Final Exam Study Guide - Summary Foundations of Nursing Practice PDF

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Final Exam Study Guide - summary of the entire course ...

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Nursing Past and Present 1 -Explain how nursing practice is regulated. ★ Nurse Practice Acts-- each state has a nurse practice act, implemented and governed by state board of nursing ○ Establishes criteria for the education and licensure of nurses ★ State Board of Nursing-- state government officials have some say in how you practice; big difference for advanced practice nursing ○ Directly responsible for regulating the practice of nursing in each state ★ Standard of Practice-- set by American Nurses Association (professional nursing association for RNs) 2- Name and recognize the four purposes of nursing care and the various types of nursing roles. ★ Promote Health-- educate patients on nutrition, exercise, washing hands, wearing a seatbelt ★ Prevent Illness-- Vaccinations, annual physicals, testing/screening for illnesses, providing vitamin supplementation ★ Restore Health-- provide antibiotics, rehabilitation services, wound care, dialysis, proper nutrition, physical therapy ★ Facilitate Coping With Disability or Death-- mental health discussion, palliative care, physical therapy ★ Interrelated Roles of Nurses-- caregiver, advocate, communicator, leader, researcher, collaborator, educator 1- Describe Benner’s Skill Acquisition Model for Clinical Competency. ★ Four Competencies ○ Cognitive-- Think quickly, intelligence, knowledge, critical thinking (apply information) ○ Technical-- Use correct technique for procedure ○ Interpersonal-- Active listening, therapeutic communication ○ Ethical/Legal-- Patient confidentiality, remain within scope of practice, legal competencies for end of life care ★ Stages of Nursing Clinical Competence ○ Stage 1: Novice (follows all procedures, black and white view of care) ○ Stage 2: Advanced Beginner ○ Stage 3: Competent ○ Stage 4: Proficient ○ Stage 5: Expert (makes decisions quickly, doesn’t need to stop and think about procedures) 2- Describe the health care delivery system in the US, including sites for care, types of workers, regulation, and financing of healthcare.

★ Education Preparation ○ BSN and ABSN-- preferred ○ Associate Degree-- shorter than BSN, community college ○ Licensed Practice Nurse (LPN) or Licensed Vocational Nurse (LVN)-- education more related to bedside nurse, able to give medication if pharmacology course taken, cannot assess patient ○ Diploma-- students live in hospital and trained while providing care, learning associated with a hospital, less than 4% of nursing workforce ○ Advanced Practice Nurse/Nurse Practitioner ○ Doctoral Program ★ Health Care Delivery System ○ Hospitals ○ Extended Care Facilities ○ Ambulatory Care Facilities ○ Home Healthcare Agencies ○ Rehabilitation Centers ○ Community or Public Health Centers ○ Assisted Living Facilities ○ Workplace ★ Financing Healthcare ○ Individual ○ Individual Private Insurance ○ Employment Based Private Insurance (another major financing) ○ Government (Majority)-- Medicare, Medicaid ○ Charitable Organizations ★ Healthcare Team ○ Physicians (MDs or DOs) ○ Advanced Practice Nurses ○ Physical Assistants ○ RN/LPN ○ Nursing Assistive Personnel ○ Pharmacists ○ Therapists-- respiratory, physical ○ Chaplains 1- Delineate the forces and trends affecting contemporary nursing practice. ★ Changing Demographics and Increasing Diversity ★ Technological Explosion ★ Globalization of the World’s Economy and Society ★ Era of the Educated Consumer, Alternative Therapies and Genomics, and Palliative Care

