NURS 136 Test 1 Satisfied Review Exam

what are some methods to reduce physical hazards and the transmission of pathogens - ANSWERSmake sure all workers wear proper protective gear such as safety glasses, gloves, hard hats, hearing protection, etc. Second, ensure that equipment is properly maintained and repaired. Proper hand hygiene. Avoiding high-risk behaviors. Immunizations. Proper home pest control. Proper disposal of human waste. Keeping a healthy world environment-avoid polluting the air and water when able. What is the influence of nursing theory on a nurse's approach to practice - ANSWERSNursing theory conceptualizes an aspect of nursing to describe, explain, predict, pr prescribe nursing care. Theories offer a framework for assessing your patient's situation, and help you to recognize and analyze clues that emerge from data what are the types of nursing theories - ANSWERS- grand theories: abstract, broad in scope, and complex - require further clarification though research to they can be applied to nursing practice - provides general framework for general ideas about nursing. Eg Imogene King's theory of goal attainment, the focus of nursing is the interaction of Hyman beings and the environment with an end goal of health, an Nightingale who thought that improving environment and nutrition would lead to restored health - Middle-range theories: address specific phenomenon and reflect practice. Eg Kolcaba's theory of comfort encourages nurses to meet pt's needs for comfort in physical, psychospiritual, environmental and sociocultural realms - Practice theories: guide the nursing care of a specific patient population at a specific time eg. pain management protocol for pts receiving from cardiac surgery - Descriptive theories: first level of theory development - describe phenomena and identify circumstances in which the phenomena occur eg. theories of growth and development describer he maturation process of an individual at various ages - Prescriptive theories: address nursing interventions for a phenomenon, guide practice change, and predict the consequences - helps to anticipate the outcomes of nursing interventions what is the relationship between nursing theory, the nursing process, and patient needs - ANSWERSThe nursing process is used in clinical settings to determine individual patient needs, and provides a systematic process for the delivery of nursing care. However, nurses use theory to provide direction in how to use the nursing process. For example, the theory of caring influences what nurses need to assess, how to determine patient needs, how to plan care, how to select individualized nursing interventions, and how to evaluate patient outcomes. what is the National Council of State Boards of Nursing Clinical Judgment Model (NCSBN-CJM) - ANSWERSit was developed to help guide nurse educators in evaluating nursing student's abilities to make the clinical judgements necessary when providing competent nursing care. The model has multiple layers that help explain the cognitive process nurses use to make clinical judgments to guide their care - layer 0: determine client needs - layer 1: clinical judgement - layer 2: form a hypotheses, refine hypothesis, evaluation - layer 3: recognize cures, analyze cues, prioritize hypothesis, generate solutions, take actions, evaluate outcomes - layer 4: environmental and individual factors that help inform a nurses clinical judgement What is theory based nursing practice - ANSWERSyou apply the principles of a theory in delivering nursing interventions - grand theories help shape and define your practice - middle range theories help to advance nursing knowledge through nursing research - practice theories help you provide specific care for individuals and groups of diverse populations and situations what are the benefits of evidence based practice - ANSWERSEBP enhances patient experience, patient satisfaction, decreases cost, empowers clinicians, improves patient outcomes, and improves the quality and consistency of health care what are the steps of evidence based practice - ANSWERS0. cultivate a spirit of inquiry within an EBP culture and environment 1. ask a clinical question in PICOT format 2. search for the most relevant and best evidence 3. critically appraise the evidence you gather 4. integrate the best evidence with your clinical expertise and patient preferences and values 5. evaluate the outcomes of practice changes based on evidence 6. communicate the outcomes of EBP decision or changes what is PICOT and give an example of a PICOT Question - ANSWERSP: patient population of interest (eg. age, sex, ethnicity, disease, etc) I: intervention or area of interest (eg. tx, diagnostic test, prognostic factor, etc) C: comparison intervention or area of interest (eg. what is the standard of care use now in practice) O: Outcomes (what is the desired result of an intervention eg. chance in behavior, physical