Nursing Fundamentals Part I Flashcards
1 - Interprofessional Team:
Provider, Occupational Therapist, Social Worker, Speech Language Pathologist
INTERPROFESSIONAL TEAM
PROVIDER: Assess, diagnoses, and treated illnesses. Includes: doctors, advance practice nurses (ex: nurse practitioners), physician assistants.
OCCUPATIONAL THERAPISTS: Helps patients regain their ability to perform ADLs (activities of daily living).
SOCIAL WORKER: Identifies and coordinates community resources and other patient needs necessary for discharge and recovery.
SPEECH LANGUAGE PATHOLOGIST: Assists with patient issues related to speech, language, and swallowing.
2 - Nursing Ethical Principles:
What are they (6)?
NURSING ETHICAL PRINCIPLES
AUTONOMY: Patient has right to make his/her own decision, even if ti is not his/her best interest.
BENEFICENCE: Do what is best fo the patient (do good).
FIDELITY: Keep your promises.
JUSTICE: Provide fairness in care and allocation of resources.
NONMALEFICENCE: Do no harm.
VERACITY: Tell the truth.
3 - Torts:
+ Unintentional Torts and Intentional Torts
TORTS
UNINTENTIONAL TORTS:
+ Negligence (ex: forgetting to set bed alarm for a patient at risk for falls.
+ Malpractice (ex: medication error that harms patient)
INTENTIONAL TORTS:
+ ASSAULT (EX: NURSE THREATENS PATIENT)
+ BATTERY (EX: NURSE HITS PATIENT, OR ADMINISTERS MEDICATION AGAINST PATIENT’S WILL)
+ FALSE IMPRISONMENT (EX: NURSE INAPPROPRIATELY RESTRAINS A PATIENT OR ADMINISTERS A CHEMICAL RESTRAIN SUCH AS A SEDATIVE).
4 - Informed Consent
+ Provider responsibilities
+ RN responsibilities
INFORMED CONSENT
PROVIDER RESPONSBILITIES:
+ Communicate purpose of procedure, and complete description of procedure in the patient’s primary language (use medical interpreter if needed).
+ Explain risks vs. benefits.
+ Describe other options to treat the condition.
RN RESPONSIBILITIES:
+ Make sure provider gave the patient the above information.
+ Ensure patient is competent to give informed consent (i.e. patient is an adult or emancipated minor, not impaired).
+ Have patient sign consent document.
+ Notify provider if patient has more questions or doesn’t understand any information provided.
5 - Advance Directives: \+ Living will \+ Durable power of attorney (DPOA) \+ Provider's orders
Mandatory reporting for RNs?
ADVANCE DIRECTIVES AND MANDATORY REPORTING
ADVANCE DIRECTIVES:
+ LIVING WILL: Communicates patient’s wishes regarding medical treatment if patient becomes incapacitated.
+ DPOA: Patient designates health care proxy to make medical decisions for them if they become incapacitated
+ PROVIDER’S ORDERS: Prescription for DNR (do not resuscitate) or AND (allow natural death).
MANDATORY REPORTING FOR RNs:
+ Suspicion of abuse (child, elderly, domestic violence)
+ Communicate diseases to local/state health department (mandated by state)
6 - Nursing Documentation:
+ Objective data, Subjective data, Legal guidelines, Incident reports
NURSING DOCUMENTATION
+ OBJECTIVE DATA: What you see, heart, feel, smell. Do not include opinions or interpretations of data.
+ SUBJECTIVE DATA: Document as direct quotes, or clearly identify information as a statement by patient.
+ LEGAL GUIDELINES: Do not leave blank spaces in documentation. Do not use correction tape/fluid or scratch/black out words. Include your name and title.
+ INCIDENT REPORTS: Created when an accident or unusual event occurs (ex: medication error, fall). Used for quality improvement at facility. IT IS NOT PART OF THE PATIENT RECORD, AND SHOULD NOT BE REFERRED TO IN THE PATIENT’S MEDICAL RECORD.
7
Telephone orders: Best practices
Information Security: What is HIPPA? Pulse for protecting patient information.
