Fundamentals Exam 1 Flashcards
QSEN - 6 Main Objectives
- Patient-Centered Care: Focus on patient needs and preferences.
- Teamwork: Work well with others for the best outcomes.
- Evidence-Based Practice: Use research and expertise for decisions.
- Quality Improvement: Make changes to enhance care.
- Safety: Prev harm w/best practices.
- Informatics: tech improves care.
Responsible
- Think Critically: Anlyz, infrmd dcsns.
- Follow Orders: instr from (HCP).
- Handle Emergencies: Respond to unexpected situations effectively.
- Patient Care: Manage multiple patients’ needs
- Family Support: Help families understand the patient’s condition.
- Monitor Changes: Obs/report neg changes in patient condition to HCP.
Honest
- Risk Management: Dishonesty puts patients at risk.
- Admit Mistakes: Acknowledge errors to ensure proper care.
- Patient Well-being: Prioritize patients’ needs over personal pride.
Caring
- Individual Response: Respond to patients as individuals, acknowledging their emotions and needs.
- Beyond Disease: See patients as people, not just their illness or condition.
- Personalized Care: Avoid a “one-size-fits-all” approach; tailor care to each patient.
Organized
- Manage Tasks: Handle multiple tasks for many patients efficiently.
- Prioritize: Determine and focus on the most important tasks first.
- Tech Knowledge: Use equipment and computers effectively.
Professionalism
- Learn from Experience: Emulate good practices and avoid bad ones based on experiences with others.
- Effective Communication: Maintain clear and respectful communication.
- Professional Appearance: Uphold a professional appearance and behavior.
- Responsibility: Take accountability for your own actions and conduct.
EBP (evidence Based Practice)
- Research-Based: Use nursing research to evaluate and improve practices.
- Historical Example: Florence Nightingale used evidence to ensure effective care.
- Policy Changes: Implement changes based on accurate, positive data.
Team Nursing
- Team Approach: Involves nurses and unlicensed assistive personnel working together.
- Patient Care: Provides care for a group of patients.
- Communication: Requires strong communication among team members.
Client-Centered Care
- Patient Empowerment: Patients manage own care, have a say in their rehabilitation, schedule, and goals.
- Reduced Miscommunication: Fewer caregivers to minimize errors and delays.
- Cross-Training: Staff are trained to handle multiple tasks for consistent care.
Case Management
- Coordination: Organizes and oversees patient care across different services.
- Facilitation: Helps patients access and navigate healthcare resources.
- Advocacy: Ensures patients’ needs and preferences are met.
- Cost-Effective: Aims to provide efficient and affordable care
Primary Nursing Care
- Single Nurse: One nurse responsible for all care of assigned patients.
- No Assistive Staff: Nurse performs all duties independently.
- High Responsibility: Nurse carries significant responsibility.
- ICU Use: Effective in areas with small patient-to-staff ratios, like ICUs.
- Less Effective: Not suitable for busy med/surg floors.
Medically Necessary
- Definition: Services or items needed for diagnosing or treating illness or injury, or improving function.
- Insurance Review: Insurance companies compare patient information with accepted criteria.
- Reasonableness: Services must be deemed reasonable for insurance to cover them.
Inpatient Setting
Stay: Patients stay overnight or longer.
- Acute Care Hospital: Short-term, intensive treatment.
- Long-Term Acute Care Hospital: Extended treatment - complex cond.
- SNF: high-level nurse care.
- Rehabilitation Facility: recov/rehab.
- Residential Care Facility: Long-term living with assistance for daily activities.
Acute Care Hospital/Medical Center
- Stay: Pts stay overnight or longer.
- Care: Provides acute medical or mental health treatments.
- Services: Includes emergency care and diagnostic testing.
- Staff: Includes doctors, nurses, assistants, therapists, and laboratory workers.
Long Term Care Acute Hospitals
- Care: Provides intensive care for serious medical problems.
- Duration: Focuses on long-term treatment, typically 20-30 days.
- Staff: Includes doctors, nurses, assistants, therapists, and laboratory workers.
Skilled Nursing Facility
- Care: Provides less intense care than traditional or long-term acute care hos
- Transitional Care: short-term care, with stays ranging from a day to 100 days before moving to a rehabilitation center. NEVER BACK HOME!
