Fundamentals of Nursing PDF

lOMoARcPSD|22650627 D⇐€⇐⇐⇐⇐€ lOMoARcPSD|22650627 tAble of contents 1 The professional nurse 2 Nursing theory 3 Evidence-based practice 4 Nursing process 5 Nursing ethics 6 Health care delivery 7 Health promotion 8 Population health 9 Cultu...

lOMoARcPSD|22650627 D⇐€⇐⇐⇐⇐€ lOMoARcPSD|22650627 tAble of contents 1 The professional nurse 2 Nursing theory 3 Evidence-based practice 4 Nursing process 5 Nursing ethics 6 Health care delivery 7 Health promotion 8 Population health 9 Cultural competencey 10 Caring and communication 11 Patient safety 12 Infection prevention 13 Vital signs 14 Head-to-toe assessment 15 Medication administration 16 Medication dosage calculation 17 Pain management 18 Activity, mobility, and exercise 19 Oxygenation and airway maintenance 20 Nutrition 21 Electrolyte imbalances 22 Skin and wound care 23 Hygiene 24 Urinary elimination 25 Bowel elimination 26 Crisis and disaster 27 Legal considerations 28 Documentation  lOMoARcPSD|22650627 1 The professional EE FIFE nurse - Levels of Nursing Proficiency 1 Novice: *Student nurse or RN in a new setting with no previous experience. o 2 Advanced - Beginner: * RN with some experience in a clinical setting. O 3 Competent: - *RN with 2-3 years experience in the same clinical setting. - Career Development n 4 Proficient:. * Advanced Practice Registered Nurse * RN with over 2-3 years experience in the * Clinical Nurse Specialist same clinical setting. *Nurse Practitioner O 5 Expert: - * Certified Registered Nurse *Lengthy experience in a clinical setting. Anesthetist *Nurse Educator - Nursing Process Steps *Nurse Administrator *Nurse Researcher A Assessment D Diagnosis Influences on Nursing O Outcomes Identification *Rising cost of healthcare *Affordable Care Act P Planning *Medically underserved populations *Demographic changes I Implementation E Evaluation Trends in Nursing - ⑦ Responsibilities of a Nurse 1 Evidence-Based Practice: - * Improves patient safety by basing nursing practice on the current * Accountability * Communicator available evidence. * Autonomy * Educator 2 Quality and Safety Education for * Advocate * Manager Nurses: * Caregiver * Core Competencies: * Patient-centered care →Nursing Code of Ethics * Ideas of right and wrong that define the * Teamwork and collaboration * Evidence-based practice * Quality improvement * Safety principles nurses use to provide care on a daily I * Informatics basis.  lOMoARcPSD|22650627 2 AFFAIRE NURSING THEORY FEET is Nightingales Environmental Theory - Peplaus Interpersonal Theory * Nurses should be able to manipulate the environment in a way that will best promote the * The nurse-patient relationship is broken patient’s overall health and quality of recovery. into several stages: I Environmental factors that can be controlled: - * Light O 1 Pre-Orientation: - *Nurse gathers data related to the patient before patient interaction. * Hygiene * Ex- receiving report at the start of * Nutrition a shift. * Noise * Ventilation o 2 Orientation: - * Nurse and patient meet for the first time, issues/problems the patient is experiencing is determined, and goals are formed. 3 Working Phase: Orems Self-Care Deficit Theory * The nurse carries out nursing interventions and therapeutic activities. 1 Patient participation in self-care activities improves patient outcomes. 4 Resolution: 2 The nurse should assist the patient * Termination of the nurse-patient when necessary to meet the patient’s relationship. physical, psychological, developmental, and sociological needs. o 3 When assisting a patient with their self-care needs, the nurse should encourage the patient to assist to the I best of their ability. p Leiningers Culture Care Theory Research / l. * Nurses need to incorporate the patient’s culture, values, and beliefs into the. patient’s plan of care in order to provide ' Practice ← Theory effective, culturally congruent care. v :¥⇐⇐ii ÷÷ lOMoARcPSD|22650627 3 Evidence-Based practice - What is Evidence-Based Practice? - PICOT Questions: * Evidence-based practice is a step-by-step process that promotes the best P: Patient population of interest *Age, gender, disease, etc. healthcare practices to achieve the best patient outcomes. I: Intervention of interest * Evidence-based practice integrates: *Treatment, test, etc. 1 Relevant, critically appraised evidence. C: Comparison of Interest *Typical standard of care 2 The nurses own clinical experience compared to your plan of care. and expertise. 3 The patients own preferences O: Outcome and values. *Desired result of the nursing intervention. 7 Steps of Evidence-Based Practice: T: Time 1 Cultivate a spirit of inquiry. *Amount of time required * Question current clinical practices and methods. 2 Ask a clinical question in “PICOT” format. o 3 Collect the best evidence. * Review hospital policy, existing guidelines, - Hierarchy of Evidence quality improvement data, and journal € articles. f o 4 Critically appraise the evidence. Reviews of * Evaluate and determine the RCTs credibility, value, and usefulness of the data. Controlled trial with randomization (RCT) O 5 Integrate the evidence with your - Controlled trail, no le own clinical expertise and your patient’s iab randomization preferences. Rel - *Apply the research and data to Case studies st your plan of care. Mo : 6 Evaluate the outcome of your practice Reviews of qualitative studies decision. *Determine if the intervention worked and if it was effective. Qualitative studies. 