Fundamentals of Nursing Finals: From ATI Concepts, Outlines and Definitions for Foundations of Nursing

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Key terms, definitions, lists, concepts for ATI Fundamental Finals from Fundamentals for Nursing 7.0, Review Module

The Joint Commission

Sets quality standards for accreditation of health care facilities

Utilization review committee

Monitors appropriate diagnosis and treatment of hospitalized clients

Federally funded health care programs

1) Medicare - for clients 65 years or older or with permanent disabilities (premiums applied either through (a) Insurance programs - DRG; or (b) MCO (Managed Care Organizations) - enrolled clients receive a comprehensive care overseen by a primary care provider
2) Medicaid - for clients with low incomes; State determines eligibility requirements

Privately funded health care plans

a) Traditional - fee for service
b) MCO - Managed Care organization; primary care provider focuses on prevention and health promotion
c) PPO - preferred provider organization; client chooses from a list
d) EPO- exclusive provider organization; client chooses from a list within a contracted organization
e) LTC - long term care insurance; expenses not covered by Medicare

Levels of health care

a) Preventive - focus on education (immunization, stress management, seat belts)
b) Primary - emphasizes health promotion (prenatal and well baby care)
c) Secondary - diagnosis and treatment of emergency, acute illness or injury (acute inpatient care, ER)
d) Tertiary - specialized highly technical care (Oncology, burn centers)
e) Restorative - intermediate follow up care for restoring health (home health care, rehab centers)
f) Continuing health care - addresses long term or chronic health care needs (hospice, adult day care)

Interdisciplinary personnel (non-nursing)

a) clergy
b) registered dietitian
c) laboratory technician
d) occupational therapist
e) Pharmacist
f) Physical Therapist
g) Provider - MD, DO
h) Radiologic technologist
i) Respiratory therapist
j) Social worker
k) Speech Therapist

Nursing Personnel

a) RN
b) LPN/LVN
c) UAP - CNA, CMA

Expanded Nursing Roles

a) APN - advanced practice nurse ( CNS - clinical nurse specialist; CRNA - certified registered nurse anesthetist; NP - nurse practitioner; CNM - certified nurse-midwife)

b) Nurse Educator
c) Nurse Administrator
d) Nurse Researcher

ETHICS

Based on an expected behavior of a certain group in relation to what is considered right or wrong. Study of conduct and character

MORALS

Values and beliefs held by people that guide their behaviors and decision making

ETHICAL THEORY

Examines different principles, ideas, systems and philosophies used to make judgments about what is right and wrong, good or bad.
a) utilitarianism - the value of a thing is based on its use; end justifies the means
b) deontology - moral rights and duties

ETHICAL PRINCIPLES related to the treatment of clients

a) Autonomy
b) Beneficence
c) Fidelity
d) Justice
e) Nonmaleficence

AUTONOMY

Ability of client to make personal decisions even when they may not be in client's best interest

BENEFICENCE

Agreement that acre given is in the best interest of the client; taking positive actions to help others

FIDELITY

Agreement to keep one's promise to the client about care that was offered.

JUSTICE

Fair treatment in matters related to physical and psychosocial care and use of resources

NONMALEFICENCE

Avoidance of harm or pan as much as possible when giving treatments

Ethical Dilemmas

Problems about which more than once choice can be made and the choice made is influenced by the values and beliefs of decision makers.

A problem in health care is an ethical dilemma if :

a) it cannot be solved solely be a review of scientific data
b) it involves a conflict between two moral imperatives
c) the answer will have a profound effect on the situation/client

Documents used to help solve ethical dilemmas

a) ANA Code of Ethics for Nurses (2001)
b) ICN Code of Ethics for Nurses (2006)
---------------------------------------------------------
for LPN/LVN - Code of Ethics by NAPNES

Basic principles of Nurse's code of Ethics

a) Advocacy - support the cause of client
b) Responsibility - willingness to respect obligations
c) Accountability - ability to answer for one's actions
d) Confidentiality - protection of privacy without diminishing care

UDDA - Uniform Determination of Death Act

Document used to assist on issues regarding end-of-life and organ donor issues

FEDERAL regulations and laws that impact nursing practice

a) HIPAA - health insurance portability and accountability Act
b) ADA - Americans with Disabilities Act
c) MHPA - Mental Health Parity Act
d) PSDA - Patient self determination Act

CRIMINAL LAW

Subsection of public law and relates to the relationship of an individual with the government.

