Quiz 1: Nursing Care and Delegation PDF

Quiz 1 **Acute illness-** [rapid onset], [short duration expected to recover] **Chronic illness-** illness that has [no cure but can be prevented] **terminal illness-** illness that [person will] [most likely not recover] **Functional nursing -- f**ocuses on [tasks and jobs] **Persons in hospit...

Quiz 1 **Acute illness-** [rapid onset], [short duration expected to recover] **Chronic illness-** illness that has [no cure but can be prevented] **terminal illness-** illness that [person will] [most likely not recover] **Functional nursing -- f**ocuses on [tasks and jobs] **Persons in hospital**- patient **Persons in long-term care center** - resident **Assist living residences (ALR)** -- [provide housing], personal care, home-like setting ([independent]); ALR includes: - [**P**ersonal care]- bathing, dressing, grooming - [**M**eals]- cooking, eating - [**H**ousekeeping] - [**P**ersonal safety] - [**T**ransportation] \*remember **PMHPT** **Delegation** -- [process a nurse uses to direct a nursing assistant to perform a nursing task], requires a [ nurse's knowledge and judgement] - Delegation process: - **[A]**ssessment of **[N]**eeds - **[C]**ommunication - **[G]**uidance and **[A]**ssistance - **[F]**ollow up and **[F]**eedback \*remember **ANCGAFF** **RN** -- registered nurse; [completed 2, 3, 4 year nursing program] and [passed a license test], [delegated by APRN], can [delegate to LPN, CNA] **LPN** -- licensed practical nurse; completed [practical nursing program] and [passed license test], can [delegate to CNA] **LVN** -- licensed vocational nurse; used in [California and Texas, can delegate to CNA] **CNA** - certified nursing assistant; [passed nursing assistant training and competency evaluation program (NATCEP)], [perform nursing tasks under the supervision of a licensed nurse], [cannot delegate] ***\*CNA ROLE IN DELEGATION*** -- you can [either accept or refuse a task]. Must [complete the task safely] and you [cannot ignore an order]. When [you agree on the task], you are responsible for your own actions. When you [refuse a task it must be because its not in your job description or did not receive training for that task] **The health team** -- involves many [health care workers whose skills and knowledge focus on the person's total care] (interdisciplinary team) **Nursing team -** [RN, LPN/LVN, CNA] \~ [part of interdisciplinary team] **Nursing care patterns** -- used depends on how many persons need care, the staff, and the cost. **[5 nursing patterns]** are: (remember **FTPCP)** - **[F]unctional** nursing -- **[f]**ocuses on tasks and jobs - **Team** nursing -- led by an **RN** - **[P]rimary** nursing -- **[p]**erson's total care - **[C]ase** management -- discharge and into home/long term care setting, **[c]**oordinates care - **Patient-focused** care -- moved from departments to bedside **Long term care centers** -- patients discharged while still recovering from illness or surgery, some need home-care, others need care until able to go home, some need care until death **memory care unit** -- [designed for persons with Alzheimer's and dementia's], unit is usually closed off from other parts of the center to provide a safe setting where residents can wander freely **hospices** - health care agency that [promotes comfort and quality life for the dying person and person's family] (less than 6 months to live) **Paying for health care** -- some avoid healthcare bc they cant pay, others pay bills without food and drugs. Health insurance covers [some] cost, [rarely] [all cost are covered]. there are 5 programs to help pay for health care 1. **private insurance** -- bought by individuals and families 2. **group insurance** -- bought by groups and organizations 3. **medicare** -- federal program for 65 y.o and older and younger persons with certain disabilities - *Part A medicare* -- hospital, SNF, hospice, and home-care - *Part B medicare* -- doctors services, preventive care, ambulance services, medical supplies, mental health care, and some drugs. This is voluntary and must pay monthly premium 4. **Medicaid** -- jointly funded by federal govt and state, usually for people with low income 5. **Health insurance marketplace** -- service that helps people shop for and enroll in affordable health insurance, part of *[Patient Protection and Affordable Care Act of 2010]*, called affordable care act (ACA) or OBAMACARE, federal govt operates this for most states but some states run their own **Medicaid** -- jointly funded by federal and state, low income **Medicare** -- federal government, 65 years old and above, young people but w/certain disabilities **Focus on older persons -Nursing centers** -- many have chronic disease, poor nutrition, memory problems, or poor health. Some are disabled from birth, accident, or disease. Nursing center staff often care for: 1. **Alert and oriented** -- normal level of consciousness and awareness. [Knows who they are and where they are] 2. **Confused and disoriented** -- mildly to severely confused and disoriented, short/long term problem 3. **Persons needing complete (total care)** -- cannot meet their own needs, daily care needs, cannot understand or day what they want or need 4. **Short term resident** -- recovering from fractures or other injuries (acute), may need tubing, wound care, goal is optimal level of function and return home 5. **Persons needing [respite] care**- person living at home goes to nursing center for a [short stay], caregiver gets a **[r]**elief trip or rest 