Module 5 - Review Guide - Exam notes PDF

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Module 5 Study Guide

Topic Review Guide Giddens

Concept 42 Ethics 1. Define and describe the concept of Ethics - Deals with right and wrong - The study or examination of morality through a variety of different approaches. 2. Identify ethical issues in nursing • Protecting patients' rights and human dignity • Respecting/not respecting informed consent to treatment • Providing care with possible risk to the nurse's health • Using/not using physical or chemical restraints • Working with staffing patterns that limit patient access to nursing care Issues that RNs find most disturbing include the following: • Coping with staffing patterns that limit patient access to nursing care • Prolonging the living/dying process with inappropriate measures • Not considering the quality of a patient's life • Implementing managed care policies that threaten quality of care • Working with unethical/impaired colleague Concept 46 Collaboration 1. Define and describe the concept of Collaboration. - The development of partnerships to achieve best possible outcomes that reflect the particular needs of the patient, family, or community, requiring an understanding of what others have to offer. 2. Recognize attributes of collaboration in the nursing profession. (1) Values/ethics (2) Roles/responsibilities (3) Communication (4) Teamwork/Team-based practice 3. Identify ways that collaboration impacts health care - Addressed in the ANA’s Code of Ethics - Nurses encouraged to work together to ensure all relevant parties have a voice in informed decision making and pt care issues.

4. Discuss the purpose of Quality and Safety Education for Nurses (QSEN) - Addresses the need for preparing future nurses with the knowledge, skills, and attitudes (KSA’s), necessary to continuously improve the quality and safety of the healthcare systems in which they work. Concept 57 Concept of Health Care Policy 1. Define and describe the concept of Health Policy -

goal-directed decision making about health that is the result of an authorized, public decision-making process. those actions, nonactions, directions, and/or guidance related to health that are decided by governments or other authorized entities.

2. Describe the Scope and Standards of Professional Nursing Practice - Licensing and regulation of health professionals, including nurses = STATE GOVERNMENTS! KNOW THIS!!!! Concept 58 Concept of Health Care Law 1. Define and describe the concept of Health Law -

the collection of laws that have a 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 recipients of health care. 2. Explain the Emergency Medical Treatment and Active Labor Act (EMTALA) - Merged with Omnibus Act in 1986 - ED’s in Medicare participating hospitals have a duty to care for patients regardless of ability to pay - Nurses must assess first before asking about insurance and treat/stabilize before transportation to another hospital 3. Explain the Health Insurance Portability and Accountability Act (HIPAA) - Enacted in 1996 - Three reasons (1) to provide pts with preexisting conditions access to health insurance specifically if they changed or lost jobs (2) to prevent health cause fraud/abuse and liability reform (3) provide provision for privacy requirements Yoost Chapter 3: Communication 1. Identify and describe types of communication. - Okay I’ve done this for 5 modules and I think I could be given a degree in communication so no I won’t do it again.

Chapter 10: Documentation 1. Identify elements of the SBAR model and describe each element. - Situation – what is going on with the patient NOW? - Background – what got the patient admitted? - Assessment - Recommendation Chapter 11: Ethical and Legal Considerations 1. Define and describe the Concept of Ethics -

A study considering the standards of moral conduct in a society. Influenced by ethics, society, norms, and practices.

2. Compare the following ethical principles or legal issues and give examples of each: * Deontology vs Utilitarianism - Deontology - an ethical theory that stresses the rightness or wrongness of individual behaviors, duties, and obligations without concern for the consequences of specific action. Meeting the needs of patients while maintaining their right to privacy, confidentiality, autonomy, and dignity. - Utilitarianism – OPPOSITE. maintains that behaviors are determined to be right or wrong solely on the basis of their consequences. * Beneficence vs Nonmaleficence -

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Beneficence – “doing good.”  Acting on behalf of others (advocacy)  Priority is needs of others over self Nonmaleficence – “first, do no harm.”  Not necessarily doing good, just avoiding doing harm.  HOSPICE CARE = gray area

* Malpractice vs Negligence - Malpractice - negligence committed by a person functioning in a professional role  Sexual activity with a patient  Calculating dosages incorrectly resulting in pt OD  Giving pt with allergy the medication they’re allergic to (penicillin  anaphylaxis)  4 D’s – Dereliction, Damages, Duty, Direct cause - 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.

* Battery vs Assault - Battery – ACTUAL physical harm caused to another person. Threat is carried out.  Performing surgery without consent  Catheterizing against will - Assault – a threat of bodily harm or violence caused by a demonstration of force * Slander vs Libel - Slander – Oral defamation of character. - Libel – WRITTEN forms of defamation of character. 3. Define each of the following ethical principles and give examples of each: * Fidelity – keeping promises or agreements with others * Justice – to act fairly and equitably (organ donation, pro bono treatment) * Veracity - truthfulness * Autonomy – allowing patients to make their own decisions * Accountability – willingness to accept responsibility for one’s actions 4. Define and Describe Advance Directives - Consists of (1) Living will, (2) power of attorney, (3) health care proxy  Living will – specifies the treatment a person wants to receive when he or she is unconscious or no longer capable of making decisions independently (extraordinary measures? Organ donation? Autopsy?)  Power of attorney – allows designated person to make legal decisions on behalf of an individual who is unable or not permitted. Limited to MED.  Health care proxy – SPECIFIC. Limits the scope of power of designeated person to MEDICAL care/treatment. Names one alternate.

