Fundamentals Flashcards
Ability of the client to make personal decisions, even when those decisions may not be in the client’s own best interest.
Autonomy
Agreement that the care given is in the best interest of the client; taking positive actions to help others.
Beneficience
Agreement to keep one’s promise to the client about care that was offered.
Fidelity
Fair treatment in matters related to physical and psychosocial care and use of resources.
Justice
Avoidance of harm or pain as much as possible when giving treatments
Nonmaleficence
Problem that cannot be solved solely by a review of scientific data, involves a conflict between two moral imperatives, and the answer will have a profound effect on the situation/client.
Ethical dilemma
Support of the cause of the client regarding health, safety, and personal rights
Advocacy
Willingness to respect obligations and follow through on promises
Responsibility
Ability to answer for one’s own actions.
Accountability
Protection of privacy without diminishing access to quality care.
Confidentiality
document that can be used to assist with end-of-life and organ donor issues
Uniform Determination of Death Act (UDDA)
A family has conflicting feelings about the initiation of nasogastric tube feedings for their
father, who is terminally ill
Ethical Dilemma
a nurse fails to implement safety measures for a
client who has been identified as at risk for falls.
Negligence
a nurse administers a large dose of medication
due to a calculation error.the client has a
cardiac arrest and dies.
Malpractice (Professional negligence)
a nurse releases the medical diagnosis of a client
to a member of the press.
Breach of confidentiality
a nurse tells a coworker that she believes the
client has been unfaithful to her spouse.
Defamation of character
the conduct of one person makes another
person fearful and apprehensive (threatening
to place a nasogastric tube in a client who is
refusing to eat).
Assault
intentional and wrongful physical contact with
a person that involves an injury or offensive
contact (restraining a client and administering an
injection against her wishes).
Battery
a person is confined or restrained against his
will (using restraints on a competent client to
prevent his leaving the health care facility).
False imprisonment
T/F: Access to the client’s medical record should be restricted to only those health
care providers who are involved directly in the client’s care.
True
SOAPIE:
S – Subjective data O – Objective data A – Assessment (includes a nursing diagnosis based on the assessment) P – Plan I – Intervention E – Evaluation
PIE:
P – Problem
I – Intervention
E – Evaluation
DAR (focus charting):
D – Data
A – Action
R – Response
Serous
Clear
Sanguinous
contains red blood cells
Purulent
contains leukocytes and bacteria
Airborne Precautions (measles, varicella, tuberculosis)
A private room
Masks/respiratory protection devices for caregivers and visitors
An N95 or high-efficiency particulate air (HEPA) respirator is used if the
client is known or suspected to have tuberculosis.
Negative pressure airflow exchange in the room of at least six exchanges per
hour
Droplet Precautions (Strep, pneumonia, scarlet fever, rubella, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia/sepsis, pneumonic plague)
A private room or a room with other clients with the same infectious disease
Masks for providers and visitors
Contact Precautions (RSV, shigella, enteric diseases, wound infections, herpes simplex, scabies, MRSA)
A private room or a room with other clients with the same infection
Gloves and gowns worn by the caregivers and visitors
Disposal of infectious dressing material into a single, nonporous bag
without touching the outside of the bag
The use of precise practices to reduce the number, growth, and spread of micro-organisms from an object, person, or area. Previously referred to
as “clean technique,” medical asepsis is used for administering oral medication, managing nasogastric tubes, providing personal hygiene, and performing many other common nursing tasks.
Medical Asepsis
The use of precise practices to eliminate all micro-organisms from an object or area. Also known as “sterile technique,” surgical asepsis is used for parenteral medication administration, insertion of urinary catheters, surgical procedures, sterile
dressing changes, and many other common nursing procedures.
Surgical Asepsis
When entering a client’s room to change a surgical dressing, a nurse notes that the client is coughing
and sneezing. When preparing the sterile field, it is important that the nurse:
place a mask on the client to limit the spread of micro-organisms into the surgical wound
According to Erikson’s developmental theory, which of the following client activities is an indicator
that the client is meeting the tasks expected in middle adulthood?
The client expresses concerns about the next generation
When performing a psychosocial assessment, a nurse should expect a healthy middle adult to
accept one’s life as creative and productive
level of prevention - addresses the needs of
healthy clients to promote health and prevent
disease with specific protections.
•immunization programs
•Child car seat education
•nutrition and fitness activities
•Health education in schools
Primary Prevention
level of prevention - focuses on early identification of individuals or communities experiencing illness, providing treatment, and conducting activities that are geared to prevent a worsening health status.
• Communicable disease scr
eening and case
finding
• early detection and treatment of diabetes
• exercise programs for older adult clients
who are frail
Secondary Prevention
level of prevention - aims to prevent the long-
term consequences of a chronic illness or
disability and to support optimal functioning.
• Prevention of pressure ulcers as a
complication of spinal cord injury
• Promoting independence for the client
who has traumatic brain injury
Tertiary Prevention
A 21-year-old male client presents to the health clinic for a sore throat. The client tells the nurse that he has not seen a doctor since high school. Which of the following health screenings should the
nurse anticipate will be performed for this client?
Testicular Cancer
Rapid over a short period of time (hours or days) LOC is usually altered Increase in Restlessness Rapid personality Change Some perceptual disturbances VS may be unstable Reversible
Delirium
Gradual deterioration of function over months or yrs LOC unchanged Behaviors usually remain stable Personality change is gradual VS usually stable Irreversible
Dementia
Caused by a loss of nerve cells and progressive decrease in dopamine activity
Parkinson’s disease
Genetically transmitted disease in which a profound state of dementia and ataxia occurs within 5 to 10 years of onset
Huntington’s disease
Caused by a transmissible agent known as a “slow” virus; clinical course is rapid, with progressive deterioration and death within 1 year
Creutzfeldt-Jacob disease
Progressive dementia caused by thiamine deficiency, usually occurring due to long-term alcohol abuse
Korsakoff’s syndrome
Both the client and family members may refuse to believe that changes, such as loss of memory, are taking place, even when those changes are obvious to others.
Denial
The client may make up stories when questioned about events or activities that she does not remember. This may seem like lying, but it is actually an unconscious attempt to save self-esteem and prevent admitting that she does not remember the occasion.
Confabulation
The client avoids answering questions by repeating phrases or behavior. This is another unconscious attempt to maintain self-esteem when memory has failed.
Perseveration
Four Stages of Alzheimer’s Disease:
- Forgetfulness
- Confusion
- Ambulatory dementia
- End stage
Legal documents that direct end-of-life issues
Advance directives
Directive documents for medical treatment per client’s wishes.
Living WIll
