FINAL (SHAWNA) Flashcards
4 basic elements of mobility
Body alignment
Joint mobility (ROM)
Balance
Coordination
What does ROM refer to? What is it varied by?
Maximum movement possible for joint
Active or Passive
Age, activity level, genetic can impact
What is Active ROM
done first as it’s less intrusive
Uses patients own strength to create the movements through the joints
Ask the patient to slowly move each joint through it’s full ROM (flexion, extension, etc.)
Tell patient to stop the movement and tell you if they experience any pain
What is Passive ROM
more intrusive as you manipulate the person’s joints for them
Tell the patient to relax and then support the joint and move it through its range of motion.
Observe and compare each side of the body for symmetry, pain, inflammation or stiffness
Factors that impair mobility? (8)
Congenital or acquired postural abnormalities eg. scoliosis
Damage to the CNS as it regulates voluntary movement
Impaired muscle development eg. MS
Direct trauma to the musculoskeletal system eg. fracture
Inflammatory diseases eg. Rheumatoid Arthritis
Bed rest or reduced activity tolerance
Pain
Medications
Rheumatoid Arthritis overview
Chronic, inflammatory disease
Primarily impacts synovial membrane but can impact organs ex. lung
Cause is unknown
Symptoms are related to inflammation
- Objective: heat
- Subjective: pain
Osteoarthritis overview
Chronic degenerative joint disease
Risk factors: older than 65. Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genes.
Symptoms: pain that worsens with activity, joint stiffness and loss of function, decreased ROM
Signs: limited joint motion
encourage weight bearing exercises, increase vitamin C & D
Osteoporosis Overview
“Brittle bones” Decreased density of bones and deterioration of bone tissue, leading to bone fragility and increased risk for fractures
Commonly seen in hip, wrist and spine
Risk Factors:
Gender- female
Age (65+)
Post-menopausal (early menopause)
Ethnicity- Caucasian, Asian
History of fractures (from minor falls/injuries)
Family history
Bone structure/body weight- thin, “small boned”
Smoking
Alcohol abuse
Health Promotion/Prevention
Diet, exercise
Fall prevention
What can immobility cause?
Stiffness and pain in the joints
Cardiovascular changes e.g. orthostatic hypotension
Metabolic changes e.g. loss of calcium, constipation
Respiratory complications e.g. atelectasis, pneumonia
Urinary changes eg. increased risk for urinary stasis or renal calculi
Poor hygiene r/t immobility can lead to skin breakdown, and sustained pressure on joints can lead to pressure ulcers
Components of Hair Assessment
Uniformity/thickness
Color
Amount of hair (alopecia)
Body hair (lanugo)
Texture (oily/dry)
Scalp is free of lesions
Parasites (lice etc.)
Components of Nail Assessment
Texture- smooth, thick/thin
Color- capillary refill, cyanosis
Cleanliness
Length eg. nail biting
Shape & curvature
Wound assessment and documentation
Size, shape and texture
Colour
Location/Distribution
Surrounding skin
Elevation
Exudate/discharge
Odour
Measure height, width and depth
Skin Assessment Methods (2) - Objective
Inspection
- Colour
- Edema
- Bruising
- Markings
- Irritation
Palpation
- Temperature
- Moisture
- Turgor
- Edema
- Texture
What does S.M.A.R.T goals stand for?
Specific, Measurable, Attainable, Realistic, Timely
Overview of medication administration?
preparing, giving, and evaluating the effectiveness of prescription and non-prescription drugs
What are the 7 rights of medication administration?
- right med
- right pt
- right dose
- right time
- right route
- right reason
- right documentation
Some practice setting have 10 rights. What are the additional 3?
- right to refuse
- right pt education
- right evaluation
What is pharmacology and why does the RPN have to be familiar with it?
- pharmacology: the study or science of drugs
- the RPN needs to know this so they can understand how each drug will affect the pt
What are the 3 names a medication might be known as?
