2303 Intro to Nursing Exam 1 Study Guide PDF

lOMoARcPSD|4446559 2303 Intro to Nursing Exam 1 Study Guide Intro to Nursing (The University of Texas at El Paso) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Angel D Escobedo (puguixbo...

lOMoARcPSD|4446559 2303 Intro to Nursing Exam 1 Study Guide Intro to Nursing (The University of Texas at El Paso) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 Blueprint Exam 1 N2303—Introduction to Nursing Practice 100 Questions over:  Chapters 1-7 of the Foundations of Nursing Practice: Essential Concepts, 4 th edition textbook  Healthy People 2020 Goals and Determinants of Health Categories power point  6 Dimensions of Health and Wellness  Rest and Sleep power point  Stress (GAS Model) power point  Behavioral Change Models (Health Belief Model, Trans-theoretical Change Model, Reversal Theory)- PowerPoint  Self-Care PowerPoint TOPIC – Please review the study guide questions as well as the topics below in preparation for the exam Chapter 1  Early historical practices - Egyptians o Mummification, sealed tombs, embalming scents - Native Americans o Burial practices - Biblical o Handwashing o Isolation of sick and diseased bodies o QUARANTINE - Respect for dead - HISTORICAL - Safe Water o Roman Aqueducts - Homeostasis o Internal regulation toward equilibrium o Claude Bernard 1878 o Walter Cannon 1925 - Four Elements (Empedocles) o Air, water, fire, earth - Greek Olympics 776 B.C.E. - Native Americans Harmony with Earth - Asian Balance o Mind - Body o Yin and Yang  Elizabethan Poor laws - Elizabethan Laws (1597-1598) o Protestant work ethic o Poor laws provide access to healthcare for poor, ill, & disabled o Basis of WELFARE programs today  Travis Illness-Wellness Continuum  Travis (1981): Health is on a FORWARD moving continuum toward high-level wellness OR toward death/disability  Alternative and Complementary healing - Holistic Healing: Multidimensional - Complementary healing o Massage, diet and nutrition Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 o Mind-body interventions  Biofeedback, meditation, relaxation techniques - Holistic Healing: Multidimensional - Spiritual or Energy healing: - Medicine men or women, shamans: Native Americans - Shamans: Asian - Curandera/Curandero: Mexican, Central American, South American - Prayers to a higher being, rituals that facilitate healing across world religions and spiritual belief systems - Alternative Healing o Acupuncture o Acupressure o Reflexology o Herbal medicines (pharmacognosy) o Bioelectromagnetic therapies  Scientific discoveries - Anton Van Leuwenhoek (1674)-Use of microscope - Edward Jenner (1796)-Vaccines (smallpox) 5/8/80 - Louis Pasteur (1861)-Germ theory - Joseph Lister (1865) – Antisepsis - Alexander Fleming (1928) – Penicillin - Jonas Salk (1955)- Polio vaccine  Notable Nurses - Florence Nightingale o Crimean War (1853-1856) / Founder of Professional Nursing o British nurse o Founder of the modern nursing profession o Crimean War (1853-1856) o Fresh air, clean sheets, and personal attention facilitate healing - Dorothea Dix o Army Nurse Corps (Civil War) - Lillian Wald o Henry Street Settlement (1893) o Metropolitan Life Insurance Company (1909) - Harriet Tubman o Underground Railroad movement (Civil War) - Clara Barton o Red Cross Founder (Civil War) - Mary Adele Nutting o Higher Education for Nurses (1901) - Mary Breckinridge o Frontier Nursing Service (1925) - Mary Seacole o Provided nursing services in the Crimean war, was a businesswoman (1850s)  The World Health Organization (MORE ON PP THAT NEEDS TO BE READ THROUGH) - World Health Organization Focus o Health promotion and disease prevention through population-based interventions, including action to address social determinants and health inequity. - World Health Organization o Health Promotion & Disease Prevention: to establish policies and population-based interventions that address social determinants of health and health inequities o Tobacco, alcohol, physical activity and diet o Dietary and nutritional interventions to tackle malnutrition (condition arising from eating a diet in which certain nutrients are lacking, in excess, or in wrong proportions) Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 o Mental health o Substance abuse - World Health Organization - Health Promotion Goal: Devise strategies to address: o Sexual and reproductive health through health education and increased access to sexual and reproductive health & family planning services o Domestic violence to include public awareness campaigns, treatment & protection of victims, linkage with law enforcement and social services - Health Promotion Goals: Encourage - Self Assessments: o Testicular, breast, skin - Physical Assessments: o Dental, ophthalmic, hearing, cardiovascular, colorectal, reproductive - Recommended Screenings: o Vision, blood pressure, cholesterol, tuberculosis, colorectal, diabetes mellitus, depression, prostate - Healthy People 2020 o It recognizes the interrelationship between the physical, social, biological, psychological, environmental, and organizational factors that determine health and health behavior and calls for interventions that promote health and prevent disease in all these determinant realms. o Addresses the need to improve and integrate health information technology and communication processes. Healthy People 2020 urges everyone to establish and sustain constant preparedness for all disasters and emergencies (Healthy People 2020). o Healthy People 2030: Engage leadership, key constituents and public across all sectors to take action and become involved in policy. - Healthy People 2020 o 1. Policy Making:  Policies at local, state, and federal levels affect individual and population health  Some policies affect entire populations over extended periods of time (seat belt safety) o 2. Social Environment  Socioeconomic conditions (concentrated poverty)  Quality schools  Transportation options  Public Safety  Residential segregation  Resource availability to meet daily needs  Social norms  Attitudes (discrimination)  Exposure to crime, violence and social disorder, social support and interactions  Exposure to mass media and emerging technologies o 3. Health Services o 4. Individual Behavior:  Many public health and healthcare interventions focus on changing individual behaviors, such as:  Substance abuse  Diet  Physical activity  Hand washing o Positive changes reduce the risk of chronic disease o 5. Biology & Genetics:  Some