NRSG 3302 WOMEN AND FAMILIES EXAM 1
Standards of care: why are they important? - Answer -Standards of care are important
because it allows for continuity across nurses, hospitals, facilities, etc.
Institutional policies - Answer -Are individualized. Every hospital and clinic is different
and have varying policies.
What is scope of practice? - Answer -Defined by the state's Nurse Practice Act.
Identifies the parameters within which nurses may practice. A state sets the parameters
by which a nurse can practice and then an institution can further limit the nurses abilities
- they can never expand
What is informed consent? - Answer -Nurses witness and make sure patients
understand medical treatment
Define negligence. How many elements are there and what are they? - Answer -4
elements.
Duty to provide care
The duty was breached
Injury occurred
Th breach of duty caused the injury
Negligence leads to - Answer -Malpractice and then a lawsuit
Errors of (blank) can be considered negligent - Answer -Omission
What is a potential fifth element of negligence? - Answer -Was the injury foreseeable?
To prove negligence what has to be proven about the nurse? - Answer -It has to be
proven that the nurses failure caused the injury
Case: nurse admitted a pregnant patient at 32 weeks who was reporting severe upper
abdominal pain, nausea, and a headache. Her BP was 165/100 and repeated at 145/90.
Her record indicated hx of elevated BP's and excess protein in her urine. Nurse notified
the MD 20 min after the second BP reading and reported that the patient presented w/
abdominal pain and nausea, stated the patient's BP was 145/90 and that the patient
was unable to void at this time. MD concluded that the patient had gastric disturbance
from the flu.
Later patient had a grand mal seizure. Why would the nurse be considered negligent? -
Answer -Nurse was not reporting all of the information to the MD. There were clear
signs of preeclampsia. Further negligence by not knowing the sx of preeclampsia in a
newborn maternal setting.
,3 Main Points of Informed Consent - Answer -1) must be understandable to the patient.
No jargon, age appropriate speech, correct language. Include risks and benefits,
success rates, and alternatives.
2) must include consequences of not receiving treatment or procedure
3) patient must be told of their right to refuse and that refusing does not result in the
withdrawal of support or care
What is the role of the nurse concerning informed consent? - Answer -We are the legal
witness to the patients signature (legal). We are also the patients advocate and need to
make sure they understand (moral/ethical).
What is mandatory reporting? - Answer -Mandatory reporting is a legal requirement, in
state statute or regulation, for nurses to report an occurrence or individual, including
another nurse, when the public is at risk.
What is autonomy? - Answer -Freedom to choose/decide to submit to treatment
offered. Free of influence and the provider should not judge the patients choice
What is justice? - Answer -Obligation to be fair, to treat the patient w/o malice, bias, or
prejudice. Distribute burdens and benefits equitably.
What is fidelity? - Answer -Keeping promises
What is veracity? - Answer -Share relevant, accurate, clear, and understandable
information. Offer facts, tell the truth, and communicate honestly.
What is nonmalficience? - Answer -Refrain from harming a patient intentionally. Duty to
not hurt them.
What is beneficence? - Answer -Maximize the benefits and minimize potential harm. To
take active steps to benefit the patients welfare. The duty to do good.
What is paternalism? - Answer -Any action, decision, rule, or policy made by a
physician or other caregiver, (or a government), that dictates what is best for the
patient(s) w/o considering the patient's own beliefs and value system. DOES NOT
RESPECT PATIENT AUTONOMY.
What is preferred gestational age? - Answer -40 weeks
What is a fetus viable? (Weeks of gestation) - Answer -Viability is b/t 23-26 weeks
Case: 22 y/o woman in her first pregnancy w/ an unremarkable prenatal course
presents w/ preterm labor at 28 weeks gestation. Contractions were successfully
stopped w/ meds. Discharge planning was reviewed w/ her and she was instructed to
follow a regimen of bed rest and meds. She reported that she did not intend to comply
, with these instructions. She believed that god would not allow her to labor unless it was
time for the baby to deliver and she indicated that He had communicated this to her.
How can the MD ensure nonmalficience towards the mother and still promote
beneficence towards her fetus? Is the mother competent? Should maternal autonomy
prevail over other ethical concerns? - Answer -You can bring in a spiritual counselor,
bring d/c info, bring neonate unit for consult. Have the mother shown the NICU, counsel
them on preemies. Bring in spouse/family. Bring in social services.
How many type of mandatory reporting are there and what are they? - Answer -Three
types of mandatory reporting.
Child abuse (written report within 48 hours. Must file if you suspect abuse. You may call
but then need to file a written report)
Elder abuse (elders are 60+ y/o. Can be emotion, verbal, physical, financial etc.)
Intimate partner violence (state laws vary regarding the duty of health professionals to
report IPV)
Who are some mandated reporters? - Answer -Nurses, doctors, teachers, police
officers, etc
What are the 7 ethical principles? - Answer -Autonomy
Justice
Fidelity
Veracity
Beneficence
Nonmalficience
Paternalism
Maybe bring in a psych consult. She may not be competent. Is she hearing voices? "He
communicated to her". You want to support nonmalficience. If shown to be non-
competent then judicial intervention may be indicated.
What situations create maternal-fetal-newborn ethical dilemmas? - Answer -Abortion
Embryonic stem cell research
Fetal research
Intrauterine fetal research
Assisted reproductive technology (IVF, surrogacy, terminating in multip pregnancy)
Emancipated minors can make their own decisions.
Minor mothers can make decisions for her baby but cannot for herself
Maternal fetal conflict
- forced c/s. Treatment for substance abuse, treatment to correct a fetal defect in utero.
Women on heroin will be put on suboxone or methadone b/c it will help detox the baby.