TELEPHONE ORDERS AND INFORMATION SECURITY
TELEPHONE ORDERS: Have second RN listen in on call, repeat prescription back, make sure provider signs prescription within 24 hr.
INFORMATION SECURITY:
+ HIPPA: Ensures the confidentiality of health information.
+ Only those responsible for patient’s care may access the patient’s medical record.
+ Do not use patient names on public display boards.
+ Communication about a patient should happen in a private place or at nursing station.
+ Password protect electronic records. Do not share passwords.
+ Do not share patient information with unauthorized people. Code system can be used.
8 - Delegation:
+ What tasks should the RN NOT delegate?
+ What tasks can a RN delegate to a PN (i.e. LVN)?
+ What tasks can a RN delegate to Assistive Personnel (i.e. CNA)?
DELEGATION
RN SHOULD NOT DELEGATE: Patient education, any task that requires nursing judgement, nursing assessment, blood transfusions.
OK TO DELEGATE TO PN: Medication administration, enteral feedings, urinary catheter insertion, suctioning, tracheostomy care, REINFORCEMENT of patient teaching.
OK TO DELEGATE TO CNA: bathing, dressing, ambulating, toileting, feeding patients WITHOUT swallowing precautions, positioning, vital signs, bed making, specimen collection, I&Os.
9 - Delegation:
What are the 5 rights of delegation?
5 RIGHTS OF DELEGATION
RIGHT TASK: Repetitive, non-invasive, doesn’t require much supervision.
RIGHT CIRCUMSTANCES: DO NOT ASSIGN A PATIENT WHO IS UNSTABLE.
RIGHT PERSON: Make sure delegate is competent and operating within their scope of practice, check facility’s job description.
RIGHT DIRECTION AND COMMUNICATION: Communicate timeline, expected results, and follow-up communication expectations.
RIGHT SUPERVISION AND EVALUATION: Intervene if needed, provide feedback.
10 - The Nursing Process:
What are the 5 steps in the Nursing Process?
THE NURSING PROCESS
ASSESSMENT/DATA COLLECTION: Includes subjective data (symptoms) and objective data (signs). ALWAYS ASSESS BEFORE TAKING ACTION!
ANALYSIS/DATA COLLECTION: Cluster the collected data, identify patterns/trends, compare data to expected values.
PLANNING: Prioritize interventions and identify measurable outcomes (time-limited, specific).
IMPLEMENTATION: Perform nursing care, document patient’s responses to intervention.
EVALUATION: Compare actual results with planned outcomes. Determine next steps.
11 - Patient admission: Key tasks/procedures
PATIENT ADMISSION
+ Document patient’s advance directive status.
+ Vital signs, height/weight, allergies, head-to-toe assessment, health history, spiritual/cultural considerations.
+ ASSESS FOR SWALLOWING ISSUES PRIOR TO ALLOWING PATIENT TO EAT/DRINK!
+ Safety assessment, implement fall precautions if appropriate.
+ Inventory patient belongings, lock valuables in facility safe.
+ Medication reconciliation: compare home meds with provider’s prescriptions.
+ DISCHARGE PLANNING STARTS AT ADMISSION!
12 - PATIENT TRANSFER: Best practice for patient handoff
PATIENT DISCHARGE: What is included in the patient’s discharge instructions?
PATIENT TRANSFER AND DISCHARGE
PATIENT TRANSFER:
+ Use SBAR (Situation, Background, Assessment, Recommendations).
INCLUDED IN PATIENT DISCHARGE INSTRUCTIONS:
+ Diet and activity restrictions
+ Detailed instructions for procedures at one (such as wound dressing changes)
+ List of medications, when to take them precautions regarding medications
+ S/S of complications, when to seek medical attention.
+ Follow-up appointment information
+ Names, numbers of providers and community resources
13 - Hand Hygiene:
+ Soap and water
+ Alcohol-based products
HAND HYGIENE
SOAP AND WATER: Wash hands w/antimicrobial soap and water (vs. alcohol-based product) for these situations: \+ hands are visibly soiled \+ before eating \+ after using the restroom \+ after contact with bodily fluids
Wash for >= 15 seconds. Dry with clean paper towel before turning off faucet.
