Management of Care Flashcards
Nursing Process
Assessing
Diagnosing
Planning
Implementing
Evaluating
HIPAA
health insurance portability and accountability Act
Law protecting the right to privacy for clients. It regulates how a clients personal, health information (example: diagnosis, test results) care used and disclosed
HIPAA Key points
Only share client info with other team members directly involved with care
Need to know basis only
No over sharing detailed information with non essential personnel (transporters, secretaries)
Never discuss client info in the hallway, elevator, public area, outside the hospital = secure private area only at work (nurses station, private room)
Do not access charts or information that is not needed directly for work
Computer charting
No password sharing - Not even with supervisor (charge nurse, director)
Log off when stepping away and log off your coworkers if they do leave the computer in the hall unattended
No taking info home
Dispose of report sheets in a secure shredder
Old medical record are kept in a locked file cabinet in the department
Information releases
Yes - clients have a right too receive a copy of the health records
No sharing information with a family or friend without clients permission
Report any breech of confidentiality
violation examples: taking about a clients condition in a hallway, elevator, cafeteria etc.
Taking home a clients report sheet (medical information) must be shredded at the end of shift
Sharing info with a clients roommate (ex. your roommate is going for a gallbladder test)
Sharing info with a clients spouse to legal guardian without permission
Charge nurse from another unit ask about the clients condition stating “the client is my neighbour and I want to check on her”…
Im sorry I cannot tell you
The nurse looks up the chart of a cousin who is not under the care of the nurse. What is the managers next action?
Contact human resource department
A nurse has shared his computer username and password with a student, possible consequences?
The nurse can be prosecuted
Husband requesting lab results for his wife. How should the nurse respond
Let me check if you have permission
19 year old female asks for prescription for oral contraception. She is under her parents insurance but doe not want her parents to know. According to HIPPA, which of the following should the provider tell the patient?
The clients parents may not view the medical record but may learn about it from their insurance billing receipts
Which off the following violates the health information privacy law?
Telling the clients transportation tech that the client has stage 4 pancreatic cancer for 3 weeks and needs to be handled gently
The new grad nurse accessing updated medical records of a client that they took care of last week but not currently assigned
Explaining the results of a clients lab reports to aa sit secretory who is organizing medical records
HIPAA Exception
Information must be shared if the client is threatening to harm themselves or other
If the client is being abused, nurses are the mandatory reporters
the nurse would be justified in breaking confidentiality if…
an older adult client discloses their caregiver hits them
Autonomy
Always in control
The clients right to make their down healthcare decisions
Respecting a clients right to refuse a treatment
Advocacy
To protect the clients rights, health and safety
Reporting critical changes in the clients condition
Beneficence
Benefit
Doing and promoting good
Calling the family of a client to tell them “critically ill and we are caring for their needs”
Fidelity
“faithful”
To stay loyal and follow through
Ex. follow through with your responsibilities
Client reports 8/10 pain. The nurse states she will return with pain meds and follows through with the act
Fidelity
Justicie
To treat fairly and equally
Provide care equally regardless of race, gender, religion, culture
Ensuring that time and resources are distributed equitably to clients
Nonmaleficene “no Mal-intent”
Avoid causing harm
Double checking drug dosage
Veracity
Very honest
Tell the truth
Med error with no adverse affects but till reporting it
Negligence
The failure to provide adequate care
Practice that its below the standard of care
nurse did not wash their hands prior to inserting a Foley catheter
