NRS 2100 Final Review PDF

NRS 2100 Review Game We will divide into 6 groups of 3-4 students. Each group will have a color assigned to them, RED, BLUE, PURPLE, GREEN, BLACK or ORANGE. Each team will have 5 -10 minutes to review their colored slides, be able to have an answer for the ………. slots and be the “expert”...

NRS 2100 Review Game We will divide into 6 groups of 3-4 students. Each group will have a color assigned to them, RED, BLUE, PURPLE, GREEN, BLACK or ORANGE. Each team will have 5 -10 minutes to review their colored slides, be able to have an answer for the ………. slots and be the “expert” on that color.  1.VS and Critical Thinking VS: Are clinical measurements that include blood pressure, pulse, body temperature, respiration, and oxygen saturation. Normal VS ranges: BP (120/80), pulse (60-100 bpm), temp (36-38 C; 96.8-100.4), respiratory rate (12-20), pulse ox (95%-100%) Different ways of assessing pulses, temps, BP: dopplers, rectal, axillary route, forehead for temp, pulse ox on toe, ear lope, and fingernail Trending of VS -What would be an improvement, what would need interventions: BP (lifestyle changes, medications, low-sodium diet, stress-reduction, weight loss, keep upright, change positions slowly); pulse (monitor brady or tachycardia); temp (cool fluids, remove excess clothing, antipyretics, antibx, or antivirals, tepid bath); RR (monitor brady or tachypnea, supplement with O2); pulse ox (o2, monitor health conditions and signs of confusion or decrease in alertness) Which is most critical? Note trends, MEWs colors is a safety net Critical thinking-The skill of learning to analyze and interpret data to solve a problem to achieve a desired outcome. 2. Safety, Infection, and PPE Infection-Includes an infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Contact: occurs when microorganisms move from an infected person to another person. Droplet: occurs when airborne droplets from the respiratory tract of a client travel through the air and into the mucosa of a host. Airborne: occurs when small particulates move into the airspace of another person. Types of Precautions Standard: is a term used to describe the infection prevention practices applied to all clients, whether or not they are known to have an infectious agent. Gloves for any “wet” contact Contact : MRSA, VRE, CRE, ESBL, Lice Gown /Gloves Contact with Enteric : C Diff, Norovirus , Gown, Gloves/SOAP and Water Droplet: Flu, Pertussis, Bacterial Meningitis , Mask on RN, mask on patient if leaves room Airborne: Tb, Varicella, Shingles, Negative pressure room, N95 or PAPR, mask on RN, mask on patient when leaves room Protective : Protects client from us, is chemotherapy/bone marrow, Mask on RN, no flowers, fresh fruit, limited visitors , no sick visitors (2,000 WBC count or less) Infection 1. Incubation: An infection enters host and begins to multiply. 2. Prodromal: The client begins having symptoms. 3. Acute illness: Manifestations of the specific infectious disease process are obvious and may become severe. 4. Decline: Manifestations begin to wane as the degree of infectious disease decreases. 5. Convalescence: The client returns to a normal or a “new normal” state of health. 3.Best Practice: Hand Hygiene #1 DEC HAIs Wash hands in warm water ( not hot ) for 20 seconds with soap and water. Use a towel to turn off taps. Holds their hands below the elbows while rinsing off soap Alcohol-based hand sanitizer Run hands together for 20 seconds HAIs CAUTI, VAP, Pneumonia, CLABSI Not on arrival to hospital , acquired during stay, - indicates poor nursing care  3.Hygiene Allow clients to as much for themselves as possible (independently) Keep skin clean and dry: to prevent breakdown Soap and warm water is best (not hot), pat dry, NO Talc, NO cornstarch Perineal care is important, clean from front to back Think about YOUR back when doing a bed bath, raise bed up 2 siderails not 4 Hold dirty linen away from you Dentures in sink with a towel Do not shake or put dirty linen on floor Keep unconscious clients on their side: protect their airway Lower bed at end of bath  3.Mobility Look at orders first- what is weight-bearing status of client Ensure safety- make sure brakes are on before moving client Get enough assistance Do not use equipment you do not know how to use like a lift Sit and dangle/ wait first Use gait belt If client begins to fall, lower client to floor Document what you did and why? Location, type, length, skin condition with application, tolerance of the application 4. Communication and Documentation Communication is a competency that promotes openness in client care PIE: plan, implementation, evaluation DAR: data, action, response SOAP: subjective, objective, assessment, plan CBE: charting by exception ISBARR: introduction, situation, background, assessment, recommendation, readback FACT: factual, accurate, complete, timely Incident report: facts only, VS, notify provider, DO not put in accident Communication Barriers: language, education, health literacy, pain, noise, overwhelmed/emotional, clients who have hearing, vision, or cognitive losses, are unresponsive, aphasic, physical status, developmental age Solutions: interpreter, educational materials and instructions in the client’s language, minimize distractions, provide privacy, actively listen, allow for silence, clarify Interprofessional Team Members RT: respiratory therapist ST: speech therapist PT: physical therapist OT: occupational therapist SW: social worker CM: case management Wound RN: wound nurse Provider: MD, NP, PA EHR Benefits Improved communication for the whole healthcare team Can help with compliance of practice standard guidelines (fall risk /Pressure ulcer risk ) Can be read read anytime and anywhere Detriments Can be hacked Can go offline Can allow access to not needed areas 5. Nutrition and the Nursing Process Intake: fluid, food Output: stool, urine, drains 1 oz = 30 mL ½ cup = 4 oz 1 cup = 8 oz Clear liquids- water, tea, coffee Full liquids- milkshakes, ice cream, strained soups, pudding (foods that are typically liquid or turn to liquid at room temperature) Pureed- mashed potatoes, soup, yogurt (foods that are smooth and thick, and