Professional Documents
Culture Documents
THEORETICAL
FOUNDATIONS
SAFE AND EFFECTIVE CARE ENVIRONMENT
HEALTH PROMOTION AND MAINTENANCE
FUNDAMENTAL CONCEPTS
REDUCTION OF RISK POTENTIAL
THERAPIES AND PROCEDURES
MANAGEMENT OF CARE
COMPETENCE,CONFIDENTIALITY AND
PRIVACY
ADVOCACY AND ACCOUNTABILITY
RESPECTFUL CARE AND
RESPONSIBILITY
PROTECTED ELATIONSHIP AND
PROMOTION OF PUBLIC HEALTH
ETHICAL STANDARDS OF CARE
INFORMED CONSENT
CAPACITY AND COMPETENCE
INCLUDES EXPLANATION OF
BENEFITS, EXPECTED
RESULTS,ALTERNATIVES AND RISK
VOLUNTARY
INFORMATION UNDERSTOOD
CANNOT SIGN IF UNDER ALCOHOL
OR PREMEDICATED
Which statement about
consent is not accurate:
It includes explanation of benefits
and disadvantages
It states that consent cannot be
withdrawn anytime
It requires a competent adult who
can make voluntary choices
Married minors and pregnant minors
can sign own consent for treatment
MANAGED CARE
WORK ALLOCATION
PATIENT NEEDS AND CONDITIONS
ABILITIES OF STAFF
CONTINUITY OF CARE
KNOWLEDGE OF STAFF AND QUALIFICATIONS\
RIGHT TASK- FUNCTION , ACTIVITY ,
DECISION…….INFORMATION ,
SUPERVISION , FOLLOW-UP
DON’T DELEGATE ASSESSMENT,TEACHING
EVALUATION,PLANNING
DELEGATION
BUILDS TRUST
EMPOWERS OTHERS
TEACHES AN MOTIVATES
TEAMWORK DEVELOPS
ENHANCE COMMUNICATION
RAPID PRODUCTIVITY AND RAISED
SKILL
WHICH OF THE FOLLOWING
IS NOT TRUE ABOUT
MANAGED CARE?
In delegation , responsibility is transferred,
accountability is shared
Responsibility is determined by Nurse
practice acts, standards of care, job
description and policy statement
In delegating identify variables
nevertheless this would not change
authority and responsibility
Delegate to the lowest person on
heirarchy that has the required skills and
abilities who is allowed to do the task
Example: “ feed client if
coherent and awake, if
confused do not feed and
notify me asap.
SCOPE
R.N.-
PLANNING AND HEALTH TEACHING
LICENSURE REQUIREMENTS
ASSESSMENT AND EVALUATION
NEED FOR KNOWLEDGE AND SKILL
LPN/LVN-
STABLE PATIENTS
STANDARD UNCHANGING PROCEDURES
SIMPLE MONITORING AND IMPLEMENTATION
SEQUENCED/PREDICTABLE OUTCOMES
STATE PRACTICE ACT INCLUSION
UAP-DIRECT PATIENT CARE ACTIVITY AND
STANDARD OPERATING UNCHANGING
PROCEDURES
INCIDENT REPORTS
SEQUENCE-UNEXPECTED OR UNPLANNED
OCCURENCE
RISK MANAGER
SITUATIONS-STATEMENT OF FACTS AND
PATIENT PHYSICAL RESPONSE
LAST RESORT
INFORMED CONSENT(PROXY)
ALTERNATIVE MEASURES FIRST
BENEFITS> RISKS
LENGTH OF TIME AND CIRCUMSTANCES
SPECIFIED
ENSURE SAFETY – CIRCULATION
CHECKS,SKIN CARE, ROM AND REMOVE
Q2H
RESTRAINTS IS USED
FOR:
THE PURPOSE OF DISCIPLINE
COMFORT AND CONVENIENCE OF
PROVIDER
REQUIRED TO TREAT MEDICAL SYMPTOMS
ENSURE USED TO CONTROL BEHAVIOR
PREVENT BREACH IN SAFE AND EFFECTIVE
DELIVERY OF MEDICAL THERAPY.
