Terms and Knowledge Flashcards
0
Q
Which of these do you DO in a change-of-shift report
- Review all biographical information already available in written form
- Review all routine care procedures or tasks
- Describe objective measurements or observations about patient’s condition and response to health problem, emphasize recent changes
- Share significant information about family members as it relates to patient’s problems
- Force oncoming staff to guess what to do first
- Describe detailed content only if staff members ask for clarification
A
- Describe objective measurements or observations about patient’s condition and response to health problem emphasize recent changes
- Share significant information about family members as it relates to patient’s problems
- Describe detailed content only if staff members ask for clarification
1
Q
Which of these do you DO during a change-of-shift report:
- Identify patient’s nursing diagnoses/health care problems and related causes
- Describe results as “good” or “poor”
- Make assumptions about relationships among family members
- Evaluate results of nursing or medical care measures
- Describe instructions given in teaching plan and patient’s response
- Relay significant changes to staff in the way therapies are to be given
A
- Identify patient’s nursing diagnoses/health care problems and related causes
- Evaluate results of nursing or medical care measures
- Describe instructions given in teaching plan and patient’s response
- Relay significant changes to staff in the way therapies are to be given
2
Q
Evidence-based knowledge
A
knowledge based on research or clinical expertise
3
Q
Critical Thinking Skills
A
Interpretation Analysis Inference Evaluation Self-regulation
4
Q
Concepts for a Critical Thinker
A
Truth seeking Open-mindedness Analyticity Systematicity Self-confidence Inquisitiveness Maturity
5
Q
Levels of Critical Thinking
A
Level 1- Basic
Level 2- Complex
Level 3- Commitment
6
Q
At this critical thinking level:
Answers to complex problems are either right or wrong
A learner trusts that experts have the right answer for every problem
Thinking is concrete and based on a set of rules or principles
A
Basic
7
Q
At this critical thinking level:
Thinkers begin to separate themselves from experts
Thinkers analyze and examine choices more independently
Each solution has benefits and risks that are weighed
A
Complex
8
Q
At this critical thinking level:
A person anticipates when to make choices without assistance
A person accepts accountability for decisions made
Action chose based on available alternatives
A
Commitment
9
Q
Steps to the Scientific Method
A
Identify Problem Collect Data Formulate Question/Hypothesis Test Question/Hypothesis Evaluate Results
10
Q
Obtaining information and using it plus what you already know to find a solution when a problem arises. Also involves evaluating the solution to ensure it is effective
A
Problem solving
11
Q
A product of critical thinking that focuses on problem resolution.
A
Decision Making
12
Q
Critical Thinking Competencies
A
Scientific method Problem solving Decision making Diagnostic reasoning and inference Critical decision making Nursing process as a competency
13
Q
Critical thinking competencies Specific to Nursing
A
Diagnostic reasoning and inference
Clinical decision making (Nursing diagnosis)
Nursing process as a competency
14
Q
The analytical process for determining a patient’s health problems; begins once you receive information about a patent in a clinical situation.
A
Diagnostic reasoning
Nursing diagnosis
15
Q
A problem-solving activity that focuses on defining a problem and selecting an appropriate action. A nurse identifies a patient’s problem and selects a nursing intervention.
A
Clinical decision making
Nursing intervention
16
Q
The process of drawing conclusions from related pieces of evidence and previous experience with evidence.
A
Inference
Assessment
17
Q
Attitudes for Critical Thinking
A
Confidence Independence Fairness Responsibility Risk taking Discipline Perseverance Creativity Curiosity Integrity Humility
18
Q
Intellectual Standards of Critical Thinking
A
Clear Precise Specific Accurate Relevant Plausible Consistent Logical Deep Broad Complete Significant Adequate Fair
19
Q
Learn how to introduce yourself to a patient
Speak with conviction when you begin a treatment or procedure
Do not lead a patient to think you are unable to perform safe care
Always be well prepared before performing activity
Encourage a patient to ask questions
A
Confidence
20
Q
Read nursing literature, especially when there are different views
Talk with other nurses
Share ideas about nursing interventions
A
Thinking Independently
21
Q
Listen to both sides of a discussion
Assume care of patients with openness and desire to meet needs
A
Fairness
22
Q
Ask for help if you are uncertain
Refer to a policy or procedure manual
Report problems immediately
Follow standards of practice
A
Responsibility and Authority
23
Q
Question wrong health care orders
Recommend alternative approaches to care
A
Risk Taking
24
Be thorough in whatever you do
Use known scientific and practice-based criteria
Manage time effectively
Discipline
25
Be cautious of an easy answer
Clarify information, or talk to patient directly
Look for patterns and find a solution
Perseverance
26
Look for different approaches
Creativity
27
Always ask why
| Explore and learn more about the patient
Curiosity
28
Recognize when your opinions conflict with the patient's
Review your position
Decide how to reach an outcome to satisfy everyone
Do not compromise nursing standards or honesty
Integrity
29
Recognize when you need more information
Ask for orientation of new areas
Ask other nurses for assistance
Humility
30
Developing critical thinking skills
```
Reflective Journaling (used to recall situations)
Meeting with Colleagues (draw from others experiences)
Concept Mapping (or care planning)
```
31
Judgement that includes critical and reflective thinking and action and application of scientific and practical knowledge
Clinical decision making
32
The thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.