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Cost of HealthCare and Challenge of Managed Care Impact of Health Policy and Regulation Growing Need for Interdisciplinary Education for Collaborative Practice Current Nursing SHortage/Opportunities for Lifelong Learning and Workforce Development ★ Significant Advances in Nursing Science and Research 1- Discuss how Florence Nightingale influenced nursing and health care. ★ Improved the welfare of hospital system by taking a group of nurses to Crimean war; learned about the importance of sanitation and its impact on illness (sanitation eliminates cholera) ★ Identified personal needs of patients and role of nursing in meeting them ★ Established standards for hospital management ★ Established nursing education and nursing as a respected occupation for women ★ Recognized two components of nursing: health and illness ★ Believed that nursing is separate and distinct from medicine ★ Recognized that nutrition is important to health ★ Instituted occupational and recreational therapy for sick people ★ Stressed the need for continuing education for nurses ★ Maintained accurate records, recognized as beginnings of nursing research Safety and Healthcare 1-List the three leading causes of accidental death in the United States. ★ Unintentional Poisoning ★ Unintentional Motor Vehicle Traffic ★ Unintentional Fall 1- Identify factors that affect safety in a person’s environment. ★ Lifestyle-- Sexual activity, nutrition, alcohol, drugs ★ Cognition ★ Sensoriperceptual Status ★ Ability to Communicate ★ Mobility Status ★ Physical and Emotional Health ★ Safety Awareness 2- Identify patients at risk for injury. ★ Patients with: ○ Poor vision ○ Cognitive impairment ○ Difficulty with walking or balance ○ Orthostatic hypotension

○ Weakness or dizziness from disease or therapy ○ Drowsiness from medications 4- Describe specific safety risk factors for each developmental stage. ★ Infants/Toddlers ○ Cannot recognize danger ○ Tactile exploration of environment ○ Totally dependent ○ Lack musculoskeletal and neurological maturity ○ Lack of clear method of communication ○ Limited ability to adjust bodily needs ○ Lack proper immunity against infections ★ Preschoolers ○ Play extends outdoors ○ More adventurous ○ Better coordination ★ School Age Children ○ Physiological maturity almost complete ○ Responses are flexible ○ New activities without practice ○ More time outside home with opportunity for independent action ○ Strangers ★ Adolescents ○ Physiologically mature ○ Can communicate verbally very well ○ Most lack adult judgement ○ False confidence, feel indestructible ○ Experimentation common ○ Risk taking behaviors, gang violence, self image ★ Adults ○ May be exposed to injury in workplace ○ Lifestyle choices impact health ○ Some decline in strength and stamina, others maintain fitness ★ Older Adults ○ Lose muscle strength, joint mobility ○ Slowing reflexes ○ Sensory losses ○ Forgetfulness 2- Describe health-teaching interventions to promote safety for each developmental stage. ★ Infants/Toddlers

○ Newborns must sleep on back, not strong enough to move head to side when on tummy and can suffocate → swaddle babies ○ Cover outlets and edges of tables ○ Safety locks for cabinets and toilets; safety gates on stairs ○ Constant supervision ○ Fence around pool ★ Preschoolers ○ ★ School Age Children ○ Stranger dangers-- teach children about specific situations, don’t answer door, different levels of authority, tell parents if feel uncomfortable ○ Don't allow children to wander off, walk in groups ○ Wear helmets and protective gear, seatbelt safety ★ Adolescents ○ Online safety ○ Safe sex, alcohol and drug safety ○ Mental health, monitor and acknowledge changes in mood or behavior ★ Adults ○ Workplace safety ○ Sleep, adults need about 8 hours ★ Older Adults ○ Prevent falls 4- Describe strategies to decrease the risk for injury in the home. ★ Prevention of Poisoning (leading cause of unintentional death) ○ Cabinet locks with poisons inside, have poison control number available at all times ★ Prevention of Scalds and Burns ○ Guardrails by fireplace, turning pot handles in, care with candles, sunscreen, care when warming food ★ Prevention of Fires ○ Smoke alarms, caution with cigarettes, fire extinguisher, no candles unattended, safety with holiday lights, care with electrical cords ★ Prevention of Firearm Injuries ○ Gun safety as soon as comfortable (especially with guns in home), ammunition separate from gun, never have a loaded gun ★ Prevention of Suffocation/Asphyxiation ○ Watch for small and removable parts, cut food into tiny pieces, pay attention to mobiles, strings, cords, plastic bags, apply barrier to pool, know heimlich maneuver