Nurse identifies the absence of peripheral pulse in a clients casted extremity in the early morning. The nurse reports it to the HCP in the early afternoon
If informed consent is withheld from a client
Health carer providers could be found guilty fo negligence
Malpractice
illegal improper or negligent actions by a licensed professional
Rn failed to check the doses on a medical viral which harmed the client
Abandonment
Desertion of a client by anyone who has assumed the responsibility of care
Assault
The threat of harm
Any threat made toward a client
I will restrain you to the bed if you keep getting up
Threatening to place a nasogastric tube in a client who is refusing to eat
Battery
The act of arm
Physical act that causes harm or unconsenting contact that causes harm
Example: performing a procedure without consent
Giving medication that the client refuses
Assault and Battery Example: chemical restraining a patient who is competent and able to make decisions
False imprisonment
Using physical restraints, reclusion or a chemical restrain to keep someone against their will
Example using restraints on a competent client to prevent them leaving the health care facility
Invasion of Privacy
Violating confidentiality right
Defamation of character
Making rude insulting remarks that harm a clients reputation
Libel: written library
Slander: spoken - break room gossip
Two nurses sitting in the lounge hear a coworker state that she believes a married HCP involved in a relationship with a client
Slander
A nurse applies restraints without a prescription… client who threatens to leave AMA… intentional torts? (SATA)
Battery
False imprisonment
Informed Consent
Required before invasive procedures and surgery
Confirms a clients voluntary decision
Performing procedure without consent is illegal
Rules for informed consent
Consent must be given by a competent adult
Parent/guardian of a minor
POA
Spouse or closest relative
Emancipated minors can give own content
Alerted level of consciousness
Not competent to provide consent
Unconscious
Mental health: bipolar, schizophrenia (during episodes)
Impaired alcohol/drugs
Dementia
Delirium
Client who are admitted involuntary have a right to informed consent as long as they remain competent
Minors (less than 18 years)
Require parent content
Exceptions: pregnant, married emancipated, substance abuse, STI, members of the military, minors who are parents
Language: non-english speakers can not consent without a medical interpreter to translate
Not friend or family - medical interpreter
emergency surgery.. cannot sign the operative content from because of sedation. The nurse should take which priority action
Obtain telephone consent from a family member witnessed by2 authorized individuals
Informed content can be provided by which of the following clients
A pregnant 16 year kid client at 36 weeks gestation with painful vaginal bleeding
14 year old prescribed antipsychotic medication without parental consent obtained
Do not give the medication and document the reason
(must have signed consent form by parent)
Informed consent: roles and goals
Provider (surgeon) not the nurse
Nurses job to witness not obtain
Providers responsibility to explain the procedure (benefits, risks and alternatives to the procedure)
Provider should answer all the questions - NOT the nurse
Provider should explain the right too refuse surgery
If an issue arises in surgery needing additional surgery
Call the clients medical power of attorney, legal guardian or next of kin to provide content for additional procedures
Life saving: provider decides based on advanced directives
Nurses role in informed consent
Witness the consent
Document in the medical record date and time the signature was obtained
verify the client is competent and voluntarily signing
Advocate: assess the client and confirm they received and understand the info, notify surgeon if client has any questions
Client questions? diet, exercise, breathing etc. after surgery can be explained by the nurse
Contact the HCP if the client does not have a correct understanding or specific questions about the procedure itself
What to AVOID with informed consent
Not educating about the procedure if there is a misunderstanding
No explaining the right to refuse surgery
If client changes their mind
Notify the provider 1st
Do not try to talk the client into surgery
Client whoo has a history of dementia but is alert and oriented x4. Who gives consent?
