Test #3 Flashcards
What if a pt comes in with a bag a pills? What do we do with them?
Give them to pharmacy or have them take them home
What should go into discharge education 7
- Written instructions in pts language and reading level
- Specific diet at home - educate on what they should and should not eat
- How to perform home procedures (like tube feedings)
- Precautions that they may need to take when performing procedures (like wound care) or when administering medications (like taking certain medications before meals)
- Symptoms or complications to report.
- Name and numbers of who to call with questions or concerns.
- What follow-up care they will have
What method can we use to see if pt understands their discharge educations
Use the teach back method
What goes into discharge documentation
- We need a provider prescribed order for discharge or an AMA
- Date, time and who went with pt for transportation
- How they were transported (wheelchair to car, gurney, etc)
- Where the pt is going (destination)
- Summary of the pts condition at the time of discharge
- Description of any unresolved difficulties and procedures for follow-up
- Return their valuables and medications
What are our responsibilities for an outbound transfer 7
- On day of transfer, confirm that the receiving facility or unit is expecting the pt, and that the room/bed is available.
- Communicate the time pt will transfer
- Complete all documentation
- Give a transfer report to receiving party
- Confirm mode of transportation the pt will use to get there (car, wheel chair, ambulance).
- Pt should be appropriately dressed
- Account for clients valuables
What are our responsibilities for an inbound transfer
- Have any specialized equipment ready
- Inform other healthcare team members of the pt’s arrival and needs
- Meet with the pt and family on arrival to complete the admission process and orient them to new facility/unit
- Assess how the pt tolerated the transfer
- Review transfer documentation
- Implement appropriate nursing interventions in a timely manner
What are critical pathways (look up in book)
Referrals (look up in book)
Why is a hospital on the hook for readmissions within 30 days of discharge
Because Medicare will not pay for readmissions within 30 days of discharge - which means the hospital will not get reimbursed
How does the American Nurses Association (ANA) define nursing
- Integrates the art and science of caring
- Protects, promotes, and optimizes health and human functioning
- Prevents illness and injury
- Facilitates healing
- Alleviates suffering through compassionate presence
What does the ANA state nursing is for
The diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.
How does ANA define the standards of practice of nursing
“The Standards of Practice describe a competent level of nursing practice demonstrated by the critical thinking model known as the nursing process. The nursing process encompasses significant actions completed by registered nurses and forms the foundation of the nurses’ decision-making.”
What are the ANA Standards of Practice
- Std 1: Assessment (The RN collects pertinent data and information relative to the healthcare consumer’s health or the situation)
- Std 2: Diagnosis (The RN analyzes assessment data to determine actual or potential diagnoses, problems, and issues)
- Std 3: Outcomes Identification (The RN identifies expected outcomes for a plan individualized to the healthcare consumer or the situation)
- Std 4: Planning (The RN develops a collaborative plan encompassing strategies to achieve expected outcomes)
- Std 5: Implementation (two parts:)
The RN implements the identified plan.
Std 5A: Coordination of Care: The RN coordinates care delivery.
Std 5B: Health Teaching and Health Promotion: the RN employs strategies to teach and promote health and wellness. - Std 6: Evaluation (The RN evaluates progress toward attainment of goals and outcomes)
What does the Scope of Nursing Practice describe
The who, what, where, when, why, and how associated with nursing practice and roles.
What are the who, what, where, when, why, and how of the RN scope of practice
- Who: all RNs that have been educated, titled, and maintain active licensure to practice nursing.
- What: definition of Nursing - The diagnosis and treatment of human responses and
advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity. - Where: any environment where there is a healthcare consumer in need of care, information, or advocacy.
- When: anytime & anywhere there is a need for nursing knowledge, wisdom, caring, leadership, practice, or education.
- Why: in “response to the changing needs of society to achieve positive healthcare consumer outcomes in keeping with nursing’s social contract and obligation to society.”
- How: all ways, means, methods, & manners that RNs use to practice PROFESSIONALLY.
What is the purpose of OSBN
To protect the public by regulating nursing educations, licensure, and practice.
Who is on the OSBN board
The OSBN is comprised of 9 state residents appointed by the Governor, confirmed by the state senate: 5 RNs, 1 LPN, 1 CNA, and 2 members of the public otherwise not eligible for appointment to the board.
What comprises the Oregon Nurse Practice Act
Comprised of Oregon Revised Statutes: Chapter 678.010-678.445 (laws) and Oregon Administrative Rules: Chapter 851 (Divisions 1-70).
How to we read or find a statute
They go by chapter - division - rule
(For example: 851-045-0040 corresponds to Scope of Practice Standards for All Licensed Nurses)
If you are not COMPETENT at something - do not do it
Know who to assign tasks to (like what can LPNs do, what CNAs can do)
Know what you need to do for a discharge (ie go over meds,
Can LPN handle chemo drugs
No
If a question asks you “which pt can you assign to an LPN”, don’t select someone who just arrived and needs an initial assessment - RNs need to perform the initial assessment.