ENSURE SAFETY OF OTHER PATIENTS
MEDIUM OF LIMIT SETTING AND
PROVISION OF EXTERNAL CONTROLS
COMPLAINTS
COMPROMISE / COLLABORATIVE
AGREEMENT
LISTEN ATTENTIVELY
EXPLAIN SCOPES AND LIMITATIONS
ASK AND RELAY EXPECTED
SOLUTIONS AND TERMS
NON-DEFENSIVE
A CLIENT WHO IS ABOUT TO BE BATHED BY A
NURSE STATES;”You are too young to know
how to do this, get me someone who knows
what they are doing”.the nurse best response
is:
We do this procedure daily, I have
done this several times, tell me what
are you afraid of?
I can see you are upset , can we talk
about it?
You’re concerns show you are upset,
we will talk about this after I have
demonstrated the procedure.
Can you be more specific about
you’re concerns?
Health teaching
C-CONSIDER SUPPORT SYSTEMS /
COMPLIANCE
H- olds MOTIVATION AND INSIGHT
A- ALLOW FEEDBACK
N-NEEDS MET AND ASSURED
G- GOALS AND PRIORITIES SET w/
pnt.
E- EMPATHETIC AND ENSURES
COLLABORATION
Patient Education
Type of learning:
Cognitive
Psychomotor
Affective
Discharge planning
Begins with first encounter
Functional level considered
Referrals and preferrences
Compromised plan
WHAT IS THE BEST GAUGE
THAT THE CLIENT
UNDERSTANDS DISCHARGE
TEACHING?
PATIENT VERBALIZES INTEREST
PATIENT ASKS QUESTIONS RELATED TO
ADAPTATION TO NEEDED CHANGE IN
BEHAVIOR
ACCURATE DEMONSTRATION OF
PROCEDURE
PLANS FOR PRACTICE SESSIONS RELATED
TO HEALTH CARE SUGGESTIONS TAUGHT
BY THE R.N.
SAFETY AND INFECTION
CONTROL pg.27-49
UNIVERSAL PRECAUTIONS
STANDARD PRECAUTIONS – BARRIER
CHILD PROOF
REFER - POISON CONTROL CENTER
IDENTIFY AND BRING AGENT
SECURE SAFETY AND ABC’S
INDUCE VOMITING W/ IPECAC
STOP/DELAY ABSORPTION W/
WATER/MILK/ACTIVATED CHARCOAL
THE NURSE SHOULD INTERVENE IF
A MOTHER OF A VICTIM OF
POISONING VERBALIZES TO DO
THE FOLLOWING:
PLANS TO INDUCE VOMITING FOR PATIENT
WITH ASPIRIN POISONING
PLANS TO INDUCE VOMITING WHEN SHE IS
CERTAIN THAT HER CHILD’S GAG REFLEX
AND LOC ARE INTACT
WILL NOT GIVE IPECAC IF CHILD IS
EXHIBITING NARROWED PULSE PRESSURE
WILL WAIT FOR THE SEIZURE TO END
BEFORE ADMINISTERING IPECAC
CONTRAINDICATIONS OF
IPECAC / INDUCTION OF
VOMITING
SEIZURE
SUBNORMAL LOC AND GAG REFLEX
SUBSTANCE CORROSIVE/PETROLEUM
DISTILATE
SHOCK-SEVERE
DISASTER PLANNING
TRIAGE-GREATEST GOOD FOR THE
GREATEST NUMBER OF PEOPLE
PRINCIPLES- ABCD , MASLOWS
IQ = MA / CA X 100
JUDGEMENT , COMPREHENSION AND
LISTENING
NORMAL VITAL SIGNS
NEWBORN=30 – 50 / MIN; 120 – 140 / MIN;
60/40 – 80/50 mmHg
ANURIA<100ML/24H
OLIGURIA< 400 ML/24H
POLYURIA > 2000 ML/24H
KEGELS –STRENGTHEN MUSCLES OF THE PELVIC
FLOOR-TIGHTEN FOR 3 SECS THEN RELAX FOR 3
SECS PERFORM LYING DOWN, SITTING AND
STANDING FOR TOTAL OF 45
BLADDER RETRAINING