Culture
33
A shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics
Ethnicity
34
An insider/native perspective of any intercultural encounter
Emic worldview
35
An outsider perspective in any intercultural incounter
Etic worldview
36
Socialization into one's primary culture as a child
Enculturation
37
When members of an ethnocultural community are absorbed into another community and lose their unique characteristics such as language, customs, and ethnicity.
Assimilation
38
A comparative study of cultures to understand similarities and differences across human groups.
Transcultural nursing
39
Care that fits the person's life patterns, values, and set of meanings.
Culturally congruent care
40
Process of acquiring specific knowledge, skills, and attitudes to ensure delivery of culturally congruent care.
Cultural competence
41
Five steps towards cultural competence
```
Cultural awareness
Cultural knowledge
Cultural skills
Cultural encounters
Cultural desire
```
42
An in-depth self-examination of one's own background, recognizing biases, prejudices and assumptions about other people.
Cultural awareness
43
Obtaining sufficient comparative knowledge of diverse groups, including their indigenous values, health beliefs, care practices, worldview, and bicultural ecology
Cultural knowledge
44
Being able to assess social, cultural, and biophysical factors influencing treatment and care of patients
Cultural Skills
45
Engaging in cross-cultural interactions that provide learning of other cultures and opportunities for effective intercultural communication development.
Cultural Encounters
46
The motivation and commitment to caring that moves an individual to learn from others, accept the role as learner, be open and accepting of cultural differences, and build on cultural similarities.
Cultural desire
47
A tendency to hold one's own way of life as superior to others
Ethnocentrism
48
Using one's own values and lifestyles as their absolute guide in dealing with patients and interpreting their behaviors.
Cultural Imposition
49
Components of cultural Assessment
```
Family Structure
Bicultural Effects on Health
Ethnic Heritage/Ethnohistory
Social Organization
Religious and Spiritual beliefs
Foods with Cultural Significance
Communication Patterns
```
50
Three Nursing Interventions that achieve culturally congruent care
Cultural care preservation or Maintenance
Cultural care accommodation or negotiation
Cultural care repatterning or restructuring
51
Retain and/or preserve relevant care values so patients maintain their well-being, recover from illness, or face handicaps and/ordeath
Cultural care preservation or maintainence
52
Adapt or negotiate with others for a beneficial or satisfying health outcome
Cultural care accommodation or negotiation
53
Reorder, change, or greatly modify patients' lifestyles for a new, different, and beneficial health care pattern
Cultural care repatterning or restructuring
54
Nurses are ______ and ______ obligated to keep all patient information ______.
legally, ethically, confidential
55
HIPAA
Health Insurance Portability and Accountability Act
56
_____ requires that disclosure or requests regarding _____ _________ are limited to the ________ necessary.
HIPAA, health information, minimum
57
Purposes of records
```
Communication
Legal Documentation
Reimbursement
Research
Education
Auditing and Monitoring
```
58
Home care Documentation:
- _____ has specific guidelines for establishing eligibility for home care.
- These guidelines sever as the basis for ______ by home care nurses.
- _______ is the quality control and justification for ______ from insurance (Medicare, Medicaid, or private)
- Nurses need to document _____ their services for payment
Medicare
Documentation
Documentation/Reimbursement
All
59
Long-Term Health care documentation:
- Patients are referred to as _______
- _____ ______ are instrumental in determining standards and policies for documentation
- The _____ of 1987includes Medicare and Medicaid legislation for long-term care documentation
- The department of health in states governs the _______ of written nursing records
- Includes the _____ _____ ______
```
Residents
Governmental Agencies
OBRA
Frequency
Minimum Data Set (MDS)
```
60
_______ communication is essential within the health care team
Interdisciplinary
61
Records or charts are _____ ______ legal documents. They are available to al members of a health team.
Confidential permanent
62
Team members communicating in a group
Conference
63
A professional caregiver giving formal advice to another caregiver
Consultation
64
______ documentation is one of the best defenses for legal claims associated with nursing
Acurate
65
When do you chart?
Immediately after providing care
66
Care not documented is....
Care not provided
67
DRGs are...
Diagnosis-related groups are the basis for establishing reimbursement for patient care.
68
Hospitals are reimbursed a ___________ _____ _____ by Medicare for each DRG
Predetermined dollar amount
| Accurate documentation= reimbursement
69
Charting mistakes that result in malpractice:
- Failing to record pertinent health or drug information
- Failing to record nursing actions
- Failing to record that medications have been given
- Failing to record drug reactions or changes in patient's condition
- Writing illegible or incomplete records
- Failing to document discontinued medications
70
Guidelines for quality documentation and reporting:
```
Factual
Accurate
Complete
Current
Organized
```
71
Objective data
observations of a patient's behaviors. (avoid words like appears, seems, or apparently)
72
Subjective data
What a patient tells you. (use quotes, use patient's exact words, back up with objective data)
73
Methods of Recording:
```
Paper records
Electronic Health Records (EHR)
Narrative
Problem-oriented Medical Record (POMR)
Source Records
Charting by Exception (CBE)
```
74
Paper Records
- Episode-oriented
| - Key information may be lost from one episode of care to another (hospital to clinic-- jeopardizes patient safety)
75
EHR
- Electronic Health Record
- A digital version of a patient's medical record
- Integrates all of a patient's information into one record
- Improves continuity of care
76
Narrative
- The traditional method for recording care
- Story-like format to document information specific to patient conditions and nursing care.
