ATI Fundamentals for Nursing RN

ATI Fundamentals for Nursing RN Medicare - CORRECT ANSWERS public federally funded programs. clients over age 65 and/or with permanent disabilities. Medicaid - CORRECT ANSWERS for clients with low income. is federally funded and individual states determine eligibility requirements. Traditional Insurance - CORRECT ANSWERS reimburses for services on fee-forservice basis. Managed Care Organizations (MCOs) - CORRECT ANSWERS comprehensive care is overseen by a primary care provider & focuses on prevention and health promotion Preferred Provider Organizations (PPOs) - CORRECT ANSWERS client chooses from a list of contracted providers. using non-contracted providers increases the client's out of pocket costs Exclusive Provider Organizations (EPOs) - CORRECT ANSWERS the client chooses from a list of providers within a contracted organization Long-Term Care Insurance - CORRECT ANSWERS provides for long-term care expenses not covered by Medicare Preventive health care - CORRECT ANSWERS focuses on educating and equipping clients to reduce and control risk factors of disease. Examples include immunizations, stress management programs, and seat belt use Primary health care - CORRECT ANSWERS emphasizes health promotion, and includes prenatal and well-baby care, nutrition counseling, and disease control. is based on a sustained partnership between client and provider. examples include office or clinic visits and scheduled school/work centered screenings (vision, hearing, obesity) Secondary health care - CORRECT ANSWERS includes the diagnosis and treatment of emergency, acute illness, or injury. examples include care given in hospital settings (inpatient and EDs), diagnostic centers, or emergent care centers Tertiary health care - CORRECT ANSWERS involves the provision of specialized highly technical care. examples include oncology centers and burn centers Restorative health care - CORRECT ANSWERS involves intermediate follow-up care for restoring health. examples include home health care, rehab centers, and skilled nursing facilities Continuing health care - CORRECT ANSWERS designed to address long-term or chronic health care needs. examples include hospice, adult day care, and in-home respite care Health care regulatory agencies include: - CORRECT ANSWERS -US Dept of Health and Human Srvcs -US FDA -State and local public health agencies -State licensing boards (to ensure providers & agencies comply with state regulations) -the Joint Commission/JCAHO (set quality standards for accreditation of health care facilities) -Professional Standards Review Organizations (PSROs) -Utilization review committees (monitor for appropriate diagnosis and treatment of hospitalized clients) Clergy - CORRECT ANSWERS Job: provide spiritual care to client (pastors, rabbis, priests) Refer to when: the client requests communication or the family asks for prayer prior to client undergoing a procedure Registered dietitian - CORRECT ANSWERS Job: assess, plan for, and educate the client reg. nutritional needs; direct care of nutritional aids Refer to when: ex- the client has low nutrient levels and/or experienced a recent unexplained weight loss Lab tech - CORRECT ANSWERS Job: obtain specimens of the client's body fluids and perform the necessary diagnostic tests Refer to when: ex- the provider orders a CBC to be performed immediately Occupational therapist - CORRECT ANSWERS Job: assess and plan for the client to regain ADLs, esp motor skills of the upper extremities; direct care of occupational therapy assistants Refer to when: ex- client has difficulties using an eating utensil with dominate hand following a stroke Pharmacist - CORRECT ANSWERS Job: provide & monitor meds for the client as prescribed by the provider; supervises pharm techs in states in which the practice is allowed Refer to when: client concerns over meds; dosage concerns; etc Physical Therapist - CORRECT ANSWERS Job: assess and plan for client to increase musculoskeletal functions, esp of lower extremities, to maintain mobility; direct care of physical therapy assistants Refer to when: ex- following a hip replacement, a client requires assistance learning to ambulate and regain strength Provider - CORRECT ANSWERS Job: assess, diagnose, and treat cllient for disease and/or injury; includes MDs, DOs, APNs, and PAs Refer to when: ex- client experiences change in vital signs Rad Tech - CORRECT ANSWERS Job: position client and perform x-rays and other imaging procedures for providers to review for diagnosis of disorders of various body parts Refer to when: ex- provider orders x-ray of client's hip after a fall Respiratory therapist - CORRECT ANSWERS Job: evaluate resp status and provide prescribed resp treatments including O2 therapy, chest physiotherapy, inhalation therapy, and artificial mechanical ventilation Refer to when: ex- client with resp disease experiences SOB and requests nebulizer treatment that is ordered PRN Social Worker - CORRECT ANSWERS Job: work with client and client's family by coordinating inpatient and community resources to meet psychosocial and environmental needs that are necessary for recovery and/or discharge Refer to when: ex- client dying of cancer wishes to go home but is unable to perform ADLs; the spouse needs med equipment in the home to care for client Speech therapist - CORRECT ANSWERS Job: evaluate and make recommendations regarding the functions of speech, language, and swallowing impacted by various client disorders or injuries; teach client techniques and exercises to improve function when possible Refer to when: ex- a client is having difficulty swallowing a regular diet after trauma to the head and neck Registered Nurse (RN) - CORRECT ANSWERS -Functions under state nurse practice laws -Perform assessments; establish nursing diagnoses, goals, and interventions; conducts ongoing client evaluations -Participate in developing interdisciplinary plans for client care -Share best practices; continuing education Licensed Practical Nurse (LPN) - CORRECT ANSWERS -Works under supervision of the RN -Collaborate with other team members -Possess technical knowledge and skills -Participate in the delivery of nursing care, using the nursing process as a framework Unlicensed Assistive Personnel (UAP) - CORRECT ANSWERS -Includes CNAs, CMAs, and non-nursing personnel -Work under direct supervision of an RN or LPN -Specific tasks usually outlined in position description -Tasks may including feeding clients, preparing meals, lifting, basic care, measuring & recording vital signs, and ambulating clients The foundation of ethics is based on: - CORRECT ANSWERS an expected behavior of a certain group in relation to what is considered right and wrong; it is the study of conduct and character Morals are: - CORRECT ANSWERS the values and beliefs held by people that guide their behaviors and decision making Ethical theory examines: - CORRECT ANSWERS the different principles, ideas, systems, and philosophies used to make judgments about what is right/wrong and good/bad Ethical principles - CORRECT ANSWERS standards of what is right/wrong with regard to important social values and norms Autonomy - CORRECT ANSWERS ability of client to make personal decisions, even when those decisions may not be in the client's best interest Beneficence - CORRECT ANSWERS agreement that the care given is in the best interest of the client; taking positive actions to help others Fidelity - CORRECT ANSWERS agreement to keep one's promise to the client about care that was offered Justice - CORRECT ANSWERS fair treatment in matters related to physical and psychosocial care and use of resources Nonmaleficence - CORRECT ANSWERS avoidance of harm or pain as much as possible when giving treatments Hospital's ethics committee - CORRECT ANSWERS may meet to discuss/resolve unusual or complex ethical issues; not a legal entity Ethical dilemmas are: - CORRECT ANSWERS problems