INTERMITTENT CATHETERIZATION AFTER ATTEMPTING
TO VOID Q 2-3H, TIME INCREASES GRADUALLY BUT NO
MORE THAN 8 HOURS
BLADDER TRAINING – DRINK A MEASURED AMOUNT Q2H
THEN ATTEMP TO VOID 30 MINS LATER-TIME
GRADUALLY INCREASED
TRIGGERING TECHNIQUES-CREDES MANEUVER AND
VALSALVA
CLAMP INDWELLING CATH BEFORE REMOVAL. THEN DUE
TO VOID 3-4 HOURS AFETR REMOVAL
HEMODIALYSIS
DONE 3-5 HOURS – 2-3 TIMES A WEEK
AV FISTULA-NO BP,VENIPUNCTURE OR
CONSTRICTIONS
PALPATE FOR A THRILL AND LISTEN FOR
BRUIT Q8H
MONITOR FOR HEMORRHAGE
DISEQUILIBRIUM
SYNDROME,HEPATITIS,HEMORRHAGE,MUS
CLE CRAMPS,AIR EMBOLISM AND SEPSIS-
COMPLICATIONS
PERITONEAL DIALYSIS
TENCKOFF,GORE-TEX CATHETER
WEIGH BEFORE AND AFTER, WARM DIALYSATE
CHON LOSS, INFECTION, -PERITONITIS(CLOUDY
OUTFLOW,BLEEDING) , FEVER , ABDL
TENDERNESS AND N & V
PREVENT CONSTIPATION BY INCREASING FIBER IN
DIET,MAINTAIN STERILE PROCEDURE,FOR
PROBLEMS WITH OUT FLOW –REPOSITION
TYPES: CAPD(4-6H INDWELLING),AUTOMATED
30MINS EXCHANGES, INTERMITTENT- 4X A WEEK
– 10H/DAY, CONTINOUS – 1 DAY INDWELLING
PREOP CARE
INFANT-DISTRACT
TODDLER-ALLOW REGRESSION AND
INVOLVE PARENTS,CONSISTENT
CAREGIVER
PRE-SCHOOL-LET CHILD HANDLE
EQUIPMENT,EXPRESSION OF FEELINGS
THROUGH PLAY DEMOFAMILIAR
SORROUNDINGS
SCHOOL AGE- EXPLAIN SIMPLY AND
ALLOW CHOICES
ADOLESCENTS- INVOLVE AND POINT OUT
STRENGTHS AND BENEFITS,EXPECT
RESISTANCE
PREOP CHECKLIST
CONSENT
HEALTH TEACHING (SPEC. POST OP
PROCEDURES)
LAB TESTS,ECG,X-RAY
SKIN PREP
BOWEL PREP
IV’S
NPO
PREOP MEDS,SEDATION AND ANTIBIOTICS
REMOVAL OF DENTURES,NAILPOLISH AND
JEWELRY
NUTRITION-TPN OR ENTERAL FEEDINGS PREOP
INTRAOP- MAINTAIN SURGICAL ASEPSIS,
MONITOR CLIENT STATUS,, APPROPRIATE
GROUNDING DEVICES, FLUID BALANCE
AND SPONGE/INSTRUMENT COUNT
POST OP- MONITOR VS
Q15X4;Q30X2;Q1HX2 THEN PRN
MONITOR I AND O , K LEVEL , CVP, BOWEL
SOUNDS, BREATH SOUNDS AND LOC
RESPIRATORY PHYSIOTHERAPY,TCBD
INCENTIVE SPIROMETRY-20 SECS
INHALATION
ENCOURAGE AMBUALTION
REFER IF UNABLE TO VOID IN 8 HOURS
APPLY TED HOSE AND PNEUMATIC
COMPRESSION DEVICE,CHECK FOR
HOMAN’S SIGN
WOUNDS
NOTE DRESSING AND INCISION
FEVER 1-2 DAYS POST OP-ATELECTASIS/
DEHYDRATION
3-7 DAYS – INFECTION
UPPER GI TUBES-GASTRIC DECOMPRESSION
LOWER GI TUBES – BOWEL DECOMPRESSION
WOUND HEALING BY 1ST INTENTION-SUTURED
AND APPROXIMATED ; 3RD INTENTION-NOT
CLOSED,W/ PURPOSE EX: DRAINS
WOUND HEALING BY 2ND INTENTION-INCREASED
INCIDENCE OF INFECTION , INCREASED SCARRING
AND LONGER HEALING TIME
POST-OP
COMPLICATIONS
SHOCK
PARALYTIC ILEUS
ATELECTASIS AND PNEUMONIA - 2ND DAY
EMBOLISM- 2ND DAY
WOUND INFECTION-3-5D
DEHISCENCE AND EVISCERATION-5-6D
PSYCHOSIS
CARDIOVASCULAR COMPROMISE-
URINARY RETENTION-8-12H
URINARY INFECTION -5-8 D
DVT-6-14 DAYS-1 YEAR