Study Guide #2 Unit 1 Rn 31 PDF

Levels of disease prevention (primary, secondary, tertiary) Preventive health care focuses on educating and equipping clients to reduce and control risk factors for disease. Examples include programs that promote immunization, stress management, occupational health, and seat belt use. Primary healt...

Levels of disease prevention (primary, secondary, tertiary) Preventive health care focuses on educating and equipping clients to reduce and control risk factors for disease. Examples include programs that promote immunization, stress management, occupational health, and seat belt use. Primary health care emphasizes health promotion and includes prenatal and well-baby care, family planning, nutrition counseling, and disease control. This level of care is a sustained partnership between clients and providers. Examples include office or clinic visits, community health centers, and scheduled school- or work-centered screenings (vision, hearing, obesity). Secondary health care includes the diagnosis and treatment of acute illness and injury. Examples include care in hospital settings (inpatient and emergency departments), diagnostic centers, and urgent and emergent care centers. Tertiary health care, or acute care, involves the provision of specialized and highly technical care. Examples include intensive care, oncology centers, and burn centers. Restorative health care involves intermediate follow-up care for restoring health and promoting self-care. Examples include home health care, rehabilitation centers, and skilled nursing facilities. Continuing health care addresses long-term or chronic health care needs over a period of time. Examples include end-of-life care, palliative care, hospice, adult day care, assisted living, and in-home respite care. Primary prevention addresses the needs of healthy clients to promote health and prevent disease with specific protections. It decreases the risk of exposure individual/community to disease. Immunization programs Child car seat education Nutrition, fitness activities Health education in schools Secondary prevention focuses on identifying illness, providing treatment, and conducting activities that help prevent a worsening health status. Communicable disease screening, case finding Early detection, treatment of diabetes mellitus Exercise programs for older adults who are frail Tertiary prevention aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning. Begins after an injury or illness Prevention of pressure ulcers after spinal cord injury  Promoting independence after traumatic brain injury Referrals to support groups Rehabilitation center Routine physical examination: Generally, every 1 to 3 years for females and every 5 years for males from age 20 to 40, more often after age 40. Dental assessment: At least once a year. Tuberculosis screen: Tuberculosis (TB) screening for all health care personnel upon hire. TB tests are generally not needed for people who have a low risk of infection with TB bacteria. Higher risks include weak immune system and drug use. Health care workers should not be screened annually unless there is known exposure or ongoing transmission. Health care personnel with latent TB should be screened for manifestations annually. Blood pressure: Regularly at each health care visit and at home. Body mass index: At each routine health care visit. Blood cholesterol: Starting at age 20, a minimum of every 5 years. Blood glucose: Starting at age 45, a minimum of every 3 years. Visual acuity: Age 40 and under: every 3 to 5 years. Every 2 years ages 40 to 64. Every year 65 and older. Hearing acuity: Periodic hearing checks as needed; more frequently if hearing loss is noted. Skin assessment: Every 3 years by a skin specialist for age 20 to 40; annually over age 40 years. Digital rectal exam: During routine physical examination or annually if have at least a 10-year life expectancy. Consult with the provider if screen should continue after age 76. Colorectal screening: Every year between the age of 45 and 75 for high-sensitivity fecal occult blood testing, or flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years for individuals who are not at an increased risk of colorectal cancer. Consult with the provider if screen should continue after age 76. Tests specific for Women Cervical cancer screening: Ages 21 to 65 years: Papanicolaou test (Pap smear) every 3 years; at age 30, can decrease Pap screening to every 5 years if human papilloma virus screening performed as well. After age 65, no testing is needed if previous testing was normal and not high risk for cervical cancer. Breast cancer screening: Clients ages 40 to 44 years should have the choice to start annual mammography; ages 45-54: annual mammograms; ages 55 and older should have the choice to have a mammogram every 1 to 2 years. Tests specific for Men Clinical testicular examination: At each routine health care visit. Monthly testicular self-examination after puberty should be at the discretion of the client and provider based on client's risk factors for testicular cancer. Prostate-specific antigen test, digital rectal examination: Discuss starting this screening with the provider