Exam 2 Modules 4-6 Flashcards
Layers of the CJM
o Layer 0: clinical decisions
o Layer 1: comprises the outcome = clinical judgement
o Layer 2: form, refine hypotheses; evaluation
o Layer 3: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes ▪ Not linear
o Layer 4: context (individual and environmental factors)
Components of CJM Layer 3
recognize & analyze cues
prioritize hypotheses
generate solutions
take action
evaluate outcomes
What do you include in shift report to oncoming nurse?
demographics, relevant med hx, current treatments, pt’s response to interventions, pending labs, procedures, current status, plan of care, concerns
Use I-SBAR-R
Assertive communication
SBAR, open, direct, honest, and non-judgmental
Passive vs Aggressive communication
Passive- I don’t count, you do.
Aggressive- I count, you don’t.
What is the primary purpose of the chart?
Communication
The EMR documentation system is problem oriented.
What are the patient issues an interdisciplinary team of professionals work on called?
Collaborative problem
What is charting by exception?
Chart only significant findings/exceptions to norms
Reduces charting time for nurses = more time w/ the pt
Omissions are the biggest problem
At what points do you triple check medications?
When pulling meds, before leaving med room, and at bedside before pt receives meds
Six Rights of Medication Administration
Right Drug
Right Dose
Right Route
Right Time
Right Patient
Right Documentation
Ways to enhance therapeutic communication
Address the pt, listen actively, establish trust, be assertive, interpret body language, use silence when appropriate, explore issues, validate feelings, clarifying statements, sit at eye level
Vulnerable populations
Homeless, poor, sexual orientation, mentally ill, physical disabilities, young, elderly, some ethnic and racial minority groups, gender
Are incident reports only for patients?
No. Can be for employees (ex: needle stick)
Do you reference incident report in the pt’s chart?
No
What do you include in incident report?
-Only state facts
-Do not place any blame
-Does not go in pt’s chart
Adverse event
An event in which care resulted in an undesirable clinical outcome
Near miss event
Caught before hand
Sentinel event
An event that results in death, permanent harm, or severe temporary harm
Examples of sentinel event
-Pt abduction
-Pt suicide
-A foreign body, such as sponge or forceps that was left in a patient after surgery
-A hospital operates on the wrong side of the patient’s body
-Hemolytic transfusion reaction involving major blood group incompatibilities
Documentation guidelines
Be clear and concise
Use correct terminology, spelling, and grammar
Timely
Signature
What time should be used when documenting?
The time the assessment/procedure was completed
Stereotype vs archetype
Archetypes- something recurrent, based on facts; usually not negative
Ex: eye or skin color based on region or geographic data
Stereotypes- Widely held unsubstantiated beliefs that have no basis in facts; negative beliefs
Ex: “Naturally athletic” “Naturally intelligent”
Discrimination
When a person acts on prejudice (stereotypes) and denies another person one or more of his/her fundamental rights
Ex: Not giving suspected drug user pain meds
VORB
Verbal Order Read Back
In person
TORB
Telephone Order Read Back
What is the purpose of the read back component?
Avoid medical errors and ensure order accuracy
Process for safe medication administration
-Know your patient history (HX, labs and assess your patient)
-Follow the orders
-Perform the Rights of Safe Med. Administration
-Triple check the medications against the MAR before the patient takes them
-Reassess your patient afterwards and document
Ampule is a __________ dose only. Use __________ needle when drawing up medication to avoid chards of glass.
single; filter
What type of needle must be used when drawing up insulin?
Insulin needle (orange) only because it is in units
Must be dual verified by another RN
Can you give personal advice/opinion to pt’s and their families?
No
How to enhance cultural awareness
Self assessment for bias and prejudices
What is needed to deliver culturally competent care?
Cultural awareness and sensitivity
What should you tell a trained interpreter before beginning any translations?
Advise them to translate everything that is said and leave nothing out
Be sure to use interpreter when obtaining consent
How to complete a cultural assessment
-Open-ended questions
-Allow patient time to explain
-Listen with respect and remain non-judgmental
Advise pt you want to provide the best care by identifying their cultural practices
I-SBAR-R
o Intro
o Situation
o Background
o Assessment
o Recommendation
o Read back
Parameters for Nitroglycerin
-Check vitals before and after each dose
-1 SL tab every 5 minutes for a maximum of 3 doses
-Must wear gloves
-Make sure pt doesn’t take Cialis/Viagra or any other ED medications
-Warn pt before first dose about wicked headache
-Instruct pt to hold med under tongue, and not to chew-
-If patient’s HR is below 60 or Systolic BP (SBP) is less than 90 hold dose and notify HCP
Should you give food with NSAIDs?
Yes. Upset stomach without it.
How to administer ear drops for adults and kids
-Use solutions at room temperature – too cold leads to dizziness
-Pull pinna up and back for adults, down and back for children
-Push on tragus to instill meds
Race is strictly related to
biology
Potential violations of HIPAA
Discussing pt’s in public areas
Leaving charts out
Not logging/locking computers
Copying forms
Social media
Providing shift report to oncoming RN does not violate HIPAA
Cardinal rule of documentation
If it was not documented, it was not done
How to correct an error in the chart
Strikethrough, write “mistaken entry”, date, and initial
Do not use whiteout
Culturally competent model of care
ASKED
Awareness- Take an honest look at your own biases
Skills- Ability to conduct a cultural assessment with sensitivity
Knowledge- Information about cultural worldviews
Encounters- Takes practice to become competent
Desire- Must want to be culturally competent
Insulin injections are
Subcutaneous (subq)
General rules for subq injections
-Max. injection is 1 mL
-Sites include upper arm, abdomen, upper back, lower back, and top of thighs
-Rotate sites
-45-90 degree angle
How should you draw up insulin?
Inject air into each vial first and then draw up regular (clear) insulin before long acting insulin (cloudy)
General rules for intramuscular injections
-Z track method
-Max. injection is 1 mL to 5 mL depending on site
-Deltoid, Vastus Lateralis, and Ventrogluteal
Max. injection & landmark for Deltoid is
1 mL
2 fingerbreadths below the acromion process in the middle third of the muscle
Max. injection & landmark for Vastus Lateralis is
3 to 5 mL
Between greater trochanter and the lateral femoral condyle - injection site is the middle third of the muscle
Max. injection & landmark for Ventrogluteal is
3 to 5 mL
Place your palm on the greater trochanter and thumb towards the groin avoiding the anterior superior iliac spine and iliac crest inject in the muscle
When can PHI be released?
For payment, treatment, and normal healthcare operations
What should be considered when administering the Albuterol?
-Check vitals before and after administering. Medication raises HR.
-Oral care
-If pt is unable to use hands, use a spacer.
General rules for intradermal injections
-Max. injection is 0.1 mL
-5-15 degree angle
-Sites include forearms, upper chest, and upper back
-Ex: TB skin test
Universals
values, beliefs, and practices that people from all cultures share
Specifics
values, beliefs, and practices that are special/unique to a culture
When do you document in the pt’s chart?
At the time of admission, transfer, discharge, ongoing care per policy, change in condition, communication
MAR
Medication Administration Record
Comprehensive list of all ordered medications for pt
