NR 222/ NR222 Exam 3 (New 2026/ 2027 Update) Health and Wellness Guide |Questions & Answers| Grade A| (Verified Solutions) 100% Correct - Chamberlain.

NR 222/ NR222 Exam 3 (New 2026/ 2027 Update) Health and Wellness Guide |Questions & Answers| Grade A| (Verified Solutions) 100% Correct - Chamberlain. Q. Beginning nursing student or any nurse entering a situation in which there is no previous level of experience. The learner learns via a specific set of rules or procedures, which are usually stepwise and linear. ANSWER Novice Q. A nurse who has had some level of experience with the situation. This experience may be only observational in nature, but the nurse is able to identify meaningful aspects or principles of nursing care. ANSWER Advanced Beginner Q. A nurse who has been in the same clinical position for 2 to 3 years. This nurse understands the organization and specific care required by the type of patients. This nurse is a competent practitioner who is able to anticipate nursing care and establish long-range goals. In this phase the nurse has usually had experience with all types of psychomotor skills required by this specific group of patients. ANSWER Competent Q. A nurse with more than 2 to 3 years of experience in the same clinical position. This nurse perceives a patient's clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. This nurse focuses on managing care as opposed to managing and performing skills. ANSWER Proficient Q. A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem. This nurse is able to zero in on the problem and focus on multiple dimensions of the situation. This nurse is skilled at identifying both patient-centered problems and problems related to the health care system or perhaps the needs of the novice nurse. ANSWER Expert Q. Nursing incorporates the art and science of caring and focuses on the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity. ANSWER American Nurses Association (ANA)- definition of nursing Q. Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings. Nursing includes the promotion of health; prevention of illness; and the care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. ANSWER International Council of Nurses (ICN)- definition of nursing The framework nurses use to apply critical thinking in nursing practice for making clinical decisions Nursing process Q. ANA Standards of Nursing Practice (Nursing Process) ANSWER 1. Assessment 2. Diagnosis 3. Outcomes Identification 4. Planning 5. Implementation 6. Evaluation Q. The registered nurse collects pertinent data and information relative to the healthcare consumer's health or the situation. ANSWER Assessment Q. The registered nurse analyzes the assessment data to determine the actual or potential diagnoses, problems, and issues. ANSWER Diagnosis Q. The registered nurse identifies expected outcomes for a plan individualized to the healthcare consumer or the situation. ANSWER Outcomes identification Q. The registered nurse develops a plan encompassing strategies to achieve expected outcomes. ANSWER Planning Q. The registered nurse implements the identified plan. ANSWER Implementation Q. The registered nurse coordinates care delivery. ANSWER Coordination of care Q. The registered nurse employs strategies to teach and promote health and wellness. ANSWER Health Teaching and Health Promotion Q. The registered nurse evaluates progress toward attainment of goals and outcomes. ANSWER Evaluation Q. A statement of philosophical ideals of right and wrong that define the principles you will use to provide care to your patients ANSWER Code of Ethics Q. An essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. ANSWER Autonomy Q. Help patients maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process. ANSWER Caregiver Q. You protect your patient's human and legal rights and provide assistance in asserting those rights if the need arises. ANSWER Patient advocate Q. The most independently functioning nurse. ANSWER Advanced practice registered nurse (APRN) Q. Is an APRN who has graduate preparation (master's degree or doctorate) in nursing and is an expert clinician in a specialized area of practice ANSWER Clinical nurse specialist (CNS) Q. Is an APRN who has graduate preparation in nursing. ANSWER Nurse practitioner (NP) Q. Is an APRN who has graduate preparation in nursing, is also educated in midwifery, and is certified by the American College of Nurse-Midwives. ANSWER Certified nurse-midwife (CNM) Q. Is an APRN with advanced education from an accredited nurse anesthesia program. ANSWER Certified registered nurse anesthetist (CRNA) Q. Works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments. ANSWER Nurse educator Q. Is responsible for management of the nursing staff in a health care agency. ANSWER Nurse administrator Q. Conducts evidence-based practice, performance improvement, and research to improve nursing care and further define and expand the scope of nursing practice ANSWER Nurse researcher Q. Established the first nursing philosophy based on health maintenance and restoration. She saw the role of nursing as having "charge of somebody's health" based on the knowledge of "how to put the body in such a state to be free of disease or to recover from disease" ANSWER Florence Nightingale Q. A state of