Healthcare Ethical Principles and Communication

Personal Ethical Principles

• Moral principles guiding individuals to act ethically
• Informed consent, veracity, nonmaleficence, beneficence

Cultural Care

• Providing care that is considerate of the patient's cultural beliefs and practices

Nonmaleficence

• "Do no harm" principle, avoiding actions that could cause harm to the patient

Chief Complaint

• The main reason the patient is seeking medical attention

Identifying Spiritual Needs

• Understanding a patient's beliefs and practices related to faith and spirituality
• Respecting and accommodating these needs during care

Purpose of Documentation

• Accurate records of the patient's health history
• Communication tool for healthcare providers
• Legal documentation of care provided

Communicating with a Client Who Doesn't Speak English

• Use an interpreter when necessary
• Utilize nonverbal communication, such as gestures and drawings

Closed Ended vs. Open Ended Questions

• Closed ended: Yes/no answers, specific information
• Open ended: Encourage detailed responses, explore feelings and experiences

Asking the Client for Examples

• Clarifies the patient's description and provides a deeper understanding

Aggravating Factors

• Factors worsening the patient's symptoms or conditions
• Example: "What makes your headache worse?"

When to Use Closed Ended Questions

• Obtaining specific medical information
• Confirming details

Therapeutic Communication

• Focused and purposeful communication
• Active listening, empathy, non-judgmental approach

### Objective Data

• Observable and measurable findings
• Examples: Vital signs, physical exam findings

Subjective Data

• The patient's self-reported feelings and experiences
• Examples: Pain level, symptoms

How to Pose Questions about Alcohol, Drugs

• Use neutral and non-judgemental language
• Ask about substance use history and current use

Interviewing Rules / What Kind of Questions Do You Ask?

• Open ended: Encourage detailed responses
• Closed ended: To obtain specific factual information
• Focused: Centered on the chief complaint
• Comprehensive: Covers the entire patient's health history

Health History

• Detailed account of the patient's past and present health
• Includes family history, social history, and medical history

Importance of Family History

• Identifies genetic predispositions to diseases
• Helps determine risk factors for certain conditions

Comprehensive Assessment

• In-depth evaluation covering all aspects of the patient's health

Focused Assessment

• Concentrated on the patient's current concern or chief complaint

First Step During Physical Exam

• Inspection: Visual examination of the patient's appearance and body

Cyanosis

• Bluish discoloration of the skin due to low oxygen levels

Infection Control

• Practices to prevent the spread of infections
• Hand hygiene, use of personal protective equipment

Head to Toe Assessments

• Systematic examinations: Begin at the head and progress to the toes

Physical Assessment Components

• Inspection: Visual examination
• Palpation: Touching to assess texture, temperature, and masses
• Percussion: Tapping to assess underlying structures
• Auscultation: Listening with a stethoscope

Korotkoff Sounds

• Sounds heard during blood pressure measurement
• Indicate blood flow through the artery

What Are You Looking For in a General Survey?

• Patient's overall appearance, behavior, and vital signs

How to Verify an Irregular Pulse

• Check for an irregular rhythm with a stethoscope

Where to Put a Pulse Oximeter

• Finger, earlobe, or toe

Tachypnea

• Increased respiratory rate

FACES Pain Scale

• Visual pain assessment tool used for children and adults who have difficulty communicating verbally

Jaundice

• Yellowing of the skin and sclera (whites of the eyes)

Pulse Point Order

• Radial (wrist)
• Brachial (upper arm)
• Femoral (groin)
• Popliteal (behind the knee)
• Dorsalis Pedis (top of foot)
• Posterior Tibial (behind the ankle)

Hypotension

• Low blood pressure

Pain in Patient Who Is Awake and Alert

• Use OLD CART to assess pain

BP Wrong Size Cuff

• Incorrect cuff size leads to inaccurate blood pressure readings

Diastolic/Systolic Represent What?

