing of this medication can be dangerous. -Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products, especially St. John's wort. Advise patient to avoid taking antacids or antidiarrheals within 2 hr of digoxin. -Advise patient to notify health care professional of this medication regimen before treatment. -Patients taking digoxin should carry identification describing disease process and medication regimen at all times. -Geri: Review fall prevention strategies with older adults and their families. -Advise female patient to notify health care professional if pregnancy is planned or suspected, may increase risk for low birth weight or preterm birth. Monitor neonates for signs and symptoms of digoxin toxicity (vomiting, cardiac arrhythmias). -Emphasize the importance of routine follow-up exams to determine effectiveness and to monitor for toxicity.
What are the Professional Standards of Decision-Making?
· Ethical decision-making is the process by which a decision is made about an ethical issue. Frequently, this requires a balance between science and morality. There are several steps in ethical decision-making: o Identify whether the issue is an ethical dilemma. o State the ethical dilemma, including all surrounding issues and individuals involved. o List and analyze all possible options for resolving the dilemma, and review implications of each option. o Select the option that is in concert with the ethical principle applicable to this situation, the decision maker's values and beliefs, and the profession's values set forth for client care. Justify why that one option was selected. o Apply this decision.
Define malpractice
· Malpractice is the failure of a person with professional training to act in a reasonable and prudent manner. The terms "reasonable and prudent" are generally used to describe a person who has the average judgment, foresight, intelligence, and skill that would be expected of a person with similar training and experience.
Creatinine normal range
0.5-1.2 Creatinine is the by-product of muscle creatinine phosphate metabolism. Creatinine production is constant as long as muscle mass remains constant and serves as a better indicator of kidney function than BUN. Creatinine values range from 0.5 to 1.2 mg/dL depending on the muscle mass of the individual. The normal ratio of BUN to creatinine is 10:1 to 20:1.
Sodium normal range
135-145 Sodium levels are a key determinant of the osmolality of ECF and control the distribution of water within the body. The sodium-potassium pump facilitates transfer of sodium from the ECF to the ICF and transfer of potassium from the ICF to the ECF, creating an action potential. This action potential is responsible for cardiac and skeletal muscle contractions and nerve impulse transmission.
Hemoglobin (Hgb) normal range
14-17.3 g/dL (males) 11.7-15.5 g/dL (females) Hemoglobin is the protein molecule within red blood cells that carries oxygen.
Potassium normal range
3.5-5.0 Potassium is the major intracellular electrolyte (cation) of the body, with 98% found within the cell. The remaining 2% is extracellular and is essential for neuromuscular function. In conjunction with sodium, potassium produces action and resting membrane potentials of muscle and nerve cells. In the function of the sodium-potassium pump, potassium's role is just as important as sodium's for heat production (thermogenesis) and cotransport. Potassium is also important for the metabolic processes of the body and protein synthesis.
Hematocrit (Hct) normal range
42%-52% (males) 36%-48% (females) Hematocrit is the percentage of red blood cells in the volume of whole blood and is dependent on the number and size of red blood cells.
Glucose normal fasting range
65-99
BUN normal range
8-21 Blood urea nitrogen (BUN) measures the nitrogen portion of urea and serves as a measure of glomerular function. Urea is the end product of protein breakdown by the liver. The normal BUN level is 8 to 21 mg/dL and varies with urine output, which reflects fluid status and renal function.
Beneficence
Care that is in the best interest of the client
Justice
Fair treatment in matters related to physical and psychosocial care and use of resources.
Fidelity
Keeping one's promise to the client about care that was offered
Autonomy
The ability of the client to make personal decisions, even when those decisions might not be in the client's own best interest.
Veracity
The nurse's duty to tell the truth.