about which more than one choice can be made and the choice made is influenced by the values and beliefs of the decision makers A problem is an ethical dilemma if: - CORRECT ANSWERS -it cannot be solved solely by a review of scientific data -it involves a conflict between two moral imperatives -the answer will have a profound effect on the situation/client Steps in ethical decision making - CORRECT ANSWERS -identify whether or not the issue is indeed an ethical dilemma -state the ethical dilemma including all surrounding issues and individuals involved -list and analyze all possible options for resolving the dilemma and review implications of each option -select option that is in concert with the ethical principle applicable to this situation, the decision maker's values and beliefs, and the profession's values set forth for client care; justify why chosen over other options -apply this decision to the dilemma and evaluate the outcomes Advocacy - CORRECT ANSWERS support of the cause of the client regarding health, safety, and personal rights Responsibility - CORRECT ANSWERS willingness to respect obligations and follow through on promises Accountability - CORRECT ANSWERS ability to answer for one's own actions Confidentiality - CORRECT ANSWERS protection of privacy without diminishing access to quality care According to the UDDA, death is determined by one of two criteria: - CORRECT ANSWERS -an irreversible cessation of circulatory and respiratory functions -irreversible cessation of all functions of the entire brain, including the brain stem A determination of death must be made: - CORRECT ANSWERS in accordance with accordance with accepted medical standards Nurse's roles in ethical decision making include: - CORRECT ANSWERS -agent for client facing an ethical decision: adolescent child debating on abortion; parent contemplating blood transfusion even when against religious beliefs -decision maker in regard to nursing practice: increasing staff load due to shift cuts; witnessing a surgeon discussion only surgical options without informing client of more conservative options Entities with codes of ethics that may be used to guide nursing practice include: - CORRECT ANSWERS -the American Nurses Association (ANA) -the International Council of Nurses (ICN) -the National Association for Practical Nurse Education and Services, Inc. By practicing nursing within the confines of the law, nurses are able to: - CORRECT ANSWERS -shield oneself from liability -advocate for client's rights -provide care that is within the nurse's scope of practice -discern the responsibilities of nursing in relationship to the responsibilities of other members of the health care team -provide safe, competent care that is consistent with standards of care Federal laws impacting nursing practice include: - CORRECT ANSWERS -HIPAA -ADA -the Mental Health Parity Act (MHPA) -the Patient Self-Determination Act (PSDA) Criminal law: - CORRECT ANSWERS -is a subsection of public law -relates to the relationship of an individual with the government -ex: a nurse falsifies a record to cover up a serious mistake may be found guilty of breaking a criminal law Civil law: - CORRECT ANSWERS -protect the individual rights of people -one type that relates to the provision of nursing care is tort law Types of unintentional torts - CORRECT ANSWERS -Negligence -Malpractice (professional negligence) Types of quasi-intentional torts - CORRECT ANSWERS -Breach of confidentiality -Defamation of character Types of intentional torts - CORRECT ANSWERS -Assault -Battery -False imprisonment Negligence - CORRECT ANSWERS example: a nurse who fails to implement safety measures for a client who has been identified as at risk for falls Malpractice (professional negligence) - CORRECT ANSWERS example: a nurse administers a large dose of medication due to a calculation error; the client has a cardiac arrest and dies Breach of confidentiality - CORRECT ANSWERS example: a nurse releases the medical diagnosis of a client to a member of the press Defamation of character - CORRECT ANSWERS example: a nurse tells a coworker that she believes the client has been unfaithful to her spouse Assault - CORRECT ANSWERS example: the conduct of one person makes another person fearful and apprehensive (threatening to place a nasogastric tube in a client who is refusing to eat). Battery - CORRECT ANSWERS example: intentional and wrongful physical contact with a person that involves and injury or offensive contact (restraining a client and administering an injection against her wishes) False imprisonment - CORRECT ANSWERS example: a person is confined or restrained against his will (using restraints on a competent client to prevent his leaving the health care facility) State laws - CORRECT ANSWERS -regulate the core of nursing practice -each state has enacted statutes defining parameters of practice and gives authority to regulate to the state board of nursing Board of nursing - CORRECT ANSWERS -has authority to adopt rules and regs for nursing practice in that state -has authority to both issue and revoke a nursing license -set standards for nursing programs -delineate scope of practice among RNs, LPNs, and APNs Nurse licensure compact - CORRECT ANSWERS allows licensed nurses who reside in a compact state to practice in other compact states under a multi-state license; must provide care in accordance to statutes and rules in state care is being provided Professional negligence - CORRECT ANSWERS -failure of person with professional training to act in a reasonable and prudent manner -issues that prompt malpractice suits include failure to: follow standards of care, use of equipment in responsible & knowledgeable manner, effectively & thoroughly communicate with the client, document care was provided 5 elements necessary to prove negligence - CORRECT ANSWERS 1) duty to provide care as defined by a standard 2) breach of duty by failure to meet standard 3) foreseeability of harm 4) breach of duty has potential to cause harm (combines 2&3) 5) harm occurs Nurses can avoid being liable for negligence by: - CORRECT ANSWERS -following standards of care -giving competent care -communicating with other health team members -developing a caring rapport with clients -fully documenting assessments, interventions, and evaluations Client's rights - CORRECT ANSWERS -legal guarantees that clients have with regard to their health care -situations where nurses have opportunity to protect client's rights include: informed consent, refusal of treatment, advanced directives, confidentiality, and information security Resident rights - CORRECT ANSWERS further protection of rights for residents in nursing facilities that participate in Medicare programs; govern the operation of such facilities Nurse's role in client rights includes: - CORRECT ANSWERS -client understands their rights -protecting rights of clients under their care The client has the right to: - CORRECT ANSWERS -be informed about the aspects of care in order to be active in the decision making process -accept, refuse, or request modification to the plan of care -receive care that is delivered by competent individuals who treat the client with respect Informed consent - CORRECT ANSWERS legal process by which the client has given written permission for a procedure or treatment to be performed Consent considered informed when the client has been provided and understands: - CORRECT ANSWERS -the reason the treatment or procedure is needed -how the treatment or procedure will benefit the client -risk involved if treatment or procedure is chosen -other options to treat the problem (including no action) Nurse's role in the informed consent process is: - CORRECT ANSWERS to witness the client's signature on the informed consent form and to ensure the informed consent has been appropriately obtained Implied consent - CORRECT ANSWERS client adheres to instructions provided by