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Terms in this set (109)
Should an RN be responsible to monitor health status?
Yes, reassess the patient for changes in the status that might dictate a different intervention ."Alfaro's rule" Assess, reassess, revise, record.
What is another purpose of the diagnosing step in the nursing process?
Formation of priority in patient problems.
Describe problems treated by nurses within their scope of practice.
Determine risk factors that must be managed . Identify resources, strengths, and areas for health promotion.
What is the most reliable basis on which to choose a nursing diagnosis?
Create a list of problems.
Naming actual & potential problems/ diagnosis, clarify what is causing or contributing to them.
Determine risk factors.
Identify resources, strengths, and areas for health promotion.
Subjective and objective data.
What guideline is correct when creating a nursing diagnosis?
Etiology-factors maintaining the unhealthy state.
Defining characteristics -identifying subjective and objective data that signal existence of a problem.
what is the main purpose of the planning step of the nursing process?
Identify & write expected outcomes
Select evidence- based nursing interventions
Communicate the plan of care
what should the home health nurse acknowledge first when the client has return back home after a fall?
The immediate environment safety.
What is it called when the nurse attributes knowledge and skills, attitudes, and behaviors to provide optimal health?
Blended competencies- cognitive and interpersonal
Which action by the nurse best provides patient-centered care?
Always involving the patient in their care. Providing care that is respectful & responsive to individual patient needs preferences and values.
Exactly the care patients want and need exactly how they want and need it. Creating a therapeutic relationship with patients to receive high quality care.
· Dignity and Respect
· Information sharing
What action should nurses focus on to provide excellent care in their community?
Interventions to manage health problems, promote health, & facilitate self-care and must be culturally competent & family centered.
Focus on Whole population within the community.
Centered on the health care needs of individuals and families.
What concept regarding the delivery of culturally competent nursing care should be noted?
based on shared characteristics of the people, the area, their social interactions and familial , culture or ethnic heritage & ties. Environment affects the ability to meet basic needs.
What examples/qualities should nurses deliver while working in a community-based stetting?
· Ability to practice autonomously. -freedom
· Manage time independently
· Enjoy being in the patient's home.
· Find satisfaction in working with community agencies.
· Able to be creative.
Community-based nurses MUST be knowledgeable and be skilled in their practice.
Be able to use critical thinking and make decisions independently.
Hold themselves accountable for what they do.
When planning and implementing care with a client who has both visual and hearing deficits, what should the nurse focus on?
· Reassessing the patient and reviewing the plan of care.
· Clarifying prerequisite nursing outcomes/situations.
· Promoting self-care: teaching, counseling, and advocacy.
· Assisting patients to meet outcomes.
Be sure that the nursing actions are safe for this particular patient and individualized to the patient's preferences.
What documentation standards should the Nurse focus on ? Characteristics of effective Documentation
· Consistent with the professional and agency standards
· Organized and timely
· Legally prudent
What type of documentation should the Nurse note regarding a history item?
Looking at the graphic record and the data base before assessment.
What type of tool should be used when assessing a child's pain?
Behavior measures, visual analog. Faces scale...
1. How should a Nurse end her documentation?
Nurse's name and initials.
Sign orders with name and title.
How does a Nurse make a correction when documenting in a patient's paper record?
One line through, what change is made and initials and date.
What type of abbreviations should the Nurse always use?
Try to not use abbreviations only use facility -approved abbreviations.
What was the aim for providing health care that was identified by the IOM report? Six outcomes
What are the Healthy People 2020 leading health indicators?
· Access to health services.
· Clinical preventive services.
· Environmental quality.
· Injury and violence.
· Maternal, infant, & child health
· Mental health
· Nutrition, physical activity and obesity
· Oral health
· Reproductive and sexual health
· Social determination
· Substance abuse
What is the goal of Healthy People 2020?
Reduce the prevalence & severity of disorders of hearing and balance; Smell & Taste; and voice, speech & language
What are the injury prevention objectives of Healthy People 2020?
Healthy people identified 13 objectives related to violence, several were use of firearms. This identifies violence as a public health issue that needs to be addressed at a community level.
What is not one of the four main goals of Healthy People 2020?
Four Main GOALS :
· Attain high quality longer life, free from preventable disease, disability, injury, and premature death.
· Achieve health equity, eliminate disparities & improve health of all groups.
· Create social and physical environments that promote good health for all.
· Promote quality of life, healthy development, and healthy behaviors across all life stages.
