Exam 1 Questions Flashcards
The Practitioner
Transforms the practice culture through application of discipline-specific work in a manner that ensures regulatory and specialty standards are used in the provision of care and service in a therapeutic manner. Review the American Nurses Association Standards of Practice.
O’Rourke Model of the Professional Role
The Professional Practice Model is a schematic that describes how we, in our nursing role, practice, collaborate, communicate, and develop professionally. It is the foundation for the structure of professional nursing at OHSU and the integrated professional activities performed within that structure. It is creating and fostering a professional practice environment in which a culture exists that supports inquiry, self-reflection, professional development, and peer review in service to improving the unit and organization for all who are present.
What are the different stages of the Nursing Process
AAPIE Assessment Analysis Planning Implementation Evaluation
determine a desired outcome (short term or long term) and create a Nursing Care Plan (NCP)
Planning :
interpret the data to make a nursing diagnosis
Analysis:
: Execute the interventions in order to fulfill the NCP
Implementation
determine if the interventions are working based on the reactions of the client. Do the observable results/statements support success in achieving a desired outcome?
Evaluation:
acquired from the client directly
Primary data
acquired from a family member or someone else on the health team
Secondary data:
this type of data is measurable and indisputable…is considered client focused
Objective data (signs)
What are these all examples of?
Vital signs, weight, skin condition, input/output, lab values, observations of a patient’s behavior /environment (patient’s assessment is considered this too)
Objective Data
what the patient reports to you:
not necessarily measureable, nausea, headaches, dizziness and pain (patient history is considered this too)
Subjective data (symptoms):
is based on a patient’s medical condition or disease
medical diagnosis
is based on patient’s response to an actual or potential health problem
nursing diagnosis
is used to select interventions
diagnosis (either nursing or medical)
What does a nursing diagnosis include?
- P (problem)—NANDA-I label—Example: impaired physical mobility
- E (etiology or related factor)—Example: incisional pain
- S (symptoms or defining characteristics)—briefly lists defining characteristic(s) that show evidence of the health problem. Example: evidenced by restricted turning and positioning page 230
This stage is necessary to measure how effective your nursing interventions are. It is used to determine if the nursing plan and goals are still appropriate. If not, it is essential to modify them accordingly in order to match the patient’s current condition. It is important to record the patient’s responses as well.
Evaluation
Nurses initiate on the basis of their knowledge and skills (scope of practice).
scope like assessing, comfort, emotional support, counseling & teaching
Activities such as skin tests, immunizations, and human blood draws are considered as independent functions (2725 b3). Observing patients’ overall condition - signs and symptoms of sickness, conduct and physical factors (2725 b4A); and responding to these observations given proper endorsement and standardized procedures, changes in patient care or in times of emergency measures (2725 b4) also cover independent functions of the nursing practice.
examples:
Teach the client to do deep breathing and coughing exercise.
Monitoring blood pressure
Independent interventions
Nurse carries out under a doctor’s order (medication or treatments)
“we need to talk…” doctor says to the nurse then nurse administers…
examples:
Administer antipyretic medication as ordered by the physician.
Administer 4 liters of oxygen as ordered.
Dependent Interventions
Nurse carries out with other health care professionals (example psychologists, pharmacists, nutritionists, radiologists, anesthesiologist, physical therapists, medical technologists, etc)
example:
Administer of total parenteral nutrition. The nutritionist is involved in the intervention.
Collaborative Interventions (also called Interdependent Nursing Intervention)
Who has access to patient data?
health care providers for treatment
patient or the patient’s personal representative it was permitted authorization/consent
HHS for complaint investigation, compliance review or enforcement; required by law for compliance with the HIPAA Transactions Rule or other HIPAA Administrative Simplification Rules
Others (reasonable reliance consent by the patient)
a public official, a professional (such as an attorney or accountant) who is the covered entity’s business associate, seeking the information to provide services to or for the patient, a researcher who provides the documentation or representation required by the Privacy Rule for research
What kind of Data is recorded in patient files?
the minimum amount of protected health information needed to accomplish the intended purpose of the use disclosure, or request.
What are the interviewing skills?
Plan the time and place of the interview
Allow the exchange to be uninterrupted and unhurried be at eye level
Assure confidentiality
What are the stages of the interview
(1) setting the stage, (2) gathering information about the patient’s chief concerns or problems and setting an agenda, (3) collecting the assessment or a nursing health history, and (4) terminating the interview. (Potter 212)
What are acceptable temperature ranges for adults?