Nonmaleficence
The nurse's obligation to avoid causing harm to the client
slander
defamation with the spoken word -a nurse tells a coworker she believes a client has been unfaithful to the spouse
libel
defamation with the written word or pictures -a nurse documents in a client's health record that a provider is incompetent
defamation
false communication or communication with careless disregard for the truth with the intent to injure an individuals reputation
Review prioritization and management of care principles when providing care to a client experiencing a myocardial infarction (MI)
o Actions • Administer oxygen Oxygen consumption and demand increases; therefore, oxygen supply should be increased. • Insert two large-bore IVs IV access is essential for medication delivery and fluid resuscitation. • Administer medications as ordered Medications are essential to be given in a timely manner: • Aspirin and heparin Aspirin and heparin are given to prevent new clot formation. • Nitroglycerin SL Nitroglycerin dilates the coronary arteries, increasing blood flow and decreasing pain. • Morphine Morphine is a narcotic given for pain relief if nitroglycerin is not effective. • Beta blockers Beta blockers decrease the sympathetic response to an MI, decreasing cardiac workload and oxygen consumption. • Fibrinolytics Fibrinolytics work to dissolve clots. • Continuous ECG monitoring Electrocardiogram monitoring is essential to evaluate the evolution of the MI and the effectiveness of treatment and to monitor for dangerous dysrhythmias that can occur. • Bed rest The patient may require bed rest as well as emotional rest to decrease oxygen and cardiac demands.
What is the key purpose of the NCLEX
· To ensure public safety, by setting a level of standard that indicates an individual has acquired the necessary knowledge and skills to enter the profession.
Review prioritization and management of care principles when providing care to a client experiencing a pulmonary embolism
o Actions • Elevate the head of the bed. Allows the diaphragm to drop, facilitating less work of breathing and better oxygenation • Administer IV fluids. Decrease viscosity of blood; caution must be used in cases of right ventricular overload. • Administer anticoagulation medications as ordered. Heparin infusion, warfarin, and factor Xa inhibitors limit the growth of PE and DVT and decrease the formation of new clots. • Administer thrombolytic medications if ordered. Thrombolytics degrade the clot; if not contraindicated, they are used when patients are hemodynamically compromised. • Administer inotropic agents if ordered. Inotropic agents increase cardiac contractility in an effort to augment cardiac output if the patient is hemodynamically unstable. • Administer norepinephrine or vasopressin as ordered. These vasoconstrictive medications are given, if necessary, to maintain a systolic BP of at least 80 mm Hg. • Institute bleeding precautions. The use of anticoagulants and/or thrombolytics can result in bleeding; minimize venipunctures; watch for blood in urine, stool, and sputum; watch for unusual bruising. • Be prepared for intubation and resuscitation. Massive PE may result in cardiogenic shock and sudden death.
Review prioritization and management of care principles when providing care to a client experiencing HIV
o Actions • Utilize universal precautions consistently. Universal precautions are designed to prevent the spread of infections between individuals. In addition to HAND WASHING for a minimum of 15 to 30 seconds, which is the MOST IMPORTANT precaution, personal protective equipment may be required. The selection of personal protective equipment, such as gloves, goggles, and gowns, is related to the risk of exposure. • Administer antiretroviral therapy (ART) as prescribed and on time. Maintaining medication levels is critical to preventing medication resistance. Several medications that are commonly used have low resistance thresholds when subtherapeutic levels are present. Administering doses more than 1 or 2 hours after the usual time can increase the risk of the development of viral resistance. • Provide nutritionally dense foods and small, frequent meals. Anorexia, nausea, and vomiting are commonly seen in individuals with HIV/AIDS as a result of medications or HIV infection. Persistent anorexia, nausea, or vomiting can lead to dehydration, weight loss, and electrolyte imbalances. Small, frequent meals/snacks, incorporating foods such as nuts or nutritional supplements, will increase caloric intake and provide protein and essential micronutrients. • Provide emotional support. Complex emotional issues, such as sexuality, shame, and anger, may be associated with HIV/AIDS. Listening and being nonjudgmental can assist the patient in developing effective coping behaviors. Referral to a mental health professional may be needed. The focus is on living with HIV, not dying with HIV.
Describe the Correct Procedures for Telephone Orders?
o Be sure to include all necessary elements of a prescription: date and time prescription was written; new client care prescription or medication including dosage, frequency, route of administration; and signature of nurse transcribing the prescription as well as the provider who verbally gave the prescription. o Follow institutional policy with regard to the time frame within which the provider must sign the prescription (usually within 24 hr). ■ Repeat back the prescription given, making sure to include the medication name (spell if necessary), dosage, time, and route. ■ Question any prescription that seems contraindicated due to a previous or concurrent prescription or client condition.
