CAPA/CPAN Review
Nursing Process - ANS-Assessment-gathering info/data; asking questions to gather this
info/data
Diagnosis
Identification of Outcomes
Planning-future tense; patient is subject, achieve overall goal
Implementation- nurse is subject, present tense.
Evaluation
DNR vs AND - ANS-DNR can WITHHOLD Palliative care
AND includes it
Ethical Principles - ANS-Autonomy-freedom of action chosen by individual
Beneficence- doing good
Nonmaleficence- do no harm
Justice- duty to be fair to all people
Veracity- truthfullness or accuracy
Fidelity- loyal or faithful
Biot's respirations - ANS-rapid gasps followed by apnea
Usually brain insults (ex. traumas)
=Increase ICP
Cheyne-Stokes respiration - ANS-gradual increase and then decrease in breathing
followed by apnea
Increase ICP
usually Cardiac problems
Kussmaul's breathing pattern - ANS-tachypnea and hyperpnea
ex. DKA, metabolic acidosis patients
Statutory Law - ANS-legislative acts declaring, commanding, or prohibiting something
written laws where you can go and reference it
ex. driving over the speed limit
Common Law - ANS-patient bill of rights
derived from principles rather than rules and regulations
,Civil Law - ANS-Based on rules and regulations
Court action lawsuits (most common)
Wrong doing
Tort Law - ANS-wrongful doing
involves compensation to those wrongfully injured
assault/battery/negligence; alarm silencing
Criminal Law - ANS-Harmful or offensive to society as a whole
ex. practicing nursing/medicine without a license; harming patients on purpose
Informed consent** - ANS-Consent obtained after the patient has been fully informed by
the physician about the risks and benefits of the treatment, alternatives, and
consequences of no treatment
*can be withdrawn at any time; even at the last second
*If signing after narcotic/benzo given-must wait at least 1/2 the half-life of the drug
*Is the patient knowledgeable, willing, competent
Informed Consent (cont)** - ANS-Competent to Sign: legal adult, minors with
parent/guardian, emancipated minor (married or in armed forces).
Exceptions: pt is unable to give consent and is a threat to life/emergent (IMPLIED
CONSENT)
**Must have documentation of emergency in staff notes
**Malpractice - ANS-Elements needed to claim medical malpractice:
Duty owed patient
Breach of duty owed patient
Causation - most difficult to prove
Injury/Damages
Intentional Torts - ANS-Violating patient rights; No actual harm necessary.
3 most common:
Assault-place person in fear of being touched
Battery-Touch without permission
False imprisonment-unjustified detention
Intentional Quasi Torts - ANS-No intent to injure or cause distress to another person.
Ex: Patient abandonment, defamation of character, invasion of privacy, breach of
confidentiality
,**Staffing Ratios - ANS-Staffing ratios see pg. 864
ISO patients 1:1
Peds <8 yo unconscious = 1:1 regardless of parent.
( if they have parent and stable you can have another patient)
1:1 New phase 1 admission (fresh out of OR), unstable hemodynamically, unstable
airway
PreAdmission - ANS--usually phone call is done 2 weeks prior to surgery
-written instructions should be at 5th grade level
-Med Rec starts at 1st PAT visit when MD decided pt needs surgery
Med History (AntiCoags) - ANS-*AntiCoag therapy, NSAIDs, Aspirin should be stopped
Aspirin-stopped up to 7 days prior
Coumadin-stopped 5 days prior (coags taken immediately before surgery)
Dipyridamole (Persantine)- stopped 2 days prior
*Interfere with plt function: Indomethacin, tricyclic antidepressants, phenothiazines,
furosemide, steroids
Med Rec (Held vs. Taken Day of Surgery) - ANS-Held Day of:
Diuretics, insulin, oral hypoglycemic, MAOI antidepressants
Taken Day of:
Cardiac, antihypertensives
Beta Blockers
Ca Channel Blockers
Anticonvulsants
Chronic Pain Meds
Herbals/Supplements - ANS-Decreases BP: Black Cohosh
Increases BP: ginseg, ephedra, licorice
Steroids: echinacea, licorice may decrease effect
Increase AntiCoag(More Bleeding):
-Ginko*, feverfew, garlic, ginger, ginseng, Vit E, fish oil, saw palmetto
, Decreases AntiCoag (more clotting)
-St John's wort*, ginseng, green tea
(more risk for DVT, PE, MI, Strokes)
Barbituates and benzos
Increases Effect: St johns wart (prolongs emergence)
Decreases Effect: sarsaparillae
Diagnostic Tests: CBC Labs - ANS-Indications for this test:
Infections
autoimmune diseases
alcohol abuse
blood disorders (anemia, coagulopathies, chronic disease states)
Expected large EBL or recent significant blood loss.
Diagnostic Tests: BMP vs CMP Labs - ANS-Indications for this test:
BMP:
Chronic Renal Failure
HTN
Heart Disease
any disease with potential fluid/electrolyte disturbance
COPD or OSA
CMP:
Chronic renal or liver disease (Liver function tests)
Malnutrition (albumin)
Usually ordered for Addiction patients (usually have low albumin levels)
Ca level (ionized "free floating calcium")
More Diagnostic Tests - ANS-ECG/EKG:
any cardiac hx patient
Hx of CVA or TIA
DM
Smoker long term
PV disease
Pregnancy Test:
Females of childbearing age
(1st to last menses +1 year WITHOUT breakthrough bleeding)
Nursing Process - ANS-Assessment-gathering info/data; asking questions to gather this
info/data
Diagnosis
Identification of Outcomes
Planning-future tense; patient is subject, achieve overall goal
Implementation- nurse is subject, present tense.