finding, etc) T: time (what amount of time is needed for an intervention to achieve an outcome) explain the levels of evidence available in the literature - ANSWERS- level I = systematic review or meta analysis or randomized controlled trials, evidence based clinical practice guidelines, based on systematic reviews - level II = well developed randomized controlled trials - level III = controlled trial without randomization (quasi experimental study) - level IV = single non-experimental study (case control, correlational, cohort studies) - level V = systematic reviews of descriptive and qualitative studies - level VI = single descriptive qualitative study - level VII = opinion of authorities and/or reports of expert committees - the level of rigs and confidence you can have in the evidence decreases as you move down the levels- what are some ways to apply evidence in practice - ANSWERSif the evidence applies to an intervention the first step is to apply the research in. It is typically best to test a new practice change by conducting a 3 month pilot before implementing on a large scale how does nursing research improve nursing practice - ANSWERSProvides a scientific basis for nursing practice and validates the effectiveness of nursing interventions. Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively. what are the steps of the research process - ANSWERSusing the scientific method - make an observation - ask questions about the aberration and gather info - analyze the literature and form a research questions or hypothesis - conduct a study using scientific. rigor - analyze the data and draw conclusions what are the priorities for nursing research - ANSWERS1. Chronic Illness or Conditions: -Self-care and symptom management -Quality of life and care 2. Behavioral Changes and Interventions -Enhancing health promotion 3. Responding to Public Health Concerns -Ex: End of life issues, health care disparities what is the relationship between evidence based practice and performance improvement - ANSWERSEBP, research, and PI are closely related by separate processes, that use best evidence. EBP uses research literature and PI data when available to provide evidence for practice change, and EBP and PI can lead to opportunities for research what are the components of a quality improvement program - ANSWERSidentify the problem the problem, identify a goal or outcome, aim, and measures. discuss the importance of consensus standards for public reporting of patient safety events - ANSWERSIt helps provide patient-centered safety and improve performance and risk management. what kind of environmental hazards pose risks to personal safety - ANSWERSOxygen (basic need) - it is highly flammable Nutrition (basic need) - people get sick form food borne illnesses due to improper storage and preparation of food Temperature (basic need) - hypothermia, hyperthermia Motor Vehicle Accidents - not wearing seatbelt, improper seats for infants and children, not wearing a helmet on motorcycles, age related decline (eg vision loss) Poison - any substances that impress heath or results in death when ingested, inhaled, injected, or absorbed eg. medications, cleaning solutions, personal hygiene products, lead, etc Falls - risk factors include age, occupation, alcohol use , poor mobility, underlying medication conditions, unsafe environments, etc Fire - improper use of cooking equipment and appliances, improper dispenses of cigarette or use of candles, etc Disasters - eg. floods, tsunamis, hurricanes, tornadoes, and wildfires discuss the specific risks to safety related to developmental age - ANSWERS- infant, toddler, and preschooler: explore the environment and have an increased level or oral activity, and put objects in their mouth - increases risk of poisoning or aspiration and choking of foreign material, suffocation hazards, drowning, burns - school age children: transportation to and from school, if involved in team and contact sports may not use protective safety equipment, school violence (eg. fighting, bullying, cyberbullying, weapon use, etc., self harm - Adolescent: experimentation with drugs, alcohol, tobacco, suicide, incidents such as drowning or motor vehicle accidents - Adult: excessive alcohol use, smoking, high stress levels - risks are typically associated with life style habits - Older adult: physiological changes associated with aging, the effects of multiple meds, psychological and cognitive changes and effects of disease increase risk for falls and other accidents (eg. burns, car crashes, etc) identify the factors to assess when patient is in restraints - ANSWERSVital signs, skin integrity underneath the restraint, nutrition, hydration, circulation to an extremity, range of motion, hygiene, elimination needs, cognitive functioning, physchological status, and need for restraint describe the 4 categories of safety risks in a health care agency - ANSWERS- procedure