Provide examples of how the nurse ensures patient Confidentiality?
o COMPONENTS OF THE PRIVACY RULE -Only health care team members directly responsible for the client's care are allowed access to the client's records. Nurses cannot share information with other clients or staff not involved in the care of the client. -Clients have a right to read and obtain a copy of their medical record, and agency policy should be followed when the client requests to read or have a copy of the record. -No part of the client record can be copied except for authorized exchange of documents between health care institutions. For example: Transfer from a hospital to an extended care facility & Exchange of documents between a general practitioner and a specialist during a consult -Client medical records must be kept in a secure area to prevent inappropriate access to the information. Using public display boards to list client names and diagnoses is restricted. -Electronic records should be password-protected, and care must be taken to prevent public viewing of the information. Health care workers should use only their own passwords to access information. -Client information cannot be disclosed to unauthorized individuals, including family members who request it and individuals who call on the phone. - Many hospitals use a code system in which information is only disclosed to individuals who can provide the code. - Nurses should ask any individual inquiring about a client's status for the code and disclose information only when an individual can give the code. -Communication about a client should only take place in a private setting where it cannot be overheard by unauthorized individuals. The practice of "walking rounds," where other clients and visitors can hear what is being said, is no longer sanctioned. Taped rounds also are discouraged because nurses should not receive information about clients for whom they are not responsible. Change-of-shift reports can be done at the bedside as long as the client does not have a roommate and no unsolicited visitors are present.
Review prioritization and management of care principles when providing care to a client experiencing tuberculosis (TB)
o Immediate isolation of the patient with suspected or confirmed TB infection in a private room with negative airflow capabilities is a priority. Negative airflow occurs when air moves into the contaminated area or into the patient's room from bordering areas. The institution of airborne precautions, the use of an N95 mask respirator for healthcare personnel entering the patient's room (requires fit-testing), and a snug-fitting surgical mask for visitors are essential interventions. The patient's movement and transportation to other departments should be limited to essential needs only. Patients who must leave the negative-pressure room should also wear a surgical mask. o Actions • Humidified oxygen Humidified oxygen helps ensure adequate oxygen delivery to the tissues and maintains the integrity of the mucous membranes. • Institute airborne isolation. Tuberculosis is an extremely contagious disease. Care must be taken to avoid transmission to other individuals, especially other hospitalized individuals with an increased risk for infection. • Administer antibiotics as ordered. Antibiotics are the definitive treatment for TB and are essential in controlling the spread of the disease. • Ensure adequate nutrition. Adequate caloric intake to maintain optimum body weight is necessary for recovery. Often, patients report substantial weight loss during the time prior to diagnosis.
Review prioritization and management of care principles when providing care to a client experiencing burns
o Primary Survey Assessment Includes: Airway and C-spine stabilization • Maintain a patent airway (may require intubation). • Consider cervical spine immobilization if warranted. Breathing • Provide high-flow 100% oxygen by mask. Circulation • Elevate extremities (no pillow under head). • Remove tight jewelry or clothing. • Neurovascular checks with circumferential burns and electrical burns to extremities Disability • Neurological examination Expose and examine • Extent and depth of burn wounds and possible associated trauma Fluid resuscitation • Insert a minimum of two large-bore peripheral IV lines and start Lactated Ringer's. Secondary Survey Assessment Includes: • Circumstances of the injury • Cause of burn injury? • Exact time of burn injury? • Enclosed space? • Associated trauma (electrical)? • Length of time before rescue? • Chemicals involved? • Use of accelerant? • Medical history, current medications, allergies, and vaccinations • Last food and fluid intake documentation • Complete "head-to-toe" physical examination • Determine the extent and depth of burn injury (calculate TBSA percentage) • Cover the wounds with a clean, dry sheet • Maintain core body temperature • Pain medication, IV narcotics preferred • Tetanus status (considered current if received within the previous 5years) • Initial laboratory values/tests: CBC, CMP, PT/aPTT, urinalysis, surveillance cultures • ABG and carboxyhemoglobin level for suspected inhalation injury • 12-Lead ECG and CK-MB/troponin for electrical injury • Fluid resuscitation calculation and IV fluid rate adjustment It is important to note that burn wound care does not begin until the patient is stabilized. The immediate concern is for airway, breathing, and circulation, followed by fluid resuscitation and prevention of hypothermia.
Five Rights of Delegation
o RIGHT task o RIGHT circumstance o RIGHT person o RIGHT direction and communication o RIGHT supervision and evaluation
civil law
protects the private and property rights of individuals and businesses -private individuals or groups may bring a legal action to court for breach of civil law (torts and contracts)
criminal law
provides protection from conduct deemed injurious to the public welfare -ex: theft by a hospital employee of supplies or drugs
tort
violation of a civil law in which an individual has been wronged -intentional: touching another person w/o consent -unintentional: malpractice and negligence actions
HA1C normal range
want less than or equal to 6.5% Measures the average blood glucose concentration over time by measuring the amount of glucose that binds to red blood cells (RBCs).
