Exam 2 Flashcards
1T = tsp
3tsp
1t = mL
5mL
mL = 1ounce
30 mL
1 kg = lb
2.2 lb
1000 mcg = mg
1 mg
1,000 mg = g
1 g
1,000 g = kg
1 kg
1,000 mL = L
1 L
Nurses spend ____ of their time giving Meds
40%
JC national patient safety goal #3
Improve safety of using medication
Medication order must contain
Pt full name, date and time written, name of drug, dosage, route, how often, reason for drug, signature of prescriber
6 rights
Pt, drug, route, time, dose, documentation
Right pt
Check pt ID against MAR, 2 pt identifiers
Right drug
By generic or trade name, should check label 3 times, know why pt is on Meds, always know what drug giving
Right route
Must be stated in order, never assume
Right time
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)
Exceptions for times
STAT (w/in 30 minutes), PRN, when peak and trough ordered (blood test before and after drug given)
Right dose
Must be on order, nurse should know recommended dose, accurately calculate any drug calculations, never use trailing zeros, always use leading zeros
Right documentation
Must document when given, when in doubt call previous nurse to make sure Meds were given, document in MAR
If patient is concerned
Recheck med and order
Always watch
Patient take Meds
Never give
Meds prepared by someone else, Meds from unlabeled container
Never leave ____ or try to ____
Meds unattended or try to multitask
Safety is
Freedom from danger, harm or risk; underlies all nursing care; responsibility for all healthcare provider
Medical errors are the ____ leading cause of death in the US (CDC)
6th
Many people die each year from medical errors that could have
Been prevented
Joint commission safety goals (1-4)
- Improve accuracy of patient identification
- Improve effectiveness of communication among caregivers
- Improve safety of using medications
- complete medication reconciliation
Joint commission safety goals 5-9
- Reduce risk of health care associated infections
- Reduce risk of patient harm resulting from falls
- Prevent health care associated pressure ulcers
- Identifies safety risks inherent in its patient population
- Universal protocol for preventing wrong site, wrong procedure, wrong person surgery
- Improve accuracy of patient identification
Use 2 identifiers (name, DOB, hospital assigned medical number), be aware of confused patients
- 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
ISBARR
Identity, situation, back ground info, assessment findings, recomendation, repeat and verify orders
- Improve safety of using medications
Reduce risk of med error, use the 6 rights
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
- 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
complete medication reconciliation should be done on
Admission, status change, transfers, and at discharge patients should be given accurate list
- 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
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.
What do we do if a patient falls?
Call MD, fill out report
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
QSEN
Quality and safety education for nurses
QSEN competencies
- Patient centered care
- Teamwork and collaboration
- Evidence based practice
- Quality improvement
- Safety
- Informatics
Patient centered care
Be the patient advocate, encourage family and patient to be involved in care, listen to patient and family concerns
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
Safety includes both
System and human errors
Sentinel events
An unexpected occurrence involving death or serious injury
Sentinel because they require immediate investigation and response
Root cause analysis
A process for identifying the factors that underlie variation in performance; a reactive response
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
Evidence based practice
Using the best current evidence with clinical expertise and patient/ family preferences and values for optimal care
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
Informatics
Use information and technology to communicate, manage knowledge, mitigate error, and support decision making
Nurse diagnosing
Refers to the reasoning process, statement regarding the nature of a phenomenon, consists of problem statement with diagnostic label plus etiology (cause)
NANDA
Part of the diagnostic label, North American Nursing Diagnostic Association
Actual Diagnostic
Problems at the time of the assessment, presence of associated sign and symptoms
Risk diagnosis
Problem doesn’t exist, has risk factors, weak and dizzy=fall risk; doesn’t normally include “as evidence by”
health promotion diagnosis
preparedness to implement behaviors to improve their health condition; beginning phrase “readiness for enhanced”
wellness diagnosis
describes human responses to levels of wellness in an individual family or community; beginning phrase “Readiness for enhanced”
syndrome diagnosis
used when diagnosis is associated with a cluster of diagnoses; example: disuse syndrome rape-trauma syndrome
problem statement in nursing diagnosis
describes pt response to health problem, leads to outcome
Etiology of nursing diagnosis
all related factors and risk factors included; identifies one or more probable causes of health problem
As evidence by statement in nursing diagnosis
signs and symptoms, evidence that supports diagnosis
the three main parts of a nursing diagnosis
NANDA (diagnostic label), Etiology, as evidence by statement
tips for writing outcomes and goals
client centered, clear, measurable, time limited, realistic, blue print for evaluation
measurable terms
identify, describe, demonstrate, verbalize, discuss
nursing interventions
can be independent or dependent (from md)
steps of the implementation
reassessing client, determine nurse’s need for assistance, implementing nursing intervention, supervising delegated care, documenting nursing activities
evaluation of nursing intervention
collect data for outcomes, draw conclusion about problem, modify or terminate care plan
parts of the nursing process
assessment, analysis, planning, implementation, evaluation
assessment
collecting all pt data
analysis
nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs; the nursing diagnosis; always prioritized
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
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)
evaluation
Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed
learning is
the rearrangement of neural pathways resulting in a temporary or permanent change in behavior, can occur without teaching
cognitive learning
knowing
psychomotor learning
doing
affective learning
feeling
adult learners
independent, rises from life challenges, like problem solving, are doers, resistant to learning when conflicts with self concepts
child learner
little experience to draw on, passive, learn in authority guided situations, subject centered, rely on others to decide what’s important
adragogy
adult learning
pedagogy
child learning
assess before client education
motivation (how it benefits), stages of behavioral change (pre-contemplation, contemplation, preparation, action, maintenance, termination)
pre-contemplation
I know it’s good but..
contemplation
I do need to
preparation
make a plan
action
doing it
maintenance
6 months- lifetime
termination
old behavior is gone
self efficacy
believing you can do it
5 rights of teaching
right time, right context, right goal, right content, right method
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
ABCD of good objective writing
A- include audience(client will…) B-behavior(demonstrate) C-condition(for nurse) D- degree (with 100% accuracy)
we remember
80% of what we say and do
We are ____ for teaching and documenting teaching.
legally responsible
Body mechanics
The efficient use of the body as a machine and means of locomotion
Nurse can improve balance by
Feet apart (base of support) and flexing hips and knees (lower center of gravity)
Factors that affect body alignment
Congenital postural abnormalities, problem with bone formation or joint mobility, problem with CNS, trauma, nutrition, mental health
Cardiovascular system with exercise
Increase efficiency of heart and blow flow through the body, decrease heart rate and BP
Cardiovascular system with immobility
Increase in cardiac workload pulse rate orthostatic hypotension vein thrombosis (DVT) and valsalva maneuver
Virchow triad
Part oF DVT- damage to vessel wall
For DVT
Check thigh and calf measurement
Musculoskeletal system with immobility causes decrease flexibility or
Contractures (freeze in position) or foot drop (permanent plantar flexion)
Shearing force
Skin sticks to object and tears
Adequate hydration is
2-3 L
What to document when using restraints
Document the need to restrain, alternative attempted, observation every hour
Must release the restraint every ____
2 hours
