Exam 2 Flashcards
0
Q
1T = tsp
A
3tsp
1
Q
1t = mL
A
5mL
2
Q
mL = 1ounce
A
30 mL
3
Q
1 kg = lb
A
2.2 lb
4
Q
1000 mcg = mg
A
1 mg
5
Q
1,000 mg = g
A
1 g
6
Q
1,000 g = kg
A
1 kg
7
Q
1,000 mL = L
A
1 L
8
Q
Nurses spend ____ of their time giving Meds
A
40%
9
Q
JC national patient safety goal #3
A
Improve safety of using medication
10
Q
Medication order must contain
A
Pt full name, date and time written, name of drug, dosage, route, how often, reason for drug, signature of prescriber
11
Q
6 rights
A
Pt, drug, route, time, dose, documentation
12
Q
Right pt
A
Check pt ID against MAR, 2 pt identifiers
13
Q
Right drug
A
By generic or trade name, should check label 3 times, know why pt is on Meds, always know what drug giving
14
Q
Right route
A
Must be stated in order, never assume
15
Q
Right time
A
Normally by institution, have an hour before or after time to administer, q6h (round the clock 6 12 6 12) QID (4 times while awake 9 1 4 8)
16
Q
Exceptions for times
A
STAT (w/in 30 minutes), PRN, when peak and trough ordered (blood test before and after drug given)
17
Q
Right dose
A
Must be on order, nurse should know recommended dose, accurately calculate any drug calculations, never use trailing zeros, always use leading zeros
18
Q
Right documentation
A
Must document when given, when in doubt call previous nurse to make sure Meds were given, document in MAR
19
Q
If patient is concerned
A
Recheck med and order
20
Q
Always watch
A
Patient take Meds
21
Q
Never give
A
Meds prepared by someone else, Meds from unlabeled container
22
Q
Never leave ____ or try to ____
A
Meds unattended or try to multitask
23
Q
Safety is
A
Freedom from danger, harm or risk; underlies all nursing care; responsibility for all healthcare provider
24
Medical errors are the ____ leading cause of death in the US (CDC)
6th
25
Many people die each year from medical errors that could have
Been prevented
26
Joint commission safety goals (1-4)
1. Improve accuracy of patient identification
2. Improve effectiveness of communication among caregivers
3. Improve safety of using medications
4. complete medication reconciliation
27
Joint commission safety goals 5-9
5. Reduce risk of health care associated infections
6. Reduce risk of patient harm resulting from falls
7. Prevent health care associated pressure ulcers
8. Identifies safety risks inherent in its patient population
9. Universal protocol for preventing wrong site, wrong procedure, wrong person surgery
28
1. Improve accuracy of patient identification
Use 2 identifiers (name, DOB, hospital assigned medical number), be aware of confused patients
29
2. Improve effectiveness of communication among caregivers
Repeat and verify orders, use standard abbreviation list, timely reporting of critical lab/test results, use reporting off guide like ISBARR
30
ISBARR
Identity, situation, back ground info, assessment findings, recomendation, repeat and verify orders
31
3. Improve safety of using medications
Reduce risk of med error, use the 6 rights
32
Reporting a medication error
Assess VS LOC and labs, assess for effects of Meds, contact the prescriber charge nurse and nursing supervisor, fill out paper work, monitor client, modify practice to prevent error
33
4. complete medication reconciliation
Procedure that prevents med error through ongoing assessment and updating the patients med list, verification (collect all of current Meds) clarification (professional review of Meds), reconciliation ( investigation of discrepancies and doc changes
34
complete medication reconciliation should be done on
Admission, status change, transfers, and at discharge patients should be given accurate list
35
6. Reduce risk of patient harm resulting from falls
Complete fall-risk assessment (various tools, pt assessment rounds), administer the "get up and go test", identify high fall risk patients on door chart and armband
36
Interventions for 6. Reduce risk of patient harm resulting from falls
Assisting w/ activities, bed/ chair alarm, non skid socks, 3 rails up, bed in low, call light within reach and restraint as a last resort.
37
What do we do if a patient falls?