ALCOHOL-BASED PRODUCT:
Use 3-5 ml of product
Rub continuously until hands are dry
14 - Practices to prevent spread of micro-organisms
PRACTICES TO PREVENT THE SPREAD OF MICRO-ORGANISMS
+ Cover mouth/nose when sneezing or coughing
+ Use tissues, dispose of them properly
+ Stand at least 3 feet away from those coughing (or have them wear a mask)
+ Keep nails short, no artificial nails or gel polish
+ Perform frequent hand hygiene; remove jewelry from hands/wrists
+ Do not shake linens
+ Clean least soiled areas first in patient’s room
+ Do not place items on floor
15 - Sterile Field/Solutions:
How to set up sterile field
Pouring sterile solutions
STERILE FIELD/SOLUTIONS
SETTING UP STERILE FIELD:
+ Position package with top flap facing away from you.
+ Open top flap away from you.
+ Open right side flap with right hand, open left side flap with left hand.
+ Open last flap towards you.
STERILE SOLUTIONS:
+ Place bottle cap face up on non-sterile surface.
+ Hold bottle so the label is against your palm.
+ Pour a small amount (1-2ml) away.
+ When pouring solution, do not touch bottle to site.
16 - Sterile Field: Key points for maintaining a sterile field
STERILE FIELD
+ Do not cough, sneeze or talk over field.
+ 1” EDGE OF FIELD IS NOT STERILE; DISCARD ANY ITEM THAT COMES IN CONTACT WITH THIS AREA.
+ Any object held below the waist or above the chest is contaminated.
+ Add objects to the sterile field at LEAST 6” above the field.
+ NEVER TURN YOUR BACK ON A STERIL FIELD OR REACH ACROSS A STERILE FIELD.
+ Any sterile item that comes In contact with moisture is considered non-sterile.
17 - Immunity: Nonspecific innate vs. Specific adaptive
IMMUNITY
NON-SPECIFIC INNATE IMMUNITY: Defense mechanisms (i.e. barriers) in the body that respond IMMEDIATELY to ALL antigens. Barriers include: skin, stomach acid, mucus, inflammatory response, phagocytic cells.
SPECIFIC ADAPTIVE IMMUNITY: Body produces antibodies in response to a SPECIFIC antigen through action of B and T lymphocytes. Requires more time, but the immune response against that antigen in the future is more efficient.
18 - Immunity: Active natural, Active artificial, Passive Natural, passive artificial
IMMUNITY
ACTIVE NATURAL IMMUNITY: Body produces antibodies in response to exposure to live pathogen.
ACTIVE ARTIFICIAL IMMUNITY: Body produces antibodies in response to vaccine.
PASSIVE NATURAL IMMUNITY: Antibodies are passed from the mom to her baby through the placenta or breastmilk.
PASSIVE ARTIFICIAL IMMUNITY: Immunoglobulins are administered to an individual after they have been exposed to a pathogen.
19 - Infections: Chain of infection, Risk factors, What is virulence?
INFECTIONS
CHAIN OF INFECTION:
Causative agent (ex: toxin, bacteria)
–> reservoir (ex: human, soil)
–> portal of exit (ex: blood, respiratory tract)
–> mode of transmission (ex: contact, droplet)
–> portal of entry –> susceptible host
RISK FACTORS:
Compromised immunity, chronic/acute disease, poor personal and hand hygiene, crowded living environment, IV drug use, unprotected sex, poor sanitation.
VIRULENCE: The ability of a pathogen to produce disease.
20 - Infections: Stages of infection
STAGES OF INFECTION
INCUBATION: Time from when the pathogen enters the body until the first symptom appears.
PRODROMAL STAGE: Time from onset of general symptoms (i.e. malaise, fatigue) to specific symptoms.
ILLNESS STAGE: Time when specific symptoms occur.
CONVALESCENCE: Time from when symptoms disappear to complete recovery (can take months).