Define ethical practice and the role of ethics in the nursing profession?
· Ethics: considers rightness from wrongness · The Code of Ethics for Licensed Practical/ Vocational Nurses issued by the National Association for Practical Nurse Education and Services also serves as a set of standards for Nursing Practice. · Relationships are the center of nursing ethics. Nursing ethics, viewed from the perspective of nursing theory and practice, deals with the experiences and needs of nurses and their perceptions of these experiences.
List the Criteria for Informed Consent? (pg.45)
· A mentally competent adult has voluntarily given the consent. · The client understands exactly as to what he or she is consenting. · The consent includes the risk involved in the procedure, alternative treatments that may be available, and the possible result if the treatment is refused. · The consent is written. · A minor's parent or guardian needs to give consent for treatment. ● Informed consent is a legal process by which a client has given written permission for a procedure or treatment to be performed. Consent is considered to be informed when the client has been provided with and understands the following. -Reason the treatment or procedure is needed -How the treatment or procedure will benefit the client -Risks involved if the client chooses to receive the treatment or procedure -Other options to treat the problem, including the option of not treating the problem -Risk involved if the client chooses no treatment ● The nurse's role in the informed consent process is to witness the client's signature on the informed consent form and to ensure that informed consent has been appropriately obtained. ● The nurse should seek the assistance of an interpreter if the client does not speak and understand the language used by the provider.
Describe Professional Accountability? (pg.22)
· Accountability is linked to fidelity and means accepting responsibility for one's own actions.
Describe what action(s) may constitute Negligence in the nursing profession?
· Actions that may constitute negligence: o Client falls o Equipment injuries o Failure to monitor o Failure to communicate o Medication errors
Describe an Advanced Directive
· Advanced Directives allow people the opportunity to make decisions about treatment in advance of a time when they might become unable to participate in the decision-making process. Through this, families can be spared the burden of having to decide what the family member would have wanted. · Two most common forms: living wills and durable power of attorney: · Living will: legally executed document that states an individual's wishes regarding the use of life-prolonging medical treatment in the event that he or she is no longer competent to make informed treatment decisions on his or her own behalf. · Durable power of attorney: a designated health care surrogate. Their role is to make the client's wishes known to medical and nursing personnel.
Describe the Role of the Nurse in Client Advocacy? (pg.35 ATI)
· Advocacy refers to nurses' role in supporting clients by ensuring that they are properly informed, that their rights are respected, and that they are receiving the proper level of care. o Advocacy is one of the most important roles of the nurse, especially when clients are unable to speak or act for themselves. o As an advocate, the nurse ensures that the client has the information they need to make decisions about health care. o Nurses must act as advocates even when they disagree with clients' decisions. o The complex health care system puts clients in a vulnerable position. Nurses are clients' voice when the system is not acting in their best interest. o The nursing profession also has a responsibility to support and advocate for legislation that promotes public policies that protect clients as consumers and create a safe environment for their care.
