Week 1; Concepts of Complexity Flashcards
DKA Review
Occurs with type I diabetes, on-diagnosed diabetes – undetected, 3 P’s (polyuria, polydipsia, polyphagia).
Can occur with Type II
DKA causes
Stressful situation, skipping meals – “starvation mode” – starts burning fats, corticosteroids, infection, trauma, omission of insulin, medications that antagonize insulin
DKA assessment findings
Kussmaul respirations – rapid deep breaths, lower CO2 (sign of metabolic acidosis), fruity breath, nausea, abdominal pain (frequent in pediatric patients), dehydration or electrolyte loss, polyuria, polydipsia, weight loss, dry skin, sunken eyes, lethargy, coma
DKA vs HHS
DKA symptoms occur suddenly as opposed to HHS – occur gradually
DKA lab findings
Serum glucose > 300 mg/dL or >200 mg/dL for pediatrics, positive urine ketones, serum pH <7.35, serum HCO3 <15 mEq/L, Ketones-positive, serum Na varies low, normal, or high, BUN >30 mg/dL, creatinine >1.5 mg/dL, serum potassium increased(mild); decreased (severe)
DKA interventions
- Correct Dehydration
- glucose level
- correct metabolic acidosis
- electrolyte balance
HHS (hyperosmolar hyperglycemic nonketotic state)
Results from a sustained osmotic diuresis. Serious, life-threatening, slow onset. Results in severe dehydration. Patient secretes just enough insulin to prevent
ketosis. EXTREME hyperglycemia – blood is
concentrated (hyperosmolarity). Mostly in Type II in pt with infection or older adult
HHS causes
Kidney disease, MI, sepsis, pancreatitis, stroke, some medications-glucocorticoids, diuretics, phenytoin, beta blockers, and calcium channel blockers.
HHS assessment findings
Polyuria, polydipsia, hypovolemia, dehydration, hypotension, tachycardia, hypoperfusion, weight loss, weakness, nausea/vomiting, abdominal pain, stupor, coma, seizures
HHS interventions
Admit to ICU if blood glucose > 700 mg/dL
Establish, maintain ventilation
Correct shock with adequate IV fluids Normal saline is
preferred.
* 1liter per hour until central venous pressure begins to rise.
* Half-normal saline for others.
If client is comatose, NG suction
Maintain fluid volume
Administer insulin to reduce blood glucose
Assess mental status and consult physician if changes
occur.
Fluid replacement therapy
IV fluids or blood: most effective treatment for
hypovolemic shock. Fluids also used to treat septic, neurogenic and anaphylactic shock. Fluids administered alone or in combination; crystalloid solutions, colloid solutions, blood and blood products are administered in massive amounts through two large-bore peripheral lines or a central line
Hypovolemic shock review
Hypovolemic shock affects all body systems
* Effects vary according to age, general state of health, extent of injury or severity of illness, time before treatment is provided, rate of volume loss
* Manifestations result directly from decrease in blood volume, initiation of compensatory mechanisms
* Shock stage progresses with sustained loss of ≥100 mL
Cardiogenic shock review
Cardiogenic shock occurs when heart’s pumping ability cannot maintain CO, perfusion. Caused by MI (most common cause), cardiac tamponade, restrictive pericarditis, cardiac arrest, dysrhythmias, pathologic changes in valves, cardiomyopathies, complications of cardiac surgery, electrolyte imbalances, drugs affecting cardiac muscle contractility, head injuries causing damage to cardioregulatory center
Obstructive shock review
Caused by obstruction in heart, great vessels. Impedes venous return or prevents effective cardiac pumping. Caused by impaired diastolic filling, increased right ventricular afterload, increased left ventricular afterload. Manifestations result from decreased CO and BP → reduced tissue perfusion, cellular metabolism.
Distributive shock (vasogenic shock)
Several types of shock resulting from widespread
vasodilation, decreased PVR. Blood volume does not change → relative hypovolemia
Septic shock (septicemia)
Leading cause of death for patient in ICUs. Part of progressive syndrome: systemic inflammatory response
syndrome. Most often result of gram-negative bacterial infection. May also follow gram-positive Staphylococcus, Streptococcus infections
Neurogenic shock
Parasympathetic overstimulation → sustained vasodilation
* Dramatic reduction in systemic PVR
* Causes: head injury or trauma to spinal cord, insulin reactions, CNS drugs, anesthesia, severe pain, exposure to heat
S/S of shock
Signs of early shock may be nonspecific; as body compensates for hypotension, hypovolemia, signs of shock include: tachycardia, increased respiratory effort, decreased urine output, diaphoresis, drop in systolic BP, narrowing of pulse pressure, reduced cerebral blood flow → decreased LOC, progression to cardiopulmonary failure, death
Shock treatment
ALL should receive oxygen
Also fluids (colloids) and drugs
Complexity
Complexity theory, as a way of understanding how
nursing is organized and adapts. Related to the field of complexity science. The term complexity theory is often used interchangeably with other terms, most notably
complex adaptive systems.
Complexity theory defined
Plsek1 defines complexity theory as ‘a collection of individual agents who are free to act in ways that are not totally predictable and whose actions are interconnected, such that one agent’s actions change the context for other agents.’
Complexity theory use
Complexity science theory is a natural framework for
nursing educators and nurse leaders to use in
leading and solving complex, unpredictable
problems in highly complex organizations and
evolving health care systems.
