ASEPSIS/INFECTION PDF

ASEPSIS/ INFECTION: 1. Identify the components chain/cycle of infection Infectious Agent: micro-organisms that are capable of causing disease (bacteria, fungi, parasites) Reservoir: place where microorganisms can live, reproduce and multiply (people, milk, food,...

ASEPSIS/ INFECTION: 1. Identify the components chain/cycle of infection Infectious Agent: micro-organisms that are capable of causing disease (bacteria, fungi, parasites) Reservoir: place where microorganisms can live, reproduce and multiply (people, milk, food, water, soiled food, OR inanimate objects/ animals) Portal of Exit: ways in which infectious agent leaves the reservoir (blood, secretions, excretions, skin) Modes of Transmission: ways in which infectious agent is spread from reservoir to susceptible host (physical contact including direct/ indirect; droplets/ airborne) Portal of Entry: ways in which infectious agent enters the susceptible host (Resp/ Dig system, tissue integrity, mucous membrane, skin) Susceptible Host: individuals that have traits that make them more susceptible to disease or severity of disease (im mune deficiency, surgery, mucous membrane/skin) 2. Identify patients at risk for infection. Susceptibility of host depends on various factors: Integrity of skin & mucous membrane pH levels of GI/GU tracts & skin # of WBC’s Level of fatigue, nutritional status, presence of pre existing illnesses, previous or current tx, certain meds Stress level 3. Describe the stages of infection Incubation Period: interval between pathogens invasion of body & symptoms (no symptoms) Prodromal Stage: person is most infectious, early signs/ symptoms of disease present but vague & non specific (pt not aware of being contagious, results in precautions not being taken) Full Stage of Illness: presence of infection specific signs/ symptoms, indicates full stage of illness Localized symptoms- limited to one area of body Systemic symptoms- manifested throughout entire body Convalescent period: involves recovery from infection ○ signs/ symptoms disappear-person returns to normal state ○ There may be temporary or permanent changes 4. Infection Prevention – Including Healthcare-Associated Infections (HAIs) Practice good hand hygiene, carry soiled linens/ equipment so they dont touch clothing, do not place soiled bed linens on floor  Avoid letting pt’s cough, sneeze, breathe directly on others (instruct to cover mouth/ nose to prevent spread of airborne droplets) Avoid raising dust (do not shake linens) Clean from least soiled area to most soiled area Pour liquids directly down drain to avoid splatter 5. “My 5 Moments for Hand Hygiene: Before touching pt Before clean/ aseptic procedure After touching pt After touching pt’s surroundings After exposure or risk of body fluids 6. Breaking Chain of Infection: Infectious Agent: diagnose & treat, antibiotics, antimicrobial stewardship Reservoir: clean, disinfect sterilize, pest control Portal of Exit: perform hand hygiene, wear PPE, control aerosols & splatter, practice respiratory etiquette/ disposal of waste Modes of Transmission: perform hand hygiene, PPE, food safety Portal of Entry: perform hand hygiene, PPE, practice personal hygiene, apply first aid, remove catheters/ tubes Susceptible Host: immunize/ educate pt’s, treat underlying diseases, have healthcare OTHER INFO TO KNOW: -common transmission mode in hospital or other healthcare facilities is through touch -hallmark signs of infection: redness, heat, pain, swelling, loss of function -for C-DIF, always wash hands instead of alcohol based hand rub -know exudates: serous (clear/ watery), sanguineous (bright red/ bloody), serosanguineous (pink), purulent (indicates infection/ green, dark yellow) LEADERSHIP/ HEALTHCARE SYSTEMS/ DELIVERY 1. Discuss what it means to be a professional nurse and relate to just culture safety/ fairness in the workplace Philosophy emphasizing safety and fairness Encourages error reporting Supports learning environment Promotes fair treatment when mistakes occur Focuses on system improvement rather than individual blame 2. Begin to discuss the historical foundation of nursing Crusades: orders of knights, nurses cares for sick, injured American Civil War: care & safety of fleeing slaves, care to dying on battlefield Crimean War: Nightingale introduced sanitation measures  WWI: progress in healthcare including: use of anesthetics, inf. control , blood typing, prosthetics WWII: cadet nurse corpse established due to nursing shortage (nurses on battlefield w/ soldiers) Vietnam War: 90% of 11,000 American military women were nurses (youngest group to ever serve in war) 3. Explore essential nursing values that demonstrate professionalism and leadership Accountability Punctuality Knowledge competency Patient-centered care Respect for confidentiality Collaboration High standards maintenance Integrity Positive attitude Compassion Work ethic 4. Connect professional behaviors to the development of trust in the nurse/client relationship Skills, education, experience Ethics, leadership, time management Doing the right thing Put it in a box, have positive attitude Communication w/ team members Concern, recognize needs, advocating Dependability, attitude, accountability, honesty, respect 5. Begin to examine the standard of practice and scope of practice ANA Standards of Practice: think ADPIE (O) Scope of Practice: involves a nursing theory, which is a framework that organizes knowledge and explains phenomenon, theorists make the theory (shapes scope of practice) 6. Provide examples of unprofessional behaviors Abuse of power, sexual harassment, bullying, breach of confidentiality 7. Discuss regulatory frameworks, healthcare systems and levels of care Regulatory Framework: - Nurse Practice Act defines legal framework by state (legislators write laws) - Board of Nursing enforces standards (people that issue your license) - ANA provides professional guidelines (grander aspects of nursing)  - Quality and Safety Education in Nursing (QSEN) establishes competencies (looks mostly at safety stuff) Healthcare Systems: - PPOs (Preferred Provider Organizations) - HMOs (Health Maintenance Organizations) - ACOs (Accountable Care Organizations) Levels of Care: A. Primary Care (office visits/ PCP) B. Secondary Care (specialty referrals) C. Tertiary Care (advanced specialized treatment) D. Education Requirements - Two-year associate degree - Four-year baccalaureate degree - Graduate education options - Continuing education (24 CEUs every two years) Professional Organizations: a. American Nurses Association b. National League for Nursing c. International Council of Nursing d. Specialty nursing organizations LEGAL/ ETHICS 1. Discuss RN licensure and the associated rights and responsibilities. National Council of State Boards of Nursing (NCSBN): - Not-for-profit organization founded in 1978 - Develops nursing licensure examinations (NCLEX) - Members include nursing boards from all 50 states, DC, and territories - Responsible for regulatory excellence in nursing - Maintains test question repository and conducts research - Monitors nursing program pass rates State Board of Nursing: - Issues nursing licenses - Enforces nurse practice act - Requires license renewal every 2 years ($85 fee) - Mandates 24 continuing education units (CEUs) per renewal period - Can suspend or revoke licenses for violations 2. Explain the legal concept of standard of care. -legal requirements for nursing practice that describe minimum acceptable nursing care (reflect knowledge/ skills of nurses in professional practice) Patient Privacy and Confidentiality (HIPAA) - Cannot access patient charts unless directly involved in care - Must maintain patient confidentiality  - Exceptions for mandatory reporting include: Abuse/neglect of minors or vulnerable adults Threats of harm to self or others Gunshot wounds and violent crimes Court orders Subpoenas Advanced Directives - Legal documents specifying patient wishes if unable to communicate - Types include: Living wills Power of attorney DNR (Do Not Resuscitate) DNI (Do Not Intubate) - Must be completed while patient is competent - May not be followed in emergencies without prior information 3. Discuss the professional standard to which the nursing student is held. - Nurses held to professional standards based on education level (nursing student held to same standards as nurse) - Must practice within scope defined by nurse practice act - Documentation requirements: Document facts, not opinions If not documented, considered not done Avoid phrases like will monitor or assess without follow-up 4. Identify sources of litigation for malpractice and negligence and guidelines for legal protection. Malpractice: act or omission during tx of a pt that deviates from accepted norms of practice in medical comm (causes injury to pt, bad practice) Negligence: failure to follow standards of care, failure to document, assess & monitor pt, failure to responsibly use equipment, 5. Describe the legal responsibilities of nurses regarding HIPAA (Health Insurance Portability and Accountability Act of 1996). - Cannot access patient charts unless directly involved in care - Must maintain patient confidentiality (pt info should be kept confidential) 6. Identify mandatory reporting required by registered nurses. abuse/ neglect Minors < 8 yrs. Old Vulnerable adults ( has physical, mental, emotional aspects that make them vulnerable) 7. Discuss legal issues surrounding informed consent and the Good Samaritan Laws. Good Samaritan Laws:  Protects nurse from any intervention done to save pt in an emergency situation Nurse cannot act willful or reckless while providing care Informed Consent: You want pt to know what were talking about as nurses (benefits/ risks) Need to be 18>, competent & can’t be swayed (exceptions include incompetency/ emergencies) 8. Discuss advanced directives. - Legal documents specifying patient wishes if unable to communicate - Types include: Living wills Power of attorney DNR (Do Not Resuscitate) DNI (Do Not Intubate) - Must be completed while patient is competent - May not be followed in emergencies without prior information 9. Identify bioethics as a branch of philosophy providing a system of moral principles governing the conduct of health professionals including nurses. -specific ethical questions that pertain to healthcare 10. Define and distinguish the five ethical principles of bioethics: autonomy, beneficence, fidelity, veracity and justice. Autonomy: self governance Beneficence: doing good Justice: equal rights Fidelity: keeping your word Veracity: telling the trust 11. Give examples of how ethical principles provide moral guidelines for nursing practice. -Altruism: selfness -Social Justice: human rights/ equity -Integrity: doing right thing when no one is looking -Autonomy (capacity to decide, ability to execute) -Dignity: self price, being worthy of respect Caring is a primary virtue in nursing Compassion, respect, dignity, Commitment to patient Promote health/ safety Maintain & improve ethical environments Advance the profession  Maintain integrity of profession 12. Discuss ways nurses act as advocates for patients with limited decisional autonomy. Nurse acts in best interest of pt, free from interference of others & free from limitations in making choices Conditions for autonomy (capacity to decide, ability to execute) 13. Describe the steps a nurse takes when ethical principles conflict. - Common situations include: End-of-life care decisions Treatment refusal Resource allocation Cultural conflicts - Approach should include: Gathering all relevant information Considering multiple perspectives Consulting ethics committees when needed Following institutional policies Documenting decisions and rationale 14. Discuss how the ANA Code of Ethics affords registered nurses’ professional autonomy while upholding their obligations to patients. providing adequate information to allow patients to make their own decisions based on their beliefs and values, even if they aren't the ones the nurse chooses. Autonomy also relates to only providing nursing care within the scope of practice defined by state and organizational rules. 