CIVIL LAW

Protects the individual rights of people. One type of civil law that relates to the provision of nursing care is TORT LAW

TORTS

a) Unintentional Torts (Negligence, Malpractice)
b) Quasi-intentional Torts (Breach of confidentiality, defamation of character)
c) Intentional Torts (Assault, Battery, False Imprisonment)

NEGLIGENCE

A nurse FAILS TO implement safety measures for a client who has been identified as at risk for falls

MALPRACTICE (Professional negligence)

A nurse administers a large dose of medication due to a calculation error. The client has a cardiac arrest and dies.

BREACH OF CONFIDENTIALITY

A nurse releases the medical diagnosis of a client to a member of the press

DEFAMATION OF CHARACTER

A nurse tells a colleague that she believes the client has been unfaithful to her spouse

ASSAULT

The conduct of one person makes another person fearful or apprehensive (threatening to place a nasogastric tube in a client who refuses to eat)

BATTERY

Intentional and wrongful physical contact with a person that involves an injury or offensive contact (restraining a client and administering an injection against her wishes).

FALSE IMPRISONMENT

A person is confined or restrained against his will (using restraints on a competent client to prevent his leaving the health care facility)

COMPACT STATE

In relation to licensure, a nurse who resides in a compact State is allowed to practice in another compact State under a multi-State license.

PROFESSIONAL NEGLIGENCE

Failure of a person with professional training to act in a reasonable and prudent manner.

Reasonable and Prudent

Used to describe a person who has the average judgment, intelligence, foresight, and skill that would be expected of a person with similar training and experience.

FIVE ELEMENTS necessary to prove NEGLIGENCE

1. Duty to provide care as defined by standard
2. Breach of duty by failure to meet standards
3. Foreseeability to harm
4. Breach of duty has potential to cause harm (combines 2 and 3)
5. Harm occurs

Ways to AVOID being liable for NEGLIGENCE

1) Follow standards of care
2) Give competent care
3) Communicate with other health team members
4) Develop a caring rapport with clients
5) Fully document assessments, interventions and evaluations

PATIENT'S (Client's) Rights

a) Informed consent
b) Right to refuse treatment
c) Advanced directives
d) Confidentiality
e) Information security

American Hospital Association (AHA) identifies patient's rights in Health Care settings

Contained in "The Patient Care Partnership"

Informed Consent

Written and signed permission (document) for a procedure or treatment to be performed.

Elements of an Informed consent

a) Reason for treatment or procedure
b) How procedure will benefit the client
c) Risks involved if client agrees to the procedure
d) Other options available to treat the problem

Nurse's ROLE in an INFORMED CONSENT

a) WITNESS THE CLIENT's SIGNATURE
b) Ensure that informed consent has been appropriately obtained

Who CAN SIGN an INFORMED CONSENT?

a) a competent adult
b) someone who is capable of understanding the information provided.

AUTHORIZED individuals to grant consent for another person:

a) Parent of a minor
b) Legal guardian
c) Court-specified representative
d) A person with a durable Power of Attorney (POA) for health care
e) Emancipated minors (independent minors such as married minors)

Patient Self Determination Act (PSDA)

Upon admission to a Health Care facility, a client must be informed of their right to accept or refuse care.

AMA (against medical advice) form

Client must sign this document when a decision is made to leave the facility without a discharge order.

Standards of Care (Practice)

Legal parameters of practice, define and direct the level of care that should be given by a practicing nurse. They are used in malpractice lawsuits to determine if that level was maintained.

Where can the "Standards of Care" be found?

in the NURSE PRACTICE ACT of each State

SCOPE OF PRACTICE

That which belongs to the area of competence as determined by training, education and licensing requirements.

ADVANCED DIRECTIVES

Communicates a client's wishes regarding and end-of-life care should the client become unable to do so. PSDA requires that all health care facilities ask if a patient has advanced directives upon admission.

Types of ADVANCED DIRECTIVES

a) Living Will - expresses client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end of life issues

b) Durable Power of Attorney for Health Care- designates a health care proxy who is an individual authorized to make health care decisions for a client who is unable

c) Provider's Orders - Unless a DNR (do not resuscitate) or AND (allow natural death) order is written, nurse initiates CPR when client has no pulse or respiration. Written order for DNR or AND must be placed in client's medical record.

