Test 2 Flashcards
Know Patient’s Rights
1.Right to considerate and respectful care
2.the right to information such as diagnosis, prognosis and treatment as well as:
a. Risks & benefits
b. Identity of care providers
c. Cost ($)
3. right to refuse care and to make decisions about the plan of care and be informed of the medical consequences if refuses
4. right to have an advance directive such as a living will or POA
5. right to every consideration of privacy
6. right to keep records confidential.
7. right to review their records
8. right to receive a reasonable response to their requests from facility such as:
a. The hospital must provide service indicated by the urgency of the care
b. Transferred
9. right to ask and to be informed of business relationships of the hospital, educational
institutions, other health care providers, and payers that may influence the patient’s treatment of care.
10. right to consent to or decline to participate in research studies- and right to have them fully explained before consent.
11. right to expect continuity of care and to be informed of available and realistic patient care options when hospital care is no longer appropriate.
12. right to be informed of hospital policies & practices that relate to patient care, treatment, and responsibilities. (Conflict, charges)
Does not change for terminally ill clients
Patient rights in a hospital
Hospital rights- • Hospitals must ensure a doctor/nurse respects the role of patients in decision making
• Hospitals must be sensitive to cultural, racial, linguistic, religious, age, gender, & other differences as well as the needs of persons with disabilities
Terminally ill patient rights
Right to DNR (right to die)
7 rights of med administration
Right patient, Right route, Right drug, Right documentation, Right to refuse tx/medications, Right time Right dose.
What is palliative care?
Comfort care or end of life care. Managing symptoms of pain, dyspnea, depression.
Lasix Teaching points & Side effects
How does it lower blood pressure??*
Give when?
Loop Acting Diuretics-
Cause the kidneys to excrete more urine by reabsorbing less water in the body & lowers blood pressure.
S/E-
increased urination
Loss of minerals/electrolytes such as sodium, potassium, magnesium
Cause dehydration, gout (joint disorders), dizziness, lower BP with postural change, and syncope (fainting), impotence, reduces edema, causes headaches, muscle cramps, and impotence
Can cause tinitius (ringing in ears) can drink caffeine/tea
Abdominal Post- Op Teaching Points
Educate patient on the agenda on the day of surgery, including respiratory exercises, pain management techniques, the possibility of drainage tubes, dressings, casts, IV lines, and monitoring or oxygen equipment
*Coughing and deep breathing, flinch belly - pay attention to surgical site, drainage , transferring, peristalsis (intestine digestion movement)
Nurses Role in pre-op:
informed consent-education, patient advocacy, documentation, ask if it’s the right procedure.
pre-op assessment
history taking, physical assessment, interpretation of laboratory studies, and familiarization with radiologic or other diagnostic tests
Nurses role:
info on what to expect before surgery, never events
- nurses- support patient advocate -prepares patient and ensures safety. Find out patient knowledge and needs for the surgery and implement interventions accordingly
Normal Urine Output
Adult: 1500-2000 ML in 24 hours
Minimum Output should be at least 30ML/Hour
HIPPA
Health Insurance Portability and Accountability Act
- Federal law
- Protects patient information in the medical record, conversations, personal insurance and billing information.
S/s of kidney stones
Elevated bp Tachycardia Restlessness Note location duration and intensity of pain Blood in urine Flank pain
Diagnostic tests used for Kidney Stones
(caused by too much calcium, dehydration, and hypernatremia)
Blood calcium, phosphorus, uric acid and electrolytes off
LABS/Tests: Bun Creatinine Urinalysis Ultrasound
K, U, B, X-ray *****
9. S/S of IBS and TX options #one cause
Give what for loose stools?
S/S of IBS and TX options
Stress is the #1 cause-
IBS: Treatment
no cure. anticholinergics, antidiarrheal agents, increase fiber, increase mobility, laxatives, decrease stress, low fat diets, don’t drink alcohol or smoke.
S/S: gas, abdominal pain, bloating, diarrhea, and constipation.
Imodium
- Bowel sounds in a post-surgical patient
* what to expect to hear?
