501 Final - Lecture notes 1-14 PDF

Preview

Summary

NSG 501 Final Lecture Notes...

Description

infection control, safety, prioritization, airway and oxygenation, awareness of personal biases, and rationales for nursing actions/skills. Week 1: · Nursing process (threaded) 5-6 questions ● Assessment, Diagnosis, Plan, Implement, Evaluation ● ADPIE is continuous until clients health is improved, restored, or maintained ● All about the human response ● Must consider patients culture when doing an assessment ● Nursing dx is human response vs medical diagnosis is the disease or condition ● Prioritize based on Maslow’s hierarchy of needs- breathing is the highest priority ○ Physiological, Safety, Love/Belonging, Esteem, Self-Actualization ● SMART goals- specific, measurable, attainable, realistic, timely ● Independent nursing intervention- nurse initiates on their own ● Inter dependent- combine professionals ● Dependent- requires an order ● Tanner’s Model- Notice, Interpret, Respond, Reflect ● Subjective data-what the patient tells you ● Objective- data you observe ● Activities of daily living (ADLs)-Performed in the course of a day, including ambulation, eating, dressing, bathing, and grooming ● Instrumental ADLs (IADLs)-Skills such as shopping, preparing meals, house cleaning, writing checks, and taking medications. ● Physical care techniques–The safe and competent administration of nursing procedures ·

Therapeutic relationship and communication (threaded) 3-5 questions ● Using empathy, timing, silence, listening ● Don’t give false reassurance ● Phases: Pre interaction phase (review data-bias may be established), orientation (set the tone-meeting the patient), working (take action), termination (evaluate goals) ● Most communication is nonverbal ● Active listening is the number 1 technique ● Open ended questions vs closed · Infection control and vital signs 2-3 questions ● Pulses should be 60-100 ● O2 95-100 measure percent of hemoglobin saturated with oxygen ● Respirations 12-20 ● BP: adult 120/80 or < normal ○ Prehypertension 120-139 or 80-89 ○ Stage 1 hypertension 140-159 or 90-99 ○ Stage 2 hypertension 160 or > or 100 or > ● Temperature: 96.8-100.4 ● Blood Glucose: 70-110 mg/dl ● Medical asepsis vs surgical asepsis Week 2: · Patient Centered Care- Safety, hygiene and comfort, activity and mobility, skin integrity, restraints and restraint-free environment, and pain 4-6 questions ● PPE- don: gown, mask, gloves doff: gloves, gown, mask

○ ○ ○

Standard precautions: gloves and gown Transmission based precautions: add mask ■ Contact: CDiff, Mrsa Droplet: Flu Airborne: Tb, Shingles, Chickenpox, Measles, Covid-19 ● Safety first after breathing ● Hand washing is most important technique for preventing infectionst ● ABC’s=awareness, belief in your gut feeling, change what's wrong--individual responsibility ● Take 5- system responsibility ● 4 P’s of intentional rounding=position, pain, personal needs, placement of items ● ISBAR=introduction, situation, background, assessment, recommendation ● Assess pain with PQRSTU- precipitating, quality, region, severity, timing, affect U - use wong baker for kids- every patient has a right to a pain assessment ● Restraints are a last resort limited to 24hrs- observe every 1 hr and nursing care every 2 hrs Week 3: · Spirituality 2-3 questions ● RNs role: Spirituality – help patients identify meaning and purpose and support relationships with others and higher power. ● Spirituality is a broad concept that is unique to the individual, religion is a formal acceptance of values within a community and is based around theistic principles. ● Faith – belief without the physical proof ● Meaning and purpose – found in both positive and negative experiences ● Inner-strength and peace – ability to cope with life challenges and fosters calm, peace and positive feelings despite ● Self-transcendence – positive force greater themselves ● Connectedness – self, others, God ● Religious – help patients maintain faithfulness to beliefs and worship practices ● Examine personal beliefs and identify biases ·Culture 2-3 questions ● Cultural awareness is a self examination and identification of biases as it relates to other cultures ● Cultural humility- critical self reflection- aware unconscious and conscious bias ● Cultural Knowledge – learning key aspects of a groups(s) culture as it relates to health and health care practices. ● 5 social determinants of health- economic stability, education, social and community context, health, neighborhood and environment ● Hispanics have higher rates of teenage pregnancies ● DO NOT use a family member as an interpreter Civility 2-3 questions ● Civility- an authentic respect for others that requires time, presence, willingness to engage in genuine discourse, and intention to seek common ground" that governs both speech and behavior toward others ● Incivility – rude behavior that results in emotional distress ● Bullying – pattern of behavior that aims to intimidate, devalue, diminish and disrespect ● Overt bullying-physical violence, name calling, yelling ● Covert- rumors, gossiping ● Avoidance : lose-lose