the nurse; ex: the nurse is preparing to administer a TB test and the client holds out his arm for the nurse For an invasive procedure or surgery, the client is required to provide ____ consent. - CORRECT ANSWERS written Individuals who are authorized to grant consent for another person include: - CORRECT ANSWERS -parent of a minor -legal guardian -court-specified representative -individual who has durable power of attorney for health care -emancipated minors (for themselves) The provider's responsibility for informed consent: - CORRECT ANSWERS -obtain informed consent -must give complete description of treatment/procedure, description of who will be involved in treatment, description of risks, options for other treatments, and the right to refuse -provide clarification if requested The client's responsibility for informed consent: - CORRECT ANSWERS -giving informed consent -must give consent voluntarily (no coercion), be competent and of legal age (or authorized individual), and receive enough information to make a decision The nurse's responsibility for informed consent: - CORRECT ANSWERS -witness informed consent -must ensure provider provided necessary information, ensure the client understood and is competent to give consent, have the client sign informed consent document, notify provider if more information or clarification needed/requested by client, and document client questions and that the provider was notified (also if interpreter was used) Refusal of treatment - CORRECT ANSWERS -PSDA stipulates all clients have the right to accept and refuse care and must be advised of this right upon admission -if client refuses treatment, will be asked to sign an "Against Medical Advice" form and nurse must document information was provided and provider notified -if client refuses to sign form, nurse must document -if a client decided to leave the facility w/o discharge order, nurse must notify provider and discuss risks of leaving prior to discharge Advanced directives - CORRECT ANSWERS -communicate client's end-of-life care wishes for them if they become unable to -PSDA requires all clients be asked if they have advanced directives upon admission -clients with out advanced directives must be provided with written information about their health care rights and how to formulate advanced directives -a health care rep should be available to help with the process Living will - CORRECT ANSWERS legal document that expresses client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues Durable power of attorney for health care - CORRECT ANSWERS document that designates a health care proxy, who is authorized make health care decisions for a client who is unable Provider's orders - CORRECT ANSWERS "do not resuscitate" (DNR) or "allow natural death" (AND) are orders written by a provider and must be placed in the client's medical record; the provider consults the client and family prior to administering a DNR or AND Nursing role in advanced directives - CORRECT ANSWERS -provide written information regarding advanced directives -document the client's advanced directives status -ensure that the advanced directives reflect the client's current decisions -inform all members of the health care team of the client's advance directives Mandatory reporting - CORRECT ANSWERS -abuse: child or elder abuse, domestic violence -communicable diseases (according to CDC) such as hepatitis and TB Documentation must be: F___, A___ & C___, C___ & C___, and O___. - CORRECT ANSWERS -Factual -Accurate & Concise -Complete & Current -Organized The client's chart or medical record is the ____ record of care - CORRECT ANSWERS legal Subjective data can be documented as: - CORRECT ANSWERS direct quote, within quotation marks, or summarized and identified as the client's statement Objective data should be documented: - CORRECT ANSWERS -descriptive and should include what the nurse sees, hears, feels, and smells -w/o derogatory words, judgments, or opinions -accurately Legal guidelines of documentation - CORRECT ANSWERS -begin each entry with date & time -legible and in black, non-erasable ink -no white out or blackened out errors -info inadvertently omitted may be added as a "late entry" -signed with signature of person making entry and dated -should reflect assessments, interventions, and evaluations Flow charts are used to record and show trends in: - CORRECT ANSWERS vital signs, blood glucose levels, pain level, and other frequently performed assessments Narrative documentation records information as - CORRECT ANSWERS a sequence of events Problem-orientated medical records consist of: - CORRECT ANSWERS a database, problem list, care plan, and progress notes; examples include SOAPIE, PIE, and DAR SOAPIE - CORRECT ANSWERS S-ubjective O-bjective A-ssessment (inc nursing diagnosis) P-lan I-ntervention E-valuation PIE - CORRECT ANSWERS P-roblem I-ntervention E-valuation DAR (focus charting) - CORRECT ANSWERS D-ata A-ction R-esponse Change of shift report - CORRECT ANSWERS -given at the conclusion of each shift by the nurse leaving to the nurse assuming responsibility for the client -can be given face-to-face, audiotaped, or presented during rounds -should include significant objective info, given in logical order, free of gossip and personal opinions, and relate recent changes in meds, treatments/procedures, or discharge plan Telephone report - CORRECT ANSWERS -useful when contacting provider or other members of the interdisciplinary team -important to have all data prepared before calling; use professional demeanor; use exact, relevant, and accurate info; document name of person called, time, content of message, and instructions or information received Telephone orders (TO) or verbal orders (VO) - CORRECT ANSWERS should be avoided but may be necessary during emergencies and at unusual times When accepting an order from a provider over the phone or verbally, the nurse should: - CORRECT ANSWERS -have a second RN/LPN listen to the phone order -repeat back the order given including med name, dosage, time and route -document reading back the order and presence of the second nurse on the telephone -question any order that may seem contraindicated due to a previous order or to the client's condition Transfer reports should include - CORRECT ANSWERS -client's demographic information -client's medical diagnosis and providers -and overview of the client's health status (physical and psychosocial), plan of care, and recent progress -any alterations that might become urgent or emergent situations -directives for assessments or client care essential w/in next few hours -most recent vital signs -meds prescribed and last doses administered (inc PRN) -allergies -diet & activity orders -presence of or need for special equipment or adaptive devices -advance directives and resuscitation status -family involvements in care & health care proxy, if applicable Incident reports (unusual occurrences) - CORRECT ANSWERS -important part of a facility's quality improvement plan -examples of incidence include med errors, falls, and needle sticks -facts documented without judgment or opinion -should not be referred to in client's medical record Delegating - CORRECT ANSWERS Process of transferring authority and responsibility to another member of the health care team to complete a task, while retaining accountability Supervising - CORRECT ANSWERS Process of directing, monitoring, and evaluating the performance of tasks by another member of the health care team RNs may delegate to - CORRECT ANSWERS Other RNs, LPNs, and AP LPNs may delegate to - CORRECT ANSWERS Other LPNs and AP RNs CANNOT delegate - CORRECT ANSWERS -nursing process -client education -tasks that require nursing judgment to LPNs or AP Prior to delegating client care, the nurse should consider: - CORRECT ANSWERS - predictability of outcome -potential for harm -complexity of care -need for problem solving and innovation -level