1020 Module 5 Session 1 PDF

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GU Assessment 5Mode of Voiding Dialysis Color Characteristic ● Clear? ● Cloudy? ● Sediment? Odor- will only have odor if pt. is dehydrated or has an infection Continence- ability to control movements of the bowels and bladder Male, check penis and scrotum - Breast Exam - Testicular Exam Abdominal Assessment Ascites-abnormal buildup of fluid in the abdomen Borborygmos - hyperactive bowel sounds Contour-describes the nutritional state (normally ranges from flat to rounded) Protuberant-protruding; bulging Hypo/Hyper Enema - Types Cystoscopy - scope of the bladder Bladder Scan - independent intervention Bowel Sounds present in all 4 quadrants - Normoactive - Hyperactive - Hypoactive - Abdomen soft, nontender, nondistended, with bowel sounds in all 4 quadrants UTI Foley Cath - high incidence of infection - Patient should urinate within 8 hours of removal Do not forget to… 1. check bilaterally 2. C + S resistance 3. symmetry

**Know vocabulary for test**

Group 1: Concept 57 Concept of Health Care Policy (Describe the Scope and Standards of Professional Nursing Practice) ● ● ● ●

Licensing and regulation of health professionals, including nurses, are the responsibility of state governments. Regulatory boards establish the scope of licensed practice and minimum standards for professional performance under that license. Professional practice errors that violate provisions of the practice act are subject to disciplinary action through established disciplinary procedures. Boards have the authority to revoke license for unsafe practice or for behaviors that lie outside the scope of practice established by the license.

There are health policies that govern professional negligence and malpractice. This occurs when a nurse acts unethically, demonstrates deficient skills or fails to meet standards of care required for safe practice. The policies are determined by the state board of nursing, professional societies or state courts. Engagement and Advocacy- Nurses are “street-level” workers who have the potential to greatly impact the implementation of policy at the bedside as well as in the community. Nurses are in a unique and pivotal position to impact the cost/quality/access equation through advocacy. In another example, nurses can advocate for nurse-managed centers to be eligible for Federally Qualified Health Clinic (FQHC) status. This is done for increased access to healthcare with affordable costs.

Group 2: Define and describe concepts of ethics Ethics - The main concepts in nursing ethics are accountability, advocacy, autonomy, beneficence, confidentiality, fidelity, justice, nonmaleficence, responsibility, and veracity. Moral principles governs Ethics = right vs. wrong Ethics is the foundation for morality Involves critical thought and action Nursing code of ethics - Strong statement of obligation and student nurses are held to the same standard Ethic committees: important in the health community Societal - serves the larger community, norm basis for behavior Organizational -principles and values that members follow Bioethics/clinical - science, technology, health policy Professional - standards and expectations of a profession Personal - individual basis * Deontology vs Utilitarianism 1. Judgements based on rightness or wrongness of individual behaviors, duties, and obligations without concern for the consequences of specific actions. 2. Judgements that are right or wrong solely on the basis of their consequences * Beneficence vs Nonmaleficence 1. Actively doing good - placing others before your own - advocating - setting up an IV even though you know it will hurt because it does good 2. The avoidance of harm - weighing the costs of side effects of a drug trial * Malpractice vs Negligence 1. Professional role fails to meet standards of care required for safe practice, unethical Ex. providing med to a patient that is allergic, Sexual interaction with patient 2. Creating a risk of harm to others by failing to do something that a reasonable person would ordinarily do or doing something that a reasonable person would ordinarily not do constitutes negligence. Duty, dereliction, damages, and direct cause, Harder to prove than malpractice due to the 4 D’s of negligence. a. Ex. not cleaning a spill * Battery vs Assault 1. Actual physical harm caused to another person a. Ex. touching without consent 2. A threat of bodily harm or violence caused by a demonstration of force by the perpetrator, feeling of imminent harm (often leads to battery) a. Ex. if you don’t finish your breakfast, I'll make you stay in the chair all day