What are the Focal areas for Healthy People 2020?
Attention to the root causes of heath inequalities and health disparities-specifically, health determined
What is the purpose of Healthy People 2020?
Address multiple determinants of health and evaluate interventions that go beyond the traditional health care provider-patient model.
Define Primary Prevention
Directed toward promoting health and preventing the development of a disease process or injury.
Prevention immunizations education public exercise programs Before they have a disease PREVENTION /EDUCATION
Define secondary prevention
PreventionFocus on screening for early detection of disease with prompt diagnosis and treatment of any found.
Patient has been exposed or meets criteria for prevention measures diagnostic always secondary.
Define tertiary prevention
Pt already has disease Chemo, burn units, Irreversible
Name some examples of Primary Prevention
· Immunization Clinic
· Family Planning
· Poison Control Information
· Accident Prevention
Directed toward promoting health and preventing the development of disease processes or injury.
Name some examples of Secondary Prevention
Screenings: mammograms, any diagnostic testing,
Assessing children for normal growth, development, & encouraging regular medical, dental, and vision examinations.
Name some examples of Tertiary Prevention
Teaching a patient with diabetes how to recognize and prevent complications, using physical therapy to prevent contractures in a patient who has a had a stroke or spinal cord injury, and referring a woman to a support group after removal of a breast because of cancer.
Which action is most helpful in providing continuity of care?
Providing care for the patient between different settings.
What is the best action provided by the nurse that assist with continuity of care?
They provide interventions to promote health, manage acute or chronic illness, and promote self-care.
Which phrase best identify continuity of care?
Process by which health care providers give appropriate, uninterrupted care and facilitate the patient's transition between different settings and levels of care.
What did the Josie King foundation promote?
To prevent patients from dying or being harmed by medical errors. Uniting healthcare workers and consumers and funding innovating safety programs.
How can a nurse empower their clients to be safe?
Encourage patients active involvement in their own care as a patient safety strategy.
What national organization investigates sentinel events?
The Joint commission: Sentinel is defined as -unexpected occurrence involving death or serious physical or psychological injury.
IOM -Institute of medicine
What is The National Quality Forum?
Membership-based organization designed to develop and implement a national strategy for healthcare quality management and reporting.
Product or device
What safety practices were created by The National Quality For?
· Complete a risk assessment
· Indicate risk for falling on patient's door & chart
· Keep bed in a low position
· Keep wheels on bed and wheelchair locked
· Leave call bell within patients reach
· Instruct pt to use call bell
· Answer call bells promptly
· Leave a light on
· Eliminate all physical hazardous in the room (clutter, wet areas on the floor).
· Provide nonskid footwear
· Leave water, tissues, bedpan/urinal within patients reach
· Move bedside commode out of site to discourage independence
· Document and report any changes in cognitive status to the health care team at the change of shift
· As a last resort use the least restrictive restraint according to facility policy
· If restraint is applied, assess patient at the required intervals.
Cognitive Skilled nursing
Scientific Rationale for PT. Plan of care
Select Nursing Intervention most likely for desired outcome.
Uses Critical Thinking to solve Problems
Displays purpose of thinking & adequacy of knowledge.
Work through potential problems & use of resources
Cognitive Skills-using critical thinking; s systematic way to form & shape one's thinking.
-using critical thinking; a systematic way to form & shape one's thinking.
Technical skilled nurses:
-manipulate equipment skillfully to produce desired outcome or result. involves everything from manual dexterity and good hand-eye coordination to ability to troubleshoot when equipment malfunctions, based on an understanding of technical workings of equipment.
Interpersonal skilled nurses:
Use interactions with patients and significant others and colleagues to promote human dignity.
Elicit personal strength and abilities of patients to achieve health goals ad establish caring relationships.
Provide the healthcare team with knowledge about patient goals and expectations.
Work collaboratively with healthcare team as respected & credible colleagues.
-promoting the dignity and respect of patients and establishing caring relationships .
Ethically /legally skilled nurses:
Are trusted to act in ways that advance interest of patients
Are accountable for the practice
Act as effective patient advocates
Mediate ethical conflict among patietn, significant others, & healthcare team
-establish a personal moral code and professional role responsibilities
Systematic Characteristics of the Nursing Process
part of an ordered sequence of activities.
Interpersonal Characteristics of Nursing Process
human being is always at the "heart of nursing".