related accidents: amassed by health care providers and include med admin errors, improper application of external devices, and accidents related to improper performance of procedures such as urinary Cath insertion or transferring patients without use of safe patient handling techniques - equipment related accidents: result from an electrical hazard or malfunction, disrepair, or misuse of equipment - chemical exposure: chemicals found in some medications, anesthetic gases, cleaning solutions, and disinfectants are potentially toxic - Falls: a preventable event that can result in fractures, bruises, lacerations, or internal bleeding, leading to an increased diagnostic tests and treatments, extended hospital stays, and discharge to rehabilitation or long term care instead of homeVita describe assessment activities designed to identify patients physical, psychosocial, and cognitive status as it pertains to their safety - ANSWERSIdentify patient's perceptions of safety needs and risks, Identify actual and potential threats to the patient's safety, Determine impact of the underlying illness on the patient's safety, Identify the presence of risks for the patient's developmental stage and patient's environment, Determine effect of environmental influence on the patient's safety. Identify relevant nursing diagnoses associated with risks to safety. - ANSWERS• Risk for falls• Impaired home maintenance• Risk for injury• Deficient knowledge• Risk for poisoning• Risk for suffocation• Risk for trauma describe nursing interventions specific to a patients age for reducing risk of falls, fires, poisonings, and electrical hazards - ANSWERS- Infants and toddlers: never leave crime sides down or infants unattended on changing tables or in infant seats, swings, strollers, or high chairs. Don't use infant seats or swings if the child becomes too big or too active. Baby-proof the home; remove small or sharp objects and toxic or poisonous substances, including plants; install safety locks on floor-level cabinets, cover electrical outlets - Preschoolers: Teach children basic physical safety rules such never attempting to use the stove or oven unassisted. Teach children not to eat items found in the street or grass. - Avoiding these items reduces risk for possible poisoning. -School age: each children proper bicycle safety, including use of helmet and rules of the road, and proper techniques for specific sports and the need to wear proper safety gear (e.g., helmets, eyewear, mouth guards), not to operate electrical equipment while unsupervised - Adolescents: Encourage enrollment in driver's education classes, Provide information about the effects of using alcohol and drugs, safe use of the Internet - older adults: Reduce the risk of falls and other accidents• Compensate for the physiological changes of aging explain the relationship between the chain and transmission of infection - ANSWERSThe chain of infection describes the complete process of an infection spreading from one host to another - the presence of a pathogen does not men an infection will occur. Infection occurs if all the following are present 1. an infectious agent or pathogen 2. a reservoir or source for pathogen growth 3. a port of exit from a reservoir 4. a mode of transmission 5. a port of entry to a host 6. a susceptible host what is an examples of the different aspects of the infection chain, and methods of preventing infection for each element of the infection chain - ANSWERS1. infectious agent (bacteria, fungus, etc) - hand hygiene 2. reservoir (humans, animals, insects, food, water, inanimate surfaces, etc) - sterilize and disinfect table surfaces clean, cleaned soiled dressings 3. portal of exit (skin, respiratory tract, urinary tract, GI tract, reproductive tract, blood) - standard and transmission based precautions (PPE) 4. mode of transmission (contact, airborne, droplet, vehicle, vector) - hand hygiene, and use of PPE, clean equipment 5. portal of entry to the host (same routs as exiting) - cover wounds, maintain skin integrity, PPE 6. susceptible host (immunocompromised, age, nutritional status, presence of chronic disease, etc) - vaccination identify the normal defenses of the body against infection - ANSWERSnormal floras, body system denseness, and inflammation are all nonspecific defenses Describe the signs and symptoms of a localized infection - ANSWERSpain, tenderness, warmth, and redness at the wound site describe the signs and symptoms of a systemic infection - ANSWERSmore generalized symptoms. They usually result in fever, fatigue, and malaise. Lymph nodes that drain the area of infection often become enlarged, swollen, and tender during palpation. Loss of appetite, nausea, and vomiting. explain conditions that promote the transmission of heath care associated infection - ANSWERSinvasive procedures, antibiotic administration, presence of multi drug-resistant organisms, and breaks of infection