NRN-46 Theory Exam #1 PDF

EXAM #1: NRN-46 Theory Week 2 - Professional Identity 1. List and define the NHS Core Values (Comportment, Competence, Caring, Collaboration, and Curiosity) Comportment: portraying professionalism; acting appropriately in professional set...

EXAM #1: NRN-46 Theory Week 2 - Professional Identity 1. List and define the NHS Core Values (Comportment, Competence, Caring, Collaboration, and Curiosity) Comportment: portraying professionalism; acting appropriately in professional settings Competence: the ability to do something successfully or efficiently Caring: displaying kindness and concern for others. Collaboration: the action of working with the multidisciplinary team to produce or create something; teamwork Curiosity: question everything; question why is this the way it is → prevents errors 2. Explore the concept of professional identity as it relates to registered nursing practice. The behaviors of a registered nurse is presented through comportment and professionalism: - Knowledge on medical terms and language - Ability of effective communication - Using Clinical Judgment - Continuing education! (EVIDENCE-BASED PRACTICE) 3. Identify and use behaviors consistent with being a professional nurse (e.g., reflection, boundary-setting with clients). Professional Identity: setting boundaries with clients, therapeutic relationships, self-reflection, and appropriate patient education. 4. Describe and define ethical principles and ethical dilemmas. Ethical dilemmas: Those situations in which a choice must be made between two options. Neither option is perceived as an ethically responsible solution. A solution is realized through thought and discussion. - Ex: truth vs loyalty Ethical Principles (7): - Autonomy: What does the patient want? Ability to accomplish patient care goals. - Veracity: Honesty - Fidelity: Keeping one’s promise. - Nonmaleficence: AVOIDING doing harm  - Beneficence : Doing good. Patients best interest - Justice: Fairness or equal distribution of benefits - Advocacy: Advocate for patient 5. Explore the concept of professional identity as it relates to registered nursing practice. The behaviors of a registered nurse is presented through comportment and professionalism: - Knowledge on medical terms and language - Ability of effective communication - Using Clinical Judgment - Continuing education! (EVIDENCE-BASED PRACTICE) 6. Identify and use behaviors consistent with being a professional nurse (e.g., reflection, boundary-setting with clients). Professional Identity: setting boundaries with clients, therapeutic relationships, self-reflection, and appropriate patient education. 7. Describe and define ethical principles and ethical dilemmas. Ethical dilemmas: Those situations in which a choice must be made between two options. Neither option is perceived as an ethically responsible solution. A solution is realized through thought and discussion. - Ex: truth vs loyalty Ethical Principles (7): - Autonomy: What does the patient want? Ability to accomplish patient care goals. - Veracity: Honesty - Fidelity: Keeping one’s promise. - Nonmaleficence: AVOIDING doing harm - Beneficence : Doing good. Patients best interest - Justice: Fairness or equal distribution of benefits - Advocacy: Advocate for patient 8. Apply ethical principles to client care situations, e.g., autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity. (NRN 110)  Ethical Principles in Client Care Situations AUTONOMY Client’s right to REFUSE care, medication, etc. ADVOCACY Reporting critical changes in the client’s condition; speaking up for the client Do no harm! An example of a nurse demonstrating this BENEFICENCE ethical principle is by holding a dying patient's hand Nurses are accountable for their nursing care and other FIDELITY actions. They must accept all of the professional and personal consequences that can occur as the result of their actions. JUSTICE Caring for a patient regardless of age, gender, religion, culture, etc. NONMALEFICENCE Always double check dosage calculation with another nurse A patient with cancer comes in with his/her daughter, the VERACITY daughter states, “I don’t want my mom to know she has cancer, she cannot handle it.” 9. Explain the purpose and the key elements of the ANA Code of Ethics and the American Hospital Association’s Patient Care Partnership. → KNOW EXAMPLES -The Code of Ethics for Nurses with Interpretive Statements (The Code) was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession -Code of Ethics has been a guide and reference for registered