starting at age 55 years and continuing through age 69. It is  recommended that clients aged 70 and older do not receive prostate-specific antigen screening for prostate cancer. Modifiable and non-Modifiable risk factors Modifiable: can be changed ; controllables. Can take steps to change them. ~behaviors and actions that can affect a clients risk for developing a disease. *Majority of chronic diseases are controllable* examples: -diet -smoking -alcohol consumption -tobacco use -exercise -blood pressure -cholesterol -excess body weight Nonmodifiable: cannot be changed; non controllables examples: -age -environmental -genetics -sex -ethnicity -family history Hand hygiene principles Always use hand hygiene. Wash hands with an antimicrobial or plain soap and water, or use alcohol-based hand rub (gels, foams, and rinses; or performing a surgical scrub). The three essential components of handwashing are the following. ○ Soap ○ Running water ○ Friction All health care personnel must perform hand hygiene, either with an alcohol-based product or with soap and water, before and after every client contact, and after removing gloves. When hands are visibly soiled, after contact with body fluids, before eating, and after using the restroom, wash them with a nonantimicrobial or antimicrobial soap and water. It is also important for clients and visitors to practice hand hygiene.  Perform hand hygiene using recommended antiseptic solutions when caring for clients who are immunocompromised or have infections with multidrug-resistant or extremely virulent micro-organisms. Perform hand hygiene after contact with anything in clients’ rooms and after touching any contaminated items, whether or not gloves were worn, and before putting gloves on and after taking them off. Performing hand hygiene might be necessary between tasks and procedures on the same client to prevent cross-contamination of different body sites. Wash hands with soap and warm water: Place hands under running water. Add soap and rub hands together vigorously for at least 15 seconds to remove transient flora and up to 2 minutes when hands are more soiled. Rinse under running water. After washing, dry hands with a clean paper towel before turning off the faucet. If the sink does not have foot or knee pedals for turning off the water, use a clean, dry paper towel to turn off the faucet(s). For hand hygiene with an alcohol-based product, dispense the manufacturer’s recommended amount in the palm of the hand. Rub hands together vigorously, remembering to cover all surfaces of both hands and fingers. Continue to rub until both hands are completely dry. Taken from Fundamentals Nursing Edition - Chapter 10 Principles of Oral Care Proper oral hygiene helps decrease the risk of infection for clients living in long-term care facilities, especially from the transmission of pathogens that can cause pneumonia. Other populations who require meticulous oral hygiene include those who are seriously ill, injured, unconscious, dehydrated, or have an altered mental status or limited upper body mobility ○ Check for aspiration risk, impaired swallowing, and a decreased gag reflex. QS ○ Clients who have fragile oral mucosa require gentle brushing and flossing. ○ Have suction apparatus ready at the bedside when providing oral hygiene to clients who are unconscious to help prevent aspiration. Do not place your fingers into an unconscious client’s mouth because the client could bite down on your fingers. Position the client on one side with the head turned toward the mattress. This will allow fluid and oral secretions to collect in the dependent side of the client’s mouth and drain out. Perform denture care for clients who are unable to do so themselves. Dentures are very fragile, so handle them with care. ○ Remove the dentures with a gloved hand, and use a gauze over the hand. Pull down and out at the front of the upper denture, and lift up and out at the front of the lower denture. ○ Place the dentures in a denture cup, emesis basin, or on a washcloth in the sink. ○ Brush in a horizontal back-and-forth motion with a soft brush and denture cleaner. ○ Rinse dentures in tepid water. ○ Store the dentures in a denture cup. Label the cup with the client’s name. ○ Place the dentures in the cup with water to keep them moist and to help the client reinsert the dentures. Principles of bathing Personal hygiene needs vary with clients’ health status, social and cultural practices, and the daily routines they follow at home. For most clients, personal hygiene includes bathing, oral care, nail and foot care, perineal care, hair care, and shaving. Because personal hygiene has a profound effect on overall health, comfort, and well-being, it is an integral component of individualized nursing care plans. When clients become ill, have surgery, or are injured and are unable to manage their own personal hygiene needs, it becomes the nurse’s responsibility to meet those needs. Before beginning any personal care delivery, it is important to evaluate the client’s ability to participate in personal hygiene. Encourage clients to participate in any way they can. Integrate assessment, range-of-motion exercises, and dressing changes