of interaction with the client Examples of questions to use to determine predictability of care: - CORRECT ANSWERS -will the completion of the task have a predictable outcome? -is it a routine treatment? -is it a new treatment? Examples of questions to use to determine potential for harm: - CORRECT ANSWERS -is there a chance something negative may happen to the client (risk for bleeding, risk for aspiration)? -is the client unstable? Examples of questions to use to determine complexity of care: - CORRECT ANSWERS -are complex tasks required as part of the client's care? -is the delegatee legally able to perform the task and do they have the skills necessary? Examples of questions to use to determine need for problem solving and innovation: - CORRECT ANSWERS -will a judgment need to be made while performing the task? -does it require nursing assessment skills? Examples of questions to use to determine level of interaction with the client: - CORRECT ANSWERS -is there a need to provide psychosocial support or education during the performance of the task? Factors to consider when selecting a delegated - CORRECT ANSWERS -education, training, and experience -knowledge and skill required to perform the task -level of critical thinking required to complete the task -ability to communicate with others as it pertains to the task -demonstrated competence -agency policies and procedures -licensing legislation (state nurse practice acts) Examples of tasks that can be delegated to LPNs - CORRECT ANSWERS -monitoring client findings -reinforcing client teaching from a standard care plan -trach care -suctioning -checking NG tube patency -admin enteral feedings -inserting urinary cath -admin meds (exc IV in most states) Examples of tasks that can be delegated to AP - CORRECT ANSWERS -ADLS -bathing, grooming, dressing, toileting -ambulating -feeding (w/o swallowing precautions) -positioning -bedmaking -specimen collection and I&Os -VS for stable clients 5 rights of delegation help decide: - CORRECT ANSWERS -what task should be delegated (right task) -under what circumstances (right circumstance) -to whom (right person) -what info should be communicated (right direction/communication) -how to supervise/evaluate (right supervision /evaluation) Right task - CORRECT ANSWERS Is repetitive, requires little supervision, and is relatively noninvasive for a certain client Right circumstance - CORRECT ANSWERS -Assess the health status and complexity of care required by the client -match complexity of care demands to skill level if team member -consider the workload of the team member Right person - CORRECT ANSWERS -assess and verify the competency of the team member -continually review the performance of the team member & determine competency of care -assess team member performance based on standards & remediate if needed right direction/communication - CORRECT ANSWERS communicate verbally or in writing: -data to collect -method and timeline for reporting -specific tasks to be completed; client specific instructions -expected results, timelines, and expectations for follow-up communication right supervision/evaluation - CORRECT ANSWERS the delegating nurse must: -provide supervision (direct or indirect) -provide clear instructions and understandable expectations of the task(s) to be performed -monitor performance -provide feedback -intervene if necessary (unsafe clinical practice) -evaluate the client and determine if client outcomes were met -evaluate client care tasks and identify needs for performance improvement activities and/or additional resources supervision: - CORRECT ANSWERS -occurs after delegation -oversees a staff's performance of delegated activities -determines if: completion of task is on schedule; performance was satisfactory; abnormal/unexpected findings documented & reported; assistance is needed to complete assigned tasks in a timely manner; assignment should be re-evaluated & possibly changed Critical thinking incorporates: R___, L___, and I___. - CORRECT ANSWERS Reflection Language Intuition Reflection - CORRECT ANSWERS purposefully thinking back or recalling a situation to discover its meaning and gain insight into the event. -"Why did I say this or do that?" -"Did the original plan of care achieve optimal client outcomes?" Language - CORRECT ANSWERS precise, clear language demonstrating focused thinking and communicating unambiguous messages and expectations to both the client and other health care team members. The nurse should consider the following: -"Did I use language appropriate for the client?" -"Did I communicate the message clearly to the provider?" Intuition - CORRECT ANSWERS an inner sensing that something is not currently supported with fact. Intuition should spark the nurse to search the data to confirm or disprove the "feeling." The nurse should ponder the following: -"Did the vital signs reflect any changes that would account for the client's present status?" -"When the client's status changed in this way last month, there was a specific reason for it. Is that what is happening here?" Levels of critical thinking - CORRECT ANSWERS -basic critical thinking -complex critical thinking -commitment basic critical thinking - CORRECT ANSWERS -the nurse trusts the experts and thinks concretely based on the "rules." -results from limited nursing knowledge and experience, as well as inadequate critical thinking experience complex critical thinking - CORRECT ANSWERS -the nurse begins to express autonomy by analyzing and examining data to determine the best alternative -results from increased nursing knowledge, experience, intuition, and more flexible attitudes commitment - CORRECT ANSWERS -the nurse expects to have to make more choices without help from others and fully assumes the responsibility for those choices -results from an expert level of knowledge, experience, developed intuition, and reflective, flexible attitudes components of critical thinking - CORRECT ANSWERS -knowledge -experience -competence -attitudes -standards Knowledge - CORRECT ANSWERS information specific to nursing and acquired through: basic nursing ed; continuing ed courses; advanced degrees and certifications Experience - CORRECT ANSWERS decision-making ability derived from opportunities to observe, sense, and interact with clients followed by active reflection. The nurse: demonstrates an understanding of clinical situations; recognizes and analyzes cues for relevance; incorporates experience into intuition. Competence - CORRECT ANSWERS cognitive processes a nurse uses to make nursing judgments, such as: -general critical thinking: scientific method; problem-solving; decision-making; diagnostic reasoning and inference; clinical decision-making - collaboration -specific critical thinking in nursing: the nursing process Attitudes - CORRECT ANSWERS mindsets that affect how a nurse approaches a problem. Attitudes of critical thinkers include: confidence, independence, fairness, responsibility, risk taking, discipline, perseverance, creativity, curiosity, integrity, humility Standards - CORRECT ANSWERS model to which care is compared to determine acceptability, excellence, and appropriateness -intellectual standards ensure the through application of critical thinking. -professional standards include: nursing judgment based on ethical criteria; evaluation that relies on evidence-based practice; demonstration of professional responsibility baseline data - CORRECT ANSWERS -provided by the admissions assessment -compared with future assessments to monitor client status and response to treatment discharge planning - CORRECT ANSWERS - an interdisciplinary process started by nurse at time of admission -conducted with both client and client's family for optimal results upon admission (but prior to client arrival to room) take necessary equipment into the room including: - CORRECT ANSWERS -appropriate documentation forms -equipment to obtain vital