Management of Care: Prioritization and Recognizing Client Deterioratoin

Question 1

medical errors are the ____rd leading cause of death.

Answer 1

3rd

Question 2

___% of sentinel events are related to communication errors.

Answer 2

70

Question 3

___% of clients who die in the acute care setting are from lack of knowledge by the nurse or inability to appreciate clinical urgency.

Answer 3

50

Question 4

any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient’s illness.

Answer 4

sentinel event

Question 5

• identify essential clinical data indicative of an acute change in patients’ health status
• initiate independent and collaborative actions to correct or minimize risks to patient’s health.
• know or why these actions are relevant.
• differentiate between problems needing immediate or subsequent action

Answer 5

skills EXPECTED of entry level professional nurse

Question 6

1. acute condition (reason admitted to the hospital)
2. co-morbidities (or past medical hx)
3. medications
4. age
5. mobility
6. nutritional status
7. fragility

Answer 6

why do patients deteriorate?

Question 7

• what is the primary problem and underlying pathophysiology?
• what clinical data from the chart is relevant and needs to be trended?
• what are the relevant nursing priorities to guide the care?
• what nursing interventions should the nurse initiate based on these priorities? what outcomes does the nurse hope to achieve?

Answer 7

questions to answer prior to providing care

Question 8

• what is the focuses area of assessment based on the primary problem or priority?
• what is the worst possible complication based on the primary problem?
• what nursing assessments will identify this complication early?
• what should the nurse do if this complication develops?

Answer 8

Additional things to consider prior to providing care

Question 9

• What clinical assessment was collected that is relevant and needs to be trended?
• should the nurse modify the plan of care based on this assessment?
• when reviewing physician notes what is the rationale for any new orders or changes made?
• are there any patient educational priorities that have been identified?

Answer 9

questions to answer during care

Question 10

setting priorities is determined by differentiation between problems that need _______ attention and problems that can wait.

Answer 10

immediate

Question 11

• ABCs
• vital signs
• lab values that need attention
• changes in mental status (what if airway is affected)
• untreated medical problems
• pain
• elimination problems.

Answer 11

priority setting

Question 12

• is the situation life threatening or life altering?
• is the situation unexpected for the disease process?
• are the lab data abnormal?
• is the situation expected for the disease process?
• is the situation or is the data normal?

Answer 12

prioritization using Maslow’s ABCs

Question 13

in priority setting and deciding what to do first using the _____ ______, assess.

• the assessment must match up with the problem is identified.
• if the nurse has enough assessment information to determine that the client is in distress implementation is more of a priority and should be done first!

Answer 13

prioritization utilizing the nursing process

Question 14

when prioritizing client problems related to psychosocial, developmental, or promotion of positive relationship and self-esteem knowing the developmental stages of ______ will help nurse to select the most appropriate approach.

Answer 14

prioritization using Erikson’s

Question 15

• trust needs revolve around caregiver.
• familiar caregiver who is consistent and sensitive to infant needs/cues. Infant will learn the world is a safe, predictable place.
• Learning to trust others is the first necessary step to learning how to have loving, supportive relationships with others and to have a positive self image.

Answer 15

trust versus mistrust
(birth - 18 months)
HOPE

Question 16

autonomy: toddlers learn they can control their actions and act on the environment to get what they want.
- young children become autonomous when caregivers are supportive and give children the safe space to make their bodies and problem solving skills without shaming or ridiculing the child.
- when children feel shame and doubt, they believe that they are not capable of making valid decisions and not capable of doing everyday tasks.

Answer 16

autonomy vs shame and doubt
( 18 mo. - 2 or 3 years)
WILL

Question 17

• when children develop initiative, they continue to develop their self-concept and gain a desire to try and to learn new things while being responsible for their actions to some extent.
• if caregivers continue to give children a safe space to experiment and appropriate stimuli to learn, the children will continue to find their purpose.
• however, if caregivers try to create too many strict boundaries around what children an do and to force too much responsibility on kids, children will feel extreme guilt for their inability to complete tasks perfectly. it is important for caregivers to encourage exploration and to help children make appropriate choices.

Answer 17

initiative vs guilt
(3 - 6 years)
purpose

Question 18

• friends and classmates play a role in how children progress through the industry vs inferiority stage. Through proficiency at play and schoolwork, children are able to develop a sense of competence and pride in their abilities. By feeling competent and capable children are able to also form a strong self-concept.
• during social interactions with peers, some children may discover that their abilities are better than those of their friends or that their talents are highly prized by others. This can lead to feelings of confidence.

Answer 18

Industry vs Inferiority
(6 - 11 years old)
competence

Question 19

• those who receive proper encouragement and reinforcement through personal exploration will emerge from this stage with a strong sense of self and a feeling of independence and control.
• those who remain unsure of their beliefs and desires will remain insecure and confused.
• resolving the crisis at this stage of development involves committing to a particular identity. This might involve committing to a career path, deciding what social groups to associate with and even developing a sense of personal style.

Answer 19

Identity vs Role confusion
(12 - 18 years)
FIDELITY

Question 20

• people who are successful in resolving the conflict of the intimacy vs isolation stage are able to develop deep, meaningful relationships with others. They have close, lasting romantic relationships, but they also forge strong relationships with family and friends.
• studies have demonstrated that those with a poor sense of self will tend to have less committed relationships and are more likely to suffer emotional isolation, loneliness, and depression.

Answer 20

Intimacy vs Isolation
(19 - 40 years)
LOVE

Question 21

• adults strive to create or nurture things that will outlast themselves; often by parenting children or contributing to positive changes that benefit other people. Contributing to society and doing things to benefit future generations are important needs at the generativity vs stagnation.
• generativity refers to “making your mark” on the world through caring for others as well as creating and accomplishing things that make the world a better place.
• stagnation refers to the failure to find a way to contribute. These individuals may feel disconnected or uninvolved with their community and with society as a whole.

Answer 21

Generativity vs Stagnation
(40 - 65 years)
CARE

Question 22

• people reflect back on the life they have lived and come away with either a sense of fulfillment from a life well lived or a sense of regret and despair over a life misspent.
• successfully resolving the crisis at this stage leads to the development of what Erikson referred to as ego integrity. People are able to look back on their life with a sense of contentment and face the end of life with a sense of wisdom and no regrets.
• Erikson defined this wisdom as an “informed and detached concern with life itself even in the face of death itself.”

Answer 22

Ego Integrity vs. Despair
(65 years - death)
WISDOM

Question 23

• most experienced nurse gets the most critical cline.t
• balance nurse workload. this does not always equal the same number of clients.
• new nurse can take care of a client who is receiving care from a student with supervision.
• most stable client can transfer to lower level of care, be discharged, or assigned to LPN.
• unstable client needs to be transferred to a higher level of care; critical care unit.
• assign float nurses based on the nurse’s experience.
• DO NOT assign clients based on location or proximity of assigned clients only.

Answer 23

Managing Groups of Clients and Determining Assignments