Nursing State Exam Prep 2019 PDF

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- STATE EXAM PREP ETHICAL / LEGAL SAFTEY............................................................................................................... NURSING COUNCIL OF NEW ZEALAND..................................................................................................... NURSING ROLES AN...

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STATE EXAM PREP 2019 ETHICAL / LEGAL SAFTEY...............................................................................................................2 NURSING COUNCIL OF NEW ZEALAND.....................................................................................................2 NURSING ROLES AND SCOPE OF PRACTICE...............................................................................................2 STANDARDS AND GUIDELINES FOR NURSES..............................................................................................3 LEGAL GUIDELINES...............................................................................................................................6 ETHICAL CONSIDERATIONS...................................................................................................................10 GUIDELINES FOR CULTURAL SAFETY AND THE TREATY OF WAITANGI............................................................11 COMMUNITY HEALTH NURSING...................................................................................................14 PRIMARY HEALTHCARE CONCEPTS.........................................................................................................14 HEALTH PROMOTION CONCEPTS............................................................................................................16 INFECTIOUS DISEASES AND IMMUNISATIONS............................................................................................16 SEXUAL HEALTH................................................................................................................................21 MATERNAL AND CHILD HEALTH NURSING.................................................................................26 PRENATAL CARE.................................................................................................................................26 LABOUR...........................................................................................................................................38 POSTNATAL CARE...............................................................................................................................40 PAEDIATRICS.....................................................................................................................................43 NURSING ASSESSMENT.......................................................................................................................46 MEDICAL NURSING........................................................................................................................55 NORMAL BODY FUNCTIONING...............................................................................................................55 CARDIAC..........................................................................................................................................68 RESPIRATORY.....................................................................................................................................81 NEURO.............................................................................................................................................94 GASTROINTESTINAL..........................................................................................................................116 ORTHOPAEDICS/ MUSCULOSKELETAL .....................................................................................................125 INTEGUMENTARY/ DERMATOLOGY.........................................................................................................134 RENAL/ UROLOGY.............................................................................................................................138 LYMPHATIC/ IMMUNITY......................................................................................................................144 REPRODUCTIVE SYSTEM....................................................................................................................150 ENDOCRINE FUNCTION......................................................................................................................153 SURGICAL NURSING....................................................................................................................159 PRE-OPERATIVE CARE........................................................................................................................159 INTRAOPERATIVE..............................................................................................................................159 POST-OPERATIVE..............................................................................................................................160 POST-OPERATIVE COMPLICATIONS........................................................................................................161 MENTAL HEALTH / PSYCHIATRIC NURSING..............................................................................166 PERSONALITY DISORDERS..................................................................................................................169 MOOD DISORDERS:..........................................................................................................................170 SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS.............................................................................174 DEMENTIA AND DELIRIUM..................................................................................................................175 EATING DISORDERS..........................................................................................................................176 SUBSTANCE ABUSE AND ADDICTION....................................................................................................177 TREATMENT....................................................................................................................................178 Assessments/ Tools.....................................................................................................................180

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ETHICAL / LEGAL SAFTEY Nursing Council of New Zealand The Nursing Council of New Zealand is the regulatory authority responsible for the registration of nurses. Its primary function is to protect the health and safety of members of the public by ensuring that nurses are competent and fit to practise. Under the Health Practitioners Competence Assurance Act 2003 is the responsible authority that governs the practice of nurses. The council sets and monitors standards in the interests of the public and the profession. The council’s primary concern is public safety. The council fulfils this function by:  Registering nurses  Setting ongoing competence requirements and issuing practicing certificates  Setting scopes of practice and the qualifications required for registration  Accrediting and monitoring education providers and setting the state examination  Providing guidelines and standards for practice  Receiving and acting on notifications of health and competence concerns  Receiving and acting on complaints about the conduct of nurses  Promoting public awareness of the council’s responsibilities

