final exam Flashcards
safety precautions
- lock wheels of the wheelchair to prevent it from moving on the client when sitting down
- call bell should be within reach @ all times, teach client to use call bell
- keep clients bed in low position
- put fall risk id on clients wrist
dirty linen
- all linen that touches floor should get put in linen bag
location of pt
pt at risk for fall should be near the nursing station
history of falls precuations for showers
put a bath seat in it
gait belt
helps support the client while walking. gait belt keeps the client center of gravity stable and helps prevents falls
precautions
- 95 mask is required for airbone precautions
- gloves are required when coming in contact with bodily fluids
- hand hygiene should be preformed in between every glove use
hippa
- when complying with hippa remember that documentation provides info to facilitate communication amoung members of the health care team and plan appropriate therapies when evaulating progress
insurance
- health care facilites hvae insurance that covers all employees
- recommended that nurses obtain their own professional liability insurance
violations of hippa
- sharing a computer password with coworkers would violate hippa
- sharing lab findings with a client family would be a violation of hippa unless the family is considered an authorized person
documentation provides
info to facilitate communication among all members of the healthcare team
interprofessional team
- an occupational therapist can assist with clients who have physical challenges with adaptive devices to help with self care activities
applying critical thinking skills
helps pt focus on their values and beliefs within their mangement of care
what does a nurse consider whom is critically thinking
immediate action with a pt condition worsens
a nurse who improves plan of care….
while thinking back on interventions and their effectiveness is critically thinking
what does concept map promote
clinical decisions and critical thinking -
nursing process and exploring other option for pt care
promote critical thinking
cane
- instruct client to move a cane an advance their weak leg forward to the cane followed by the advancing strong leg past the cane
- provides clients body weight to be distributed between the cane and the stronger leg
where should height of the cane be
equal distance between the floor and the hip
which side should the cane be on
strong side of pt. body
how should the elbows be when holding cane
keep their elbow slightly flexed when they use their cane
walker
client should lift the walker in advance it and then set it down
- nurse should walk slightly behind client who is using a walker in case they need assistance
how should the client move feet with walker?
the client should move one foot up to the walker and move the walker first
where should the walker land on a person body
below the level of the clients waste
nursing process first step
assessment
includes:
- organizing clients data
- nurse should assess the client’s date first and then analyze the data to determine what is a priority
steps of nursing process
assessment analysis planning implementation evaluation
nursing plan of care
comes after implementation of care
- plan following by evaluation to determine the effectiveness of the interventions that the nurse has done
sterile field
- open package over a sterile package over the middle of sterile field
- pull flaps of the package away from body, grasping it from side to side to avoid reaching over the sterile field and contaminating
- label into palm of hand so that the solution doe snot drip down the label in ruin it