prevention and control activities. The number of health care employees having direct contact with a patient, the therapy received, and the length of hospitalization are also risks. If the patient has multiple illnesses, is an older adult, or has a compromised immune system what is the difference between medical and surgical asepsis - ANSWERSMedical asepsis techniques are used for all patients even when no infection is diagnosed. They include hand hygiene, use of PPE, and routine environmental cleaning - reduces the number of microorganisms Surgical asepsis is a sterile technique that prevents contamination of an open wound, and serves to isolate an operative of procedural area from an unsterile environment. It includes procedures to eliminate all microorganisms what is the rationale for standard precautions - ANSWERSstandard precautions are the primary strategies for prevention of infection transmission and apply to contact with blood, body fluids, non intact skin, mucous membranes, and equipment or surfaces contaminated with potentially infectious materials - apply to all patients how do you perform proper hand hygiene - ANSWERS4 techniques: hand washing, antiseptic hand washing, antiseptic hand rub, surgical hand antisepsis. - hand washing is the vigorous, brief rubbing together of all surfaces of lathered hands followed by rinsing under a stream of warm water for 15 seconds. - antiseptic hand washing is washing hands with warm water and soap or other detergents containing an antiseptic agent - antiseptic hand rub means applying an antiseptic hand rub product to all surfaces of the hands to reduce the number of microorganisms present - surgical hand antisepsis is an antiseptic hand wash r hand rub technique that surgical personnel perform before surgery to eliminate transient flora and reduce resident hand flora how do infection control measures differ in the home vs. hospital - ANSWERSPatients are more susceptible to infections in the hospital due to a large number of reasons. Including unclean equipment, large number of other patients, invasive procedures, etc. Therefore, more infection control measures are taken in a hospital setting. In a home setting there are less microbes and potential for infection transmission, however pts still need to be educated on how to use infection control practices such as good hand hygiene. explain procedures for airborne precautions - ANSWERSdiseases that are transmitted in small droplets that remain in the air for longer periods of time. pt should be in a private room with negative pressure airflow of at least 6-12 exchanges per hour via HEPA filtration. PPE includes a respiratory mask, gloves, gown, and eye protection explain procedures for droplet precautions - ANSWERSused for diseases transmitted by large droplets (greater than 5 microns) expelled within 3 feet of the patient. pt should be in a private room, or in a room with patient with the same disease. PPE includes a surgical mask and gloves, proper hand hygiene and dedicated care equipment explain procedures for contact precautions - ANSWERSused for direct or indirect contact with pts and their environemnt. pt should be in a private room, or in a room with patients with the same disease. PPE includes gloves and gown what is occupational exposure - ANSWERS"reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties". what is the post exposure process for health care workers - ANSWERSreport an exposure and follow up for risk of acquiring infection begins with source patient testing. Test pt for HIV, HBV, and HCV, if positive test pt for syphilis. Testing the employee at the time of exposure is not needed immediately unless required by state law. Prophylactic treatment of the pt is recommended if they test positive for blood borne pathogen. what is the purposes of using nursing diagnosis in practice - ANSWERSis a part of the nursing process and is a clinical judgment that helps nurses determine the plan of care for their patients. These diagnoses drive possible interventions for the patient, family, and community. differentiate among a nursing diagnosis, medical diagnosis, and collaborative problem - ANSWERSa medical diagnosis is the identification of a disease condition based a specific assessment of physical signs and symptoms, a patients medical history and the results of diagnostic tests and procedures. A nursing diagnosis is a clinical judgement made by a nurse to describe a patient's response or vulnerability to a health problem or life events what is the relationship between critical thinking and the nursing diagnostic process - ANSWERSapplication of knowledge and experience, the consideration of environmental factors, and the use of critical thinking attitudes and intellectual an professional standards improve analysis and diagnostic accuracy Diagnostic reasoning analyzes data, your analysis involves logically explaining a clinical judgement b using