Ethical, Legal, Cultural, Safety Flashcards
most effective teaching strategy
teach back or return demo
native hawaiian problem
SIDS
kosher diet
-meat and milk not eaten together
-seafood w/o fins and scales not allowed
yin yang
yin cold
yang hot
best approach if pt speaks different language
interpreter/translator
jehova’s witness
any blood containing products
avoid admiring child
hispanic
illness are attributed to overexertion
chinese
use of herbal medicines w/ healing properties
native americans
abandonment
RN walks out esp when understaffed
negligence vs malpractice
unintentional vs intentional harm
assault
threat
intentional touching w/o consent
battery
not allowing pat to leave
false imprisonment
written defamation
libel
oral/verbal defamation
slander
deliberate deception to gain
fraud
discourages organ donation
orthodox church
body parts SHOULD NOT be removed, donated or transplanted
islam
organ transplant if allowed by rabbi
after autopsy, body parts must be buried together
orthodox judaism
self determination (independence)
autonomy
no harm
nonmaleficence
do good
beneficence
equal distribution
justice
truth
veracity
fulfill promises
fidelity
staff assignment criteria
acuity of pts
skills of staff
tornado protocol
doors and windows closed
curtains down
beds away from windows
blankets over bed confined pts
ambulatory pts in the hallway away from windows & doors
if staff is doing illegal
report to sup
if staff will be doing an immediate harm to others
confront
if staff is doing something inappropriate
approach/counsel later on
fire RACE
rescue
activate alarm
confine
extinguish
fire PASS
fire extinguisher
pull pin
aim at the base
squeeze handle
sweep side to side
fire safety
turn off oxygen & appliances
dont use elevator
on life support: ambu bag manually
ambulatory: move away or help pts on wheelchair
electrical safety
3 pronged cord
no overloading
no wire under carpet
no electric at sink or w/ water source
extension wire only when necessary and tape
if pt had electrical shock, FIRST turn off electricity before touching pt
radiation safety
label radioactive materials
keep bedlinens til implant removed
use of dosimeter (film badge) for exposure level
pt w/ implant in a private room
do not touch dislodged implants
reduce radiation exposure by
limit time
make a reasonable distance
use shield device (lead apron)
prevent needle stick injury by
-proper disposal (close, puncture-resistant, leak-proof, colorcoded, properly labeled)
-not recapping, bending or breaking needles
use of side rails is not considered a restraint when
they are used to prevent a sedated client from falling out of bed
rules of side rails
bed positioned at lowest
top two side rails up for emergency
rules of restraints
-ordered by the physician
-not PRN
-assess body part on restraint q 30mins & release q 2hrs
-offer liquid & toilet q 2hrs
alternative to safety devices for confused
-place pt near station
-always open the door
-place familiar objects in the room
-objects w/ visual & auditory stimuli (clock, calendar, TV, radio)
poison control
-remove any possible poisonous
-call poison control center
-if vomiting, save the vomitus
-never induce vomiting if household items (lye-soap making, bleach etc), petroleum products, grease were ingested
donning ppe
gown
mask
face shield
gloves
removing ppe
gloves
face shield
gown
mask
Z track method
ventrogluteal muscles
im esp deltoid (max volume)
& sq
im 3ml
deltoid 2ml
sq 1.5ml
combining insulin (which comes first)
RN
regular then NPH
post op autograft, skin graft
immobilize 3 to 7 days
skin: elevate & avoid lifting
(give time for the graft to adhere & prevent movement & shearing of graft)
position: burns face & head
elevate head of bed
(prevent/reduce edema)
position: burns in extremities
elevate extremities above heart level
(prevent/reduce dependent edema)
position: mastectomy
semi fowlers
affected arm elevated w/ pillow
(promote lymphatic fluid return)
position: perineal & vaginal procedures
lithotomy
position: hypophysectomy
elevate HOB
(prevent ⬆️ icp)
position: thyroidectomy
semi fowlers to fowlers
avoid neck extension
sandbags or pillows to support head or neck
(reduce swelling & edema)
position: hemorrhoidectomy
lateral/side lying
(prevent pain/bleeding)
position: GERD
reverse trendelenberg (slanting head high)
(promote gastric emptying & prevent reflux)
position: liver biopsy during procedure
right side upper abdomen exposed
right arm behind head
position: liver biopsy after procedure
right lateral/right side lying w/ small pillow/folded towel in the puncture site
position: paracentesis
semi fowlers or
sit up right on the side of bed or
chair w/ feet supported
position: NGT insertion
high fowlers
head tilted forward
(closes trachea & opens esophagus)
position: irrigation & tube feedings
semi fowlers
fowlers
(prevent aspiration)
also maintained elevated 30mins to 1hr after feeding
position: rectal enema & irrigations
sims position
