Ethical Principles in Nursing

Ethical Principles in Nursing

• Autonomy: Respecting patient's decisions about healthcare, even if differing from the nurse's perspective.
• Beneficence: Acting in the patient's best interest, promoting their well-being, and providing comfort and necessary care.
• Fidelity: Being truthful, loyal, and faithful to the patient.
• Veracity: Providing honest and accurate information, even if difficult.
• Justice: Ensuring equitable distribution of resources.
• Non-maleficence: Avoiding and minimizing harm.

Code of Ethics in Nursing

• Guidelines: Applying to all nurses, setting ethical standards for conduct and behavior, promoting health and optimal care.
• Primary Commitment: To the patient.
• Compassion and Respect: Demonstrating compassion and respect for patient dignity.
• Authority/Accountability: Having authority, accountability, and responsibility for nursing practice.

HIPAA

• Confidentiality: Protecting patient privacy without hindering quality care access.

Evidence-Based Practice

• Minimizing Intuition: Focusing on research over personal experience.
• Finding the "Why": Seeking answers through research.
• Steps: Identifying the problem, researching relevant studies, evaluating findings, and justifying intervention choices with the strongest evidence.

Diagnostic Reasoning

• Critical Thinking-Based: Using critical thinking for data analysis.
• Gathering and Clustering Data: Analyzing and organizing assessed data.
• NANDA Nursing Diagnoses: Wellness, risk of, and actual.
• Steps: Identifying normal and abnormal data, clustering information, proposing diagnoses, validating evidence, and documenting conclusions.

Health Assessment Purpose

• Gathering Information: Obtaining health status data and insights into current conditions.
• Establishing a Database: Creating a baseline for future comparisons.
• Identifying Patterns: Evaluating trends and assessing conditions.
• Nursing Process Start: Serving as the initial stage of the nursing process.

Health Assessment Types

• Emergency: Focused on immediate, potentially life-threatening issues (assessment and intervention often simultaneous).
• Focused: Concentrating on a specific patient problem, usually one or two body systems.
• Comprehensive: A wider scope to cover the patient's medical history, perception of health, functional abilities, and support systems, including a physical exam.

The Nursing Process

• Assess: Gathering data and information.
• Diagnose: Interpreting data, clustering information, and making judgments.
• Plan: Establishing specific, measurable, achievable, realistic, and time-bound patient outcomes guided by nursing interventions.
• Implement: Executing the chosen nursing interventions.
• Evaluate: Assessing the effectiveness of interventions in achieving planned outcomes.

Nursing Goals

• Health Promotion: Improving health.
• Illness Prevention: Reducing vulnerability to illness.
• Response Management: Addressing reactions to health or illness.
• Advocacy: Supporting individuals, families, communities, and populations.

HEENT Assessment (Head, Eyes, Ears, Nose, Throat)

Subjective Data:

• Medical, surgical histories and risk factors from patient perspective. Lifestyle, medications, family history, symptoms.

Objective Data (Head):

• Position, cranium shape, facial symmetry, hair distribution, texture, and cleanliness.

Objective Data (Neck):

• Muscle symmetry, trachea position, presence of masses or nodes. Important to document findings.

Objective Data (Scalp):

• Symmetry, tenderness, masses, lesions, or differences in firmness. If issues are found, assess texture, size, and consistency.

Objective Data (Eyes):

• Structure (lids, eyebrows, sclera, conjunctiva, pupils, iris, accommodation). Age-related changes to monitor.
• Visual Acuity: Snellen and Jaeger charts. Test distance and near vision.
• Extraocular Movements (EOMs): Evaluate alignment for Ptosis.
• Corneal Light Reflex (CRL): Assess symmetry.
• Pupillary Reflexes: Assess for direct and consensual responses.

Objective Data (Ears):

• Function: Air and bone conduction, conductive and sensorineural hearing loss, causes.
• Assessment: Rinne and Weber tests for conductive and sensorineural loss. Whisper test to assess hearing acuity.

Objective Data (Nose):

• Symmetry, midline, skin surface, color, drainage, and discharge (abnormal).

Objective Data (Mouth & Throat):

• Lips: color, moisture, lesions, oral competence.
• Buccal Mucosa (inside cheek): color/pigmentation.
• Teeth, gums, and uvula: Overall appearance and positioning.
• Examination of Mouth: Open mouth wide with tongue assessment included.
• Throat: Observe pharynx, tonsils, soft palate, and anterior/posterior pillars for color, symmetry, enlargement, and lesions.

Swallowing Considerations:

• Dysphagia: Difficulty swallowing.
• Aspiration: Food/liquids entering the trachea instead of esophagus. Risk factors like cognitive impairment or impaired gag reflex must be considered. Assessment during eating/drinking to note aspiration signs.

Neuro Assessment

Nervous System Components:

• Central Nervous System (CNS): Brain (cerebellum, cerebrum, brainstem) and spinal cord.
• Peripheral Nervous System (PNS): Nerves outside of brain and spinal cord; relays signals.
• Autonomic Nervous System: Controls involuntary functions (sympathetic and parasympathetic).
• Cranial Nerves: Assessment of 12 pairs crucial.

Subjective Data (Neuro):

• Past medical or surgical history, risk factors, medications, family history, relevant lifestyle information, and concerning symptoms (headache, weakness, paresthesia, involuntary movements, balance problems, vision/hearing changes, etc.)

Objective Data (Neuro):

• Level of Consciousness (LOC): Full consciousness to coma; use Glasgow Coma Scale (GCS).
• GCS Limitations: Drugs, alcohol, shock, and low oxygen levels can affect GCS scores.
• Posturing (Decortication & Decerebration): Identifies severe brain injury type.
• Motor System Assessment: Symmetry, muscle tone, and strength; graded 0-5.
• Reflexes: Deep tendon reflexes are graded.
• Romberg Test: Equilibrium assessment using eyes open/closed stance.
• Sensory Function: Assessment using touch, temperature, vibration, and proprioception to ascertain intactness.

Urgent/Acute Neuro Assessment:

• Critical for preventing detrimental outcomes by recognizing changes in LOC, motor strength, facial symmetry, and sensation.
• Pupil checking and other essential tests.

Special Populations (Neuro):

• Post-cardiotomy delirium: monitoring for cognitive/mental status changes.
• Post-CVA (stroke): Acute & rehabilitation phase assessments differ.
• Tumour Assessment: Look for progressing symptoms.