patient assessment data to arrive a a nursing diagnosis what are the steps of the nursing diagnostic process - ANSWERS- assess the patients health status - validate data with other sources - determine if additional data is needed (if use, reassess step 1) - analyze and interpret the meaning of the data, look for data cluttering patterns - determine if the data you obtained was expected (if no, determine if any additional data is needed) - identify related factors to form assessment - formulate a diagnoses and collaborative problem what is the relationship between planning to assessment and nursing diagnosis - ANSWERSAssessment of a patient will lead to a diagnosis. Based on the diagnosis the nurse can then make a plan to fix the patient's problem. what criteria is used in priority setting - ANSWERS- based on urgency (highest priority goes to dx that will cause harm to the pt if not treated soon) - intermediate priority are non emergent and not life threatening - low priority are not always directly related to a specific illness but affect the patient's future well being - problem-focused or negative diagnosis take priority - short term, acute take priority over chronic - can use ABC, or mallows hierarchy of need to determine higher priority what is goal setting - ANSWERSa strategy that assists individuals to identify specific behaviors to change and how to go about doing so. goals may help clinicians link recommended plans of care to desired outcomes what is the difference between a goal and an expected outcome - ANSWERSgoal - a broad statement that describes a desired change in a patient's condition, perceptions, or behavior eg. pain relief, expected outcome - a measurable change (patient behavior, physical state, or perception) that must be achieved to reach a goal what are the 7 guidelines for writing an outcome statement - ANSWERS- patient-centered goals or outcomes - specific: outcomes reflect a specific patient behavior or response - observable - measurable: must be able to measure or observe whether a change takes place in the patients status - time-limited: set a time for each outcome to be met - mutual factors - realistic: set expected outcomes that are realistic and relevant for the pt what are the differences between nurse initiated, physician initiated and collaborative interventions - ANSWERSNurse initiated intervention- actions performed by a nurse without physician order Physician-initiated intervention-action initiated by a physician in response to a medical diagnosis but carried out by a nurse (requires a physicians order) what is the process of selecting nursing interventions during planning - ANSWERSconsider 6 factors 1. desired patient outcomes 2. characteristics of the nursing diagnosis 3. research base knowledge for the intervention 4. feasibility for doing the intervention 5. acceptability to the patient 6. your own competency what are some examples of evaluation measures to determine a patient progress toward an outcome - ANSWERS-assessment of skills and techniques (observations, physiological measurements, patient interview)-ex. measure diameter of ulcer daily, note odor and color of drainage from ulcer, inspect color, condition, and location of pressure ulcer how does evaluation lead to discontinuation, revision, or modification of a plan of care - ANSWERS-modify care plan (introduce new interventions, repeat entire nursing process)-reassess all patient factors (shows missing link)-redefine diagnosis (correct diagnosis?)-change interventions (standard of care -> minimum level of care accepted to ensure high quality of care to patients)-a patient's nursing diagnosis, priorities, and interventions sometimes change as a result of this-examines two factors: appropriateness of the interventions selected and the correct application of the intervention what is an actual nursing diagnosis - ANSWERSa clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. what is a collaborative problem - ANSWERSis a problem that requires both medical and nursing interventions to treat eg. a patient enters the clinic with an infected leg would. The health care provider prescribes antibiotics and the nurse monitors for fever and provides wouldn't care, a dietitian recommends an appropriate therapeutic diet, and the patient collaborates by learning good hand hygiene and wound care practices what is heath promotion nursing diagnosis - ANSWERSa health promotion nursing diagnosis identifies a situation in which a patient experiences interest in improving their health. what is NANDA International (NANDA-I) - ANSWERSNANDA International is a professional organization of nurses interested in standardized nursing terminology, that was officially founded in 1982 and develops, researches, disseminates and refines the nomenclature, criteria, and taxonomy of nursing diagnosis What is risk nursing diagnosis - ANSWERSa diagnosis that applies when there is an increased