Nursing Fundamentals: Coordinator and Management of Care - EXAM 1 Study Guide PDF

Nursing Fundamentals: Coordinator and Management of Care - Study Guide Coordination of Care ​ Care is team-based: Share information among healthcare providers and patient care teams. ​ Utilize information literacy: Identify, evaluate, and apply sources of information. ​ Use evidence-...

Nursing Fundamentals: Coordinator and Management of Care - Study Guide Coordination of Care ​ Care is team-based: Share information among healthcare providers and patient care teams. ​ Utilize information literacy: Identify, evaluate, and apply sources of information. ​ Use evidence-based practice: Integrate nursing research, clinical expertise, and patient preferences. 4 Steps of Care Coordination 1.​ Establish Responsibility: Clarify who is accountable for specific aspects of care. 2.​ Communicate Effectively: Share patient information clearly and promptly. 3.​ Assist with Transitions: Facilitate care changes (e.g., case management). 4.​ Assess Patient Needs and Goals: Tailor care to each patient’s unique situation. Chain of Command ​ Follow hierarchy for problem-solving: ○​ Nursing Chain: Administrator → DON → Assistant DON → Nursing Staff. ○​ School Chain: Instructor → Course Coordinator → Division Chair → Directors. ​ Prioritize communication and escalate issues systematically. Prioritization in Nursing ​ Address life-threatening needs first: ○​ A-B-C-S-D-E-F: Airway, Breathing, Circulation, Safety, Discomfort, Education, Feelings. ○​ CURE: Critical, Urgent, Routine, Extras. ​ Consider Maslow’s hierarchy to prioritize care. C - Critical Needs Definition: Immediate life-threatening situations that require urgent attention to preserve life.​ Maslow’s Level: Physiological Needs (Airway, Breathing, Circulation). Medical Examples: 1.​ Patient with Airway Obstruction: ○​ A post-surgical patient begins choking due to a blocked airway. ○​ Action: Clear the airway (e.g., suctioning, Heimlich maneuver) immediately to restore breathing. 2.​ Severe Hypoglycemia in a Diabetic Patient: ○​ A patient has a blood glucose of 40 mg/dL, appears confused, and is at risk of losing consciousness. ○​ Action: Administer 15g of oral glucose or IV dextrose immediately. 3.​ Cardiac Arrest: ○​ A patient collapses, becomes unresponsive, and has no pulse. ○​ Action: Begin CPR and call for a defibrillator immediately. U - Urgent Needs Definition: High-priority tasks that, while not immediately life-threatening, could become critical if delayed.​ Maslow’s Level: Physiological Needs (e.g., oxygenation, hydration) and Safety Needs (preventing harm). Medical Examples: 1.​ Oxygen Saturation Decline: ○​ A patient with COPD has an oxygen saturation level of 88% and is visibly short of breath. ○​ Action: Increase oxygen flow or adjust the delivery method to improve oxygenation. 2.​ Post-Operative Pain Management: ○​ A patient reports pain 8/10 after surgery, affecting their ability to mobilize or breathe deeply. ○​ Action: Administer prescribed pain medication to prevent complications like pneumonia. 3.​ Wound Care for a Patient with Diabetes: ○​ A diabetic patient has an open wound showing early signs of infection (redness, warmth). ○​ Action: Clean the wound and apply prescribed antibiotics to prevent worsening infection. R - Routine Needs Definition: Tasks that contribute to daily care but don’t have immediate urgency.​ Maslow’s Level: Physiological Needs (e.g., food, hygiene) and Safety Needs (e.g., preventing discomfort). Medical Examples: 1.​ Feeding a Stable Patient: ○​ A patient who is unable to feed themselves is waiting for lunch assistance. ○​ Action: Assist with feeding after addressing critical and urgent needs. 2.​ Hygiene for Bedridden Patients: ○​ A patient needs a bed bath but is stable and not at risk for infection or skin breakdown. ○​ Action: Schedule hygiene care as part of routine activities. 3.​ Ambulation Assistance: ○​ A patient recovering from surgery requires help walking to regain strength. ○​ Action: Prioritize ambulation after addressing patients with critical or urgent needs. E - Extras Definition: Tasks that can be delayed without negatively affecting patient outcomes.​ Maslow’s Level: Love and Belonging, Esteem, and Self-Actualization. Medical Examples: 1.​ Social Interaction: ○​ A lonely elderly patient requests extra time to talk about their family. ○​ Action: Provide attention and conversation once all higher-priority needs are met. 2.