Jarvis Chapter 21: Abdomen 1. Describe developmental changes in infants, children, women and aging adults. - Infants/Children: In newborns, the umbilical cord shows prominently, liver takes up more space. Bladder is higher. During early childhood, the abdominal wall is less muscular = easier to palpate. - Women: Nausea/vomiting, heartburn with pregnancy. Motility decreases leading to constipation. Enlarging uterus = organs everywhere, diminished bowel sounds. Striae/Linea Negra appear. - Aging Adults: abdominal muscles relax, salivation decreases, esophageal emptying is delayed, gastric acid secretion decreases, liver size decreases, gallstone incidents increase, constipation occurs more often.

2. Describe the appropriate assessment techniques for inspection, palpation, percussion, and auscultation of the abdomen. - Inspection Contour Symmetry Umbilicus Skin Pulsation or movement Hair distribution Demeanor - Auscultation Bowel sounds Note any vascular sounds - Percussion Percuss all four quadrants Percuss borders of liver, spleen - Palpation Light palpation in all four quadrants Deeper palpation in all four quadrants Palpate for liver, spleen, kidney 3. Identify normal range of findings of the abdomen related to the following a. Contour – Describes nutritional state. Ranges from flat to round. b. Symmetry – Should be symmetric bilaterally. c. Umbilicus – Should be midline and inverted, w/ no discoloration, inflammation, or herniation. Everted/pushed upward during pregnancy. d. Skin – Should be smooth and even, with homogenous color. e. Pulsation or movement - Normally you may see the pulsations from the aorta beneath the skin in the epigastric area, particularly in thin people with good muscle wall relaxation. Respiratory movement also shows in the abdomen, particularly in males. Finally, waves of peristalsis sometimes are visible in very thin people. They ripple slowly and obliquely across the abdomen. 4. Describe the character and frequency of bowel sounds - Originate from the movement of air and fluid through the stomach and large and small intestine. - High-pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5 to 30 times per minute. Do not bother to count them. - Because the sounds radiate widely over the abdomen, the gurgle you hear in the RLQ may originate in the stomach. So listening in all four quadrants usually is not necessary. 5. Perform a sequentially correct assessment of the abdomen. - Inspection  Auscultation  Percussion  Palpation

Chapter 24 Male GI System, 25 Anal, Rectum and Prostate, 26 Female GI System 1. Describe normal examination findings of the anal, rectal and prostate structures. - Anal: Opening tightly closed. No lesions. No break in skin integrity/protrusion through opening when performing Valsalva maneuver. - Rectal: Canal should feel smooth and even. Sphincter should tighten evenly around finger. Rectal wall normally feels smooth with no nodularity. - Prostate: The surface should feel smooth and muscular; search for any distinct nodule or diffuse firmness.

Size—2.5 cm long by 4 cm wide; should not protrude more than 1 cm into the rectum

Shape—Heart shape, with palpable central groove

Surface—Smooth

Consistency—Elastic, rubbery

Mobility—Slightly movable

Sensitivity—Nontender to palpation

2. Describe normal examination findings of the internal and external female genitalia. - Skin color should be even; labia minora = darker pink, moist, symmetric. Hair distribution should be in an inverted triable. Labia majora = symmetric, plump, well formed. No lesions should be present aside from occasional sebaceous cyst. Urethral opening appears stellate, midline. Perineum smooth aside from possible episiotomy scar following vaginal birth. Pressure with insertion should produce no pain. Labia should feel soft and homogenous. Perineum should feel thick, smooth, and moist in the nulliparous woman, thick and rigid in the multiparous woman. Cervical mucosa should be pink and even (normal), blue (2 nd month of

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pregnancy), pale (post menopause). Cervix should be midline (anterior or posterior), 2.5cm, and smooth (unless postpartum, then may be everted). Vaginal wall wall looks pink, deeply rugated, moist and smooth, and free of inflammation or lesions. Normal discharge is thin and clear or opaque and stringy but always odorless. When doing a bimanual examination:

• Rectovaginal septum should feel smooth, thin, firm, and pliable. • Rectovaginal pouch, or cul-de-sac, is a potential space and usually not palpated. • Uterine wall and fundus feel firm and smooth. 3. Describe normal examination findings of the male genitals. - The skin normally looks wrinkled, hairless, and without lesions. The dorsal vein may be apparent. The glans looks smooth and without lesions. Ask the uncircumcised male to retract the foreskin, or you retract it. It should move easily. Some cheesy smegma may have collected under the foreskin. The urethral meatus is positioned just about centrally and meatus edge should appear pink, smooth, and without discharge. At the base of the penis, pubic hair distribution is consistent with age. Hair is without pest inhabitants. Shaft should be smooth, semifirm, and nontender. Scrotal size varies with ambient room temperature. Asymmetry is normal, with the left scrotal half usually lower than the right. Normally no scrotal lesions are present, except for the commonly found sebaceous cyst. The scrotal contents should slide easily. Testes normally feel oval, firm and rubbery, smooth, and equal bilaterally and are freely movable and slightly tender to moderate pressure. Each epididymis normally feels discrete, softer than the testis, smooth, and nontender. You should feel smooth, nontender spermatic cords....