signs -pulse oximeter -hospital attire for client When client arrives to room the nurse should: - CORRECT ANSWERS -intro yourself, explain your role and role of other nursing staff, provide hospital attire, position comfortably, apply ID/allergy bracelets, provide written info and info on advanced directives, document advanced directives in medical record -assess/collect: baselines, reason for seeking care, health history, family history, psychosocial history, nutrition, review of systems, spiritual info, safety assessment, discharge info -inventory personal items brought by client Upon admission, orient client and family to room/facility including: - CORRECT ANSWERS -call light -bed operation -telephone/tv -overhead lighting -smoking policy -restroom locations -waiting areas -meal times -usual times for physician visits -dining/vending services -visiting policies indications for transfer and discharge - CORRECT ANSWERS -client's level of care has changed -another setting is required to provide necessary client care -facility does not offer type of care now required -client no longer needs inpatient care and is ready to return home discharge planning - CORRECT ANSWERS -should begin when client is admitted (with the exception of LTC) -assess if the client will be able to return home and/or if they will need assistance at home -assess residence to see if adaptations or specific equipment will be necessary -make referral to social worker if needed -communicate client health status and needs to community service providers -if client chooses to leave before discharged, notify provider and have pt sign off discharge education should: - CORRECT ANSWERS -be clear and concise and also print ed for client to take home -identify safety concerns at home -review s/s of potential complications and when to contact provider -include provider phone number -provide names and numbers of community resources -instructions for continuing treatments -dietary restrictions and guidelines -amount and frequency of therapies -directions and information on medications Items to be transferred/discharged with the client include: - CORRECT ANSWERS - personal belongings at the bedside -valuables from the safe -medications -assistive devices -medical records or transfer form responsibilities of the nurse when transferring/discharging the client: - CORRECT ANSWERS -on day/time of transfer, confirm they are expecting and have a bed -communicate time client will be arriving -complete documentations -give verbal transfer report in person or over the phone -confirm mode of transportation to complete transfer/discharge -ensure client is dressed appropriately -account for all of client's valuables responsibilities of the nurse when receiving the transferred client - CORRECT ANSWERS -have any specialized equipment ready -inform roommate of client's arrival (if applicable) -inform other team members of arrival -meet with client and family to complete admissions/orientation process -assess how client tolerates the transfer -review transfer docs -implement appropriate nursing interventions in a timely manner transfer documentation should include: - CORRECT ANSWERS -med diagnosis and care providers -client demographic info -overview of health status, plan of care, and recent progress -any alterations that may be of immediate concern -notification of any assessments/client care needed within the next few hrs -most recent vital signs and meds (inc PRNs) -allergies -diet and activity orders -presence of/need for special equipment or adaptive devices -advanced directives & emergency code status -family involvement and health care proxy (if applicable) discharge documentation should include - CORRECT ANSWERS -type of discharge -date/time of discharge, how the client was transported out and with who -where discharged to -summary of condition upon discharge -description of any unresolved difficulties and procedures for follow up -deposition of valuables and meds -copy of discharge instructions discharge instructions should include: - CORRECT ANSWERS -step-by-step for procedures done at home -precautions to take when performing home procedures and with meds -s/s of complications that should be reported -names and numbers of providers and community services contacts -plans for follow-up care and therapies asepsis - CORRECT ANSWERS -the absence of illness-producing micro-organisms -maintained through the use of aseptic technique with hand hygiene as the primary associated behavior medical asepsis - CORRECT ANSWERS -aka "clean technique" -the use of precise practices to reduce the number, growth, and spread of microorganisms from an object, person, or area -used for administering oral meds, managing NG tubes, providing personal hygiene, and many other common nursing tasks surgical asepsis - CORRECT ANSWERS -aka "sterile technique" -the use of precise practices to eliminate all micro-organisms from an object or area -used for parenteral med administration, insertion of urinary catheters, surgical procedures, sterile dressing changes, and many other common nursing procedures before beginning any task or procedure that requires aseptic technique, health care team members must check for: - CORRECT ANSWERS -latex allergies (client and team members) -if there is a known allergy, latex-free gloves, equipment, and supplies must be used the number one measure to reduce the growth and transmission of infectious agents is: - CORRECT ANSWERS -hand hygiene -hand hygiene refers to both handwashing with an antimicrobial or plain soap and water as well as the use of alcohol-based gels, foams, and rinses the three essential components of hand washing include: - CORRECT ANSWERS - soap -water -friction time requirements for handwashing - CORRECT ANSWERS -at least 15 seconds to remove transient flora from the hands -up to 2 minutes when hands are more soiled do not place items on the floor in the client's environment (even soiled laundry) because - CORRECT ANSWERS the floor is considered "grossly" contaminated do not ___ linens because do can spread micro-organisms in the air - CORRECT ANSWERS shake all health care staff should: - CORRECT ANSWERS -follow facility protocols for isolation and protection -wash hair frequently and keep it short or pulled back to prevent contamination of care area or client -not wear artificial nails while providing care and keep natural nails short and clean -remove jewelry from hands and wrists to facilitate hand disinfection prolonged exposure to airborne micro-organisms can make sterile items nonsterile. Avoid: - CORRECT ANSWERS -coughing, sneezing, and talking directly over a sterile field -air movement should be controlled by special ventilation only sterile items may be in a sterile field - CORRECT ANSWERS -the outer wrapping and 1 inch edges are non-sterile -touch sterile materials only with sterile gloves -any object held below the waist or above the chest is considered contaminated -sterile materials may only tough other sterile materials/surfaces; contact with nonsterile materials at any time renders a sterile area contaminated, no matter how short the contact microbes can move by gravity from a nonsterile item to a sterile item: - CORRECT ANSWERS -do not reach across or above a sterile field -do not turn your back on a sterile field -hold items to be added to a sterile field at a min of 6 inches above the field sterile fields and moisture - CORRECT ANSWERS -keep all areas dry -discard any sterile packages that become wet equipment and sterile fields - CORRECT ANSWERS -select a clean area in the client's environment to set up the sterile field -check that all sterile packages are dry and have a future expiration date -make sure an appropriate waste receptacle is nearby sterile procedure steps - CORRECT ANSWERS -perform hand hygiene -open packaging, slipping package onto center of workspace with top flap opening away from the body -reach around to open