biologic & genetic factors affect specific populations more than others  Older adults prone to poorer health than adolescents due to physical and cognitive effects of aging Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024  Age  Sex  HIV status  Inherited conditions such as sickle-cell anemia, hemophilia, cystic fibrosis  Carrying BRCA1 or BRCA2 gene, increasing risk for breast & ovarian cancers  Family history of heart disease - Healthy People 2030 o 1. Economic Stability o 2. Education Access and Quality o 3. Social and Community Context o 4. Health Care Access and Quality o 5. Neighborhood and Built Environment  Healthy people 2020 Determinants of health Barriers o Barriers:  Lack of availability  High cost  Lack of insurance coverage  Limited language access  Delays in receiving appropriate care  Inability to get preventive services  Preventable hospitalizations  5 Determinants of Health - Policy making  Policies at local, state, and federal levels affect individual and population health  Some policies affect entire populations over extended periods of time (seat belt safety) - Social Factors  Socioeconomic conditions (concentrated poverty)  Quality schools  Transportation options  Public Safety  Residential segregation  Resource availability to meet daily needs  Social norms  Attitudes (discrimination)  Exposure to crime, violence and social disorder, social support and interactions  Exposure to mass media and emerging technologies - Physical environment  this includes the natural environement  plants, weather, climate  the built environment (buildings, transportation)  work sites  schools  recreational centers  housing and neighborhoods  exposure to toxic substances and other physical hazards  physical barriers  aesthetics - Health services  Covers the lack of insurance  Limited language access  Delay in receiving appropriate care  Inability to receive preventative care and preventable hospitalizations - Individual behaviors Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024  Substance abuse  Diet  Physical activity  Hand washing  Positive change in these can reduce the risk of chronic disease - Biology and genetics  Age  Sex  HIV Status  Inherited conditions or genes  Family history  Vaccine-preventable diseases - Smallpox - Measles, Mumps, Rubella (MMR) - Diphtheria, Pertussis, Tetanus (DTaP) - Human Papilloma Virus (HPV) - Varicella/Shingles - Haemophilus Influenzae B - Hepatitis A, B and C - Rotavirus - Pneumonia  Social Security Act (1935) - Intended as economic relief following o World War I (1914-1918) o The Great Depression (1929) - Federal old-age pension benefits & and unemployment benefits - Provisions for older adults and disabled individuals - Maternal and child health - Public health - Medicare / Medicaid (1965) - Obama Health Care Reform (ACA) o (Patient Protection and Affordable Care Act 2010) improved access and availability but not affordable to all o >Partial repeal by Tax Reform Law of 2017  Governmental Influences - Shattuck Report (1850): Lemuel Shattuck, Architect of American Public Health o Local and state health departments o Vital statistics - Sheppard Towner Maternity and Infancy Protection Act o 1921 1st federally funded social welfare program (1 million dollars) - Combat high maternal and infant mortality rates - Childbirth the 2nd leading cause of death for women; 1 in 5 children died before age 1, and 1 in 3 children died before age 5 -  6 Dimensions of Health and Wellness - Occupational - Physical - Social - Intellectual - Spiritual - Emotional  Define illness, wellness, disease - Health: (World Health Organization, 1974): “a state of complete physical, mental and social well-being and not just the absence of disease” Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 - Wellness – State of mind with or without disease - Disease –Biomedical, recognizable health deviation - Illness – Imbalanced, unsustainable relationship with the environment  Treatment models and models of health (health care perspectives) - Treatment Models o Suchman’s Stages of Illness: symptoms, sick role, dependent role, recovery and rehabilitation - Models of Health (perspectives) o Smith: Clinical, Role Performance, Adaptive, Eudaimonistic o Travis: Illness Wellness Continuum o Dunn: Genetic & Environmental Impact on High-Level Wellness o Ardell: Self-responsibility, nutrition, physical fitness, environmental sensitivity, stress management o Greenburg’s Asymmetrical Dot Matrix o Hettler: The Six Dimensions of Wellness Model  Men in nursing - European Renaissance o Humanitarian aspect of caring for the poor o Female-dominated caregivers (religious orders, nuns) o Nursing care during war - Men in nursing roles o Ancient Greece Hippocratic period o India 3rd century B.C.E. o Ancient Rome: Military hospitals Nosocomi - Crusades o Knights Hospitallers of St. John Jerusalem o Knights of Saint Lazarus o Templar Knights o Teutonic Knights - Hospitals (1050-1080) o Monks (monasteries) o Nuns (convents) - Walt Whitman (U.S. Civil War) Chapter 2  Health Insurance and coverages (PPO, HMO) - Private Health Insurance o Premiums + co-pay + deductibles - HMO (Health Maintenance Organization) o Capitated prospective payment to providers (preset amount of $ paid up front to keep patient healthy) o The aim is to keep members healthy o Requires Primary Care physician & referrals to specialists o Coordinated care through primary care physician - PPO (Preferred Provider Organization) o Retrospective payment: Reimbursement for services based on pre-established fees for designated services (Diagnosis Related Groups-DRGs) set by insurance companies o Specialists accessed without a referral o Minimal coordination -  Healthcare costs, access, quality - Cost Containment Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 - Managed Care o (Insurance companies) - vs. - Care Management o (Coordination of health care, especially in transition through health care delivery system, includes patient advocacy) - Health Care Access o Time (hours of operation of clinics, scarcity of clinics) o Distance (rural areas) o Transportation (volunteer organizations, religious organizations) o Insurance (affordability, residency status) - Quality of Health Care Delivery - National Committee on Quality Assurance o Medicare & Medicaid fraud (CMMS) - The Joint Commission o CORE MEASURES: Standards of Safety o Standards to safeguard against infection o Electronic Health Records - Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) surveys - Magnet status of hospitals ANCC American Nurses Credentialing Center - Cost and efficiency vs. quality for-profit and not-for-profit hospitals -  Primary, Secondary, Tertiary Care Delivery - Primary Care (1st contact – entry) o Usually in a doctor’s office or clinic, school nurse, workplace clinic, ambulatory outpatient care - Secondary Care (Most expensive $$$$$$) o In-house patients with acute or chronic problems needing medicinal or surgical interventions HOSPITAL or home health care - Tertiary Care o Patients with non-acute conditions needing assistance with ADLs; includes skilled nursing facilities, rehabilitation services, hospice  Cost containment  Cost Containment  Managed Care o (Insurance companies) vs.  