Nursing Foundations Exam 1 PDF

Nursing Foundations: 6 questions Florence nightingale- first correlation bw infection and unclean conditions, careful data collection (notes and graphs), first training school, wash hands and sterilize equipment, ○ Clara barton- american red cross, formalized nursing school, serv...

Nursing Foundations: 6 questions Florence nightingale- first correlation bw infection and unclean conditions, careful data collection (notes and graphs), first training school, wash hands and sterilize equipment, ○ Clara barton- american red cross, formalized nursing school, served on battlefields ○ Dorthea dix- teacher, volunteer -> superintendent of army nurses, mental health and indigenous right advocate ○ Ildaura Murillo-Rhode- founded national association of hispanic nurses (NAHN) ○ Edie bernice johnson- faced segregation, first nurse in congress, introduced STEM, provided grants for minorities pathways/ education ○ 2 year associate ○ 3 year diploma program ○ 4 year bachelor of science BSN can continue to get masters while others cannot ○ Licenced practical nurse (LPN)/licensed vocational nurse (LVN)- degree obtained in 1 year ○ Registered nurse (RN)- 2-4 years Diploma nurse- non degree Associate degree in nursing (ADN) Bachelors in science (BSN) ○ Graduate programs- Masters or doctorate, certifications (like APRN) ○ LPN/LVN practice under RN ○ All nursing student take NCLEX Health literacy- clients knowledge and understanding of conditions ○ Client researches Novice to expert nurse- introduced by Dr. Patricia Brenner in 1982 ○ Stage 1- novice, initial stage, nursing students and new nurses, cannot draw on own judgment, struggle to decide priority of tasks ○ Stage 2- advanced beginner, involved in enough real life situations to recognize patterns, focus too much on memorization of rules and regulations, needs clinical support to set priorities ○ Stage 3- competent, can prioritize tasks based on experience, not as quick as stage 4 nurses, mastery in multiple areas, recognize patterns faster than stage 2 nurses ○ Stage 4- proficient, understands bigger picture-> improved decision making, responds to changing situations and can modify plans to face different events ○ Stage 5- expert, extensive knowledge and experience, self confident and can trust intuitive sense, knows what needs to be done and performs it well Holistic care- take care of the person as a whole ○ Situation ○ Background ○ Assessment ○ Recommendations  Nursing roles ○ Care provider- nurse, holistic, advocate for client, empathy, good communication to all involved, culturally competent, patient centered care ○ Case manager- conduit bw client and health care system, afford client highest level of care through an interdisciplinary care plan, takes care of insurance, create a plan of care, coordinate clients educational needs, communicates and coordinates client care with all team members ○ Researcher- evidence based practice, be up to date on current meds, procedures, and tech ○ Educator- promote better health and self care management, teach student/new nurses ○ Leader- influences a group to achieve a common goal, effective communication, assigned and emergent leadership ○ Manager- assigned leadership, responsible for team of nurses, hiring, orientation,evaluate nurses, problem solve, manage supply and equipment, client safety ○ Change agent- make changes through research Nursing competencies- knowledge, attitude, value, skills expected of nurse ○ Advocacy ○ Change management- bring about change with a goal ○ Communication ○ Collaboration Nursing organizations ○ National academy of medicine- scientific evidence based approach to solve issues ○ National student nurses association (NSNA) - for student nurses, 6 core values Advocacy Leadership Professionalism Care Diversity Quality education ○ American Nurses Association (ANA)- supports nurses, code of ethics, scope and standards of practice, principles of nursing practice (info regarding social media, staffing, and pay) ○ National league for nursing- excellence in nursing education, diverse workforce, 4 core values Caring Integrity diversity/inclusion Excellence Infection control and isolation: 6 questions Chain of infection- sequence necessary for infection to occur ○ Infectious agent  ○ Reservoir- infectious agent lives and grows/reproduces ○ Portal of exit- infectious agent leaves reservoir ○ Mode of transmission- get from place to place ○ Portal of entry- provides place for agent to replicate or toxins to act ○ Susceptible host- infectious agent takes hold, not everyone has symptoms Contact- move from infected person to another person, PPE should be donned before interaction with client ( masks, eye protection, gown, gloves,haircaps, face