top flap -open side flaps, using left hand for left flap and right hand for right flap -grasp last flap and turn it down toward the body -open additional sterile packages and add contents directly to sterile field by dropping contents into place -pour sterile solutions -don sterile gloves steps to donning sterile gloves: - CORRECT ANSWERS -with cuff side pointing toward the body, use non-dominate had to pick up dominate glove -while picking up edge of the cuff, pull the dominate glove onto the hand -with sterile dominate hand gloved, place fingers of dominate hand inside cuff of left hand, lifting it off the wrapper and put non-dominate hand into it -when both hands are gloved, adjust fingers as needed -during this time, only sterile gloved hand can touch the other sterile gloved hand risks of infection - CORRECT ANSWERS -inadequate hand hygiene (client and caregivers) -compromised health or defenses against infection -use of poor medical/surgical asepsis by caregivers -clients who have poor personal hygiene, poor nutrition, and those who are stressed -clients who live in a very crowded environment -older adult clients -clients who used IV drugs and share needles -clients who engage in unprotected sex -clients who have recently been exposed to poor sanitation, mosquito-born/parasitic diseases, or diseases endemic to area visited but not in client's home country individuals with compromised health or defenses against infection include: - CORRECT ANSWERS -those who are immunocompromised -those who have had surgery -those with indwelling devices -a break in the skin -those with poor oxygenation -those with impaired circulation -those who have chronic or acute disease health-care associated infections (HAIs) - CORRECT ANSWERS -an infection acquired while the client is receiving care in a health-care setting -formally called nosocomial infections -can come from exogenous source or endogenous source -most common setting for HAIs is the ICU -best way to prevent HAIs is through frequent and effective hand hygiene -most common site of HAIs is the urinary tract -most common causative agents are Escherichia coli, Staphylococcus aureus, and enterococci -an iatrogenic infection results from a diagnostic or therapeutic procedure -HAIs are not always preventable and not always iatrogenic s/s of generalized or systemic infection - CORRECT ANSWERS -fever -increased pulse and resp rate (in response to high fever) -malaise -anorexia, nausea, and/or vomiting -enlarged lymph nodes s/s during 1st stage of the inflammatory response (local infection): - CORRECT ANSWERS -redness (from dilation of arterioles bringing blood to the area) -warmth of the area on palpation -edema -pain or tenderness -loss of use of the affected part the types of exudate appearing at the site of infection during the 2nd stage: - CORRECT ANSWERS -serous (clear) -sanguineous (contains RBCs) -purulent (contains leukocytes and bacteria) during the 3rd stage of infection, ___ ___ is replaced by ___ ___. - CORRECT ANSWERS damaged tissue is replaced by scar tissue lab results indicating infection include: - CORRECT ANSWERS -leukocytosis (WBCs > 10,000/uL -increases in the specific types of WBCs on differential (left shift = increase in neutrophils) -elevated erythrocyte sedimentation rate (ESR) -presence of micro-organisms on culture of the specific fluid/area components of the chain of infection include: - CORRECT ANSWERS -an infectious agent (bacteria, virus, fungi, protozoa) -a reservoir where the infectious agent grows (wound drainage, food, oxygen tubing) -an exit portal of the infectious agent (skin, resp or GI tracts) -a means of transmission (droplet, person-to-person contact, touching contaminated items) -an entry portal to a susceptible host (same as exit) -a host that must be susceptible to the infectious agent adequate fluid intake/hydration prevents: - CORRECT ANSWERS -the stasis of urine by flushing the urinary tract and decreasing the growth of micro-organisms -the skin from breaking down which will help prevent micro-organisms from entering the body pulmonary hygiene for immobile clients - CORRECT ANSWERS -includes turning, coughing, deep breathing, incentive spirometry -done every 2 hrs or as prescribed -decreases growth of micro-organisms and development of pneumonia by preventing stasis of pulmonary excretions, stimulating ciliary movement and clearance which expands the lungs components of hygiene/cough etiquette that applies to anyone entering a health care setting includes: - CORRECT ANSWERS -covering the mouth and nose when coughing and sneezing -using facial tissues to contain respiratory secretions, and disposing of them promptly into a hands-free receptacle -wear surgical mask when coughing to minimize contamination of the surrounding environment -turning head when coughing and staying a min of 3' away from others, especially in common waiting areas -performing hand hygiene after contact with respiratory secretions isolation guidelines - CORRECT ANSWERS -group of actions that include hand hygiene and use of barrier precautions, which are intended to reduce the transmission of infectious organisms -apply to everyone regardless of diagnosis, and must be implemented whenever contact with a potentially infectious material is anticipated -PPE is changed after contact with each client and between procedures with the same client if in contact with large amounts of blood and body fluids standard precautions (tier 1) - CORRECT ANSWERS -applies to all body fluids (excluding sweat), non-intact skin, and mucous membranes -hand hygiene recommended after all contact and alcohol-based waterless product is preferred unless hands are visibly dirty; also required after removal of gown -clean gloves are worn when touching all body fluids, non-intact skin, mucous membranes, and contaminated equipment/articles -gloves removed and hand hygiene completed between each client -masks, eye protection, and shields required when splashing or spraying of body fluid may occur -gloves worn whenever touching anything that has potential to contaminate hands of the nurse -sturdy, moisture resistant bag used for soiled items; contaminated laundry to be bagged and handled to prevent leaking; equipment for client care properly cleaned and one time use items disposed of -safety devices on all equipment/supplies enabled after use and sharps disposed of properly -private room not needed unless client is unable to maintain appropriate hygienic practices transmission precautions (tier 2) include: - CORRECT ANSWERS -airborne precautions -droplet precautions -contact precautions airborne precautions - CORRECT ANSWERS -used to protect against droplet infections smaller than 5mcg (measles, varicella, pulmonary or laryngeal TB) -require a private room, masks/respiratory devices for caregivers and visitors (N95 or HEPA respirator for known/suspected TB), and negative pressure airflow exchange room of at least 6 exchanges per hr droplet precautions - CORRECT ANSWERS -protect against droplets larger than 5 mcg (streptococcal phryngitis or pnemonia, scarlet fever, rubella, pertussis, mumps, mycoplasma, pneumonia, meningococcal pneumonia/sepsis, pneumonic plague) -require a private room or room with clients with the same infectious disease and masks for providers and visitors contact precautions - CORRECT ANSWERS -protect visitors and caregivers against direct client/environmental contact infections (respiratory syncytial virus, shigella, enteric diseases caused by micro-organisms, wound infections, herpes simplex, scabies, multidrug-resistant organisms) -require a private room or a room with other clients with the same infection, gloves and gowns worn by caregivers and visitors, and disposal of infectious dressing material into a single, nonporous bag without touching the outside of the bag transporting client in infection control/isolation - CORRECT ANSWERS -if movement is unavoidable, take