Nurs 317 first exam Flashcards
describe four categories of safety risks in health care agency
falls, patient inherent accidents, procedure related accidents, equipment related accidents
patient inherent accidents
self induced
procedure related accidents
during therapy or treatment
what do patients want from health care and providers
access, safety, outcomes, and respect
2018 national patient safety goals
medication safety, core measures (standardization of care), surgical care improvement, safe patient handling, hand off communication, alarm fatigue
what can you do as a provider to improve patient safety
follow protocols, speak up with concerns, listen to patients colleagues and mentors, take care of yourself
patient centered care
providing respectful and responsive care to patient’s preferences, needs, values and ensuring patient values guide plan of care
evidence based care
process that promotes optimal heath care based on research
never events and examples
serious and preventable events that should never occur in hospital setting. example: pressure ulcer or wrong site surgery
sentinel events and examples
unexpected outcomes or risk involving death or serious physical or psychological injury. example is patient suicide, medication error, or delay in treatment
analyze for safety concerns: immobile patient with dysphagia having to stay in the hospital for a prolonged amount of time.
This would increase the risk for the patient to develop pressure ulcers. I would look for any erythema that does not blanch. I would also look at the record and make sure the patient is being turned every few hours and make sure to record each time I move the patient. I would communicate with the patient’s family or caregiver how important it is for the patient to be turned and educate them on what to look for. I would pay extra attention to areas where skin breakdown is most common, like the sacrum, spinal processes and occipital bone
Articulate role of the Florence Nightingale in nursing
Florence Nightingale is credited to being the founder of “Modern Nursing”
Nightingale transformed nursing into a professional role, not just caregiving
She used biostatistics to demonstrate the efficacy of her interventions
Verbalize the definition of a professional nurse
protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response and advocacy in care of patients
dependent nursing actions
doing something in guidance of the physician. example: medication administration
independent nursing action
part of the nursing process. you challenge the ways others think and look for rational and logical answers to problems.
collaborative nursing action
also known as interdependent. working together with another healthcare professional to get things accomplished for patient’s care.
domain
It is the knowledge of nursing practice and nursing history, nursing theory, education, and research. Gives nurses a comprehensive perspective that allows you to identify and treat patients’
health care needs in all health care settings
theory
a set of concepts,definitions,and assumptions in order to explain a particular phenomenon.
paradigm
is a pattern of beliefs used to describe the domain of a discipline
Henderson’s theory
there are 14 basic life activities a patient needs assistance with, help with these needs until patient is able to do them alone. Ex: breathing, eating/drinking, elimination, movement/positioning, sleep/rest, clothing, body temp., hygiene, safety, communication/socialization/play, practice of faith, learning
Leininger’s theory
focusing on culture as nursing and health care would become more global. know how to care for patient based on their culture allows for comfortable and effective care
Nightingale’s theory
based on bringing patient closer to nature; incorporate good environment to help with healing. Ex: sunlight helps patients with healing.
Orem’s theory
teaching patients to be self sufficient, practice self care, Goal: teaching patient to manage own health problems
Neuman’s theory
role of nurse is to stabilize patient, identify stressors, and assess the whole
Roger’s theory
unitary beings. Nurses role is to be truly present with patient and accept the patient’s view on reality
Watson’s theory
Caring. seeing patients spiritual needs.
Roy’s theory
adaptation. People have ability to adapt, nurses need to help them adapt physically, emotionally and mentally.
why we use nursing diagnoses instead of medical diagnoses to plan care
We use a nursing diagnoses instead of a medical diagnoses because we don’t diagnose off signs and symptoms. We make clinical judgements about our patients in response to an actual or potential health problem and therefore educating our patients.
process of data collection
collection, validation, patient centered. The data may come from primary(patient) secondary(family/friend), patient’s history,lab,imaging,or prior consultations.
subjective data
symptoms. what a patient tells you
objective
signs. what you observe
patient centered interview
courtesy, comfort, connection, confirmation, and open-ended questions
courtesy
addressing the people in the room and asking permission to conduct the interview
comfort
making sure the environment is correct like the room isn’t too cold. You want correct room temperature and good lighting
connection
eye contact, sit down, take time listening to them
confirmation
ask:Is there anything else you want to share? Ask if you got their information correct
nursing diagnosis
clinical judgement about the patient in response to an actual or potential health problem
3 components of nursing dx
problem, etiology, and defining characteristics
problem
labeling the health concern (Dx)
etiology
why does the problem occur - cause
defining characteristics
signs and symptoms that validate what is going on.