● ● ●

●

Accommodation: lose-win Competition: lose/win-lose/win Compromise: lose - lose Collaboration: win-win

Week 4: · Metabolism: Aspiration precautions, NG decompression, bowel elimination 4-6 questions ● Normal BMI 18.5-24.9, obese=>30 ● Fat soluble vitamins-A, D,E, K ● Water soluble B,C ● Water is essential but NOT a nutrient ● Vegans are higher risk for vitamin/protein deficiency ● Preventing aspirations○ pureed, mechanically altered and advanced solid foods ○ Thin, nectar, honey, spoon thick liquids ○ Dysphagia diet- nectar, honey, pudding ○ Small bites, sitting upright, assist ○ No straw ● Bowel elimination ○ Examine abdomen, inspect, auscultate, percuss, palpate ○ Observe stool- patterns, appetite, diet, mobility, pain, exercise, meds ○ Enemas- administered in left side lying sims position, wear gloves- have pulse rate monitor on could have sudden decline in pulse ● Urine ○ Oliguria- low urine ○ Anuria- no urine ○ Polyuria- excessive ○ In a day 800-2000ml/24hrs ○ 30mL/hr or 0.5ml/kg/hr ○ Want to get cath and IV out ASAP ● NG Decompression ○ Small or large tube inserted to stomach through nose ○ Purpose for medications (Small) or decompression (salem sump pump) ○ Use for obstructions, post op ○ Low intermittent suction Week 5: · Oxygenation, ventilation and perfusion 4-6 questions ● Ventilation- moving gas in and out of lungs ● Perfusion- pumping oxygenated blood to tissues ● Diffusion- exchange of gases across alveoli and capillaries ● diagnoses ○ Ineffective breathing pattern-individuals respirations don’t enable adequate ventilation ○ Ineffective peripheral tissue perfusion-decrease in blood circulation to periphery ○ Impaired gas exchange-excess or deficit in O2/CO2 ● Gas exchange is at the alveoli ● S1-lub S2-dub

● ● ● ●

Blocked airways are at the highest priority Sit patient up if they are having trouble breathing Encourage incentive spirometer Face masks ○ Low flow O2 delivery: ■ Simple face mask- short term use ■ Nasal cannula ○ Plastic face mask with reservoir bag- A partial rebreather or nonrebreather mask is a simple mask with a reservoir bag that should be at least one-third to one-half full on inspiration and delivers a flow rate of 10 to 15 L/minute (60-90% oxygen) minimum flow must prevent bag from deflating. ○ High-flow oxygen systems should be humidified. ■ venturi - higher oxygen concentration 24% to 60% and usually requires oxygen flow rates of 4 to 12 L/min ■ Nonrebreather masks ○ Which face mask is the most severe? ■ I think it’s non rebreather mask b/c it at a 60-99% oxygen rate ○ Safety guidelines ■ Pt. with sudden vital sign changes, LOC or behavior might have hypoxia ■ Tracheal suctioning before pharyngeal suctioning ■ Use caution when suctioning pt. With head injury ■ Do not use normal saline into airway before suctioning ■ Check institutional policy before stripping or milking chest tubes ■ Most serious trach. Complication is airway obstruction -> cardiac arrest ■ Patients with COPD who are breathing spontaneously should never receive high levels of O2 therapy Week 6: ·

Sensation and perception 2-4 questions ● Patients tend to revert back native language with dementia ● Some women only want women to exam them ● Do not assume that pt is health literate ● Assessment & evaluation of the LOC and mentation are the most important parts of the neurologic examination. A change in either is usually the first clue to CNS dysfunction. ● Sensory Deficits•A deficit in the normal function of sensory reception or perception. ● •Sensory Deprivation-Occurs when a person receives an inadequate quality or quantity of stimulation (monotonous or meaningless stimuli) ● •Sensory Overload- Multiple sensory stimuli that cannot be perceptually disregarded or selectively ignored ● Decerebrate is most severe posturing- extension of wrists ○ Decorticate → Decerebrate → Flaccid

·

Older adults 2-4 questions ● 4 M-What MATTERS, MEDICATIONS decrease polypharm, Mentation –manage depression, dementia, and delirium, Mobility –function ● Orient older adults and people with visual deficits to the room ● Polypharm is a big issue with the older community ● Hyperopia - farsightedness

● ● ● ● ● ● ● ● ●

Myopia - nearsightedness Xerostoma - dry mouth related to salivary gland function Aphasia - loss of ability to speak Dysphagia - inability to swallow Dysphasia - trouble speaking Ataxia - loss of muscle control Hemiplagia - paralysis of one side Atonic bladder - not empying bladder Analgesia - absent sense of pain