b. Threatening the patient if you don’t take the pill I’ll spank you * Slander vs Libel 1. Spoken information that is untrue that jeopardizes that person's reputation. 2. Written information that is untrue that can jeopardize that person's reputation. Group 3 Fidelity- Keeping promises or agreements which is important for building trust Example: A nurse agrees to bring the analgesic medication after the patient verbally stated that he was experiencing pain rating a 9/10. Justice- Acting fairly, every patient treated impartially Example: A nurse who holds every dying patient’s hand no matter what race or religion they are Veracity- Honesty and truthfulness promotes a strong nurse-patient relationship. Promotes integrity. Ex: A patient diagnosed with an STD is told privately to protect their dignity and build trust even if family doesn’t want them to. Autonomy- Nurses can make independent health care decisions. Ex: A nurse gets a patient more pillows without orders and tells the patient the goals, plans, and any other things that the patient requests. Accountability- accept responsibility for one’s actions without being questioned. Accountability is being honest and initiates the best nursing practices. ex: A nurse reports errors and takes responsibility to ensure patients safety regardless of consequences. Advocacy* - speaking up for your patient

Group 4

Obj 1: Define and describe the concept of Health Policy. ● Government decided public policy that supports health-related goals and priorities. ● Goal-directed decision making. Obj 2: Identify the process of health policy development. ● Created by federal and state legislative bodies. Government institutions decide, implement, and regulate policies.

Obj 3: Discuss the application of health policy in nursing practice. ● Nurses are particularly instrumental in the agenda setting phase by helping to frame the health issue at hand. ● After a health policy law has been implemented on the federal level, it is the individual state’s responsibility to set the scope of practice. ● Regulates nursing license (State board of Nursing) ● Establishes standards of care for legal nursing practice. ● Keeps current with EBP Examples: ADA (Americans with Disabilities Act of 1990), Medicare (65+, disabled, end stage renal disease, federal program), Medicaid (based on income, federal funded but state disperses (runs) ), Workers Comp (state program), Cobra (state program)

Group 5 Objective 4. Define and describe the concept of health care law. Objective 5. Explore theoretical perspectives of health care law. Objective 6. Discuss the application of health care law to nursing and health care. Definition: Health care law is the collection of laws that have direct impact on the delivery of health care or on the relationships among those in the business of health care or between the providers and recipient of health care. Health law when it comes to nursing and health care: Administration and regulation- the USDHHS is the federal government's principal agency which include 11 divisions (examples: CDC, USFDA) -licensing and scope of practice- state licensing laws grant health care professionals permission to provide care. Licensure laws a.k.a practice acts create regulatory bodies such as the State Board of Nursing. Licensing of health care institutions. Theoretical Perspectives Deontology – an ethical theory that stresses the rightness or wrongness of individual behaviors, duties, and obligations without concern for the consequences of specific actions This theory serves as the foundation of most professional codes of ethics, including the Code of Ethics for Nurses. Meeting the needs of the patients while maintaining their right to privacy, confidentiality, autonomy, and dignity is consistent with the tenets of deontology Utilitarianism- views actions as neither right nor wrong without knowing how they benefit the greater good or society. Advocates of utilitarian thought tend to be highly concerned with social justice while exhibiting resistance to rules and regulations. EX: a cancer patient may be asked to participate in the trial of a new chemotherapy regimen. Although society may benefit from information gained during the drug trial, the patient undergoing treatment may react violently to the medication and become more ill. In this case, which action is best?

Group 6 Define and give examples of the following terms: the 3 Advanced directives 1. Durable Power of Attorney- a legal document that allows a designated person to make legal decisions on behalf of an individual unable or not permitted to make legal decisions independently. It sets limits on the powers of the person designated as having power of attorney and is not limited to matters related to medical care. Spouses, domestic partners, and attorneys are the most common people to be granted power of attorney. Stays in place even if you become impaired for any reason

2. Living Will- specifies  the treatment a person wants to receive when he or she is unconscious or no longer capable of making decisions independently. Specifications in a living will may address end-of-life care and the circumstances under which treatment should be withheld or stopped. Mentally sound. A living will may indicate when a person wants to have extraordinary measures, such as cardiopulmonary resuscitation (CPR) or ventilator treatment, terminated. Preferences regarding organ donation, performance of an autopsy, and a designated spokesperson also may be specified in a living will. What you want to happen to you if you cannot speak.