15. Define social justice. Equal opportunity & fairness, opportunities, political & social rights, economic justice, has 5 principles: 1. Access 2. Diversity 3. Equity 4. Participation 5. Human rights NURSING PROCESS/ CLINICAL JUDGMENT 1. Describe the concepts of critical thinking, clinical reasoning, and clinical judgment. Critical Thinking: the first step towards developing clinical reasoning. (involves managing care, accountability, collaboration, documenting & reporting) Critical Reasoning: the cognitive process used for analyzing knowledge relative to a clinical situation or a specific patient it is the  application of critical thinking to the clinical situation (analyze & interpret data in order to determine what our clinical judgment is) Critical Judgment: Clinical judgement is the outcome of clinical reasoning and is the interpretation or conclusion about whether or not to take an action based on clinical reasoning (nurses decision) 2. Describe person-centered practice Promoting human dignity Establishing caring relationships Preparing attention/ intention for each clinical encounter Enjoying reward of mutual exchange 3. Describe the five phases in the nursing process 1. Assessment: determine the need for nursing care 2. Diagnosing: determine nursing diagnosis for actual/ potential health problems 3. Outcome: identification/ planning *identify expected outcomes & plan of care 4. Implementing: implement care 5. Evaluating: evaluate the results of care given 4. Organize assessment cues that are relative to each other into a pattern -group together related pieces of information based on their similarities, considering factors like the body system they relate to, the patient's reported symptoms, and observable physical signs, essentially creating clusters of data that point towards a potential health concern; Identify relative assessment categories Gather assessment cues Cluster related cues EX: resp distress (labored breathing, rapid breathing, chest tightness, wheezing) 5. Formulate nursing diagnosis statements appropriate to the client's priority needs Rule out similar problems/ diagnosis Name actual/ potential health problems & clarify what's causing/ contributing to them Determine risk factors to be managed Identify resources/ strengths & areas for health promotion 7. Describe how nursing outcomes/interventions are used to implement care. Help motivate client/ nurse by providing a sense of achievement Support therapeutic nurse-pt relationship Short term vs. long term goal What we want to see in client 8. Evaluate the nursing plan of care based on the evaluation of the client's response. Was the goal not met? Partially met? Or met? Documentation, look at goal/ statement Always modified w/ client’s change  9. Describe the steps of concept mapping 1. Collect pt problems/ consents onto a list 2. connect/ analyze relationships *main vs. related problems 3. Create diagram demonstrating problem recognition, critical thinking, nursing action 4. Keep in mind key concepts *nursing process, holism, safety, advocacy 10. Describe the prioritization of nursing care Maslow's hierarchy of Needs Self actualization most important Self esteem Love belonging Safety/ Security Physiological Pt preference, anticipation of future problems ADDITIONAL INFO TO KNOW: -3 part nursing diagnosis statement: problem, related to, as evidenced by -2 part nursing diagnosis statement: problem, related to -SMART goal: single, measurable, attainable, realistic, time framed COMMUNICATION 1. Describe the various modes of communication. Verbal: pace, simplicity, clarity, timing, adaptability, credibility, humor Non-verbal: body language, observation, cultural component Electronic Advantages: improves fast continuity of care, fast, efficient Disadvantages: client confidentiality risk, socioeconomics, HIPPA, urgent info 2. Describe barriers and influences for successful communication. Barriers: Changing topics (HUGE ONE) Agreeing disagreeing Influences: Developmental: language varies w/ age Gender/ sociocultural: females/ males communicate differently Values/ perceptions: standards that influence behavior, personal views of an event Personal Space: distance people prefer in interactions w/ others Territoriality/ environmental: space and things individuals believe as belonging to itself  Roles/ relationships: first meeting vs. developed relationship (formal/ informal) 3. Contrast various styles of communicating and discuss the positive and negative results of each style. Passive Communication: focus on needs of others Positive: Can maintain harmony in sensitive situations, avoids direct confrontation. Negative: Can lead to unaddressed needs, feelings of being taken advantage of, and low self-esteem due to not expressing opinions Aggressive: focus on own needs Positive: Can be direct and assertive in achieving goals, may stand up for themselves effectively in certain situations. Negative: Can be hurtful, domineering, and damage relationships due to lack of consideration for others' feelings Assertive: declare/ affirm opinions Positive: Promotes open and honest communication, respects others' opinions while clearly expressing personal needs, fosters healthy relationships. Negative: May be perceived as too direct or confrontational in certain situations, requiring active listening and understanding to avoid misunderstandings 4. Predict the impact on client care when the nurse communicates assertively. Pt might stop listening, shows non verbal awareness 5. Differentiate between attentive listening and physical attending. Attentive: mindful listening, paying attention to verbal/ nonverbal messages, listen for key themes, be aware of own biases Physical: face the person, adopt an open posture, lean towards person, maintain good eye contact, try to be relatively relaxed 6. Discuss therapeutic communication techniques. Offering Self: making oneself available Open Ended Q’s: asking neutral q’s that encourage pt to express concern Summarizing: highlights important points of a convo by condensing what was said 7. Explain the phases of the therapeutic relationship. 