Mandatory Reporting

Nurses are mandated to report any suspicion of abuse (child or elder abuse, domestic violence) following facility policy.

Communicable disease Reporting

Nurses are also mandated to report to the proper agency (local or State health department) when client has been diagnosed with a communicable disease (e.g. tuberculosis, hepatitis A)

Client's CHART OR MEDICAL RECORD

Legal record of care: confidential, permanent and legal document that is admissible in court.

Information included in the Client's Chart

a) Assessments
b) Medication Administration
c) Treatments given and the client's responses
d) Client education

PURPOSES for MEDICAL RECORDS

a) communication
b) legal documentation
c) financial billing
d) education
e) research
f) auditing/monitoring

Purpose of reporting

Provide continuity of care

Good qualities of DOCUMENTATION

a) Factual - Subjective and Objective
b) Accurate and Concise
c) Complete and Current
d) Organized

LEGAL GUIDELINES OF a GOOD DOCUMENTATION

a) Begin entry with DATE and TIME
b) Record legible with non-erasable black ink; do not LEAVE BLANK SPACES
c) Do NOT USE Correction Fluid
d) Information inadvertently omitted may be added as "LATE ENTRY". Must include time charting was done and the time the charting reflects
e) Should reflect assessments, interventions, and evaluations performed by the person signing the entry.
f) for electronic charting, password must be PRIVATE

DOCUMENTATION FORMATS

a) Flow Charts - record and show trends in vital signs, blood glucose levels, pain level and other frequently performed assessments

b) Narrative Documentation - records information as a sequence of events

c) Charting by exception (CBE) - standardized forms that identify normal findings/values and allows selective documentation of abnormal findings.

d) Problem oriented medical records (POMR) - consists of database, problem list, care plan, and progress notes.

POMR (Problem oriented medical records)

a) SOAPIE
b) PIE
c) DAR (focus charting)

SOAPIE

S = subjective data
O = objective date
A = assessment (includes Nursing Diagnosis based on assessment)
P = Plan
I = Intervention
E = Evaluation

PIE

P = problem
I = intervention
E = evaluation

DAR (focus charting)

D = data
A = action
R = response

Change-of-shift Reports

Given at the conclusion of each shift by the nurse leaving to the nurse assuming responsibility for the client.

Transcribing Medical orders

a) Have a second nurse listen to telephone order
b) Repeat back the order given: medication name, dosage, time and route
c) Document reading back the order and presence of nurse
d) Question any order that may seem contraindicated due to a previous order or due to the client's condition

TRANSFER REPORTS SHOULD INCLUDE

CLIENT's:
a) demographic information
b) medical diagnosis
c) directives
d) most recent vital signs
e) current prescribed medication
f) allergies
g) diet and activity orders
h) special equipment
i) advanced directives
j) family involvement

Components of the Privacy Rule of HIPAA:

a) Only health care team members directly responsible for client care should be allowed access to client records.
b) Clients have the right to read and obtain a copy of their medical record, and facility policy should be followed when client requests as such.
c) No part of the client chart can be copied except for authorized exchange of documents between health care institution or health care providers.
d) Client medical records must be kept in secure area
e) EMR should be password protected
f) Health care workers should only use their own passwords

INFORMATION SECURITY PROTOCOLS

a) Logging off from computer before leaving work station
b) Never share a user ID or password with anyone
c) Never leave a client's chart or other patient document where others can access it.
d) Shred any printed or written client information used for reporting or client care after it is no longer needed.

Five RIGHTS of DELEGATION

a) Right Task
b) Right Circumstance
c) Right Person
d) Right Direction/Communication
e) Right Supervision

Nursing Process (overview)

a) Cyclical, critical thinking process that consists of five steps; variation of scientific reasoning
b) client centered, problem solving and decision making framework
c) Provides the framework throughout which the nurse can apply knowledge, experience, judgment and skills to the formulation of a nursing care plan
d) Includes five sequential but overlapping steps
e) allows nurse to integrate creative critical thinking
f) Promotes professionalism

Five steps of Nursing Process

1) Assessment/data collection
2) Diagnosis - Analysis/data collection
3) Outcome - planning
4) Implementation - intervention
5) Evaluation

Methods of Data Collection

1) Observation
2) Interviews
3) Comprehensive or focused physical examination
4) Diagnostic and laboratory reports
5) Collaboration