what do you use when deciding prioritization
ABCs and mallows hierarchy of needs
priorities
high, interm, and low
ABCs
airway, breathing, and circulation
maslows hierarchy of basic needs
At the base is physiological needs Then safety Then love/beloging Esteem And at the top (which means it is the least important) is self actualization
SMART
specific, measurable, attainable, relevant, and time used when making a short-term goal
characteristics of a critical thinker
confidence, fair, responsible, accountable, risk taking, discipline, perseverance, creativity, curiosity, integrity, humility, thinking independently, uses evidence, uses reflection, uses standards
dreyfus model
shows how students acquire skills through formal instruction and practicing. students move through 5 stages.
5 stages of Dreyfus model
novice (beginner), advanced beginner, competence, proficiency, and expert
karaoke-yahiro and saylor model
three levels of things as you grow as a nurse from a beginner to expert
three levels of karaoke-yahiro and saylor model
basic - experts are always right, complex - begin to separate learner from authority, and commitment - anticipates needs to make choices and assumes accountability for them
Identify some ways that you can build your critical thinking
reflective journals, take notes after clinicals, ask yourself these questions: What are you feeling about the situation? Did this situation remind you of a past experience? Where are the connections between clinical and class?, meet the peers to get new perspectives on situations, and use concept maps
standards of care
o Provide physical exams and health histories
o Health promotion, counseling and education
o Administer medication
o Wound care
o Personalized interventions
o Interpret patient information and make critical decisions about needed actions
o Coordinate care in collaborate with a wide array of healthcare professionals
o Direct and supervise care delivered by other healthcare professionals
o Conduct research about improved practice and patient’s outcomes
direct interventions and example
treatment performed by interactions with the patient. giving medications or educating patient
indirect interventions and example
Treatment performed away from the patient but on the behalf of the patient of groups of patients. nurse requesting consultation
steps to evaluation process
make decisions, articulate the purpose of evaluation, identify and collect relevant information, and analyze and interpret information
Describe how evaluation leads to the modification of the plan of care
If they were NOT met then start a new plan and begin that plan by redoing the assessment and starting from there.
If the goals WERE met then the new goal may be to met higher expectations of wellness and reduced risk
high priority needs
if left untreated will result in harm to patient. Those issues related to airway status, circulation, safety, and pain are of highest importance. Example would be if someone has an obstructed airway.
intermediate priority
nursing diagnoses that are non emergent, non life-threatening needs of patients. An example would be monitoring a risk for infection
low priority needs
not always related to a specific illness or prognosis but affects a patient’s future well being. It focuses on the patient’s long-term healthcare needs. An example would be focusing on a patient’s anxiety.
Explain the role of how health promotion can decrease costs
Health promotion can decrease costs because it can reduce incidence of disease, minimizes complications, and reduces the need for more expensive resources
primary care services
first entrance into the healthcare system
secondary and tertiary care
are the most common services. The focus is on the diagnosis and treatment of the disease
secondary acute care
emergency care, acute medical care, radiology procedures
restorative care
regain maximal functional status and enhance quality of life by promoting independence and self care. examples are home health, rehabilitation, and extended care facilities
home health
uses nursing services to offer patient care like vital signs, wound management, medication management, and nutrition. Limitation of home health is the patient is often homebound and cannot access these services any other way
rehabilitation
restores a person to the fullest physical, mental, social, vocational and economic potential possible
extended care facilities
provide intermediate medical, nursing, or custodial care for recovering patients.
respite care
provides short term relief or time off for people providing home care to an individual who is ill, disabled, or frail.
standards of professional performance for the nursing profession
being ethical, educated, utilize evidence based practice, have a high quality of practice, communicate effectively, have good leadership, collaborate, professionally evaluate, utilize resources, practice in a safe healthy manner
assessment
it is pertinent to gather information to make accurate judgements about a pt’s current condition. A comprehensive assessment moves from general to specific. includes collection of info and interpretation.
reassessment
If a nursing diagnosis is unresolved or a new problem has developed, reassessment is necessary
plan of care
Focuses on improving health of pt to discharge them from hospital as soon as possible.