7 Share the outcomes with others. Opinion of experts #  4 FEEEffi EEF Nursing Process EE - What is the Nursing Process? o 4. Planning * The nursing process is a 6-step * Nurse must establish priorities when creating process for nurses to follow to achieve the plan of care. the best possible patient outcomes. * Maslows Hierarchy of Needs * The process provides a framework * There are 3 types of planning: to create a care plan for the patient. 1. On admission after assessment 2. Ongoing planning during care 3. Discharge planning - Steps of the Nursing Process: Maslows Hierarchy of Needs: o 1. Assessment nt ta * Collect data related to patient health and r po situation. Im Self-esteem * Information is gathered from patient µ medical history, observation, patient interviews, physical examinations and diagnostic reports. Mo st Love and belonging * Collect subjective and objective data. Safety and security ii. *Subjective: symptoms, feelings, and. descriptions from patient. Physiological *Objective: Observation and physical assessment. * Interpret and document data. 5. Implementation 2. Diagnosis * Implement the identified nursing interventions. * Analyze assessment and determine what * Promote, maintain, and restore patient nursing diagnoses are relevant to the patient health. and situation. * Perform nursing actions and document * Nursing diagnoses are clinical ÷ care. judgements about the patients current/ potential health problems or needs. 3. Outcomes Identification 6. Evaluation : * Identify and set measurable and * Evaluate the patients responses to the achievable goals and outcomes for the implemented nursing interventions. patient. * Goals should be both short and long-term. * Determine if the patient has met the * Goals promote individualized care and goals and expected outcomes. patient participation. * Determine the effectiveness of the care plan.  lOMoARcPSD|22650627 5 Nursing ethics Ethical Principles: Basic Principles of Ethics: * Standards of right and wrong in relation to social values and norms. 1 Advocacy: *Support of the patient's rights. Values: 2 Accountability: * Personal beliefs that influence behavior. *Taking responsibility for your own actions. Morals: 3 Responsibility: *Respecting and carrying out * Personal beliefs about what is and is professional responsibilities. not acceptable for yourself to do. 4 Confidentiality: *Protection of patient Privacy. Ethical Dilemma: * Occurs when there is a conflict between 2 moral principles, not enough scientific data, and the decision will heavily impact the patient. Ethical Principles for Patient Care Solving an Ethical Dilemma: 1 Autonomy: 1 Question if it is an ethical dilemma. * An individuals right to make their own decisions. 2 Gather all important information 2 Justice: related to the dilemma. * Fair and equal healthcare and distribution of resources. 3 Reflect on your own values. 3 Beneficence: 4 State the dilemma and related issues. * Acting in the best interest of others. 5 Analyze all possible options. 4 Non-maleficence: * The commitment to do no harm. 6 Select a plan that most closely aligns with the ethical principle in question. 5 Fidelity: * Remaining faithful to promises 7 Apply the plan and evaluate the 6 Veracity: outcome. * Commitment to tell the truth.  lOMoARcPSD|22650627 6 REA IT RARE Health Care PFEIFER Delivery.. T 0 EE Participants Levels of Healthcare. O * Consumers * Providers o 1 Preventive: - * Unlicensed providers * Education and prevention. n 2 Primary Care: - Healthcare Settings. * Health Promotion. * Provider offices, clinics, schools. * Hospitals * Community health dept. * Provider's offices * Occupational health o 3 Secondary Care: - * Urgent care * Surgical centers * Diagnosis and treatment * Homes * Assisted-living * Inpatient, emergency care centers. * Schools * Adult day care * Hospices O 4 Tertiary Care: - * Specialized care. * ICU, specialty units and centers. Healthcare Plans 5 Restorative Care: 1 Medicare: * Helps patients reach functional *Federally funded program for adults 65 potential. or people with permanent disabilities. * Home care, rehabilitation, extended care. 2 Medicaid: *Federally and state funded program for 6 Continuing Care: patients with low income. * Prolonged care. * Hospice, assisted living, pallitive care. 3 Private Insurance: *Traditional Fee-for-service plan. ta - 4 State children's Health Insurance program: *For uninsured children up to age 19. - 5 Affordable Care Act: *Also known as Obamacare, increases access to healthcare and decreases - Issues Facing Healthcare Delivery healthcare costs. } 1 Nursing shortage 2 Provider competency 3 Quality and safety *Patient Satisfaction *Outcomes directly related to nursing care. 4 Nursing Informatics and technological. advancements 5 Globalization of healthcare  lOMoARcPSD|22650627 7 HEALTH EEE PROMOTION EEE River err.. - Internal Variables Affecting Health: - Levels of Prevention: ⇐tE * Educational level * Developmental stage * Age * Perception of functioning Tertiary * Spirituality Prevention * Emotional Factors * Genetics Secondary Prevention - External Variables Affecting Health: * Culture * Family practices Primary Prevention * Socioeconomic status * Psychosocial factors * Environment 1 Primary Prevention: * Lifestyle * Focused on health promotion, disease Risk Factors: prevention, and wellness education. * Immunizations, yearly wellness visits, : 1 Genetics: fitness activities, health education. * Determines predispositions to hereditary disorders. 