Two Types of DATA

a) Subjective Data - Symptoms; what patient says
b) Objective Data - Signs; what is seen in a patient

Sources of DATA

a) Primary = the CLIENT
b) Secondary = all other sources which does NOT COME FROM THE client

Nurse engages in three types of PLANNING

a) Comprehensive plan of care upon admission
b) Ongoing planning based upon new information and new assessments and new evaluations
c) Discharge planning. Begins as soon as the client is admitted

Maslow's hierarchy of needs

A framework used as a guideline to set priorities

Types of INTERVENTIONS

a) Nursing initiated/independent interventions - within Scope of Practice as identified by ANA Standards of Practice, State Nurse Practice Act and health care facility policies
b) Physician initiated/dependent interventions - the nurse initiates as a result of a physician's order
c) Collaborative intervention - the nurse carries out in collaboration with other health care team professionals.

Components of CRITICAL THINKING

a) Knowledge
b) Experience
c) Competencies
d) Attitudes
e) Intellectual and Professional Standards

Levels of Critical Thinking

a) Basic Critical thinking - results from limited knowledge and experience
b) Complex critical thinking - expresses autonomy by analyzing and examining data to determine best alternatives
c) Commitment - results from an expert level of knowledge, experience, developed intuition, and reflective flexible attitudes

Assessment/Data collection

Collect information about client's present health status to identify client's needs and to identify additional data to collect based on nurse's findings

DIAGNOSIS: Analysis/Data collection

Interpret or monitor the collected database, reach an appropriate nursing judgment about client's health status and coping mechanisms, and provide direction for nursing care

OUTCOME: Planning

Establish priorities and optimal outcomes of care than can be measured and evaluated, then select the nursing interventions to include in a client's plan of care to promote, maintain, or restore a client's health

Implementation

provide client care based on assessment data gathered, analyses done, and the plan of care developed in the previous steps of the nursing process.

Evaluation

Examine a client's response to nursing interventions and form a clinical judgment about the extent to which goals and outcomes have been met.

Attitudes of a critical thinker

1) Confidence - feels sure of abilities
2) Independence - Analyzes ideas for logical reasoning
3) Fairness - objective, nonjudgmental
4) Responsibility - practices according to standards of practice
5) Risk taking - takes calculated chances in finding better solutions to problems
6) Discipline - Develops a systematic approach to thinking
7) Perseverance - continues to work until problem is resolved
8) Creativity - using imagination to find solutions unique to client problems
9) Curiosity - requires more information about clients and problems
10) Integrity - practices truthfully and ethically
11) Humility - Acknowledges weakness
12) Standards - Model to which care is compared to determine acceptability, excellence and appropriateness

Asepsis

Absence of illness-producing micro-organisms, maintained through the use of aseptic technique with hand hygiene as the primary behavior associated with asepsis/aseptic technique.

Two types of Asepsis

a) Medical Asepsis - clean technique - reduction of micro-organisms
b) Surgical Asepsis - sterile technique - elimination of micro-organisms

Components of Hand washing

a) Soap
b) Water
c) Friction

Length of time required for hand washing

at least 15 seconds to remove transient flora and up to 2 minutes when the hands are soiled.

Iatrogenic infection

Type of HAI resulting from a diagnostic or therapeutic procudure

Signs and symptoms of generalized systemic infection

a) Fever
b) Increased pulse and respiratory rate (in response to high fever)
c) Malaise
d) Anorexia, nausea, and/or vomiting
e) Enlarged lymph nodes (repositories of waste)

HAI - Health-care Associated Infection

Formerly known as nosocomial infection, they are acquired while receiving care in a health care setting. These can come from an exogenous source (outside the client) or an endogenous source (inside the client)

Inflammation

Body's local response to injury or infection

3 Stages of the inflammatory response

I. FIRST STAGE - inflammatory response (local infection)
a) Redness from dilation of arterioles bringing blood to the area
b) Warmth of the area on palpation
c) Edema
d) Pain or tenderness
e) Loss of use of the affected part

II. SECOND STAGE - micro-organisms have been killed. Fluid accumulates and exudate appears at the site of infection
a) Serous
b) Sanguineous (contains red blood cells)
c) Purulent (contains leukocytes and bacteria)

III. THIRD STAGE - damage tissue is replaced by scar tissue. Gradually new cells take on characteristics that are similar in structure and function of the old cells.

