Patient Safety and Learning Domains

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Questions and Answers

What is the correct action to take if a patient starts to fall?

Try to catch the patient to prevent a fall.

Lower the patient to the floor using your body. (correct)

Push the patient towards a nearby chair.

Stand aside and let the patient fall.

What angle should an intradermal injection be administered at?

15 degrees (correct)

90 degrees

45 degrees

30 degrees

Which factor does NOT impact patient learning?

Attentional set

Cognitive ability

Time of day (correct)

Motivation

When using the Z-Track method for intramuscular injections, what is the primary purpose?

To reduce localized skin irritation. Signup and view all the answers

Which of the following is an example of cognitive learning in a patient?

Listing three foods that are low in sodium. Signup and view all the answers

Which gauge and length of needle is typically used for a subcutaneous injection?

25-gauge, 1/2 to 5/8 inch Signup and view all the answers

What method is used to administer an IM injection to ensure the medication is contained within the muscle?

Employing the Z-Track method. Signup and view all the answers

What should be done if a patient is injured after a fall?

Fill out an incident report and inform the provider. Signup and view all the answers

Which of the following is a characteristic of appropriate nursing documentation?

Non-judgmental Signup and view all the answers

What is one of the primary purposes of a medical record?

Communication with other healthcare professionals Signup and view all the answers

When documenting a sentinel event, which of the following details should be included?

Factual descriptions of what occurred Signup and view all the answers

Which abbreviation is considered inappropriate in patient charting and requires writing out its full term?

QOD Signup and view all the answers

What should be emphasized in discharge instructions for patients?

Relevant health information and follow-up care Signup and view all the answers

One of the key patient safety considerations is:

Medication safety Signup and view all the answers

Which of the following best describes 'legally prudent' documentation?

Adheres to legal standards and accuracy Signup and view all the answers

What should a nurse do if a patient expresses concerns about their treatment?

Include the patient's statements in the medical record Signup and view all the answers

Which site is NOT appropriate for subcutaneous injections?

Bony prominences Signup and view all the answers

What is the correct landmarking technique for locating the ventrogluteal injection site?

Landmark with the heel of the hand on the greater trochanter Signup and view all the answers

Which of the following is NOT a rule for needle safety?

Dispose of sharps in a regular trash bin Signup and view all the answers

Which insulin types should NEVER be mixed together?

Regular and NPH insulin Signup and view all the answers

What action should be taken if a sharps container is more than 2/3 full?

Replace it with an empty container Signup and view all the answers

How is the SBAR format used in communication?

To convey a situation and its background Signup and view all the answers

Which method is appropriate for landmarking the vastus lateralis injection site?

Place one hand above the knee and the other below the groin Signup and view all the answers

What is an important consideration when managing injection sites?

Take note of bruising or discoloration Signup and view all the answers

What is the primary purpose of the risk management department in healthcare?

To identify potential hazards and eliminate them before harm occurs Signup and view all the answers

Which of the following is NOT a common risk factor for patient falls?

Using assistive devices like walkers Signup and view all the answers

What is one recommended nursing intervention to prevent patient falls?

Educate patients and families about fall risks Signup and view all the answers

During a Falls Risk Assessment, which question is relevant to understanding the patient's home environment?

Do you have safety bars for the toilet and tub? Signup and view all the answers

Which of the following conditions is a significant risk factor for falls due to confusion?

Parkinson's disease Signup and view all the answers

What should be included in a patient's chart regarding incidents?

All procedures and any incidents that occur Signup and view all the answers

What technique is crucial for safely transferring a patient?

Using proper body mechanics and assistive devices Signup and view all the answers

Which of the following is a feature of a Falls Risk Assessment Tool?

It identifies patients at high risk for falls Signup and view all the answers

What is one primary purpose of assistive devices in patient care?

To conserve energy for the caregiver. Signup and view all the answers

How do gait belts assist nurses in providing care?

They help maintain control of patients while walking. Signup and view all the answers

What should nurses be aware of in order to manage risks effectively?

Potential safety hazards and risk management procedures. Signup and view all the answers

Which QSEN competency focuses on minimizing risk of harm?

Safety Signup and view all the answers

What is a characteristic of therapeutic communication?

It encourages patients to express their feelings. Signup and view all the answers

How does understanding a patient's diagnosis impact care planning?

It helps develop appropriate and relevant goals. Signup and view all the answers

What is the role of evidence-based practice in healthcare?

To use the best current evidence for optimal care. Signup and view all the answers

What is a consequence of incorrect body alignment during patient care?

Potential physical injury for both patient and caregiver. Signup and view all the answers

Study Notes

Patient Safety

If a patient starts to fall, lower them to the floor using your body to avoid injury to both of you. Don't try to catch them.
Get assistance to help the patient back into a chair.
If the patient is injured, notify the provider and fill out an incident report.

