comprehensive_review_1

1. Prioritize questions: Prioritization: Prioritizing is deciding which needs or problems require immediate action and which ones could tolerate a delay in response until a later time because they are not urgent ● The nurse can use the ABCs (airway, breathing, circulation) as a guide when determining priorities; client needs related to maintaining a patent airway are always the priority ● If CPR is necessary, the order of priority is CAB (compressions, airway, breathing) this is the exception to using the ABCs when determining priorities ● The nurse can use Maslow’s Hierarchy of Needs theory as a guide to determine priorities and to identify the levels of physiological needs, safety, love and belonging, self-esteem, and self-actualization (basic needs are met before moving to other needs in the hierarchy) ● The nurse can use the steps of the nursing process as a guide to determine priorities, remembering that assessment is the first step of the nursing process Role of a PT: A physical therapist assists in examining, testing, and treating physically disabled clients Role of an OT: An occupational therapist develops adaptive devices that help chronically ill or handicapped clients to perform activities of daily living Role of a ST: A speech therapist evaluates a client’s ability to swallow safely and effectively and communicates a plan to improve a client’s swallowing ability Patient autonomy: Client rights when hospitalized include ● Right to considerate and respectful care ● Right to be informed about diagnosis, possible treatments and likely outcome, and to discuss this information with the health care provider ● Right to know the names and roles of the persons who are involved in the care ● Right to consent or refuse a treatment ● Right to have an advanced directive ● Right to privacy ● Right to expect that medical records are confidential ● Right to review the medical record and to have information explained ● Right to expect that the hospital has relationships with outside parties that may influence treatment or care ● Right to consent or refuse to take part in research ● Right to be told of realistic care alternatives when hospital care is no longer appropriate ● Right to know about hospital rules that affect treatment, and about charges and payment methods Reporting responsibilities: Nurses are required to report certain communicable diseases or criminal activities such as child or elder abuse or domestic violence; dog bite or other animal bite, gunshot or stab wounds, assaults, and homicides; and suicides to the appropriate authorities ● Report impaired nurses to nursing supervisors/nursing administration in a confidential manner ● Occupational safety and health act (OSHA): OSHA requires that an employer provide a safe workplace for employees according to regulations. Employees can confidentially report working conditions that violate regulations. An employee who reports unsafe working conditions cannot be retaliated against by the employer ● Sexual harassment 2. Delegation • Delegation: Even though a task may be delegated to someone, the nurse who delegates maintains accountability for the taks; the person who assumes responsibility for the task is also responsible. The 5 rights of delegation include the right task, right circumstances, right person, right direction/communication, and right supervision/evaluation. ● In general, noninvasive interventions such as skin care, range of motion exercises, ambulation, grooming, and hygiene measures, can be assigned to the UAP ● In general, a LPN/LVN can perform not only the tasks that a UAP can perform, but also certain invasive tasks, such as dressing changes, suctioning, urinary catheterization, and medication administration (oral, subcutaneous, intramuscular, and selected piggyback medications). The LPN can also review with the client teaching plans that were initiated by the RN ● A registered nurse can perform the tasks that an LPN can perform and is responsible for assessment and planning care, initiating teaching, and administering medications intravenously. 3. Legal Issues 4. Malpractice ● Negligence is malpractice saunders box 6-3 pg. 61 ○ medication errors that result in injury to the client ○ Intravenous admin errors such as incorrect flow rate ○ Falls that are result of failure to provide safety to client ○ Failure to check equipment for proper function ○ Failure to use sterile technique ○ Burns sustained from failure to monitor bath temp ○ Failure to monitor clients’ condition ○ Failure to report changes in client’s condition to PCP Failure to provide a complete report to the oncoming nursing staff 5. Defamation of character Libel/slander- Defamation is a false communication that causes damage to someone's reputation, either in writing (libel) or verbally (slander). 6. Battery Know the nurse’s role in the following ethical issues: Battery, negligence ● Battery- is an intentional touching of another's body without the others consent. 