2 Secondary Prevention: * Heart disease, cancer, etc. * Focused on diagnosis and intervention to delay disease progression. 2 Gender: * Disease screenings, early treatments, *Some diseases are more common in a exercise programs. certain gender. - 3 Tertiary Prevention: - 3 Physiological: * Focused on rehabilitation, prevention of *There are certain states in which people long-term consequences, and promoting are more at risk. independence. *Ex- pregnancy. * Rehabilitation centers, support groups. - 4 Environment: *Frequent exposure to toxic chemicals or pollutants at home or work. - Nursing InterventionS: J o 5 Lifestyle: - * Assess patient risk factors *Stress, substance abuse, sun exposure, * Encourage patient behavior-change if poor diet, lack of exercise. necessary. * Promote healthy behaviors. O 6 Age: - *Certain health conditions become more common with aging. ed  lOMoARcPSD|22650627 8 Prime referee Population Health Social Determinants of Health Vulnerable Populations: * Social determinants of health are factors 1 People living in poverty: - that contribute to an individual's current * Hazardous environments, high-risk state of health. jobs, less nutritious diets. O 1 Biology and Genetics: - O 2 Older adults: - *Sex and age * Chronic diseases and a greater need for health services. O 2 Personal Behavior: O - * Alcohol, drug use, sex practices, smoking. 3 Homeless individuals: - ' * No proper shelter, poor nutritional status, lack of access to healthcare. 4 Immigrants: * Language barriers, lack on benefits, lack of resources. 3 Social Environment: * Discrimination, income, gender. 5 People with mental illness: * Higher risk for homelessness and abuse. 4 Physical Environment: * Living conditions. 6 People in abusive relationships: * Urban or rural area. * Possible fear of seeking healthcare. o Roles of a Community Nurse:. * Caregiver * Epidemiologist * Educator * Patient Advocate - 5 Health Services: * Counselor * Change Agent * Access to healthcare. * Collaborator * Case Manager * Access to health insurance. - Community Health Assessment: - Health Disparities: * Identifies key heath needs of a population or community through data collection. * A higher burden of disease, disability, or mortality experienced by disadvantaged O 1 Structure: - populations that is preventable. * Geography, services, housing, * Related to unequal distribution of transportation. resources. o 2 Population: - * Can be related to sex, race, ethnicity, * Age, sex, growth, density, ethnicity, education. income, sexual orientation, religion of members of the community. or geography. O 3 Social System: - * Government, education system, and health system.  lOMoARcPSD|22650627 9 Cultural : aw ti 's & :m Competency r rises ima ;D 's 's :# HEY '. ' - What is Culture? J Culture and Perception of Illness and Disease: * Customs, norms, and values passed through generations of a particular * Illness: How patients and their families react to - nation, people, or group. a diagnosis or disease. *Disease: The actual physiological and biological - Transcultural Nursing: - disease process in the body. D * Nursing with a primary focus of get understanding similarities and differences of cultures in order to grog ⑧ provide culturally competent care. - Culturally Congruent Care: * Nursing care that aligns with the patient's. cultural beliefs, values, and worldview. -. J Cultural Competency: 5 Components of Culturally * The ability of a healthcare provider to Congruent Care: provide care that meets the cultural beliefs and practices of their patients. 1 Cultural Awareness: *Examine your own biases, beliefs, background, and assumptions. 2 Cultural knowledge: *Knowledge of the beliefs, values, and Cultural Assessment: practices of many cultures. * Completed with the goal of gathering 3 Cultural Skills: information that is relevant to the patients *Ability to collect relevant cultural data that culture to form a culturally congruent plan will influence the care of your patient. of care. Ask about: - - 4 Cultural Encounters: *Engagements with culturally diverse patients Doo * Cultural affiliation that provide opportunities to learn about * Cultural restrictions other cultures. * Health beliefs and practices * Religious affiliation 5 Cultural Desire: - * Nutrition *Motivation to learn about other cultures * Primary language and become more culturally aware. * Values  lOMoARcPSD|22650627 10 Caring EEE and communication EEE EEE MEEE TEA se - Aspects of Caring in Nursing: Therapeutic Communication: 1 Be Present: * Encourages patient to express thoughts * Creates a sense of openness and and feelings. understanding. * Creates trust and respect between nurse *Forms a connection between nurse and and patient. patient. J * Includes eye contact, body language, tone Therapeutic Communication of voice. Techniques: o 2 Listening: - o 1 Active Listening: *Interpret and understand what the patient - * Paying complete attention to the patient. is saying in an accepting and non-judgmental o 2 Body Language: way. - * Sit facing patient * Maintain comfortable eye contact and O 3 Touch: open position. - *Conveys a sense of comfort and security 3 Touch: to the patient. * Be comforting and nonthreatening *Be aware patient's cultural practices * Ask permission before initiating touch. related to touch. 4 Silence: * Allows patient to sort out their thoughts. 4 Relief of symptoms: 5 Validation: *Improves the patients level of comfort * Acknowledge patient's feelings / thoughts. and conveys respect and dignity. 6 Paraphrase: *Restate what patient said to show active 5 Family Care: listening. *Know the family as well as you know the patient. - 5 Levels of Communication: Hi * Intrapersonal: = * “Self-talk", your own thinking. * Interpersonal: - Non-therapeutic Communication *Face-to-face, between nurse and another * Discourages the patient from expressing person. their feelings. * Small-Group: * Damages the nurse-patient relationship. = *Between a small number of people. * Public: * Speaking to an audience. * Electronic: JNon-therapeutic Communication Techniques: * Personal questions opinions -8 * Communication using technology. * Asking for explanations * Approval or dissaproval * Arguing * False reassurance * Changing the subject  lOMoARcPSD|22650627 11 FAT T.EE?TTTF Patient safety ÷i± - Basic Physiological Safety: O Falls: * Oxygen * Must be met before any * Older adults, people with vision or * Nutrition other needs! balance problems, and people on certain * Temperature medications are at higher risk. * Fall prevention = major nursing priority. - Safety Risks By Age: - Fall Prevention: o 1 Infant- Preschool: - * Complete a fall-risk assessment * Injuries, accidental poisoning, choking. * Place call bell in reach of patient 2 School-Age * Provide adequate lighting for patient *Head injuries, bicycle accidents, car * Orient patients to their setting accidents. * Keep bed in low position with locked brakes 3 Adolescent: * Keep floor clear of obstructions *Alcohol and drug use, sexually transmitted infections, car accidents. Seizure Precautions: 4 Adult: *Alcohol use, smoking, stress, car * Maintain airway patency accidents. * Remove items that could cause injury 5 Older Adult: * Do not restrain patient *Falls * Lower patient to floor or bed Seclusion and Restraint: * Use only when less restrictive measures are not effective. O * Must obtain order from provider ASAP. * Assess skin integrity frequently and provide range-of-motion exercises. * Regularly determine need for restraints. - Personal Risk Factors: * Patient age o Fire Safety: * Impaired Mobility O M} * Sensory or communication deficits R: Rescue patients * Lifestyle A: Activate alarm * Lack of safety awareness C: Contain fire E: Extinguish fire - Risks in Healthcare Facilities: IT D * Falls P: Pull pin * Accidents that result from an action of the A: Aim at base patient. S: Squeeze handle * Procedure- related accidents * Equipment-related accidents S: Sweep area  lOMoARcPSD|22650627 12 TREEET Infection FEE TIRE fi prevention i ÷÷÷: - Types of Pathogens: o Virulence: - Standard Precautions: * Bacteria * Fungi * A pathogens * Precautions that apply to all patients. * Viruses * Parasites ability to invade *Hand hygiene * Prions and damage a *Gloves when in contact with bodily host. fluids - Types of Immunity: *Masks and eye protection when there is O 1 Innate: immunity we are born with. - potential spraying of bodily fluids. * Skin and mucous membranes. c- 2 Adaptive: acquired when people are exposed to diseases or vaccinations. - Transmission Precautions: O 3 Passive: immunity that is produced by an - O 1 Airborne Precautions: protects against external source and is only temporary. - droplet infections smaller than 5 mcg. *Ex- through breastfeeding *Ex- measles, varicella, tuberculosis. Chain of Infection: *Private room *Masks (N95 or HEPA respirator for 1 Causative agent: the pathogen. tuberculosis) 2 Reservoir: areas and objects *Negative pressure room. where the pathogen can grow *Full face protection if chance of and multiply. splashing or spraying. 3 Portal of exit: the means by which the pathogen can leave the reservior. 2 Droplet Precautions: protects against 4 Mode of transmission: how the pathogen can droplets larger than 5 mcg. spread from one place to another. * Ex- strep, pneumonia, rubella, pertussis, - 5 Portal of entry: where the pathogen is able mumps. to invade the host. * Private room or placed with another - 6 Susceptible host: people with compromised patient with the same condition. defense mechanisms. * Masks J Stages of Infection: E. o 3 Contact Precautions: protects caregivers - when within 3 feet of the patient. - 1 Incubation: time between pathogen invading the * Ex- shigella, wound infections, herpes, host and the first symptom. scabies. = 2 Prodromal Stage: time between onset of first *private room or placed with another symptoms to more distinct symptoms. patient with the same condition. 