Care Management o (Coordination of health care, especially in transition through health care delivery system, includes patient advocacy)  Primary, Secondary, Tertiary Prevention - Targeted Recipients of Health Care - Primary Prevention: Healthy populations o Health education o Vaccines o mRNA vaccines o Healthy lifestyle behaviors - Secondary Prevention: At-risk populations due to age, genetics, exposure o Screenings (determine if an individual needs further evaluation)-screening IS NOT diagnostic - Tertiary Prevention: Populations of individuals already diagnosed with a disease o Chronic disease health education - Screening Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 Purpose  to assess need for further evaluation o Pre-screening Requirements/Protocols Reliability  Repeatability Validity Sensitivity Identifying true positives (those who truly need further evaluation) Specificity Identifying true negatives (excluding those who truly do not need further evaluation)  Medicare and Medicaid  Original Medicare (for those over the age of 65 IF they have worked in the U.S. and have contributed to the fund and those with end-stage renal disease, Amyotrophic lateral sclerosis (ALS), or disability)  Part A Hospital (no premium but requires deductible and co-pay on day 61 of inpatient stay) o Hospital care, skilled nursing facility, hospice, home health  Part B Medical (requires premium + deductible + co-pay-20%) o Physician office visits, diagnostic tests, outpatient care, home health, durable medical equipment (i.e. wheelchairs, walkers), screenings, shots, vaccines, annual wellness visits  Part D o Pharmaceuticals (from formulary) - Medicare Advantage (Part C) o Part C Monthly premiums vary based on which plan you join. The amount can change each year. o Pay one premium to one collector. o Some plans offer vision, hearing, and dental services, unlike traditional Medicare. o You must keep paying your Part B premium to stay in your plan. o Deductibles, coinsurance, and copayments vary based on which plan you join. o Plans also have a yearly limit on what you pay out-of-pocket. Once you pay the plan’s limit, the plan pays 100% for covered health services for the rest of the year. - Medicaid for those considered at or below the poverty level o Social Security Act 1965 o National program administered through states o No premium o Covers all medical expenses except vision, dental o Covers pharmaceuticals o Pregnant females and children under the age of 5 covered ABOVE poverty level o WIC o Health Steps - CHIP (Child Health Insurance Plan) o Available for children of families above poverty level but unable to afford private insurance o Low premium - Tri-Care o Military insurance for active duty servicemen and families - Veterans Affairs o For all those who have served in the U.S. military  Costs of care—DRG - Health Care Costs o Diagnostics (expertise, technology) o Pharmaceuticals o Specialists o Growing older adult population o Sicker patients, decreased length of stay Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 o Chronic conditions o Liability insurance, litigious society - DRGs-Insurance companies decide what they will pay  Patient Protection and Affordable Care Act - Improve Cost factors associated with health care o Federal funds offered to states to expand Medicaid programs o Federal funds offered to small business owners to help subsidize coverage for their employees o Federal funds offered to private individuals (those not qualifying for Medicaid but with low income) to help cover the cost of health insurance premiums repealed by Tax Reform Law (2017) - Increase Access to health care o More clinics available in rural areas o Improved hours of operation  Policy- Patient Self-Determination Act - Health Care Policies - Patient Self Determination Act: Right to advanced directives, informed consent, to refuse treatment o Advanced Directives o Informed Consent o HIPAA o American with Disabilities Act o Equal Educational Opportunities Act  Advanced Directives, Informed Consent - Advanced Directives o Living will (legal document for end of life, terminal illness): Dialysis, tube feedings, ventilator support o Durable Power of Attorney for Healthcare (medical power of attorney) o Physician Orders for Life-Sustaining Treatments (POLST), must be signed by HCP (physician) o Do Not Resuscitate Order (DNR) Only honored in the hospital (there are also Out-of-hospital DNRs) o Organ and tissue donation - Informed Consent: No procedures or treatments unless physician o Fully explains procedure, risks & benefits of treatment/non-treatment o Ensures patient has cognitive ability to understand, non-sedated, not in pain, not too tired o Ensures patient is free from coercion, voluntarily agrees to treatment or not -  HIPAA - Health Insurance Portability and Accountability Act - Safeguards patient health information and confidentiality - Illegal and unethical to discuss patient’s diagnosis or status with anyone who does not have the right or need to know - Americans with Disabilities Act: Equal access to opportunities as those who do not have disabilities, protects people with disabilities from discrimination - Equal Educational Opportunities Act: Provides services to those who, due to location or economic status, would not have access to certain opportunities available to others; all children enrolled in public schools are entitled to equal educational opportunity without regard to race, color, sex, or national origin Chapter 3  Characteristics of a profession - Nursing is an autonomous service profession that is based on scientific knowledge and consists of evidence based procedural and communication skills that are implemented in a caring, humanistic approach to Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 individuals and families across the life span, for the express purpose of promoting and/or restoring health, preventing disease, minimizing complications of disease and facilitating quality of life to its fullness. - Characteristics of a Profession Unique Body of Knowledge Autonomy Service oriented practice Research (evidence basis of practice) Organization Standards of Practice Code of Ethics - Characteristic (desirable) Traits of Nursing Caring Art Science Client centered Holistic Adaptive Helping Culturally sensitive  Nursing Body of Knowledge- components (GO BACK TO BOOK BECAUSE THIS MAY BE WORNG) - Theories guide understanding of patients and their needs & nurse thinking to improve outcomes - Metaparadigm (foundation to all nursing theories) - Person - Environment - Health - Nursing - Levels of Theory - Grand - Mid-range  Practice-level  Cultural sensitivity skills and definitions - Nursing is a Profession of Blended Skills - Interpersonal Skills o Therapeutic, purposeful, respectful, clarifying communication - Cultural Sensitivity o Awareness of uniqueness of self and each individual o Awareness of cultural variations o Avoiding stereotyping especially related to pain - Cultural Sensitivity Definitions o Ethnocentrism: excessive pride in ones culture, race or creed that it is usually perceptible by anyone outside this realm Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 o Stereotyping: making assumptions about an individuals associated with very little knowledge or experience with other individuals with similar characteristics o Bias: preference for a particular race or gender o Prejudice: habitual dislike or hatred for persons of certain color or creeds o Cultural Blindness: Is assuming that we are all alike, and that we all like the same things o Cultural Imposition: the tendency of a persons or group of people that impose their values and ways of behaving onto other people -  Nurse Practice Act- what is it? - Nurse Practice Act (guaranteeing safety of practitioners for consumers) - Standards of Practice o safe environment for patients o competency in assessment and procedural skills o timeliness in monitoring, intervening and reporting, and documentation - Standards of Care o expectations relating to ethical and legal behaviors. -  Accountability-what is it? - Accountability: Held accountable for their actions - Beneficence, -- always for the betterment of patient - Advocacy – speaking for patient - Safety - Confidentiality (HIPAA) - Patient Autonomy o Advanced Directives o Informed Consent - Veracity – truthfulness within scope of practice - Justice – fairness in treatment protocols -  Nursing Theorists (focus on the table on pg. 72). - Florence Nightingale –Environmental Theory-Assessment and alteration of environmental impact on healing: fresh air and cleanliness (fresh air and cleanliness) - Virginia Henderson – Nursing Need Theory-14 individualistic and holistic human needs - Martha Rogers – the Science of Unitary Human Beings-Dynamism: nursing and health as energy forces undergoing constant change (Dynamism of change) - Callista Roy – Adaptation Model of Nursing (adaption) - Dorothea Orem – Self-Care Deficit Nursing Theory (self-care) - Madeleine Leininger – the Transcultural Nursing Theory -Cultural Sensitivity - Jean Watson – Nursing Theory of Caring (caring)  Goals of nursing (health promotion, health maintenance, health restoration) - Goals of Nursing - Health Promotion o Teaching, encouraging, and motivating patients to engage in healthy lifestyle practices - Health Restoration o To nursing of individuals who have experienced an acute illness or injury that is amenable to medical or surgical treatment interventions - Health Maintenance o Minimizing negative potential consequences of disease o Preventing complications and/or anticipating adverse effects -  Components of nursing theories - Nursing Theories based on definitions of - PERSON (recognizing the value system of both the patient and the nurse) Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 - HEALTH STATUS (illness or wellness) - PHILOSOPHY (intrinsic belief of CARE) - PURPOSE (using nursing skills and judgment, e.g. the nursing process) -  Nursing skills required, like emotional intelligence, technical, interpersonal, etc. - Nursing is a Profession of Blended Skills - Physical Skills o Ability to stand, bend, flex, lift - Cognitive Skills (knowledge) o Anatomy and Physiology o Pharmacotherapeutics o Science o Nutrition o Growth and Development - Emotional Intelligence Skills - Technical Skills o vital signs o starting intravenous therapies o administering medications by various routes o catheterizations o suctioning o tube feedings o wound care o ambulation techniques - Interpersonal Skills o Therapeutic, purposeful, respectful, clarifying communication - Cultural Sensitivity o Awareness of uniqueness of self and each individual o Awareness of cultural variations o Avoiding stereotyping especially related to pain  Educational and practice levels of nurses (ADN, BSN, DNP, PhD, CNA, LVN/LPN) - The Nursing Profession Accountability standards - Nursing Comprehensive Licensure Exam (NCLEX) - Accreditation of Schools of Nursing o Association of Accredited Colleges of Nursing (AACN) o National League of Nursing (NLN) - Board of Nursing approvals o Board of Nursing continuation of licensure  Continuing Education credits  Background checks  Enforcement of Nurse Practice Act - Nursing Education o Certified Nursing Assistant (CNA) o Licensed Vocational Nurse (LVN) o Associate Degree in Nursing (ADN) o Bachelor of Science in Nursing (BSN) o Master of Science in Nursing (MSN) o Advanced Practice o Nurse Practitioner o DNP in Nursing o PhD in Nursing Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 Chapter 4  Nursing Process- what is it, components (ADPIE) - The Nursing Process is a fivefold strategy that is usually made into a Nursing Care Plan. The plan is an ongoing process of - Assessment Data - Nursing Diagnosis - Nursing Plan / Goals - Nursing Interventions - Evaluation / Reassessment - The Nursing Process is a Blueprint for Action - An evidence based guide for evidence based interventions for positive patient outcomes - Individualized to the uniqueness of each patient and their unique response to illness - Putting the pieces together  Categories of NANDA 1 Nursing Diagnoses (actual, risk, health promotion) - Organizing Data to formulate a Nursing Diagnosis (NANDA-I) stated