exam 3 Flashcards
What is the nursing process?
A series of steps that go in order but can move back and forth between steps like planning, implementation, and evaluation to achieve optimal results.
Define critical thinking.
The skill of analyzing and interpreting data to solve a problem to achieve a desired outcome.
What components are included in critical thinking?
- Questioning
- Analysis
- Synthesis
- Interpretation
- Inference
- Inductive and deductive reasoning
- Intuition
- Application
- Creativity
What factors influence critical thinking?
- Knowledge
- Experience
- Attitudes
- Intellectual standards
- Professional standards
What is clinical reasoning?
The mental process used to analyze all the data of a clinical situation to make decisions based on that analysis.
What does clinical reasoning require from the nurse?
- Assessing and compiling data
- Selecting and discarding information based on relevance
- Making decisions regarding client care based on nursing knowledge
Define clinical judgment.
Clinical reasoning over time that improves with practice, considering nursing knowledge, client situations, and prioritization of client problems.
What is the purpose of evidence-based practice?
- Improve client outcomes
- Increase nurses’ professional satisfaction
- Lower the cost of quality health care
- Provide a framework for clinical judgment based on research
What are some applications of evidence-based practice?
- Scientific literature
- Clinical guidelines
- Critical pathways
- Standards of care
What is delegation in nursing?
The process of assigning tasks to others while considering various factors such as predictability of outcome and potential for harm.
What factors should a nurse consider when delegating a task?
- Predictability of the outcome
- Potential for harm
- Complexity of care
- Need for problem-solving innovation
- Level of interaction with the client
What tasks can a nurse delegate?
- Activities of daily living (ADLs)
- Bed making
- Specimen collection
- Intake and output (I & O)
- Vital signs (stable patient)
What tasks should not be delegated?
- Nursing process
- Client education
- Tasks requiring nursing judgment
- Medication administration
- Documentation of a task performed by the RN
What are the Five Rights of Delegation?
- Right task
- Right circumstance
- Right person
- Right direction and communication
- Right supervision and evaluation
What is Evidence-Based Practice (EBP)?
A practice that improves client outcomes and increases nurses’ professional satisfaction.
What are the benefits of Evidence-Based Practice?
Improves client outcomes, increases professional satisfaction, lowers health care costs, and provides a framework for clinical judgment.
What does the Spirit of Inquiry in Nursing involve?
Contemplative reflection to confirm performance and identify areas for professional growth.
What is a Spirit of Inquiry?
The desire to clarify complex issues through research and trends that influence client outcomes.
What are the essential elements of Evidence-Based Practice?
Sources, the Scientific Method, and Nursing Research.
What is the Scientific Method?
A systematic research process that applies new knowledge to nursing practice and re-evaluates outcomes.
How does the Scientific Method minimize bias?
It limits bias by addressing gaps in specific nursing knowledge and collecting empirical data.
What is empirical data?
Data collected through observations, assessments, and measurement.
What is a literature review?
A critical summary of research on a topic of interest, providing context for a research problem.
What does ‘study population’ refer to?
The participants in the study.
What is sample size?
A subset of a population selected to participate in a study.
What is the setting in research?
Specific places where data collection occurs.
What are instruments/tools in research?
Devices used to collect data, such as questionnaires or observation schedules.
What are major findings in a study?
The results of the study.
What does application to practice mean?
How research findings are applicable to current nursing practice.
What is the main objective of examining the communication process?
To understand how communication occurs and the factors that influence it.
This includes identifying different modes and types of communication.
What are the factors that influence communication?
Various personal, environmental, and contextual factors.
Factors may include cultural backgrounds, emotional states, and environmental distractions.
What is non-verbal communication?
Messages sent without words, including body language and gestures.
Non-verbal cues can significantly affect the interpretation of verbal messages.
What elements are involved in professional communication?
Clarity, respect, active listening, and empathy.
These elements ensure effective and respectful interactions among healthcare providers.
What is the purpose of standardized communication techniques in nursing?
To ensure consistent and clear communication among healthcare providers.
Standardized techniques help reduce misunderstandings and improve patient safety.
What are common barriers to communication in healthcare?
Language differences, cultural diversities, and environmental factors.
Other barriers may include speech or hearing impairments and cognitive disorders.
What are therapeutic communication techniques?
Methods that promote a trusting and healing relationship between the nurse and the patient.
Techniques include active listening, empathy, and nonjudgmental attitudes.
What role does communication play in client-centered care?
It facilitates understanding of patient needs and preferences for better care planning.
Effective communication is crucial for establishing trust and rapport with clients.
What is the acronym ‘SOLER’ used for in therapeutic communication?
A technique to enhance active listening and engagement.
SOLER stands for: Sit, Open posture, Lean, Eye contact, Relax.
What does the ‘S’ in ‘SOLER’ stand for?
Sit facing the patient.
