Safety/Quality: Ch. 27 Flashcards
What is the Nursing Process?
- Assessment
- Diagnosis
- Plan
- Implementation
- Evaluate
Define the following terms:
EHR
MAR
UAP
Provider
EHR: Electronic Health Record
MAR: Medication Administration Record
UAP: Unlicensed Assistant Personnel
Provider: MD, NP, PA, prescriber, etc
What are the Universal Competencies for Safety?
Tasks done for every patient, every time
2 Patient Identifiers: name, DOB
Bed in lowest position
Wheels locked
Call light within reach
Allergies confirmed
Needle safety
Body safety- pt and RN
What age range is at the highest risk for MVCs and not wearing their seatbelts?
Ages 16-19
What should be done if a patient is poisoned?
Doctor calls the poison control center to get advice, nurse carries out orders
What is orthostatic (postural) hypotension?
A drop in Systolic BP by at least 20 mmHg or a drop in Diastolic by at least 10mmHg, within 3 mins of rising to an upright position
What are some possible factors for someone being marked a fall risk?
Alcohol/drugs
Medications
Orthostatic hypotension/underlying medical conditions
Polypharmacy
Physical inactivity/poor mobility
Unsafe environment
Foot/shoe problems
History of falls
If someone has a history of falls, what is immediately done?
They are marked as a fall risk for the entire duration of their stay
How is a fall risk identified?
Yellow wristband, signs, bed alarm
Why would a fall risk patient be placed in a room near the nurse’s station?
If the bed alarm goes off, you want to be close by for someone to come help
How are allergies identified?
Red wristband and documented in the EHR
always ask patient prior to administration/procedures
How does safe patient handling begin?
Assessment!
What two acronyms are involved in fire safety?
RACE: Rescue Alarm Contain Evacuate
PASS: Pull Aim Squeeze Spray
Explain the RACE acronym for fire safety
R: Rescue patients directly in harms way
A: set off fire alarm
C: contain fire by closing doors
E: evacuate patients if necessary
Explain the PASS acronym for fire safety
P: Pull the pin
A: Aim extinguisher
S: squeeze trigger
S: Spray base of fire
Vaccinations are HUGE and part of every assessment on _____
Children
What is a seizure?
A hyperexcitation and disorderly discharge of neurons in the brain
During a seizure, patients are at risk for _______
Musculoskeletal or head injury
Patients with a history of seizures should be placed on __________
seizure precautions
What should you do if a seizure lasts more than 5 minutes?
Administer rescue medications or call 911
When should you insert a bite-block or oral airway to someone in advance of a seizure?
If you recognize the possibility of a tonic-clonic seizure (rapid jerking and stiffening muscles)
What should you do after reorienting and reassuring a patient after a seizure (after making sure they’re comfortable and safe)?
Conduct a head-to-toe evaluation, inspect mouth for cuts or broken teeth, inspect body for bruises/injury
What is KEY when using restraints?
Keeping everyone, the patient/RN, safe when using restraints
No harm should come to the patient due to restraints
If a restrained patient’s cap refill is insufficient, how do you restrain the patient while restoring blood flow?
Loosen the restraints, or use a chemical or different type of restraint
What part of the nursing process can be delegated to a UAP/AP?
NONE
5 Rights of Delegation
- Right Task
-Appropriate for them to do? - Right Circumstance
-patient’s status/stability - Right person
-do they know how to do this? - Right Directions/Communication
-Do they understand the request? - Right Supervision & Evaluation
-How did the patient respond to the task performed by the UAP?
The skills of _____ and communicating a patient’s risks for falling _____ be delegated to AP.
Skills used to prevent falls ____ be delegated
Assessing-cannot
can be
