Evening Unit (Wednesday Group).pdf

Evening Study Group (Wednesday Group) Nursing 101 September 18, 2024 Unit 1 Study Guide Medical Asepsis ○ Handwashing: Steps: Gather Supplies Remove jewelry...

Evening Study Group (Wednesday Group) Nursing 101 September 18, 2024 Unit 1 Study Guide Medical Asepsis ○ Handwashing: Steps: Gather Supplies Remove jewelry Turn on Water Rinse Hands ○ Downward ○ 1-inch above wrist Add Appropriate amount of soap Lather hands for 15-20 seconds ○ Between the fingers ○ Under the nails ○ Creating friction ○ Above the wrist Rinsing the hands ○ Let the water flow downwards starting from the wrist Pat Dry ○ Fingertips up  Turn Off Water Reason: To disinfect the hands from any microorganism In case you come in contact with any bodily fluid ○ PPE Donning: Glown (Precautions: Standard, Droplet, Content Mask (Precautions: Standard Airborne, Droplet Goggles/Face Shield (Precautions: Standard, Airborne, Droplet Gloves (Precautions: Standard, Airborne, Droplet, Contact Doffing: Gloves Gown Goggles/Face Shield Mask ○ Handsantizing Check the direction of the product Add the correct amount on palm of your hand Distribute through the hand Between the fingers Under the nails With friction Let it dry while distributing  ○ Bed Bath Nursing & Nursing Practice ○ Nursing Definition care of others, which may involve all types of activities and blended skills Nursing = blend of Art (application of knowledge) + Science (Knowledge) Primary duty is to the patient: ○ Social ○ Spiritual ○ Emotional ○ Physical ○ Roles of Nursing Caregiver - (primary role) the nurse being compassionate and open minded, self reflecting (art of nursing), education prep, research, evidence-base (science of nursing) Communicator - interpersonal and therapeutic communication skills to establish and maintain helping relationships with patients Teacher/Educator - the use of communication skills to assess, implement, and evaluate individualized teaching plans to meet learning needs of patients Counselor - the use of therapeutic interpersonal skills to provide information, make appropriate referrals, and facilitate the patient’s problem-solving and decision-making skills  Leader - the assertive, self-confident practice of nursing when providing care, effecting change, and functioning with groups Researcher - the participation in or conduct of research to increase knowledge in nursing and improve patient care Advocate - the protection of human or legal rights and the securing of care for all patients based on the belief the patients have the right to make informed decision Collaborator - the effective use of skills in organization, communication, and advocacy to facilitate the functions of all members of the health care team as they provide patient care All are interrelated ○ Nursing Aims Promote health Motivated by the desire to increase a person’s well-being and health potential Prevent illness Primarily by teaching and by personal habits ○ I.e hand washing, education programs in different types or care, health assessments on physicals Restore health Focus on the person with illness and range from early detection of a disease to rehabilitation Facilitate coping with disability or death  Four Blended Competencies: ○ Cognitive - knowledge ○ Technical - skills ○ Interpersonal - communication ○ Ethical/Legal - legality ○ Nursing as a Profession: Nurse Practice Act: Laws established in each state in the United States to regulate the practice of nursing Protects nurses and public against people not adequately prepared to become a nurse ANA: Defines what IS IN YOUR SCOPE OF PRACTICE Nursing Criteria (next slide) Well-defined body of specific and unique Knowledge Strong service orientation Recognized authority by a professional group Code of ethics (well identified) Professional organization that sets standards Ongoing research Autonomy and self-regulation ○ Selective Nursing Theory  General System Theory Break whole things into parts and learn how the parts work together Adaptation Theory A continuous occurring process that effects change and involves interaction and response Developmental Process of growth and development of humans as orderly and predictable Nursing Provides rational and knowledgeable reasons for nursing interventions ○ Nursing Theorist: Florence Nightingale - initiated many reforms in health care/nursing training Modern Nursing Identify personal needs of Patient Establishing standards for hospital management Establishing