- generic name: name given by the developer of the medication/official name (ex; ibuprofen)
- trade name: brand name, given by the manufacturer and can vary in diff countries (ex; advil)
- chemical name: describes the med’s molecular structure
What is drug classification? (2)
the desired effect on the body system
the type of drug it is
What do medication forms tell you?
indicates route
must ensure correct form is used as this affects absorption and metabolization
ex; tablet, ointment, suppository
What are pharmacodynamics?
the study of what the drug does to the body
What is the therapeutic effect? (pharmacodynamics)
- intended or expected effect on the body
- ex; tylenol will relieve a headache
What is a side effect? (pharmacodynamics)
- unintended secondary effects
- ex; morphine may cause a rash
What are toxic effects? (pharmacodynamics)
- an accumulation of meds in the body to the point where it is poisonous
What is a contraindication? (pharmacodynamics)
- any characteristic of the pt that makes the use of the med dangerous
- ex; pregnancy, other meds
What is pharmaceutics?
- how various med forms/routes influence the way the body metabolizes a drug and the way the drug effects the body
- ex; oral, sublingual, inhalation etc
What is pharmacokinetics?
- how the medication moves into, through, and out of the body
What is absorption? (pharmacokinetics)
the movement of a drug from its site of administration into the blood
What is distribution? (pharmacokinetics)
transport of a drug in the body by bloodstream to its site of action
What is metabolism? (pharmacokinetics)
the biological transformation or metabolic breakdown of a drug in the body (most commonly done in the liver)
What is excretion? (pharmacokinetics)
- the elimination of drugs from the body
- kidneys are the primary way
- bowel and liver are responsible to a lesser extent
What is parenteral admin? (pharmacokinetics)
- IV
- IM
- subcutaneous (SC)
What is inhalation admin? (pharmacokinetics)
- nebulizers
- nasal sprays
What is transmucosal admin? (pharmacokinetics)
sublingual
What is gastroenteral admin? (pharmacokinetics)
- PO
- suppositories
Transdermal/topical admin (pharmacokinetics)
- patches
- creams
- ointments
What is onset of action? (pharmacokinetics)
- time is takes for the drug to elicit a therapeutic response
What is peak effect? (pharmacokinetics)
- time needed for a drug to reach it’s maximum therapeutic response
What is duration of action? (pharmacokinetics)
- length of time that the concentration is sufficient to elicit a therapeutic response
- time it lasts before it wears off
What is a half life? (pharmacokinetics)
- the time it takes for one half of the drug to be eliminated from the body
What is a drug schedule?
- determined by Health Canada
- whether or not a drug requires a prescription; regulates access
- based on its medicinal ingredients and puts the drug on the Prescription Drug List
- schedule I, IA, II, III, IV must be sold from pharmacies
What is a schedule I drug?
- need a prescription
- ex; amoxicillin, sertraline
What is a schedule IA drug?
- abuse potential, requires triplicate/duplicate prescription in order to sell for tracking and forgery purposes
- ex; Tylenol #3, (30 mg codeine) fentanyl
What is a schedule II drug?
- no prescription req but pharmacist supervises sale
- ex; Tylenol #1 (8 mg codeine)
What is a schedule III drug?
- drugs that can be sold without a prescription (locked after closure, if no pharmacist on duty, cannot sell)
- hydrocortisone topical cream
What is a schedule IV drug?
prescription by pharmacist
What is a unscheduled drug?
- no restriction, can be sold anywhere
- ex; Tylenol, Tums
Natural health product advantages:
adjunct therapy to support conventional pharmaceutical therapies
Natural health product disadvantages:
- drug-drug interactions
- allergic reactions
- adverse side effects
- people believe they are safe
Common OTC meds:
- NSAIDS: ASA, ibuprofen
- Non-opioid analgesics: acetaminophen
- Anti-emetics: dimenhydrate
- Antihistamines: diphenhydramine
- natural health products (NHPs)
Nursing process: assessment (med admin)
- gather comprehensive medication profile including:
- all meds pt takes on regular basis
- hx of allergies
- use of OTC and NHPs
- intake of alcohol, tobacco, caffeine
- illicit drug use
Nursing process: dx (med admin)
- developed from assessment data through critical thought
- nursing dx r/t medication therapy:
- variance in knowledge base
- variance in protection
- variance in health beliefs
Nursing process: planning (med admin)
- goals are pt focused
- they include a time frame
Nursing process: interventions (med admin)
- interventions are based on evidence-based practice
- interventions are done as independent nursing functions or collaborative interdisciplinary care
- nurse to discuss with pt the risks of not taking meds as prescribed
- have pharmacist discuss side effect profile
- provide education on long term consequences stopping
Nursing process: evaluation (med admin)
- include monitoring whether or not the pt goal has been met or not
- includes observing for therapeutic effect, adverse effects, toxicity of a medication
- if the goal is not met then nursing care plan will need to be revised
Administering medication overview:
- read the DRs orders and check it against the MAR
- DRs order are transcribed onto the MAR by either the nurse or a unit clerk
- contact the doctor the pharmacy to clarify any unclear or questionable orders prior to adminstering
- never leave poured medications unattended
- plan your time wisely so that the medication is giving within 30 mins of the ordered time
- don’t let yourself multi task or be distracted while pouring or admin meds
- provide adjuctive interventions as indicated
- ensure 3 med checks
- dientify client by name and check write band against MAR
- inform the client about what medication you’re giving listen to them if they express a concern
- don’t forget to ask about allergies
- admin drug
- record drug admin on MAR
- evaluate and document the client’s response to drug
when and how many safety checks are there?