6. **Life long resident**- disabilities from birth, childhood, adult disease, injuries, physical and intellectual impairments. Life long assistance and special devices are needed 7. **Persons with mental health disorder** -- behavior and function are affected, physical and mental health disorder, self care and independent living are F 8. **Persons who are terminally ill** -- dying, end of life care **The survey process/your role** -- [done to see if standards are met], your role are: - Provide quality care - Protect the persons rights - Provide for the persons and your own safety - Help keep agency clean and safe - Act in a professional manner - Have good work ethics - Follow agency policies and procedures - Answer questions honestly and completely **Resident rights** -- **[OBRA]** \~ set minimum standards for quality of care in nursing centers, maintain and improve persons quality of life, health, safety, must protect and promote [persons rights] **focus on surveys** -- surveyors observe staff behavior and action, what you say and do must promote quality of life, health and safety. A close up of a paper Description automatically generated **box 2-1 - residents rights**  **Privacy/confidentiality** - *right to personal privacy*, must maintain privacy of the persons body, privacy is [maintained for all personal care measures: bathing, dressing, and elimination] **Advocate --** acts or speaks on behalf of another person **Involuntary seclusion --** separating a person from others against the persons will **Ombudsman --** someone who supports or promotes the needs and interests of another person **representative -** someone with the legal right to act on the patients or resident's behalf **Freedom from Restraints -** *right not to have body movement restricted*, [only used if required to treat medical symptoms], [doctors orders restrains], its not used for staff convenience or discipline the person **OBRA** -- *omnibus budget reconciliation act of 1987*, federal law, applies to all 50 states, sets minimum requirements for NATCEP \*obra requires 75 hours of instruction \* obra requires 16 hours of clinicals \*obra requires 3 takes of the exam **Competency evaluation --** [written and skills test], 3 attempts, [taken after your training program] **nursing assistant registry**- obra requires nursing assistant registry in each state, it's the [official record/listing of who completed the state's approved NATCEP.] + where your informations are keptWhat's in the record: - **Full name** - **Identifying information** - **Date NATCEP was passed** - **Information about findings of abuse, neglect, or dishonest use of property** **certification** - [official recognition] by a state that standards have been met **Registry for nursing assistance -** obra removes registry if person did not work for 24 months and must retrain and take NATCEP **Maintaining competence -** agencies provide 12 hours of education to nursing assistants every year. Those who did not work for 24 months must take a new competency evaluation or both retraining and a new competency evaluation **Roles and responsibilities -** scope of practice or range of functions- to [protect the person from harm,] you [must understand what you can and cannot do, and the legal limits of your role] **box 3-2** **box 3-3**  **Job description -** [ document] that describes what the [agency expects you to do] **Agency expectations -** agency can limit your role but they cannot expand your range of functions, always obtain a written job description when you apply **p22** **5 rights of delegation box-** right person, right task, right circumstance, right directions and communication, and right supervision and evaluation \*REMEMBER: **RIGHT TCPDCSE** A paper with text and words Description automatically generated **Accepting a task** -- if you agree on a task, you are responsible for your actions and you must complete the task safely **refusing a task-** you have the right to refuse but you should never ignore an order. You can only refuse if its beyond your range of function, job description, role, or if it may harm the person as you didn't receive training for it **focus on communication**  **Abuse [-]**[Willingful] infliction **Assault -** [attempting] to touch a persons body without consent **Battery -** [ touched]/touching a persons body without consent **Chapter 4 Key terms** - **Boundary crossing:** meets the persons needs (hug) - **Boundary violation:** meets your needs and not the person (abuse) - **Defamation[: ]**[injuring a persons name and reputation] by making false statement to a 3^rd^ person - **Libel:** making false statement in [writing or print] - **Slander:** making false statement through [spoken words] - **False imprisonment:** [unlawful restraint] of persons freedom of movement - **Ethics:** knows [what is right and what is wrong conduct] - **Medical battery:** gave treatment to a person who refused a treatment - **Malpractice:** gave the wrong care **Unintentional torts --** harm was [not intended] **intentional torts --** harm was [intended], on purpose, meant to be harmful and may be crimes (defamation, libel, slander, false imprisonment) **Professional boundaries -** separate helpful actions and behaviors from those that aren't helpful (under-involved and over-involved) **Criminal laws --** concerned with offenses against the [public and society in general]. act that [violates a criminal law] is called a crime (murder, rape, robbery, abuse) **civil laws -** concerned with [relationships between