nursing education Two components of nursing: health and illness Nursing separate and distinct from medicine Nutrition is important to health Instituting occupational and recreational therapy for sick people  Need for continuing education for nurses Maintaining accurate records, recognized as the beginnings of nursing research Clara Barton - Founder of the American Red Cross Lavinia Dock - Nursing leader and women’s rights activist ○ QSEN Competencies Quality & Safety Education for Nurses Guides education models to improve patient safety outcomes Collaborative of healthcare professionals focused on education, practice, and scholarship to improve the quality and safety of healthcare systems Vision- inspire healthcare professionals to put quality and safety as core values to guide their work Patient-centered Care ○ Evidence Based Practice: Research Evidence and Evidence Based Theories Clinical Expertise Evidence from Patient Assessment, initial assessment Patient Preference and Values Clinical Decision Making Quality Patient Outcomes Communication ○ Communication Process Define: Exchange of information, feelings, needs, preferences, between 2 people Active Process: Informing, sending, receiving Includes: Listening, observing, processing, comprehension Feedback (Return Message): Indicates message has been received, processed, comprehended Goal Establish a mutual understanding of the messages meaning (shared meaning) = Message was communicated as intended Sender, receiver, message, response ○ Types of Communication Verbal Words (Written or Spoken) Nonverbal Body Language ○ Facial Expression; body position; posture; gesture; touch; behavior; general appearance Convey more of what a person feels, means, thinks than what is stated with words Verbal & Nonverbal communication should be congruent Remember to SMILE ○ Styles of Communication  Passive or Avoidant: (non-therapeutic) Desire to Avoid Confrontation ○ Inability to share feelings/needs with others ○ Have trouble asking for help ○ Other may take advantage of them Aggressive (non-therapeutic) Putting own needs/feelings/rights before others ○ Exhibit superior attitude ○ Try to humiliate others ○ Communicate in angry, hostile way that doesn't acknowledge others feelings Assertive (therapeutic) Standing up for oneself w/o violating basic rights of others ○ Show respect for others ○ Express feelings in honest/direct way in consistent manner (enhances self worth) ○ **Most Effective Communication Style** ○ Levels of Communication Intrapersonal: “Self-talk” Interpersonal: 2+ people Goal to exchange information Group: Small: 2+ people  ○ Communicate to achieve goals Organizational: Councils ○ Communicate to achieve goals ○ Three Phases of the Nurse - Patient Relationship 1. Orientation (Introductory): Establishes trusting relationship Explanation of nurses' role & purpose of interactions Mutually agreed upon goals set Discuss confidentiality and client rights Establish time parameters (Begins termination phase) 1. Working: Discuss areas of concerns Discuss and resolve problems Teach new adaptive behaviors 3. Termination: Summarize goals and objectives Reinforce positive/adaptive behaviors Feelings/experiences shared by both patient & patient ○ Therapeutic Communication Patient-centered Promote greater understanding of patient’s needs, concerns, feelings Helps patient explore their own feelings and thoughts, encourages expression, avoids barriers Techniques: General leads: “Tell me about your current treatment plan” “I see what you’re saying, then what happened?”  Using silence: Offering self: “What can I do to help you accomplish your goals?” Open-ended questions: “Tell me more about what brings you in today…” Restatement (Validation): “You felt you weren’t heard?” Seeking Clarification: “Are you saying…” ○ Dispositional trait/rapport builders Rapport A feeling of mutual trust experienced by people in a satisfactory relationship facilitate open communication ○ Specific Objectives - having a purpose for the interaction provides guidance toward achieving meaningful encounter with the pt (i.e. doing a head-to-toe assessment) ○ Comfortable Environment ○ Privacy ○ Confidentiality ○ Patient v. Task Force (Patient Focused) Patient: I don’t know why these injections scare me, but they do Nurse: You are afraid of these injections? ○ Using Nursing Observations Helps increase the awareness of a patient’s nonverbal messages  ○ Optimal Pacing Do not rush ○ Open-ended questions ○ Factors that Affect Communication Personal Space: (Distance Zones: Intimate, casual, social-consultation, public) Body Position: Folded arms, slumped position, standing over a patient Language choices: RN needs clear meaning of words which is unbiased Culture: Shared values and beliefs. ○ Includes roles, behaviors, values, religious/spiritual practices Attitude: Position toward a person or thing; body position/posture ○ (be opened not closed) ○ Must be nonjudgmental and accepting Emotion: Be aware of emotionally charged words ○ (cancer, death) Health & Illness` ○ Health, Illness, Disease  Health A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity ○ All the component’s are being successfully met Illness Abnormal process that alters the patient functioning response to the disease Disease Pathological change in the body’s function or structure or of the mind ○ Often with medical diagnosis with doctor ○ Morbidity & Mortality Used to measure overall health of a population Morbidity How frequent a disease occurs ○ Incident The occurrence of new cases as a proportion or rate over a period of time ○ Prevalence What % of the population has the disease Mortality The number of deaths associated with a specific illness or disease (mortality rate) ○ Acute v. Chronic Illness Acute Illness Rapidly occurring It’s course is short Pt return to previous level of functioning after ○ I.e: Appendicitis Chronic Illness Irreversible Permanent physical impairment Long-term health care ○ Remissions (involved) ○ Exacerbations (involved) Ex: Diabetes ○ Health Equity Attainment of the highest level of health for all people Referring to the population of patients or individual ○ Health Disparity A specific difference that is closely linked to social, economic, and/or environmental disadvantage Provide for a lack of access to health & health care or health information ○ Race, ethnicity, age, disabilities, socio-economic status, geographic location ○ Remission & exacerbation Remission Period in a chronic illness when the disease is present, but the person does not experience symptoms of the disease ○ I.e: Cancer Exacerbation Period in a chronic illness when the symptoms of the disease reappear ○ I.e. asthma or COPD These concepts related to illness that mean the opposite of each other with the sense ○ Health Promotion Behavior of an individual motivated by a personal desire to increase well-being and health potential Help a person achieve the max level of wellness in health Healthy People 2030 ○ Wellness An active state of being healthy Lifestyle of promoting good physical, mental, and emotional health ○ Term interchangeable with health ○ Stages of Illness & Sick Role Stage 1: Experiencing Symptoms  Initial Stage May not identify “what is wrong” ○ I.e. “I just don’t feel like myself” Then symptoms appear ○ Rash, fever, pain, etc. Stage 2: Assuming the Sick Role Self-defines as being sick Seeks Validation Gives Up Normal Activities Assume a “Sick Role” Some Individual they may: ○ Choose to do nothing ○ Buy over-the-counter medicine ○ Seek out healthcare provider Focus is on their symptoms Stage 3: Assuming a depending role Person decides to accept the diagnosis and follow treatment plan ○ Or Seek second opinion Deny the diagnosis (if denial) May require hospitalization (may interrupts patients normal routine) Facilitating adherence to the treatment plan:  ○ Rapport (relationship) w/ caregivers Good trusting, nurse - patient Relationship ○ Knowledge about the illness (educate) ○ Individualized care plan Stage 4: Achieving recovery and rehabilitation Gives up dependent role Resumes normal activities In some situations ○ Recovery & Rehab at home or Rehab Center ○ Health Models The Health Belief Model How people view their situation in health ○ Perceived susceptibility to a disease ○ Perceived seriousness of a disease ○ Perceived benefits of action Modifying factors include ○ Demographic, socio psychological, structural Health & Illness Continuum Model Conceptualizes a person’s level of health ○ Used to determine need for action (treatment) Constantly changing state Interaction between an external agent, a susceptible host, and the environment  ○ When there is a balance bwtn 3 factors the person will not get ill Health Promotion Model Intent to describe how people interact with their environment Individual characteristics and experiences and behavior-specific knowledge and beliefs, to motivates health-promoting behavior