Should not be absent
Should return to normal in 24-48 hours
Know the 7 ethical principles
Beneficence- Nonmaleficence- Autonomy- Justice- Veracity- Fidelity- Accountability-
To do good for the Patient
Beneficence-
Least invasive procedure to benefit and do good for patient
Nonmaleficence
freedom for the patient to decide what they want to do on their own
Autonomy
Treat everyone equally
Justice
Tell the truth
Veracity
Loyalty
Fidelity
Accountability-
Responsibility
S/S of Pyelonephritis
Infection of the upper urinary system
Infection Goes to kidney
6 Symptoms of pyelonephritis:
Fever, blood in Urine, urgency, chills, flank pain, n/v, headaches, increase HR and Resp., HTN, nocturia, hyperkalemia, acidosis, inability to develop sodium.
is A Process through which scientific evidence is identified, appraised, and applied in health care interventions
EBP
EBP: why is it needed?
When to use?
Provides the guidelines for effective practice
Increases certainty and predictability in the effect of the practice on the outcome
Quality improvement
When new research comes out
- Know what to ask for a health history and assessment for evaluating a patient’s elimination
status
*see table in book pg 232- chart 14
Determine usual elimination status, stool characteristics, diet hx, appetite, fluid intake, hx of surgery or illnesses affecting GI tract, medication hx, exercise, emotional hx, mobility, dexterity. Asses mouth, teeth, tongue, gums, ability to chew, abd shape/color, rectum, anus for lesions, discoloration, inflammation, hemorrhoids. Lab tests, x-rays, hx of tumors, bleeding, parasites, infection.
failure to use ordinary or reasonable care or the failure to act in a reasonable and prudent(careful) manner.
Malpractice
unreasonable and preventable risk of harm to patient.
Negligence
being responsible by law- which malpractice and negligence can lead to.
Liability
Complications associated with diarrhea
Dehydration, electrolyte loss, and vascular collapse may occur.
S/S of UC and treatment options
Diarrhea, hallmark sign (with blood/mucus) Abd pain Cramping Rectal pain/bleeding Painful/increased urgency to poop but unable Urgency Weight loss/anorexia Nausea/loss of appetite Fatigue/anemia Fever Skin rash or eye irritation Joint pain/arthritis
UC Tx includes
broad spectrum antibiotics, steroids, immunosuppressive agents, and surgery (resection of bowels) correct F&E, pain control, decompression.
Types of Ostomies and the care of them ?
??
Subtotal colectomy, ileocecectomy, proctocolectomy with ileostomy
Have bag on right and measured correctly when cutting around
Abdominal assessment
??
Inspection, auscultation RLE, palpation, and percussion. Privacy, position (flat, knees, bent), Pee, pain, suction off, look, listen, feel, suction on.???
Management of a colon resection and teaching points
Excision of the colon-
Rapid progression to normal diet-
make adjustments for diarrhea, constipation, flatus, odor
Must have colostomy during healing- colon connected to opening of skin
Bag placed over site must be changed regularly.
Colon is site of water reabsorption to form solid stool- removing colon means this does not happen.
Know PSDA
PSDA- Patient Self Determination Act of 1990, patient legally have a right to autonomy and veracity
EMTALA-what is it?
EMTALA stands for?
EMTALA-Not transferring a patient, but providing them care even if they cannot pay in the emergency room at least until they are stable?
EMTALA stands for?
Emergency medical treatment and labor act
Know the Good Samaritan Law
Protects rescuers from being sued for giving emergency care.
Nurses are mandated reports- What items have to be reported?
People who are required to report suspected or observed abuse or neglect. It includes reporting certain events, acts, and situations. Reportable events are determined by local law. Notify manager immediately.
What is informed consent? When is it needed? When is it not needed?
Statement stating that the patient has the capacity to consent and that they have been informed of information regarding tx/procedure and has agreed and has given permission to treatment. Nurse must witness informed consent and ensure provider gave information and they are competent to give consent, document and inform pcp of any questions.
It is needed- verbal or written consent Unless emergency-implied
Include the diagnosis, predicted course with or with out tx, costs, need for tx, advantages and disadvantages, risks, long term effects, time, effect on job performance.