The client
When the client is not oriented the POA would make the decision
Ive changed my mind and dont want to have the surgery. What should the nurse respond
I will notify the provider about your decision
While obtaining the clients signature before surgery the client states “I done understand what is included in a low sodium diet after surgery? how should the nurse respond
Teach the client about a low-sodium diet
A client is about to undergo a surgical procedure does not fully understand the risk. Which of the following is duty of the nurse
Witnessing the clients signature on the informed consent form
Acting as an advocate to ensure the client has all the necessary information
Advanced directives
Separate from a final will
Document that describes the kind of treatment wanted
Legal documents outlined medical care if the client becomes unable to verbalize their wishes
Example: client glascowma scale score less than 7 or client with a brain bleed with aphasia
Document Placment
Clients medical record
Copies should be given to family and friends and everyone listed as health care proxies
Not need to be notarized - ca be completed in the healthcare setting if there are 2 wittnesss
Not the nurses or HCPs directly involved in the carer of the client
Not individuals named as health carer proxies
No advanced directive = full treatment
Client newly diagnosed with mild Alzheimer disease. Which action should the nurse prioritize at this Time when teaching the client and family
Encourage the client to make an advanced directive before cognitive abilities decline further
Durable power of Attorney
POA
Assigns another person to make medical decisions for the client if the client becomes incapacitated
There are ma y types of POAS = clarify the POA that can make the healthcare decision
Living Will
a signed document that outlines wishes and desired medical care if the client becomes incapacitated or unable to communicate
Level of interventions
Life-sustaining (ex ventilator, tube feeding)
Full Code
Full resuscitative measurers
Chemical code
Medications only - non CPRR, electric shocks or respirations
DNR
Do not resuscitate
No CPR, no bag valve mask or resuscitative actions
AND
Allow natural death
DNI
Do not intubate
The clients condition is worsening the nurse ice unsure of the clients resuscitative status which action should the nurse take first
Call for the charge nurse to check the advanced directive while continuing to assess the client
PSDA
Patient self determination act
Requires facilities to ask all admitted clients if they have advanced directives
If no advanced directive found?
the law requires the facility to furnish written information outlining the clients rights, wishes and healthcare decisions
Right to refuse
Right to refuse treatment if they are competent to do so
Right to refuse medications and other therapies if they were involuntary admitted (expect in emergency treatment)
A client refuses to take medication. What is the most therapeutic response by the nurse?
You don’t have to take the medication if you don’t want to
Client who is AOx4 is a Jehovahs witness and its refusing to receive blood products. Their partner is not a Jehovahs witness and wants the client to receive the blood. The nurse should
Respect the clients right refuse the treatment
AMA
Leaving against medical advice
The client can choose to leave the hospital before proper discharge
Does the client have the right to leave
Was the client properly educated as to why they should stay
Are they competent to make the decision
Do they have legal hold (sucide watch)
Which of the following clients cannot be allowed to sign out AMA
A client who states that the voice is telling him to kill his child
A client who is altered
An intoxicated client whoo haas been drinking heavily and cannot walk
Nursing actions for AMA
inform he client of the risk of refusal
Notify the Porrivder
DI not call security
Discuss the risks associated with leaving AMA
have the client sign AMA form (or document refusal to sign form)
Remove any IV catheters or tubes
A client admitted voluntarily for treatment of an anxiety disorder demands to be releases. What action should the nurse take initially
Contact the clients primary HCP
Mandatory reporting
Report suspected abuse
Only after a detailed assessment and full history
Interventions:
Protect client from immediate harm
Separate interview client away from suspected abuser
Collect and prepare evidence
Safety plan and provide information on shelters and safe houses
PEE DON and DOFF
DON:
Gown
Mask
Goggles/face shield
Gloves over the gown sleeves
DOFF:
Gloves
Face. shield/ Googles
Gown
Mask
Case management
Assist client to maintain independence - utilize available resources
Care plan for each client
Discharge care plan: available resources in the community, info about meds, follow-up visits, future lab tests
5 Rights of delegation
Right task: Can the task be safely delegated
Right circumstances: is the client stable and is the outcome predictable
Right Person: scope of practice dose the person know whom the task will be delegated have the necessary knowledge and appropriate skills)
Right communication/Direction: Specific task to be performed, expected results, follow-up communication)
Right Supervision: Clear directions, intervene if necessary, take responsibility
Establishing Priorities
ABC’s
Maslow’s hierarchy of needs
TIme
Agency policy and procedures
Client preferences
Care related to client activity
Priorities in medican therapy
Priority Patients
Not in order
Post Op clients just out of surgery
Status has deteriorated from normal baseline
Signs of shock
Allergic reactions
Chest pain
Post diagnostic procedure clients who require temporary monitoring
Clients who tell you they have unusual symptoms
Clients with malfunctioning equipment or tubing