burnout and secondary traumatic stress. It occurs without warning and often results from giving high levels of energy and compassion over a prolonged period to those who are suffering, often without experiencing improved patient outcomes ANSWER Compassion fatigue Q. Is the trauma that health care providers experience when witnessing and caring for others suffering trauma. ANSWER Secondary traumatic stress Q. The condition that occurs when perceived demands outweigh perceived resources. It is a state of physical and mental exhaustion that often affects health care providers because of the nature of their work environment. ANSWER Burnout Q. Describes the study of all the genes in a person and interactions of these genes with one another and with that person's environment ANSWER Genomics Q. The observed outcome of critical thinking and decision making (identify a prioritized patient concern, and generate the best possible evidence-based solutions to make the decisions needed to deliver safe patient care.) ANSWER Clinical judgement The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process Critical thinking A form of decision making that involves being able to understand and think through clinical problems, gather information about the problem, analyze clues or individual cues, understand the meaning of evidence, and know when there is enough information to make an accurate diagnosis. Diagnostic reasoning Moves from reviewing specific data elements to making an inference by forming a conclusion about the related pieces of evidence. Inductive reasoning Moves from the general to the specific. Deductive reasoning An in-depth knowledge of a patient's patterns of responses within a clinical situation and knowing the patient as a person. Knowing the patient Level of Critical Thinking- • Answers to complex problems are perceived as either right or wrong (e.g., when an intravenous [IV] fluid is not infusing correctly, the rate must be regulated correctly). • A single solution usually resolves each problem (e.g., adjusting the rate instead of trying to position the patient's arm to prevent catheter kinking). • This is an early step in developing critical thinking. Basic Level of Critical Thinking- • Make clinical decisions more independently. • Creativity allows nurses to generate many ideas quickly, be able to change viewpoints, and create original solutions to problems. • Thinking abilities and initiative to look beyond expert opinion begin to change. Complex Level of Critical Thinking- • Able to consider wider array of clinical alternatives for a patient's situation. • Recognize that sometimes a proper action is the decision to not act or to delay an action until a later time based on experience and knowledge. • Able to apply all elements of clinical judgment model almost automatically. Commitment Involves purposefully visualizing a situation and taking the time to honestly review everything you remember about it. Reflection Belief in oneself, one's judgment and psychomotor skills, and one's possession of the knowledge and the ability to think critically Confidence As you gain new knowledge, you learn to consider a wide range of ideas and concepts before making a judgment. Thinking independently A critical thinker deals with situations justly. This means that you do not let bias or prejudice affect your decisions. Fairness The knowledge that you are accountable for your decisions, actions, and critical thinking. Responsibility Desirable, particularly when the result is a positive outcome. A critical thinker will take risks when trying different ways to solve problems. The willingness to take risks, without causing harm to a patient, comes from experiences with similar clinical problems Risk taking Misses few details when assessing a patient, considering care options and resources, or making decisions about nursing intervention Discipline A critical thinker is determined to find effective solutions to patient care problems Perserverance This means that you find solutions outside the standard routines of care while still following standards of practice. Creativity Critical thinkers question and test their own knowledge and beliefs. As a nurse it builds trust from your co-workers. Integrity Admitting to any limitations in your knowledge and skill. Humility and self-awareness A guideline or principle for rational thought. Intellectual standard Refer to ethical criteria for nursing judgments, evidence-based criteria used for evaluation, and criteria for professional responsibility Professional standard Type of Assessment- conducted during a nursing history Patient- centered interview Type of Assessment- conducted during ongoing contact with patients Periodic assessments Your patients' verbal descriptions of their health problems gathered during interviews (informal and formal). Include patient feelings, perceptions, and self-reported symptoms. Subjective data The findings resulting from observation of patient behavior and clinical signs as well as direct measurement, including what you see, hear, and touch. Objective data Phases of Assessment Interview 1. Orientation or setting an agenda 2. Working phase—collecting assessment data 3. Termination of the interview Begin by introducing yourself. Explain why you are collecting