How complexity ties in with nursing
Nurses promote, restore, or maintain optimal health. Nurses must be able to apply developmental theory
and provide care appropriate to needs of patients. Nurses must understand and be able to apply
principles of SAFETY. Nurses must be able to understand cultural diversity and provide culturally sensitive care. Nurses must have knowledge, skills, and attitudes to be care coordinators, transition managers, caregivers, patient educators, leaders, and advocates for the patient and family
Professional nursing concepts include
Patient-centered care, safety, teamwork and interprofessional collaboration, evidence-based practice, quality improvement, informatics and technology, clinical judgment, ethics, health care organizations, health care disparities
Patient centered care attributes
Respect for patients’ values, preferences, and
expressed needs, coordination and integration of care, information, communication, and education, physical comfort, emotional support and alleviation of fear and anxiety, involvement of family and friends, transition and continuity, access to care
Care coordination
Deliberate organization of and communication about
patient care activities. Takes place between two or more health care team members (including the patients). Facilitates appropriate, continuous health care to meet the patient’s needs
Case management; provides quality and cost-effective services and resources to achieve positive patient outcomes
Transition management; provides safe and seamless movement of patients among health care settings, health care providers, and the community for ongoing care to meet patient needs
Interventions to Help Family Cope With Hospitalization
Provide written materials explaining the client’s diagnosis or condition, actively involve the family in team meetings, promptly follow up with family concerns or questions, encourage the family to go home and rest, encourage the family to call for updates when they cannot be present, suggest ideas for stress-reducing activities (e.g., walking, meditating), inform the family about on-site availability of a clergy member or chapel, encourage the family to participate in care activities as appropriate, keep the family informed of the client’s progress, help the family to identify sources of stress and develop strategies to work through and dissolve the root cause, provide anticipatory guidance regarding outcome and expectations for discharge
Trauma informed nursing practice
Introduce Yourself and Your Role in Every Patient
Interaction, Use Open and Non-Threatening Body Positioning, provide Anticipatory Guidance, Ask Before Touching, Protect Patient Privacy, Provide Clear and Consistent Messaging About Services and Roles, Use Plain Language and Teach Back, Practice Universal Precautions
Medication Reconciliation and Safety
Formal Evaluative Process in which patient’s
actual current medications are compared to his
or her prescribed medications at time of
admission, transfer, or discharge. Important to know if patient has seen different providers. Medication errors occur from multiple meds from multiple providers, duplications, omissions, contraindications. Discrepancies can cause negative outcomes
Patient harm and errors generally occur as a result of:
Lack of clear or adequate communication, lack of attentiveness, monitoring, lack of clinical judgment, inadequate measure to prevent health complications, errors in med administration, errors in interpreting provider prescriptions, lack of professional accountability and patient advocacy, inability to carry out interventions in an appropriate and
timely manner, lack of mandatory reporting
Culture
Purnell (2014) defined culture as “the totality of
socially transmitted behavior patterns, arts,
beliefs, values, customs, lifeways, and all other
products of human work and thought
characteristics of a population of people that
guides their world view and decision making”.
Culture characteristics
Learned, taught, shared by its members, dynamic and adaptive, complex, diverse, exist at many levels, common beliefs and practices, provides identity
Ethnicity
Members share a common social and cultural
heritage. May include race, but not the same as race.
Race
Based on biological similarities. Strictly related to
biology such as skin color, blood type, or bone
structure. Page 313 gives examples.
Religion
Ordered system of beliefs
Ethnocentrism
Tendency to think your own group (cultural,
professional, ethnic, or social) is superior to
others and to view behaviors and beliefs that
differ greatly from your own as somehow wrong,
strange, or unenlightened. Exist in all groups, not just the majority group.
Health care disparities
Health Care Disparities; differences in patient access to or availability of appropriate health care services, especially older adults, ethnic minorities, LGBTQ
Culture universals vs culture specifics
Are values, beliefs, and practices that people from all cultures share vs values, beliefs, and
practices that are special or unique to a culture.
Archetype vs sterotype
Archetypes are something recurrent, based
on facts. Stereotypes are widely held but oversimplified
beliefs that have no basis in fact.
Nursing as a Subculture
Nursing is the largest subculture in health-
care culture. Nursing values include; silent suffering as a response to pain, caring, nursing autonomy, use of nursing process, knowledge, critical thinking
Unconscious incompetence –
not being aware you lack knowledge about another culture
Conscious incompetence-
being aware you lack knowledge about another culture
Conscious competence –
learning about the client’s culture, verifying generalizations about the culture, and
providing culture specific interventions
Unconscious competence –
automatically providing culturally congruent care to clients of divers cultures
Barriers to culturally competent care
Bias, ethnocentrism, cultural stereotypes, prejudice, discrimination, racism, sexism, language barrier, street talk, slang, jargon, lack of knowledge, emotional responses, self-knowledge
BALI acronym
Be aware of own cultural heritage
Appreciate that the client is unique; influenced, but not defined by his culture
Learn about the client’s cultural group
Incorporate the client’s cultural values/behaviors
into the care plan
LIVE and LEARN acronym
Like
Inquire
Visit
Experience
Listen
Evaluate
Acknowledge
Recommend
Negotiate
Culturally and Linguistically Appropriate Services Standards
Healthcare facilities must provide language
assistance services such as bilingual interpreters, bilingual staff, face to face interpretation by trained person or telephone interpreters. Healthcare interpreters should be used to obtain informed consent and to assist the patent to understand the treatment plan.
Never Events –
serious reportable events
(foreign objects left in patients after surgery,
administering wrong type of blood, falls and
trauma, infections from urinary and IV catheters,
DVT)