What would be considered tachysystole? - Answer -Uterine contractions more than 5
within 10 minutes
Standards of care: why are they important? - Answer -Standards of care are important
because it allows for continuity across nurses, hospitals, facilities, etc.
Institutional policies - Answer -Are individualized. Every hospital and clinic is different
and have varying policies.
What is scope of practice? - Answer -Defined by the state's Nurse Practice Act.
Identifies the parameters within which nurses may practice. A state sets the parameters
by which a nurse can practice and then an institution can further limit the nurses abilities
- they can never expand
What is informed consent? - Answer -Nurses witness and make sure patients
understand medical treatment
Define negligence. How many elements are there and what are they? - Answer -4
elements.
Duty to provide care
The duty was breached
Injury occurred
Th breach of duty caused the injury
Negligence leads to - Answer -Malpractice and then a lawsuit
Errors of (blank) can be considered negligent - Answer -Omission
What is a potential fifth element of negligence? - Answer -Was the injury foreseeable?
To prove negligence what has to be proven about the nurse? - Answer -It has to be
proven that the nurses failure caused the injury
Case: nurse admitted a pregnant patient at 32 weeks who was reporting severe upper
abdominal pain, nausea, and a headache. Her BP was 165/100 and repeated at 145/90.
Her record indicated hx of elevated BP's and excess protein in her urine. Nurse notified
the MD 20 min after the second BP reading and reported that the patient presented w/
abdominal pain and nausea, stated the patient's BP was 145/90 and that the patient
was unable to void at this time. MD concluded that the patient had gastric disturbance
from the flu.
Later patient had a grand mal seizure. Why would the nurse be considered negligent? -
Answer -Nurse was not reporting all of the information to the MD. There were clear
signs of preeclampsia. Further negligence by not knowing the sx of preeclampsia in a
newborn maternal setting.
,3 Main Points of Informed Consent - Answer -1) must be understandable to the patient.
No jargon, age appropriate speech, correct language. Include risks and benefits,
success rates, and alternatives.
2) must include consequences of not receiving treatment or procedure
3) patient must be told of their right to refuse and that refusing does not result in the
withdrawal of support or care
What is the role of the nurse concerning informed consent? - Answer -We are the legal
witness to the patients signature (legal). We are also the patients advocate and need to
make sure they understand (moral/ethical).
What is mandatory reporting? - Answer -Mandatory reporting is a legal requirement, in
state statute or regulation, for nurses to report an occurrence or individual, including
another nurse, when the public is at risk.
What is autonomy? - Answer -Freedom to choose/decide to submit to treatment
offered. Free of influence and the provider should not judge the patients choice
What is justice? - Answer -Obligation to be fair, to treat the patient w/o malice, bias, or
prejudice. Distribute burdens and benefits equitably.
What is fidelity? - Answer -Keeping promises
What is veracity? - Answer -Share relevant, accurate, clear, and understandable
information. Offer facts, tell the truth, and communicate honestly.
What is nonmalficience? - Answer -Refrain from harming a patient intentionally. Duty to
not hurt them.
What is beneficence? - Answer -Maximize the benefits and minimize potential harm. To
take active steps to benefit the patients welfare. The duty to do good.
What is paternalism? - Answer -Any action, decision, rule, or policy made by a
physician or other caregiver, (or a government), that dictates what is best for the
patient(s) w/o considering the patient's own beliefs and value system. DOES NOT
RESPECT PATIENT AUTONOMY.
What is preferred gestational age? - Answer -40 weeks
What is a fetus viable? (Weeks of gestation) - Answer -Viability is b/t 23-26 weeks
Case: 22 y/o woman in her first pregnancy w/ an unremarkable prenatal course
presents w/ preterm labor at 28 weeks gestation. Contractions were successfully
stopped w/ meds. Discharge planning was reviewed w/ her and she was instructed to
follow a regimen of bed rest and meds. She reported that she did not intend to comply
, with these instructions. She believed that god would not allow her to labor unless it was
time for the baby to deliver and she indicated that He had communicated this to her.
How can the MD ensure nonmalficience towards the mother and still promote
beneficence towards her fetus? Is the mother competent? Should maternal autonomy
prevail over other ethical concerns? - Answer -You can bring in a spiritual counselor,
bring d/c info, bring neonate unit for consult. Have the mother shown the NICU, counsel
them on preemies. Bring in spouse/family. Bring in social services.
How many type of mandatory reporting are there and what are they? - Answer -Three
types of mandatory reporting.
Child abuse (written report within 48 hours. Must file if you suspect abuse. You may call
but then need to file a written report)
Elder abuse (elders are 60+ y/o. Can be emotion, verbal, physical, financial etc.)
Intimate partner violence (state laws vary regarding the duty of health professionals to
report IPV)
Who are some mandated reporters? - Answer -Nurses, doctors, teachers, police
officers, etc
What are the 7 ethical principles? - Answer -Autonomy
Justice
Fidelity
Veracity
Beneficence
Nonmalficience
Paternalism
Maybe bring in a psych consult. She may not be competent. Is she hearing voices? "He
communicated to her". You want to support nonmalficience. If shown to be non-
competent then judicial intervention may be indicated.
What situations create maternal-fetal-newborn ethical dilemmas? - Answer -Abortion
Embryonic stem cell research
Fetal research
Intrauterine fetal research
Assisted reproductive technology (IVF, surrogacy, terminating in multip pregnancy)
Emancipated minors can make their own decisions.
Minor mothers can make decisions for her baby but cannot for herself
Maternal fetal conflict
- forced c/s. Treatment for substance abuse, treatment to correct a fetal defect in utero.
Women on heroin will be put on suboxone or methadone b/c it will help detox the baby.
What would be considered tachysystole? - Answer -Uterine contractions more than 5
within 10 minutes