Laboratory results indicating infection

a) Leukocytes (WBC more than 10,000 ul)
b) Increases in the specific type of WBCs on differential (left shift = an increase in neutrophils)
c) Elevated erythrocyte sedimentation rate (ESR)
d) Presence of micro-organisms on culture of the specific fluid/area

COMPONENTS OF THE CHAIN OF INFECTION

a) Infectious agent - bacteria, virus, fungi, protozoa
b) Reservoir - where infectious agent grows (wound drainage, food, oxygen tubing)
c) Exit - portal of the infectious agent (skin, respiratory or GI tract)
d) Means of transmission (droplet, person to person contact, touching contaminated items)
e) Entry - portal to a susceptible host (same as Exit)
f) Host - must be susceptible to infectious agent

Infection control for immobile clients

Ensure that pulmonary hygiene (turning, coughing, deep breathing, incentive spirometry) is done every 2 hours, or as prescribed. Good pulmonary hygiene decreases the growth of micro-organisms and the development of pneumonia by preventing stasis of pulmonary excretions, stimulating ciliary movement and clearance, and expanding the lungs

Isolation guidelines

a) group of actions that include hand hygiene and the use of barrier precautions

b) applies to every client, regardless of diagnosis and must be implemented whenever contact with a potentially infectious material is anticipated

c) 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 One)

a) applies to all body fluids (except sweat), nonintact skin, and mucous membranes.
b) Hand hygiene using alcohol based waterless product is recommended after contact with client, body fluids, and contaminated equipment.
c) Alcohol-based waterless antiseptic is preferred unless hands are visible dirty, because alcohol based product is more effective in removing micro-organisms.

d) Clean gloves are worn when touching body fluids, nonintact skin, mucous membranes, and contaminated equipment
e) Gloves are removed and hand hygiene performed between each client.
f) Masks, eye protection, and/or face shield are required when care may cause splashing or spraying of body fluids.

g) Hand hygiene is required after removal of the gown. A sturdy moisture-resistant bag should be used for soiled items and the bag should be tied securely in a knot at the top.
h) All equipment used for client care is to be properly cleaned, one time use should be disposed accordingly.
i) Contaminated laundry should be bagged and handled to prevent leaking or contamination of clothing or skin

j) Safety devices on all equipment/supplies must be enabled after use; sharps must be disposed of in a puncture-resistant container
k) A private room is not needed unless the client is unable to maintain appropriate hygiene practices.

TRANSMISSION PRECAUTION (Tier Two)

a) Airborne precautions are used to protect against droplet infections smaller than 5 mcg (measles, varicella, pulmonary or laryngeal tuberculosis). Airborne precaution require: (1) Private room; (2) Mask, respirators for providers and visitors; N95 or HEPA (high efficiency particulate air) respirator if patient is suspected to have TB; (3) Negative pressure airflow exchange in the room of at least six exchanges per hour.

b) Droplet precautions against droplet larger than 5 mcg (streptococcal pharyngitis or pneumonia, scarlet fever, rubella, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia/sepsis, pneumonic plague). Droplet precautions require: (1) Private room or a room with other clients having the same infection; (2) Masks for providers and visitors

c) Contact precautions - 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, multi-drug resistant organisms. Contact precautions require: (a) private room or room with other client with the same disease; (b) gloves and gown worn by caregivers and visitors; (c) disposal of infectious dressing material into a single, nonporous bag without touching the outside of the bag.

TRANSPORTING THE CLIENT

If movement of client to another area is not avoidable, take precautions to ensure that the environment is not contaminated. For example, a surgical mask is placed on the client with an airborne or droplet infection, and a draining wound is well covered.