Discuss the mechanism of action, indications for use, nursing considerations, adverse/side effects and client teaching/education for the following medications: atorvastatin
· Atorvastatin o Mechanism of action: -Inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, an enzyme which is responsible for catalyzing an early step in the synthesis of cholesterol. o Indications: -Adjunctive management of primary hypercholesterolemia and mixed dyslipidemia. -Primary prevention of coronary heart disease (myocardial infarction, stroke, angina, and coronary revascularization) in asymptomatic patients with increased total and low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol. o Nursing considerations: -Obtain a diet history, especially with regard to fat consumption. -Evaluate serum cholesterol and triglyceride levels before initiating, after 2-4 wk of therapy, and periodically thereafter. -Monitor liver function tests prior to initiation of therapy and as clinically indicated. If symptoms of serious liver injury, hyperbilirubinemia, or jaundice occurs discontinue atorvastatin and do not restart. May also cause ↑ alkaline phosphatase and bilirubin levels. -If patient develops muscle tenderness during therapy, monitor creatine kinase levels. o Adverse/side effects: -CV: chest pain, peripheral edema -Derm: rash, pruritus -EENT: rhinitis -Endo: hyperglycemia -GI: abdominal cramps, constipation, diarrhea, flatus, heartburn, altered taste, drug-induced hepatitis, dyspepsia, ↑ liver enzymes, nausea, pancreatitis -GU: erectile dysfunction -MS: RHABDOMYOLYSIS, arthralgia, arthritis, immune-mediated necrotizing myopathy, myopathy, myositis -Neuro: amnesia, confusion, dizziness, headache, insomnia, memory loss, weakness -Resp: bronchitis -Misc: HYPERSENSITIVITY REACTIONS (including anaphylaxis and angioedema) o Client teaching/education: -Instruct patient to take medication as directed. Take missed doses as soon as remembered, if more than 12 hrs since missed dose; omit and take next scheduled dose. Do not double up on missed doses. Advise patient to avoid drinking more than one quart of grapefruit juice per day during therapy. Medication helps control but does not cure elevated serum cholesterol levels. -Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smoking. -Instruct patient to notify health care professional if unexplained muscle pain, tenderness, or weakness, especially if accompanied by fever or malaise, or signs and symptoms of liver injury (fatigue, anorexia, right upper abdominal discomfort, dark urine, jaundice) occur. -Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications. -Advise patient to notify health care professional of medication regimen prior to treatment or surgery. -Rep: Instruct females of reproductive potential to use effective contraception during therapy, to notify health care professional promptly if pregnancy is planned or suspected, and to avoid breastfeeding during therapy. -Emphasize the importance of follow-up exams to determine effectiveness and to monitor for side effects.
Describe Defamation of Character and list some examples?
· False communication or communication with careless disregard for the truth with the intent to injure an individual's reputation. · Examples: -After a nurse resigned, her supervising manager wrote defamatory statements in a letter of reference. She mentioned that the nurse was unstable. The nurse could not get another job, but when she found out what the letter of reference had stated, she filed suit. She did not have a history of mental illness. She wanted a part-time job so that she could look after her mother, who was ill. Adherence to the guidelines set by professional ethics would have avoided this suit and many other suits.
Review purpose and normal range of the following lab values: H&H, Potassium, Sodium, HA1C, Creatinine, BUN, Glucose (fasting).
· H&H: -Hemoglobin: 14-17.3 g/dL (males) and 11.7-15.5 g/dL (females) -Hematocrit: 42%-52% (males) and 36%-48% (females) · Potassium: 3.5-5.0 · Sodium: 135-145 · HA1C: want less than or equal to 6.5% · Creatinine: 0.5-1.2 · BUN: 8-21 · Glucose (fasting): 65-99
Describe examples of when the HIPAA Laws can be Breached?
· Health care team members not directly responsible for the client's care access the client's records. When nurses share information with other clients or staff not involved in the care of the client. · If other parts of the client record is copied other than for authorized exchange of documents between health care institutions. For example: o Transfer from a hospital to an extended care facility o Exchange of documents between a general practitioner and a specialist during a consult · Client medical records kept in an unsecure area. Or public display boards to list client names and diagnoses. · Leaving a computer screen up in the middle of the hallway for people passing by to see. · Health care workers sharing their passwords. · Client information being disclosed to unauthorized individuals, including family members who request it and individuals who call on the phone. o Many hospitals use a code system in which information is only disclosed to individuals who can provide the code. o Nurses should ask any individual inquiring about a client's status for the code and disclose information only when an individual can give the code · Communication about a client that takes place in a public setting where it can be overheard by unauthorized individuals. The practice of "walking rounds," where other clients and visitors can hear what is being said, is no longer sanctioned. Taped rounds also are discouraged because nurses should not receive information about clients for whom they are not responsible. Change-of-shift reports can be done at the bedside as long as the client does not have a roommate and no unsolicited visitors are present. · A patient's information being posted on any social media platform.
What Constitutes Invasion of Client Privacy?
· Invasion of privacy as it relates to health care is the release of client health information to others without the client's consent. · Intrusion into a client's private affairs or a breach of confidentiality (a nurse releases the medical diagnosis of a client to a member of the press) · Nurses who disclose client information to an unauthorized person can be liable for invasion of privacy.
Incorporate Maslow's Hierarchy of Needs as a framework for recognizing and prioritizing what actions must come first when providing care.
