Ch 6, 7, & 32 Flashcards
Advocacy
protection and support of another’s rights
Autonomy
self-determination; being independent and self-governing
Beneficence
principle of doing good
Bioethics
ethics that encompass all those perspectives that seek to understand human nature and behavior, the domain of social science, and the natural world
Care-Based Approach
approach to bioethics that directs attention to the specific situations of individual patients viewed within the context of their life narrative
Code of Ethics
principles that reflect the primary goals, values, and obligations of the profession
Conscientious Objection
refusal to participate in certain types of treatment and care based on the nurse’s personal and professional ethical beliefs and standards
Deontologic
ethical system in which actions are right or wrong independent of the consequences they produce
Moral Agency
ability to behave in an ethical way; to do the ethically right thing because it is the right thing to do
Ethical Dilemma
situation that arises when attempted adherence to basic ethical principles results in two conflicting courses of action
Ethics
system dealing with standards of character and behavior related to what is right and wrong
Feminist Ethics
type of ethical approach that aims to critique existing patterns of oppression and domination in society; especially as these affect women and poor
Fidelity
keeping promises and commitments made to others
Justice
process that distributes benefits, risks, and costs fairly
Moral Resilience
developed capacity to respond well to morally distressing experiences and to emerge strong
Morals
like ethics, concerned with what constitutes right action; more informal and personal than ethics
Nonmaleficence
principle of avoiding evil
Nursing Ethics
subset of bioethics; formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments
Principle-Based Approach
approach to bioethics that states that the rightness or wrongness of an action depends on the consequences of the action
Values
set of beliefs that are meaningful in life and that influence relationships with others
Value System
organization of values ranked along a continuum of importance
Values Clarification
process by which people come to understand their own values and value systems
Virtues
human excellences; cultivated dispositions of character and conduct that motivate and enable us to be good human beings
Law
a standard or rule of conduct established and enforced by the government
Four sources of law exist at both the federal and state level
constitution
statutory law
administrative law
common law
Litigation
the process of bringing and trying a lawsuit
Credentialing
refers to the way professional competence is ensured and maintained
Three Processes for credentialing in nursing
accreditation
licensure
certification
Accreditation
as in a school
Licensure
met minimum requirements (government)
Certification
non-governmental association grants recognition
Intentional Torts
assault (threat) and battery (assault carried out)
defamation of character (slander=spoke, libel=written)
invasion of privacy (breaking HIPAA)
false imprisonment
fraud (deceitfulness)
Unintentional Torts
negligence
malpractice (negligence from professional)
elements of liability
standards of care
Competent Practices for Nurses
developing and maintaining interpersonal communication skills
respecting legal boundaries of practice (follow rules)
following institutional procedures and policies
owning personal strengths and weaknesses
evaluating proposed assignments; refusing to accept responsibilities for which you are unprepared
keep current in nursing knowledge and skills
respecting patient rights and developing rapport with patients
working within the facility to develop and support management policies
keeping careful documentation
Document All:
clinical observations and critical diagnostics
conversations with other providers regarding patient issues
which specific health care provider was notified of which specific concerns at what specific time
that the chain of command has been engaged when necessary
Cover Your Ass
make SURE the medical record reflects that you pursued your concerns to resolution
Competent practice includes developing sensitivity to common sources of patient injury such as:
falls
restraints
malfunctioning equipment
taking measures to prevent patient injury
Issues Affecting Competence
cause improper care or incompetence
nurse fatigue (burnout) and impaired nurse (addiction/substance abuse)
Informed Consent
In all health care facilities, informed and voluntary consent is needed for:
admission
diagnostics
treatment procedures
A signed consent is not needed in which situations?
emergency; if there is immediate threat to life or health
Who is responsible for obtaining informed consent?
whoever is doing the procedure/treatment (physician or surgeon)
What is the role of the nurse when obtaining informed consent?
confirm informed consent is signed and in patient’s chart before procedure/treatment
Nursing Responsibilities
patient education (must be done by RN)
executing provider orders
delegating nursing care (to LPNs or CNAs)
documentation (EVERYTHING)
appropriate use of social media
whistle-blowing (standing up for what is right)
professional liability insurance
adequate staffing
Purpose of Risk Management
identify, analyze, and treat risks as well as reduce malpractice claims
Near Miss
error that would have happened except for someone’s alertness and ability to identify and prevent the error
Just Culture
encourages open reporting of errors, recognizes that errors may be systemic rather than personal failures and focuses on determining the root of the problem
3 Types of behaviors contribute to errors
human error (unintentional)
at-risk behavior (cutting corners)
reckless behavior (disregard all safety measures)
Incident Reports are also called
variance or occurrence reports
Incident Reports are used by
health care facilities to document the occurrence of anything out of the ordinary that results in, or has the potential to result in, harm to a patient, employee, or visitor
What results from ignoring mistakes
more harm than good
Should documentation in the patient record include the fact that an incident report was filed?