Domains of Learning

Cognitive: New knowledge is acquired through intellectual thinking and behaviors. An example is a patient listing three foods low in sodium.
Affective: Patients express feelings, opinions, or values related to a newly learned concept, such as attending a grief support group.
Psychomotor: New knowledge is demonstrated through physical skills and muscular activity. An example is a patient demonstrating the application of a colostomy appliance.

Factors Impacting Patient Learning

Attentional set
Motivation
Psychosocial adaptation to illness
Developmental level
Physical capability
Cognitive ability
Literacy
Environmental conditions

Injection Techniques

Intradermal: Injected into the dermis only using a tuberculin syringe at a 15-degree angle with the bevel up, typically 1mL or less. This technique is used for skin testing such as TB or allergy tests, and forms a bleb.
Subcutaneous: Medication injected into the loose connective tissue under the dermis, with slower absorption than IM injections. Common medications include heparin and insulin. Use a 25-gauge, 1/2 to 5/8 inch needle. Pinch 2 inches (5 cm) of tissue and insert at a 90-degree angle, or pinch 1 inch (2.5 cm) of tissue and insert at a 45-degree angle.
Intramuscular: Faster medication absorption than SQ injections. Typically use a 1 to 1.5 inch long needle (19 to 21 gauge) and insert at a 90-degree angle. An average adult volume is 2 to 3 mL. The site must be properly landmarked to avoid injury.
Z-Track: Recommended for most IM injections to reduce localized skin irritation by sealing the medication in the muscle. Pull the skin laterally or downward, inject the medication slowly, and keep the needle in place for approximately 10 seconds. Release the skin after withdrawing the needle. This method is particularly important for medications with known caustic effects on the skin.

Appropriate Sites for Injections:

SQ: Posterior aspect of upper arms, abdomen, anterior thighs, scapular area of upper back. Avoid sites with lesions, bony prominences, large underlying muscles, and nerves.
IM:
- Ventrogluteal: Patient lying laterally, landmark with the heel of the hand on the greater trochanter, thumb towards the groin, and index finger towards the anterior superior iliac spine.
- Vastus Lateralis: Middle third of the thigh, landmark by placing one hand below the groin and the other above the knee, forming "goal posts".
- Deltoid: Smaller muscle, suitable for volumes of 2 mL or less (e.g., flu shot). Landmark by placing three fingers below the acromion process.

Managing Injection Sites:

Understand when, where, and what time you would give an injection, taking note of bruising or discoloration.

Needle Safety:

Preventing needle stick injury is crucial as it can cause exposure to blood-borne pathogens.
Use needle safety devices such as sheaths and retractable needles.
Dispose of sharps in puncture- and leak-proof sharps containers.
Never dispose of sharps in a wastebasket, pocket, patient's bedside, or regular trash.
Never reach into a sharps container.
Don't use a sharps container if it's more than 2/3 full.
Use needleless devices when available.
Take your time and be cautious.
Report any needle stick incidents immediately.

Rules for Mixing Different Types of Insulin:

Use an insulin syringe only (marked in units).
U-100 is the most common, used with insulin vials of 100 units/mL.
NEVER mix NPH insulin with regular insulin because regular insulin is rapid-acting and used when a patient’s blood sugar is high, while NPH is intermediate-acting and would slow down the onset of action of regular insulin.
Follow the "Nancy Reagan RN" mnemonic:
- N: Inject air into the NPH vial.
- R: Inject air into the regular vial and invert.
- R: Withdraw the desired amount of regular insulin.
- N: Withdraw the desired amount of NPH insulin.

SBAR Format for Communication:

S: Situation: State what is happening at the present time that is concerning. Include the admitting and secondary diagnoses and identify the current problem.
B: Background: Briefly state pertinent history. This could include past medical history, lab and test results, psychosocial issues, allergies, and code status.
A: Assessment: Summarize the patient’s condition and state what you think the problem is. This might include recent vital signs, relevant assessment findings, current treatments, and recent lab/test results.
R: Recommendation: State your request - what do you want the physician or other healthcare professional to do?

Characteristics of Appropriate Nursing Documentation:

Objective
Non-judgmental
Organized
Concise
Factual
Timely
Legible
Accurate
Complete
Legally prudent
Confidential

Purposes of the Medical Record/Patient Chart:

Communication with other healthcare professionals
Legal and historical documentation
Insurance reimbursement
Record of diagnostic and therapeutic orders
Care planning
Record of the use of the nursing process
Quality of care reviews
Research
Decision analysis
Education

Documentation of a Sentinel Event/Incident Report:

Document the incident in the facility’s incident report and in the patient’s notes.
Include a factual, honest, and objective description of what occurred, the time, the name of the doctor notified, and the patient's assessment.
Document the treatment, follow-up care, and the patient’s response.
Do not write “incident report completed” in the chart as this destroys the confidentiality of the report.
Include any statements the patient made.