potential or vulnerability for a patient to develop a problem or a complication eg. risk for unstable blood pressure, risk for fall what are collaborative interventions - ANSWERStreatments initiated by other providers and carried out by a nurse. what are critical pathways - ANSWERSare protocols to reduce variations in clinical practice, standardize evidence based care, reduce patient length of stay, and improve patient outcomes what is an expected outcome - ANSWERSThink of expected outcomes as your program's hoped-for results for children, families, and the community - the forecasted results define goal, long term and short term - ANSWERSa goal is broad statement that describes a desired change in a patient's condition, perceptions, or behavior eg. pain relief A short term goal describe dependent and independent nursing interventions - ANSWERS*Independent: - Initiated by nursing- Do not require an order from another professional- based on scientific rationale - eg positioning patients to prevent PI *Dependent: - Actions that require an order from a physician or other health care provider- Advanced practice nurses may write dependent nursing interventions eg. medication admin, implementing an invasive procedure *Collaborative Interventions: Interdependent - Therapies that require the combined knowledge, skill, and expertise of multiple health care professionals. Ex. Interdisciplinary team meetings. what is a nursing care plan - ANSWERSprovide a centralized document of the patient's condition, diagnosis, the nursing team's goals for that patient, and measure of the patient's progress. Nursing care plans are structured to capture all the important information for the nursing team in one place what is a patient centered goal - ANSWERSa tool for promoting a patient-centered approach to care. They should include meaningful activities (walking), feelings (joy), or capabilities (energy) that the patient desires but cannot achieve as a result of their social status, environmental setting, illness or injury what is planning - ANSWERSthe use of critical thinking and decision making to form clinical judgements: reviewing a patient's nursing diagnosis and other collaborative problems, prioritizing nursing diagnosis and problems, setting outcomes to guid the plan of care and choosing relevant interventions for patient care plan of care = a document format a nurse should use to communicate the strategies identified to address patients needs what is priority setting - ANSWERSthe ordering of nursing diagnosis or patient problems to establish the preferred order in which yo u will implement nursing interventions what is implementation - ANSWERSthe process in which a nurse applies critical thinking to carry out nursing interventions using good clinical judgement what is a nursing intervention - ANSWERSany treatment or actions based on clinical judgement and knowledge that nurses perform to achieve patient outcomes eg. patient education what is evaluation - ANSWERScrucial final step of the nursing process that determines whether patient's condition or well being improved after the nursing interventions were delivered explain direct vs. indirect care - ANSWERSdirect care are treatments that are provided through client interaction eg. bathing, wound care, and inserting an intravenous catheter. Indirect care are treatments that are performed away from the patient on their behalf eg. calling the dr, charting, consultation what is a standard of care - ANSWERSthe minimum level of care accepted to ensure high quality patient care Outcomes need to be - ANSWERSSMART (specific, measurable, attainable, relevant, timely) what is the nurse's responsibility in making clinical decisions - ANSWERSdefining client problems and selecting appropriate treatment. Know your client. Keep them in center focus select therapies most likely to relieve problem how does reflection improve a nurses' capacity for making future clinical decisions - ANSWERSIt will help you become aware of how you used clinical decision-making skills and understand the experience and develop the ability to apply theory in practice what are the components of a critical thinking model for clinical decision making - ANSWERSKnowledge base, experience, critical thinking competencies, attitudes ,and standards what is the relationship between clinical experience and critical thinking - ANSWERScritical thinking skills focus on evaluating alternatives and forming sound judgments, clinical experience helps support your findings and conclusions what are the critical thinking attitudes used in clinical decision making - ANSWERSThese define how a successful thinker approaches a problem, Knowing when information is misleading and recognizing your own limits are examples how attitudes guide thinking. what is the relationship between the nursing process and critical thinking - ANSWERSNursing Process is a systematic, rational method of