· Maslow's Hierarchy of Needs (top to bottom): o Self-actualization o Self-esteem o Love and belonging o Safety and security o Physiological · The nurse should consider this hierarchy of human needs when prioritizing interventions. For example, the nurse should prioritize a client's: o Need for airway, oxygenation (or breathing), circulation, and potential for disability over need for shelter. o Need for a safe and secure environment over a need for socialization.
Define NCLEX
· National Council Licensure Examination
Define Negligence
· Negligence: Practice or misconduct that does not meet expected standards of care and places the client at risk for injury (a nurse fails to implement safety measures for a client who has been identified as at risk for falls) · Negligence is an unintentional tort of acting or failing to act as an ordinary, reasonable, prudent person, resulting in harm to the person to whom the duty of care is owed.
Discuss the mechanism of action, indications for use, nursing considerations, adverse/side effects and client teaching/education for the following medications: potassium
· Potassium o Mechanism of action: -Maintain acid-base balance, isotonicity, and electrophysiologic balance of the cell -Activator in many enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion; renal function; tissue synthesis; and carbohydrate metabolism o Indications: -Treatment/prevention of potassium depletion o Nursing considerations: -Assess for signs and symptoms of hypokalemia (weakness, fatigue, U wave on ECG, arrhythmias, polyuria, polydipsia) and hyperkalemia (see Toxicity and Overdose). -Monitor serum potassium before and periodically during therapy. Monitor renal function, serum bicarbonate, and pH. Determine serum magnesium level if patient has refractory hypokalemia; hypomagnesemia should be corrected to facilitate effectiveness of potassium replacement. Monitor serum chloride because hypochloremia may occur if replacing potassium without concurrent chloride. o Adverse/side effects: -CV: ARRHYTHMIAS, ECG changes -GI: abdominal pain, diarrhea, flatulence, nausea, vomiting tablets, capsules only: GI ulceration, stenotic lesions -Neuro: paralysis, paresthesia, confusion, restlessness, weakness o Client teaching/education: -Explain to patient purpose of the medication and the need to take as directed, especially when concurrent digoxin or diuretics are taken. A missed dose should be taken as soon as remembered within 2 hr; if not, return to regular dose schedule. Do not double dose. -Emphasize correct method of administration. GI irritation or ulceration may result from chewing enteric-coated tablets or insufficient dilution of liquid or powder forms. -Instruct patient to avoid salt substitutes or low-salt milk or food unless approved by health care professional. Patient should be advised to read all labels to prevent excess potassium intake. -Advise patient regarding sources of dietary potassium (see food sources for specific nutrients). Encourage compliance with recommended diet. -Instruct patient to report dark, tarry, or bloody stools; weakness; unusual fatigue; or tingling of extremities. Notify health care professional if nausea, vomiting, diarrhea, or stomach discomfort persists. Dosage may require adjustment. -Emphasize the importance of regular follow-up exams to monitor serum levels and progress.
Review blood administration process and principles. (MedSurg book)
· Prior to releasing a blood component for administration to a patient, the blood bank or laboratory carefully matches the intended component to the sample of the patient's blood to ensure that they are compatible using ABO, Rhesus (Rh), and human leukocyte antigen (HLA) testing. · Patient identification and specimen labeling of blood samples collected from the patient require independent identification by TWO separate healthcare providers. · Before the blood component is obtained from the laboratory, the patient's informed consent and an order for the administration of the blood component need to be confirmed. o The order should indicate the type of blood component to be administered, the number of units or volume of the blood component to be infused, the flow rate or duration of the infusion, and other parameters for infusion. o Once the component is obtained from the laboratory, there needs to be verification performed by two licensed staff members, which includes matching the blood product to the order and matching the patient to the blood product. o The blood product should agree with the type of component prescribed, the volume or number of units to be transfused, and the patient's full name and one other patient identifier. · The expiration date and the date and time the component was released from the laboratory need to be confirmed as acceptable. · Immediately prior to starting the blood transfusion, a patient assessment needs to be completed, including baseline vital signs and respiratory status. The nurse needs to include clinical manifestations to immediately report. · Close observation is required to detect any reaction the patient may have, especially during the first 15 minutes when reactions are most likely to occur. Assessments should continue at least every hour for the duration of the transfusion and should include respiratory status; vital sign status; and any complaints of discomfort, dyspnea, or itching.
Define Professionalism and describe why it is important in the nursing profession?