people] (tort) **Elder abuse --** any knowing, intentional, or negligent act by caregiver or any other person to an older adult. Act causes harm or serious risk of harm **types of abuse:** - **Physical abuse-** intentional use of force can result in injury, pain, death - **Neglect-** fails to protect a vulnerable person from harm (failed to provide food, water, clothing, shelter, basic activities of daily living) - **Financial abuse-** older persons resources are mis-used (exploitation- misuse of money, property, assets; misappropriation -- illegal, dishonest or wrongful use of persons money, property, assets for ones own use) - **Emotional/psychological abuse-** verbal or nonverbal behavior that causes mental pain, anguish, distress - **Sexual abuse-** forced or unwanted sexual interaction of any kind with an older adult - **Abandonment-** person is deserted/left by someone who's supposed to provide care **Neglect -** fails to protect a vulnerable person from harm (failed to provide food, water, clothing, shelter, basic activities of daily living) **Intimate partner violence (IPV) --** physical and sexual violence, stalking, or psychological aggression by [current or former partner] **Report elder abuse -** tell the nurse **box 4-5+ box 4-6** A page of a book with text Description automatically generated **Informed consent -** process which person receives and understands information about a treatment or procedure and is able to decide to receive or refuse the treatment - CNA are not responsible for obtaining written consent but you can be a witness to a consent - Doctors are responsible for getting informed consent **focus on communication p35** **Chapter 5 key terms** - **Gossip:** spread rumors or talk about private matter of others - **Stress:** response or change in the body caused by any emotional, psychological, physical, social, or economic factor - **Harassment:** to trouble, torment, offend, or worry a person by one's behavior or comments **Professional appearance (Perfumes/colognes /Necklaces/earrings) box 5-1** A page of a brochure Description automatically generated **Goor work ethics figure 5-1**  **Planning your work --** decide on what to do and when is called [priority] (most important thing at a time) **meals and break -** usually 30 minutes, others are 15 mins, [leave for and return from breaks on time, tell the nurse when you leave and return to the unit] **Dealing with conflict -** it's a clash between opposing interest or ideas, care is affected, *resolve conflict by communicating and practicing good work ethics* (1. Define the problem, 2. Collect information about the problem, 3. Identify possible solutions, 4. Select the best solution, 5. Carry out the solution, 6. Evaluate the results) **Courtesies -** polite, considerate, or helpful comment or act (calling by their last name, saying thank you and sorry, kind acts) **Attention -** your focus matters and you should not be distracted (not participating, talking while instructor is talking, sleeping, using phones during class are examples of being distracted). Listen well and participate **personal matter -** [personal matters must not interfere with your training and job] (make phone calls during break, don't let family or friend visit you at school or unit, if they must see you it must be on a break) **job safety -** you must protect patients, residents, families, visitor, co worker, and yourself from harm (follow agency rules, function and responsibilities, know what you can and cant do, report accurately, be responsible for your own actions) **Resigning from a job --** give a 2 week notice and reason for leaving **losing a job -** could be for poor performance, not following rules, always late, not getting along with others, abuse, harassment, violating rules and rights **Chapter 11 key terms** - **Coma --** prolonged state of unconsciousness - **Dementia -** loss of cognitive and social function - **Suffocation -** breathing stop - **Elopement --** when a patient or resident leaves the health care agency without staff's knowledge - **Paralysis -** loss of muscle function - **disaster -** [harmful event]: earthquake, tornado, hurricane, blizzard, volcano eruption, flood, and some fire **Safety needs /Safety measures** A close up of a paper Description automatically generated **Identifying nursing center residents-** follow center policy and care plan to identify the person **Patient ID bracelets --** persons name, date of birth, ID number, room and bed number. [Always use 2 identifiers (name and DOB).] [Compare ID bracelet to assignment sheet] **Prevent burns -** smoking, spilled hot liquids, electrical items, and very hot water are common cause of burns **Poisoning -** [any substance harmful to the body when ingested] (make sure they cannot reach this, keep it away from their containers, read labels carefully **Choking *-*** *foreign body airway obstruction (FBAO*). clutching at throat is the universal sign of choking. [Most common cause is when eating, large poorly chewed piece of meat] **Abdominal thrust --** relieve severe airway obstruction **chest thrust --** only used for persons who are obese and pregnant **RACE --** Rescue, Alarm, Confine, Extinguish **PASS --** Pull safety pin, Aim low, Squeeze lever, Sweep back and fourth **Hazardous substances -** [any chemical that is a physical hazard or health hazard], have pictograms and are placed in contaminated waste or biohazardous waste (color red and has biohazardous symbol) **Labeling -** have pictograms(symbols used to