Week 7: · Teaching /learning 1-3 questions ● What things are allowed to be delegated ○ Cannot delegate: meds, formal teaching, enema, removing IV? ○ Can delegate: vitals, linen changes, assisting toileting, assist repositioning, measuring I/O ● Cognitive-acquired knowledge, pt. Will state two ways to prevent an infection ● Psychomotor- acquiring skills (mental and msk), pt. Will demonstrate range of motion ● Affective- deals with expression of feelings, acceptance of attitude, opinion, and values, pt. Will verbalize acceptance of need to stop smoking ● Teach back - pt. Explains back what you just taught → confirms pt. Understanding, and adequate communication on behalf of the nurse. · Care of the surgical patient: pre-op and post-op care, wound care and pressure ulcer care, ostomy care, catheterization and urinary care 10-12 questions ● Urgency- elective, urgent, emergency ○ Elective- pt. Choosing, not necessary for life saving, nose job ○ Urgent-can wait until patient is medically stable ○ Emergency-must be performed without delay ● Safety-have a time out before starting the surgery ● Principles of surgical asepsis- make sure object remains sterile, only sterile objects touch it, no prolonged exposure, edges of field are dirty, must remain in line of vision and above waist, fluid flows in direction of gravity, once an object is wet it is no longer sterile ● How often should you turn the patient?-every 2 hours ● How long can a patient sit in a chair?-2 hours ● Deep tissue pressure injury-purple non blanching area of intact skin due to deep tissue destruction + boggy ● Dehiscence- incision fails to heal and layers separate ● Evisceration- total separation of wound, this is an emergency ● Primary Intention - wound closed ● Secondary Intention - wound slightly open and scar tissue forms “crater” ● Tertiary intention - wound open and will be closed at a later date (2 surgeries) ● Pressure Ulcers stage: ○ 1- intact skin, red, non blanchable ○ 2-like a blister, exposed dermis ○ 3-full thickness loss, fat visible ○ 4-exposed fascia/muscle/bone

○ ○

Unstageable pressure injury- full thickness skin and tissue loss, extent of damage cannot be confirmed due to slough or eschar, wound base cannot be assessed Deep tissue injury- bruise, purple

Week 8: ·

Stress and coping 2-4 questions ● Stress – natural physiologic, psychological and/or spiritual response to the presence of a stressor ● Stressor – internal or external demand or situation that threatens ● Everyone experiences stress at some point ● Stress can help you stay alert, provide motivation and discomfort ● Stress includes work, family, chronic and acute stressors; daily hassles; trauma; and crisis. ● Types of stress○ Acute-time limited that threaten for brief amount of time ○ Chronic-stable conditions and results from stressful roles- living with lifetime illness ○ PTSD- acute stress disorder, may have flashbacks ● Types of crisis-crises is a situation that can’t be resolved with normal methods of coping. Crisis is a response to stress. ○ developmental crises- occurs at life stages- puberty, divorce, childbirth, Adverse Childhood Experiences (ACES) ○ situational crises-external such as job change, MVC, death, severe illness ○ adventitious crises-rare accident/tragedy, earthquake, tornado,plane crash ● ● ●

●

●

●

•PRIORITY INTERVENTION assess if they are SAFE ASSESS LETHALITY ACES=adverse childhood experiences General adaptation syndrome: ○ 3 stages ■ Alarm-fight or flight ■ Resistance-body compensates/stabilizes ■ exhaustion/recovery Transactional model of stress ○ situation/event -> appraisal -> perceived threat or no threat -> if threat perceived you can either cope (positive stress) or not cope (negative stress) Physiological model- fight or flight reaction ○ Increased heart rate, vasoconstriction, increased breathing, increased blood glucose through glycogenolysis, GI decreased How do patients respond and cope with stress○ Meaning based- induce positive emotions ○ Outcomes of coping-emotional well being/functional status ○ Dispositional coping- generalized way of behaving that affects a person’s reaction ○ Optimism ○ Information seeking ○ Monitoring v. avoidance ○ Defensive coping

Week 9: ·

Nursing and Public health 2-3 ● Public health can be measured through-Infant Mortality & Low Birth Weight- US has high infant mortality and low birth weight, HIV, drug related deaths, cardio disease

● ● ● ● ●

·

US spends the most and had the worst outcomes Social and economic factors play a huge role in health outcomes National prevention strategy- healthy people 2030, goal to increase number of americans who are healthy at every stage of life Question to always ask- where did your patient come from and where are they going next Social determinants of health- economics, education, physical environment, healthy behaviors, childhood experiences, employment, income, clinical care, gender, culture, race- there was a test question asking to eliminate the one that was not a social determinant of health

Evidence Based practice/research and the Microsystem 2-4 questions ● PICOT-patient/population, intervention, comparison, outcome - how to write research question ● •Level 1- Systematic Review- A comprehensive review of all published and unpublished quantitative and qualitative data relevant to the clinical question, Meta-Analysis- Subset of systematic review which includes a comprehensive review with statistical analysis.Practice Guidelines- Produced by experts based on a review of the evidence and sets a standard of best practice - usually multi-disciplinary approach, systematically developed guidelines based on the ●