- Medical Visits: weekly, not daily.
- Documentation: Medicare requires regular documentation of patient progress.
Rehabilitation Facility
- Types : Intense PT, OT, or ST, drug, alcohol, and mental health
- Setting: Hosp or free-standing facility
- Oversight: Physician specializing in phys medicine/rehabilitative services
- Staff: Nurses, aids, (PT), (OT), (ST), Social services
- Requirement: Patient must participate in therapy for at least 3 hours a day
Residential Care Facility
Patients reside at the facility, long time
- Nursing Homes: 24/7 med care/sup
- Assisted Living: Offer help with daily activities but allow for more in
- Memory Care: Specialize in care for individuals w/Alzheimer’s/dementias
- Independent Living: Designed for seniors, generally ind but want access to community services and amenities
Outpatient Care
- Hospital Outpatient: Services at a hospital without overnight stay
- Mental Health: Therapy
- Rehabilitation: Card/pulm rehab
- Ambulatory Clinics: Gen med serv
- Health Departments: Preventive care and education
- Medical Offices: Routine med care
- Home Health: Care at home
- Hospice: Comfort care - terminal
Hospital Outpatient Department
- Outpatient surgery - Surgical procedures performed w/out overnight
- Therapy: Includes pt, ot, etc
- Radiation: Cancer treatment involving radiation therapy
- 24-hour Observation Units: Short-term mon/care for up to 24 hrs
- Mental Health Therapy: Counseling and treatment for mental health conditions
Outpatient Mental Health Services
- Partial Day Treatment Programs: Structured treatment during the day with return home in the evenings
- Counseling: Individual and group therapy for mental health support
- AA and NA: Support groups for alcohol and drug addiction recovery
Cardiac/Pulmonary Rehabilitation
- Goal: Help patients recover, manage long-term illness, and improve overall quality of life
- Exercise: Structured phys ed - fitness
- Nutritional Counseling: Guidance on diet and nutrition
- Risk Factor Modification: Strategies to manage and reduce risk factors
- Counseling: Support for mental and emotional well-being
Ambulatory Care Clinics
- Urgent Care Centers: For non-emergency urgent medical issues
- Occupational Health Centers: For work-related health concerns and injuries
- Ambulatory Surgical Centers: Provide elective same-day surgical procedures at a lower cost than hospitals
Health Department
- Funding: Public facilities funded by county, city, state, and fed gov
- Cost: Lower than healthcare facilities
- Services Offered: Immunizations, Family Planning, Maternity Counseling, Well-Baby Checks, Child Development Services, Environmental Health
- Disease Tracking: Communicable diseases such as TB, Measles, Mumps, Rubella, Hepatitis, STDs, Flu, COVID-19
Medical Office
- Services Offered: Evaluation and Assessment, Treatment, Simple Diagnostic Tests, Simple Surg Proc
- Specialization: Healthcare professionals may focus on specific conditions
- Team Members: MD (Medical Doctor), Physician’s Assistant, Nurse Practitioners, Nurses, Other Medical Office Personnel
Home Health Care
- Care provided at home for patients confined due to illness or disability
- Services Provided: Skilled Nursing Visits, PT, OT, and ST, Social Work
- Home Health Aids: Assist with homemaking, laundry, personal care, shopping, and cooking
- Requirements: Must be ordered by an MD and deemed medically necessary for Medicare or private insurance coverage
- Licensing: Skilled services must be performed by licensed professionals
Hospice
- Interdisciplinary program offering palliative care & support for terminally ill patients and their families
- Eligibility: no longer seeking curative treatment & has 6 months/less to live
- Focus: Quality of life and comfort
- Services Provided: Pain & Symptom Management, Emotional Support, Medication Administration, Medical Supplies Provision, Grief Sup for Family
Hospital vs stand alone Surgical center surgeries
- Hospital - complex/high-risk surgeries - monitoring, specialists, advanced equipment, comprehensive medical support, overnight stays, & emergency care
- Surgical Center: elective/lower-risk procedures that don’t require overnight stays, focus on specific types of surgeries, more cost-effective, quicker, less complex experience
Surgical Consent
The surgeon or physician is in charge.
Nurse’s Role: Witness the signature.