36° to 38° C (96.8° to 100.4° F)
What are acceptable respiration ranges for adults?
12 to 20 breaths/min
Which temperature methods are body core readings?
oesophagus, pulmonary artery or urinary bladder
Which temperature methods are body surface readings?
oral, axillary, temporal, tympanic
What is average blood pressure for adults?
Average: <120/80 mm Hg
How do you calculate pulse pressure?
Pulse pressure= (Systolic - Diaystolic):
What is the average pulse pressure of an adult?
30 to 50 mm Hg
What is the average pulse of an adult?
60 to 100 beats per minute
Which sites are more accurate temperature readings? Core sites or surface sites?
Core sites
easily accessible, comfy, accurate surface reading, reflect rapid change in core temp, reliable in intubated pt, delay if pt recently ingested food/liquid, not for oral surgery/facial trauma, not for infants, kids, confused, risk for body fluid exposure
Oral temperature reading
Where do you place the probe stem with plastic cover to get a temp reading orally?
posterior sublingual pocket lateral to center
this temperature reading method is easily accesible, get without disturbing pt, pt with tachypnea w/o disturbing breathing, accurate core reading, 2-5 sec, unaffected by intake food/liquid, used in newborns, variability of measurement, need to remove hearing aid, not for ear surgery pt, affected by ambient temp devices (heater, fans), hard to do in kids
Tympanic
How do you get a tymApanic temperature reading?
right ear if right handed, left ear if left handed, ear wax?, slide disposable cover over lens tip until locks, pull ear pinna backward, up, and out, fit tip snug, point toward nose, press scan, beeps
this temperature readinng method is reliable, lag behind core temp during rapid change, not for diarrhea/rectal surgery, requires positioning, risk for body fluid exposure, requires lube, not for infants, impacted stool mess up readings, invasive
Rectal temp reading
safe/inexpensive, for newborns, unconscious, long measurement time, continuous positioning, measurement lags behind core temp during rapid temp change, not for fever in kids, exposure of thorax, temp loss in newborns, underestimates core temp
axilla temp reading
draw curtains, supine or sitting, move clothing, probe stem to plastic cover until it locks, raise pt arm, dry axilla if needed, put probe into center of axilla, lower arm over probe, arm across chest, hold until it beeps
method of axilla reading
easy, rapid, comfy, no need to disrobe, for premmies, newborns, kids, reflects rapid change in core temp, sensor cover not required, inaccurate with head covering, affected by skin moisture
method of temporal temp reading
dry forehead, sensor firmly on forehead, red scan button, slide across forehead, sensor flat and firmly on skin, clean sensor
temporal temperature reading
increase heat loss, reduce heat production, prevent complications; interventions - blood cultures, min heat production - limit physical activity, max heat loss - reduce coverings, keep clothing/bed linen dry, antipyretics, maybe drug sensitivity, antibiotics maybe, environment temp 70-80,
method for treating a fever
Means the same as evaluation
Conducting reflective practice
(analyzing information, gathering additional findings, and sensing a problem), and self-confidence
Critical thinking concepts
Pain scale is an example of which intellectual standard
Consistency
a symptom that occurs along with a primary symptom
concomitant symptom: an accessory symptom to the primary symptom
an immunization shot is an example of what type of prevention
Primary prevention
rimary prevention involves preventing risk factors that lead to chronic diseases, infections and injuries. Types of primary prevention include vaccination, condom usage, and nutrition. Secondary prevention reacts to prevent further exacerbation of a known problem. Types of activities used in secondary prevention include using medication to treat conditions such as high blood pressure or high cholesterol
What is always patient centered?
The goal (nothing is care provider centered)
What is the goal for an “at risk diagnosis”
to avoid or prevent the condition at risk (referr question 5 CH 20)
What is the goal for a nursing diagnosis
Provides a precise definition of a patient’s problem that gives nurses and other members of the health care team a common language for understanding the patient’s needs
- Allows nurses to communicate (e.g., written and electronic) what they do among themselves with other health care professionals and the public
- Distinguishes the nurse’s role from that of the physician or other health care provider
- Helps nurses focus on the scope of nursing practice
- Fosters the development of nursing knowledge
- Promotes creation of practice guidelines that reflect the essence of nursing (Potter 224)
Engages in evidence-based clinical practice standards and performance; links professional role competency with clinical, service, and financial outcomes. Review the ANA Standards for Professional Practice related to Quality of Practice, Practice Evaluation, Education, and Research.
The Scientist Role