require little to no chewing) Soft Diet- eggs, applesauce, soup (foods easy to swallow and digest, and are usually low in fiber and soft in texture Advance as tolerated- if tolerated, clear liquids then they can advance diet to full liquid; a patient’s diet should be gradually progressed from restricted to soft/regular diet Label specimens at patient’s bedside at time of collection 6. Professional Practice Nursing Process Recognize cues: make assessment, gather all the data Analyze cues: sort data into priority list Prioritize the hypotheses: decide most important problem to fix first Plan to address main problem using SMART: specific, measurable, attainable, realistic, timely Implement: the plan into action Evaluate outcomes: decide if your plan worked or not worked BON And Nurse Practice Act Each state has a legislative process that passes a Nursing Practice Act Each state regulates and monitors the law set by the Nurse practice act Each RN must pass NCLEX to obtain first license in the state that they took their exam: All 50 states have same criteria for passing exam Every 2 years nursing must renew their license , showing CEUS/Competencies/certifications and lack of issues with authorities Can request additional licenses in other states if covered under the Compact Nursing License (COMPACT) Would have to apply and pay for the state in which they want to work additional fees.  7.Quality and Safety Falls Things that help reduce risks: non-slip socks, bed at lowest position, assistive devices, “call don’t fall” signs, position, potty assistance, possessions in reach, bed alarm, two rails up Home no floor rugs, cords behind furniture, raised toilet seats, grab bars in bathrooms and showers. Nonslip mat in bathtub Hinder safety – Hospitals- Cognitive issues/confusion/ violence/ harmful environment Home- poor footwear, backless shoes, loose slippers Safety PASS: pull pin, aim, squeeze, sweep RACE: rescue, activate alarm, confine fire, extinguish Run Hide Fight: active shooter protocol Fall safety: safety prevention Back safety: elevate bed when assisting patient  8.Advocacy and Health Policy Advocacy: use of your skills for the benefit of others Confidentiality: protecting personal identifiable info (HIPAA) Fidelity: doing what you say you are going to do, being faithful and keeping promises (ex: coming back) Responsibility: respect one’s professional obligations and follow through, maintain competence, asking for help when needed (ex: washing hands upon entering pt room) Chain of Command: LPN, RN, charge nurse, unit manager, house supervisor, chief nursing officer; for students: clinical instructor, school instructor, dept chair, dean Scope of Practice: allowed to do under licensure ANA: American Nurses Association AACN: American Association of College of Nursing- BSN essentials 9.Scholarship and Nursing Discipline Roles of Nurses Researcher – …………………………. Educator- ……………………….. Collaborator-……………………………  9.EBP Evidence Based Practice 17 theory gap analysis Discovery= Research EBP= Use of information from research and other sources to determine safe and effective nursing care with the goal of improving patient care and outcomes Performance Improvement = clinical practice guidelines, (ex: Plan Do Check Act (PDCA) Plan Do Study Act (PDSA) LEAN Six Sigma Focus Analyze Develop Execute (FADE) Continuous Quality Improvement (CQI) Total Quality Management (TQM)) Qualitative: RCT, experimental, correlational Quantitative: narrative, grounded theory, phenomenology, descriptive PICOT: patient population, implementation, comparison, outcome, time Levels of evidence: Level V11- Opinion/ Level 6 one study or qualitative, Level 1 Well designed random controlled trial (Best meta-analysis) 10.Client Education Cognitive: have patient list out what they learn Psychomotor: patient demonstrates what they have learned Affective: patient states how they feel about what was taught Positives: Negatives: Teach back: patient teaches what they have learned 11. Legal and Ethical Principles LEGAL Laws HIPPA: PHI (personal health info) includes name, age, insurance , payments , condition, PNH EMTALA: medical screening for each individual, MUST be cared for in 250 yards , Must have reason for transfer : specific and MUST have receiving MD, bed aval and report RN to RN before the client leaves Good Samaritan Act – Nurse provide care at scene of accident, Ok if they stay in their scope of practice Affordable Care Act- reduce health care disparities Legal Assault: verbal threats Battery: physical harm False Imprisonment: 4 side rails, restraints, keeping pt against their will if they want to leave Whistleblowing: reporting evidence or suspicion of wrongdoing Slander: saying something that you shouldn’t be saying– verbal defamation Negligence care falls below standard (not giving medication on time) Malpractice – type of negligence , needs 4 parts 1: duty to patient 2: failure in some part 3: harm is done 4: can be right in some way Ethics Beneficence: taking positive action to benefit the client; risks and benefits outweigh the risks (ex: vaccinations, chemo, surgery) Nonmaleficence: do no harm, avoid harm or hurt (ex: washing hands, being sober on shift, putting in lines to practice for residents) Justice: being fair, treating everyone the same especially during times with limited resources Autonomy: clients/patients have the right to make their own decisions (ex: DNR) Fidelity: doing what you say you going to do, being faithful and keeping promises (coming back after saying you would, being honest) Veracity: telling the truth despite the circumstances Code of Ethics- (COE) 12. DEI/Culture Assimilation: merged with dominant culture Cultural Bias: disparities in health care Tuskegee/Henrietta Lacks, native American mistrust Translator, clear sentences, RN faces patient, watch face and body language, use simple words, allow extra time. Documents translator ID. Do not use family friends who may speak some English LEARN Model: Listen, Explain, Acknowledge, Recommend, Negotiate 4 Cs: Call, Cope, Concerns, Cause FICA: faith, implications, influence, importance, community, address (how may these beliefs affect your healthcare