Forms- implied, expressed, and written consent
Send letter to pt if refusal occurs- document date, signed by PCP, pt and witness- document pcp info goven to pt. , pts understanding of risks, pt reasons for refusal.
5th grade reading level
What is an advanced directive
What does it include
A legal document that people use to decide how their healthcare should be carried out when they are no longer able to due to illness. (CPR/DNR) It includes Living Wills, healthcare proxy, treatment directive, and POA. Can be oral or written. POA must be at least 18 years of age and not an owner of healthcare facility which the patient resides. A copy should be given to POA, provider, and hospital.
Pre-op Assessment-Blood thinners - what to know
Blood thinners increases chances of bleeding/hemorrhage during surgery.
Doc will have patient stop taking before surgery
Dietary adjustments for constipation
Increase fiber and fluids. Such as raw fruits, veggies, bran, and whole grains.
How to care for a patient with an indwelling (foley) catheter
Wipe front to back, clean hose from body outward.
Irrigate the catheter every shift to ensure patency
Label the catheter with the date it was inserted
Ensure tubing is secured to patient
Hang the collection bag on the side rail of bed.
What is the primary prevention tool used for colon cancer screening?
Occult blood and Colonoscopy- age 50 and older every 10 years?
Colonoscopy Prep Teaching
Stay on a clear liquid diet the day before,
avoid red, orange, or purple beverages.
Drink gaterade after to reprise electrolytes.
NPO.
Avoid NSAIDS/anticoagulants,
need cleansing bowel before.
Don’t use golytely (cleanses bowels) older adults with fluid and electrolyte losses.
8 fluid oz every 10 min until you drink all of it. - help poop
involuntary escape of larger amt of urine with strong urge to void.
Urge Incontinence-
Benefits of conscious sedation
Allows patient to maintain airway and respond appropriately to physical or verbal commands.
Less risk of complications
S/of malignant hyperthermia
What is it and tx?
What to give for it?
When can it start
is an inherited muscle disorder acute life threatening complication of anesthesia
- characterized by increased body temp, potassium, calcium, uncle metabolism
- Acidosis, heart dysthymias
MH can start immediately, few hours into surgery or after completion.-
depends on diagnosis and actions of surgical team.
**dantrolene is a muscle relaxant which is the medication of choice for MH.
Risk factors of glomerulonephritis (kidney disease)
Recent strep infection
HTN
Diabetes
High protein , sodium diets
Older adults due to slow working nephrons
(Nausea , fatigue, joint aches)
S/s of bowel obstruction and tx
Crampy, coliky, abd pain
Nausea and dark green/yellow bilious vomiting
Constipation
Loud growling abd noise
NG down throat into stomach decompression - bowel Resection or laparoscopic surgery
When and how can you make changes to advanced directives
You should review your advance directives periodically to ensure that they still reflect your wishes. If you want to change anything in an advance directive once you have completed it, you should complete a whole new document.
Colon cancer screening lab test
FEcal occult blood test
CBC
When to give incentive spirometer
give to patients to encourage to take deep breaths in slowly to promote lung expansion and prevent pulmonary problems such as pneumonia every 1-2 hours
skin complications after surgery
Pressure injuries Skin rashes or contact allergies Wound infection Wound dehiscence Wound evisceration
Categories of surgery :
Diagnostic-
Curative-
Restorative-
Palliative-
To determine diagnosis such as cancer -biopsy
Resolve health problem- appendix
Improve function ability such as hip replacement
Performed to relieve s/s but does not cure- osteomy
Urgency of surgery :
Elective
Urgent
Emergent
Planned for correction on non acute problem- cataract surgery
May be life threatening if left untreated for more than 24-48 hours-fracture/obstruction/kidney stones
Requires immediate intervention due to life threatening consequences- gunshot wound/severe bleeding/appendectomy/compound fracture/aneurysm
Surgical approach:
Simple:
Minimally invasive surgery:
Radial:
- only most affected areas involved in surgery (mastectomy)
- surgery performed through one or more endoscopes that can correct problems,remove organ or take biopsy (arthroscopy)
- extensive surgery beyond area involved l- finding a root cause -radial hysterectomy