Provide additional information and answer questions. Confirm understanding. Document the process.
Negligence
A failure to provide the level of care that a reasonable person would in similar circumstances, resulting in harm or injury to another. In healthcare, negligence might involve errors in treatment, failure to monitor, or not following established protocols, leading to patient harm.
Assault
Assault
Definition: An intentional act that causes a person to fear imminent bodily harm or unwanted physical contact. It does not require actual physical injury, just the apprehension of harm. In healthcare, assault might involve threatening behavior or gestures that make a patient feel threatened or unsafe.
Battery
The intentional and unlawful physical contact with another person without their consent. It involves actual physical harm or contact, unlike assault, which only involves the threat of harm. In healthcare, battery might occur if a provider performs a procedure or physical touch without the patient’s consent.
Malpractice
Professional misconduct or negligence by a healthcare provider that results in harm to a patient. It involves a breach of the standard of care expected from professionals in that field. Malpractice can include errors in diagnosis, treatment, or management that lead to patient harm.
Emancipated Minor
Has legally gained independence from parental control and is responsible for their own care and decisions. They have the legal rights of adults in many areas, including making medical decisions and entering into contracts.
1. Legal Process: Court proceeding.
2. Financial Independence
3. Living independently
4. Maturity: Handles adult respons
RACE
Rescue - remove patients from danger
Alarm - Sound fire alarm
Confine - confine fire, close doors
Extinguish - only extinguish small fires
PASS
Pull the pin found between the handles
Aim the nozzle of the fire extinguisher at the base of the flames
Squeeze the handles together to release the contents of the extinguisher
Sweep the nozzle back and forth at the base of the flames to extinguish the fire
1 Safety Concern
Falls!!
Implanted Radiation Patient
- Limit Time: near the patient.
- Keep Distance: when not giving care
- Use protective gear - lead aprons - sheilding, film badges - track exposure
- Private Room: warning sign in room
- Limit Visitors
- Patient Info: avoid close contact with others.
Medical Asepsis
Reducing germs to prevent spread. Keep environment clean and prevent infections
1. Wash hands regularly.
2. Keep areas and equipment clean.
3. Use gloves, masks, or gowns as needed.
4. Dispose of waste properly.
5. Avoid spreading germs between patients.
Surgical Aspesis
Keeping everything completely free of germs during surgery
- Wash hands and wear sterile gloves.
- Use only sterilized tools.
- Keep surgical area clean and sterile.
- Don’t touch anything non-sterile.
Restraints
- Phys Restraints: wrist/ankle straps, vests, bed rails.
- Chemical Restraints: Sedatives
- Environmental Restraints: Secured rooms, locked doors.
- Seclusion: Isolating patient in room.
- Soft Restraints: Gentle devices limit moving. Soft straps, fabric restraints.
- Alarms: Alerts when the patient moves. Bed/chair/leg alarms
Localized vs Systemic Infections
- Local Infection: Infection confined to a specific area of the body - redness, swelling, or pain at a specific site. Abscess, wound infection, ear infection.
- Systemic Infection: Infection that spreads throughout the body, affecting multiple systems or organs, fever, fatigue, or chills - Sepsis, influenza, systemic bacterial infect - tuberculosis
Bacterial vs Viral Infection
- Bacterial Infections: ANTIBIOTICS - Target and kill bacteria or inhibit their growth. - Penicillin, amoxicillin, ciprofloxacin.
- Viral Infections: NOT ANTIBIOTICS, rest, fluids, and over-the-counter medications to relieve symptoms.