Guidelines for cleaning contaminated equipment

1) Always wear gloves
2) Rinse first in cold water (hot water coagulates proteins)
3) Wash the article in hot water with soap
4) Use a brush or abrasive to clean corners
5) Rinse well in warm or hot water
6) Dry the article - considered clean at this point
7) Clean the equipment used in cleaning
8) Remove gloves and perform hand hygiene

Older Adults increased risk for falls

a) Due to decreased strength
b) Impaired mobility and balance
c) Limited endurance
d) Decreased sensory perception

Other clients with increased risk for falls

1) Those with decreased visual acuity
2) Generalized weakness
3) Gait and balance problems (CP, Injury, MS) and cognitive dysfunctions
4) Side effects of medication (orthostatic hypotension, drowsiness)

GENERAL MEASURES to PREVENT FALLS

1) Call light location and use
2) Respond to call lights in a timely manner
3) Orient client to setting
4) Place client at risk for falls close to the nursing station
5) Ensure bedside table and frequently used items are within reach
6) Maintain bed in low position
7) For clients who are sedated or unconscious, bed rails are up, bed is kept low
8) Avoid the use of full side bed rails for clients who get out of bed without assistance
9) Provide clients with nonskid footwear
10) Keep floor free from clutter with a clear path to the bathroom
11) Keep assistive devices nearby after validation of use
12) Lock wheels on beds, wheelchairs and carts
13) Use chair or bed sensors for clients at risk for getting up unattended to alert staff

SEIZURES

Sudden surge of electrical activity in the brain. May occur anytime, may be due to epilepsy, fever or a variety of medical conditions. Partial seizures are surges in one part of the brain. Generalized seizures involve entire brain.

Seizure precautions (most important)

1) Do not put anything in a client's mouth (except for status epilepticus, where an airway is needed) in the event of a seizure

2) Do not restrain a client in an event of a seizure. Lower him to the floor or bed. Protect head, remove nearby furniture, provide privacy, put client on his side with head flexed slightly forward, loose clothing to prevent injury

3) Stay with the client and call for help
4) Administer medication as ordered
5) After seizure, explained what happened to client. Provide comfort.
6) Document thoroughly: duration, behavior, description, length, injury, aura, postictal state, and report to provider

Two types of restraints:

a) Physical
b) Chemical

Seclusions and restraints must never be used for:

a) convenience of the staff
b) punishment for the client
c) clients who are extremely physically or mentally unstable
d) clients who cannot tolerate the decreased stimulation of a seclusion room

Restraints should:

a) never interfere with treatment
b) restrict movement as little as is necessary to ensure safety
c) Fit properly
d) Be easily changed to decrease the change of injury and provide for the greatest level of dignity

A prescription for restraint should contain the following:

a) reason for restraint
b) type of restraint
c) location of the restraint
d) how long the restraint may be used
e) type of behaviors demonstrated by the client that warrant use of restraint

How often should a physician rewrite a prescription for restraint?

every 24 hours

Frequency of client assessment in regards to food. fluid, comfort and safety in relation to a restraint

every 15 to 30 minutes

Other important things to know and do about a restraint

a) Always explain the need for restraint to client
b) Obtain signed consent from client or guardian
c) Review manufacturer's instructions for correct application
d) Remove or replace restraints for good circulation
e) Pad bony prominences
f) Use quick release know to tie restraint to the bed frame
g) Ensure that restraint is loose enough to fit two fingers between device and the client
h) Never leave client unattended without restraint

Fire response in a health care setting follows this pattern

R - Rescue, protect and evacuate clients in close proximity to the fire
A - Alarm, Report the fire by setting off the alarm
C - Contain the fire by closing the doors and windows as well as turning off any sources of oxygen. Clients who are on life support are ventilated with a bag-valve mask
E - Extinguish the fire if possible using an appropriate fire extinguisher

3 Classes of fire extinguisher

Class A = paper, wood, upholstery, rags or other types of trash
Class B = flammable liquids, and gas fires
Class C = for electrical fires

to USE a FIRE EXTINGUISHER

P = pull the pin
A = aim at the base of the fire
S = squeeze the lever
S = sweep motion back and forth over the fire

Factors that contribute to a client's risk for injury

a) Age and development status
b) Mobility and balance
c) Knowledge about safety hazards
d) Sensory and Cognitive awareness
e) Communication skills
f) Home and work environment
g) Community in which the client lives

Risk factors for falls among older adults

1. Physical, cognitive and sensory changes
2. Changes in the musculoskeletal and neurological systems
3. Impaired vision and/or hearing
4. Frequent trips to the bathroom at night because of nocturia and incontinence

Places an older adult at risk for burns and other type of tissue injury

Decrease in tactile sensitivity

Modifications that can me made to improve home safety for Older Adults

1. Remove items that could cause a client to trip, such as throw rugs and carpets
2. Place electrical cords and extension cords against a wall behind furniture
3. Make sure that steps and sidewalks are in good repair
4. Place grab bars near the toilet and in the tub or shower and install a stool riser
5. Use a non-skid mat in the tub or shower
6. Place a shower chair in the shower
7. Ensure that lighting is adequate both inside and outside of the home