· Professional characteristics or behaviors include: o Consideration o Empathy o Respect o Ethical and moral values o Accountability o Commitment to lifelong learning o Honesty · Professionalism denotes a commitment to carry out specialized responsibilities and observe ethical principles while remaining responsive to diverse recipients. · Professional responsibilities are the obligations that nurses have to their clients. To meet their professional responsibilities, nurses must be knowledgeable in the following areas: client rights, advocacy, informed consent, advance directives, confidentiality and info security, info technology, legal practice, disruptive behavior, and ethical practice.
What are the guiding principles that inform the RN's decision-making about delegation (including appropriate and inappropriate delegation of activities or tasks to different nursing team members)?
· Seven components of the Delegation Decision-Making Grid: o Level of client acuity o Level of unlicensed assistive personnel capability o Level of licensed nurse capability o Possibility for injury o Number of times the skill has been performed by the unlicensed assistive personnel o Level of decision making needed for the activity o Clients ability for self care · For example, the RN assigns the NAP to take vitals but the NAP is already authorized to take vitals. However, if the RN directed the NAP to check the amount of drainage on a fresh postop abdominal dressing, this would be considered delegation because the RN retains responsibility for this action.
Describe the Nurses Code of Ethics and related principles, and why it is important in the nursing profession?
· The ANA Code of Ethics for Nurses provides values, standards, and principles to help nursing function as a profession. · ETHICAL PRINCIPLES are standards of what is right or wrong with regard to important social values and norms. Ethical principles pertaining to the treatment of clients include the following. o Autonomy: The ability of the client to make personal decisions, even when those decisions might not be in the client's own best interest. o Beneficence: Care that is in the best interest of the client. o Fidelity: Keeping one's promise to the client about care that was offered o Justice: Fair treatment in matters related to physical and psychosocial care and use of resources. o Nonmaleficence: The nurse's obligation to avoid causing harm to the client. o Veracity: The nurse's duty to tell the truth. · It is important in the nursing profession to help make decisions regarding care.
What is Client Autonomy?
· The freedom to make decisions for oneself.
Define Confidentiality
· The principle of confidentiality states that anything patients say to nurses and other health-care providers must be held in the strictest confidence. · The Privacy Rule of HIPAA requires that nurses protect all written and verbal communication about clients.
Define and describe Client-Centered Care? (pg.52 ATI)
· The provision of caring and compassionate, culturally sensitive care that addresses client's physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values.
Describe the Good Samaritan Law and provide examples of the application of this law?
· These laws protect health-care professionals from civil liability as long as they behave in the same manner as an ordinary reasonable and prudent professional in the same or similar circumstances. · Examples: -Witnessing a car crash and helping the victims
Describe how the nurse supports Client Autonomy?
· This principle requires that nurses respect patient's rights to make their own choices about treatments. · Nurses often find themselves in a position to protect a patient's autonomy. They do this by preventing others from interfering with the patient's right to proceed with a decision. If a nurse observes that a patient received insufficient information to make an appropriate choice, is being coerced into a decision, or lacks an understanding of the consequences of the choice, then the nurse may act as a patient advocate to ensure the principle of autonomy.
Review blood administration process and principles. (from previous quizlet)
· Verify order and product with 2 RNs · Serial number, type of blood product, blood type, Rh factor, expiration date, 2 patient identifiers · Check VS prior to, at 15 minutes, then hourly · 18 gauge IV · Prime tubing with 0.9% Normal saline · Transfuse whole blood and packed RBC within 4 hours of obtaining from lab · Transfuse plasma, platelets, cryoprecipitate over 20 minutes · Blood transfusion tubing (has special filter) · Start infusion slow (10 gtts/min) and remain at bedside for 15-30 minutes · If reaction occurs: disconnect blood product, get new tubing and run normal saline, take tubing and blood to lab, call provider for new orders.
Nurse's responsibility regarding an Advanced Directive?
● Providing written information regarding advance directives ● Documenting the client's advance directives status ● Ensuring that advance directives are current and reflective of the client's current decisions ● Recognizing that the client's choice takes priority when there is a conflict between the client and family, or between the client and the provider ● Informing all members of the health care team of the client's advance directives · Because directives are often implemented on care units, nurses must be knowledgeable regarding living wills, advance directives, and health care surrogates. They need to be prepared to answer questions that clients may ask about the directives and formed used by the health-care institution. · The responsibility for creating an awareness of individual rights often falls on nurses because they act as client advocates.