while providing hygiene care. Nursing Assessments Inspect the skin for color, hydration, texture, turgor, and any lesions or other impaired integrity. Check the condition of the gums and teeth for dryness or inflammation of the oral mucosa. Does the client report any pain? Assess the skin surfaces, including the feet and nails, and note the shape and size of each foot, any lesions, and areas of dryness or inflammation. Significant alterations can indicate neuropathy and/or vascular insufficiency. Are all pulses palpable and equal bilaterally? Identify hygiene preferences to understand how clients perform hygiene at home and what additional education and care to provide. Monitor for safety issues (altered positioning, decreased mobility) and the ability to participate in self-care. Alter the plan of care according to the client’s capabilities. Principles of perineal care It is important to maintain skin integrity to relieve discomfort and prevent transmission of infection (catheter care). Principles of perineal care Provide privacy. Maintain a professional demeanor. Remove any fecal material from the skin. Cleanse the perineal area from front to back (perineum to rectum). Dry thoroughly. Retract the foreskin of male clients to wash the tip of the penis, clean from the meatus outward in a circular motion, then replace the foreskin. Barriers to communication barriers can lead to misunderstandings and medical errors. Spanish, Mandarin, Cantonese, and Russian are all popular languages in the U.S. but are underrepresented in nurses having the ability to speak them. This communication barrier can lead to misunderstandings between the nurse and client regarding important health care decisions. ○ The use of a qualified medical interpreter is a strategy to overcome this communication barrier and, as of 2000, is mandated for any health care facility that receives federal funding (Medicare or Medicaid reimbursement). ○ Family members, especially those younger than 18 years, as well as nonprofessional phone apps should not be used as medical interpreters. Nonmedical persons may not fully understand what the nurse wants to translate to the client and provide information in error. ​Cognitive and developmental impairments can make it difficult for clients to exchange and understand information. These impairments can be related to another medical condition, such as dementia, stroke, or autism. Adverse effects from medications can cause cognitive deficits for some clients as well. Using uncomplicated words, avoiding medical terms, and speaking clearly at a slower pace may be helpful in communicating with clients who have barriers in any area. Providing a well-lit supportive environment with limited noise and other distractions can be beneficial. The nurse should be aware of the client's body language to determine if there is more to the message that the client cannot or is choosing not to communicate. Modes of communication Verbal communication commonly refers to oral communication. This mode can occur through face-to-face communications and via telephone. ○ Members of the baby boomer generation rely mostly on this mode of communication to convey messages. ○ Many health care facilities now use client portal health applications and text reminders rather than follow-up telephone calls. Depending on the age, culture, and socioeconomic background of the client, these electronic communication methods may be underused or viewed as lacking a personal connection Nonverbal communication is body language. Actions such as eye contact, facial gestures, posture, and overall appearance send messages to the receiver in addition to what the sender is saying. ○ Nonverbal cues can also lead to confusion and misunderstandings, depending on the sender’s competence with face-to-face interactions and the receiver’s ability to interpret. Electronic - mode includes email, texting, video conferencing, and social media. ○ This technology can allow healthcare team members to communicate with each other and their clients more efficiently, but also can lead to privacy violations, mistakes from typographic errors, and distractions.  ○ The Joint Commission has required the use of secure messaging when transmitting client information to help maintain client confidentiality and reduce Health Insurance Portability and Accountability Act (HIPAA) violations. The Health Insurance Portability and Accountability Act, also known as the Privacy Act, legislation is to protect insurance coverage and private information of clients. Its purpose is to protect client privacy and personal health information from security breaches, particularly electronic data. ○ According to the HIPAA Security Rule, any electronic communication containing PHI must have the following safeguards: each user must have a personalized login that can be monitored, the system must have an automatic logoff function if left unattended, and PHI sent as attachments must be indecipherable if intercepted. Written communication includes electronic communication and can be in the form of a letter, handwritten or typed, or an email or computer-based post. These modes of communication lack the nonverbal cues that face-to-face interactions possess, leading some users to view them as detached. ○ Literacy, language differences, and visual impairments may all present a barrier to effective written communication. Types of communication styles 1.Passive Persons who display a passive communication style have developed a pattern to avoid conflict, expressing feelings or opinions, or standing up for themselves when boundaries are crossed. example: “I’ll do whatever you want.” Even if they do not agree with the sender, they may fear going against the person or may lack the knowledge to suggest another option. 