planning and providing care which requires critical thinking skills to identify and treat actual or potential health problems and to promote wellness.It provides a framework for the nurses to be responsible and accountable. what are the purposes of a health care record - ANSWERS-Facilitates interprofessional communication among health care providers -provides a legal record of care provided -Justification for financial billing and reimbursement of care -Auditing, monitoring, and evaluation of care provided -Education and research discuss legal guidelines for documentation - ANSWERSdocumentation needs to follow agency standards, including a clear description of individualized and outcome-directed nursing care you provided based on you assessment. Always document in a timely manner, a document all aspects of the nursing process what are 5 quality guidelines for documentation - ANSWERS- stick to the facts/make sure it is accurate - make sure the information you are writing is current - write in short sentences - use simple, short words - avoid the use of jargon or abbreviations what is the relationship between documentation and financial reimbursement for health care - ANSWERSdocumentation allows one to determine the severity of the pt's illness, the intensity of services received, and the quality of care provided during an episode of care. This is used by insurance companies to determine payment or reimbursement for health care services what are the advantages of standardized documentation forms - ANSWERSContinuity of care, less errors what elements should you include when documenting a patient's discharge plan - ANSWERSUse clear, concise descriptions in the patient's own language. •Provide step-by-step description of how to perform a procedure (e.g., home medication administration). Reinforce explanation with printed instructions. •Identify precautions to follow when performing self-care or administering medications. •Review signs and symptoms of complications that should be reported to the health care provider. •List names and phone numbers of health care providers and community resources that the patient can contact. •Identify any unresolved problem, including plans for follow-up and continuous treatment. •List actual time of discharge, mode of transportation, and who accompanied the patient. what are important aspects of home care and long term care documentation - ANSWERSHome care- documentation is for quality control and for payment. Nurses document all of their services. Some parts of the record stay at home with the patient, while other parts are kept at the office. Long term care- careful documentation for reimbursement. Nurses assess resident using resident assessment instrument / minimum data set ( RAI/MDS) for reimbursement. what are some ways to reduce data entry errors - ANSWERSComputerized provider order entry (CPOE) is a process by which a health care provider directly enters orders for patient care into the hospital information system.Write clearly and in black ink, do not use white out, if an error is made then mark through the error and write "error" and initial and date, repeat back VO or TO, ask questions to clarify what are the 5 rights of medication administration - ANSWERSright patient, right dose, right drug, right route, right time what factors should be considered when choosing routes for med admin - ANSWERSthe properties and desired effect of the medication and the patient's physical and mental condition compare and contrast the roles of the health care provider, pharmacist, and nurses in med admin - ANSWERSthe provider prescribes the medication for the patient by writing an order, the pharmacist prepares and distributes medications and the nurse administers the medication and monitors for effects what factors influence medication actions - ANSWERSage, route of administration, circulation, kidney function, body mass, total body water, gastric emptying rate and GI motility, liver function/mass, biorhythmic cycles, phycological factors, tolerance, genetics developmental factors that influence pharmacokinetics include - ANSWERS- absorption: as gastric pH is less acidic, gastric emptying slower as is peristalsis because decreased muscle tone, blood flow to GI is reduced due to decreased to cardiac output and blood flow, absorptive surfaces in intestines decreased due to flattened villi - Distribution: senior adult has less water in body, fat is increased because of decrease in lean body mass, protein binding sites reduced due to decreased production of proteins by aging liver and reduced intake - Metabolism: in older adult levels of microsomal enzymes are decreased due to the reduced capacity of liver to produce them. Liver blood flow is reduced by 1.5% per year after the age of 25 decreasing hepatic metabolism. Metabolism of the drug in the liver decreases. - Excretion: in older adult is decreased because of the granular filtration