Describe a method used for assessing culture
method used for assessing culture is a comprehensive cultural assessment in which the patient is asked different questions in order to best understand his/her worldview.
enculturation
experiences, observations, and norms that an individual learns and develops as their primary culture.
acculturation
adoption of a second culture which replaces the primary culture
assimilation
the loss of culture such as language or customs. Seen in people who move to different countries
multiculturalism
being aware of the different cultures, and has an impact due to cultural values, health beliefs and practice
stereotyping
generalized idea or image about a person based on ethnic background
ethnocentrism
a person’s belief that their own culture is superior over others
emic worldview
is an insider’s perspective into their own native culture
etic worldview
An etic worldview is an outsider’s perspective. In other words, an etic perspective is the perspective from an observer
Describe the actions of a nurse during the process of delegation
Appropriate delegation begins with knowing which skills you are able to delegate.
access the knowledge and skills of the delegate match tasks to the delegate's skills communicate clearly listen attentively provide feedback
how to determine your scope of practice
Nurse Practice Acts define the scope of nursing practice
nursing process
assess, analyzing, planning, implementation, evaluating
risk nursing diagnosis
only two parts - dx with related to
values
beliefs. ideals that give meaning to an individual’s life. Values are also abstract values that give a person a sense of what is right or wrong. We develop values in childhood and they tend to change with life experience or situations
morals
the fundamental standards of right and wrong. Morals are learned from external influences and are based on religious beliefs, societal norms, personal, and family values.
ethics
behavior. principles or standards that govern proper conduct
Deontology theory of ethics
Right or wrong are determined on the basis of one’s duty or obligation to act not on the consequences of action
Utilitarianism theory of ethics
Right or wrong are based on the consequences of a given action. measures the effect that an act will have.
altruism
a concern for the welfare and well being of a patient
autonomy
is the right to self determination. A person’s right to choose and ability to act on that choice (based on respect for human dignity), even when it is not in their best interest
human dignity
respect for the inherent worth and uniqueness of patients and populations
integrity
acting in accordance with appropriate code of ethics and accepted standards of practice.
social justice
upholding moral, legal and humanistic principles
professional values of nurses
altruism, autonomy, human dignity, and integrity
five major ethical principles of health care
justice, fidelity, paternalism, veracity, nonmaleficence
justice
being fair to all people
fidelity
the obligation to be loyal to commitments made to oneself and to others. In nursing, fidelity includes the nurse’s faithfulness to responsibilities accepted as a member of the profession
paternalism
occurs when health care providers decide what is “best” for clients. Can be a negative outcome of beneficence
veracity
the duty to tell the truth
nonmaleficence
the obligation of the health care provider to do no harm
Nonmaleficence double effect
intended foreseen effects of actions by the professional nurse. Four conditions must be presented to justify the use of the double effect principle: 1) the action must be good or at least morally indifferent (neutral), 2) The healthcare provider must intend only the good effects, 3) The undesired effects cannot be a means to the end or good effect, 4) There is a favorable balance between desirable and undesirable effects
self determination
he right to make healthcare decisions for oneself, even if the healthcare provider does not agree with the decisions made
Identify situations in which principle of autonomy occurs
The client’s right to refuse treatment is based on the principle of autonomy. Our obligation s that they have all the information to make that decision
Identify situations in which principle of fidelity may occur in nursing
when a nurse is asked to work overtime after completing a 12 hour shift which requires the nurse to remain fidelity with oneself, the patients, employer, and the profession. So if the nurse agrees, it is important that promise is kept and the level of care/work is not decreased.
beneficence
a nurse’s actions should promote good. Doing good is thought of as doing what is best for the patient.
advocacy
the act or process of supporting a cause or proposal. As a nurse you advocate for the health, safety, and rights of patients, including the right to privacy and their right to refuse treatment
steps to resolving an ethical dilemma
Step one: ask the question, is this an ethical dilemma?
Step two: gather information
Step three: clarify values. Distinguish among fact, opinion, and values
Step four: verbalize the problem.