- Repetitious and time consuming
77
POMR
-Problem-Oriented Medical Record
-Method of documentation that emphasizes patients' problems
Includes these major sections:
-Database
-Problem List
-Care plan
-Progress Notes
78
SOAPIE progress notes
```
S-Subjective data
O-Objective data
A-Assessment
P- Plan
I- Intervention
E- Evaluation
R- Revision
(Originated from medical records)
```
79
PIE progress notes
P- Problem
I- Intervention
E- Evaluation
(has a nursing origin)
80
DAR progress notes
D-Data
A- Action (nursing intervention)
R- Response
(addresses patient concerns, FOCUS CHARTING)
81
Has a separate section for each discipline to record data.
Source Record (eg- nursing, medicine, social work, respiratory therapy)
82
Focusing on documenting deviations from established norms.
CBE- Charting by exception
83
- Allows you to quickly and easily enter assessment data about a patient (vital signs, routine repetitive care (ADLs), weight, safety and restraint checks)
- Help team members quickly see patient trends over time and decrease time spent on writing narrative notes
Flow sheets (graphic records)
84
Guides the nurse through a complete assessment to identity relevant nursing diagnoses or problems
Admission nursing history form
85
A portable flip-over file or notebook with patient information
Kardex
- Activity and treatment
- Care plan
- Code status
- Allergies
- Emergency contact
- ADLs
- Safety Precautions
- Scheduled tests/procedures
- Nursing orders
- Current health care provider orders
- Medical diagnosis
- Health care provider
- Demographic data
86
Preprinted, established guidelines used to care for patients who have similar health problems.
Standardized carep lans
87
Determine hours of care and staff required for a given group of patients. Not part of a patient's medical record.
Activity record
88
The application of computer and information science for managing health-related data
Health Informatics
89
A specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice
Nursing Informatics
90
Types of Reporting
Hand-off Report
Telephone Reports
Verbal or Telephone Orders
Incident or occurrence reports
91
SBAR
-Standardizes telephone communication of significant evens or changes in the patient's condition and is a communication strategy designed to improve patient safety
Situation
Background
Assessment
Recommendation
92
Important part of the quality improvement program of a unit
Incident Reports (or occurrence reports)
93
Guidelines for Telephone/Verbal Orders
- Clearly determine patient's name, room number, and diagnosis
- Repeat any prescribed orders back to the physician or health care provider
- Use clarification questions to avoid misunderstandings
- Write TO or VO, including date and time, name of patient, the complete order; sign the name of the physician or health care provider and nurse
- Follow agency policies (some institution require TO/VO to be reviewed by two nurses)
- The health care provider must co-sign the order within a time frame required by the institution (avg. 24hrs)
94
A process by which a health care provider directly enters orders for patient care into the hospital information system
CPOE- Computerized provider order entry
95
Legal Guidelines for recording:
- Do not erase, apply correction fluid, or scratch out errors
- Do not document retaliatory or critical comments
- Do not enter personal opinions
- Correct all errors promptly
- Record all facts
- Do not leave blank spaces
- Record legibly and in black ink
- Record clarification
- Chart only for yourself
- Avoid generalized, empty phrases (had a good day, status unchanged)
- Begin entry with date, time and end with signature and title
- Keep password to yourself
96
Maintaining confidentiality of records and reports
Do not include patient identifiers on student written material
Never print material from EHR
HIPAA policies for disclosure and requests
97
__________ reports happen any time one health care provider transfers care of a patient to another health care provider.
Hand-off or Change-of-shift
98
Which of these do you DO at a change-of-shift report
1. Use critical comments about patient's behavior
2. Describe basic steps of a procedure
3. Review ongoing discharge plan
4. Verbalize priorities to which oncoming staff must attend
5. Provide essential background information about patient
6. Engage in idle gossip
3. Review ongoing discharge plan
4. Verbalize priorities to which oncoming staff must attend
5. Provide essential background information about patient
99
Like learning, ______ is a lifelong learning process for nurses
communication
100
Human tendencies that interfere with accurately perceiving and interpreting messages from others.
Perceptual biases
101
Levels of Communications
```
Intrapersonal
Interpersonal
Transpersonal
Small-group
Public
```
102
Communication that occurs within an individual
Intrapersonal Communication
103
A one-to-one interaction between two people
Interpersonal Communication
104
Interaction that occurs within a person's spiritual domain
Transpersonal Communication
105
n interaction that occurs when a small number of persons meet.
Small-group communication
106
An interaction with an audience.
Public communication
107
Something that motivates one person to communicate with another.
Referent
108
The person who encodes and delivers a message
| The person who receives and decodes the message
Sender
| Receivers
109
Content of the communication
Message
110
Means of conveying and receiving messages through visual, auditory, and tactile senses.
Channels
111
The message the receiver returns.
Feedback
112
Factors within both the sender and receiver that influence communication
Interpersonal variables
113
Setting for sender-receiver interaction
Environment
114
Using spoken or written words
Verbal communication
115
Forms of communication:
- Verbal
- Nonverbal
- Symbolic
- Metacommunication
116
Vocabulary, Pacing, Intonation, Clarity and Brevity, Timing and Relevance
Verbal communication
117
Includes the five senses and everything that does not involve the spoken or written word.