as o Patient holistic response related to  Actual or Potential (risk for) problems  Wellness diagnosis: Patient desire to enhance aspect of their health o Identified Cause  Not the medical diagnosis  Pathophysiology o As evidenced by (AEB)  Symptoms -  Dependent vs. independent nursing interventions - The Nursing Process INTERVENTIONS o Within Scope of Practice  Independent  Based on nursing expected competencies and critical thinking  Monitoring (assessment)  Teaching  Positioning / Procedures o Dependent  Physician, PA, or Advanced Practice RNs/ agency protocol - Re-assessing patient status and progress - Re-establishing NEW patient need priorities - Re-formulating more realistic GOALS - Planning DIFFERENT or MORE EFFECTIVE nursing interventions - Goal is either met, partially met, or not met - If goal is not met, write about the MODIFICATION-the changes you will make to assist the patient in meeting their goal -  Assessment-data (objective vs. subjective) - ASSESSMENT (evaluate against NORMAL standards) - Subjective Data o Patient history (medications, allergies, surgeries, injuries, etc.) o Patient perspective of what is happening Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 - Objective Data o Criteria detected by  Observation  Palpation  Percussion  Auscultation o Chart review of reports (EHR) o Communication with other health professionals -  Maslow’s Hierarchy of Needs - Prioritization of patient needs o Maslow’s Hierarchy of needs - Establishing Goals o Observable and measurable o Set WITH the patient o Reverse of Nursing Diagnosis o Include short term and long term goals  Congruent with DRGs o That reflect behavioral change o A designated time frame  Assessment- observation, palpation, percussion, auscultation - ASSESSMENT (Objective data) - Observation o Symmetry o Color / ecchymosis o Posture o Facial expressions - Palpation o Pulse strength and rate o Skin texture / moisture o Muscle strength and/or resistance o Edema - Auscultation o Blood pressure o Heart sounds/rate/rhythm o Lung sounds/rate/depth o Bowel sounds o Circulatory bruits - Percussion o Assessment of organ size and/or inflammation -  How to write out 2-part and 3-part nursing diagnoses (AEB, Related to statements) - The Nursing Process Written Formats Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 - 3 Part Statements: Actual Nursing Dx o “Nursing dx (problem) R/T (related to) AEB (as evidenced by) a sign or symptom - 2 Part Statements o Risk: Risk for _______ R/T (situation that sets up the patient for a risk for a problem) o Wellness: Readiness for enhanced (aspect of health) AEB (usually the patient’s statement of wanting to improve an aspect of their health) - Goals are: o Specific o Measurable o Attainable o Realistic o Time framed  Difference between nursing and medical diagnoses Chapter 5  Ethical Perspectives (utilitarian, deontological, principle-based) - Utilitarian o Relating to usefulness / purpose o Relating to outcome (harm / no harm) o Greatest good for greatest number - Deontologic o Relating to right or wrong by God-like moralistic standards - Principle based (Nursing) o Relating to basic human rights  autonomy, confidentiality, privacy, self-respect, honesty, fairness and self-preservation -  Ethical traits (beneficence, non-maleficence, advocate, fidelity, justice, autonomy, HIPAA-confidentiality) - Beneficence / Non-maleficence - Justice (equality / fairness) - Respecting Patient Autonomy o Advanced Directives o Informed Consent  Full disclosure of information  Ability to fully understand  Free willingness to participate - Fidelity (Accountability) - Veracity (Truthfulness) o To patients and in acknowledging mistakes - Ethical Nurses o Knowledgeable o Competent o Accountable o Caring o Sensitive Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 o Conscientious o Trustworthy persons of integrity o Committed to safe, effective and efficient care -  Whistleblower Law, Safe Harbor Law - Ethical Dilemmas in Nursing o Lack of congruency between treatment options (decisions) and personal values o Observance of less-than-optimal care by co-workers or agency Whistleblower Laws: makes it illegal for employers, both in the private and public sectors, to harass or punish workers who report unlawful activity or other wrongdoing Safe Harbor Laws: A safe harbor is a legal provision in a statute or regulation that provides protection from a legal liability or other penalty when certain conditions are met.  Scope of practice: What does this mean?  Legal Implications- assault, battery, libel, slander, duty, breach of duty, negligence, malpractice, fraud - Usually based on Peer Review – what a nurse with similar education and experience would have done in a similar situation - Scope of practice and competence - Crime (wrongful act against person or property) -- requires remuneration o Misdemeanors (fines) o Felonies (time served) o Torts (civil violations) - Intentional Torts o Assault / Battery o Defamation of Character o Slander / Libel o Invasion of Privacy (HIPAA) o False Imprisonment (restraints) o Fraud - Unintentional Torts o Negligence o Malpractice -  Informatics and Documentation-what should be included in nursing documentation Medications: time, route, patient response Precautions or preventive measures (bed rails, bed alerts, turning and repositioning, heel protectors and assistance in frequency of toileting) Patient refusals of medication, treatment, procedures Procedures: date, time, what was done using what equipment, how patient tolerated procedure and overall patient response. - Key things that should NOT be done in professional documentation - Use of white out or erasure – simple line through error and identify self with initials. - Finger pointing at errors or omissions by fellow workers Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 - Omitting to state WHY medications were not given on time or as ordered - Leaving charting by exception boxes unchecked. N/A better than “not assessed” - Non-pertinent information - Use of non-approved medical abbreviations  ANA Provisions - Personal relationships - Nurse commitment to all patients - Nurse role in promotion and protection of health safety and the rights of the patient - Nurse accountability to nursing profession/appropriate delegation - Nurse ability to preserve integrity, competence and personal growth - Nurse obligation to establish, maintain and improve health care environments - Nurse role in promoting advancement of health - Nurse collaboration with other health care professionals - Nursing values and the integrity of the nursing profession - Updated changes related to - The right to conscientious objection to participate in procedures that are found to be against personal moral standards - Nurses obligation to respect the wishes of a dying patient even if not perceived by the nurse as the best option - Nurses may NOT participate in ending a person’s life - Chapter 6  What is evidence-based practice? What does it mean to be a change agent? - Haste makes waste - Haste makes errors o In medication administration o In negligence associated with infections o In negligence associated with falls o In failure to document accurately Nurses are called to be Change Agents: a person who helps an organization or community change by promoting, enabling, and supporting change initiatives - Nurses must stay current with o Research from reliable resources -  Elements of research (problem, hypothesis, review of literature, etc.) -Essential Elements in a Research Study Identify topic of interest Clear statement of the problem Statistics or scenarios that portray positive or negative outcomes in an existing situation Define research questions Target (defined) population Rationale for study or background Identify study variables (independent and dependent) Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 Hypothesis (projection) - Methods - Results and Analyses - Discussion - Strengths and Limitations of Study - Recommendations or Implications for Practice (nursing research-clinical practice or education) - Conclusion (summary) - Clear statement of purpose of the study - Review of the literature o Multiple studies with consistent outcomes - Conceptual Framework - Research Design (quantitative, qualitative, mixed methods) -  Variables (dependent/independent)  Dependent variable is sometimes called the “response,” the “symptoms”, or the “outcome”. The dependent variable is often the focus of the research study.  Independent variables: Independent variables aren't affected by any other variables that the study measures. -  Legal and Ethical rights of participants in research - Patient right to know o What research is about o Alternative outcomes - Patient right to awareness of random selection but not privy to which group assigned - Patient right o To voluntarily participate or not o To quit participation at any time - Patient right to be protected from harm - Patient right to confidentiality -  Belmont Report - Belmont Report: a document that outlines ethical principles and guidelines for research involving human subjects - Institutional Review Boards - History of unethical research on human subjects o Nazi experiments o Tuskegee Syphilis Study 1930s-1970s - Responsibility of Researchers to ensure ethical studies -  Qualitative vs. Quantitative definitions - Quantitative o Data gathered with testing instruments o Data is represented numerically for statistical analyses o Experimental, quasi-experimental, descriptive, correlational - Qualitative o Data gathered through observations and interviews o Finding meaning in behavior o Historical, phenomenology, ethnographic, case studies, grounded theory, action research Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 - Mixed-methods o Triangulation, embedded, explanatory, exploratory - Classifications of Research: - What question is the research trying to answer? - Descriptive o Describes populations - Exploratory o Examines relationships (how factors relate to each other) - Experimental o Cause-and-effect relationships -  Legitimate, reliable scientific research sources for academic journals (i.e. PubMed, CINAHL) - Responsible interpretation of Research o Pros and cons o Objective o Multiple studies (reliability) - Reliable web sites o AHRQ (http://www.ahrq.gov) o Cochrane Library - http://www.cochrane.org/resources/brochure.htm o CINAHL - Classifications of Research - Basic o Theoretical o Acquire knowledge for the sake of knowledge - Applied – practical in direct application o Includes studies that will directly affect clinical practice - Chapter 7 (MORE IN PP ON WHAT IS ON THE EXAM)  Therapeutic communication techniques and barriers (See textbook and therapeutic communication PDF) - THERAPUTIC COMMUNICATION: o FOCUS: Undivided attention to what is being communicated o CLARIFYING: Restate information if it is not understood o CONSTRUCTIVE CONFRONTATION: Not accusatory but a statement of the fact o REFLECTION: Mirrors what a nurse may think is a patient’s feelings behind what is being said o EMPATHY: Putting yourself in someone else’s shoes - BARRIERS TO THERAPUTIC COMMUNICATION: o ANXIETY: o NEGATIVE ATTITUDES: o GAPS OF AGE OR CULTURE: o RESISTANCE: blocking/ opposite of being open to what the patient is saying or doing o TRANSFERENCE: reaction to persons that remind us of someone we know o SYMPATHY: is more personal, painful sorrow  Domains of learning (cognitive, psychomotor, affective) (GO BACK INTO THE BOOK) - COGNITIVE o Knowledge/ information: Knowing target audience and cognitive abilities cognitive preferences - PSYCOMOTOR Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 o Motivational: Focus on what learner wants to learn, not on what you want to teach - AFFECTIVE o Emotional: Assessment of previous knowledge / health literacy (reinforcement/ clarification of information)  Principles of teaching and learning (GO BACK TO THE BOOK) - Assessment of previous knowledge / health literacy (reinforcement/ clarification of information) - Focus on what learner wants to learn, not on what you want to teach - Knowing target audience and cognitive abilities cognitive preferences  Stages of Grief, grief and loss (GO BACK TO THE BOOK) - Kubler- Ross stages of grief o Denial o Anger o Bargaining o Depression o Acceptance - Grief and Loss o Types of loss o Experience of grief o Death - Role of Nurse o Self awareness o Supporting patients and families o Being “Present” -  The Health Belief Model (GO BACK TO THE BOOK) - Attempts to explain an individual’s reluctance to participate in preventative health care - Expanded to apply to people’s responses to both existing health problems and therapeutic interventions - Ways of behaving are governed by beliefs and emotions - Changes over time is based on linear (step by step) decision making - INTERACTING BELIEFS INFLUENCING BEHAVIOR o Perceived Susceptibility: Perception of vulnerability o Perceived Severity: Seriousness, consequences o Perceived