Predictive Factors of personal, biologic, psychological, sociocultural Goal= attaining health behaviors leading to positive health outcomes ○ Behavior induce negative or positive subjective response/affect ○ Types/levels of Prevention Primary care/ prevention Before something happens ○ Preventing the development of disease (strategy) Includes: ○ Immunization Clinics ○ Family Planning Services ○ Poison-control information ○ Accident-prevention education ○ Health education (diet, exercise, etc.) Secondary:  Screening for early detection (lead to better strategies for the patient) ○ Examples include: Assessing children for normal growth & development Encouraging regular medical, dental, and vision examinations Screenings (for early prevention) Mammograms, Paps, Testicular Exams, etc Tertiary After an illness is diagnosed and treated, rehabilitate patients to a maximum level of functioning (the disease already happened and it’s being treated) ○ Examples Teaching patient Physical Therapy Referrals (Support group) Medication, surgeries, physical, and occupational therapy ○ Risk Factors for Health and Illness Age Environment Economical  Cultural Education Lifestyle ○ Vulnerable Populations Living in Poverty Women Children Older Adult Rural and Inner City Residents New Immigrants The Homeless Mentally ill patient People with disabilities Special Health-Care Needs Maslow & Erikson ○ Maslow’s Hierarchy of Needs The premise of his theoretical framework is to show the basic human needs for everyone in a pyramid scale Nursing: the foundation is to improve our practice by positively improving the health and quality of the patients [foundational knowledge of are concepts that helps explain what is done for patients] Used to understand the relationship of basic human needs and for establishing priorities of care when delivering care.  Five Levels of Maslows Physiological Needs (Bottom) ○ Needs for oxygen, food, water, rest, and elimination The need of sex isn’t necessary for an individual but necessary for the survival of humankind Safety Needs ○ Needs for shelter and freedom from harm and danger Call bell, hand washing, security guards, rails up, locking the bed, emergency exit, cords, & spills (etc) Belonging Needs ○ Need for affection, feelings, of belonging, and meaningful relationships with others Family-Friend support, Support Groups, etc Esteem Needs ○ Needs to be well thought of by oneself as well as by others Positive reinforcement during treatment and in rehab, celebrating little wins (etc) Self Actualization Needs ○ Needs to be self-fulfilled, learn, create, understanding, and experience one’s potential Patient’s need to be and do what the person was set out to be ○ Erikson Levels of Developments 8 Stages Infancy: Trust v Mistrust ○ Development progress determine by the quality of parenting ○ Important to meet basic physical needs, warmth, comfort, food, and love Ex: Competency: Baby is hungry, I feed it - baby happy Conflict: Baby hungry, I feed it when I feel like it, baby cries, feed it, not attending after Toddler: Autonomy v. Shame ○ Striving for independence “Me do it” ○ Strong wills; negative behaviors [acting out, temper tantrums] ○ Attached to parents ○ Solitary/parallel play Ex: Competency: Making child confident and reassuring them when learning a new skill (adequacy)  Conflict: Inadequacy, self, doubt, shame, lack of confidence Pre-school: Initiative v. Guilt ○ Actively seek out new experiences ○ Ask how and why ○ Super independent, take responsibility, play a lot ○ Assert power and control over the world through directing play and other social interact Ex: Competency: Like to play a lot (a lot of hero worshiping), likes to take responsibility, successful, very capable, able to lead others & reach goals Conflict: lift with a sense of guilt, self doubt, lack of initiative, come to believe what they want to do is wrong School Age: Industry v. Inferiority ○ Develop sense of pride, being productive (complete certain task) ○ Psychosocial development is many areas ○ Self-concept ○ Coping patterns Ex:  Competency: Children who are encourage by parent’s or teachers develop feelings of confidence and believe in themselves Conflict: Those who receive little to no encouragement, doubt their ability to be successful and a sense of inferiority Adolescence: Identify v. Role Concept ○ Striving for emotional independence from parent ○ Identity Sexual Group Family Vocational Moral Health ○ Answer the question “who