3 Illness stage: acute, illness-specific symptoms. * Gloves and gown. - 4 Convalescence: Acute symptoms dissapear, * Infectious dressing material put into recovery begins. non-porous bag. = Personal Protective Equipment: 4 Protective Precautions: protects patients Donning PPE: Removing PPE: who are immunocompromised. * Private room with positive airflow and - - 1. Hand hygiene 1. Gloves 2. Gown 2. Goggles HEPA filtration. 3. Mask 3. Gown * Mask for patient when out of their 4. Goggles 4. Mask room. 5. Gloves 5. Hand hygiene  lOMoARcPSD|22650627 13 Vital Signs ÷÷i÷÷ Temperature: Pulse: *Rate = beats / min Oral: (mouth) * Normal = 60-100 beats (min (adult) *Normal= 96.80-100.4°F or 36-38°C. * Pulse rate is usually higher in children. *Place thermometer under the tongue. * Rhythm: intervals between pulses. *Only use with patients age 4 and older. * Strength: strength of each contraction/ Tympanic: (ear) beat. *Normal = 0.5-1.0°F or 0.3-0.6°C higher 0 = absent than oral. 1+ = diminished *Pull ear back and place probe in outer ear 2+ = brisk, as expected canal. 3+ = increased, strong * For patients older than 3 months. 4+ = bounding Rectal: ' * Tachycardia: Pulse over 100 beats / min. * Normal = 0.9°F or 0.5°C higher than oral. * Bradycardia: Pulse under 60 beats / min. * Patient in SIMS position, place probe 1-1.5 * Radial pulse most common for inches in. measurement. *Do not use on patients with diarrhea or if * Measure 30 seconds and multiply by 2. they are on bleeding precautions. *Use on patients older than 3 Months. * Most common pulse points: Axillary: (armpit) * Carotid * Popliteal * Normal = 0.9°F or 0.5°C lower than oral. * Brachial * Dorsalis pedis * Place in center of armpit and hold arm * Ulnar * Posterior tibial pedis down. * Femoral * Can be used with all ages. Blood Pressure: Temporal: (forehead) *Normal = 1.0°F or 0.5°C higher than oral. * Width of cuff should be 40% of arm. *Slide probe across forehead to temporal * Cuff should be placed 1 inch above the artery. elbow crook in line with brachial artery. *Can be used with all ages. * Inflate cuff 30mm Hg above estimated palpated systolic pressure. Respirations: * Release pressure slowly until first clear * Rate = full inspirations and expirations in one sound (systolic) and release after minute. sounds disappear (diastolic). *Normal = 12-20 breaths / minute (adults), Systolic 30-40/min (newborns), 20-30/min (children). *Recorded as: Diastolic * Depth = how much the chest wall expands * Classifications: with each breath. Systolic Diastolic * Rhythm = time intervals between breaths. Normal < 120 < 80 Pulse Oximetry: Prehypertension 120-139 80-89 * Measures oxygen saturation Stage 1 hypertension 140-159 90-99 * Clips onto finger or earlobe * Normal = 95-100% Stage 2 hypertension > 160 > 100  lOMoARcPSD|22650627 14 Head-To-Toe Assessment Ets General Survey: O Mouth: O Throat: * Physical appearance * Behavior * Lips should be pink, moist and * Uvula should be pink, * Body structure * Mood and speech smooth. midline, and should move. * Nutritional status * Hygiene and dress * Gums and mucous membranes * Tonsils should be the same * Mobility should be pink with no lesions color as the surrounding * Teeth should be clean, white, area. y Vital Signs: and smooth. * Temperature * Blood pressure * Pulse * Respirations * Oxygen Saturation 0 Lungs and Heart: * Chest should be round, convex, and y Head and Face: symmetrical. * Palpate chest surface for lumps and * Head: lesions. * Should be symmetrical and proportionate * Percuss thorax and compare each side. to body. * Auscultate lung sounds on both the anterior and * Assess for depressions, masses, and posterior sides in ladder formation. deformities. * Face: * Auscultate heart sounds: *Features should be symmetrical and * Aortic: 2nd right intercostal space. proportionate. * Pulmonic: 2nd left intercostal space. * Assess for touch sensation and motor *Erbs Point: 3rd left intercostal space. function by asking patient to run through a *Tricuspid: 4th left intercostal space. series of expressions. *Mitral: 5th intercostal space at Neck: midclavicular line. * Lymph Nodes: Abdomen: * Palpate from lower head and down the neck for enlarged nodes. * Inspect shape and symmetry. * Thyroid: * Auscultate bowel sounds in all 4 quadrants. * Palpate while instructing patient to swallow. * Percuss all 4 quadrants. * Assess for any enlargement or masses. * Palpate all 4 quadrants and assess for rebound * Trachea: tenderness. J *Should be midline with no masses. Eyes: O Skin: * Inspect skin's color, moisture, turgor, texture, and i.IS * Assess coordination by asking patient to presence of lesions. move their eyes in the six cardinal * Assess color, firmness, curvature, and capillary directions. refill or nails. * PERRLA: pupils clear, equal, round, reactive to * Assess cleanliness and distribution of hair. light, and accommodating. f * Note any abnormal discharge or tenderness. Peripheral Arteries: O Ears: O Nose: * Assess strength and equality of pulses. * Should be midline and * Assess the presence of edema. * Check for lesions, * Edema assessment: deformities, and discharge. symmetrical. * Mucous membranes 1+ : 2mm depression, immediate rebound * Tympanic membrane 2+ : 3-4mm depression, rebound < 15 seconds should be intact and should be intact and pink. 3+ : 5-6mm depression, rebound 10-30 seconds landmarks visible. 