precautions to ensure that the environment is not contaminated -for example surgical mask placed on client with airborn or droplet infection and a draining wound is well covered guidelines for cleaning contaminated equipment - CORRECT ANSWERS -always wear gloves -rinse 1st in cold water -wash the article in hot water with soap -use a brush or abrasive to clean corners or hard-to-reach areas -rinse well in warm or hot water -clean the equipment used in cleaning and the sink (still considered dirty unless a disinfectant is used) -remove gloves and perform hand hygiene reporting communicable diseases - CORRECT ANSWERS reporting allows officials to: -ensure appropriate medical treatment of diseases (TB) -monitor for common-source outbreaks (foodborne - Hep A) -plan and evaluate control and prevention plans (immunizations for preventable diseases) -identify outbreaks and epidemics -determine public factors that affect the client's ability to protect himself include: - CORRECT ANSWERS -age, with young and old at greatest risk -mobility cognitive -sensory awareness -emotional state -lifestyle -safety awareness when dealing with safety, all health care workers must be aware of: - CORRECT ANSWERS -how to assess for and recognize clients at risk for safety issues -procedural safety guidelines -protocols for responding to dangerous situations -security plans -identification and documentation of the incidents and responses per health care agency policy it is the ___'s ___ to assess, report, and document client allergies and to provide client care that avoids exposure to allergens - CORRECT ANSWERS provider's responsibility equipment should only be used by the nurse after: - CORRECT ANSWERS a safety inspection and instruction falls - CORRECT ANSWERS -older adults at increased risk due to decreased strength, impaired mobility and balance, and endurance limitations combined with decreased sensory perception -other clients at increased risk include those with decreased visual acuity, generalized weakness, urinary frequency, gait and balance problems, and cognitive dysfunction; also side effects of some medications -clients are at greater risk when >1 of the risk factors are present -fall prevention is a major nursing priority complete a fall-risk assessment ___ ___ & at ___ ___ to limit risk of falls - CORRECT ANSWERS upon admission & at regular intervals general measures to prevent falls includes: - CORRECT ANSWERS -be sure client knows how to use call light, it is within reach, and encourage its use -respond to call lights in a timely manner -orient client to setting and assistive devices -place clients at risk for falls near nursing station -ensure bedside table and frequently used items are within client's reach -maintain bed in low position -for clients who are sedated, unconscious, or otherwise compromised, bed rails are kept up and bed kept in low position -avoid use of full side bedrails for clients who get out of bed or attempt to get out of bed without assistance -provide nonskid footwear -keep floor free of clutter with a clear path to the bathroom -keep assistive devices nearby after validation of safe use by client and family -educate client and family/caregivers on identified risks and plan of care -lock wheels on beds, wheelchairs, and carts -use chair or bed sensors for clients at risk for getting up unattended report and document ___ incidents per facility policy - CORRECT ANSWERS all seizure precautions include: - CORRECT ANSWERS -ensure rescue equipment is at bedside -inspect client's environment for items that may cause injury in event of seizure -assist client at risk for seizure with ambulation and transferring -advise all caregivers and family not to put anything in client's mouth in event of seizure (with exception of status epilepticus) -advise caregivers and family not to restrain in event of seizure but to lower to bed/floor, protect head, move nearby furniture, provide privacy, put on side with head flexed slightly forward, and loosen clothing to prevent injury -in event of seizure, stay with client and call for help -admin meds as ordered -note duration of seizure and sequence and type of movement -after seizure, explain what happened to client and provide comfort and quiet -document the seizure along with precipitating factors along with description of event and report it to provider seclusion and restraints - CORRECT ANSWERS -must be ordered -should be ordered for the shortest duration necessary and only if less restrictive measures are not sufficient -a client may voluntarily request temp seclusion -restraints can be physical or chemical -if used, frequency of client assessments in regards to food, fluid, comfort, and safety should be performed and documented every 15-30 min seclusion and/or restraint must never be used for: - CORRECT ANSWERS - convenience of the staff -punishment for the client -clients who are extremely physically or mentally unstable -clients who cannot tolerate the decreased stimulation of a seclusion room restraints should: - CORRECT ANSWERS -never interfere with treatment -restrict movement as little as is necessary to ensure safety -fit properly -be easily changed to decrease the chance of injury and to provide for the greatest level of dignity the following must occur in order for seclusion or restraint to be used: - CORRECT ANSWERS -all other less restrictive means have to be exhausted -the treatment must be prescribed by provider in writing based on a face-to-face assessment of the client (exception is in emergency situation where client is a danger to himself or others and providers order must be written asap) -rx must include reason, type, location, how long it may be used, and type of behavior that warranted the restraint -provider must rewrite the rx every 24hrs or as specified by the facility -PRN rx is not allowed nursing responsibilities in regards to isolation/restraints: - CORRECT ANSWERS -must be identified in the protocol -include how often the client should be: assessed; offered food/fluid; provided for means of hygiene/elimination; monitored for vital signs; offered ROM of extremities other responsibilities of health care providers when dealing with isolation/restraints include: - CORRECT ANSWERS -always explain need to client and family -obtain signed consent from client or guardian, if required -review manuf. instructions for correct application -remove or replace restraints frequently to ensure good circulation and full ROM of restricted limb -pad bony prominences -use quick-release knot to tie restraints to bed frame -ensure restraint is loose enough for ROM and 2 fingers can fit between device and the client -regularly assess need for continued need -never leave client unattended w/o the restraint complete documentation of isolation/restraint use includes a description of: - CORRECT ANSWERS -precipitating events and behavior prior to seclusion/restraints -alternative actions taken to avoid seclusion/restraint -time restraints applied and removed (if discontinued) -type of restraint and location -client's behavior while restrained -type and frequency of care -client's response when restraint removed -meds administered all staff must be instructed in fire response procedures including: - CORRECT ANSWERS -location of exits, fire extinguishers, and O2 shut-off valves -evacuation plan for the unit and facility the fire response in the health care setting always follows the ____ sequence - CORRECT ANSWERS RACE -Rescue: protect and evacuate clients in close proximity to the fire -Alarm: report the fire by setting off the alarm -Contain: close doors and windows as well as turning off any oxygen sources; clients on life support are ventilated with bag-valve mask -Extinguish: extinguish the fire if possible using an appropriate fire extinguisher The 3 classes of fire extinguishers: - CORRECT ANSWERS -Class A: for paper, wood, upholstery, rags, or other types