am I” Ex: Competency: Strong sense of who they are, strong sense of self, feeling of independence and in control Conflict: end up insecure and confused about who they are themselves and their future  Young Adult: Intimacy v. Isolation ○ Career ○ Single/Married ○ Social ○ Exploring personal relationship, strong sense of personal identity Ex: Competency: more committed relationship, strong sense of self Conflict: Less committed relationship, more likely to suffer, emotional isolation, loneliness, and depression Middle Age: Generativity v. Stagnation ○ Beginning of Retirement ○ Children leaving home ○ Career Changes ○ Adapting to Physical Changes ○ “Sandwich” Generation (support own kids while caring for parents) Ex: Competency: Contributing to the world by being active in their home and their community  Conflict: Feeling of not being productive, feel uninvolved in the world, stagnant Older Adult: Integrity v. Despair ○ Sees oneself as an aging individual ○ Adjusting to retirement ○ Adjusting to decreased physical abilities ○ Redefining relationships w/ adult children ○ Finding ways to maintain quality of life ○ Reflecting back on one's life and accepting one's life on a positive matter comes to terms with death. Bacteriologic Safety ○ Skin Integrity Skin Largest Organ in the Body with 2 layers ○ Epidermis Top layer and protects the body from forming a barrier that resist pathogen ○ Dermis Second layer - hair follicle ○ Subcutaneous Layer Fatty Tissue Function of Skin is protection Body temp regulation  Normal Attributes Warm, dry, and intact Smooth to the touch and soft in Color of the skin expected to be shades of pinkish white to shades of brown Expect skin turgor full or normal (when skin is pinched, the recoil of the skin is immediately) Nails expected to be smooth & firm, non-tender Hair to be resilient and evenly distributed throughout the body Skin Integrity Assessment and Prevention Assess ○ The Braden Scale Prevention ○ Hygiene ○ Moisturizers ○ DO NOT MASSAGE ○ Protect from Incontinence ○ Avoid Friction & shearing forces ○ Diet & nutritional supplements ○ Improve mobility/activity ○ Primary v. Secondary Skin Lesions Primary Wheel  Macule Patch Bulla Nodule Plaque Vesicle Secondary Excoriation Fissure Erosion Ulcer ○ PU Stages (1-4, Unstageable) Stage 1 Skin is unbroken (intact) but inflamed (sometimes red)  Stage 2 Skin is broken to epidermis or dermis Stage 3 Ulcer extends to subcutaneous fat layer Stage 4 Ulcer extends to muscle or bone Unstageable Usually covered with slough (soft, moist, yellow or white loose/stringy material) or Eschar (hard, dark [Black or brown], and dry) ○ Slough v. Eschar Slough Soft, moist, yellow or white loose/stringy material Eschar Hard, dark [Black or brown] and dry ○ Healing Stage If an ulcer is a stage 3 and it's getting better and healing it is still considered A HEALING STAGE 3 ○ Intervention (Preventative Measures) Prevention Hygiene Moisturizers DO NOT MASSAGE Protect from Incontinence Avoid Friction & shearing forces Diet & nutritional supplements  Improve mobility/activity Health Assessment ○ Pulse Amplitude +1 Faint +2 Normal +3 Bounding ○ Apical Pulse S1 sounds The Mitral and Tricuspid valves closing S2 sounds The closure of the Aortic and Pulmonary Valve ○ 8 Pulse Sites Temporal Pulse Carotid Pulse Radial Pulse Brachial Pulse Femoral Pulse Popliteal Pulse Posterior Tibial Pulse Dorsalis Pedialis Pulse ○ Blood Pressure (Pulse Pressure) Normal blood Pressure Range Systolic  ○ Less than 120 Diastolic ○ Less than 80 Elevated Blood Pressure Systolic ○ 120-129 Diastolic ○ 80 Hypertension Stage 1 Systolic ○ 130-139 Diastolic ○ 80-89 Hypertension Stage 2 Systolic ○ 140-179 Diastolic ○ 90-119 Hypertensive Crisis Systolic ○ 180 and above Diastolic ○ 120 and above  Pulse Pressure Systolic - Diastolic = Pulse Pressure ○ PERRLA Pupils are equal round, reactive, and accommodating (Light Test) Accommodation is when the pupils constrict with light and dilate with darkness Convergence is when the pupils move when tracking a pen ○ Skin Turgor The Elasticity of the skin Should normally be less than 2 seconds If it stays pinched for a while the skin has loss the elasticity (usually seen in older people) ○ Dentures When cleaning a patient that has dentures: You put a towel on the bottom of the sink ○ Normal Ranges of TPR Temperature Fahrenheit ○ 97 - 99 Celsius ○ 36.1-37.2 Pulse 60-100  Respirations 12-20 ○ Pulse Deficit Subtracting the Radial Pulse from the Apical Pulse