Nonverbal communication
118
Personal appearance, Posture and gait, Facial expression, Eye contact, Gestures, Sounds, Territoriality and personal space
Nonverbal Communication
119
The verbal and nonverbal symbolism used by others to convey meaning
Symbolic communication
120
A broad term that refers to all factors that influence communication
Metacommunication
121
Professional Nursing relationships:
Nurse-patient helping
Nurse-family
Nurse-health
Nurse-community
122
Elements of professional communication:
```
Courtesy
Use of names
Trustworthiness
Autonomy and Responsibility
Assertiveness
```
123
Being self-directed and independent in accomplishing goals and advocating for others
Autonomy
124
Allows you to express feelings and ideas without judging or hurting others.
Assertiveness
125
Communication: Factors related to Assessment
- Physical and emotional factors
- Developmental factors
- Sociocultural factors
- Gender
126
Communication: Factors affecting Diagnosis
- Many clients experience difficulty with communication
- Lacking skills in attending, listening, responding, or self-expression
- Inability to articulate/inappropriate verbalization
- Difficulty forming words
- Difficulty with comprehension
127
Communication: Factors influencing Planning
- Goals and outcomes must be specific and measurable
- Setting priorities
- Continuity of care: Collaboration with other health care providers
128
Communication and Implementation:
Therapeutic communication
Nontherapeutic communication
Adapting communication techniques
129
Therapeutic Communication Techniques
```
Active listening
Sharing observations
Sharing empathy
Sharing hope
Sharing humor
Sharing feelings
Using touch
Using silence
Providing information
Clarifying
Focusing
Paraphrasing
Asking relevant questions
Summarizing
Self-disclosure
Confrontation
```
130
Specific responses that encourage the expression of feelings and ideas and convey acceptance and respect.
Therapeutic Communication Techniques
131
Being attentive to what a patient is saying both verbally and nonverbally
Active Listening
132
SOLER
How to Actively Listen
- S- sit facing the patient
- O- Observe an open posture
- L- Lean toward the patient
- E- Establish and maintain intermittent eye contact
- R- Relax
133
The ability to understand and accept another person's reality, accurately perceive feelings, and communicate this understanding to the other.
Empathy
134
Nontherapeutic Communication Techniques
```
Asking Personal questions
Giving personal opinions
Changing the subject
Automatic responses
False reassurance
Sympathy
Asking for explanations
Approval or disapproval
Defensive responses
Passive or aggressive responses
Arguing
```
135
Techniques that hinder or damage professional relationships. Cause recipients to activate defenses to avoid being hurt or negatively affected.
Nontherapeutic Communication Techniques
136
concern, sorrow, or pity felt for a patient.
Sympathy
137
Changing the way you communicate based on the patient.
Adapting Communication Techniques
138
Communication and Evaluation
- Determine whether the plan of care has been successfully met (nurse and patient)
- Evaluate effectiveness of nursing interventions
- Modify plan of care as needed
139
Law created by elected legislative bodies such as state legislatures and US Congress
Statutory law
140
_____ _____ _____ describe and define the legal boundaries of nursing practice within each state.
Nursing Practice Acts
141
Laws that reflect decisions made by administrative bodies such as State Boards of Nursing when they pass rules and regulations
Regulatory law (or administrative law)
142
This law results from judicial decisions made in courts when individual legal cases are decided
Common law
143
Protect the rights of individuals within our society and provide for fair and equitable treatment when civil wrongs or violations occur.
Civil laws
144
Protect society as a whole and provide punishment for crimes, which are defined by municipal, state, and federal legislation
Criminal laws
145
A crime of serious nature that has a penalty of imprisonment for longer than 1 year or even death.
Felony
146
A less serious crime that has a penalty of a fine or imprisonment for less than 1 year.
misdemeanor
147
Legal requirements for nursing practice that describe minimum acceptable nursing care.
Standards of care
148
The _______ develops standards for nursing practice, policy statements, and similar resolutions.
ANA- American Nurses Association
149
Standards of care are set by _____ and ______ laws that govern where nurses work
state and federal
150
The rules and regulations enacted by a ______ _____ __ _____ define the practice of nursing more specifically
State Board of Nursing
151
The _____ _______ requires accredited hospitals to have written nursing policies and procedures
Joint Commision
152
Proof of Negligence
- The nurse owed a duty to the patient
- The nurse did not carry out the duty or breached it
- The patient was injured (Medical bills, lost wages, pain and suffering, perinatal damages, wrongful death damages)
- The patient's injury was caused by the nurse's failure to carry out the duty
153
Federal Statutory Issues in Nursing Practice:
```
Americans with Disabilities Act
Emergency Medical Treatment and Active Labor Act
Mental Health Parity Act
Uniform Anatomical Gift Act
Living Wills, Durable Power of Attorney
Advance Directives
Health Insurance Portability and Accountability Act
Restraints
```
154
A broad civil rights statute that protects the rights of people with physical or mental disabilities.
American with Disabilities Act (ADA 1990)
155
Provides that, when a patient comes to the emergency department or the hospital, an appropriate medical screening occurs within the capacity of the hospital.
Emergency Medical Treatment and Active Labor Act (EMTALA)
156
Forbids health plans from pacing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits.