1. Pre-Introduction Phase: prepare, discuss, review materials 2. Introduction Phase: 1st nurse-pt meeting/ establish rapport 3. Working Phase: data, promote change, evaluate progress, discuss alternatives 4. Termination: summarizes goals, strategies, review situation, closure 8. Relate the importance of therapeutic communication to the development of a therapeutic Relationship  it creates a safe and trusting environment where a patient feels comfortable sharing personal information, which is crucial for a healthcare professional to effectively assess and address their needs QSEN: 1. Describe each element of thoughtful, person-centered practice: the nurse’s personal attributes, knowledge base, and blended and QSEN competencies; clinical reasoning, judgment, and decision making; person-centered nursing process; and reflective practice leading to personal learning The nurses personal attributes include Open mindedness, sense of value of the person, self awareness, sense of personal responsibility, motivation to do best, leadership skills, bravery to question system Knowledge base: ability to draw upon a body of nursing knowledge/ evidence Cognitive competencies: critical thinking, purpose of thinking, adequacy of knowledge, potential problems Interpersonal competencies: promoting human dignity/ respect, establishing caring relationships, enjoying reward of mutual exchange Ethical/ legal competencies: understanding legal boundaries, scope of practice, owing personal strengths & weaknesses 2. Describe how to use evidence-based practice to promote quality improvement. Problem solving approach to making clinical decisions using the best evidence available Specific nursing interventions/ guidelines established for the care of pt’s w/ certain illnesses or tx’s or surgical procedures Mandates analysis & systematic review of research findings 3. Define just culture and its relationship to healthcare. Approaching errors at systemic level instead of a culture on blame leads to identifying core issues, determining evidence based solutions, implementing those solutions & evaluating the outcome of those changes 4. Implement the principles of just culture in healthcare Identify real/ potential unsafe environments/ situations Incorporate accident prevention into ADL’s Implement safety measures in environment Use available resources for safety information Core Competencies a. Patient-Centered Care - Focus on individual patient needs rather than diagnosis alone - Care customization based on patient preferences and values - Patient as the source of control b. Teamwork and Collaboration - Integration between providers, nurses, dietitians, and therapists - Emphasis on breaking down departmental silos  - Includes patient and family as part of the care team c. Evidence-Based Practice - Shift from tradition-based to evidence-based approaches - Problem-solving methodology using best available scientific evidence - Integration of science and art of nursing - Implementation of care bundles for better outcomes d. Quality Improvement - Systematic actions for measurable healthcare service improvement - Focus on patient access and engagement - Continuous evaluation and enhancement of care processes - Four-step improvement process: problem discovery, strategy planning, change implementation, and assessment e. Safety - System-wide approach to preventing errors - Environmental safety measures - Accident prevention integration - Emphasis on transparency in error reporting f. Informatics - Integration of nursing science with information management - Focus on data, resources, and technology - Opportunity for specialization at master's level IMMUNITY/ INFLAMMATION/ TISSUE INTEGRITY 1. Discuss the processes involved in wound healing. 1. Hemostasis: initial response to stop bleeding, activates WBC’s to control infection 2. Inflammatory: lasts 2-3 days, WBC (macrophages & leukocytes) move to wound Macrophages ingest debris & release growth factors that attract fibroblasts to fill the wound Exudate formed & accumulates, causing pain, redness, swelling *pt has generalized body response 3. Proliferation: lasts several weeks, new tissue is built to fill wound space through action of fibroblasts, granulation tissue forms foundation for scar tissue development 4. Matuariton: final stage of healing, collagen is remodeled after 3 weeks, new collagen tissue deposited, which compresses blood vessels in wound, causing scar 2. Identify factors that affect wound development and healing. Pressure, trauma, edema infection, excessive bleeding Desiccation (dehydration) Maceration (overhydration) Necrosis, presence of biofilm 3. Identify patients at risk for pressure injury development. Age, malnutrition, dehydration, poor mobility, pt’s will illnesses (incontinence) 4. Describe the method of staging of pressure injuries. 1. Stage 1: non blanchable erythema of intact skin 2. Stage 2: partial thickness loss w/ exposed dermis 3. Stage 3: full thickness skin loss, not involving underlying fascia 4. Stage 4: full thickness skin & tissue loss 5. Unstageable: obscured full thickness skin & tissue loss 6. Deep Tissue Pressure Injury: persistent nonblanchable deep red, maroon or purple discoloration 5. Provide nursing interventions to prevent pressure injuries. Assess at risk pt’s daily Maintain higher humidity use. Moisturizers Cleanse skin routinely, protect skin from excessive moisture Minimize skin injury from friction or shearing, use appropriate support surfaces (pillows) Proper positioning, turning, transferring Nutritional supplements Improve mobility, activity 6. State the physiologic reasons behind five cardinal signs of acute inflammation. Redness: increased blood flow Heat: increased blood blow, metabolic activity Pain: chemical/ nerve signals (histamine) Swelling: increase of fluid on tissues (histamine) Loss of Function: damage to the tissue & pain induces inhibition of movement (histamine) 7. Describe the vascular changes in an acute inflammatory response. Vasodilation (increased blood flow; redness/ heat) Histamine released causes permeability of vessels & protein rich fluid, exudate to get to site of injury (pain, swelling, loss of function) 8. Discuss the systemic manifestation of inflammation. Fever & malaise Loss of function of extremities 9. Describe the body’s general immune responses and the stages of the immune response. Recognition: recognizes antigen as foreign Use of lymph nodes/ lymphocytes for surveillance Macrophages play important role in helping circulating lymphocytes macrophages/ neutrophils have receptors for antibodies/ complement Proliferation: circulating lymphocytes containing antigenic message return to nearest lymph node Stimulate some of T/B