protection, shoe covers), disinfect/sterilize equipment ○ direct - from person to person without a person or object in between ○ indirect - from person to person with an object or person in between Droplet- airborne droplets from respiratory tract travel through the air and into mucosa of another, can be affected by humidity and air temp Airborne- small particles move into the airspace of another person, patients should be placed in negative pressure room, can travel long distance Can also transfer through vectors and vehicles (insects, contaminated water) ○ Vehicle- contaminated items to multiple persons ○ Vector borne- they are not infected but carry microorganisms Route depends on agent Break in any links can prevent development of infection Level of immunity can determine how host reacts If agent is efficient at making people ill its more potent/virulent than other agents ○ Virulent- how efficient an infectious agent is making people ill Factors that increase host susceptibility ○ Age ○ Underlying disease (HIV/AIDS) ○ Malignant ○ Transplants ○ Meds- immunosuppressants, anti rejection,antineoplastics, antimicrobials, corticosteroids, gastric suppressants ○ Surgical procedures ○ Radiation therapy ○ Indwelling devices- catheters, tubes, implants Physical and chemical barriers ○ Skin- largest organ, reduce loss of water, protect against abrasion and microorganisms, provide permeable barrier against the environment Lipid layer (stratum corneum)- reduce water loss, help fight infection, regenerates quickly (half layer restored in 6 hours, full restoration 5-6 days) ○ Mucous membranes- secrete mucus to protect from invaders ○ Tears, sweat, WBC- remove waste from body ○ Cilia- prevent particles from entering body ○ Cough- removes materials ○ Gi tract- secretes acids, natural flora ○ Genitourinary tract- urethra is longer in males  ○ Vagina- natural pH Nonspecific immunity- phagocytes eat and destroy microorganisms, neutrophils and macrophages are released during inflammatory response Specific immunity- antibodies (immunoglobulins) and lymphocytes, antibodies bind to agent and call to WBC to complement and destroy them Inflammatory response- inflammatory pathways are activated, markers are released, cells are received Meds can block chems released by mast cells like antihistamines ○ Can be solitary- occurs for a short period of time like getting hit with a ball ○ Can repeat itself like asthma Manifestations can present: heat, redness, swelling, pain, loss of function in area Stages of infection ○ Incubation- infection enters host and begins to multiply ○ Prodromal- client has symptoms ○ Acute illness- manifestations of specific infectious diseases ○ Decline- manifestations begin to wane as degree of infectious disease decreases ○ convalescence - client returns to normal state Local infections- confined to one area Systemic infections- start local and spread to the bloodstream Diagnostics test- on prescribed when needed Increased presence of white blood cells= inflammation or infection Hand hygiene- if visibly soiled use soap and water, alcohol rubs, antiseptic agents- alcohols, chlorhexidine, chlorine, chloroxylenol No artificial, gel, long nails, no rings Medical asepsis- clean technique Surgical asepsis- ensures sterility Sterilization- cleaning of all microorganisms even spores Disinfection- almost all microorganisms are eradicated but not all Healthcare associated infections (HAI)- acquired in the healthcare facility Communication: 12 questions Communication: Info transferred from one person to another, shared between sender and receiver, received through verbal, body language, emotions elaboration , cognition, hearing, speech, motor coordination Shannon- weaver communication model- one of the first communication module, 6 concepts ○ Sender ○ Encoder ○ Channel ○ Decoder ○ Receiver ○ Noise Schramm’s model of communication- sender and receiver send messages back and forth and receive feedback Berlo’s model of communication- one way process, no feedback, SMCR 4 components  ○ Sender ○ Message ○ Channel ○ Receiver No feedback- incomplete communication Theodore newcomb’s model of communication (ABX model)- sender, receiver, message/topic Verbal vs nonverbal- nonverbal tends to outweigh what is said ○ Understanding non-verbal- take into consideration culture, age, language,physical deficits, development levels ○ Therapeutic communication- improve communication like active listening, empathetic tone that reduces stress and encourages honesty ○ Auditory communication- what message the receiver hears, speed/tone of voice ○ Emotional communication- express feelings and emotions ○ Energetic communication- bioelectric energy- emotions affect electrical impulses verbal - spoken communication, in person or over the phone, speak clearly with volume and pitch that the receiver can understand, ensure the receiver understands what is said, decrease distractions, face the receiver while speaking Nonverbal- body language, be aware of facial positions, open posture, touch may be acceptable and therapeutic Electronic- use of technology, encrypt health data to protect private info, use personalized login, ensure computer is logged off ○ Health insurance portability and accountability act (HIPAA)- privacy act, protect insurance coverage and private info of clients, protect privacy and health info from security breaches, particularly electronic data, reduce fraud and deter inappropriate use of client health info Written- handwritten/ non typed and also electronic/typed, wording is clear and concise, may be viewed as detached Passive- want to avoid conflict so individual says nothing or simply agrees Assertive- honest and clear comm. That does not violate the rights of others, “I” statements, displays confidence, fair and receptive aggressive - verbally,sometimes physically abusive, “you” statements, hostile and forceful Passive aggressive- appears passive on surface, but is demonstrating anger in subtle, indirect, or secretive way Most effective is assertive bc cooperative straightforward Effectiveness: psychosocial and physiological factors can influence communication effectiveness (dementia, down syndrome, autism spectrum disorder) (hearing loss, cultural diff, language barriers, environmental factors) If nurse does not communicate concerns w/ client, client may interrupt it negatively and not receive emotional support Developmental and cognitive factors- give short, directive instructions that are clear/ free from slang, med terms, or abstract imagery  Situational and environmental factors- excessive noise, extreme temps, poor/bright light, use of social media/texting, situational issues that cause strong emotions can hinder effective exchange like fatigue, anxiety, fear Cultural and demographic factors- language, religion, sexual orientation, age, gender, healthcare itself is affected by institutional racism-> inequitable access to care and minorities being underrated, some clients fear disclosing sexual orientation Therapeutic communication- listening skills, empathy, desire to build professional relationships Non therapeutic- hinders communication such as stating the person is wrong Therapeutic relationships- compassionate, caring, empathetic Jean watson’s theory of human caring- be authentic, protect human dignity, practice loving-kindness Caritas processes (caring practices) ○ Strengthen your spiritual beliefs ○ Maintain meaningful relationships ○ Be a good listener ○ Approach All problems w caring attitude and healing environment ○ Be open minded and respect the needs of others in order to maintain human dignity ○ Treating oneself and others with compassion and kindness ○ Be in the moment and respect the world and those around you Hildegard Peplaw’s “theory of interpersonal relationships”- nurse is guide throughout process, 4 phases ○ Orientation- initial phase, client reaches out to the nurse ○ Identification- establish mutually respectful relationship ○ Exploitation- active phase, nurse educates client to change situation or behavior ○ resolution/termination- final phase, issue resolved, relationship is terminated Therapeutic communication techniques- techniques to improve nurse-client communication ○ Silence ○ Active listening ○ Ask open ended questions ○ Accepting- acknowledge that the nurse heard or client understood ○ Give recognition of changes w/out complaints ○ Restating ○ Summarizing ○ Reflecting ○ Offering to spend time or sit with the client ○ Focus Effective interprofessional communication ○ Interprofessional education collaboration (IPEC) competencies Have mutual respect Understand one's own role and that of their colleagues Communicate in a timely manner and focused on prevention  Support positive team work ○ 4 core competencies for interprofessional collaborative practice Work together utilizing each others knowledge to promote health and take care of clients Communicate effectively to promote clients health Work w each other respectfully Use effective dynamics and values w/in the team to develop and use client-centered care and health promotion Motivational interviewing- therapeutic communication that allows the nurse to develop plans to promote client care, empowers receiver to make positive changes, main obstacle is lack of time to build trust, motivational interviewing is a better use of time, OARS ○ Open ended questions ○ Affirmations ○ Reflective listening ○ Summarizing Group vs individual communication- recent