FINAL Flashcards
What is the RHPA
What does it contain
Regulated Health Professions act, 1991, act that governs ontarios regualted health professions
- contains controlled acts, scope of practice statment for nursing
Act that governs Ontarios regulated health porfessions
What are the 5 controlled acts auhroized to Nursing
- Perofrminf a prescribed procdue bwlo the dermis or mucous membrane
- admisntering a usbtance by injeciton or inhaltion
- putting intrumnet, hand or finger beyon the external ear canal, nasal passage, larynx, urthra, labia majora, anal verge, artifical openiing
- dispensing a drug (give med for pt to take at later time)
- treatment nby means of pyshcotherpay
What is an exception to the need for autroization to perfrom controlled acts
being a student - when under supervision and learning ot become a member of the profession and the procedure is within ther scope of that profession
What is a direct client order, directive and delegation
Direct client order - pracitoner directs specifict intervnetion for a psecific client
Directive - order that may be implennted for multiple lcients when specific contions are met and exist
Delegation - formal, a regulated health porfesisonal who is authorized - delagets the perfomrance of the procdure to somsone regualted/unregualted who is not authorized
what is the nursing scope of practice statment
Key points
the practice of nursing is the promotion of health and the assessmnet of the provision of care for and the treatment of health conditons by supprtive, prevetive, therpaeutic, pallitive, rehabilitative means in order to attain or maintain optimal function
What are the 4 things nurses must consider when performing a procedure
- appropaite health care provider
- auhtroity (do thye have)
- competence
- manaing outcomes (can you)
what are the 7 core vlaues of client-centered care
- respect
- clients are leaders of their own care
- client goals cirect care of the health care team
- timeliness
- human dignity
- clients are experts of themselves
- communication and consistency
What are the 4 corse processes of CCC (client-centered care)
what is it similar to?
- identifying concners/needs
- making decisions
- caring and service
- evlauting outcomes
The nursing process (assessment, planning, implementing, evaluating)
What are the common themes when it comes to profesisonal practice standards for a therapeutic nurse-cleint relationship.
listen, undersand, respect, disocver meaning of behaviour
thereapeutic communication - goal oriented about the pateint
What are the 4 types of linguistic control
Overt power (commands)
Persuasion (manipulation)
Controlling the agenda (most common - reinforcing the action that the pt should take)
Terms of enderament (nurse is parents, pt is child)
What does ABCD stand for
A- airway
B- breathing
C- circualtion
D- disability
if patient has ciruclation and airway porblem - deal with airway first
What portion of the respriatry system does ariway focus on
airway - upper airway to to the larynx
What do you assess when looking at A- Airway
- is airway patent
- Secretions
- mucous & vomit
- Swelling (pressure on airway)
- tongue (LOC - tongeu can block airway)
What are interventions to maintain A- Airway
- Open airway (head tilt chin lift & jaw thurst if spinal injury)
- Suction - yankauer
- Oropharygeal tube (no gag reflex)
- nasopharyngeal airway (if trauma to mouth, or still conscious)
- HOB FLAT no pillows
What do you assess when looking at B- breathing
- Respiraotry rate, depth (shallow, deep), rhythm (ex. kussmaul, DKA acid)
- accessory muslce use
- Quick listen ( wheezing (air), crackles (fluid), air entry (pneumothroac, COPD etc) - percussion (fluid = dull, air=hyper resonance)
- SpO2 (95% +)
What are interventions for B-breathing
- Position (high fowlers chest can expand more, ^ gas exchange, if fatigue semi-fowlers & tripod (COPD))
- Coached breathing ( pursed lip breathing causes PEEP )
- Oxygen - NP (2L (21%) 6L(40%)) - face mask (5-10L to get out CO2), Venturi mask 24-50% O2 Non-rebreather & partial rebreather
- Bronchodilators (ventolin)
- Bipap - help keep lun open
- Intubation
- ventilation - ambu bag
PEEP -limit air that comes in, max exhalation - keep alveloi open longer
What is part of your assessment for C-Circulation
- skin colour, temperature, turgor (hydration)
- capilary refill (less then 2 seconds)
- Pulse - (radial pulse systolic >90, brachial >60, carotid >40)
- blood pressure - (systlic what heart has to overcome, diastolic is peripheral venous resistance )
What interventions are part of C-circulation
- positioning
- fluids (maybe)
- Drugs - epi (increase HR) norpinephrine (BV, constrict) , inotropic (increase Ca, heart contract harder) /anti inotropic, antiarrythmias
- address underlying cause
- ECG
What do you assess as part of D-disability
- LOC
- neuro exam
- AVPU - Alert, respond to verbal, resond to painful, unresponsive
- VS - cushings triad (increase systolic, widneing pusle pressure, bradycarida - increased ICP(mannitol get rid of fluid )
- GCS (3-15) - eyeopneing, verbal, motor - less then 8 will be intubated
- CT scan - HTN
- hypoglycemia - drug overdose
If someone comes in unconcious, with respiratory problems, with no knoweldge of why - what will you give
D50 (hypoglycemia), B12 (alcoholic), & nalaxone
Respiratory Distress VS Failure
Distress - increased WOB in the presence of normla state & oxygenation abilities - increase resp rate and effort. - trying to maintian homestatsis
Failure - inability of the respiraotry system to fulfil gas exchange needs of the patient - hypoxemia - abnormla PO2 and PCO2
What is normal values for PCO2 and PO2
PO2 - grater then 60mm Hg
PCO2 less then 50 mmHG
NOTE - with COPD O2 often less then 60 ane Co2 higher then 50
what are causes of hypoxemic respiraotry failure