Some HAZARDS of SMOKING:

a) Passive smoking is the unintentional inhalation of tobacco smoke
b) Exposure to nicotine and other toxins places people at risk for numerous diseases including cancer, heart disease, and lung infections.
c) Low birth weight infants, prematurity, still births, and sudden infant death syndrome (SIDS) have been associated with maternal smoking.
d) Smoking in the presence of children is associated with the development of bronchitis, pneumonia, and middle ear infections

HAZARDS of CARBON MONOXIDE

1. Carbon monoxide is a very dangerous gas because it binds with hemoglobin and ultimately reduces the oxygen supplied to the tissues in the body.
2. Carbon monoxide cannot be seen, smelled or tasted
3. Symptoms of carbon monoxide poisoning include: nausea, vomiting, headache, weakness and unconsciousness
4. Death may occur with prolonged exposure
5. Measures to prevent Carbon Monoxide poisoning include proper ventilation when using fuel-burning devices (lawn-mowers, wood burning and gas fireplaces)
6. Gas burning furnaces, water heaters and appliances should be inspected annually.
7. Carbon monoxide detectors should be installed and inspected regularly

Hazards of FOOD POISONING

a) Food poisoning is a major cause of illness in the US
b) Most food poisoning is caused by some type of bacteria such as Escherichia coli, Listeria monocytogenes, and Salmonella
c) Most food poisoning occurs because of unsanitary food practice
d) Very young, very old, pregnant and immunocompromised individuals are at risk for complication
e) Performing hand hygiene, ensuring that meat and fish are cooled to the correct temperature, handling raw and fresh food separately to avoid cross contamination, and refrigerating perishable items prevent food poisoning.

Hazards of Bioterrorism

1. Bioterrorism is the dissemination of harmful toxins, bacteria, viruses, and pathogens for the purpose of causing illness or death
2. Anthrax, variola, Clostridium botulism, and Yersinia pestis are examples of agents used by terrorists

ERGONOMICS

Factors or qualities in an object's design and/or use that contribute to comfort, safety, efficiency and ease of use.

Good body mechanics

Positioning and moving clients to promote safety for the client as well as for health care providers

Mobility assessment

Needed before attempting to move or position a client. Begin with ROM and progress as long as client tolerates. Include balance, gait and exercise

Body Mechanics

Proper use of muscles to maintain balance, posture, and body alignment when performing a physical task. Nurses use body mechanics when providing care to clients by lifting, bending, and carrying out the activities of daily living.

Center of gravity

1) it is the center of mass
2) Weight is the quantity of matter acted on by force of gravity
3) To lift an object, the nurse must overcome the weight of the object and know the center of gravity of the object.
4) When the human body is in the upright position, the center of gravity is in the pelvis
5) When an individual moves, the center of gravity shifts
6) The closer the line of gravity is to the center of the base of support, the more stable the individual is.
7) The lower the center of gravity, bend the hips and knees

LIFTING

a. Use the major muscle groups to prevent back strain, and tighten the abdominal muscles to increase support to the back muscles

b. Distribute the weight between the large muscles of the arms and legs to decrease the strain on any one muscle group and avoid strain on smaller muscles.

c. When lifting an object from the floor, flex the hips, knees and back. Get the object to thigh level, keeping the knees bent and the back straightened. Stand up while holding the object as close as possible to the body, bringing the load to the center of gravity to increase stability and decrease back strain.

d. Use assistive devices whenever possible, and seek assistance whenever it is needed.

When pushing or pulling a load

a) Widen the base of support
b) Pull objects toward the center of gravity rather then pushing away
c) If pushing, move the front foot forward, and if pulling, move the rear leg back to promote stability
d) Face the direction of movement when moving a client
e) Use own body as counterweight when pushing or pulling to make the movement easier
f) Sliding rolling and pushing require less energy than lifting and offer less risk for injury
g) Avoid the thoracic spine and bending the back while hips and knees are straight.