Can LPNs perform assessments and create plans of care
No - this is the RNs job
What is interesting about assessments for LPNs versus RNs
LPNs can perform assessments (like listening for bowel sounds) but they can’t evaluate those sounds and qualify them as hypoactive, normal, or hyperactive
Is it within an LPNs scope of practice to provide patient teaching
No
Can LPNs administer blood
No
Can LPNs administer tube feedings
Yes
Can LPNs delegate tasks
Yes, but they also are accountable for that task
Define community
Groups of individuals (can be grouped based on location, or something that pulls them together, like being a part of a church)
What is population
often refers to a geographic area; can also mean a particular group of people with shared characteristics. Examples: homeless population, worker population, Latinx population
What is aggregate
Aggregate is a group of people with at least one shared personal characteristic. Example: Female teens of childbearing age
- “toddlers”, “infants”
- basically one group that shares a common thing
Define health
State of complete physical, mental and social well-being, and not merely the absence of disease or infirmity
What is an example of a structure
Refers to the general characteristics of a community - Demographics and data about healthcare services
“like Lebanon”
What is status
Described by a variety of health indicators
- Biological: Morbidity/mortality rates, life expectancy, risk factors for age groups, prevalence of lifestyle choices (i.e. nicotine)
- Emotional: Mental health and consumer satisfaction with certain community markers (how people feel about things)
- Social: Crime rates, community involvement, leadership capacity
What is process
Process: Describes the overall effectiveness of the community
- Do groups perceive a common purpose?
- Do community members gather and interact?
- Is there an established mechanism for conflict resolution?
What is community health nurse
Providing care OUTSIDE of the acute care setting
What does it mean when we say community health nursing is autonomous
These community health nurses have more independence to make decisions and lookout for the WELFARE of their clients (they can be independent - they can provide education, explain the diagnosis, help people access care, etc)
What is the goal of community health nursing
Promote, preserve and maintain the health of a population by bringing services to individuals, families, and groups – continuity and improved access to care
Where might we see community health nurses
- Senor center
- Soup kitchens
- Schools
- Work
- Faith community
What is the difference between direct and indirect care
- Direct care: provide care to that individual, this is community-BASED nursing (providing wound care to a pt in their home, school nurse teaching a student who has asthma about medications)
- Indirect care: provide care upstream, like developing an intervention program to teach a group, this is community - ORIENTED nursing
What is the focus of care for community oriented nursing? What is the primary goal? What might these nursing activities look like?
- Focus: aggregates, communities, populations
- Goal: health promotion and disease prevention
- Activities: Indirect care - program management, might include direct care for at-risk individuals and populations
What is the focus of care for community based nursing? What is the primary goal? What might these nursing activities look like?
- Focus: individuals and family
- Goal: management of acute and chronic conditions
- Activities: Direct care - where community nurses are working to help individuals manage their acute or chronic conditions
What are examples of community-based care
Includes healthcare or rehab services performed OUTSIDE of the acute care hospital facility
Examples:
Clinics, mobile care units
Surgery centers
Outpatient rehabilitation centers
Skilled nursing facilities
Assisted living communities
Consumer’s home
What is community health nursing
Focus on the health of an individual, family or group in order to impact the entire health of the community
What is a good way to remember the difference between community and public health nursing
Public health nursing focuses on the population “how can we help this specific population”, versus community oriented nursing which focuses on helping specific members of the population
What are the 3 “essential services” of public health nursing
- Assessments (what is going on in the community, what do we want to fix)
- Policy developments
- Assurance (want to have healthcare access for all, enforce laws and rules that impact health and safety, link people to services, ensure that healthcare workers or competent, evaluate)
Do community health nurses like to focus more on health promotion or health protection (disease prevention)
Health promotion
What is the difference between health promotion and health protection (disease prevention)
Health promotion is before there is any illness, where you are motivated to just stay healthy, while with health protection (disease prevention) you are motivated to avoid a certain illness, like heart disease
(think about her heart disease story and iron mountain) (basically the activities can be the same, but the motivation is different)
What are examples of primary prevention (before there is any disease)
- Neighborhood clean-up
- Access to trail systems and daily exercise
- Access to healthy food in neighborhood groceries
- Lifestyle education (smoking, nutrition, hygiene, etc.)