of trash fires -Class B: for flammable liquids and gas fires -Class C: for electrical fires to use a fire extinguisher: - CORRECT ANSWERS PASS -pull the pin -aim at the base of the fire -squeeze the levers -sweep back and forth over the fire home safety risks for infants and toddlers include: - CORRECT ANSWERS -aspiration -suffocation -poisoning -falls -motor vehicle/injury -burns home safety risks for preschoolers and school-age children include: - CORRECT ANSWERS -drowning -motor vehicle/injury -burns -poison home safety risks for adolescents include: - CORRECT ANSWERS -motor vehicle/injury -burns home safety risks for young and middle age adults include: - CORRECT ANSWERS - motor vehicle crashes -occupational injury -high alcohol consumption -suicide home safety risks for older adults include: - CORRECT ANSWERS -physical, cognitive and sensory changes -changes in musculoskeletal and logical systems -impaired vision and/or hearing -nocturia and incontinence prevention education for risk of aspiration in infants and toddlers: - CORRECT ANSWERS -keep small objects out of reach -check toys for loose parts -do not feed infant hard candy, peanuts, popcorn, or whole/sliced pieces of hot dog -do not place infant in supine position while feeding or prop the bottle -pacifiers should be constructed of one piece -provide information on prevention of lead poisoning prevention education for risk of suffocation in infants and toddlers: - CORRECT ANSWERS -keep plastic bags out of reach -ensure crib mattress fits snugly and no more than 2 2/3 inches between crib slats -never leave alone in bathtub -remove crib toys, including mobiles, as soon as infant begins to push up -keep latex balloons out of reach -fence swimming pools and use locked gate -begin swimming lessons as soon as developmental status allows -keep toilet lids down and bathroom doors shut prevention education for risk of poisoning in infants and toddlers: - CORRECT ANSWERS -keep house plants and cleaning agents out of reach -place poisons, paint, and gas in locked cabinets -keep medication in child-proof containers and locked up -dispose of meds which are no longer used or out of date prevention education for risk of falls in infants and toddlers: - CORRECT ANSWERS - keep crib and playpen rails up -never leave unattended on changing table or other high surface -restrain while in high chair, swing, stroller, etc -place in low bed when toddler starts to climb prevention education for risk of motor vehicle/injury in infants and toddlers: - CORRECT ANSWERS -use backward facing car seat until yr old and weighs at least 20 lbs -all car seats should be federally approved and be placed in the back seat prevention education for risk of burns in infants and toddlers: - CORRECT ANSWERS - test temp of formula and bath water -place pots on back burner and turn handle away from front of stove -supervise use of faucets prevention education for risk of drowning in preschoolers and school-age children: - CORRECT ANSWERS -ensure child knows how to swim and knows rules of water safety -locked fences around home and neighborhood pools prevention education for risk of motor vehicle/injury in preschoolers and school-age children: - CORRECT ANSWERS -use booster seats for children < 4'9" and <40 lbs -use seat belts properly after booster seats no longer necessary -use protective equipment when participating in sports or riding/passenger on a bike -supervise and teach safe use of equipment -teach to play in safe areas, rules of the road, and what to do if approached by a stranger -begin sex education for school-ages children prevention education for risk of burns in preschoolers and school-age children: - CORRECT ANSWERS -reduce setting on water heater to no higher than 120 deg F -teach dangers of playing with matches, fireworks, fire arms, etc -teach school-aged children how to use microwave and other cooking instruments prevention education for risk of poison in preschoolers and school-age children: - CORRECT ANSWERS -teach about hazards of alcohol, prescription, non-prescription, and illegal drugs -keep potentially dangerous substances out of reach prevention education for risk of motor vehicle/injury in adolescents - CORRECT ANSWERS ensure teen has completed driver's ed -set rules on # of people in car, seat belt use, and to call for ride home if driver is impaired -reinforce teaching on proper use of protective equipment used in sports -be alert to signs of depression -teach about hazards and safety precautions of firearms -teach to check water depth before diving prevention education for risk of burns in adolescents - CORRECT ANSWERS -teach to use sunblock and protective clothing -teach dangers of sun bathing and tanning beds -educate on hazards of smoking safety prevention education for young and middle age adults includes: - CORRECT ANSWERS -remind clients to drive defensively and not to drive after drinking -reinforce teaching about long term effects of high alcohol consumption -monitor for s/s of depression/suicide and refer as appropriate -encourage clients to be proactive about safety in workplace -ensure understanding of hazards of excessive sun exposure and the need to use sun block and protective clothing safety prevention education/modifications for older adults includes: - CORRECT ANSWERS -home hazard evaluation conducted by nurse, physical therapist, occupational therapist if deemed necessary -remove items that could cause client to trip, such as throw rugs and loose carpets -place electrical cords against wall and behind furniture -ensure steps and sidewalks in good repair -place grab bars near toilet and in tub/shower and installing a stool riser -non-skid mat in tub or shower -place shower chair in shower -ensure lighting is adequate inside and outside home home fire safety plan should include: - CORRECT ANSWERS -emergency numbers near the phone -ensure number and placement of fire extinguishers and smoke alarms are adequate and that they are operable -set specific time to check batteries in alarms and operation of extinguishers -have family plan for evacuation and practice regularly -review "stop, drop, and roll" to extinguish fire of clothing or skin -review oxygen safety measures oxygen safety measures: - CORRECT ANSWERS -use/store according to manufacture's recommendations -place a NO SMOKING sign near front door of home and on door of client's bedroom -inform client and family of smoking in presence of oxygen and that smokers should smoke outdoors -ensure electrical equipment is in good repair and well grounded -replace bedding that can generate static electricity (wool, nylon, synthetics) with cotton -keep flammable items (such as heating oil and nail polish remover) away from client when O2 in use -follow general safety measures for fire safety additional safety risks in home/community include: - CORRECT ANSWERS -passive smoking -carbon monoxide poisoning -food poisoning -bioterrorism passive smoking - CORRECT ANSWERS -unintentional inhalation of tobacco smoke -exposure can put one at risk for numerous diseases including: cancer, heart disease, and lung infections -low-birth weight, prematurity, stillbirths, and SIDS have been associated with maternal smoking -smoking in presence of children is associated with development of bronchitis, pneumonia, middle ear infections, and an increase in frequency/severity of asthma attacks the nurse should inform the client who smokes and his/her family about: - CORRECT ANSWERS -hazards of smoking -available resources for smoking cessation -the effect of visiting or riding in a car with a smoker can have on a non-smoker carbon monoxide poisoning - CORRECT ANSWERS -carbon monoxide binds with hemoglobin and reduces oxygen supply to tissues -cannot be seen. smelled, or tasted -s/s include: nausea, vomiting, headache, weakness, and unconsciousness -death may occur with prolonged exposure -prevention by ensuring proper ventilati