2.assertive -Assertive communicators are viewed as most effective because they communicate clearly and honestly. -Assertive communication is fundamental for good communication, mental health, and healthy relationships. 3. aggressive Assertive communication is fundamental for good communication, mental health, and healthy relationships. example: “It’s your fault the client fell. You never listen to me.” 4.passive-aggressive -appear passive only on the surface. Often, the individual is acting out anger in a subtle, indirect, or secretive way. -stems from feelings of powerlessness and resentment. -sarcasm or witty responses example: -nurse who is a passive-aggressive communicator might ignore a client who has pushed the call light several times or state they will do something and then not follow through. Novice to expert model Stage 1: Novice This initial stage covers nursing students and new nurses who have no previous experience. Novices cannot yet draw on their own judgment. The novice struggles to decide which tasks are most relevant in real-life situations. Stage 2: Advanced Beginner The advanced beginner has been involved in enough real-world situations to be able to recognize patterns and recurrent situations. A problem at this stage is that the focus is on remembering and following the rules and guidelines that have been taught. The advanced beginner needs clinical support to set priorities so that clients receive the care they need. Stage 3: Competent The competent nurse is able to prioritize tasks by drawing on past experiences. These nurses may not function with the same speed or ease of change as proficient nurses, but they have mastery in multiple areas. Competent nurses recognize patterns in clinical situations more quickly and accurately than advanced beginners can. Stage 4: Proficient The proficient nurse is able to understand the bigger picture or the desired outcome of situations, which facilitates improved decision making. Proficient nurses are able to respond to changing situations and modify plans in the face of different events. Stage 5: Expert The expert nurse has extensive experience and knowledge to draw from when responding to complex client conditions. At this stage, nurses have self-confidence and trust their intuitive sense of a situation. Expert nurses know what needs to be done and are able to perform it well. Professional vs unprofessional behavior Professionalism: is the actions, behaviors, and attitudes of an individual that are reflective of the core values, ethical principles, and regulatory guidelines of the profession. - requires not only understanding the standards of practice, but also possessing the knowledge and capability to identify a client’s need for further assessment or an obligation to report information. Example: a nurse acts with professionalism when they take the time to use technology or a certified medical translator with a client who speaks a language other than that of the nurse. Professionalism Cont. Nurses must be mindful of their surroundings, look for areas of improvement, and strive for an elevated level of individual professional practice. Unprofessional: refers to conduct that does not adhere to the standards of practice or the Code of Ethics. misconduct cited as “conduct unbecoming of a nurse” -Unprofessional behavior is misconduct often cited as “conduct unbecoming of a nurse,” which means to dishonor, disgrace, or harm the standing or reputation of the profession in the eyes of the public. The BON may investigate reports of inappropriate disclosures made on social media by a nurse based on any of the following. examples: Unprofessional conduct Unethical conduct Breach of confidentiality Mismanagement of client records Revealing privileged communication Moral turpitude (conduct that opposes community standards of honesty, justice, and good morals) Addictions: drugs or alcohol; diverting drugs either by taking the wasted portion, not administering drugs to clients, or removing excess amounts of as needed (PRN) medications Breaking the law: at work or outside of work Dual relationships: cheating Disruptive behavior: displaying anger, yelling, throwing things, making faces, gossiping, etc. Financial improprieties: selling items, taking or asking for money or gifts HIPAA or confidentiality violations: snooping; leaving a computer terminal unattended after logging on; releasing client information; photos, text, or social media with client content; disposing of client information improperly Inappropriate conduct: flirting, touching, asking for personal numbers or other contact information Irresponsible