data and that you will keep all information confidential Orientation or setting an agenda Involves gathering accurate, relevant, and complete information about a patient's condition. Working phase—collecting assessment data You summarize your discussion with a patient and check for accuracy of the information you collected during this phase of an interview. Termination phase Types of questions you ask to seek specific information about a problem. Close-ended questions What type of question are these en example of 1. "It seems to me this is bothering you quite a bit. Is that true?" 2. "That wasn't very hard to do, do you agree?" Leading questions Active listening prompts such as "all right," "go on," or "uh-huh." This technique shows that you have heard what a patient says, are interested in hearing the full story, and are encouraging the patient to give more details. Back channeling A formal method used to collect data about a patient Nursing health history Using PQRST to guide your assessment, what does each word stand for P—Provokes: How did it come about? What might be the causes for the symptom? What makes it better or worse? Are there activities (e.g., exercise, sleep) that affect it? Q—Quality: What does the symptom feel like? If the patient has difficulty in describing symptoms, offer probes. What does the illness or symptom mean to the patient? R—Radiate: Where is the symptom located? Is it in one place? Does it go anywhere else? Have the patient be as precise as possible. S—Severity: Ask the patient to rate the severity of a symptom on a scale of 0 to 10 T—Time: Assess the onset and duration of symptoms. When did the symptom first occur? Does it come and go? If so, how often and for how long? What time of day or on what day of the week does it occur? Involves systematic collection of subjective information from patients about the presence or absence of health-related issues in each body system. Review of systems (ROS) The comparison of data with another source to determine data accuracy. Validation Nursing assessment involves two steps: 1. The collection of information from as many sources as possible 2. The interpretation and validation of data to determine whether more data is needed or if the database is complete to make clinical judgments. medical record a confidential, permanent legal documentation of information relevant to patient's health care -treatment received, patient education, continuing status, etc report oral, written or audiotape exchanges of information between healthcare team -change of shift, accident, incident informatics use of information and computer technology to support all aspects of nursing practice healthcare informatics system group of systems used within a health care organization that support and enhance health care administrative information system used to manage the financial, personnel, materials, facilities, and other resources used in the delivery of healthcare services -payroll, quality clinical information systems monitoring systems, order entry, and laboratory, radiology, and pharmacy systems -EHR/EMR -CPOE computer provider order entry (CPOE) where physicians enter orders electronically benefits of computerized documentation reduction of errors standardized nursing care plans increased nurse productivity electronic medical record (EMR) patient medical record from a single medical practice, hospital, or pharmacy -part of EHR electronic health record (EHR) a computerized lifelong health care record for an individual that incorporates data from providers who treat the individual joint commission an independent, not-for-profit organization that evaluates and accredits healthcare organizations audits determine if quality standards have been met care that is undocumented is not _________. done reimbursement determined by DRGs (diagnostic related groups) how should you write subjective info on charts? using quotation marks military time 24 hr clock begins at 0001 and ends at 2400 -ex) 11:42 am is 1142 hrs 2:00 pm is 1400 hrs what time is 7pm military time? 1900 hrs problem-oriented medical record (POMR) documentation system organized according to the person's specific health problems -includes database, problem list, plan of care, and progress notes database (POMR) includes all available assessment information problem list (POMR) created by members of the health care team after assessment information is analyzed -can add/remove -main diagnosis is first -chronological order care plan (POMR) for nurses, includes nursing diagnosis, expected outcomes, and interventions -developed for each member of the health care team progress notes (POMR) monitor and record progress of patient narrative documentation records information as a sequence of events in a story-like manner -traditional method -common in emergency situation SOAP documentation subjective-objective assessment plan -used by nurse practitioners PIE documentation problem intervention evaluation -oriented from problem -flowsheet for daily assessment -simplifies documentation focus charting (DAR) data action response -incorporates all aspects of the nursing process -highlights a patient's concerns -can be integrated into any clinical setting -signs, symptoms, behavior -nursing diagnosis charting by exception reduces