"Do Not Use" Abbreviations in Patient Charting:

MSO4 and MGSO4: Write out Morphine Sulfate and Magnesium Sulfate.
U: Write out Unit.
QD: Write out Daily.
QOD: Write out Every Other Day.
IU: Write out International Unit.
Trailing zeroes: Use 3 instead of 3.0.
Lack of leading zeroes: Use 0.3 instead of .3.

Patient Safety Considerations:

Fall prevention
Medication safety
Safe use of alarms
Infection prevention
Suicide risk reduction

Risk Management Department – Purpose, Role in Patient Safety:

Purpose: To ensure appropriate nursing care by identifying potential hazards and eliminating them before harm occurs.
Role in patient safety: Identifying, analyzing, and reducing risks. They also evaluate incidents through occurrence reports to determine corrective measures, prevent recurrence, and alert the team to potential litigation.

Nursing Assessment of Fall Risks:

Conduct a Falls Risk Assessment, including questions about the home environment.
Questions might include:
- Do you use assistive devices?
- Do you have difficulty with personal care or using the bathroom?
- Do you have safety bars for the toilet and tub?
- Do you have difficulty preparing meals?
- What medications do you take?
- Have you had any falls at home?
- Do you live in a two-story home?
- Are there steps to enter your home?
- Do you have someone you can call in case of an emergency?
- Do you have any fire hazards?
- Do you have working smoke detectors, fire extinguishers, and carbon monoxide detectors?

Risk Factors for Patient Falls:

Unsteady gait
Poor balance and coordination
Muscle weakness/deconditioning
Multiple comorbidities
Multiple medications (especially blood pressure medications, diuretics, and pain medications)
Confusion
Mental status changes
Incontinence
History of previous falls

Nursing Interventions to Prevent Patient Falls:

Use a Falls Risk Assessment Tool to identify patients at high risk.
Educate patients and family members on fall risks.
Provide a call bell and encourage patients to ask for help.
Identify fall risk patients with bracelets.

Knowing What Goes in a Patient’s Chart and What Does Not:

This question is a bit broad. The sources provide a lot of information about what should and shouldn't be in a patient's chart, including documentation of procedures and incidents, as well as rules for documentation.

Knowing the Basics of How to Move a Patient:

Review transfer techniques, proper body mechanics, and the use of assistive devices like gait belts, walkers, and lifts.

Reviewing Assistive Devices and When to Use Them:

The sources discuss various assistive devices, their purposes, and how to use them.

Purposes of Assistive Devices and What They Help Maintain:

Prevent physical injury to the caregiver and patient.
Promote correct body alignment.
Facilitate coordinated, efficient muscle use.
Conserve energy for the caregiver and prevent undue strain.
Facilitate mobility and activity for the patient.
Increase patient self-esteem by decreasing dependence.
Decrease physical stress on weight-bearing joints and unhealed skeletal injuries.

Looking at Gait Belts:

Gait belts help nurses maintain control of patients while walking, reducing the risk of falls.

Being Able to Understand Your Diagnosis and Goals and How They Work Together:

The sources don't explicitly explain how diagnoses and goals work together. However, understanding a patient's diagnosis helps you develop appropriate and relevant goals for their care plan.

Falls, Risk Assessments, Diagnoses for Fall Risks, and Prevention for Patients and Yourself:

This refers back to information discussed earlier about fall risks and prevention strategies for both patients and nurses.

Knowing Your Risk Management:

Nurses must be aware of potential safety hazards and take steps to prevent them. They should be familiar with risk management procedures, including incident reporting.

6 QSEN Competencies:

Patient-Centered Care: Respect for patient’s preferences, values, and needs.
Teamwork and Collaboration: Communication and shared decision-making to support quality patient care.
Evidence-Based Practice: Optimal care using best current evidence (along with clinical expertise and patient preferences).
Quality Improvement: Using data to monitor quality and safety in healthcare.
Safety: Minimizing risk of harm to patients and providers.
Informatics: Using technology to mitigate error and support decision-making in healthcare.

Applying Your Domains of Learning and Knowing the Teachings and Responses for Each Domain:

This refers back to the three domains of learning and how to apply appropriate teaching methods for each.

Knowing Therapeutic and Non-Therapeutic Communication:

Therapeutic Communication: Techniques that encourage patients to express their feelings and ideas and that convey acceptance and respect.
Non-therapeutic Communication: Communication techniques that hinder or damage the professional relationship.

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Description

This quiz covers essential concepts related to patient safety and the domains of learning in healthcare. It includes strategies for preventing patient falls, understanding different learning domains, and factors that influence patient learning. Assess your knowledge on how to ensure patient safety while facilitating effective learning.