or lax supervision: putting client care aside, completing tasks unsafely Misrepresentation, falsification: lie to, swindle, or harm a client; use false statements in documentation Practicing with an expired license: working without a current or active license Practicing outside scope: performing duties that are not allowed by the scope of practice or the organization Sexual and nonsexual boundary violations: disclosing unnecessary personal information with the client; befriending the client on personal time; hugging, caressing, or kissing the client; exploiting the client Skeletal muscle function - Movement/motion - Organ protection - Posture/stability - Generate body heat  - Storage (minerals) - Produce - Support Pre-mobility assessments Principals of repositioning a client in bed - Postion clients, especially those who are unale to move themselves, so that they maintain good body alignment - Frequent position changes to prevent discomfort, contractures, pressure on tissues, and nerve and circulatory damage, and stimulate postural reflexesm and muscle tone - Use pillows, bath blankets, hand rolls, boots, splints, trochanter rolls, ankle support devices, and other aids to maintain proper body alignment - Positioning is the process of intentionally placing the body or a body part in a specific way. Proper positioning involves aligning the body in a neutral position, supporting the natural curves, and eliminating pressure points, hyperextension, or lateral rotation. Goals for client positioning and alignment consist of the two P’s: promotion and prevention. - Promotion: comfort, safety, dignity, privacy, participation, frequent position changes - Prevention: strain, injury, and skin breakdown  Maximum assistance: The client cannot bear weight, assist, or maintain a seated position. Use a total mechanical lift or sling. Moderate assistance: The client can maintain a seated position and has some upper extremity strength but lacks enough lower extremity strength to transfer safely. Use sit-to-stand powered lifts and assistive devices. Minimum assistance: The client can rise from a seated position and sustain a steady stand. Use a gait belt and ambulation assistive devices as indicated. No assistance: The client can stand, march or step in place, and walk without any help. Body mechanics - Coordination between the musculoskeletal and nervous system - Ergonomics: science that focuses on factors or qualities in an object’s design/use that contribute to comfort, safety, efficiency, and ease of use - Mechanics involve using muscles for balance, posture, and alignment, and lower the risk of injury - Center of gravity = the center of mass (for adults this is the pelvis) - Weight: quantity of matter on which force of gravity acts  - Use assistive devices for anything greater than 35 lbs QSEN competencies Safety- involves minimizing risk Example:good hand hygiene, needle safety, locking bed before transferring patient Informatics - involves a nurses ability to utilize technology as an information gathering tool Example- researching academic journals,showing patient an educational video about a skill they will perform Quality- improve process to better meet the patients and staffs needs Example- changing the discharge process to make it easier for both staff and patients Evidence based practice- making decisions based on research related to clinical practice Example: florence nightingale observing soldiers getting sicker in unhygenic conditions, and changing the practice around cleanliness Team work and collaboration- ability to function effectively within nursing and inter- professional teams, fostering open communication,mutual respect, and shared decision- making to achieve quality patient care. Patient centered care- example asking patient for their viewpoint and ideas when making decisions Example: asking the patient about their concerns about an intervention, asking what a patient prefers. Physiological effects of immobility Bones: Immobility reduces mechanical load and stress on bones contributing loss of mass density and strength.y Disuse osteoporosis- when bones become thinner and weaker as a result of bed rest, can lead to fragility fractures Muscle: immobility causes muscles to atrophy Atrophy causes: poor muscle coordination, reduced ability to perform ADL’s, weakness in legs after a few days of bedrest Joints: immobility causes changes in tissue tenison, elasticity and shape which leads to joint stiffness and decreased range of motion Connective tissue forming joints softens and weakens and cartilage detiorates Prolonged immobility cause abnormal tissue between joint spaces which restricts nourishment to joint Joint contractures- abnormal fixation of the joints that occur as a result of changes to muscle and connective tissue Limit range of motion,and may need surgical correction to restore range of motion Foot drop- type of joint contracture that results in a partial or total inability to pull the toes up toward the head (dorsiflexion). client is unable to place the heel on the floor, causing the toes to drag while walking. Cardiovascular effects- immobility after 24 hours leads to, body fluids redistributing to the