7. AMA _Against Medical advice • Leaving the hospital against the physician's advice may expose the patient to risk of an inadequately treated medical problem and result in the need for readmission. • Among records that documented a reason for leaving AMA, the most common reason was dissatisfaction with care (15.3%). Other reasons for leaving AMA included family concerns/obligations (7.3%), patient felt better (7.3%), personal reasons (6.7%), and work/financial reasons (5.3% 8. Palliative and Hospice Care Hospice care ● Hospice care provides support and care for clients, in the last phases of incurable diseases so that they might live as fully and as comfortably as possible, clients and family needs are the focus of any intervention. ● Approaching death within 6 months or less ● Hospice care: caregiver continuously in the home when the patient is no longer able to safety care for themselves ● Comfort measures ● No cure, but can relieve symptoms Palliative care 9. Sickle cell Anemia Sickle cell crisis- These patients will always have a port. Pain level should always be assessed. Pain management. Interventions: ● Maintain adequate hydration: IV and oral fluids ● Administer oxygen ● Blood transfusion are needed ● Analgesics ● Bed rest ● High calorie, high protein diet, add folic acid supplements pg 380 ● Antibiotics as needed to prevent infection a. Acute vaso-occlusive- very painful, causes tissue hypoxia, inflammation, necrosis. When reperfusion is started- free radicals are released causing damage to the vessel b. Pain in joints, hands, feet, swelling of extremities, hematuria, signs of a stroke, dyspnea, shock, visual disturbances, increased WBC b. Aplastic- from infection of HPV, hem falls rapidly and isn’t compensate for c. Sequestration- when organs pool the sickled cells- mostly the spleen in children and liver in adults d. IV fluids and supplemental oxygen , opioids and non opioids for pain/ breakthrough pain, blood transfusion is needed, help with electrolytes, promote rest, antibiotics, treat underlying cause e. Avoid cold, ROM as tolerated, I&O, rehydration, pain, monitor size change of organs, infection, potassium Don’t give meperidine places at risk for seizures 10. Pertussis • A highly contagious respiratory tract infection that is easily preventable by vaccines • Whooping cough is particularly dangerous for infants. • Besides a cough that sounds like "whoop," symptoms include a runny nose, nasal congestion, and sneezing. • Treatment includes antibiotics. • Droplet precautions 11. Reportable disease Reportable diseases: Anthrax, Botulism, Cholera, Congenital rubella syndrome (CRS), Diphtheria, Giardiasis, Gonorrhea, Hep A,B,C, HIV infection, Influenza-associated pediatric mortality, Legionellosis/Legionnaires’ Disease, Lyme disease, Malaria, Meningococcal disease, Mumps, Pertussis (whooping cough), Poliomyelitis, paralytic, Poliovirus infection nonparalytic, Rubella (German measles), Salmonellosis, SARS-CoV, Shigellosis, Smallpox, Syphilis, Tetanus, Toxic shock syndrome (TSS), TB, Typhoid fever, Vancomycin intermediate and vancomycin- resistant, Vital hemorrhagic fever (Ebola), Staphylococcus aureus (VISA/VRSA) 12. Streptococcal glomerulonephritis (PSGN) • PSGN is a kidney disease that can develop after infections caused by bacteria called group A Streptococcus (group A strep). These infections include throat and skin infections like strep throat, scarlet fever, and impetigo. PSGN is not a group A strep infection of the kidneys. Instead PSGN results from the body’s immune system fighting off the group A strep throat or skin infection. • It usually takes about 10 days after the start of symptoms of strep throat or scarlet fever for PSGN to develop. It takes about 3 weeks after the start of symptoms of group A strep skin infection for PSGN to develop • PSGN is more common in children than adults. Developing PSGN after strep throat or scarlet fever is most common in young, school-age children. Developing PSGN after impetigo is most common in preschool-age children. Symptoms of PSGN can include: • Dark, reddish-brown urine • Swelling (edema), especially in the face, around the eyes, and in the hands and feet • Decreased need to pee or decreased amount of urine • Feeling tired due to low iron levels in the blood (fatigue due to mild anemia) In addition, someone with PSGN usually has: • Protein in the urine • High blood pressure (hypertension) Some people may have no symptoms or symptoms that are so mild that they don’t seek medical help. Treatment of PSGN focuses on managing symptoms as needed: • Decreasing swelling (edema) by limiting salt and water intake or by prescribing a medication that increases the flow of urine (diuretic) • Managing high blood pressure (hypertension) through blood pressure medication People with PSGN who may still have group A strep in their throat are often provided antibiotics, preferably penicillin.