The Mental Health Parity Act (1996)
157
Written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition
Living Wills
158
A legal document that designates a person or persons of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf.
DPAHC (Durable power of attorney for health care)
159
Advance Directives
Living Wills
Health care proxies
Durable power of attorneys for health care
160
Requires health car institutions to provide written information to patients concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives.
The Patient Self-Determination Act (PSDA, 1991)
161
Prohibits the purchase or sale of organs
The National Organ Transplant Act (1984)
162
The ______ has a contract with the federal government and sets policies and guidelines for the procurment of organs
UNOS- United Network for Organ Sharing
163
The right of patients to keep personal information from being disclosed
Privacy
164
Protects private patient information once it has been disclosed in health care settings.
Confidentiality
165
Gives residents in certified nursing homes the right to be free of unnecessary and inappropriate restraints.
The Federal Nursing Home Reform Act (1987)
166
_______ and _____ have set standards for reducing the use of restraints in health care settings and for using them only with extreme caution.
Centers for Medicare and Medicaid Services and The Joint Commision
167
Restraints can only be used under these three circumstances:
1. To ensure the physical safety of the resident or other residents
2. When less restrictive interventions are not successful
3. Only on the written order of a health care provider
168
A _________ licenses all registered nurses in the state ni which they practice.
State Board of Nursing
169
All states have _______ laws enacted to encourage health care professionals to assist in emergencies. Also offers immunity from liability as long as you acted without gross negligence.
Good Samaritan
| Failure-to-act laws in Louisiana, Minnesota, and Vermont
170
The ______ and _______ provide guidelines on a national level for safe and healthy communities and work environments
CDC (centers for disease control and prevention) and OSHA (occupational health and safety act)
171
Irreversible cessation of circulatory and respiratory function
Cardiopulmonary standard of death
172
Irreversible cessation of all functions of the entire brain, including the brainstem
whole-brain standard of death
173
States that health care providers can use either the cardiopulmonary or the whole-brain definition to determine death.
Uniform Determination of Death Act (1980)
174
First statute that permitted physician or health care provider-assisted suicide.
The Oregon Death with Dignity Act (1994)
175
The _____ has held that nurses' participation in assisted suicide violate the code of ethics for nurses while the ______ supports the International Council of Nurses' mandate to ensure an individual's peaceful end of life.
ANA (American Nurses Association)
| AACN (American Association of Colleges of Nursing)
176
A civil wrong made against a person or property
Tort
177
Willful acts that violate another's rights such as assault, battery, and false imprisonment
Intentional torts
178
Any action that places a person in apprehension of a harmful or offensive contact without consent. No contact is necessary (threatening)
Assault
179
Intentional touching without consent. Contact can be harmful and cause injury or merely offensive to the person's dignity
Battery
180
Unjustified restraint of a person without legal warrant.
False Imprisonment
181
Acts in which intent is lacking but volitional action and direct causation occur.
Quasi-intentional tort
182
A violation of a patient's right to be free from unwanted intrusion into his or her private affairs
Invasion of Privacy
183
Publication of false statements that result in damage to a person's reputation
Defamation of character
184
Occurs when one speaks falsely about another.
Slander
185
Written defamation of character
Libel
| charting false entries in a medical record
186
Conduct that falls below a standard of care.
Negligence
187
Professional negligence resulting form falls below a standard of care.
Malpractice
188
Common Negligent Acts
Failure to assess and/or monitor- in a timely fashion, with the proper equipment and to document
Failure to make a nursing diagnosis
Failure to notify health care provider of problems
Failure to follow orders
Failure to follow the six rights of medication administration
Failure to convey discharge instructions
Failure to ensure patient safety
Failure to follow policies and procedures
Failure to properly delegate and supervise
189
A person's agreement to allow something to happen such as surgery or an invasive diagnostic procedure, based on full disclosure of risks, benefits, alternatives, and consequences of refusal
Informed Consent
190
Statutory guidelines for legal consent: Adults
- Competent individual 18 years of age or older
- Parent for his or her unemancipated minor
- Any guardian for his or her ward
- Any adult for the treatment of his or her minor brother or sister (if an emergency and parent not present)
- Any grandparent for a minor grandchild (if an emergency and parents are not present)
191
Statutory Guidelines for legal consent: Minors
- For his or her child and any child in his or her legal custody
- For himself or herself if: lawfully married or a parent, pregnant, venereal disease, drug or substance abuse
- Unemancipated minors may not consent to abortions without: consent of one parent, self-consent granted by court order, consent specifically given by a court
192
US Supreme Court ruled that there is a fundamental right to privacy, which includes a woman's right to have an abortion
Roe v. Wade
193
Some states require viability tests if the fetus is more than 28 weeks gestational age.
Webster v Reproductive Health Services
194
Nursing students are _____ if their actions cause harm to patients.
Liable
| along with instructor, hospital, university
195
______ problems occur if there are not enough nurses to provide ____ care or if nurses work ____ overtime
Legal, competent, excessive
196
based on census load and patient acuities
Floating
197
Abandonment and Assignment Issues
Short Staffing
Floating
Health Care Providers' Orders
198
An organization's system for ensuring appropriate nursing care by identifying potential hazards and eliminating them before harm occurs.