nurses since its development in the 1950s. It serves as a moral compass to promote high levels of care, an ethical standard for those entering the nursing profession, and a commitment to society affirming the responsibilities of the registered nurse  10. Describe the registered nursing scope of practice with reference to the California Nurse Practice Act. The California Nurse Practice Act defines the responsibilities and scope of practice of registered nurses in the state of California. The Nurse Practice Act is based on state regulation and should be related to the Board of Nursing for that specific state. -The NPA is very specific on what you can and cannot do as a nurse, it is STATE LEVEL, therefore differs from state to state. -Nurses must verify informed consent is signed by the patient and is aware of the risk/ procedure explained by the physician. -RN scope of practice is typically defined by the Nurse Practice Act and governed by the Board of Registered Nursing Federal Law includes: -EMTALA -HIPAA -Affordable Care Act -Patient Self-Determination Act 11. Compare the roles and responsibilities of interprofessional healthcare team members. UAP: Do NOT perform assessments and tasks that require critical thinking or judgment → Can perform ADLs, Hygiene, Linen change, V/S on stable clients ONLY, I&Os, Positioning LVN: Reinforce what the RN has already done, never FIRST → Monitor RN findings, reinforce pt education, routine procedures, care for STABLE clients only, med administration (except IV), ostomy care, tube feedings, focused assessments RN: First to assess and implement ALWAYS → Clinical assessment, initial and discharge client education, clinical judgment, initiate blood transfusions, IVs, care for UNSTABLE clients - PHYSICIANS CAN DELEGATE TO MEDICAL ASSISTANT - CHARGE NURSE TO THE NURSES → time management → delegation of tasks with APPROPRIATE use of scope of practice  12. Cite the qualities of effective nurse leaders. - Week 3 Health Care Law/Ethics 1. Define and describe the concept of health care law and health care policy. - Healthcare Law:This is a reference to overall bodies of rules and regulations with which American industries are required to remain in compliance. Most educational institutions do not view this as a single cohesive area of study, but as an umbrella term for a number of specialized fields. These relevant areas of specialized expertise include public healthcare, occupational healthcare, bioethics, infectious disease control, global healthcare and more. - Healthcare Policy: This is a reference to specific rules and regulations, which are meant to achieve (or prevent) Specific goals or outcome -- or, to prevent one -- regarding the larger scope of public healthcare regulation. These are actual rules and guidelines meant to bring an organization or government initiative to specific ends. They may be maintained as legal measures by the United States government at the local, state or federal level, or they may be implemented by a company or organization with regard to its own practices. In the latter case, this is usually the result of that organization adhering to the government's public safety guidelines, and overall legal requirements. 1. Describe types of communication used by professional nurses. (general overview in ATI module) Verbal Communication – The ability to speak clearly, concisely, and effectively communicate a point. Non-Verbal Communication – The ability to communicate with patients, family members, and colleagues without speaking, through eye contact, body language, and posture. Written Communication – Being able to write clearly, concisely, and in an easy to understand manner using correct language, spelling, and grammar. - 2. Describe and cite examples of therapeutic communication techniques: - Silence, active listening, open-ended questions vs. focused or specific questions clarifying techniques: (restating, reflecting, paraphrasing, exploring), offering general leads, giving broad opening statements, showing acceptance and  recognition, focusing, giving information, presenting reality, summarizing, offering self, and touch. - 3. Describe and cite examples of non-therapeutic communication: - asking closed-ended questions, asking irrelevant personal questions, offering personal opinions, giving advice, giving false reassurance, minimizing feelings, changing the topic, asking why questions,making value judgments, excessive questioning, responding approvingly/disapprovingly, making assumptions, social responses, cliché’s (stereotypical responses) - 