-between prone to supine
-left side lying
-left leg flexed, right leg slightly bent
-left arm flexed in front, right arm resting straight at the back
(allow gravity to flow to the natural direction of the colon)
position: Sengstaken-Blakemore and Minnesota tubes
fowlers (enhance lung expansion, portal blood flow & permitting effective tamponade of the esophagus)
position: copd
tripod position but arms supported w/ pillows or overbed table (to breathe easier)
position: laryngectomy / radical neck dissection
semi fowlers/fowlers
(prevent edema & maintain patent airway)
position: post bronchoscopy
semi fowlers
(prevent choking/aspiration)
position: postural drainage
lung segment to be drained should be in the uppermost position
or trendelenberg may be used (slanting, feet elevated)
position: thoracentesis during procedure
-sitting at edge of bed, leaning over bedside table w/ feet supported on stool OR
-lying on the unaffected side, affected side exposed on Fowlers
position: thoracentesis after procedure
position of comfort
positio : abdominal aneurysm resection
side to side BUT
head elevated not more than 45°
(avoid flexion of graft)
position: amputation of lower extremity
*24hrs post op
elevate unaffected foot
(reduce edema)
residual limb w/ pillow but not elevated
*after 24hrs, residual limb flat on bed w/ limb wrapping techniques
(risk of flexion contractures)
*prone positon 20-30mins/day
(stretch muscles & prevent hip flexion contractures)
position: arterial vascular grafting of an extremity
-24hr bed rest
-affected extremity kept straight
-limit movement & avoid flexion of hip & knee
(promote graft patency)
position: cardiac catheterization
if femoral vessel was accessed:
bed rest 4 to 6hrs
then turn side to side
affected extremity kept straight
elevate head of bed not > than 30°
position: heart failure & pulmonary edema
upright
preferably legs dangling
(decrease venous return & lung congestion)
position: peripheral arterial disease
elevate feet but legs not above heart
(promote enough arterial blood flow)
position: DVT
24hrs bed rest w/ leg elevation
out of bed if receiving heparin & tolerable pain
position: varicose veins
elevate legs above heart
minimize prolonged sitting or standing
position: venous insufficiency & leg ulcers
elevate leg
position: cataract surgery
immediate post op: semi or fowlers
on the back or nonoperative side
(prevent edema)
position: retinal detachment
bed rest
bilateral eye patching
(minimize eye movement & prevent extension of detachment)
position: autonomic dysreflexia
high fowlers
(promote ventilation, prevent hypertensive stroke)
position: cerebral aneurysm
bed rest
elevate head of bed 30 to 45°
(prevent pressure)
position: cerebral angiography
bed rest
extremity where contrast injected immobilized & kept straight for 6 to 8hrs
position: hemorrhagic stroke
head of bed elevated 30°
(reduce ICP)
position: ischemic stroke
head flat on bed
(helps blood flow velocity)
position: craniotomy
elevate head of bed 30 to 45°
affected site not to be covered
maintain head neutral & midline
(facilitate venous drainage)
avoid hip flexion
(reduce intrathoracic pressure)
avoid knee flexion
(facilitate venous drainage)
position: laminectomy & other vertebral surgery
post op out of bed but w/ back braces
back kept straight w/ feet supported
position:⬆️ icp & *stroke
elevate head of bed 30 to 45°
maintain head neutral & midline
(facilitate venous drainage)
avoid hip flexion
(reduce intrathoracic pressure)
avoid knee flexion
(facilitate venous drainage)
position: lumbar puncture
during procedure
-lateral/side lying, back bowed, neck flexed that chin resting on chest, knees flexed up to abdomen
after procedure
-supine 4 to 12hrs
position: spinal cord injury
-immoblize w/ spinal backboard
-head neutral (prevent further injury)
-immobilize head with firm padded cervical collar
-log roll
position: total hip replacement
-avoid extreme internal and external rotation
-Avoid adduction; in most cases sidelying is permitted as long as an abduction pillow is in place
-Maintain abduction when in supine or positioned on the nonoperative side
-Place a wedge (abduction) pillow between legs to maintain abduction
-instruct not to cross the legs
ergonomic principles
-call for help or use mechanical aids
-encourage pt to help/assist
-avoid twisting
-keep back, neck, pelvis, feet aligned
-knees flexed, feet wide apart
-position close to pt
-raise bed for weight at your center of gravity
-use arms and legs not back
-tighten abdominal & gluteal muscles
trochanter rolls
prevents legs from moving outward
wedge pillow
triangle placed between legs to maintain abduction after total hip replacement surgery
sarin
chemical warfare agent
highly toxic nerve gas
phosgene
chemical warfare agent
colorless gas used in chemical manufacturing
mustard gas
chemical warfare agent
yellow to brown color
garlic-like odor
irritates the eyes
causes skin burns & blisters