A description of the nursing intervention/implementation that was performed.
the client's response to the intervention.
Potential Breaches in Patient Confidentiality
Displaying information on a public screen
Sending confidential e-mail messages via public networks
Sharing printers among units with differing functions
Discarding copies of patient information in trash cans
Holding conversations that can be overheard
Faxing confidential information to unauthorized persons
Sending confidential messages overheard on pagers
What is confidential?
All information about patients written on paper, spoken aloud, saved on computer
- Name, address, phone, fax, social security
- Reason person is sick
- Treatments patient receives
- Information about past health conditions
Health Promotion & Illness
the behavior of a person that is motivated by their own personal desire to increase their own personal desire to increase their well-being & health promotion.
behavior motivated by a desire to avoid or detect disease or to maintain functioning within the constraints of an illness or disability
What are considered Health Risk Assessments?
an assessment and educational tool that indicates a client's risk for disease or injury during the next 10 years by comparing the client's risk with the mortality risk of the corresponding age, sex, and racial group
What does the nurse do to determine Health Risk Factors ?
use of health-style self-test to help see the "big picture"
a specific population of a group of people living in the same geographic area under similar regulations that have common values, interests & needs.
What does a healthy community offer?
Access to healthcare services for all members providing both treatment for illness and health promotion activities.
Maintain a safe & healthy environment .
Have other services available to meet the needs of the residents.
Centered on the health care needs of individuals and families
nursing practicing community based nursing
interventions to manage health problems., promote health, & facilitate self-care and must be culturally competent & family -centered.
Institute of Medicine of the National Academies; a nonprofit organization created to provide unbiased, evidence based and authoritative information and advice concerning health and science policy
Improving Patient Experiences of Health Care
Improving the Health of Individuals and Populations
Reducing the Cost of Healthcare
to help govt. & the private sector make informed health decisions by providing reliable evidence.
The Joint commission
National Patient Safety Goals
Sentinel Events Review
Unexpected occurrence involving death or serious injury, or the risk thereof.
The Joint Commission (TJC) Goal
independent non profit that accredits & certifies more than 17,000 healthcare organizations in the U.S.
GOAL to improve healthcare
What are the national patient safety goals?
Improve the accuracy of patient identifiers
Use at least two patient identifiers when providing care, treatment or services.
Improve the effectiveness of communication among caregivers
Improve the safety of using medications
Reduce the risk of heath care-associated infections.
Accurately & completely reconcile medications across the continuum of care.
Reduce the risk of patient harm from falls
Encourage patients' active involvement in their own care as a patient safety strategy
Prevent health care-associated pressure ulcers
Improve recognition and response to changes in a patient's condition.
an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof
Surgery on the wrong body part
A maternal death
Tubing & catheter misconnection
Overdose with commonly used anticoagulants
Discharge of infant to wrong family
National Quality Forum (NQF)
a private, nonprofit, membership organizational focused upon improving the quality of care through national goal setting, development and endorsement of performance measurement standards, and educational initiatives
National Quality Forum (NQF) Goal
To set national priorities, endorse national consensus standards for measuring & publicly reporting on performance, and promoting attainment of national goals through education and outreach.
vulnerable populations contributing factors
Social economic status (SES), Racial/ethnic minorities
Poor chronic disease
lack access to care
lack necessary physical capabilities
lack educational backgrounds
lack communicative skills
Lack financial resources
Persons with AIDS
Alcohol or substance abuser
Residents of rural areas
English Language Learners
Poorly educated / illiterate
Reasons for homelessness
Unemployment & underemployment
Nature disaster /fires
political unrest & wars
What is the name of the family structure that has "a family who has divorced parents raising their children by sharing time between both homes?"
What is a blended family?
two parents and their unrelated children from previous relationships
What is the Nuclear family?
a couple and their dependent children, regarded as a basic social unit.
Group of genera that share many characteristics
Blended competencies of nursing
the set of intellectual, interpersonal, technical, and ethical/legal capacities needed to practice professional nursing to promote or restore health, to prevent disease, illness & facilitate coping with altered functioning.
How do we define one of the blended competencies "Ethical"?
Responsible for certain basic ethical skills:being true to oneself, to the patients you are responsible for, the healthcare team the profession and society. Examining sense of accountability.
How do we define Technical?
Mastering manual skills essential in the nursing process; interpersonal : Promoting dignity & respect of PTS as people and establishing a caring relationship.
What are some of the most desired needs expressed by a patient?