​ Patient Education on Lifestyle Changes: ○​ A patient asks for detailed instructions on long-term weight management after discharge. ○​ Action: Schedule time to educate the patient after ensuring all immediate care needs are addressed. 3.​ Room Comfort Adjustments: ○​ A patient wants their bed repositioned for better TV viewing. ○​ Action: Adjust the bed after attending to critical, urgent, and routine care tasks. Comprehensive Scenario: Applying C.U.R.E. with Maslow’s Hierarchy Patient: A 65-year-old male with COPD, diabetes, and post-operative pain. 1.​ Critical: The patient’s oxygen saturation drops to 85%, and he’s struggling to breathe. ○​ Action: Administer oxygen and monitor closely (Physiological: Airway/Breathing). 2.​ Urgent: The patient reports severe post-operative pain (8/10), making it hard to take deep breaths. ○​ Action: Administer prescribed pain medication to improve comfort and prevent complications like pneumonia (Physiological/Safety). 3.​ Routine: The patient requests assistance with eating lunch. ○​ Action: Help feed the patient after stabilizing breathing and addressing pain (Physiological). 4.​ Extras: The patient asks for additional information about his new diabetes medication. ○​ Action: Provide education after other needs are met (Esteem/Self-Actualization). Why Use C.U.R.E. with Maslow’s Hierarchy? ​ C.U.R.E. ensures tasks are prioritized effectively to prevent harm. ​ Pairing it with Maslow’s Hierarchy ensures patient needs are addressed holistically, starting with life-sustaining care and moving toward emotional and self-fulfillment goals. Delegation ​ Who can delegate? 1.​ RNs to LPNs or CNAs. 2.​ LPNs to CNAs. ​ When to delegate? 1.​ Patient is stable. 2.​ Task is within scope. 3.​ Teaching, monitoring, and evaluation are feasible. ​ 5 Rights of Delegation: 1.​ Right Task 2.​ Right Circumstances 3.​ Right Person 4.​ Right Direction 5.​ Right Supervision Critical Thinking in Nursing ​ Steps to Critical Thinking: ○​ Recognize problems. ○​ Gather clinical data. ○​ Analyze and act based on evidence. ​ Examples: ○​ Identifying changes in patient conditions. ○​ Evaluating causes of symptoms. The Nursing Process 1.​ Assessment: Gather and cluster objective (e.g., vital signs) and subjective (e.g., pain) data. 2.​ Diagnosis: Use NANDA guidelines; prioritize actual problems over potential risks. 3.​ Planning: Set SMART goals (Specific, Measurable, Attainable, Realistic, Timely). 4.​ Implementation: Perform interventions based on evidence and tailored to patient needs. 5.​ Evaluation: Assess goal achievement and adapt the care plan as needed. Nursing Roles Registered Nurse (RN) ​ Initiates teaching, develops POC, assesses unstable patients, administers IV meds, and delegates tasks. Licensed Practical Nurse (LPN) ​ Reinforces teaching, assists in POC development, administers non-IV meds, and cares for stable patients. Patient Care Assistant (PCA) ​ Assists with ADLs, vital signs, and patient mobility. Sample Questions for Review 1.​ Delegation: A RN delegates vital signs to the nursing assistant except for which patient? ○​ Answer: The patient with post-op complications related to appendectomy. 2.​ Prioritization: Which patient to assess first?  ○​ Answer: A 50-year-old with asthma and shortness of breath. 3.​ Chain of Command: What steps do you follow when a problem arises? ○​ Answer: Follow the hierarchy systematically, starting with your instructor. There can sometimes be challenges with scope of practice for "NCLEX World". Here is just a recap of delegation and scope of practice as a resource: Remember: Delegation of tasks must fall within the practice parameters of the person to whom they are delegating. RN ​ Cares for unstable clients ​ Initiates IVs, IVPBs, care plans, teaching….. ​ Performs assessments ​ Administer IV bolus medications (pushes) ​ Administer titrated IV medications LPN ​ Cares for stable clients ​ Gathers data ​ Reinforces teaching, care plans….. ​ Administer subsequent IVPB if the med is routine ​ Change IV bags Unlicensed Assistive Personnel ​ Assists with care of stable clients ​ Assists with basic activities of daily living (ADLs) ​ Gathers specific data: VS, I&O If at any time a client becomes unstable, the RN assumes care. Only RNs and LPNs can ​ Perform tasks requiring sterile technique. ​ Perform invasive procedures Assistive personnel receive assignments from the RN or LPN specific to tasks they may perform. Nurses can only delegate tasks appropriate to the education, experience and skill level. Prior to delegating the nurse must predict stability of outcome, potential for harm, complexity of care, need for problem solving and level of interaction with the client. The nurse must follow the five rights of delegation (e.g. right task, right circumstances, right person, right direction or communication, right supervision or feedback). Communication of a delegated task must be specific and clear.  