3. Health Care Proxy- The specific durable power of attorney for medical care is called a health care proxy. This is the person who can make healthcare decisions for an individual who is unable to comprehend information or communicate his or her w  ishes.

4. Informed Consent- is permission given by a patient after discussing each of the following topics with the physician, surgeon, or advanced practice nurse who will perform the surgery or procedure: (1) exact details of the treatment, (2) necessity of the treatment, (3) all known benefits and risks involved, (4) available alternatives, and (5) risks of treatment refusal. By witnessing a patient's signing of an informed consent the nurse verifies that the patient is mentally competent. Patients who are mentally incompetent or are under the influence of alcohol or drugs are not legally permitted to give informed consent due to their inability to comprehend the required information. 5. Civility - treat others as you want to be treated 6. Self Determination Act - providers provide info so patients can make decisions based on all available information

Group 7 ( crimes: definitions from study guide) Assault- a threat of bodily harm or violence caused by a demonstration of force by the perpetrator. You have a feeling of imminent harm. Ex. threatening by saying to a patient if you don’t take this pill, I’m gonna spank you Battery- actual physical harm caused to another person Ex. if you perform a procedure on a patient that didn’t want/consent to it Negligence-Creating a risk of harm to others by failing to do something that a reasonable person would ordinarily do or doing something that a reasonable person would ordinarily not do constitutes n  egligence. For instance, if water is spilled on a hospital corridor floor, a reasonable person would recognize it as a potential fall hazard, seek to alert others to its presence, and have it cleaned up as quickly as possible. Malpractice- is negligence committed by a person functioning in a professional role. Malpractice may occur when a professional (such as a nurse) acts unethically, demonstrates deficient skills, or fails to meet standards of care required for safe practice. Examples of these types of malpractice include engaging in sexual activity with a patient; calculating medication dosages inaccurately, resulting in a patient's drug overdose; and administering penicillin to a patient with a documented penicillin allergy, resulting in the patient's death from a severe allergic (anaphylactic) reaction. Slander: Considered oral defamation of character. Categorized as an intentional tort (wrongs committed by individuals who deliberately seek to injure or hurt another person). Ultimately committing slander is failing to act responsibly. Slander is intentionally speaking(orally) untrue information that can lead to jeopardizing someone's reputation. Someone who has committed slander may be charged by civil law. Libel: Considered written defamation of character. Also categorized as an intentional tort. Announcing or even reading statements out loud that are intentionally done to hurt someone's reputation. If someone is guilty of libel they can also be charged by civil law.

Group 1: 1. Good Samaritan Law- Good Samaritan laws protect healthcare professionals who provide assistance to accident victims while maintaining standards of care. It ensures that fear of legal repercussions doesn’t stop someone from trying to help in an emergency. Protects from charges of negligence in emergency care 2. Federal laws- created by the federal government, and based on the constitution to draft federal health care laws. The federal government is the government that runs the entirety of the country, rather than governments at a smaller level such as state, province, or city. Impacts nursing indirectly -Emergency Medical Treatment and Labor Act (EMTALA) -Health Insurance Portability and Accountability Act (HIPAA) -American Disability Act (ADA) Know definition of federal, statutory and regulatory law Group 2: Statutory Laws ● Created by legislative bodies such as the U.S. Congress and state legislatures. ● Referred to as statutes ● Should be consistent with federal laws ● Example: NPA (nursing practice act), Social Security Act, Patient Self-Determination Act, HIPAA, Patient Protection and Affordable Care Act, Controlled Substance Act Regulatory Laws - State legislatures give authority to administrative bodies, such as state boards of nursing, to establish regulatory law, consistent with the nurse practice act. - Healthcare Quality Improvement Act, Medicare, Medicaid, CHIP, Hospital Readmissions Reduction Program, Patient Safety and Quality Improvement act Group 3: Code of Ethics- This guides decisions for practice and conduct. Nurses use ANA Code of Ethics for Nurses which calls for all nurses and nursing organizations to advocate for the protection of human rights and social justice. HIPAA- Health Insurance Portability and Accountability Act of 1996. To protect a patient's privacy and private information.