lymphocytes to enlarge, divide T lymphocytes differentiate into cytotoxic T-cells B lymphocytes produce, release antibodies Response Phagocytic response: WBC’s ingest foreign material/ destroy invading agents Humoral/ antibody response: B lymphocytes transform into plasma cells that manufacture antibodies Cellular: T lymphocytes attack pathogens Effector Humoral Immunity: interplay of antibodies  Cellular Immunity: action by cytotoxic T-cells 10. Differentiate between cellular and humoral immune responses. Cellular: T lymphocytes, cytotoxic killer cells that attack pathogens Attack invaders directly, secrete cytokines & stimulate immune system response Humoral: antibody response, B lymphocytes transform themselves into plasma cells that manufacture antibodies Antigen recognition (B lymphocytes respond to antigen by triggering antibodies, memorize antigens) 11. Compare and contrast the innate and adaptive immune response. Innate: non-specific, no memory, physical barriers Addaptive: specific, has memory, humoral and cellular response innate immunity is what you're born with, while adaptive immunity is acquired through exposure to pathogens 12. Compare the development and function of the T and B lymphocytes. T lymphocytes Develop in thymus and differentiate into cells w/ various functions Helper T cells: stimulate immune system Suppressor T cells: suppress B lymphocytes to maintain balance Cytotoxic T cells: attack antigens directly B lymphocytes: mature in bone marrow and includes: Memory cells: circulate in blood as clone to antibody to illicit rapid response in case of re-infection Plasma cells: become antibodies/ immunoglobulins (assist in the removal of antigen by attaching it to allow phagocytosis) HOLISTIC LEARNING 1. Describe the process of teaching and learning Assess needs & readiness (are they ready to learn) Identify needs (what does client need) Develop outcomes (goals) Create a plan (focused on teaching/ education) Implement plan Evaluate the learning (is it working?) 2. Identify how QSEN relates to teaching & learning You need to ask yourself these questions Do I have info/ resources I need Is there evidence to support my teaching What is the teaching plan (short vs. long term) Is my communication effective  Do I need to collaborate w/ other professionals? What should I document/ was there a good outcome? INTERNET IS NOT A RELIABLE SOURCE 3. Assess learning needs Knowledge, attitude, skills needed to be independent Readiness to learn (are they motivated/ what is their motivation) Learning strengths (recall info & ask client what they think their strengths are) IS PT READY TO LEARN, WHAT EXACTLY DOES PT NEED, WHAT IS PT’S LEARNING STYLE 4. Discuss factors that affect learning related to age and developmental stage: a. Infants - Teaching directed to parents - Adult learning principles apply b. Preschoolers - Involve both parents and child - Use simple tasks and information - Incorporate pictures, props, games c. School-Age Children - Provide clear explanations - Developing logical thinking - Reinforce teaching through parents, school, caregivers d. Adolescents - Assess ability to use logic and problem-solve - Consider peer pressure influence - Promote independence and autonomy - Connect information to peer experiences e. Adults - More independent learning style - Can draw from past experiences - Prefer immediately applicable information - Consider social and employment roles f. Older Adults - Consider sensory limitations - Allow extra time for processing - Use shorter teaching sessions (15-30 minutes) - Focus on quiet, well-lit environments - Connect new information to long-term memories 5. Provide methods of teaching for anticipatory guidance when teaching clients  a. Coaching - Partnership approach - Focus on present and future - Emphasis on empowerment and motivation - Wellness-oriented goals b. Counseling - Focus on past to present - Types: Short-term (situational crisis) Long-term (developmental crisis) Motivational interviewing Type of counseling/ teaching that helps clients prepare for future Relies on advice. Information given to client ANTICIPATORY CHANGES OCCURING IN DEVELOPMENT AND HAVE CONVERSATIONS ABOUT SAFETY BEFORE THESE CHANGES OCCUR 6. Describe learning domains and assessment parameters a. Cognitive Domain - Comprehension and analysis - Evaluating information worth - Teaching methods: lectures, panel discussions, written materials b. Psychomotor Domain - Physical skills development - Teaching methods: demonstrations, step-by-step guides c. Affective Domain - Attitude changes during learning - Teaching methods: role modeling, discussions, audiovisual materials 7. Discuss Bloom’s Taxonomy a. T: Tune into patient's needs and focus b. E: Edit information to fit patient needs c. A: Act on teaching moments when available d. C: Clarify understanding and build trust e. H: Honor patient as partner in education Outcomes need to be very specific/ measurable w/ short term vs. long term goal Cultural Competency a. Use appropriate language resources b. Employ professional interpreters c. Avoid family members as translators d. Consider cultural norms and values e. Provide culturally appropriate materials  Quality and Safety Considerations a. Ensure evidence-based information b. Verify resource availability c. Assess communication effectiveness d. Document outcomes e. Review and revise teaching plans f. Consider environmental factors g. Maintain professional standards FLUID/ ELECTROLYTES & ELIMINATION Fluids and Electrolytes, Acid Base Balance 1. Describe the location and functions of body fluids, including the factors that affect variations in fluid compartments. a. Body maintains constant equilibrium through homeostasis b. Water comprises ~60% of adult body weight (higher in children) c. Can survive ~3 days without water versus 40+ days without food d. Fluid compartments: - Intracellular fluid (ICF): 35-40% body weight - Extracellular fluid (ECF): 15-20% body weight - Plasma: 5% body weight 2. Describe the functions, regulation, sources, and losses of the main electrolytes of the body. a. Sodium (Normal: 135-145 mEq/L) - Most abundant cation in ECF - Controls volume and distribution - Critical for nerve conduction - Works with potassium for nerve