Nursing Roles and Scope of Practice Enrolled Nurse (EN):  Practice under the direction and delegation of a registered nurse to deliver nursing care and health education.  Contribute to nursing assessments, care planning, implementation and evaluation of care (The RN maintains overall responsibility for the plan of care).  Able to administer medicines and undertake other care responsibilities appropriate to assessed competence.  Are accountable for their nursing actions and practice competently in accordance with legislation.  Qualifications: 1. Successfully complete an 18-month programme in enrolled nursing at level 5 2. Pass an assessment by an approved provider of the nursing council’s competencies for enrolled nurses 3. Pass a state examination for enrolled nurses Registered Nurse (RN):  Utilise nursing knowledge and complex nursing judgement to assess health needs and provide care and to advise and support people to manage their health.  Practice independently and in collaboration with other health professionals, perform generalised nursing functions, and delegate to and direct enrolled nurses, healthcare assistants and others.  Provide comprehensive assessments to develop, implement and evaluate an integrated plan of health care, and provide interventions that require substantial scientific and professional knowledge, skills and clinical decision making – this occurs in a range of settings in partnership with individuals, families, whanau and communities.  May practice in a variety of clinical contexts depending on their education preparation and practice experience. May also use this expertise to manage, teach, evaluate and research nursing practice.

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Are accountable for ensuring all health services they provide are consistent with their education and assessed competence, meet legislative requirements and are supported by appropriate standards. Conditions are placed on the scope of practice of some registered nurses according to their qualifications or experience limiting them to a specific area of practice. Some registered nurses who have completed the required additional experience, education and training will be authorised by the council to prescribe some medicines within their competence and area of practice. Qualifications: 1. A bachelor’s degree in nursing approved by NZNC; or 2. A graduate nursing qualification at level 7; or 3. A postgraduate nursing qualification at level 8 4. Pass an assessment of nursing council competencies for registered nurses 5. A pass in an examination for registered nurses

Nurse Practitioner:  Nurse practitioners have advanced education, clinical training and the demonstrated competence and legal authority to practice beyond the level of a registered nurse.  Work autonomously and in collaborative teams with other health professionals to promote health, prevent disease, and improve access and population health outcomes for a specific patient group or community.  Manage care as the lead healthcare provider in partnership with health consumers and their families/ whanau.  Combine advanced nursing knowledge with diagnostic reasoning and therapeutic knowledge to provide patient-centred healthcare services including the diagnosis and management of health consumers with common and complex health conditions.  Provide a wide range of assessment and treatment interventions, ordering and interpreting diagnostic and laboratory tests, prescribing medicines within their area of competence and admitting and discharging from hospital and other healthcare services.  As clinical leader they work across healthcare settings and influence health service delivery and the wider profession.  Qualifications: 1. A master’s degree; and 2. Four years working in chosen field. Annual Practicing Certificates (APC): Anyone who is practicing as a nurse must hold a practicing certificate. Nurses who practice without a certificate may be referred to a professional conduct committee. To protect the public safety employers also have a responsibility to ensure that employed nurses hold a current APC. Five Rights of Delegation by a registered nurse to a health care assistant: 1. Right activity 2. Right circumstances 3. Right person 4. Right communication 5. Right direction

Standards and Guidelines for Nurses Code of Conduct for Nurses:

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The code of conduct is a set of standards defined by the Council describing the behaviour or conduct that nurses are expected to uphold. The code of conduct provides guidance on appropriate behaviour for all nurses and can be used by health consumers, nurses, employers, the nursing council and other bodies to evaluate the behaviour of nurses. Failure to uphold these standards of behaviour could lead to disciplinary investigation. This is not a code of ethics – it does not seek to describe all the ethical values of the profession or to provide specific advice on ethical issues, ethical frameworks or ethical decision making. The code consists of four values underpinning professional conduct:  Value 1: Respect Treating health consumers, families and colleagues with respect enables nursing relationships that support health consumers’ health and well-being. Treating someone with respect means behaving towards that person in a way that values their worth, dignity and uniqueness. It is a fundamental requirement of professional nursing relationships and ethical conduct.

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Value 2: Trust Nurses are privileged in their relationships with health consumers. Nurses need to establish trusting relationships with health consumers to effectively provide care. Health consumers need to be able to trust nurses to be safe and competent, not to harm them and to protect them from harm. Nurses must be trustworthy and maintain the public’s trust in the nursing profession.

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Value 3: Partnership Partnership occurs when health consumers are given sufficient information, in a manner they can understand, in order to make an informed choice about their care and treatment and are fully involved in their care and treatment. Their independence, views and preferences are values. Nurses must be aware of the inherent power imbalance between themselves and health consumers, especially when the health consumer has limited knowledge, may be vulnerable or is part of a marginalised group.

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Value 4: Integrity Being honest, acting consistently and honouring our commitments to deliver safe and competent care is the basis of health consumers’ trust in nurses. Integrity means consistently acting according to values and principles and being accountable for actions and must be able to justify their decisions.