accessibility aspect- shares protected health information for those who need it and limits access to individuals or agencies who are after prejudice or monetary gain. portability section- prevents individuals who have health care through an employer for at least 12 months from losing coverage during a job change Privacy and confidentiality- two expectations of HIPAA most relevant to nursing practice enables an individual to control the sharing of personal information and the individual can grant specific permission. A patient is asked to identify a code word that the patient's family member or friend must share with the nurse before receiving any information on the patient's condition from the nurse.

Group 4: OBRA ( think Nursing home / Restraints) - Omnibus Reconciliation Act (AKA Nursing Home Reform Act); federally mandated standards that mandate how nursing home residents should be cared for. Dramatically improved the quality of care in a nursing home. - Guidelines for restraint use - chemical or physical restraint COBRA- Consolidated Omnibus Budget Reconciliation Act; the option for a person to continue healthcare coverage if the person loses their job or their hours get reduced to where they no longer qualify for insurance through their job. (has to be offered to you) Typically offered for 1 year.

Group 5: 1. ADA (Americans With Disabilities Act) ● Provides protection against discrimination for individuals who have a physical or mental impairment that interferes with one or several life activities, have a history of impairment, or are perceived as having a disability. 2. EMTALA (Emergency Medical Treatment and Active Labor Act) ● The policy underlying EMTALA is that hospitals that have emergency departments have a duty to care for those requiring emergency medical services irrespective of patients' ability to pay. ● Any Medicare-participating hospital that offers emergency services must provide an appropriate medical screening exam to any person who presents for treatment of an emergency medical condition and must stabilize any emergency  medical condition before transfer to another facility.

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At the patient's request, or if the hospital is unable to stabilize the patient's condition, the hospital can arrange for transfer to appropriate level of care.

3. QSEN (KSA) Quality and Safety Education for Nurses A national initiative to assess knowledge, skills, and attitudes (KSA) of nurses Six Core areas for both students and professionals 1 patient-centered care (Ex: collecting information on a patient’s values during the interview) 2 teamwork/collaboration (Ex: requesting input from other members of the healthcare team) 3 EBP- evidence based practice 4 Quality improvement 5 Safety 6 Informatics Group 6: Self Determination Act: is a federal law. Requires health care providers to supply all patients with written information regarding their rights to make their own informed medical decisions. That is done through advance directives. There are 3 examples: (1) living will, (2) durable power of attorney, and (3) health care proxy, commonly referred to as a durable power of attorney for health care. Affordable Care Act (ObamaCare): a health care reform law designed to extend health insurance to millions of uninsured Americans. Prevents insurance companies from denying coverage for pre-existing conditions require plans to cover a host of essential health benefits. You qualify if your total income is between 100 percent and 400 percent of the poverty threshold. Group 7: 13. Healthy People 2020: Publication describing a national movement that addresses the priorities of prevention and public health in the United States. It reiterates the 3 A’s (accurate, accessible, and actionable) of health information identified in the National Action Plan to Improve Health Literacy.

14. Mental Health Parity & Addiction Equity Act: states that if mental health or substance

abuse care is covered by a private insurance plan, then these conditions must receive coverage equitable to other physical medical conditions. Falls under Federal law

**Test Review** Ethics Vocabulary Policy and Procedure EBP, Keep up with laws difference between felony and misdemeanor Against Medical Advice Documentation - after doing, meds check prior to giving document after COBRA HIPAA EMTALA OBRA PPE - droplet isolation, contact isolation *Ch. 26 in Yoost Nursing Diagnosis - PES, PE Health (Wellness) Promotion Bowel sounds every 20-25 seconds, may take up to 30 seconds for normoactive GU - distended bladder, percuss and palpate midline to suprapubic Elderly systems decrease Spleen LUQ - if its injured you don’t want to palpate because it could cause rupture Difference between obese, herniated, scaphoid, protuberant, flat, convex, concave, and bulging Communication and collaboration - module...