4- Describe nursing interventions to prevent injury to patients in the health care setting. ★ Hospital Acquired Condition Reduction Program ○ Performance across these 5 healthcare-acquired infections: ■ Central Line-Associated Bloodstream Infection (CLABSI) measure ■ Catheter-Associated Urinary Tract Infections (CAUTI) ■ Surgical Site Infection (Colon Surgery and Abdominal Hysterectomy) ■ Methicillin-Resistant Staphylococcus Aureus (MRSA) ■ Clostridium Difficile (C. diff) ★ Prevention ○ Barcoding Medications ■ Scan patient bar code number to ensure giving patient correct medication ○ Scan body to check if stuff inside ○ Surgeon must go to patient and physically mark the extremity getting surgery, time out: all stand together and confirm the surgery before continuing ★ Preventing falls ○ Risk assessment ○ Orientation to surroundings ○ Night light ○ Eliminate clutter ★ Preventing fires ○ Ban smoking ○ Know the fire plan ○ First priority is patient 1- Identify alternatives to using restraints. ★ Do not use restraints unless last resort; can cause circulatory problems, must provide skin care; must have physician order and reauthorized every 24 hours ★ Alarm system ★ Placing follows, large plants, furniture ★ Ask family to supervise patient, ★ Floor mats on each side of bed 4- Define function/purpose of Joint Commission (JCAHO); define sentinel event; identify patient safety goals; describe root cause analysis. ★ Joint Commission (JCAHO) ○ Develops standards and evaluates compliance of HCOs against these benchmarks ○ Accredits nearly 16,000 hospitals and programs in the US ○ Independent, nonprofit organization ○ Mission: Improve the safety and quality of care provided to the public through the provision of health care accreditation. ★ Root Cause Analysis for Sentinel Events ○ Sentinel Event: event that never should have occurred and is life threatening (ex: patient undergoes amputation to the wrong leg)

○ Review how the event occurred and what needs to be done next time to prevent ★ Examples of Never Events ○ Stage III and IV pressure ulcers ○ Falls and Trauma ○ Surgical Site infection ○ Catheter associated urinary tract infection ○ Administration of incompatible blood ○ Air embolism ○ Foreign object in the patient’s body after surgery ★ Patient Safety Goals ○ Goal 1. Identify patients correctly. ○ Goal 2. Improve staff communication. ○ Goal 3. Use medicines safely. ○ Goal 6. Use alarms safely. ○ Goal 7. Prevent hospital acquired infection. ○ Goal 15. Identify patient safety risks (specifically, suicide risk). ○ *UP 1. Prevent mistakes in surgery. Infection Prevention and Control 2- Explain the six links in the chain of infection. ★ Infectious Agent ○ Normal Flora: may become pathogenic ○ Transient Flora: normal microbes that a person picks up by coming into contact with objects or another person (ex: touch soiled dressing). Can remove with hand washing ○ Resident Flora: live deep in skin layers where they live and multiply harmlessly; permanent inhabitants and can’t be removed with hand washing; not harmful unless enter deep tissues (open wound) or vulnerable to disease ○ Pathogens ■ Bacteria: most commonly observes, shape, gram negative vs positive, aerobic vs anaerobic ■ Virus: smallest, antibiotics have no effect on viruses, antiviral meds can shorten full stage of illness ■ Fungi: plant like organisms, present in air, soil, and water ■ Parasites: live on or in a host and rely on it for nourishment ★ Reservoir ○ A place where pathogens survive and multiply ○ Most pathogens flourish in a warm, moist, dark environment. This is why the human body is the most common reservoir for pathogens.