time of documenting by check marking info but when things are abnormal it must be written out to not change in patient condition benefits of charting by exception easy to track unexpected changes eliminates repetition and subjective data decreases time spent on charting case management model of delivering care that includes a multidisciplinary approach -quality care in the most cost effective way critical pathway used to monitor and direct patient care -fosters identification of variances variance the unexpected event that occurs during the use of a clinical pathway; can be positive or negative admission nursing history form guides the nurse through a complete assessment to ID relevant nursing diagnoses or problems -baseline for data and changes within condition -used for diagnosis flow sheets and graphic records help team members quickly see patient trends over time and decrease time spent on writing narrative notes patient care summary contains an overview of valuable patient information such as documentation, lab and test results, orders, and medications -shredded at the end of the day of care standardized care plan formal plan that specifies nursing care for a group of clients with common needs discharge summary form completed when patient is being discharged or transferred to another institution or home -may include instructions for care and the final progress note acuity record rank patients as high-to-low acuity in relation to both the patient's condition and need for nursing assistance or intervention. -determines nursing staff & time spent hand-off report any time one health care provider transfers care of a patient to another health care provider -change of shift report -transfer report telephone report notifying physician -SBAR communication (situation background assessment recommendations) -cannot be taken by students -should reverify w/ doctor then document orders incident report reporting falls, medication errors, etc -not part of patient record what does pain alert us to? tissue damage gate-control theory the theory that the spinal cord contains a neurological "gate" that blocks pain signals or allows them to pass on to the brain -when the gate is open pain impulses pass through -when the gate is closed by neuromodulators pain impulses are blocked/regulated -Melzac & Wall 1990s -CNS pain threshold the point at which a person feels pain pain pathway Transduction Transmission Modulation Perception transduction signal formulated and pain begins -converts energy produced by stimuli into electrical energy -stimulus can be energy, heat, trauma, chemicals -thermal, mechanical, or chemical -release biochemical mediators such as histamine, bradykinin transmission how an electrical signal is sent -cellular damage from injury results in the release of excitatory neurotransmitters -pain stimulus enters spinal cord - travels along peripheral nerve fibers -afferent (towards the brain) -2 fibers (large and small) A fibers myelinated, large, conduct impulse fast -delta fibers C fibers unmyelinated, small diameter, afferent nerve fibers that transmit pain slowly to the CNS, resulting in pain sensations that are diffuse, long-term, and aching -chronic perception receiving and interpretation of impulse -CNS takes location, duration and quality -thalamus is the first structure reached modulation brain stimulates descending neurons that inhibit ascending pathway, producing natural pain relief -excretes endogenous opioids and neurotransmitters seretonin and epinephrine -work to inhibit painful stimuli -reflex response pain reception intact PNS and spinal cord -trauma -diabetes protective reflex mechanism sensory neurons synapse over to motor neurons and muscles reflex acute/transient pain Protective, identifiable, short duration; limited emotional response chronic/persistent noncancer pain is not protective, has no purpose, may or may not have an identifiable cause -greater than 6 mos chronic episodic pain occurs sporadically over extended duration cancer can be acute or chronic; nociceptive, and/or neuropathic -tumor progression -invasive procedures and treatments idiopathic chronic pain without identifiable physical or physiological cause visceral pain internal organs -vague and not well localized bone pain becomes worse with movement -common w/ trauma, metastatic cancer muscle spasms cramping and pulling sensation referred pain pain that is felt in a location other than where the pain originates radiating pain pain that spreads out from an area -common in myocardial infarction (heart attack) -spreads to jaw, down the arm phantom pain pain or discomfort felt in an amputated limb remission the temporary, partial, or complete disappearance of the symptoms of a disease without having achieved a cure exacerbation period in chronic illness when the symptoms of the disease reappear and worsen -an ACUTE onset of a CHRONIC illness intractable pain severe chronic pain that is extremely resistant to relief measures PQRSTU P- precipitating factors Q- quality of pain R- relief measures R- region S- severity (pain scale) T- timing U- "you" how it is affecting patient and their ADLs COLDSPA Character Onset Location Duration Severity Pattern Associated factors concomitant existing concurrently -factors accompanying disease -ex) fatigue, anger, fear physical methods of pain relief positioning and hygiene cutaneous simulation transcutaneous electrical nerve stimulation (TENS) cognitive measures of pain relief anticipatory guidance distraction (music, humor) guided imagery hypnosis behavioral pain relief interventions relaxation meditation biofeedback nonopioid analgesics acetylsalicylic acid (ASA- aspirin) acetaminophen non-steroidal anti-inflammatory agents (NSAIDs- ibuprofen, naproxen) toradol opioid anagesic demerol morphine codeine hydrocodone oxycodone adjuvants sedatives anticonvulsants antidepressants antianxiety agents muscle relaxants corticosteroids (hydrocortisone, decadron, prednisone) transdermal patch a small patch with medication placed on the skin -worn 48-72 hrs placebo doses that contain no pharmacologic actions -considered unethical nerve block anesthesia an injection made into a nerve to block the conduction of impulses between the nerve and the CNS epidural administered in epidural space via a catheter for long or short term therapy -prevent displacement -prevent infection -monitor for respiratory depression -maintain catheter function -maintain urinary function -prevent complications such as nausea and vomiting restorative care to provide the client with long term pain control -morphine infusion -hospice -pain clinics -end-of-life care surgical asepsis sterile technique/asepsis -ABSENCE of all microorganisms -used when skin's integrity is compromised -incision or puncture of skin -insertion of catheter, devices or instruments into body cavities sterile field organism free area prepared for sterile procedure -includes surfaces or equipment -can never be covered -must remain in view -establish immediately prior to use -avoid sudden movements -avoid coughing, sneezing, or talking over sterile objects must remain above what? the waist TRUE or FALSE: the sterile border is the 2 inches on the edges of sterile field FALSE; 1 inch surgical conscience feeling that one must and will strictly adhere to principles of sterile technique how long can you use saline for after it's opened? 24 hrs which glove do you apple first when donning sterile gloves? dominant pressure injury localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device normal capillary pressure 12-22 mm Hg accluded vessel when capillary pressure surpasses 32 mm Hg -shut contributing factors to pressure ulcers shearing force friction excessive moisture poor nutrition slough thick, yellow dead tissue -must use debridement to assess injury eschar thick, necrotic, devitalized tissue -similar to slough but darker stage 1 pressure injury intact skin with localized area of nonblanchable erythema stage 2 pressure injury partial thickness skin loss with exposed dermis stage 3 pressure injury full thickness tissue loss with visible adipose tissue stage 4 pressure injury full thickness tissue loss with exposed bone, muscle, tendon or ligament unstagebale pressure ulcer full thickness tissue loss -depth unknown due to slough and/or eschar in the wound bed deep tissue pressure injury purple or maroon localized area of discolored intact skin or blood-filled blister ischemia lack of blood flow to tissues hyperemia redness of the skin due to increased blood flow -blanchable Braden Scale sensory perception moisture activity mobility nutrition friction shear -higher score=lower risk high risk= 10-12 extremely high risk= 9 how often should you turn a bed bound patient? minimum of every 2 hrs anasarca severe generalized edema scar tissue never as strong as original tissue -not tinsile enough nicotine effects on wound healing vasoconstriction hypertension delayed wound healing Hoyer lift a piece of equipment designed to raise a patient slowly above a surface to assist in transferring the patient to another surface effects of obesity on wound healing excess adipose tissue has less blood supply stress effects on wound healing increased levels of cortisone which slow wound healing primary intention wounds with little or no tissue loss -clean cut -surgical incision -edges well approximated -lower risk for infection secondary intention wound involving loss of tissue, skin edges cannot coem back together -pressure injuries -heals from inside out -granulation tissue grows and fills wound bed tertiary intention delayed primary closure -ensure that there is no infection before; could be a surgical wound that got infected and it needs to stay open to get the infection out, once the infection is removed then the surgeon will close it up to heal by primary intention -common w/ emergency surgery such as ruptured appendix partial thickness wound repair loss of only epidermis and/or part of dermis -inflammatory response -epidermal repair -dermal repair partial thickness wound heals by ________ primary intention inflammatory response erythema, increased blood flow to area -may be red, swollen -usually 1st 24 hrs after injury dermal repair epidermal and dermal repair happen simultaneously -epidermal cells migrate across wound to approximate edges -24-72 hrs after injury full thickness wound repair loss of epidermis, dermis, and possible extension into subcutaneous layers, bone and/or muscle -hemostasis phase -inflammation phase -proliferative phase -remodeling phase full thickness wound heals by __________ secondary intention hemostasis phase body sends platelets, blood vessels constrict to slow bleeding inflammation phase WBC migrate and clean -can last up to 3 days or even longer proliferative phase production of new tissues -epithelialization -new capillaries formed -collagen fibers regenerated -wound coming back together remodeling phase collagen reorganizing to make tissue stronger -about 1 yr -scar tissue debridement removal of tissue lacking blood supply and foreign matter from a wound granulation tissue pink to beefy red moist tissue that contains new blood vessels, collagen, and fibroblasts; repair to dermis ecchymosis brusing/purple tissue cellulitis inflammation in cells and tissue characterized by redness, swelling, and tenderness -signifies spreading of infection induration accumulation of collagen by day 5-9 after surgery extending 1 cm on either side of surgical incision -hardness or firmness of skin wound base center/cleanest point of wound wound margin rim or border of wound scant amt. of drainage less than 25% small amt. of drainage 25% moderate amt. of drainage 50% large amt. of drainage 75% saturated dressing 100% serous drainage clear, watery plasma purulent drainage thick green, yellow, or brown drainage -sign of infection -often has foul odor serosanguineous drainage pale, red, watery: mixture of serous and sanguineous sanguineous drainage bright red; indicates active bleeding hemorrhage internal or external bleeding hypo-bulimic shock happens as a result of hemorrhage inside internal organ hematoma localized collection of of clotted blood underneath tissues -often happens as a result of internal hemorrhage dehiscence separation of wound layers evisceration wound separation with protrusion of organs always clean from ________ to ________ least contaminated to most contaminated -clean to dirty -inside wound to outside how should you clean a linear wound? inside wound, away from you, towards you how should you clean a drain site? clockwise motion what should you remember when irrigating wound? irrigate from least to most contaminated -keep solution at body temp -slow continuous pressure -tip should not touch wound stitches sterile thread used to close a wound or surgical opening; suture -monofilament thread steri-strips adhesive tape that allows for rapid slots urge of wounds margins -stay on 7-10 days and should fall off on their own staples uses staple gun and staple remover what should we remember when removing sutures? -only snip once -never pull visible contaminated portion through underlying tissue JP drain (Jackson Pratt) hollow bulb-like device used to collect drainage Hemovac Closed wound drainage system connected to a suction often used for mastectomy and total knee/hip replacement TRUE or FALSE: Nurses can insert drainage devices. FALSE -only physicians can insert these when should we empty drainage devices? when they become half full who does the 1st dressing change? physician montgomery straps special adhesive strips that are applied when dressings must be changed frequently at the surgical site -tie instead of tapes ABD pad thick, absorbent pad for abdominal wounds transparent film dressing traps wounds moisture over the wound -ideal for small superficial wounds -can remain in place for up to 5-7 days -allows visual assessment of wound bed without removing dressing hydrocolloid dressing opaque, biodegradable, non-breathable, adherent dressing -maintains a moist environment alginate dressing soft, absorbent, cotton like, for wounds with exudate, require packing and absorption, absorb a TON enzymatic debriding agents (EBA) cream which eats dead tissue -used for diabetic necrotic ulcers pallor paleness parasthesia tingly feeling "falling asleep" 5 Ps of bandages and binders pallor pain parasthesia paralysis pulselessness abdominal binder supports large incisions vulnerable to stress splinting use of pillow or towel to apply pressure to wound when stress such as sneezing, coughing, or standing occurs negative pressure wound therapy (NPWT) and wound vacuum assisted closure (wound vac) device that assists with wound closure by applying negative pressure to draw wound edges together -improves tissue perfusion -removes drainage -stimulates granulation tissue and wound contraction -mechanical debridement of wound when would a wound vac be used? chronic open surgical wounds traumatic wounds stage 3 and 4 pressure ulcers heat therapy promotes vasodilation -improves blood flow -promotes muscle relaxation -reduces pain from muscle spasms treats edematous body parts, menstrual cramping; hemorrhoidal, perineal and vaginal inflammation -localized joint pain, muscle strains, and lower back pain moist heat therapy whirlpool sitz bath moist compression dry heat therapy heating pads aquathermia pads cold therapy promotes vasoconstriction -reduces blood flow -reduces edema and inflammation -reduces muscle spasms often used immediately after direct trauma such as strains, sprains and fractures -after minor burns, superficial lacerations or puncture wounds -decreases inflammation sitz bath a warm soak of the perineal area to clean perineal wounds and reduce inflammation and pain -help hemorrhoids and healing after birth common law decided upon by a judge -ex) Roe v. Wade statutory law law