NO
Patient Rights
addresses the expectations, rights, and responsibilities of the patient while receiving care in the hospital
Good Samaritan Laws
designed protect health care providers when they give aid to people in emergency situations
Student Liability
states you are responsible for your own practice, including negligence that may result in patient injury
Never Events
extremely rare events that should never happen to a patient
OSHA (Occupational Safety and Health)
reduce work-related injuries and illnesses (safety standards)
Controlled Substances
laws that regulate the distribution and use of controlled substances
Reporting Obligations
communicable diseases (STDs)
rape
abuse such as
-physical
-verbal
-sexual
-emotional
-neglect
-abandonment
Discrimination and Sexual Harassment
Civil RIghts Act of 1964 says you cannot discriminate based on race, color, religion, sex, or national origin. Pregnant women are protected as well.
HIPAA (Health Insurance Portability and Accountability Act)
privacy
Restraints
long-term care residents have the right to be free
People w/ Disabilities
protects people w/ mental, physical disabilities, people w/ communicable diseases, and people recovering from alcohol and drug abuse
Wills
intentions of a testator to be carried out upon his or her death
Legal Issues related to death and dying
advance directives, DNR, assisted suicide, direct voluntary euthanasia, organ donation, autopsy, and inquest
Abscess
collection of infected fluid that has not drained
Bandage
piece of gauze or other material used to cover wound
Biofilm
thick grouping of microorganisms
Debridement
cleaning away devitalized tissue and foreign matter from wound
Dehiscence
separation of layers of surgical wound; may be partial, superficial, or a complete disruption of surgical wound
Dermis
below epidermis
nerves, hair follicles, and blood vessels
made of collagen
Desiccation
dehydration; process of being rendered free from moisture
Dressing
protective covering placed over a wound
Epidermis
top layer
protective, made of keratin
Epithelialization
stage of wound healing in which epithelial cells form across the surface of a wound; tissue color ranges from color of “ground glass” to pink
Erythema
redness of the skin
Eschar
thick, leathery scab or dry crust that is necrotic and must be removed for adequate healing to occur
Evisceration
protrusion of viscera through an incision
Exudate
fluid that accumulates in a wound; may contain serum, cellular debris, bacteria, and white blood cells
Fistula
abnormal passage from an internal organ to the skin or from one internal organ to another
Friction
occurs when 2 surfaces rub together against each other; resulting injury resembles an abrasion and can also damage superficial blood vessels directly under skin
Granulation Tissue
new tissue that is pink/red in color and composed of fibroblasts and small blood vessels that fill an open wound when it starts to heal
Hematoma
localized mass of usually clotted blood
Ischemia
deficiency of blood in a particular area
Maceration
softening through liquid; overhydration
Necrosis
death of cells and tissues
Negative Pressure Wound Therapy
NPWT; activity that promotes wound healing and closure through application of uniform negative pressure on the wound bed, reduction in bacteria in the wound, and removal of excess wound fluid
Pressure Injury
localized damage to skin and underlying tissue that usually occurs over a bony prominence or is related to the use of a (medical or other) device; any lesion caused by unrelieved pressure that results in damage to underlying tissue; formerly known as pressure ulcer
Purulent Drainage
comprised of WBCs, liquefied dead tissue debris, and both dead and live bacteria
Sanguineous Drainage
containing or mixed with blood
Scar
connective tissue that fills a wound area
Serosanguineous Drainage
mixture of serum and red blood cells
Serous Drainage
composed of clear, serous portion of the blood and from serous membranes
Shear
force created when layers of tissue move on one another
Subcutaneous Tissue
underlying layer that anchors the skin layers to the underlying tissues of the body
adipose tissue (where fat for energy is stored)
cushion for protection
Wound
a break or disruption in the normal integrity of the skin and tissues
The skin is the body’s first line of
defense
The skin is continuous with
mucous membranes
Layers of the Skin
Epidermis
Dermis
Subcutaneous
Skin Functions
protection
temperature regulation
vitamin D production (from sun)
immunologic (destroy harmful microbes)
absorption