4+ : 8mm depression, rebound in > 20 seconds -  lOMoARcPSD|22650627 15 Medication Administration I administration Pharmacokinetics A o 4. Inhalation Route: - Absorption: medication reaches the * Administered through nasal or oral bloodstream from the site of administration. passages. €0 Distribution: medication is distributed to.. 5. intraocular Route: *Administered to the eye area for - tissues and organs. Metabolism: medication reaches the a localized effect. - intended site and begins to break down. Excretion: metabolized medication leaves -. - Types of Medication Orders: the body through the kidneys, bowels, lungs O 1. Routine Orders: - and glands... *Given on a regular schedule until the provider cancels or replaces the order. J Medication Actions o 2. PRN Orders: - *Given at the request of a patient i Therapeutic effects: expected response - Adverse effects: unintended responses or when the RN observes the need. ÷ 3. One-Time Orders: f *Side effects *Toxic effects: excess amounts in blood *To be given once at a specific time. *Idiosyncratic reactions: unexpected 4. STAT Orders: response *To be given once and immediately. *Allergic reactions 5. Now Orders: Medication Interactions *To be given once up to 90 minutes after the order is given. Routes of Administration 6 Rights of Medication Administration 1. Oral, Buccal, and Sublingual: 1. Right medication 4. Right route *Most convenient and easiest. 2. Right dose 5. Right time *Avoid if patient has difficulty 3. Right patient 6. Right documentation swallowing, GI issues, or vomiting. 2. Parenteral Routes: *Intradermal: injection into the dermis - Components of Medication Orders = *26-27 gauge, 10-15 degree angle *Subcutaneous: injection below the dermis * * Patient’s full name * Route Date + time of order * Time/frequency *25-27 gauge, 45-90 degree angle * Medication name * Provider’s signature *Intramuscular: injection into a muscle. * Dosage * 18-27 gauge, 90 degree angle *Intravenous: injection into a vein - *16-24 gauge, 15-30 degree angle J i Preventing Medication Errors O 3. Topical Administration: - * Read labels 3 times and compare with *Applied to the skin or mucous membranes MAR. for a localized effect * Use at least 2 patient identifiers. *Apply evenly with gloves and applicators * Double check all calculations. * Follow the 6 rights of medication. l administration. *Document all medications as soon as they l are given.  lOMoARcPSD|22650627 16 dosage IT THENIET I IT Calculation s Conversions: s Liquid Dosages: * Order: 30mg Prozac PO daily ②* -x * 1 Kg = 2.2 lbs * 1 L = 1,000 mL * Available: Prozac 20mg per 5mL * 1 mg = 1,000 mcg * 1 tsp = 5 mL * Solve: How many ML should be administered? * 1 g = 1,000 mg * 1 tbsp = 15 mL * 1 oz = 30 mL * 1 tbsp = 3 tsp 5 mL 30 mg 7.5 mL 20 mg X a Rounding: Injectable Dosages: * Less than 1.0 = round to nearest * Order: Benadryl 80mg IM four times/day. hundredth * Available: Benadryl 50mg per mL. * Greater than 1.0 = round to nearest * Solve: how many ML will be administered? tenth. 1 mL 80 mg -x-=£ 1.6 mL y Dimensional Analysis: * Order: 600mg acetaminophen q 6 hrs PRN 50 mg X Weight-Based Dosages: ng * Available: 300mg tablets * Order: Amoxicillin 40mg per 1 kg divided into 2 doses ÷ 1 Determine the unit that you are calculating. * Available: Amoxicillin suspension 400mg 15mL. * Tablets * Solve: how many ML given per dose for a 2 Determine the quality available. 22lb child? * 1 tablet 1 Convert lb to kg: 22 lb / 2.2 = 10 kg 3 Determine the dose available. * 300 mg 2 Calculate dose in mg: 40 mg 1o kg 400 mg 4 Determine the desired dose. 1 kg * 600 mg X 3 Divide dose by frequency: 5 Do you need to convert units? 400mg / 2 = 200 mg per dose * No 6 Set up the problem and solve. 4 Convert mg to mL: Quanity Desired dose 5 mL 200mg 2.5 mL per dose × 400 mg X Available dose X 1 Tablet 600 mg = O 2 tablets J IV Flow Rate with Electronic Pump: x * Order: 1000 mL of D5W in 8 hours - - 300 mg X Volume = X ml/hr 1000 mL = 125 mL/hr o - Solid Dosages: Time 8 hours * Order: Motrin 800mg PO 3 times a day Manual IV Infusions: * Available: 400mg tablets * Order: 1200mL to be infused over 6 hours. * Solve: how many tablets per dose? * Solve: how many gtt/min if the drop factor is 15 gtts 1mL? 1 Tablet 800 mg x =D 2 Tablets Volume Drop 1200 mL 15 gtts =L - - 400 mg X - X - x - 50 gtts/min Time (min) factor 360 min 1 mL  lOMoARcPSD|22650627 17 PAIN Pfi MANAGEMENT IT lit FEET IF. - Physiology of Pain: - Factors That Influence Pain: O 1 Age * Transduction: - * Infants can't verbalize pain. * Conversion of painful stimuli to electrical O 2 Cognitive function impulse. * Patients with cognitive impairment may * Transmission: - have difficulty verbalizing pain. * Electric impulse travels along nerve fiber. y 3 Fatigue * Perception: s 4 Genetic sensitivity - * Awareness of pain in the brain. 