Step five: identify possible courses of action
Step six: negotiate a plan
Step seven: evaluate the plan over time.
euthanasia
the practice of intentionally ending a life to relieve pain and suffering
passive euthanasia
withholding or withdrawing life-prolonging or life-sustaining measures in order to allow for the death of a person such as pulling the plug
active euthanasia
involves a deliberate action which intentionally causes the death of a person
living will
directs treatment according to client wishes in the event of illness
durable power of attorney for health care decisions
designates a person to make health care decisions when one cannot make them any longer
DNR
physician’s order that support life sustaining treatment like putting a patient on ventilator or performing CPR does not happen when that is the patient’s wishes
Physician order for life sustaining treatment: (POLST)
very specific, and followed in whatever settings. Provide medical ordered to be honor and followed by health care workers during medical crisis.
characteristics of a good nurse
compassionate, and one who provide patient centered care
characteristics of a bad nurse
not caring for patients or provide a lack of care
characteristics of a non caring nurse
have a problem with communication
Identify what a nurse can do to improve quality
measure and collect data on quality
Identify opportunities for improvement
Participate in interdisciplinary teams
Developing policies and procedures.
role of standards of professional performance for the nursing profession
- Quality of care
- Performance appraisal: nurse is accountable for providing competence care
- Education: nurse must continue to pursue knowledge
- Collegiality: the use of interdisciplinary rounds working with other health care workers
- Ethics: delivery care in a non-discriminatory, sensitive and culturally appropriate manner
- Collaboration: interaction between provider and patient.
- Research
- Resources utilization.
- Communication
- Leadership
activities of assessment
look, listen, feel fro head to toe
activities of plan of care
what actions will be taken in order to reach a goal
AIDET
acknowledge, introduce, duration, explanation, thank you
using LAST in conflict resolution
Listen, advice/apologize, solve, thank you
hourly rounding of patient care
4 P’s pain, potty, position, and possessions
AMA
against medical advice and refers to a patient who wants to leave the hospital against the orders of the physician
Differentiate between a “Code Blue” and “Rapid Response”
A Code Blue is called in a life threatening crisis (example: the patient is not breathing or does not have a pulse).
Rapid Responses are called when a nurse needs help within 15 minutes. In this case, the pt is deteriorating such as a heart rate less than 40
CUS
I am concerned. I am uncomfortable. Stop there is a safety issue
Identify general formatting rules of margins, font, and size of type in APA
Margins should be 1 inch around. Font should be times new roman size 12.
Identify actions to take to avoid plagiarism.
Properly quote and paraphrase (more than 50% reworded)
Properly cite to give author credit and allow readers to also visit that source
Recheck work for plagiarism
Level I: Systematic Review
Highest level of evidence
Gives broad overview of what the literature is reporting
Level II: evidence
evidence obtained from one well designed study
Level III/IV: evidence
Expert opinion and case reports
nursing paradigm
people, environment, nursing, health
questions to ask when critical thinking
who, what, when, how, where, and why
each nursing intervention needs to have
a rationale
rationale
why you are doing what you do
medicare part A
hospital insurance
medicare part B
covers some preventative and primary care
medicare part C
medicare advantage plan
medicare part D
prescription drug coverage
medicaid
state administered program
3 nursing interventions
do something, assess something, teach something
o If a nurse decides to withhold a medication because it might further lower the patient’s blood pressure, the nurse will be practicing the principle of?
accountability
how many interventions per nursing diagnosis
3
goal should start with
patient will
related to
refers to why you think the nursing dx is happening
as evidence by
the signs and symptoms that prove the point
what type of event would you report to the joint commission
sentinel event
a volunteer receives a care giver temporarily so the care giver can run errands. what type of care is the volunteer providing?
respite
what type of medicare pages 50% of mental health services?
B
maintaining accountability in the delegation of care and managing risk in the provision of healthcare services are components of what?
scope of practice of the nurse/ role of the nurse
five rights of delegation
right person, right task, right supervision, right communication, and right circumstance
pneumonic - please take sue cold cuts
what are title heading that are included on a concept map?
signs and symptoms, MD orders, labs, goals, and nursing interventions
interactive model of a theory puts emphasis on?
interpersonal relationships between the nurse and person
if a patient is having trouble affording his meds, so the nurse asks the Dr to prescribe a generic one instead, what theory is this demonstrating?
neuman - the patient is experiencing financial stress so the nurse attempts to decrease it by finding a way to reduce the cost
a patient falls while at the hospital. this does not fulfill which of the health care initiatives
safe patient handling
three classifications of theories
interactive, systems, and developmental