elimination (sweat glands)
Mucous Membranes
line body cavities, joining with the skin
also found in GI tract, respiratory passages, and urinary and reproductive tracts
function to absorb substances from their surface
Developmental Considerations that Affect Skin Integrity
kids <2 have thinner skin
skin becomes resistant to injury w/ age because it grows thicker
older adults have thinner skin
State of Health Affecting Skin Integrity
very thin/obese population
dehydration
exposure to long term moisture
jaundice
disease of the skin (eczema or psoriasis)
Ecchymosis
bruising
Intentional Wound
planned, invasive
surgery, lumbar punctures, IV therapy
Unintentional Wound
accidental
trauma, burns, stabbing
Open Wound
occurs w/ trauma and surgery
when skin integrity is comprised
Closed Wound
when skin is not broken, but underlying tissues are damaged
internal injuries, hematoma, bruising
Acute Wound
short-term
surgical incisions
Chronic Wound
long-term
delayed healing time
Wound Healing Stages
hemostasis
inflammatory phase
proliferation phase
maturation phase
Hemostasis
occur at time of injury
blood vessels constrict, blood clotting will begin with platelet activation and blood vessels dialate, capillary permeability increase allowing plasma to leak out
bleeding, clear fluid, start of scabbing
Inflammatory Phase
couple days after injury
leukocytes sent to ingest bacteria and macrophages sent to ingest debris, signal growth factors to create new epithelial cells and blood vessels to begin healing process
acute inflammation: redness, swelling, drainage, increase temp
Proliferation Phase
when regeneration phase of new tissue is built by fibroblast (skin begins to start growing back together), capillaries growing across wound, most WBCs left, body starts making collagen to form back skin
BE EXTRA CAREFUL
Maturation Phase
3 weeks post-injury
when collagen formed strengthens and wound starts looking more like adjacent tissues
Factors Affecting Wound Healing (diagnoses)
dehydration
maceration
trauma
edema
infection
excessive bleeding
necrosis
biofilm
Factors Affecting Wound Healing (environmental)
age
circulation and oxygenation
nutritional status
wound etiology (cause of wound)
medications/health status
immunosuppression (AIDS/HIV)
adherence to treatment (non-compliant)
Wound Complications
infection (bacteria can invade at time of trauma)
hemorrhage (bleeding, post-surgical is common)
dehiscence (splitting of wound)
evisceration (complete separation of wound, usually in abdomen)
fistula formation
Factors in Pressure Injury Development: Two Mechanisms
External Pressure: compressing blood vessels so blood supply is unable to get through and tissue dies (leads to ischemia)
Friction/Shear
Who is at risk for Pressure Injury?
immobility (unconscious or paralyzed)
nutrition and hydration
moisture (increase risk of trauma)
mental status (interfere w/ body awareness)
age
Psychological Effects of Wounds and Pressure Injuries
pain, anxiety/fear, ADLs
Assessing Wounds
appearance of the wound - location, size (mm), peri-wound
drainage - color and odor
sutures and staples and dermabond
Nursing Interventions to Prevent Pressure Injuries
assess for risk of pressure injuries (braden scale)
nutritional status
moisture exposure
previous injuries
assess skin every shift
manage pressure load
cleanse skin regularly
avoid using hot water
skin moisturizer (for dry skin)
humidifiers for dry climates
make sure drink water
avoid massaging bony prominences
minimize friction and shearing
pressure relieving devices
increase mobility
encourage patients to make frequent position changes
promote adequate nutrition (high protein)
investigate nutritional deficiencies
Cleaning a Wound
gentle
use mechanical/chemical force to remove debris
use normal saline, cleansing sprays prescribed to patient
irrigate wound w/ what’s ordered
Removing a Dressing
standard precautions
gentle
edges first, pulling in direction of hair growth, stabilize skin while pulling tape back
can use moist saline if having troubles
don’t cause further damage
Applying a Dressing
apply skin layer around wound (vaseline)
ensure dressing is just on wound
Securing a Dressing
self-adhesive (when possible)
gauze roll, bandages, tape
Closed Wound Drainage Systems
Chest Tube
Jackson-Pratt
T-Tube
Hemovac
Open Wound Drainage Systems
Penrose Drain
Gauze Packed
Dry Heat Therapy
bags of hot water
heating pads
hot packs
Moist Heat Therapy
warm washcloths
warm soaks
sips bath (perineal area)
Dry Cold Therapy
ice bags
cold packs
frozen vegetables
Moist Cold Therapy
cool washcloths
lukewarm baths (soaks)