head, abdomen, and chest areas due to gravity; this increases blood volume returning to the heart, releasing hormones to regulate fluid balance. Causes diuresis and dehydration, blood thickening, this causes lower circulating blood volume, causing heart atrophy also known as Cardiac deconditioning. Orthostatic hypotension- decrease in blood pressure and dizziness when pt sits or standing Due to reduced blood volume and cardiac deconditioning Increases fall risk Guidelines for orthostatic hypotension: systolic decrease of 20 mmhg or more OR diastolic decrease of 10mmhg or more Deep vein thrombosis:occurs when a thrombus or blood clot develops in one or more of the deep veins; typically in arms, pelvis, thighs, and lower legs Pulmonary embolism: The most serious complication of DVT, occurs when part of the thrombus breaks off and travels into the lungs via the bloodstream Respiratory system effects- immobility( especially with SUPINE) reduces the amnt of air exchanged and increases the risk of infection. Ateclasis: partial or complete collapse of the lungs, including airways and small sections of lung tissue. RESULT of SHALLOW BREATHING. Decreases number alveoli available to exchange O2 and CO2. Pneumonia- occurs in clients with limited mobility as a result of shallow breathing, thickened mucus, and decreased ability to cough. Gastrointestinal system effects decreased appetite and overall food intake, leading to vitamin and mineral deficiency and a reduced intake of calories, leading to INCREASED MORTALITY Slows peristalis, reduces mucosal ligning, constipation, fecal impaction. Genitourinary system effects supine bed rest increases the risk of incomplete emptying (urinary retention) Can lead to renal calculi(kidney stones) can lead to bacterial infection Integumentary system effects immobilitiy compresses the skin and tissue between the bone and the firm surface, restricting the flow of blood and lymph to those areas. Areas most susceptible to pressure wounds: back ofhe head, shoulder blades, elbows, sacrum, ischium, and heels, skin exposed to moisture from sweat, wound drainage, or incontinence. Pressure injury- localized damage or necrosis of the skin and/or underlying tissue. Physiological effects increased dependence on others Loss of privacy Inability to participate in work and hobbies Loss of self concept, self esteem, frustration, anxiety, depression Nursing roles (caretaker, researcher, etc...) - Care Provider: have been educated to provide knowledge, compassionate care to promote health/address illness, scientific foundation, critical thinking, safety, and evidence base nursing skills - Case Managers: a conduit between clients and the health care system, ensure clients receive the care they need to safely navigate the health care sister and to achieve a safe outcome, and afford clients the highest level of care through an interdisciplinary care plan - Leaders: individuals influence a group of other individuals to achieve a common goal - Researcher: evidence based practice that helps assure are receiving the best care - Educator: client education, nursing students, new nurses, etc. - Managers: assigned leadership role - Change agents: all nurses - Advocacy: pillar of nursing in which the nurse helps the client by making sure they receive the safety, care, and support that they deserve - Counseling - Change Management - Communication - Collaboration - Compassion - Honesty - Integrity The role of the Joint Commission - Recognizes health care delivery facilities for maintaining standards of excellence through accreditation ( ~20,000 hospitals accredited) - Best practices: authored the National Patient Safety Goals (#1 goal is to increase safety through confirming patient identity) - Publish information of sentinel events - An independent, nonprofit organization that accredits health care organizations in more than nine different types of health care settings.  - Monitors state legislative and regulatory changes and updates its standards accordingly Sentinel event - A patient safety event that results in death, permanent injury, or severe temporary harm. - Ex: administration of blood products with the incorrect blood type to a client, and infant death, and a srugical procedure performed on the incorrect arm or leg Patient satisfaction scoring system Acute care facilities use the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to measure client satisfaction. Before the HCAHPS tool became available, client satisfaction tools were not standardized and results were typically under-reported, leaving clients unable to compare one facility to another. Chain of command ​The chain of command confirms that the appropriate leaders, beginning with those closest to the level of the event, are notified and involved. A nurse can initiate the chain of command to make an immediate supervisor aware of a situation, communicate issues, or inform them that a process is outside or beyond their scope of practice or level of expertise/education. ○ A nurse caring for a client would take their concern to the charge nurse and escalate up the chain of command as needed. The nurse is required to document their efforts as they move along the chain of command.