Evaluation
DNR vs AND - ANS-DNR can WITHHOLD Palliative care
AND includes it
Ethical Principles - ANS-Autonomy-freedom of action chosen by individual
Beneficence- doing good
Nonmaleficence- do no harm
Justice- duty to be fair to all people
Veracity- truthfullness or accuracy
Fidelity- loyal or faithful
Biot's respirations - ANS-rapid gasps followed by apnea
Usually brain insults (ex. traumas)
=Increase ICP
Cheyne-Stokes respiration - ANS-gradual increase and then decrease in breathing
followed by apnea
Increase ICP
usually Cardiac problems
Kussmaul's breathing pattern - ANS-tachypnea and hyperpnea
ex. DKA, metabolic acidosis patients
Statutory Law - ANS-legislative acts declaring, commanding, or prohibiting something
written laws where you can go and reference it
ex. driving over the speed limit
Common Law - ANS-patient bill of rights
derived from principles rather than rules and regulations
,Civil Law - ANS-Based on rules and regulations
Court action lawsuits (most common)
Wrong doing
Tort Law - ANS-wrongful doing
involves compensation to those wrongfully injured
assault/battery/negligence; alarm silencing
Criminal Law - ANS-Harmful or offensive to society as a whole
ex. practicing nursing/medicine without a license; harming patients on purpose
Informed consent** - ANS-Consent obtained after the patient has been fully informed by
the physician about the risks and benefits of the treatment, alternatives, and
consequences of no treatment
*can be withdrawn at any time; even at the last second
*If signing after narcotic/benzo given-must wait at least 1/2 the half-life of the drug
*Is the patient knowledgeable, willing, competent
Informed Consent (cont)** - ANS-Competent to Sign: legal adult, minors with
parent/guardian, emancipated minor (married or in armed forces).
Exceptions: pt is unable to give consent and is a threat to life/emergent (IMPLIED
CONSENT)
**Must have documentation of emergency in staff notes
**Malpractice - ANS-Elements needed to claim medical malpractice:
Duty owed patient
Breach of duty owed patient
Causation - most difficult to prove
Injury/Damages
Intentional Torts - ANS-Violating patient rights; No actual harm necessary.
3 most common:
Assault-place person in fear of being touched
Battery-Touch without permission
False imprisonment-unjustified detention
Intentional Quasi Torts - ANS-No intent to injure or cause distress to another person.
Ex: Patient abandonment, defamation of character, invasion of privacy, breach of
confidentiality
,**Staffing Ratios - ANS-Staffing ratios see pg. 864
ISO patients 1:1
Peds <8 yo unconscious = 1:1 regardless of parent.
( if they have parent and stable you can have another patient)
1:1 New phase 1 admission (fresh out of OR), unstable hemodynamically, unstable
airway
PreAdmission - ANS--usually phone call is done 2 weeks prior to surgery
-written instructions should be at 5th grade level
-Med Rec starts at 1st PAT visit when MD decided pt needs surgery
Med History (AntiCoags) - ANS-*AntiCoag therapy, NSAIDs, Aspirin should be stopped
Aspirin-stopped up to 7 days prior
Coumadin-stopped 5 days prior (coags taken immediately before surgery)
Dipyridamole (Persantine)- stopped 2 days prior
*Interfere with plt function: Indomethacin, tricyclic antidepressants, phenothiazines,
furosemide, steroids
Med Rec (Held vs. Taken Day of Surgery) - ANS-Held Day of:
Diuretics, insulin, oral hypoglycemic, MAOI antidepressants
Taken Day of:
Cardiac, antihypertensives
Beta Blockers
Ca Channel Blockers
Anticonvulsants
Chronic Pain Meds
Herbals/Supplements - ANS-Decreases BP: Black Cohosh
Increases BP: ginseg, ephedra, licorice
Steroids: echinacea, licorice may decrease effect
Increase AntiCoag(More Bleeding):
-Ginko*, feverfew, garlic, ginger, ginseng, Vit E, fish oil, saw palmetto
, Decreases AntiCoag (more clotting)
-St John's wort*, ginseng, green tea
(more risk for DVT, PE, MI, Strokes)
Barbituates and benzos
Increases Effect: St johns wart (prolongs emergence)
Decreases Effect: sarsaparillae
Diagnostic Tests: CBC Labs - ANS-Indications for this test:
Infections
autoimmune diseases
alcohol abuse
blood disorders (anemia, coagulopathies, chronic disease states)
Expected large EBL or recent significant blood loss.
Diagnostic Tests: BMP vs CMP Labs - ANS-Indications for this test:
BMP:
Chronic Renal Failure
HTN
Heart Disease
any disease with potential fluid/electrolyte disturbance
COPD or OSA
CMP:
Chronic renal or liver disease (Liver function tests)
Malnutrition (albumin)
Usually ordered for Addiction patients (usually have low albumin levels)
Ca level (ionized "free floating calcium")
More Diagnostic Tests - ANS-ECG/EKG:
any cardiac hx patient
Hx of CVA or TIA
DM
Smoker long term
PV disease
Pregnancy Test:
Females of childbearing age
(1st to last menses +1 year WITHOUT breakthrough bleeding)
