MARKED A+
✔✔Percussion - ✔✔tapping on a surface to determine the difference in the density of
the underlying structure
✔✔Ausculation - ✔✔listening to sounds within the body
✔✔Bell - ✔✔low pitched sounds
(mummers)
✔✔Diaphragm - ✔✔high pitched sounds
(bowel and lung sounds)
✔✔What should we do before leaving the patients room? - ✔✔Patients safety
Bed to lowest position
Side Rails
Call button and personal belongings in reach
✔✔Contextual awareness - ✔✔Understanding the status of the client and the events
that led to their interaction
✔✔Analyzing assumptions - ✔✔Evaluating the client's clinical situation
✔✔Exploring alternatives - ✔✔The use of holistic approaches for treating the whole
person
(physical health, lifestyle choices, culture, living environment, life experiences)
✔✔Reflecting and deciding - ✔✔Reflect on the client's goals and decide on the
intervention with client input
✔✔Steps for communicating with members of the health care team - ✔✔1.Identify the
member by name and title
2.Provide info regarding the current situation
3.Provide info regarding the background situation
4.Give the most recent set of vital signs
5.Provide suggestions that may be helpful to the situation
6.Repeat the orders back that are given to you by the provider
✔✔Nonmaleficence - ✔✔Do no harm
✔✔Beneficence - ✔✔Promote good
, ✔✔Autonomy - ✔✔the right to make own choice
✔✔Justice - ✔✔Fairness
✔✔Confidentiality - ✔✔HIPPA
✔✔Identify steps to ensure client privacy and safety.
Privacy - ✔✔-Physical privacy is needed to make the client feel secure.
-Personal privacy: Maintaining confidentiality and ensuring the client has been identified
properly.
-Infection control
-Hand Hygiene
-PPE
✔✔5 factors influencing the use of therapeutic communication. - ✔✔-Maintain
professionalism
-Maintain a neutral attitude
-Do not impose own values on others
-Practice empathy
-Cultural competence
✔✔Therapeutic Communication - ✔✔an approach to communicate that is both verbal
and
nonverbal. Focus on the person and not the problem.
✔✔Electronic Records (EHR) - ✔✔Communication tools for documenting progress,
treatments, interventions, and client responses to care.
✔✔Paper Records - ✔✔Maintain integrity. Properly date and time each entry followed
by a full
signature and title.
✔✔9 Types of Nursing Documentation Errors - ✔✔-Sloppy or illegible handwriting
-Failure to date, time and sign a medical entry
-Lack of documentation
-Incomplete or missing documentation
-Adding entries later on
-Documenting Subjective data
-Not questioning incomprehensive orders
-Using wrong abbreviations
-Entering info into the wrong chart
✔✔steps to performing general survey - ✔✔1.General appearance
2.Behavior