passed by the U.S. Congress or state legislatures -ex) nurse practice acts -Administrative Disability Acts (ADA) administrative law regulatory agencies -rules and regulations that govern us -renewing licenses every 1-2 yrs nursing licensure compact (NLC) a multistate licensing arrangement that enables traveling nurses to function in multiple states criminal law against the safety and health of the public -practicing w/o a license -misuse of narcotics --felony --misdemeanor civil law focuses on relationships -wrongful actions or omissions against a person or their property -monetary compensation --assault --battery --negligence (nonintentional) --malpractice informed consent the patient's autonomous decision about whether to undergo a surgical procedure or study -responsibility of health care provider to obtain, not RN delegation the transfer of responsibility for the performance of an activity to another individual while retaining accountability for the outcome mandated reporting must report when has knowledge of or observes child abuse, sexual abuse, elder abuse, suicidal behaviors, or communicable disease legal nurse consultant function on legal time to give medical advice, read charts, and give lawyers medical insight restraint any manual method that reduces patient to move freely -can result in serious injury or death Good Samaritan Act urges nurses to provide care in emergency -only under scope of practice risk management/quality improvement committees who form plans to decrease incidence of problems advance directives patient's right to refuse care -living will -DNR (do not resuscitate) -DNI (do not intubate) power of attorney grants power to a representative of your choosing to legally act and make decisions on your behalf altruism unselfish concern for the welfare of others autonomy independence -both nurse and patient nonmaleficence do no harm beneficence doing good deontology defines actions as right or wrong -based on truths and justice utilitariansim based of consequences -determines value off usefulness -greatest good fro greatest # of people feminist ethics decisions based off how they will effect women and act in a way to repair women's history ethics of care suggest that health care workers resolve ethical dilemmas by paying attention to relationships and stories of the participants and by promoting a fundamental act of caring unintentional injuries falls, motor vehicle crashes, poisonings, drowning, fire associated injuries, suffocation by ingested objects, and firearms intentional injuries deliberate acts of violence or abuse and often have fatal consequences such as suicide and homicide Maslow's Hierarchy of Needs physiological safety love/belonging esteem self-actualization sentinel event an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof -must be investigated and reviewed by the Joint Commission internal factors affecting safety body system integrity lifespan external factors affecting safety pollution lighting communicable diseases workplace hazards lead poisoning causes irreversible damage & problems in children -often caused by paint 6 rights of medication right drug right dose right time right patient right route right documentation John Hopkins Fall Assessment Tool seven-item tool, used in hospitals -can be completed quickly and easily -includes fall prevention intervention guidelines Morse Fall Scale Six-item fall risk assessment tool, widely used nationally and internationally since the late 1980s in acute care and long-term care settings Hendrich II Fall Risk Model eight-factor assessment model, well established and used widely in acute care settings to assess the fall risk of patients RACE (fire safety) rescue all patients activate fire alarm contain the fire extinguish the fire intrapersonal communication communication with oneself interpersonal communication direct, face-to-face communication between two or more people public communication interaction with an audience preinteraction phase before meeting the patient -gather data from chart or peers orientation phase describe purpose of interview and data to be collected, time to be acquainted -identify and prioritize patient goals working phase nurse and patient work together to solve problems and accomplish goals termination phase indicate interview ending soon, allow questions dysarthria the inability to use speech that is distinct and connected because of a loss of muscle control after damage to the peripheral or central nervous system expressive aphasia trouble communicating thoughts through speech or writing receptive aphasia inability to understand spoken or written words kidneys primary filter in the body nephron functional unit of the kidney -filters and produces urine glomerulus initial site of urine production -filters glucose tubule 98% is reabsorbed -travels down ureters to bladder increased alcohol absorption leads to _________ ADH decreased -therefore, the person will urinate more what effect does caffeine have on the bladder? it increases bladder contractions what effect does anesthesia have on bladder contractions? it decreases bladder contractility very dark urine liver disease -excessive billirubin blue/green urine Amitryptiline or Elavil orange urine Phenazopyridine or pyridium (prescribed to UTI patients)