Before taking out med
During pouring out med
After med is poured
3 checks
Patient medication adherance:
- have you ever stopped taking a prescribed medication? why did you stop?
- when pts stop their medication we need to be curious open to their reasons
What do regulatory bodies do?
- protect the public
- grant your license
Regulation: (5)
- registration
- educational programs
- enforce/regulate/monitor standards of practice
- inquiry + discipline
- try to promote interprofessional collaboration
Who protects the nurses?
- BCCNM
- BC nurses union
What is involve in the duty to report:
- if you have knowledge of a nurse who is incompetent or impaired, you have a duty to report
- ex; drug use, sexual relations, untx MH conditions
What are the 4 main documents of the BCCNM?
- code of ethics
- scope of practice
- professional standards: broad; how you shld behave as a professional
- standards of practice: narrower; baseline req. for specific actions; documentation, duty to report, indigenous safety, etc.
Scope of practice triangle:
- bottom: Health Practitioner’s Act (HPA)
- bottom middle: standards, limits, conditions
- top middle: employer, health authority
- top: RPN; individual competence
What is considered documentation?
- any written or electronically generated information about a client that describes the care or service provided to that client
- a nursing action that produces a written account of pertinent pt data, nursing clinical decisions and interventions, and pt responses in a health record
Key purposes of documentation: 3
- communication
- safe and appropriate nursing care
- professional and legal standards
BCCNM professional standards: documentation
Standard 2, #7, #8
- Standard 2: competent, evidence- informed practice
- # 7: documents the application of the clinical decision-making process in a responsible, accountable, and ethical manner
- # 8: applies documentation principles to ensure effective written/electronic communication
Legal issues of documentation:
- client’s record is a permanent, legal document
- may be req. to provide evidence in court and/or coroner’s inquests
- must clearly document all nursing care given, that care decisions were based on assessment, and that the nurse cont. to monitor, document, and report pt responses
- in court: care not documented = care not given
- FOIPPA
Ethical issues of documentation:
- RPN code of ethics:
- # 8: protects the confidentiality of all info gathered in the context of the professional relationship
- # 9: practices within relevant legislation that governs privacy, access, use
Ways to Keeping records confidential:
- use computer passwords, log out when finished
- be mindful of screens and papers and that they are not viewable
- be aware of agency policies re: documenting sensitive info
- ensure all written documentation is secured
- it is up to the RPN to safeguard the privacy, security, and confidentiality of health records
Common principles of documentation
- Only use agency-approved abbreviations
- Never use pencil, only dark blue or black ink
- Document ASAP in chronological order, not prior to giving care
- Follow proper protocol for errors, no erasing or white out is permitted
- Documentation must be clear, concise, factual, objective, timely and legible
- RPN’s must add their signature and designation in a clear, legible manner (F. Nightingale DCSPsycN)
What do we chart?
- status and health concerns of the client (assessment data)
- changes in status
- nursing care, interventions
- advocacy by nurse on behalf of thee client
- client responses and effectiveness of the care provided
- effectiveness of meds and PRN meds
Problem-oriented/charting by exception:
- DARP, SOAP(IE)
- focusing on documenting only deviations from the norm, narrative format