Call MD, fill out report
38
Fire safety RACE
R- rescue an remove all patients in immediate danger
A- activate fire alarm
C- contain the fire, close doors and windows turn off o2 supply and electrical equipment
E- evacuate patients and others to safe area/ extinguish the fire if trained to do so
39
QSEN
Quality and safety education for nurses
40
QSEN competencies
1. Patient centered care
2. Teamwork and collaboration
3. Evidence based practice
4. Quality improvement
5. Safety
6. Informatics
41
Patient centered care
Be the patient advocate, encourage family and patient to be involved in care, listen to patient and family concerns
42
Teamwork and collaboration
Communication is key to preventing medical errors, patient safety is a responsibility of all healthcare teams and members including MD residents radiology specialists nutrition nursing
43
Safety includes both
System and human errors
44
Sentinel events
An unexpected occurrence involving death or serious injury
| Sentinel because they require immediate investigation and response
45
Root cause analysis
A process for identifying the factors that underlie variation in performance; a reactive response
46
FEMA
Failure modes and effects analysis
| A systemic evaluation of a process and a look at each step in the process that can fail; a proactive approach
47
Evidence based practice
Using the best current evidence with clinical expertise and patient/ family preferences and values for optimal care
48
Quality improvement
Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to improve the quality and safety of health care systems
49
Informatics
Use information and technology to communicate, manage knowledge, mitigate error, and support decision making
50
Nurse diagnosing
Refers to the reasoning process, statement regarding the nature of a phenomenon, consists of problem statement with diagnostic label plus etiology (cause)
51
NANDA
Part of the diagnostic label, North American Nursing Diagnostic Association
52
Actual Diagnostic
Problems at the time of the assessment, presence of associated sign and symptoms
54
Risk diagnosis
Problem doesn't exist, has risk factors, weak and dizzy=fall risk; doesn't normally include "as evidence by"
55
health promotion diagnosis
preparedness to implement behaviors to improve their health condition; beginning phrase "readiness for enhanced"
56
wellness diagnosis
describes human responses to levels of wellness in an individual family or community; beginning phrase "Readiness for enhanced"
57
syndrome diagnosis
used when diagnosis is associated with a cluster of diagnoses; example: disuse syndrome rape-trauma syndrome
58
problem statement in nursing diagnosis
describes pt response to health problem, leads to outcome
59
Etiology of nursing diagnosis
all related factors and risk factors included; identifies one or more probable causes of health problem
60
As evidence by statement in nursing diagnosis
signs and symptoms, evidence that supports diagnosis
61
the three main parts of a nursing diagnosis
NANDA (diagnostic label), Etiology, as evidence by statement
62
tips for writing outcomes and goals
client centered, clear, measurable, time limited, realistic, blue print for evaluation
63
measurable terms
identify, describe, demonstrate, verbalize, discuss
64
nursing interventions
can be independent or dependent (from md)
65
steps of the implementation
reassessing client, determine nurse's need for assistance, implementing nursing intervention, supervising delegated care, documenting nursing activities
66
evaluation of nursing intervention
collect data for outcomes, draw conclusion about problem, modify or terminate care plan
67
parts of the nursing process
assessment, analysis, planning, implementation, evaluation
68
assessment
collecting all pt data
69
analysis
nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs; the nursing diagnosis; always prioritized
70
planning
Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient; the goals and outcomes
71
implementation
Nursing care is implemented according to the care plan Care is documented in the patient’s record; interventions or actions; only includes one assessment (normally first)
72
evaluation
Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed
73
learning is
the rearrangement of neural pathways resulting in a temporary or permanent change in behavior, can occur without teaching
74
cognitive learning
knowing
75
psychomotor learning
doing
76
affective learning
feeling
77
adult learners
independent, rises from life challenges, like problem solving, are doers, resistant to learning when conflicts with self concepts
78
child learner
little experience to draw on, passive, learn in authority guided situations, subject centered, rely on others to decide what's important
79
adragogy
adult learning
80
pedagogy
child learning
81
assess before client education
motivation (how it benefits), stages of behavioral change (pre-contemplation, contemplation, preparation, action, maintenance, termination)
82
pre-contemplation
I know it's good but..
83
contemplation
I do need to
84
preparation
make a plan
85
action
doing it
86
maintenance
6 months- lifetime
87
termination
old behavior is gone
88
self efficacy
believing you can do it
89
5 rights of teaching
right time, right context, right goal, right content, right method
90
the education process
ASSURE model, A-assess S-state objectives S-select media methods materials U- utilize media methods and materials R-require participation E- evaluate
91
ABCD of good objective writing
A- include audience(client will...) B-behavior(demonstrate) C-condition(for nurse) D- degree (with 100% accuracy)
92
we remember
80% of what we say and do
93
We are ____ for teaching and documenting teaching.
legally responsible
94
Body mechanics
The efficient use of the body as a machine and means of locomotion
95
Nurse can improve balance by
Feet apart (base of support) and flexing hips and knees (lower center of gravity)
96
Factors that affect body alignment
Congenital postural abnormalities, problem with bone formation or joint mobility, problem with CNS, trauma, nutrition, mental health
97
Cardiovascular system with exercise
Increase efficiency of heart and blow flow through the body, decrease heart rate and BP
98
Cardiovascular system with immobility
Increase in cardiac workload pulse rate orthostatic hypotension vein thrombosis (DVT) and valsalva maneuver
99
Virchow triad
Part oF DVT- damage to vessel wall
100
For DVT
Check thigh and calf measurement
101
Musculoskeletal system with immobility causes decrease flexibility or
Contractures (freeze in position) or foot drop (permanent plantar flexion)
102
Shearing force
Skin sticks to object and tears
103
Adequate hydration is
2-3 L
104
What to document when using restraints
Document the need to restrain, alternative attempted, observation every hour
105
Must release the restraint every ____
2 hours