- Lifting devices for bed-bound consumer care
- Immunizations
- Fluoride in water
What are examples of secondary prevention (early detection and tx)
- Community assessments for environmental hazards
- Screen home and children for lead
- Blood sugar screening and diabetes education for those diagnosed with pre-diabetes
- TB screen
- Genetics testing
- Mammography and other cancer screenings
- Lipid testing,
- EKG for heart disease
- Trauma-informed care (Trauma-informed Oregon)
What are examples of tertiary prevention (stop disease progression and/or restore functioning)
- Surgery for broken hip and physical therapy
- Medication for glaucoma
- Living Well with Chronic Conditions (class)
- Case management
- Lead abatement
- Support groups
- PT/OT
- Exercise for hypertension
- Exercise rehab
- Nutritional counseling for Chrohn’s disease
What are prevention examples at each level for falls?
- Primary - grab bars, no rugs
- Secondary - Gait assessment, screening for falls
- Tertiary - fixing a broken hip
What are prevention examples for lead?
- Primary - Testing for lead in water, paint, old toys
- Secondary - screening children for the lead
- Tertiary - tx for lead
What are examples of disease surveillance
- Contact tracing
- Collecting and analyzing infectious disease data
- Monitoring patterns to identify an outbreak and track origin
- Communicable disease reporting
What are examples of primary, secondary and tertiary prevention at the community level
Primary: Prevent occurrence through vaccination, elimination of the source (mosquitoes, for example - hand out free nets), education prior to foreign travel
Secondary: Post-exposure prophylaxis (rabies, HIV, etc.), quarantine, screening, and case finding (contact tracing, like when a nurse has to call someone for STDs for contact tracing)
Tertiary: Monitor treatment compliance (DOT), link consumers to needed rehabilitation resources
What is DOT
Direct observation therapy (watch them take their medicine) like with TB
Define epidemiology
study of health-related trends in populations for the purposes of disease prevention, health maintenance and health protection (where these diseases started, how it’s spreading, etc)
Define endemic
disease or condition that is moderate and ongoing in a given location (like the flu)
Define epidemic
rate of disease greater than usual endemic level
Define pandemic
epidemic in multiple countries or continents
Define attack rate
Number of people exposed to a specific agent who develop the disease/total number exposed
What is the difference between morbidity vs mortality
Morbidity - talks about the number of people that are getting the sickness (people that “live”) (this includes incidence and prevalence)
Mortality - number of deaths
How do you calculate crude mortality rates
Number of deaths divided by population total multiplied by 1,000
How do you calculate infant mortality rates
Number of infant deaths before 1 yo in one year divided by the number of live births in the same year multiplied by 1,000
How do you calculate the incidence rate
Number of NEW CASES in the population divided by the total population multiplied by 1,000 (so there are 8 per 1000)
How do you calculate the prevalence rate
Number of existing cases in the population at a specific time divided by the total population multiplied by 1,000 (so the prevalence is 20 per 1000)
Say you have 8 existing cases of nosebleeds out of a population of 15. Is this incidence or prevalence? What is the number?
It’s prevalence, because they are EXISTING and not new cases. Number is 8/15 x 1000 = 533
What is a windshield assessment
You’re looking at a community to see what issues they might have (are there a lot of overweight people, is there good access to walking trails, what are the ethnicities, is there presence of public protection, where are the community boundaries)
What do we call people who make “too much” money to get help from the state, but don’t make enough money to really support themselves
Asset limited income constrained employed (ALICE)
What are the 5 social determinants of health
- Education access and quality
- Health care access and quality
- Neighborhood and built environment
- Social and community context (includes culture)
- Economic stability
What influences risk (think of the sandman)
The hazard itself plus any outrage with it (think of that “safe” column and “risky” column) (feels “risky” if it’s coerced, exotic, unknowable, controlled by others, etc.)
When you’re assessing someone’s environment, what acronym can you use? What does it stand for?
I PREPARE acronym:
- Investigate potential exposures
- Present work – exposures, PPE, clothing brought home
- Residence – age of home, heating, chemicals, water
- Environmental concerns - air, water, waste site, etc.
- Past work – exposures, farm work, military, volunteer, etc.
- Activities – hobbies, gardening, fishing, soldering, alternative medicines
- Referrals and resources EPA, DEQ, Agency for Toxic Substances and - Disease Registry, AAOHN, SAIF, OR OSHA, County health department
- Educate – risk reduction, prevention, follow-up
If an individual believes they have control over their immediate situation and environment, what will happen with that individual
They will have less stress and be more likely to seek out healthy behaviors
What happens to a person’s health if they believe that their outcome is pre-determined and cannot be changed
They are not as likely to get healthy (“what’s the point in trying to change anything”)
What are biomedical beliefs
focus on identifying a cause for every effect – the body as machine. Most US healthcare systems function under this belief.