Guidelines to prevent injury

1) Plan ahead for activities that require lifting, transfer, or ambulation of client, and ask others to be ready to assist at the planned time
2) Be aware that the safest way to lift a client may be with the use of assistive equipment.
3) Rest between heavy activities to decrease muscle fatigue
4) Maintain good posture and exercise regularly to increase strength in arms, legs, back, and abdominal muscles, so these activities will require less energy.
5) Use smooth movements when lifting and moving clients to prevent injury through sudden or jerky muscle movements.
6) When standing for long periods of time, flex the hip and knee through use of a foot rest. When sitting for long periods of time, keep the knees slightly higher than the hips.
7) Avoid repetitive movements of the hands, wrists, and shoulders. Take a break every 15 to 20 minutes to flex and stretch joints and muscles.
8) Maintain good posture (head and neck in straight line with the pelvis) to avoid neck flexion and hunched shoulders, which can cause impingement of nerves in the neck.
9) Avoid twisting the spine or bending at the waist (flexion) to minimize the risk for injury.

SEMI-FOWLER'S POSTION

1) Used to prevent regurgitation of tube feedings and aspiration in clients with difficulty swallowing
2) Supine with head of the bed elevated approximately 30 degrees and knees slightly elevated about 15 degrees

FOWLER'S POSITION

1) Used during procedures such as NG tube insertion and suctioning. Also for better chest expansion and ventilation, as well as better dependent drainage after abdominal surgeries
2) Supine with head of bed elevated about 45 degrees, and knees slightly elevated about 15 degrees.

HIGH-FOWLER'S POSITION

1) Promotes lung expansion by lowering the diaphragm and is used for clients experiencing severe dyspnea
2) Supine with head of bed elevated slightly 90 degrees and knees may or may not be elevated

SUPINE OR DORSAL RECUMBENT

1) Ideal for patients with lower back problems
2) Lies on back with head and shoulders elevated on a pillow. Forearms may be placed on pillows or placed at side. A foot support prevents foot drop and maintains proper alignment.

PRONE POSITION

1) Promotes drainage from the mouth for clients following throat or oral surgery, but inhibits chest expansion
2) Flat on abdomen with head to one side

LATERAL OR SIDE-LYING POSITION

1) This is a good sleeping position, but the client must be turned regularly to prevent development of pressure ulcers on the dependent areas. A 30 degree lateral position is recommended for clients at risk for pressure ulcers.
2) Client lies on side with most of his weight on the dependent hip and shoulder. Arms should be flexed in front of the body. A pillow is placed under his head and neck, the upper arm, and under the leg and thigh to maintain body alignment

SIM'S OR SEMI-PRONE POSITION

1) This is a comfortable sleeping position for many clients, and it promotes oral drainage.
2) Client is on his side halfway between lateral and prone positions. (Weight is on the anterior ileum, humerus and clavicle. Lower arm is behind the client while the upper arm is in front. Both legs are flexed, but the upper leg is flexed at a greater angle than the lower leg at the hip as well as the knee.

OTRHOPNEIC POSITION

1) This position allows for chest expansion and is especially beneficial to clients with CPOD
2) Sits in the bed or at the bedside. Pillow is placed on the over-bed table, which is placed across the client's lap. Client rests his arms on the over-bed table .

TRENDELENBURG POSITION

1) Used during postural drainage, facilitates venous return
2) Entire bed is tilted with the foot of the bed lower than the head of the bed.

REVERSE TRENDELENBURG POSITION

1) Promotes gastric emptying and prevents esophageal reflux
2) Entire bed is tilted with the foot of the bed lower than the head of the bed.

DISASTER

Mass casualty or intra-facility event that overwhelms or interrupts at least temporarily the normal flow of services of a hospital.

TWO TYPES OF DISASTER

a) INTERNAL EMERGENCIES - loss of electric power, severe damage or casualties within the facility
b) EXTERNAL EMERGENCIES - hurricanes, floods, volcano eruptions, terrorist acts, building collapse, safety and hazardous materials.

Categories of Triage

The principles of triage should be followed in health care institutions involved in a mass casualty event. Categories are separated in relation to their potential for survival, and treatment is allocated accordingly
1. Class I (Emergent Category) - Highest priority is give to clients who have life-threatening injuries but also have a high possibility of survival once they are stabilized
2. Class II (Urgent Category)

Inhalational Anthrax

SIGNS AND SYMPTOMS: sore throat, fever, muscle aches, severe dyspnea, meningitis, shock
TREATMENT PREVENTION: IV ciprofloxacin (Cipro)

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