To receive high quality, safe care.
Which intervention is important to the nurse to have in order to develop a therapeutic nurse-client relationship?
Always knock and pause before entering the patient's room.
What is the single greatest factor that contributes to the struggle of providing patient-centered care?
Increased patient load
Administering immunizations to individuals at a county health clinic is what type of action?
Which purpose of patient education is the nurse fulfilling when she is teaching a group of healthy adults about the flu injection?
The midwife prescribes iron to the pregnant women who has developed anemia. What level of prevention is represented by the administration of the medication for the disease?
What level of prevention is being used when a public health nurse is providing long-term medication to patients at the Hepatitis C clinic due to terminal damage to the liver?
What level of prevention is the community health nurse implementing regarding a program like providing influenza immunizations to employees at a local preschool?
What level of prevention is the school nurse performing when she is assisting a child with a percussion vest due to his cystic fibrosis?
What level of prevention is performed by the school nurse that identifies lice in the first grade class and also gives Benadryl to a child after a bee sting that has never previously been diagnosed with a reaction?
What level of prevention is performed by the occupational health nurse who is monitoring the employee's well-being after he has had surgery?
What level of prevention is the occupational health nurse performing when she is evaluating new food options for the cafeteria and purchasing PPE?
What level of prevention is the occupational health nurse performing when she is educating employees how to prevent injuries on the job?
What level of prevention is the school nurse performing when she is assessing each child's hearing and vision?
What level of prevention is the school nurse performing when she is demonstrating the use of a piece of equipment to a child that has been diagnose with chronic asthma?
What level of prevention is the nurse performing when she is teaching a patient about his diabetes?
What is the best rationale for considering influences in the neighborhood affecting the health and well-being of the community?
It is necessary to consider the history, demographics, ethnicity, and values and beliefs of the entire community because these factors can be used as part of a systems approach by teams to effectively assess a community.
What can a Case Manager provide to a client who has come into the Emergency Room for assisting in his/her health care needs?
coordinate your care and health insurance coverage.
In treating patients equally what word best describes the nurse starting an IV for a homeless man the same way an IV is started with a wealthy patient?
Justice, Autonomy, Fidelity, or Veracity? Which word would you choose?
What populations face economic barriers or cultural and / or linguistic barriers to primary medical care services called?
Under served populations
Define Transcultural nursing.
care that recognizes cultural diversity and is sensitive to the cultural needs of the patient and family.
What would be some reasons to refer to a Social Worker regarding a "failure to thrive" child's family? "Failure to thrive" refers to a child not doing well or not meeting a healthy functional state.
Psychological, social, or economic problems within the family
What is the best example of a resource barrier?
lack of understanding
lack of transportation
facility not open at a convient timing
What individual should be following a patient being discharge from the hospital with home health services?
Personal Support systems
know resources of who can help
Family friends and neighbors are best support
HARM REDUCTION for community health?
Preventing disease and promoting health that meets people where they are, rather than making judgements about where they should be in terms of their lifestyle.
What is an inexpensive method a nurse can meet with parents in the community to obtain information regarding the risk of Covid-19?
Primary care ( educate family)
ENVIRONMENTAL community assessment?
use of seatbelts
Hazardous waste elimination
What is one factor that a nurse can associate the overall health of the community?
offers access to healthcare services for all members providing both treatment for illness and health promotion activities .
Maintain a safe & healthy environment.
What level of prevention is a camp nurse performing when she is educating about the importance of regular exercise?
When a Nurse is providing Community Care to a patient, what elements should he/she address?
offers access to healthcare
What is "Near Miss"?
an error that would have happened except for someone's alertness & ability to identify & prevent the error.
What principles should a nurse follow to prevent medication errors?
Increasing safe medication administration
Eliminating ambiguous abbreviations
What should a nurse do first when she finds out she has given the wrong medication?
Ensure the patients safety.
What does "CUS" stand for?
I am "Concerned"
I am "Uncomfortable "
This is a "Safety" Issue
What is the difference between a rural population and an urban population?
Urban communities -public transport for easier access to health care providers.
County & state funding for services is better in urban areas.
Rural communities- Possibility of traveling long distances to receive care.
Recommended textbook explanations
Clinical Reasoning Cases in Nursing
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Brunner & Suddarth's Textbook of Medical-Surgical Nursing
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BSCS Biology: A Molecular Approach
Florida Science Fusion: Grade 7
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