communicate specific information about chemical hazard) and are [placed in contaminated waste] or biohazardous waste (red and has biohazardous symbol) **Safety data sheets -** check SDS/MSDS [before] using hazardous chemical, [cleaning a leak] or spill, or [disposing] the substance. [Call the nurse about leak] or spill right away but [do not leave unattended] **Preventing equipment accident-** all equipment that are broken, not used correctly, or not working properly, in need of repair [must not be used]. [Inspect items before use] (wheelchair, hospital beds, etc) [usually have a weight of 250-350 pounds.] **"EC" refers to -** [expanded capacity] (bariatric patients can weigh 250-1000 pounds and must use EC or *[Bariatric equipment]*) **Workplace violence-** violent acts directed towards persons at work or while on duty **Agitated patient box 11-6 p128** **Yellow wristband --** fall risk **Red wristband -** allergy **Purple -** DNR **Chapter 14 key terms** **Microorganisms --** small living thing seen only with a microscope; *microbe* **Local infection --** in a [body part] **Systemic infection -** whole body **Healthcare associated infection (HAI) --** infection that [develops in a person cared for in any setting where health care is given] *(nosocomial infection)* **Washing your hands box 14-2** A page of a book with text Description automatically generated **Hand washing Procedure -** stand away from sink, don't touch the inside of sink at all times, wet wrist and hands, keep hands [lower] than elbows, rub your hands create [friction] for at least [20 seconds], wash thoroughly, dry your hands from [fingertips to wrist], turn off faucet with a [dry paper towel on each faucet] **Disinfection --** process of [killing pathogens] **Chemical disinfectants --** can burn and irritate skin **safety --** wear [utility gloves] to prevent skin irritation *\*don't wear disposable gloves when disinfecting* **Bloodborne pathogens standard -** regulation of OSHA, protects health team from exposure to bloodborne pathogens, standard has requirements for employers to follow in order to protect workers who may be exposed to blood or OPIM (*other potentially infectious materials)* **Sterilization-** [autoclave]: pressure steam sterilizer **Vaccination --** giving vaccine to [produce immunity against infectious disease] **Vaccine -** preparation containing dead or weakened microbes - **[Hep B]** is offered in work within 10 days of your first working day, [agency pays for it.] You can decline but must sign a statement, or you can get it at a later date - **[Injection 2 of Hep B]** is given a month after first injection and **[injection 3]** is given after 4 months after the first one*[. Vaccination can be before of after HBV exposure]* **Universal /Standard precautions --** used in all situations for all persons **Transmission-based precautions -** used when persons have or may have certain infections (commonly called ***isolation precaution***) there are 3 types of transmission based precautions: contact, droplet, airborne **box 15-2+ box 15-3** A white and black sign with black text Description automatically generated **Gowns --** [front and sleeves] are considered contaminated. [Wet gown] is also considered contaminated **Gloves -** outside is contaminated, provide barrier, they protect you from pathogens and the person from microbes on your hands. - *Wearing gloves is the most common measure for Standard Precautions and Transmission based precaution* **Mask/respirators -** [front of mask] is contaminated. [Wet or moist] mask is considered contaminated. Must [fit snugly] over your nose and mouth - *Agency approved respirators are worn when caring for persons with infectious spread by airborne (ex: TB)* **Meeting basic needs --** person is [more isolated] and knows the disease can spread to others. Staff may [not enter often] because of needed PPE[. Sadness and loneliness are common]. Do not avoid person, show [kindness and respect] **focus on older persons --** [PPE may cause confusion, fear, and agitation]. Tell the person who you are and what you need to do, use calm soothing voice, do not rush the person, use touch to reassure person, follow care plan and nurse's instruction for other measures to help the person, and report signs of increased confusion or behavior changes **Don --** *[applying]* PPE: 1. [Gow]n, 2. [Ma]sk, 3. [Go]ggles, 4. [Glo]ves (GowMaGoGlo) **removing PPE -** 1. [Glo]ves, 2. [Go]ggles, 3. [Gow]n, 4. [Ma]sk (perform hand hygiene after removing PPE) (GloGoGowMa) **ADDITIONAL NOTES:** - CNA don't draw blood, give drugs, and [sterile] - [Specimens] are [placed in a biohazard bag] (color red and has a biohazard symbol) - MRSA = nose - VRE = intestines, rectum - ESBL = urine (BL=Bowel=URINE) - Nursing task = nursing care - Source: pathogen - Reservoir: pathogen needs a place to grow and multiply - Portal of exit: pathogens needs a way to leave the reservoir (*respiratory, GI, urinary, breaks in skin, blood, and reproductive tracts)* - Method of transmission: pathogen is transmitted to another host (touch, airborne, droplet, sharp injuries) - Portal of entry: pathogen enters body (respiratory, GI, urinary, breaks in skin, blood, and reproductive tracts) - Susceptible host: transmitted microbe needs a host where it can grow and multiply, they are at risk for infections **ACCIDENT RISK FACTORS** - Some people cannot protect themselves - Impaired mobility: person may not be able to move to safety. Some cannot walk or propel the wheelchair. Some are paralyzed