Barriers: Financial, inconvenience, pain o Perceived Benefits: Belief change will improve life o Cues to Action: External motivating factors o Self-Efficiency: Belief own efforts will work - CHANGE IS INITIATED BY o Motivation: of the individual which is based on the beliefs above o Environmental: factors and barriers  The Transtheoretical Model of Change (GO BACK TO THE BOOK) - SIX STAGES o PRE- CONTEMPLATION:  patient is not contemplating change  may be in denial regarding the need for change  believes consequences are not serious o CONTEMPLATION  Patient is ambivalent about change  The patient will assess their own personal barriers  They will weigh the loss versus gain (loss from cutting fats from diet) o PREPARATION  Patient preparing to make the change Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024  May experiment with small changes first (sampling low fat food) o ACTION  Patient is trying but is not yet committed to the change  It is important that they be praised at this stage, so they are motivated to sustain the change o MAINTENANCE  Will need to incorporate the changes over the long haul  May become discouraged especially if results are not apparent  Except Slip Ups  May recycle through the stages several time before the change ‘sticks’ o RELAPSE  Reversal Theory (GO BACK TO BOOK) - Belief that there are opposite or competing or competing emotional states that may require ‘reversal’ to make needed changes - There is not an inherit good or bad state – individuals just demonstrate dominance in one end or the other of the continuum - Telic- pursue subjective goals, cautions, future oriented - Paratelic- activity oriented, immediate enjoyment, spontaneous - Conformist- rule follower, dutiful, obedient - Negativistic- value freedom and independence, rules are restrictive - Autic- individualism important, value personal responsibility - Alloic- unselfish, value identifying and assimilating others - Mastery- transactions involve getting or giving - Sympathetic- transactions involve being liked or loved  Stress and Sleep - Physiology of Sleep o 2 Process Model of Sleep Regulation - Sleep – Wake balance o Determines the timing, duration and structure of sleep - Circadian Rhythm of sleep wake arousal o Internal 24-hour clock in the brain (hypothalamus) which controls the timing or rhythms of many behavioral, physiological, and metabolic functions, including sleep o Determines the timing, duration, and structure of sleep - Sleep Deprivation - Acute – 24 hours or more of no sleep - Chronic- the same effect on the body as acute o After 2 weeks with less than 6 hours per night, the person will have the same detrimental effect as acute sleep deprivation - Physical Consequences o Drowsiness, micro sleeps, unintended sleep o Changes in mood (anxiety and depression) o Decreased motor and cognitive performance o Impairment of memory and concentration o Poor communication and decision making o Increased risk-taking o Weight gain o Increased risk of metabolic disorders and diabetes o Increased risk of hypertension, stroke, and heart attack o Increased risk of some cancers o Impaired immune response - Sleep-related breathing disorders Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 o Most common is obstructive sleep apnea defined as obstruction of air flow by at least 90% for 10 seconds (snoring, apneic periods, followed by gasps) o Prevalent in o Middle age o Overweight (BMI 30 or more) o More common in men and post menopausal women - Hypersomnia (excessive daytime sleepiness) o Due to an intrinsic disorder in the brain - 3 types o Narcolepsy- or “sleep attacks” o Cataplexy- sudden loss of muscle tone that causes patient to crumple in a heap o Idiopathic hypersomnia-day time sleep with no known cause -  Realms of Nursing Practice - Health Promotion o Helping others to stay healthy and keep from getting sick  Therapeutic Communication  Establishing rapport / comfort / trust  Feedback  Body Language congruency with words  Appropriate use of space  Active listening  Use of humor  Use of silence  Flexibility - Health Restoration o Helping the sick get well (restore health) - Health Maintenance o Helping those with chronic conditions to live with their condition or o Helping recovery efforts with adaptation techniques (rehabilitation) - Nursing in Crisis o Nursing wellness and self-care o Disaster Response o Trauma-Informed Care  Self-Care Power Point (performance enhancers, importance of self-care and self-inventory), Wellness & Self- care, burnout (textbook)  Self-Care: Prioritize exercise, sleep, and nutrition  Self- inventory: Explore Beliefs: Reflect on your values and purpose - Job-Related Causes: Long hours, physical demands, & emotional labor - Systemic Challenges: Factors like nursing shortage & increased demand due to aging populations & pandemic exacerbate stress - Moral Injury: feel must act against moral beliefs, especially during challenging situations - Early Warning Signs: - Feeling constantly overworked - Regularly feeling too tired to go to work - Lack of enthusiasm for job - Feelings of unappreciation or ineffectiveness - Other Symptoms: Trouble sleeping, body tension, or feelings of depression - Impact - Decreased empathy - Errors - Poor communication Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 - Quality of patient care - (PERFORMANCE ENHANCERS) - Ergogenic Aids: Substances that enhance physical/mental performance, ranging from caffeine to illegal drugs - Safe Ergogenic Supplements - Examples: - HMB (amino acid), CLA (reduces muscle damage) - Carnitine (fat transport), Chromium (muscle mass), Creatine (builds muscle) - Note: May have side effects (e.g., cardiovascular, liver, kidney) - Harmful/Illegal Ergogenic Aids - Steroids, DHEA, Diuretics, Blood doping - Ephedrine, HGH, Narcotics, Cannabinoids - Beta-2 agonists/blockers - (RISKS) - Anabolic Steroids: - Boost strength, muscle mass, and recovery - Risks: Shrinking testicles, breast growth (men), deep voice, hair loss (women), severe acne, liver damage, high cholesterol, heart problems, aggression, and mental health issues - Banned in sports and illegal for doping - Androstenedione (Andro): - A hormone turned into testosterone and estrogen - Risks: Heart attack, stroke, shrinking testicles, deeper voice, hair loss, and acne - Legal only with prescription - Human Growth Hormone (HGH): - Aids in muscle growth, limited evidence of performance boost - Risks: Joint pain, carpal tunnel, high blood pressure, and heart