And eight primary principles:

Professional Boundaries Guidelines: Nurses must be aware of their professional responsibility to maintain appropriate personal, sexual and financial boundaries in relationships with current and former health consumers and their families. The importance of maintaining boundaries in professional relationships: Professional relationships are therapeutic relationships that focus on meeting the heath or care needs of the health consumer. Nurses must be aware that in all their relationships with health consumers they have greater power because of their authority and influence as a health professional, their specialised knowledge, access to privileged information about the

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health consumer and their role in supporting health consumers and those close to them when receiving care. The power imbalance is increased when the health consumer has limited knowledge, is made vulnerable by their health circumstances or is part of a vulnerable or marginalised group. Nurses must take care to ensure their own personal, sexual or financial needs are not influencing interactions between themselves and the health consumer. It is the nurse’s responsibility to maintain the appropriate professional boundary. Pre-existing relationships: When a nurse has a pre-existing relationship with a health consumer, such as being a neighbour, acquaintance or business associate, the nurse needs to be aware of the potential for boundary confusion and possible harm. The nurse must clarify and if necessary, communicate this new professional relationship with the person in Order to provide appropriate nursing care, and also declare it to the other members of the team and document it in the health consumers record. The health consumer should be offered the choice to be assigned to another nurse, if possible. Nurses need to ensure that the pre-existing relationship does not undermine their professional judgement and objectivity when the person is in their care. If possible, the nurse should not be the primary nurse or only health practitioner involved in this person’s care. Working with Maori consumers: Effective and culturally responsive practice with Maori is likely to be based on an understanding of tikanga. Whanaungatanga involves establishing a relationship of trust by making connections. This may include sharing information about whanau, whakapapa or own personal life to establish trust – this is appropriate. Manaaki involves sharing hospitality or kai to show respect and establish relationships – it is important nurses partake in rituals around food. Caring for close friends or family: In situations where a nurse provides care to close friends or family it is rarely possible for the nurse to maintain sufficient objectivity about the person to enable a truly professional relationship. In these situations, where possible, another nurse should be assigned responsibility for that person’s care. When a nurse has no option other than to care for a close friend or family member, care should be handed over to another appropriate care provider when it becomes practicable. It is also important for nurses to be clear about their role when a close friend or family member is receiving care. They have a role as an informed support person but are not there to make decisions about the nursing care. Working in small, rural or remote communities: The nurse has to ensure the persons care needs are first and foremost and they must manage privacy issues appropriately. Must also take extra care in maintaining confidentiality and privacy. Social media and electronic forms of communication: Maintain professional boundaries in the use of social media. Keep your personal and professional life separate as far as possible. Avoid online relationships with current or former health consumers.

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Do not use social medical or electronic communication to build or pursue relationships with health consumers. Concluding professional relationships: Knowing how and when to conclude professional relationships is as important as knowing how to begin them. The conclusion of a relationship occurs when a health consumer and their family are able to manage their own health needs. Termination rituals may be appropriate in some circumstances where there has been a close involvement. This could happen in different ways e.g. attendance of a tangihanga or funeral may be appropriate way of showing respect. Signs of over involvement in a nurse-health consumer relationship: The nurse reveals feelings and aspects of his/her personal life to the health consumer beyond that necessary for care. The nurse becomes emotionally close to a health consumer The nurse attempts to see the health consumer (or vice versa) outside of the clinical setting The nurse receives gifts or continues contact with a former health consumer The nurse provides health consumer with personal contact information The nurse participates in flirtatious communication, sexual innuendo or offensive language The nurse fosters dependency in the health consumer and does not encourage selfmanagement Sexual relationships with current health consumers/ health consumers partners or family members/ former health consumers: Sexual relationships with current health consumers are inappropriate – can cause significant and enduring harm to health consumers, damage health consumers trust in the nurse and the public trust in nurses, impair professional judgement and influence decisions about care and treatment. It is the reasonable expectation that the professional relationship will not be exploited in any way by the nurse to have his/her own needs met – this includes relationships with family members. Relationships with former health consumers are likely inappropriate however long ago the professional relationship ceased. The reason for this is the relationship may be influenced by previous therapeutic relationship where there was a clear imbalance of power. Gifts: “Standard 7.6: accepting gifts, favours or hospitality may compromise the professional relationship with a health consumer. Gifts of more than a token value could be interpreted as the nurse gaining personal benefit from his/her position, the nurse taking advantage of a vulnerable health consumer, an attempt to gain preferential treatment, ...