What are naturalistic beliefs
imbalance in nature is believed to cause disease; foundational in Eastern Medicine, also in some Mexican cultures
Should you use an interpreter from the same community
No (think of china town example)
What 4 ethical principles should be applied to community nursing
- Respect for autonomy
- Nonmaleficence (make sure no harm is done)
- Beneficence (maximize benefits with the least harm)
- Distributive justice (fair distribution)
What does non-maleficence mean
No harm is done in the process of providing care
What does beneficence mean
Maximizing the benefit, while minimizing harm
What are the 4 stages of emotional reactions during a disaster
- Heroic – Intense excitement, concern for survival. Often manifests as a rush of support from outside the area
- Honeymoon – Affected individuals bond and share their experiences
- Disillusionment – Depression and exhaustion among responders, frustration with delays in aid and/or aid distribution (“I am tired and don’t think I’ll be able to fix everything” “my old hobbies don’t seem interesting anymore since the tornado”)
- Reconstruction – Adjusting to the new reality; new normal. Counseling may be needed. Those affected begin looking ahead. (“things will never be the same, but we will find a way to go on”)
Where are the most common injuries in an earthquake
Hands, feet and head. (that’s why you want gloves and shoes)
When beginning a cultural assessment, which action should a nurse take first
Gather data about the pt’s cultural beliefs
Do community health programs manage the women, infants, and children program
No - the state does
Do community health programs report communicable diseases to the CDC
No - the state does
What are examples of secondary data
When you are using data that was gathered by someone else
- Birth statistics
- Previous health survey results
- Health records
What is the process of planning a community program
Think of ADPIE (with an extra P)
1. Pre-planning (brainstorming)
2. Assessment
3. Diagnosis
4. Plan
5. Implementation
6. Evaluate
What is the disaster response circle
- Mitigation (prevent the disaster - identify populations at risk, etc)
- Preparedness
- Response
- Recovery
When you’re doing a community assessment, what components are you taking in
- Demographics
- Biological factors (race, gender)
- Social factors (occupations, education, etc)
- Cultural factors (language, customs)
- Physical factors (geography, terrain)
- Environmental factor
What are the steps in community assessment
- Define the community (what are our boundaries)
- Collect data
- Analyze data
- Develop a community diagnosis (no clean water)
- Plan programs
- Implement programs
- Evaluate programs
What are the different data collection methods
- Secondary data (data you did not gather yourself)
- Informant interviews
3 Community forums - Participant observation
- Focus groups
- Surveys
- Windshield surveys
What two things should your assessment include
- Is there an interest and readiness for change
- Will this change meet the needs
What is a PIT count
PIT (point in time) count is a snapshot of how many homeless people on one day in January
What are the least effective interventions for changing health outcomes
Education and health counseling (these are the easiest, but are only as effective as the person receiving and giving the information)
According to the CDC, what are the biggest to least impacts on a person’s health
- Socioeconomic factors (biggest impact)
- Changing the context (to make individual’s default decisions healthy)
- Long-lasting protective interventions
- Clinical interventions
- Counseling and education (smallest impact)
What is interesting about our older adults 2
- Increasing proportion living alone
- Consume about 1/3 of all prescribed meds
What are the 4 different ways we can view families
- A component of society
- A system (internal to itself)
- A client (family unit first, then individual)
- Context (individual first, then family)
What are the steps in the transtheoretical model of change
- Precontemplation (haven’t thought about it)
- Contemplation (thinking about it)
- Preparation (what do I need to do)
- Action
- Maintenance
- Termination (I will always do this)
For public health, what 3 things do they work to change
- Policy
- Systems (changes that impact all areas of an organization or institution)
- Environment (changes in physical, social, or economic factors that affect how people behave)
What are the six sources of influence
- Make the undesirable desirable
- Over invest in skill building
- Harness peer pressure
- Find strength in numbers
- Design rewards and demand accountability
- Change the environment
With the six sources of influence, how many should we meet in order to influence
At least 4
How can we do health promotion
- Disseminating information (how are we going to get the information out)
- Changing lifestyle and behavior (having information and support)
- Protecting the environment
- Assessing wellness and appraising health risk (two different assessments)
Who motivates a person, a nurse or the person
The person, the nurse can help them with goal setting, etc.
In the home setting, are urinary catheters and tracheostomy clean or sterile
Clean - they are often reusing in the home setting
Should we treat sweat as being infected so we should use standard precautions
No - all body fluids, except sweat, are considered dangerous, so use standard precautions
If you are exposed to something, when should you get post-exposure prophylaxis
Within 1 hour
What are our airborne illnesses
- TB
- Measles
- Chickenpox
- COVID
What are our droplet illnesses
- Common cold
- Flu
- Norovirus
- COVID
What are our contact illnesses
- Chickenpox
- C diff
- Common cold
What is the “three point system” for buses and trucks
- Face the vehicle when entering and exiting
- Three of four limbs remain in contact with vehicle at all times
- Only one limb in motion at a time
- When getting down, or out, step down backwards, rather than stepping or jumping forward
How long can food stay out before it may become a hazard
2 hours