rate of the kidneys. GFR decreased by 40-50% primarily due to decreased blood flow. The number of nephrons are also decreased. Explain HIPPA - ANSWERSfirst federal legislation to provide protection for patient records; governs all areas of patient information and management of that information - requires providers to notify patients of privacy policies and obtain written acknowledgement of HIPPA What are the different levels of care - ANSWERS- primary + preventative: educate patients to reduce risk factors for disease eg. immunizations - secondary: diagnosis and treatment of acute disease and illnesses eg. urgent care - tertiary: highly specialized care eg. burn unit, oncology centers, ICU - restorative: respiting health eg. rehab centers, sports medicine - continuing health care: long term or chronic health conditions eg. pain management, hospice How should a patient use a walker - ANSWERSFirst, position your walker about one step ahead of you, making sure that all four legs of the walker are on even ground. With both hands, grip the top of the walker for support and move your injured leg into the middle area of the walker. Do not step all the way to the front. Push straight down on the handgrips of the walker as you bring your good leg up so it is even with your injured leg. Always take small steps when you turn and move slowly. How should a patient use crutches - ANSWERSLean forward slightly and put your crutches about one foot in front of you. Begin your step as if you were going to use the injured foot or leg but, instead, shift your weight to the crutches. Bring your body forward slowly between the crutches. Finish the step normally with your good leg. When your good leg is on the ground, move your crutches ahead in preparation for your next step. Always look forward, not down at your feet. How should a patient use a cane - ANSWERSmake sure it is fitted properly, hold the can on the unaffected side, 4-6 inches away from your leg, move you affected leg forward simultaneously with your cane What needs to be included on physician orders - ANSWERSpatient's full name, date and time the order was written, medication name, dosage, route of administration, time and frequency of administration, signature of the health care provider explain the different documentation formates - ANSWERS- narrative note: restates what the patient states - PIE: Problem or diagnosis, Interventions that will be used, Nursing Evaluation - Focus Charting: uses a DAR (data, action or nursing interferon, response of the patient) to report problems - SOAP Note: Subjective, Objective, Assessment, Plan what are unapproved abbreviations - ANSWERSU or u for unit IU for inernational unit QD of Q.D for daily QOD, Q.O.D for every other day trailing zero lack of a leading zero MS for morphien sulfate MSO4 and MgSO4 What are the professional responsibilities and roles of nurses - ANSWERSAutonomy and accountability, caregiver, advocate, educator, communicator, manager Who developed the middle range theory that includes interpersonal relations among nurse, a patient, and a patient's family and developing the n nurse patient relationship - ANSWERSHildegard Paplau. She found that nurses help reduce anxiety by converting it into constructive actions What are the 6 QSEN (quality and safety education for nurses) competencies - ANSWERS- safety: policies and procedures that protect the patient and provider - patient centered care: involving patients in their healthcare - evidence based practice: using current scientific evidence, clinical experience, and patient preference - informatics: use of info and tech to communicate, and manage knowledge -quality improvement: using data to monitor outcomes of care and using that data to improve the quality of care - team work and collaboration: function effectively in nursing working in a team Define the knowledge, skills, and attitudes necessary to promote safety in a health care setting. - ANSWERSknowledge gained during assessments of the patient's beliefs and attitudes about safety will ensure the chosen inventions are patient centered . Findings for an nurses environmental assessment are critical for planning safety strategies what are the normal lab ranges for K+ - ANSWERS3.5-5 mEq/L what are the normal lab ranges for Na - ANSWERS136-145 mEq/L what are the normal lab ranges for Hct - ANSWERSfor males 42%-52% for females 37%-47% what are the normal lab ranges for Hgb - ANSWERSfor males 14-18 g/dl for females 12-16 g/dl what is the normal lab ranges for WBC's - ANSWERS5,000-10,000 mm^3 what are the normal lab ranges for platelets - ANSWERS150,000 - 400,000 mm^3 what are the normal lab ranges for ammonia - ANSWERS10-80 mcg/dL what are the normal lab ranges for glucose - ANSWERS70-105 mg/dL What are the 5 social determinants of health - ANSWERSeconomic stability, education, health and health care, neighborhood and built environment, social and community contex