impulses b. Potassium (Normal: 3.5-5.0 mEq/L) - Major cation in ICF - Essential for nerve and muscle function - Must be obtained through diet - Most supplements not well absorbed - Found in foods like potatoes, sweet potatoes, tomatoes c. Calcium (Normal: 8.6-10.2 mg/dL) - Most abundant positive charge electrolyte - Stored in bones and teeth - Important for blood pressure, clotting, nerve conduction - Works with magnesium d. Magnesium (Normal: 1.3-2.3) - Second most abundant ICF cation - Helps with muscle function  - Used in laxatives - Important for elderly monitoring - Can cause respiratory arrest if too high 1. Fluid Imbalances a. Dehydration (Fluid Volume Deficit) - Signs include: Poor skin turgor Sticky mucous membranes Thirst Low blood pressure Weakness Dizziness b. Fluid Volume Excess - Manifests as: Edema in legs Third spacing Pulmonary edema Abdominal ascites - Common in renal failure and heart failure 3. Explain the principles of osmosis, diffusion, active transport, and filtration. a. Diffusion: Movement from higher to lower concentration b. Filtration: Fluid passage through membranes based on pressure c. Osmosis: Balancing system dependent on pressure gradient d. Active Transport: Requires ATP energy to move substances against concentration gradient 4. Describe how thirst and the organs of homeostasis (kidneys, heart and blood vessels, lungs, adrenal glands, pituitary gland, parathyroid glands) function to maintain fluid homeostasis. Kidneys - Retention and excretion of body fluids Heart and blood vessels - Circulation Lungs- control levels of CO2 Adrenal glands- regulate blood volume and sodium and potassium balance by secreting aldosterone Pituitary gland- releases antidiuretic hormone resulting in water conservation or water loss Parathyroid gland - parathyroid hormone regulates calcium and phosphate IN DEPTH KIDNEYS: - Regulate extracellular fluid (ECF) volume and osmolality by selective retention and excretion of body fluids - Regulate electrolyte levels in the ECF by selective retention of needed substances and excretion of unneeded substances - Regulate pH of ECF by excretion or retention of hydrogen ions - Excrete metabolic wastes (primarily acids) and toxic substances - Normally filter 180 L of plasma daily in the adult, while excreting only 1.5 L of urine HEART AND BLOOD VESSELS: - Circulate nutrients and water throughout the body - Circulate blood through the kidneys under sufficient pressure for urine to form (pumping action of the heart) - React to hypovolemia by stimulating fluid retention (stretch receptors in the atria and blood vessels) LUNGS: - Remove approximately 300 mL of water daily through exhalation (insensible water loss) in the normal adult - Eliminate about 13,000 mEq of hydrogen ions (H+) daily, as opposed to only 40 to 80 mEq excreted daily by the kidneys - Act promptly to correct metabolic acid-base disturbances; regulate H+ concentration (pH) by controlling the level of carbon dioxide (CO2) in the extracellular fluid ADRENAL GLANDS: - Regulate blood volume and sodium and potassium balance by secreting aldosterone, a mineral corticoid secreted by the adrenal cortex, causing sodium retention (and thus water retention) and potassium loss. - Decreased secretion of aldosterone causes sodium and water loss and potassium retention. - Cortisol, another adrenocortical hormone, has only a fraction of the potency of aldosterone. However, secretion of cortisol in large quantities can produce sodium and water retention and potassium deficit. PITUITARY GLAND: - Stores and releases the antidiuretic hormone (ADH) (manufactured in the hypothalamus), which acts to allow the body to retain water. It acts chiefly to regulate sodium and water intake and excretion. - When osmotic pressure of the ECF is greater than that of the cells (as in hypernatremia—excess sodium—or hyperglycemia), ADH secretion is increased, causing renal retention of water. - When osmotic pressure of the ECF is less than that of the cells (as in hyponatremia), ADH secretion is decreased, causing renal excretion of water. - When blood volume is decreased, an increased secretion of ADH results in water conservation. When blood volume is increased, a decreased secretion of ADH results in water loss. PARATHYROID GLAND: - Regulate calcium (Ca2+) and phosphate (HPO42−) balance by means of parathyroid hormone (PTH); PTH influences bone reabsorption, calcium absorption from the intestines, and calcium reabsorption from the renal tubules. - Increased secretion of PTH causes elevated serum calcium concentration and lowered serum phosphate concentration. - Decreased secretion of PTH causes lowered serum calcium concentration and elevated serum phosphate concentration. 5.. Describe the role of buffer systems and respiratory and renal mechanisms in achieving and maintaining acid–base balance. 1. Acid-Base Balance a. Normal pH range: 7.35-7.45 b. Four main imbalances: - Respiratory acidosis: excess carbonic acid - Respiratory alkalosis: insufficient CO2 - Metabolic acidosis: insufficient bicarbonate - Metabolic alkalosis: excess bicarbonate  ELIMINATION 1. Summarize the physiology of the renal and gastrointestinal systems related to elimination. Renal: helps rid the body of waste products & materials that exceed bodily needs Kidneys filter & excrete blood constituents that are not needed and retain needed ones (excretes urine) GI: ingestion, propulsion, mechanical digestion, chemical digestion, absorption, defecation 2. Examine the relationship between elimination and other concepts/systems. Fluids/ Electrolytes: proper fluids/ electrolytes balance crucial for efficient waste removal from body Inflammation: difficult to void & eliminate if body is inflamed Mobility: can cause incontinence if sedentary Self: can lower self-esteem if having issues w/ elimination Teaching/ learning: bowel/ bladder training may be necessary 3. Identify commonly occurring alterations in elimination and their related therapies. Urinary retention more common in men than women (bc prostate) diarrhea/ constipation Flateleance (excessive gas in intestine/ colon) Bowel incontinence/ impaction Bowel cancer/ obstruction diet/fluid/ activity 4. Differentiate common assessment procedures used to examine urinary and