Health Promotion HP- is is the process of enabling people to increase control over, and to improve their health (World Health Organization) Cultural Influences: ​ Attitudes and practices differ among cultures, including: ○​ Birth and death practices. ○​ Responses to pain and suffering. ○​ Personal hygiene and privacy. ○​ Adjustment to life changes. Key Illness Terms: ​ Acute Illness: Sudden onset, resolves quickly (e.g., cold). ​ Chronic Illness: Develops over a long period, persists for life Longer than 6 months (Heart Disease, COPD). ​ Terminal Illness: Incurable and ends in death.(Compound Fracture) ​ Primary Illness: Not caused by another condition. (Spontaneous) ​ Secondary Illness: Infection ​ Idiopathic Illness: Cause unknown. (Unknown Cause) ​ Exacerbation: Worsening of symptoms. (Chrones) ​ Remission: Reduction or disappearance of symptoms. ​ Asymptomatic: No noticeable symptoms. Levels of Prevention: 1.​ Primary Prevention: Health education, immunizations, screenings.(Teaching Handwashing) Person is usually healthy 2.​ Secondary Prevention: Early detection and treatment (e.g., mammograms). (A screening, rapid covid testing) Nonsymtomatic but disease/illness is there 3.​ Tertiary Prevention: Rehabilitation and preventing further complications. (Defect is permanent) (Sick Person Permanent defect) Risk Factors For Illness or Injury: ​ Genetic and physiological factors Age Environment Lifestyle Gender ​ Difference in modifiable and nonmodifiable risk factors: Modifiable: Diet NonModifiable: Gender & Family History Cancer Screenings: ​Breast Cancer: Most Common, Monthly (usually after menstruation) Clinical Exam is every 3 years. After 39 annually. Look for: Hard lump, Non Mobile, Non Tender, Irregular, Perform Self exam in hot shower, laying down or looking in mirror. ○​ Monthly self-exams. ○​ Clinical breast exams every 3 years (ages 20-39); annually after 39. ○​ Mammograms every 2 years from age 40 to 74. ​Cervical Cancer: Lethotomy Position: Age 21 or ate the beginning of sexual intercourse. 21-29–3 years, 30-65–5 years pap smear + HPV test. Human Papiloma Virus ○​ Pap smears from age 21; every 3 years (ages 21-29); Pap and HPV every 5 years (ages 30-65).  ​ Prostate Cancer: Annually Manually, PSA antigen test annually, Usually not performed by nurse. Norm Smooth, Rubbery Abnormal: Lumpy and tender ○​ Digital rectal exams annually from age 50. ○​ PSA testing annually. ​ Colorectal Cancer: ○​ Colonoscopy every 10 years from age 50. Cancer Screenings Colonoscopy: Begin screenings at 50, unless otherwise indicated, screening should be done every 10 years. Family History, – examines the length of large and small intestine in Colon Prep. NPO after midnight. Cancer Screenings: MAMMOGRAM:: All Women get screened (mammogram) every other year starting at age 40 and continuing through age 74. Most Reliable. Cancer Screenings: UTERINE CANCER:: Screening begins 3 years after having vaginal intercourse, or no later than age 21. Pelvic Exam annually and Pap Test Annually Immunizations: Effective in decreasing or eliminating diseases, *Informed Consent Required*, *Assess for allergies and previous immunization reactions before administration*, Immunization Schedule – required for licensed childcare programs and schools, Should not immunize if acutely ill (running fever, etc.) Defer until healthy. ​ Follow CDC schedules for all age groups. ​ Assess for contraindications such as severe allergies or immunosuppression. Injection sites: LOCATIONS: Deltiod(Arm) Vastis Lateralis (Thigh) Dorsogluteal (Butt) Ventrogluteal (Hip) Administer the vaccine using either a 1-mL or 3-mL syringe, 22- to 25-gauge needle, Recommended site for IM injections: the vastus lateralis muscle in the anterolateral thigh, Gluteal Not recommended for