• Diastolic: Pressure in the arteries during the heart's relaxation phase
• Systolic: Pressure in the arteries during the heart's contraction phase

Normal Heart Rate/ Vital Signs

• Heart Rate: 60-100 beats per minute (bpm)
• Blood Pressure: 120/80 mmHg or less
• Temperature: 97.8-99.1 degrees Fahrenheit (36.5-37.3 degrees Celsius)
• Respiratory Rate: 12-20 breaths per minute

OLD CART

• Onset: When did the pain start?
• Location: Where is the pain located?
• Duration: How long does the pain last?
• Characteristics: What does the pain feel like?
• Aggravating Factors: What makes the pain worse?
• Relieving Factors: What makes the pain better?
• Treatment: Have you taken anything for the pain?

Level of Consciousness (LOC)

• Patient's awareness of their surroundings and ability to interact

Aphasia

• Impaired ability to communicate due to brain damage

Safety/Mental Status Exam

• Assessing patient's safety and mental state
• Includes orientation (time, place, person), mood, thought process

Ask Direct Questions About Abuse

• Private and safe environment is crucial
• Use non-judgemental language

Comatose

• State of deep unconsciousness

Normal Skin Turgor

• Skin elasticity, tested by gently pinching the skin
• Normal skin springs back quickly

Pruritus

• Itching

Vesicles

• Small fluid-filled blisters

How to Best Assess Skin

• Inspect thoroughly for color, texture, lesions, and moisture

Normal Nail Assessment Findings

• Pink, smooth nail beds with a capillary refill of less than 2 seconds

Stage I Pressure Ulcer

• Non-blanchable erythema of intact skin

Eschar

• Dry, dead tissue that may be black, brown, or tan in color

Ethical Principles

• Nonmaleficence means doing no harm.
• Cultural care involves respecting and incorporating the patient's cultural beliefs and practices into their care

Client Communication

• Open-ended questions encourage detailed responses and exploration of the client's perspective.
• Closed-ended questions are used to gather specific information, often with yes/no answers.
• Therapeutic communication involves active listening, empathy, and clear, respectful communication to build trust and rapport with the client.

Patient Assessment

• Subjective data is what the client tells you about their condition, such as their pain level or symptoms.
• Objective data is what you observe or measure, such as vital signs or physical findings.
• Aggravating factors are things that worsen the client's condition (e.g., physical activity, certain foods).
• Health history includes information about past illnesses, surgeries, medications, and family medical history.
• Family history is important for understanding the client's genetic risk factors.
• Comprehensive assessment is a thorough evaluation of the client's overall health status.
• Focused assessment is an evaluation of a specific problem or concern.

Physical Examination

• The first step of a physical exam is inspection.
• Cyanosis is a bluish discoloration of the skin due to low oxygen levels.
• Head-to-toe assessments are examples of systematic examinations.
• Korotkoff sounds are the sounds heard during blood pressure measurement.

General Survey & Vital Signs

• General survey includes observing the client's appearance, behavior, and overall health status.
• Pulse oximetry measures oxygen saturation in the blood.
• Tachypnea is an abnormally rapid breathing rate.
• FACES Pain Scale is used to assess pain levels in children and individuals who have difficulty expressing pain verbally.
• Jaundice is a yellowing of the skin and sclera (whites of the eyes) caused by bilirubin buildup.
• Hypotension is low blood pressure.
• Diastolic blood pressure measures the pressure in the arteries when the heart is relaxed between beats, while systolic blood pressure measures the pressure in the arteries when the heart contracts.
• OLD CART is an acronym used to gather information about a client's pain: Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatment.

Mental Status

• Level of consciousness (LOC) refers to the patient's alertness and responsiveness to stimuli.
• Aphasia is a language disorder affecting the ability to communicate.

Skin Assessment

• Normal skin turgor is the skin's ability to return to its original position after being pinched.
• Pruritus is itching.
• Vesicles are small, fluid-filled blisters.
• Stage I pressure ulcer is characterized by non-blanchable redness of intact skin.
• Eschar is a thick, leathery scab that can form over a wound.