Risk management
199
Steps involved in Risk Management
Identify Possible Risks
Analyze Risks
Act to Reduce Risks
Evaluate Steps Taken
200
Tool used in risk management
Occurrence report/Incident report
201
Serves as a database for further investigation
| Alerts risk management to potential claim situation
Occurrence report
202
The study of conduct and character. Determining what is good or valuable for individuals, for groups of individuals, and for society at large
Ethics
203
Freedom from external control
Autonomy
204
taking positive actions to help others
Beneficence
205
Harm or hurt
Maleficence
206
Avoidance of harm or hurt
Nonmaleficence
207
Fairness
Justice
208
The agreement to keep promises
Fidelity
209
A set of guiding principles that all members of a profession accept. It is a collective statement about the group's expectations and standards of behavior
Code of Ethics
210
The support of a particular cause
Advocacy
211
A willingness to respect one's professional obligations and follow through on promises
Responsibility
212
The ability to answer to one's actions
Accountability
213
Personal beliefs about the worth of a given idea, attitude, custom, or object that set standards that influence behavior
Values
214
Basic principles of Codes of Ethics
Advocacy
Responsibility
Accountability
Confidentiality
215
Defines actions as right or wrong
Deontology
216
Proposes that the value of something is determined by its usefulness
Utilitarianism
| consequentialism or teleology
217
Focuses on the inequality between people
Feminist Ethics
218
Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives
Ethics of Care
219
_______ _____ almost always occur in the presence of _____ values.
Ethical dilemmas, Conflicting
220
To resolve ethical dilemmas, one need to distinguish among ______, ______, and _______
Values, facts, and opinions
221
Processing an ethical dilemma (7 steps)
1. Ask if this is an ethical dilemma
2. Gather all relevant information
3. Clarify values
4. Verbalize the problem
5. Identify possible courses of action
6. Negotiate a plan
7. Evaluate the plan
222
_______ _________ are usually multidisciplinary and serve several purposes: education, policy, recommendation, and care consultation. They process ethical dilemmas and may be requested by nurses, physicians, health care providers, patients, and family members.
Ethics Committees
223
Issues in Health care Ethics
Quality of life
Genetic screening
Care at the end of life
Access to care
224
Central to discussions about end-of-life care, cancer therapy, physician assisted suicide, and DNR
Quality of life
225
Can alert a patient to a condition that may not yet be evident but that is certain to develop in the future (What are the risks and benefits to individuals and society of earning about the presence of a disease that has not yet caused symptoms or for which a cure is not yet available?)
Genetic Screening
226
Interventions unlikely to produce benefit for the patient, futile
Care at the end of life
227
Number of insure in the US grew from 39million to 46.3million-- more than 15% of the total population
Many uninsured are women and children
Although two thirds of the uninsured are poor, nearly 80% come from working families
Access to Care
228
Describes the anguish experienced when a person feels unable to act according to closely held core values. Is a shared experience, efforts to alleviate are most successful when also shared
Moral Distress
229
Includes the willingness to speak up
Moral Distress
230
Biomedical ethics is based on four principles
Autonomy
Normaleficence
Beneficence
Justice
231
DECIDE model
```
D efine problems
E thical review
C onsider options
I nvestigate ethical outcomes (advocate)
D ecide on a plan (clarify/advocate)
E valuate results (clarify/advocate)
```
232
Problems in Ethical Dilemma resolution
- Breakdown in Communication
- Nurse concerns are not elicited
- Nurses aren't included in decision making
233
Mandatory Reporting: Child abuse or Neglect
CFS and Law enforcement
234
Mandatory Reporting: Spousal abuse
CFS
| *Do not report to law enforcement- HIPAA violation
235
Mandatory Reporting: Elder/Disability abuse:
CFS
236
SANE nurse
Certified nurse for sexual abuse examination (usually in the ER)
237
Healthcare professionals making decisions about diagnosis, therapy, and prognosis for the patient. Based upon the health care professional's belief about what s in the best interest of the patient, he/she choses to reveal or withhold patient information in these three important arenas.
Paternalism
238
Medication Legislation and Standards:
Pure Food and Drug Act
Food and Drug Administration
MedWatch Program
State and local regulations
Health care institutions and medication laws
Medication regulations and Nursing Practice Acts
239
Law that requires all medications to be free of impure products
Pure Food and Drug Act
240
Ensures that all medications on the market undergo vigorous testing before they are sold to the public
Food and Drug Administration (FDA)
241
Voluntary program that encourages nurses and other health care professionals to report when a medication, product, or medical event causes serious harm to a patient by completing a form
MedWatch program
242
These laws must conform to federal legislation, but have additional controls, including control of substances not regulated by the federal government (alcohol, tobacco)
State and Local Regulation of Medication
243
Agencies that establish individual policies to meet federal, state, and local regulations.
Health Care Institutions and Medications Laws
244
Have the most influence over nursing practice by defining the scope of nurses' professional functions and responsibilities.
Nurse Practice Acts (NPAs)
245
Name of medication that provides an exact description of its composition and molecular structure.
Chemical (ex. N-acetyl-para-aminophenol)
246
Common names of a medication
Trade Name (ex. Tylenol)
247
The official name listed in official publications such as the USP
Generic Name (ex. Acetaminophen)
248
Indicates the effect of a medication on a body system, symptoms the medication relieves, and medication's desired effect.