This encourages openness and attentiveness.
What does the ‘O’ in ‘SOLER’ represent?
Maintain an open stance or posture.
An open posture promotes a welcoming environment.
What does the ‘L’ in ‘SOLER’ signify?
Lean toward the speaker.
This shows interest and engagement in the conversation.
What does the ‘E’ in ‘SOLER’ refer to?
Maintain eye contact without staring.
Eye contact conveys attentiveness and respect.
What does the ‘R’ in ‘SOLER’ remind the nurse to do?
Relax during the conversation.
Relaxation helps create a comfortable environment for both the nurse and the patient.
What is collaboration in healthcare?
Cooperation among healthcare professionals from various disciplines.
This team approach enhances patient care and outcomes.
What is the purpose of interprofessional teams?
To improve access to and coordination of healthcare services.
Collaborative teams can enhance efficiency in client referrals and care services.
What is a consultation in healthcare?
A formal request for another provider’s input on a patient’s condition.
It involves collaboration to determine the best treatment approach.
What is the difference between referral and transfer of care?
Referral delegates responsibility to another provider; transfer of care systematically turns over care.
Both processes involve communication to ensure continuity of care.
What does I-SBAR-R stand for?
Introductions, Situation, Background, Assessment, Recommendation, Readback.
This is a standardized communication tool used during transfers of care.
What should be included in change of shift reports?
Identifying information, current health status, current orders, and patient concerns.
Comprehensive hand-off reports ensure continuity and safety in patient care.
What does ‘Receive-Record-Read Back’ involve?
Recording a prescription, reading it back as written, and verifying it.
This process minimizes errors in medication administration.
What is ethics?
Ethics is the study of moral principles that govern a person’s behavior or the conducting of an activity.
What are values and morals?
Values are beliefs about what is important, while morals are principles or rules of right conduct.
Why are values and morals important to nursing practice?
They guide nurses in making ethical decisions and provide a framework for patient care.
What is the Nursing Code of Ethics?
A set of guidelines that outlines the ethical obligations and duties of every nurse.
What are ethical principles?
Fundamental guidelines that inform ethical decision making, such as autonomy, beneficence, nonmaleficence, and justice.
What is an ethical dilemma?
A situation in which a choice must be made between two or more conflicting ethical principles.
What is ethical decision making?
The process of evaluating and choosing among alternatives in a manner consistent with ethical principles.
What are common issues in nursing ethics?
Confidentiality, informed consent, end-of-life decisions, and resource allocation.
What are legal considerations in nursing practice?
Guidelines and laws that govern nursing actions and protect patient rights.
What are the sources of law in nursing?
Constitutions, statutes, administrative regulations, and case law.
What is a tort?
A civil wrong that has been committed against an individual.
What is implied consent?
Consent that is inferred from a person’s actions rather than explicit verbal or written agreement.
What is informed consent?
Consent that is expressed in writing after being fully informed about the risks, benefits, and alternatives.
What are advanced directives?
Written instructions regarding a client’s health care preferences, especially concerning life-sustaining measures.
What is confidentiality in nursing?
The obligation to protect patient information and privacy.
What are Good Samaritan laws?
Laws that protect healthcare workers who provide aid in emergency situations from civil liability.
What is mandatory reporting in nursing?
The legal obligation of nurses to report certain findings, such as abuse or communicable diseases.
What types of abuse must nurses report?
Child abuse, domestic abuse, elder abuse, and other forms as per policy.
What is the nurse’s role regarding communicable diseases?
To report cases to state and local health departments, including the CDC.
What are examples of reportable diseases in New Jersey?
- COVID-19
- Varicella
- Syphilis
- Chlamydia
- Gonorrhea
- Lyme’s disease
- Mumps
- Measles
- Pertussis
- Rabies
What constitutes a breach of nursing practice?
Failure to uphold standards of practice, lack of confidentiality, falsification of health records, fatigue, and substance use.
Fill in the blank: Informed consent requires providers to educate clients about the _______ of procedures.
risks, benefits, and alternatives
True or False: Good Samaritan laws apply to all healthcare workers regardless of whether they are on duty.
False
What are Electronic Health Records (EHRs)?
A longitudinal record of care that becomes part of the electronic medical record (EMR) which documents a single episode of care.
What is the purpose of nursing documentation?
To provide a comprehensive record of patient care including admission database, care plans, progress notes, and more.
What must be included when taking verbal and telephone orders?
Must be taken by an RN who: repeats the order verbatim, enters it into the system, documents as a verbal/phone order, includes date, time, physician’s name, and RN signature.
True or False: Nurses are legally and ethically obligated to keep patient information confidential.
True
What does the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require?
It requires disclosure requests regarding health information.
What is considered confidential information about patients?
All information about patients written on paper, spoken aloud, saved on computer including name, address, phone number, reason for sickness, treatment, and past health conditions.