diagnosis would be individual, client continuing education could be group communication like a support group or community classes Non therapeutic techniques- opposite of therapeutic, increase stress,poor relationships, poor overall outcome ○ If client asks for advice use reflection so that they can discover the answer themselves ○ Telling client what to do is seen as belittling or disrespectful ○ Rejecting or disagreeing will lead to defensiveness or stop the communication ○ Probing (asking too many questions) may cause client to stop talking ○ Subject change can hinder communication- seems one sided ○ Do not give false assurance Communication barriers ○ Language diffs- use medical interpreter ○ Cultural diversities- learn acceptable and unacceptable behaviors, show respect and compassion ○ speech/hearing impairments- ensure assistive devices are present and in use ○ developmental/cognitive disorders- be aware of body language ○ Medication/recreational drug effects- wait for effects to fade ○ Distress ○ Environmental factors- like tv volume Clinical Judgment process: 6 questions Scope and Standards of practice: 6 questions State nursing practice acts (NPA)- state law of functions and responsibilities, general guidelines, each state makes rules and regulations to further explain NPA, NPA establishes nursing titles, BON approved nursing curriculums, executed by BON  ○ 2 step process- State legislature passes NPA to regulate nursing practice w/in the state-> state identifies regulatory body to enforce regulations set by NPA Scope and standards- established via state law Scope of nursing practice- services/activities licensed professionals are permitted to perform Standards of practice- professional behavior, hold nurses accountable following a code of conduct, uphold ethical values, nurses evaluate their own practice, nurses should seek out info and guidance to ensure competent care is provided, nurses are responsible for their actions, nursing process ○ Assessment ○ Analysis ○ Planning ○ Implementation ○ Evaluation American Nurses Association (ANA)- standards of practice and standards of professional practice Regulation of nursing education- must be approved by BON, accreditation for education in nursing (ACEN), Commission on collegiate nursing education (CCNE) Quality and safety education for nurses (QSEN) institute- set nursing competencies and proposed targets for knowledge, skills, and attitudes ○ Safety- minimize risk of injury ○ Evidence based practice ○ Patient centered care- ensure patient is involved in care ○ Informatics- use info tech to communicate and gather data ○ Teamwork and collaboration ○ Quality improvement- plans to improve client care National league for nursing (NLN) integrating competencies- to build strong and diverse workforce, ensure all students are educated at the same fundamental level, 4 competencies that new grads should demonstrate and 4 integrating competencies: ○ Human flourishing ○ Nurse judgment ○ Professional identity ○ Spirit of inquiry ○ ○ Caring ○ Integrity ○ Diversity ○ Excellence American Association of college of nursing (AACN) BSN essentials- represents nursing schools throughout the US, expected curriculum content and required competencies  Bsn Essentials- skills knowledge and attitude that should be displayed after graduation ○ Knowledge for nursing practice- creates foundation for clinical judgment and innovation into nursing practice ○ Person centered care- focused on the individual client in multiple complicated contexts ○ Population health- prevention and disease management strategies ○ Scholarship for nursing discipline- nursing knowledge to transform and improve health ○ Quality and safety- minimize harm ○ Interprofessional partnerships- collab with others to improve health ○ System based practice- responding and leading within complex health care systems ○ Informatics and health care technologies- use tech and informatics to collect data ○ Professionalism- accountability, personal characteristics, values ○ Personal, professional, leadership development- self reflection, resiliency, personal well being, lifelong learning National council of state boards of nursing (NCSBN)- regulatory bodies who protect the public by recommending nursing practice regulations and competency assessments ○ NCSBN transition to practice (TTP) model- assist from education to practice LPN/LVN- national association for practical nurse education and service (NAPNES) responsible for setting education standards ○ Communicating using interpersonal and therapeutic communication skills ○ Competence collecting data, report data, evaluate clients response ○ Use collected data to collab with rn to plan/revise client care ○ Caring demeanor ○ Care for client as intended by healthcare provider ○ observe , check monitor, collect client data and report to RN ○ Determine pain level, assist triage, report changes to RN ○ Can delegate tasks to another LPN or unlicensed assistive personnel (AP) ○ Not permitted to diagnose or treat clients ○ Nursing process- planning, implementing, evaluating Scope of employment- job description signed during hiring process Place of work can limit role but can never broaden it past NPA regulations RN ○ Independently perform client assessment ○ Determine priorities ○ Develop client plan ○ Delegate tasks ○ Can provide teaching  ○ Can provide IV therapy, administer blood products, administer meds, IV fluid ○ Evaluate client response Advanced practice registered nurse (APRN) ○ Certified nurse anesthetist (CRNA) ○ Certified nurse midwife (CNM) ○ Clinical nurse specialist (CNS) ○ Certified nurse practitioner (NP) Periodic license renewal is required to maintain the right to practice nursing Nurse licensure compact (NLC) permits nurses to practice in their home state and other compact states under 1 license, must have a primary state license to get a multi state license National council licensure examination (NCLEX)- nationwide standardized test Authorization to test (ATT) is valid for 90 days credentialing - verification and recognition of an individual's qualifications and competencies Evidence based Practice: 6 questions Vital signs: 6 questions Managing Client Care: 6 questions Time management ○ Time management matrix Important Not important Urgent Not urgent Organizational skills ○ Skills that allow nurses to be efficient and accurate in delivering client care SMART GOALS ○ Specific ○ Measureable ○ Attainable ○ Realistic ○ Timely SBAR ○ Situational ○ Background ○ Assessment ○ Recommendation SOAP ○ Subjective - chief complaint ○ Objective - physical assessment ○ Assessment - problem  ○ Plan - consultation Client assignments ○ Process of dividing responsibility for care of multiple clients among the nursing staff Acuity level ○ Complexity of a clients condition Documentation: 6 questions Health record is an individualized collection of health information & data about a clients health. Provides health services that have been provided to the client. EHR - Electronic health records ○ First emerged in the 1960s. Only 75& of hospitals use EHR Source - oriented medical records ○ Traditional form of documentation, divided into specific sections with the medical records (history, physical exam, progress notes, etc) Problem oriented ○ More comprehensive & organized approach to recording and reading client data A database in which assessment data are documented A problem list that lists the clients problems chronologically An initial plan that outlines goals, expected outcomes, and further data if necessary Progress notes using SOAP Subjective Objective Assessment Plan PIE Model ○ Problems ○ Interventions ○ Evaluations Focus charting ○ Documents clients specific health care problem by focusing on the nursing diagnosis as well as changes in the clients conditions, events, & concerns DAR - Data, Action, Response Charting by exception ○ Focuses on documenting only unexpected or unusual findings based on standardized protocols Electronic documentation ○ Real time access to client records by all members of health care team ○ Built in clinical alerts that contribute to the reduction and prevention of medical errors and duplicate test  ○ Increased coordination of care ○ Elimination of illegible records ○ Client portal that allows the client to interact with providers FACT Acronym ○ Factual - should contain concrete, objective and descriptive information; for direct observation and measurement ○ Accurate - should establish accuracy by including exact descriptions and measurements ○ Complete - must contain what, when, where, why, and how & must be unbiased ○ Timely - all documentation should be put in chronological order Verbal prescriptions ○ Provided by health care providers who have the authority to prescribe treatments and medications ○ Can be received in person or via telephone ○ Should only be used in emergency situations ○ Make sure to read it back & only time it should not be written down is in an emergent situation or a sterile environment ○ Once a verbal prescription is documented it should be signed immediately by the individual receiving the prescription HIPPA ○ Health Insurance Portability & Accountability Act (1966) Meant to ensure that clients confidentiality is maintained when information is communicated with other members of the health care team or transmitted electronically Computerized provider order entry (CPOE) ○ Allows providers to write & transmit prescriptions electronically