○ Others can act as a reservoir but not exhibit manifestations of disease (ex: HIV) ○ Other reservoirs: animals, birds, mosquitoes/insects, soil, water, food, ○ Environment for Reservoir: moisture, need nutrients (salmonella), darkness, warmth (95º), some need oxygen, pH balance (5-8) and electrolytes ★ Portal of Exit ○ Body Fluids ■ Coughing, sneezing, diarrhea ■ Seeping wounds ○ Non Intact Skin ■ Seeping wounds ■ Tubes, IV lines ○ In the case of human or animal reservoirs, the most frequent portal of exit is through body fluids, including blood, mucus, saliva, breast milk, urine, feces, vomitus, semen, or other secretions ★ Mode of Transmission ○ Direct Contact ■ Touching, kissing, sexual contact ○ Indirect Contact ■ Contact with a fomite (clothes, utensils, furniture) ○ Droplet ■ Cough, sneeze ○ Airborne ■ Via air conditioning, sweeping ○ Vector ★ Portal of Entry ○ Normal body openings: Mouth, Eye, etc ○ Abnormal body openings: Wounds ○ Bites or stings ○ Tubes, needles ○ In healthcare settings, common portals of entry include wounds, surgical sites, and insertion sites for tubes or needles ★ Susceptible Host ○ Age, chronic illness, a lot of antibiotics, young children, immune deficiency ○ Four determining factors ■ Virulence-- how strong organism is ■ Organism’s ability to survive in the host’s environment ■ Number of organisms ■ Host’s defenses 1- List the stages of a typical infectious process. ★ Incubation-- from the time of infection until manifestations of symptoms, can infect others, patient may not know they are infected ★ Prodrome: appearance of vague symptoms, not all diseases have this stage ★ Full illness: signs and symptoms present, may end in death ★ Decline: number of pathogens decline, signs and symptoms begin to fade

★ Convalescence: tissue repair, return to health 1- Identify patients at increased risk for infection. ★ Developmental stage ★ Breaks in first line defense ★ illness/injury ★ Tobacco use ★ Substance abuse ★ Multiple sex partners ★ Environmental factors ★ Chronic disease ★ Medications ★ Nursing/medical procedures 1-Describe nursing interventions to break the chain of infection. ★ Reduce exposure to pathogens by using aseptic technique ★ Maintain skin integrity and support natural defenses against infection ★ Reduce stress ★ Promote immune function through immunization, healthy diet and activity, sleep and lifestyle ★ Provide supportive measures to decrease the length and time that a patient needs invasive devices, such as IV line and urinary catheters ★ Specific nursing activities ★ Teaching infection prevention 7- Implement CDC guidelines for standard and transmission based precautions, to include: contact, droplet, or airborne disease transmission. ★ Standard Precautions: ○ Protects healthcare workers from exposure ○ Decreases transmission of pathogens ○ Protects clients from pathogens carried by healthcare workers ★ Contact Precautions: ○ Pathogen spread by direct contact ○ Possible private room ○ Clean gown and glove use ○ Disposal of contaminated items in room ○ Double bag linen and mark ★ Droplet Precautions: ○ Spread via moist droplets (ex: pneumonia, influenza, whooping cough, bacterial meningitis) ○ Coughing, sneezing, touching contaminated objects ○ Same as those for contact with addition of mask and eye protection within 3 feet of client