Early AM Care
Toileting, Oral care and washing face
Morning Care
After breakfast - toileting, dentures, shower/bath, dressing, shaving, back massage
Afternoon Care
After lunch - toileting, straighten up room, oral fluids, positioning, comfort to visit with guests
bedtime
prepare for bed - fluids, remove dentures, massage, toileting
Flat position - supine
used for resting/sleeping, after lumbar punctures and back surgery
low Fowler’s Position
30 degrees, prevent aspiration while tube feeding
Semi-fowlers position
45 degrees, watch tv, converse with visitors, abdominal surgeries, difficulty breathing
Trendelenburg
lying on back with arms at sides, bed positioned so that feet are higher than head, abdominal surgeries
Reverse Trendelenburg
lying on back with arms at asides, head higher than feet, after angiography procedures, head elevated without pressure on femoral artery
Supine
on spine with arms at sides - physical exam, resting, anesthesia
Dorsal Recumbent
flat on back, arms to sides, legs apart, knees bent, feet flat - physical exam of abdomen, genitalia, perineal care and examination during labor
Lateral
lying on left or right sides supported behind back and between knees and ankles with pillows, good body alignment, comfort and to promote lung/cardiac function
sims (left semi prone),
lying on left side in semi-prone position with right leg flexed and drawn up toward chest, left arm positioned along patient’s back - rectal exams/enemas
right semi-prone
lying on right side in semi-prone position with left leg flexed and drawn up toward chest, right arm positioned along patient’s back - relieves pressure on tailbone
high fowler’s position
90 degrees, eat/drink without choking, difficulty breathing
orthopneic
90 degrees, feet flat on floor, patiently leaning forward slightly, arms raised, elbows flexed, supported on overbed table - severe respiratory distress
Prone
lying on stomach with head turned to side - improve oxygenation in patients with acute respiratory distress, relieve pain on back and tailbone
lithotomy
lying back with knees flexed above hips and legs supported in stirrups - vaginal examination, delivering neonates, pelvic/gynecological surgery/procedures
Open Bed
top linens fan folded to foot of bed. patient can easily slip into bed and pull blankets up
surgical bed
top linens fan folded to side of bed, when patient returns on stretcher can easily be moved into bed
closed bed
bed made with fresh linens, top linens spread to top of bed, when patient is discharged
Orthostatic Hypotension (postural hypotension)
decrease in blood pressure that occurs when a patient changes from reclining of flat position to an upright position, such sitting or standing common after patient has been restricted to bed rest. Dizzy, pale, clammy, or nauseated, possibly fainting, assist to sit or recline if noticed, stay with patient
Nclex is national, education will be the same, scope of practice may change
Fall Risk
Higher the #, greater the chance of falling
age and ability to understand, impaired mobility, communication, pain and discomfort, delayed assistance, equipment
Standard Precautions
Safety measures performed to prevent transmission of pathogens found in blood and body fluids, hand hygiene, appropriate protective equipment if exposure is possible, cough etiquette, performed with every patient, protect worker and patient from blood borne pathogens such as hepatitis B and HIV, PPE - wash hands and use gloves
Contact
gloves and gown, plus standard precautions - direct/indirect contact, wound drainage, fecal incontinence, MDROS -MRSA, C diff
Droplet precautions
mask - N95 may be required, respiratory hygiene/cough etiquette, plus standard precautions, respiratory/mucus secretions, FLU A, Streptococcus bacterial meningitis, rubella, and mycoplasma pneumonia,
Airborne
N95 or higher respirator, patient placed in airborne infection isolation room with negative pressure, plus standard precautions, prevent tuberculosis, rubeola, chickenpox, and severe acute respiratory syndrome
Delegating
Right task, right circumstances, right person, right directions/communication, right supervision and evaluation - make sure you stay within scope of practice to avoid court hearings
Student Nurse vs Nurse Expectations
Student Nurse:
Learning Focus: Prac skills w guidance.
Supervision: Work under precept/instr.
Respons: basic tasks, assist care.
Decision-Making: Limit, with guidance.
Prof: Dev skills, dress codes.
Registered Nurse (RN):
Clinical Competence: Independent care.
Autonomy: Make decs, prior needs.
Resp: Man complex care, mentor stud.
Leadership: Oversee teams, del tasks.
Prof Dev - Stay updated with knowledge.
incident report
Keep the report factual and objective
1. Date/Time: when incident happened.
2. Patient Info: patient’s name and ID.
3. Desc: What happened, step by step.
4. Witnesses: List names and roles
5. Actions Taken: actions/care prov.
6. Outcome: patient’s status/effects
7. Follow-Up: Record add care needed.
8. Signature: Sign and date the report.
Restraint Assessment
- Skin for redness or sores.
- Blood flow (no cold/swollen areas).
- Patient’s comfort and pain.
- Mental state (calm or upset).
- Ability to move within restraints.
- Restraints are not too tight.
- Right after applying restraints.
- Every 2 hours or as per policy.
- When restraints are removed.