Classification
249
the _____ of medication determines its route of administration
form (tablet, capsule, elixir, suppository)
250
```
The study of how medications:
Enter the Body
Are absorbed and distributed into cells ,tissues, or organs
Reach their site of action
Alter physiological functions
Are metabolized
Exit the body
```
Pharmacokinetics
251
Passage of medication molecules into the blood from the site of medication administration.
Absorption
252
Factors influencing absorption
```
Route of administration
Ability of medicine to dissolve
Blood flow to site of administration
Body surface area
Lipid solubility
```
253
Medication distributed within the body to tissues and organs and ultimately to its specific site of action.
Distribution
254
Factors affecting distribution:
```
Physical and chemical properties of the medication
Physiology of the person taking it
Circulation
Membrane permeability
Protein binding
```
255
Medications ______ into a less active or inactive form that is easier to excrete
Metabolized
256
_______ occurs under the influence of _____ that _____, break down, and remove biologically active chemicals
Biotransformation, enzymes, detoxify
257
Biotransformation occurs in:
```
The liver (mostly)
lungs
kidneys
blood
intestines
```
258
Medication exits the body
Excretion
259
medication excreted by:
Kidneys
liver
bowel
lungs- gaseous and volatile compounds
exocrine glands- lipid-soluble medications
(the chemical makeup of a medication determines the organ of excretion)
260
Types of medication action
```
Therapeutic Effects
Side Effects
Adverse Effects
Toxic Effects
Idiosyncratic Reactions
Allergic Reactions
```
261
Expected or predicted physiological response that a medication causes
Therapeutic effect
262
Predictable and often unavoidable secondary effects produced at a usual therapeutic does
Side Effect
263
Unintended, undesirable, and often unpredictable sever responses to medication
Adverse Effects
264
Develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion
Toxic Effect
265
Unpredictable effect in which a patient overreacts or under-reacts to a medication or has a reaction different (or opposite) from normal.
Idiosyncratic Reactions
266
The medication acts as an antigen, triggering the release of antibodies into the body.
Medication Allergy
267
Severe reaction which is life threatening and characterized by sudden constriction of bronchiolar muscles, edema of the pharynx and larynx and server wheezing and shortness of breath
Anaphylactic Reactions
268
When one medication modifies the action of another
Medication Interaction
269
When two medcations' combined effect is greater than the effect of the medications when given separately
Synergistic Effect
270
The plasma level of a medication below which the effect of the medication does not occur
Minimum effective concentration (MEC)
271
The level at which toxic effects occur
Toxic concentration
272
The range in which you want to keep a medicaiton
therapeutic range
273
Time it takes for a medication to produce a response
Onset
274
Time at which a medication reaches its highest effective concentration
Peak
275
Minimum blood serum concentration before next scheduled dose
Trough
276
Time medication takes to produce greatest result
Duration
277
Point at which blood serum concentration is reached and maintained
Plateau
278
Time for serum medication concentration to be halved
Biological half-life
279
All medication have a ________ which is the time it take for ______ processes to lower the amount of unchanged medication by ______. This number never changes no matter how ______ _______ is given.
biological half-life, excretion, half, much medication.
280
Routes of administration
```
topical
oral
inhalation
parenteral
intraocular
```
281
Sublingual Route
Under tongue
| Not swallowed
282
Buccal route
Between back teeth and cheek
Alternate cheeks
Should not be swallowed
283
Parenteral Routes:
Intradermal (Injection into the dermis/ just under epidermis)
Subcutaneous (Injection into tissues just below dermis)
Intramuscular (Injection into the muscle)
Intravenous (Injection into a vein)
Epidural (via catheter)
Intrathecal (via catheter in subarachnoid space in brain)
Intraosseous (infusion of medication into bone marrow)
Intraperitoneal (into the peritoneal cavity)
Intrapleural (Syringe, needle or chest tube into pleural space)
Intraarterial (directly into arteries)
Intracardiac (injection into cardiac tissue)
Intraarticular (injection into a joint)
284
Topical Administration:
```
transdermal disk or patch
Intraocular
Skin
Nasal
Eye
Ear
Vaginal
Rectal
```
285
Instillation
Fluid retained
286
Irrigation
Fluid not retained
287
Prescriber
Physician
Nurse practitioner
Physicians Assistant
288
AMDS
Automatic Medication Dispensing System
289
Verbal Order guideines
- Nurse writes down complete order
- Enters it into computer
- Reads it back
- Receives confirmation from prescriber to confirm accuracy
- Indicates time and name of prescriber who gave order
- Signs order and follows agency policy to indicate it was read back
- Prescriber countersigns the order at a later time, usually within 24 hours of giving it
* Nursing students cannot take them.