gastrointestinal health across the lifespan. a. Pregnancy - First trimester: increased frequency due to uterine pressure - Second trimester: less pressure as uterus rises - Third trimester: increased pressure returns - May show glucose in urine; excess indicates gestational diabetes - Postpartum risks include retention and incomplete emptying b. Infants and Children - No voluntary control at birth - 6-8 wet diapers daily normal - Control typically develops between ages 2-5 - Kidneys double in size between ages 5-10 c. Older Adults - Decreased autonomic regulation - Weakened pelvic floor muscles - Higher risk of hyponatremia - Decreased bladder capacity - Generally maintain function until age 90 unless other health issues present 5. Explain management of urinary and bowel health and prevention of urinary and bowel illness. a. Maintain healthy weight b. Regular exercise c. Proper toileting habits d. Adequate fluid intake e. Kegel exercises f. Privacy considerations g. Cultural sensitivity h. Professional terminology while maintaining clear communication i. Regular screening and assessment 6. Compare and contrast common independent and collaborative interventions for clients with alterations in elimination 1. Special Considerations a. Positioning during elimination (squatting preferred over lying flat) b. Privacy and modesty needs c. Gender preferences for healthcare providers d. Cultural attitudes and practices e. Professional yet understandable terminology OTHER INFO TO KNOW: a. Transient: temporary, resolves within 6 months b. Overflow: bladder overdistention c. Functional: external factors prevent proper toileting d. Reflex/Urge: involuntary emptying e. Stress: triggered by physical pressure f. Mixed: multiple types occurring together g. Total: complete loss of control  COGNITION 1. Summarize the physiology of the neurological system in relationship to cognition. Nervous system has to be functional, person has to be in proper developmental stage Function of nervous system w/ complex set of mental activities like: acquire, process, store, retrieve, use information Brain functions as foundation for cognition by utilizing complex networks of neurons to receive, process & transmit info 2. Examine the relationship between cognition and other concepts/systems. Health, wellness, illness Violence, stress, coping Addiction, nutrition, chemicals 3. Identify commonly used tools related to cognition assessment and examination. Assessment Tools - SLUMS (St. Louis University Mental Status) - Mental status examinations - Orientation assessments - Memory evaluations - Caregiver strain assessments Nursing Care Considerations Safety assessments Support for caregivers Prevention strategies Basic needs management Family involvement Holistic treatment approach IQ: 80-115= normal, >120=superior, >70=deficit 4. Identify the concept of mood and affect. a. Mood: Internal feelings b. Affect: External expression c. Assessment considerations: - Appropriateness - Range - Stability - Intensity - Congruence d. Influenced by: - Genetics - Environment - Chemical imbalances  - Exposure to violence - Stress levels 5. Explore cultural implications related to cognition, mood and affect Genetic Conditions a. Down Syndrome - Early onset dementia - Cardiac problems - Skin issues - Reduced life span b. Fragile X - X chromosome mutation - Characteristics include: Longer face Larger ears - Associated with: ADHD Learning disabilities Seizures Autism Developmental delays Cultural Implications a. Mental illness is culturally defined b. Different cultures handle elderly care differently c. Some cultures expect family care versus institutional care d. Family considerations vary by culture The Three D's: Depression, Delirium, and Dementia a. Delirium - Medical emergency - Acute onset, sudden confusion - Usually temporary and reversible - Causes include: Infections Medications Dehydration Chemical imbalances Blood sugar issues b. Dementia - Progressive loss of cognitive function - Slow onset and progression - Not normal part of aging  - Most common form is Alzheimer's - Can occur early (around age 40) - Risk factors include: Age Genetics Down Syndrome Diabetes Mental illness c. Depression - Can mimic dementia symptoms - Often underdiagnosed in elderly - May be triggered by life changes - Can be chemical imbalance-related 7. Identify normal cognitive parameters for clients across the lifespan a. Vygotsky's Theory - Children learn through cultural and social interactions - Environment drives cognitive development - Children progress at different rates b. Information Processing Theory - Mind continuously evolves as computational system - Processes information into answers - Fluid and continuous development c. Piaget's Theory - Cognitive development follows orderly, sequential process - Four major stages: Sensorimotor (birth-2 years): Self-awareness develops Preoperational (2-7 years): Focus on self Concrete Operations (7-11 years): Forming logic Formal Operations (11+ years): Forming hypotheses OXYGENATION/ PERFUSION 1. Describe respiratory and cardiovascular anatomy and physiology. Cardiovascular System a. Heart composed of two upper atria and two lower ventricles b. Blood flow cycle: - Deoxygenated blood → right heart → lungs - Oxygenated blood → left heart → body c. Oxygen transport: - 98% via hemoglobin - 2% dissolved in plasma d. Carbon dioxide transport:  - 30% via hemoglobin - 10% dissolved in plasma - 60% as bicarbonate Heart Function a. Controlled by autonomic nervous system b. Three major phases: - Diastole: Resting phase, continuous blood flow - Atrial systole: Atrial contraction - Ventricular systole: Ventricular contraction c. Cardiac output = Heart rate × Stroke volume d. Factors affecting blood pressure: - Blood volume - Blood viscosity - Heart pumping action - Age, race, gender - Stress and medications 2. Describe the function and role of the respiratory and cardiovascular systems in oxygenation. Respiratory: intake of oxygen and release of CO2 Occurs via diffusion, movement of O2 and CO2 between air and blood Cardiovascular: deoxygenated blood returns to right side of heart from systemic circulation Oxygenated blood travels through arteries to capillaries where perfusion occurs 3. Describe factors