5 Anxiety or fear * Modulation: - o 6 Culture: * Muscle reflexes that move the body away * Influences people's meaning of pain. from painful stimuli. * Pain threshold: point at which someone feels J Patients at Risk for Pain Under-Treatment: = pain. * Pain tolerance: amount of pain someone can * Older adults stand. * Patients with substance abuse disorders. * Children Types of Pain: * Infants 1 Chronic: Non-pharmacological Pain * Ongoing, lasting over 6 months. Management: 2 Acute: * Relaxation * Temporary, has a direct cause, often * Guided imagery alters vital signs. * Distraction 3 Nociceptive: * Music * Caused by tissue damage, localized. * Cutaneous stimulation: heat. ice, etc. 4 Neuropathic: * Acupuncture, acupressure. * Caused by damaged pain nerves. - Pain Assessment: T e Pharmacological Pain Management: 1 Non-opioid analgesics: * Heart rate, respiratory rate, blood pressure, * Ex- acetaminophen and muscle tension may be increased. * Monitor liver function * Expected behaviors include restlessness, * Take with food O 2 Opioids: guarding, crying, grimacing, decreased - attention span. * Ex- morphine * Used to manage acute, severe pain *Ask: * Consistent timing of administration is * Location and feeling of pain? important * Rate pain on scale of l-10? * Monitor: * When did it start? * Respiratory depression * Is it constant or intermittent? * Sedation * What makes it better? * Urinary retention * What makes it worse? * Orthostatic hypotension * Vomiting * Constipation ⇐±i÷⇐÷ lOMoARcPSD|22650627 18 Activity RELIENT and E. iii. Mobility EREMITE - J Exercise and Activity: Pathological Influences on Activity: * Important for maintaining health. * Treatment for chronic illnesses. - 1 Disorders involving bones, joints, and * Enhances functioning of all body systems. muscles: - * Osteoporosis: reduction of bone mass. - Assessment of Activity: * Osteomalacia: inadequate bone * Assess body alignment and posture. calcification. * Ask if patient has any muscle or joint pain. * Arthritis: inflammation in joints. * Ask if patient has shortness of breath or * Joint degeneration chest pain during activity. 2 Damage to the central nervous system: * Ask how often the patient exercises. * Paralysis 3 Musculoskeletal trauma: Effects of Exercise: * Broken bones * Increased cardiac output and stronger Maintaining Mobility: : contractions * Improved venous return * Stretching exercises * Improved alveolar ventilation * Active Range of motion exercises * Improved basic metabolic rate * Low-intensity walking. * Improved muscle tone * Improved tolerance to physical activity Assistive Devices for Walking: * Reduced bone loss 1 Walker: * Improved stress tolerance * Provides stability * Patient steps. Moves Walker forward, - Transfer and Positioning: then steps again. * Use mechanical lifts or teams when patient is unable to assist.. 2 Cane: * RN should widen stance for more stability. * Cane goes on the stronger side of the * RN should lower their center of gravity. body. * RN should Face the direction of movement. * Patient moves cane forward, steps forward with weaker leg, then stronger leg. T Activity and Chronic Illness: o 3 Crutches: o - 1 Hypertension: * Usually for temporary use. A - * Exercise reduces blood pressure. * Position the grips so bodyweight isn't on o 2 Coronary Heart Disease: - * Reduced mortality and morbidity GE armpits * Crutches can be used with a 2-point or o * Improved ventricular function * Increased functional ability 3 COPD: - Qb swing-through gait. * When ascending stairs: step up with unaffected leg, then crutches and * Helps to lessen progressive deconditioning affected leg follows. that causes dyspnea. * When descending stairs: crutches are O 4 Diabetes - : placed on the stair below, affected leg * Improved glucose control and lower blood follows, then unaffected leg. sugar levels.  lOMoARcPSD|22650627 19 Oxygenation EB.EgqtoE.mhghamaaa.at THEY Eta ftp.EHMMMII.ae Baotou Litman ¥= J E F¥iE Physiological Impacts on Oxygen Therapy: Oxygenation: 1 Low-Flow Oxygen Delivery: - * Nasal cannula: 1 Decreased oxygen carrying capacity: - * Delivers 1-6 L / Min, 24-44 % * Ex: anemia, carbon monoxide poisoning. * Assess Patency of nose o 2 Hypovolemia: - * Assess for skin breakdown * Reduced blood volume (dehydration, shock). O * Simple Face Mask: 3 Decreased inspired oxygen: - - * Delivers 5-8 L / Min, 40-60% * Ex: airway obstruction. O * Assess for proper seal and fit 4 Increased metabolic rate: - * Assess For skin breakdown * Ex: pregnancy, wound healing, exercise. * Partial Rebreather Mask: = Changes in Respiratory Function: * Delivers 6-10 L / Min, 40-70% * Reservoir bag should not completely deflate. - 1 Hyperventilation: * Non-rebreather mask: * Rapid respirations causing exhalation of - * Delivers 10-15 L / Min, 60-100% excessive amounts of carbon dioxide. * Frequently assess valve function 2 Hyperventilation: * Inadequate oxygen intake. 