* Do not use abbreviations when documenting order or other information about medications
290
Each medication order needs to include:
```
Patients name
Order date
Medication Name
Dosage
Route
Time of administration
Drug indication
Prescribers signature
```
291
Types of orders
```
Standing/Routine
PRN orders
Single (one-time) orders
STAT orders
Now orders
Prescriptions
```
292
Prepares and distributes prescribed medications
pharmacist
293
A nurse must asses a patient's _____ to self-administer a medication, determine whether the patient should ____, administer medication ________, and closely ________ effects.
ability, receive, correctly, monitor
| *Do not delegate this
294
Medication errors
```
Inaccurate prescribing
Administering the wrong medication
Giving the medication using the wrong route
Giving the medication at the wrong time
Administering extra doses
Failing to administer
```
295
The nurse is responsible for preparing a written ______ _____ for medication errors
Occurrence report
296
Process for Medication Reconciliation
```
Verify
Clarify
Reconcile
Tranmit
*Nurses play essential role
```
297
Critical Thinking and Medication Administration
Knowledge
Experience (psychomotor skills)
Attitudes (discipline, responsible, accountable)
Standards (6 rights)
298
Six rights for medication administration
```
Drug
Dose
Patient
Route
Time
Documentation
```
299
MAR
Medication Administration Record
300
Maintaining a patients' rights:
- Be informed of the name, purpose, action and potential undesired effect of a medication
- To refuse a medication regardless of the consequences
- To have qualified nurses or physicians assess a medication history, including allergies and use of herbals
- To be properly advised of the experimental nature of medication therapy and given written consent for its use
- To receive labeled medications safely without discomfort in accordance with the six rights
- To receive appropriate supportive therapy in relation to medication therapy
- To not receive unnecessary medication
- To be informed if medications are a part of a research study
301
Assessment for Medication administration:
```
Medical History
Allergies
Medications
Diet History
Patients adherence to therapy
Patients perceptual or coordination problems
Current Condition
Attitude about medication use
Understanding of and adherence to therapy
Learning needs
```
302
Nursing diagnosis with Medical Administration
```
Anxiety
Ineffective health maintenance
Readiness for enhanced immunization status
Deficit knowledge (medications)
Noncompliance (medications)
Disturbed visual sensory perception
Impaired swallowing
Effective therapeutic regimen management
```
303
Planning:
Organize care to ensure safety of medication administration
Setting Goals and Outcomes
Setting Priorities (Provide most important information first)
Teamwork and Collaboration (on discharge ensure that patients know where and how to obtain medications)
304
Implementation: Teaching family and patient about medication administration
```
Medication benefits
How to take the medication correctly
Symptoms and side effects
Safe use and storage of medications
Establish a medication routine
Refer them to community resources for transportation if needed
```
305
Implementation: Acute care and medication administration
Receiving, transcribing, and communicating medication orders
Accurate dose calculations and measurement
Correct administration
Recording medication administration
306
Specific Considerations for Medication Adminsitration
Infants and children (dose and psychological prep)
Elderly
Polypharmacy
307
When a patient takes two or more medications to treat the same illness, takes two or more medications from the same chemical class, uses two or more medications with the same or similar actions to treat several disorders simultaneously or mixes nutritional supplements or herbal products with medications.
Polypharmacy
308
Increased risk for Polypharmacy
Taking OTC medications frequently
Lack of knowledge about medications
Incorrect beliefs about medications
Visiting several health care providers to treat different illnesses
309
Medication administration Evaluation
```
Reactions
Physiological measures
Behavioral responses
Rating scales
Patient statements
```
310
How many times do you check the MAR/drug dose?
3
Before you prep the meds
After you prep the meds
At the bedside
311
How do you discontinue a medication on the MAR?
Initial, circle, write "Discontinued, "DATE"" then highlight in yellow
312
Best way to verify tube placement
X-ray
313
Advantages of Topical administration
```
Provides local effect
Painless
Limited side effects
(Skin^)
Prolonged systemic effects with limited side effects
(Transdermal^)
```
314
Disadvantages of topical administration
Client with skin abrasions are at risk for rapid medication absorption and systemic effects
Medication slowly absorbed through skin
(Skin^)
Leaves oily or pasty substance on skin and sometimes soils clothing
(Transdermal^)
315
These medication are absorbed directly through the skin or mucous membranes and applied directly to body surfaces or body cavities
Topical
316
Advantages of Parenteral Route
No GI upset
Emergencies
Effective route for drug delivery when compromised mental or physical state
Can deliver precise dose to targeted area of the body (Joint, spinal canal)
317
Disadvantages of Parental route
```
Patient anxiety
Hematoma
Allergic reactions
Higher risk of reactions
Introduction of microorganisms
Injury to tissue, nerves, veins, vessels
Can strike bone
Can traumatize a vein
More invasive
Expensive
```
318
What is the least painful/safest IM injection site?
ventrogluteal
319
Average: Gage, needle size, dose for an IM
23G (20-25)
Deltoid- 1" or 1/2", 0.5mL (up to 2mL)
Vastus Lateralus- 1" or 1/2", 2mL (1-5mL)
Ventrogluteal: 1 1/2", 2mL (1-5mL)
320
Average gage, needle size, and dose for SC
25G (25-27 or 28-31In)
5/8" or 1/2"In
1-3mL or 25, 50, 100u
321
Average gage, needle size, dose ID
27G (25-27)
1/2"
0.1mL (0.001-1.0mL)
322
Skills for client teaching
1. Assess client's knowledge of subject and readiness to learn
2. Review goals of session with client
3. Assemble materials and prepare environment
4. Implement teaching plan, using appropriate content
5. Obtain evaluative feedback
6. Summarizes content taught
7. Evaluates effectiveness of session and documents
323
Nurses role in Medication Administration
Assess that medication ordered is correct
Assess patient's ability to self-administer medications
Determine whether a patient should receive a medication at a given time
Administer medications correctly
Closely monitor effects of medications
Educate patient and family about proper medication administration
*Do not delegate these tasks