● ● ●

best evidence for patient care. •Level II- Randomized Control Trial- Gold standard for research, Randomly assigns people to an experimental group or a control group, Controls for the influence of variables - only one population should be studied at a time, The only difference is the outcome variable being studied. Macro system- hospital as a whole, IT, transport Meso system- support the microsystem- CT, radiology,OR Micro system- specific unit

Week 10: ·

Information and Documentation 2-3 ● IF IT WASN'T DOCUMENTED IT DID NOT HAPPEN ● Must get permission to break the glass, only sign in on your patient, when you walk away sign out ● DAR-Data, action, response ● Safety event- only objective data, should not assign blame “just culture”, not part of the legal EMR. Harm does not have to occur. These are reported to improve quality. ● Completed by nurse-admission data, physical assessment, ongoing assessments, meds, labs, care plans, acuity ratings, education

·

Quality and safety 2-4 questions ● Joint Commission Safety Goals- id patient correctly, admin meds correctly, improve communication, surgical mistakes, use alarms safely, prevent infection, ID patient risks ● Adverse event- patient safety event that caused harm, CAUTI, pressure injury ● Sentinel event-death/permanent injury to patient- NOT an infection ● No harm event- something wrong was done but doesn’t harm the patient ● Close call- good catch ● Hazardous conditions-increases possibility of harm to patient ● Latent failure is removed from the practitioner; involves decisions affecting organizational policies, procedures, allocation of resources. Ex: meds are mislabelled ● Active failure involves direct patient contact

● ● ● ● ● ●

Organizational system failure is indirect and involves management, organizational culture, protocols/processes, transfer of knowledge, and external factors. Ex: understaffing Technical failure is indirect failure of facilities or external resources. Ex: pump stops working Data is how you measure QI HCAHPS- help understand the patient experience, consumer assessment of healthcare and systems Model of quality improvement- PDSA Cycle- plan, do, study, act EBP is the key to delivering high quality care and ensuring best patient outcomes through research

Week 11: · Medication Administration/Calculations 2-4 questions ● RN is the last line of defense before med given at bedside ● Everything must be correctly ordered on the medication with correct dosage, time, and patient if not ask for order to be completed ● Right drug, dose,route, time, patient, documentation ● Know military times ● The larger the gauge number the smaller the needle is ● Prevent needlesticks ○ Most happen with safety device before disposal ○ Never recap ○ Your safety before patients ○ Eyes on needles all the time ○ Discard in sharps ○ Engage safety device with one hand ● Naming meds ○ Chemical- what’s in it, acetyl-ara-aminophenol ○ General- manufacturer-acetaminophen ○ Trade-tylenol ● How meds move through body- pharmacokinetics ○ Absorption- passage through site- blood, oral is slow, injection is fastest (usually intestine for oral meds) ○ Distribution- how it moves through body ○ Metabolism- after med reaches site of action- usually liver, can accumulate if not metabolized properly ○ Excretion-kidney, liver, lungs, bowels ● 6 rights to medication ○ Right dose ○ Right time ○ Right drug ○ Right patient ○ Right documentation ○ Right route ● Routes ○ Oral- easiest and most common but watch for swallowing problems, never crush a long acting ○ Otic- room temperature, child pull down, adult pull up

○ ○

●

Intraocular- go from inner to outer Injections ■ Intramuscular- 90 degrees, best in, hip/deltoid ■ Subcutaneous- 45 degrees, abdomen/upper thigh/back of arm/ butt ■ Intradermal- 15 degrees, TB test, inner forearm ○ Inhalers- metered dose (helps if pressing and inhaling are not synchronous) with spacers are good for kids ■ Sit straight up, shake for 2-5 seconds before using ■ Must prime if not used within 48 hours ■ Breath in and then depress canister ■ Hold breath for 10 seconds ■ Wait 1 minute between ■ Rise with water after using Med math ○ 1mg=1000 mcg, 1g=1000 mg, 1L=1000mL, 1mL=1cc, 1 kg=2.2 lbs ○ Desired dose/amount on hand X quantity ○ ex) NP ordered 500 mg of IBP for patient and you have .25 g on hand, how many tablets ■ .25 g=250mg, 500 mg/250 mg= 2 tablets

Week 12: · Loss and grief 4-5 questions ● Loss leads to grief ● Grief is a response to intense feelings (loss) ● Kubler-Ross Stages of grief- denial, anger, depression, bargaining, acceptance ● Curative Care → Palliative Care → Hospice Care (a continuum) ● Palliative care- treating symptoms, improve quality of life ● Hospice-end of life care, not...