2 High-Flow Oxygen Delivery: 3 Hypoxia: * Venturi mask : * Inadequate tissue oxygenation * Delivers 4- 12 L / Min, 24-50% * Life-threatening * Assess flow rate and ensure tubing Pneumothorax: Air in the pleural space. is free of kinks. * Aerosol Mask: Hemothorax: Blood and fluid in the pleural * Face tent, tracheostomy collar - space. * Delivers at at least 10 L / min * High humidification Lifestyle Factors: - Incentive Spirometry: o * Nutrition * Substance abuse * Exercise * Stress * Promotes deep breathing * Smoking * Prevents postoperative respiratory complications. o Pulse Oximetry: - Pursed-Lip Breathing: * Measures oxygen saturation in blood. * Measure when patient is experiencing: * Deep inspiration and extended exhalation * Wheezing * Prevents alveolar collapse * Coughing * Cyanosis * Changes in respiratory rate IT T Diaphragmatic Breathing: * Normal finding = 95-100 % * Improves breathing efficiency * Values may be lower in older adults and * Focuses on breathing more with the patients with COPD. diaphragm and less with the accessory muscles.  lOMoARcPSD|22650627 20 NUTRITION www.pogzt.BE iBaFBFEAm NUTRITION imma. - Units of Nutrition: - Nutrition Assessment: - 1 Carbohydrates: * Dietary History: * body's main source of energy. - * What patient eats in a day * Ex: whole grain bread, potatoes, brown rice, * Fluid intake etc. * Allergies O 2 Proteins: - * Appetite * Growth, maintenance, and repair of tissue. * Religious and cultural restrictions * Ex: beef, whole milk, poultry, etc. * Activity levels ← 3 Fats: * Most calorie dense * Clinical Measurements: - * Provides vitamins and energy. * Height and weight 4 Water: * Skin fold measurements * Critical for cell function. * Lab values (cholesterol, electrolytes, etc.) 5 Vitamins: * BMI: * Necessary for metabolism. Underweight < 18.5 6 Minerals: *Essential for biochemical reactions in body. Normal 18.5 - .9 Overweight -29.9 Factors Affecting Nutrition: Obese 30-34.9 * Financial Status: Extremely Obese > 35 * Low income patients may not have access to nutrient-dense foods. Therapeutic Diets: * Appetite: * Clear liquid: clear fruit juice, gelatin, broth. # * Can increase or decrease with illness, # medication, and pain. * Full liquid: clear liquid plus liquid dairy. # * Age: * Puree: liquids plus pureed meats, fruit, and T eggs. - * Affects nutritional requirements. * Religion and culture: * Mechanical: liquid and diced /ground foods. z * High fiber: whole grains, fruits. - * Some cultural practices influence food choices. * Low sodium: no added salt, under 2g sodium. * Low cholesterol: less than 300 Mg / day. TL Eating Disorders: *=Diabetic: Balanced intake of carbs, proteins, and fats. O 1 Anorexia: - * Dysphagia: thickened liquid, pureed food. * Consistent restriction of caloric intake. - * Intense fear of gaining weight. O 2 Bulimia: - J Recording Input and Output: * Recurrent cycle of binge eating and * Important for patients with fluid and purging. electrolyte imbalances. O 3 Binge-Eating Disorder: - * Weigh patients: * Repeated episodes of binge eating. * Same time of day * Lack of control. * After voiding * Wearing the same type of clothing.  lOMoARcPSD|22650627 21 FIFI Electrolyte FEIFFER THEImbalances Hyponatremia: Na < 135 Hypernatremia: Na > 145 Causes: * Fluid loss * Heart failure Causes: * Diabetes insipidus * Fluid losses * Hyperglycemia * Diuretics * Heat stroke * Inadequate sodium intake * Dehydration * Increased ECF volume * Sodium retention Symptoms: * Headache * Hypothermia Symptoms: * Hyperthermia * Confusion * Tachycardia * Tachycardia * Dizziness * Nausea * Thirst * Lethargy * Edema * Restlessness Hypokalemia: K < 3.5 Hyperkalemia: K > 5.0 Causes: * Vomiting Causes: * Sepsis * uncontrolled * Bulimia * Diarrhea * Corticosteroids * Trauma diabetes * Gastric suctioning * Kidney failure * Dehydration * Osmotic diuretics * Metabolic acidosis Symptoms: * Hyperthermia * Weakness Symptoms: * Irregular pulse * Abdominal * Weak pulse * Muscle cramps * Irritability cramps * Hypotension * Flattening T-Waves * Parenthesis * V-fib * Respiratory distress * Decreased reflexes Hypocalcemia: Ca < 9.0 Hypercalcemia: Ca > 10.5 Causes: * Diarrhea * Hypothyroidism Causes: * Bone cancer * Pancreatitis * Alcoholism * Hypothyroidism * Malabsorption * Prolonged Immobilization * Vitamin D Deficiency * Glucocorticoid use Symptoms: * Numbness Symptoms: * Bone pain * Prolonged QT * Heart dysthymia * Tingling interval * Constipation * Anorexia * Muscle spasms * Weakness * weak Pulse * Deceased reflexes Hypomagnesemia: Mg < 1.3 Hypermagnesemia: Mg > 2.1 Causes: * Diarrhea * Alcoholism Causes: * Gastric suction * Kidney failure * Thiazide diuretics * Low adrenal function * Malnutrition * Laxatives containing Mg Symptoms: * Tatany * Dysrhythmias Symptoms: * Seizures * Tachycardia * Muscle paralysis * Coma * Hypotension * Cardiac arrest * Hypoactive bowel * Hypertension * Decreased respiratory rate  lOMoARcPSD|22650627 22 Skin EE EFF EA and Wound Care ¥i¥÷¥¥¥¥ - Stages of Wound Healing: - Pressure Wound Staging: FIE o 1 Inflammatory Phase: - * Stage 1: * Lasts 3-6 days after injury - * Skin intact, but non-blanchable * Vasoconstriction and WBCs in the area. * Appears reddened