★ Airborne Precautions: ○ Spread through air currents, ventilation systems, shaking sheets, sweeping (Tuberculosis, chicken pox, measles) ○ Same as contact with addition of negative pressure room and N95 mask 1- Describe the difference between medical and surgical asepsis. Identify when to use each. ★ Medical Asepsis ○ Absence of contamination by disease causing microorganisms, procedures that decrease the potential for the spread of infections ○ “A state of cleanliness that decreases the potential for the spread of infections” ○ Promoted through: ■ Maintaining clean environment ■ Maintaining clean hands ■ Follow guidelines from CDC ■ Creating a protective environment in some situations ■ Controlling contaminated supplies ★ Surgical Asepsis ○ Creation of sterile environment and use of sterile equipment ○ Environmental services personnel perform throughout cleaning using special solutions and procedures to create sterile area ○ All personnel must wear appropriate surgical attire and perform a surgical hand scrub ○ Promoted through: ■ Creation of sterile environment ■ Use of sterile equipment/supplies ■ Sterilization of reusable supplies ■ Surgical hand scrub ■ Surgical attire ■ Sterile gloves ■ Sterile field ■ Use of sterile technique ★ Difference ○ Surgical asepsis is more complex and not necessary for all patients ★ Basic Principles of Surgical Asepsis ○ Allow only a sterile object to touch another sterile object. Unsterile touching sterile means contamination has occurred. ○ Open sterile packages so that the first edge of the wrapper is directed away from the worker to avoid the possibility of a sterile surface touching unsterile clothing. The outside of the sterile package is considered contaminated. Avoid spilling any solution on a cloth or paper used as a field for a sterile setup. The moisture

penetrates through the sterile cloth or paper and carries organisms by capillary action to contaminate the field. A wet field is considered contaminated if the surface immediately below it is not sterile. ○ Hold sterile objects above the level of the waist. This will ensure keeping the object within sight and preventing accidental contamination. ○ Avoid talking, coughing, sneezing, or reaching over a sterile field or object. This helps to prevent contamination by droplets from the nose and the mouth or by particles dropping from the worker’s arm. ○ Never walk away from or turn your back on a sterile field. This prevents possible contamination while the field is out of the worker’s view. ○ Keep all items sterile that are brought into contact with broken skin, or used to penetrate the skin to inject substances into the body or to enter normally sterile body cavities. These items include dressings used to cover surgical incisions, needles for injection, and tubes (catheters) used to drain urine from the bladder. ○ Use dry, sterile forceps when necessary. Forceps soaked in disinfectant are not considered sterile. ○ Consider the edge (outer 1 inch) of a sterile field to be contaminated. ○ Consider an object contaminated if you have any doubt as to its sterility. 2-Define hospital-associated infections; identify patients at risk for HAI. ★ Hospital Associated Infections: an infection acquired as a result of healthcare ★ Nosocomial Infection: more specifically hospital acquired infections ★ Iatrogenic Infection: infection due to a medical treatment ★ Exogenous HAI: need to determine source of pathogens in a patient infected while in facilities, acquired from the healthcare environment ★ Endogenous HAI: pathogen arises from normal flora when some form of treatment causes the normally harmless microbe to multiple and cause infection ○ Ex: yeast infection in client receiving antibiotics after surgery 3- Identify and describe the body’s defenses against infection. ★ Primary Defenses ○ Skin ○ Mucus membrane ○ Respiratory tree ○ Eyes ○ Mouth ○ GI and GU tract ★ Secondary Defenses ○ Phagocytosis ○ Complement cascade ○ Inflammation ○ Fever (only treat 102 F and above) ★ Tertiary Immunity

○ Active Immunity ■ Natural Active: body makes its own antibiotics ■ Artificial active: weakened or dead virus vaccine ○ Passive Immunity ■ Passes from one body to another ■ Natural passive: mother to baby ■ Artificial Passive: serum from person with antibodies to person without ○ Specific Immunity ■ Process by which the body’s immune cells learn to recognize and destroy pathogens they have encountered before Communication - 8 1-Describe the communication process between sender and receiver; include all five elements. 1-List the characteristics of verbal and nonverbal communication. ★ Verbal ★ Nonverbal ○ Facial expressions, touch, eye contact ○ Posture, gait, gestures ○ General physical appearance ○ Mode of dress and grooming ○ Sounds, silence 1-Analyze factors that influence the communication process. ★ Verbal ○ Factors that influence communication ■ Vocabulary/terminology ■ Literal/implied meanings ■ Pace of speech ■ Tone of voice ■ Clarity ■ Timing ■ Credibility ■ Humor ■ Language ★ Nonverbal ○ Factors that influence communication ■ Facial expression: Communicates feelings behind a message ■ Posture and gait: Clue...