What are potential breaches in patient confidentiality?
Displaying information on public screens, sending confidential emails via public networks, sharing printers among units, discarding patient information improperly, overheard conversations, faxing to unauthorized persons, sending messages overheard on pagers.
What is the legal significance of nurses’ notes?
Nurses’ notes are legal documents that must meet specific guidelines to provide protection in case of legal issues.
What should every entry in a nursing note include?
Date, time, signature.
Fill in the blank: Care not documented is _______.
care not done.
What are the two types of medical records?
- Source Oriented Medical Record
- Problem-Oriented Medical Records
What is the SOAP note format?
- Subjective
- Objective
- Assessment
- Plan
What does the PIE model stand for?
- Problem
- Intervention
- Evaluation
What is the focus of charting by exception?
Documenting only unexpected or unusual findings.
What are guidelines for electronic documentation?
- Never use anyone else’s login
- Use strong, unique passwords
- Log off when done
- Protect computer screens
- Ensure correct electronic signatures
What are some potential problems with paper medical records?
- Difficult to locate
- Single-user access
- Susceptible to damage
- Illegible handwriting
- Storage issues
What is the purpose of an incident report?
To document details of an unusual and unexpected event involving a patient, visitor, or staff member.
What should an incident report be like?
Factual only, objective, nonjudgmental.
How does technology improve patient safety in medication administration?
Using systems like bar-code medication administration (BCMA) reduces errors.
What are the benefits of health care informatics?
- Improved organization
- Enhanced communication
- Better decision making
- Reduced duplicate orders
- Safer medication administration
- Enhanced information access
What is the relationship between informatics and quality nursing/health care?
Informatics supports improved quality of care through better data management and decision-making.
What does the acronym ‘WOWs’ stand for in the context of healthcare technology?
Workstations on wheels.
what are electrolytes?
minerals in the body that can conduct electricity
where are electrolytes found?
urine, blood, tissues, well as other body fluids
what is included in electrolytes?
potassium, sodium, calcium, magnesium
what are electrolytes responsible for?
balancing the amount of water in the body, balancing the body’s PH (acid,base) level, moving waste out of the body cells, moving nutrients into body cells, allowing the body’s muscles, heart, nerves, and brain to function properly
hypovolemia
loss of both fluid and electrolytes, can lead to decrease in circulating volume, third spacing( crazy immune response, capillaries become leaky), laboratory testing( CBC, chem panel), treatments ( administer o2, IV fluid, transfusion for blood
what is dehydration? symptoms? causes?
lack of fluid in the body, from insufficient intake or excessive loss.
symptoms: vital signs- hypothermia(hypovolemia) or hyperthermia (dehydration), tachycardia, thready pulse, hypotension, orthostatic hypotension, decreased central venous pressure, tachypnea (increased respirations), hypoxia
neuromusculoskeletal- dizziness, syncope (fainting or passing out), confusion, weakness, fatigue, seizures (rapid/severe dehydration)
GI- thirst, dry mucous membranes, dry furrowed tongue, nausea, vomiting, anorexia, acute weight loss
renal- oliguria (decreased production of urine)
other findings- diminished capillary refill, cool clammy skin, diaphoresis, sunken eyeballs, flattened neck veins, absence of tears, decreased skin turgor.
causes: hyperventilation or excessive perspiration without water replacement, prolonged fever, diabetic ketoacidosis, insufficient water intake (enteral feeding without water administration, decreased thirst sensation, dysphagia), diabetes insipidus, osmotic diuresis, excessive intake of salt, salt packets, or hypertonic IV fluids
what type of lab tests will you do for a patient you think is dehydrated?
HCT: increased in both hypovolemia and dehydration unless the fluid volume deficit is due to hemorrhage
blood osmolarity: dehydration- increased hemoconcentration osmolarity (greater than 295 m0sm/kg)
urine specific gravity: dehydration- increased concentration (urine specific gravity greater than 1.030)
blood sodium: dehydration- increased hemoconcentration (greater than 145 mEq/L)
BUN: increased (greater 25 mg/dL) due to hemoconcentration
dehydration: increased protein, electrolytes, glucose
what is the proper nursing care for a patient with dehydration?
-monitor respiratory rate, effort, and oxygen saturation (SaO2)
- check urinalysis, CBC, and electrolytes
-administer supplemental oxygen as prescribed
-measure the client’s weight daily at same time of day using the same scale
-observe for nausea and vomiting
-assess for postural blood pressure and pulse (check for hypotension and orthostatic hypotension)
-check neurologic status to determine level of consciousness
-assess heart rhythm
- initiate and maintain IV access
- provide oral and IV rehydration therapy as prescribed
-monitor level of consciousness and ensure client safety
-observe level of gait stability
-encourage the client to use the call light and ask for assistance
- encourage the client to change positions slowly (rolling from side to side or standing up