that affect respiratory and cardiovascular function and influence the care of patients with oxygenation problems. Respiratory Narrowing of passages, such as asthma constricting bronchioles Thickening of alveolar capillary membrane (pulmonary edema) Changes in surface are of alveoli (emphysema) Cardiovascular dysrhythmia/ arrhythmia (heart failure) Myocardial ischemia/ angina (myocardial infarction) 4. Identify changes in oxygenation and perfusion throughout the lifespan. Age-Related Changes a. Neonates/Infants - Immediate post-birth changes: Begin breathing Closure of foramen ovale and ductus arteriosus - Higher risk of heart failure compared to older children b. Children - Airways and eustachian tubes elongate  - Respiratory rate faster than adults - Common issues: infections, asthma, congenital cardiac defects c. Older Adults - More rigid airways and tissues - Decreased diaphragm efficiency - Increased risk of pneumonia - Different presentation of cardiac symptoms May present with fatigue rather than chest pain 5. Identify components of the nursing assessment pertinent to oxygenation and perfusion. 1. Assessment and Diagnostic Tools a. Physical assessment components: - Vital signs - Heart sounds - Breath sounds b. Common breath sounds: - Vesicular: Low-pitched, soft - Bronchial: High-pitched, longer - Bronchovesicular: Medium pitch c. Abnormal breath sounds: - Crackles: Fluid-related sounds - Wheezes: Continuous sounds during expiration - Rhonchi: Low-pitched, coarse sounds 2. Treatment and Interventions a. Promoting proper breathing: - Deep breathing exercises - Incentive spirometry - Pursed-lip breathing b. Medications: - Bronchodilators - Corticosteroids - Mucolytic agents - Antihistamines 6. Understand laboratory values and common diagnostic tests related to oxygenation and Perfusion. a. Physical assessment components: - Vital signs - Heart sounds - Breath sounds b. Common breath sounds: - Vesicular: Low-pitched, soft  - Bronchial: High-pitched, longer - Bronchovesicular: Medium pitch c. Abnormal breath sounds: - Crackles: Fluid-related sounds - Wheezes: Continuous sounds during expiration - Rhonchi: Low-pitched, coarse sounds 7. Relate other concepts to oxygenation and perfusion. Cognition: brain usually protected first w/ oxygenation Comfort: pain w/ impaired tissue perfusion Fluid/ Elec: organ failure affecting perfusion so inappropriate redistruction of body fluids Intracranial Reg: cerebral blood flow decreases Gastric/ Nutrition: nausea/ vomiting 8. Identify nursing diagnosis, goals, and interventions pertinent to oxygenation and perfusion Common nursing diagnoses: - Impaired gas exchange - Ineffective breathing pattern - Decreased cardiac output Goals include: - Promoting healthy lifestyle choices - Maintaining proper vaccination - Reducing anxiety - Ensuring good nutrition - Managing comfort - Teaching proper breathing techniques SPIRITUALITY/ CULTURE 1. Explain concepts of cultural diversity and respect. Cultural Diversity: coexistence of different ethnic, racial and socioeconomic groups w/ one social unit Varies with religion, language, physical size, sexual orientation, disability, occupational status, geographical location Culture: shared system of beliefs/ values and behavioral expectations Combination of a body of knowledge, a body of belief, and a body of behavior Provides social structure for daily living Influences roles/ interactions with others and in families/ communities May change/ adapt to environment, defines what is acceptable behavior 2. Describe influences that affect culturally respectful health care. Physiological variations Reactions to pain Mental health/ assigned sex roles language/ communication & orientation to space/ time  Food & nutrition/ family support Socioeconomic factors/ health disparities 3. Discuss examples of how diversity affects health and illness care, including culturally based traditional care. Stereotyping: one assumes that all members of a culture think alike (neg or positive) Implicit Bias: holding attitudes/ stereotypes about people w/o a conscious awareness Cultural Imposition: belief that everyone else should conform to one’s own belief system Cultural Conflict: person becomes aware of cultural differences, feels threatened and responds by ridiculing the other culture to make themselves feel more secure 4. Discuss the factors that play a role in health equity and health disparities including social determinants of health. Health Equity: Economic Stability: Income level, employment status, poverty, wealth gap - Individuals with lower income often have poorer health due to limited access to nutritious food, healthcare, and safe housing. Education Access and Quality: Educational attainment level impacts health literacy, decision-making abilities, and access to higher-paying jobs, with lower education levels often associated with poorer health outcomes. Healthcare Access and Quality: Insurance coverage, availability of healthcare providers, quality of care received, and language barriers can significantly impact access to necessary medical services. Neighborhood and Built Environment: Quality of housing, access to safe parks and recreational spaces, environmental hazards like air pollution, and neighborhood safety all play a role in health outcomes. Social and Community Context: Social support networks, community cohesion, social norms, discrimination, and stigma can affect health behaviors and access to resources Health Disparities: Racial/Ethnic Disparities: Systemic racism leads to unequal access to quality education, employment opportunities, and healthcare, contributing to poorer health outcomes among minority groups. Geographic Disparities: Differences in healthcare access and quality across different regions, with rural areas often facing limited healthcare options. Socioeconomic Disparities: Individuals with lower socioeconomic status experience higher rates of chronic diseases, lower life expectancy, and poorer overall health due to limited resources 5. Identify the three spiritual needs believed to be common to all people. 1. Need for meaning and purpose 2. Need for love and relatedness  3. Need for forgiveness 6. Describe the influences of spirituality on everyday living, health, and illness