problems - Erythropoietin (EPO): - Boosts red blood cells and oxygen levels - Risks: Stroke, heart attack, and death - Diuretics: - Used for rapid weight loss and masking other drugs - Risks: Dehydration, cramps, low potassium, and fainting - Nursing Wellness and Self-care  Healthy lifestyle choices  Mindfulness  Social connectedness -  The nursing process - Assessing the patient (motivational state & perceived need) - Diagnosing or determining where the patient falls in terms of readiness - Planning for the change with the patient and/or family - Directing interventions based on where the patient is in terms of stage of change (Trans Theoretical) or motivational state (Behavioral Belief or Reversal Theory) - Evaluating success of short term and long term goals, modifying interventions to ensure long term sustainability of change  3 Behavioral change Models - Health Belief Model o Attempts to explain an individual’s reluctance to participate in preventive health care o Expanded to apply to people’s responses to both existing health problems and therapeutic interventions Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 o Ways of behaving are governed by beliefs and emotions o Change over time is based on linear (step by step) decision making - Trans Theoretical Change Model o Pre-contemplation o Contemplation o Preparation o Action o Maintenance o Relapse - Reversal Theory o Belief that there are opposite or competing emotional states that may require ‘reversal’ to make needed changes o There is not an inherent good or bad state – individuals just demonstrate dominance in one end or the other of the continuum o Motivational States o Telic -----Paratelic o Conformist-----Negativistic o Mastery-----Sympathy o Autic------Alloic  Reversal Theory Definitions  Telic- pursue subjective goals, cautions, future oriented  Paratelic- activity oriented, immediate enjoyment, spontaneous  Conformist- rule follower, dutiful, obedient  Negativistic- value freedom and independence, rules are restrictive  Autic- individualism important, value personal responsibility  Alloic- unselfish, value identifying and assimilating others  Mastery- transactions involve getting or giving  Sympathetic- transactions involve being liked or loved  Stress management - Avoiding unhealthy behaviors Eating/drinking to excess Recognizing what has worked in the past Relaxation techniques Recognizing and availing of resources Support system - We cannot totally avoid stressors, but we can control our reaction to them. - Common Stressors - Birth / Death - Marriage / Divorce - Buying a house - Starting a career / losing a job - Illness - Management o Biofeedback o Yoga o Diaphragmatic Breathing o Hypnosis o Meditation o Massage o Image Visualization o Guided Imagery o Music Therapy Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024 o Autogenic training o Entrainment -  Basic nutrition principles (healthy diet) - Nutrients o Servings in food groups not equal o Complex carbohydrates vs. simple carbohydrates - Limited fats - Healthy Fruits and Vegetables - Vitamins o Vitamin A, B, C, D, E, K - Portions - Time of day for meals - Buying wisely o Reading labels - Storing properly o Temperature control o Keep it hot or keep it cold or don’t keep it! - Preparing correctly / optimally o Baking vs. Frying o Steaming vs. boiling  Optimal exercise guidelines - Habitual - 150 minutes of moderate - intensity or 75 minutes vigorous intensity per week - Moderate intensity - Sufficient to stimulate heart and lungs without fatiguing muscles and/or causing pain - Target heart rates - With adequate hydration (WATER IS BEST) - To minimize muscles cramping and pain from fluid loss - Importance of Regular Exercise: Physical activity helps maintain a healthy weight, improves mood, reduces stress - Recommendations for Adults: o At least 150 minutes a week of moderate-intensity activity such as brisk walking o At least 2 days a week of activities that strengthen muscles - Children and adolescents (6 to 17) need to be active for at least 60 minutes every day - Incorporating Movement into Daily Routine: Utilize short breaks for quick exercises, take the stairs  General Adaptation Syndrome (GAS) (Hans Selye) (MORE IN THE PP) - ALARM/FIGHT OR FLIGHT: Increasing HR, R, and BP (adrenaline rush) with stimulation of the sympathetic nervous system - ADAPTATION OR RESISTANCE: The pituitary stops secretion of hormones, adaptation occurs and is based on the individual - EXHAUSTION: All efforts to cope from the stressors has been used and have been ineffective - General S/S of stress response o Anxiety, headache, fatigue, difficulty concentrating, insomnia, hair loss, bowel reactions, VS changes - General response o React o Defend o Exhaust - Downloaded by Angel D Escobedo ([email protected])  lOMoARcPSD|4446559 Revised Fall 2024  Nursing in Crisis: Disaster Response stages 1. MITIGATION: Preventing or limiting the catastrophe’s cause, effect and consequences 2. PREPARDNESS: Planning, Training, and education for unanticipated circumstances 3. RESPONSE: Triage (priority screening), anticipated patient rush at hospital, community members seeking guidance for motor vehicle crashes, medical emergencies, ect. 4. RECOVERY: Debriefing, family reunification, Restoration of regular services and supply replenishment  Trauma Informed Care 6 Principles 1. Safety: Respectful and discreet interactions; patients can find way around environment 2. Transparency and Trustworthiness: Inform patients of procedures, step by step, printed information 3. Collaboration and Mutuality: Non-judgmental discussion on health behavior change 4. Empowerment, Voice, and Choice: Safe place to voice worries and wants, offered choices 5. Peer Support: “Trauma Survivors” to establish optimism (support groups) 6. Cultural, Historical and Gender Issues: Practices eliminate biases and prejudices, provide gender- sensitive services (identify outside of the binary sale)  Stages of Disaster - Mitigation o Preventing or limiting the catastrophe’s cause, effect, and consequences - Preparedness o Planning, training, and education for unanticipated circumstances - Response o Triage (priority screening), anticipated patient rush at hospital, community members seeking information about injured and/or seeking guidance for motor vehicle crashes, medical emergencies, etc. - Recovery o Debriefing o Family reunification o Restoration of regular services and supply replenishment Downloaded by Angel D Escobedo ([email protected])