5. Describe the components of the SBAR technique as an example of professional communication. HIPAA Health Insurance Portability Accountability Act - Federal law - Access medical records to patients you are assigned to  1. Notice risk factors for impaired glucose regulation. - Obesity - Age - Diet - Genetics - Sedentary lifestyles 2. Recognize when an individual has compromised glucose regulation. - Hypoglycemia - confusion - heart palpitations - shakiness - Anxiety - Sweating - Hyperglycemia - polyuria - polydipsia - polyphagia - weight loss - blurred vision Diabetes - Hemoglobin A1C (HgB A1C): hemoglobin molecules bound to glucose molecules; used as a diagnostic measure of average daily blood glucose levels in the monitoring and diagnosing of diabetes (POSITIVE RESULT of diabetes: 6.5+ HgB A1C) - Fasting blood sugar test: sugar less than 100 mg/dL is normal; 126 mg/dL or higher on - OGTT >200 - Random >200 2 SEPARATE TESTS is a positive result for diabetes KNOW HOW TO PROVIDE CLIENT EDUCATION (RIGHT/WRONG ANSWER) “More teaching”→ wrong answer 3. Compare and contrast clinical manifestations of hyperglycemia vs. hypoglycemia. - HYPERGLYCEMIA: HOT & DRY SUGAR IS HIGH  - Sympathetic nervous system activated → tachycardia, diaphoresis, polyuria, polydipsia, polyphagia, blurred vision, unintentional weight loss - HYPOGLYCEMIA: COLD & CLAMMY NEEDS SOME CANDY - Sympathetic nervous system activated → tachycardia, shaking, sweating, confusion, headache, irritability, nervousness, dizziness, hunger 4. Identify values, nursing implications, and client teaching points for diagnostic tests necessary for the management of Diabetes Mellitus; fasting and random serum glucose testing, HbA1C, urine ketones. DIAGNOSTIC LABS FOR DIABETES MELLITUS GTT “TOLERANCE” RANDOM FASTING HgB A1C Test with syrupy glucose NORMAL 70-100 (115) UNDER 100 UNDER 140 UNDER 5.7 PRE-DM X 100-125 140-199 5.7-6.4 DM 200+ 126+ 200+ 6.5+ When a patient has uncontrolled diabetes; the patient is susceptible to: → neuropathy, nephropathy, retinopathy: Neuropathy - damage to the nerves leading to pain and burning sensation, affects hands, feet, hands, legs, Nephropathy - damage to the kidneys Retinopathy - damage to the eyes  - Low to moderate level: A ketone level of 0.6 mmol/L to 1.5 mmol/L is considered a low to moderate amount and may increase your risk of ketoacidosis. - High level: A ketone level of 1.6 to 2.9 mmol/L is considered a high level\of ketones which means you need to see a healthcare professional, especially if you have diabetes. → KETOACIDOSIS RISK!!!← - 5. Provide appropriate nursing and collaborative interventions to optimize glucose regulation. - provide client teaching - Encourage healthy diet - Encourage active lifestyle - Educating patients on eating a healthy diet with plenty of fruit and vegetables, referring clients to a dietician for further diet teaching. 6. Teach clients how to manage diet and exercise to maintain glucose control goals with awareness of the client's unique characteristics (family dynamics, culture and spirituality) - Support from family - Show importance of maintaining glucose regulation Nutrition 1. Recognize when an individual is experiencing inadequate nutrition - Poor wound healing, changes in skin hydration status, brittle hair & nails - Severe weight loss, lack of appetite - Scaphoid abdomen - Fatigue, weakness from anemia - Vitamin B12 and C deficiency, mouth ulcers Indicators for poor nutrition include: - Weights - Labs: Lab test good to resource to indicate of malnutrition- #1-prealbumin as it gives you current protein status Risk factors for poor nutrition: - No access to resources - Medical conditions: dumping syndrome - anxiety/depressed  - 2. Provide appropriate nursing and collaborative interventions to optimize nutrition for clients across the lifespan. - Assess swallowing* - Encourage and provide oral care and oral intake - Use clock-method to help visually-impaired individuals feed themselves - Eat a balanced diet (balanced nutrition) - Incorporate their food preferences 3. Recognize inadequate nutrition by a. Using lab tests such as albumin, prealbumin, glucose, HgB A1C, lipid profile, electrolytes; hgb/hct. Using anthropometric measurements, physical assessment findings, and nutritional screening tools (e.g., Mini Nutritional Assessment) PREALBUMIN: more sensitive (half-life 2-4 days) → short term impairment ALBUMIN: long term impairment (last months worth) 4. Provide appropriate nursing and collaborative interventions to optimize nutrition including patient education. ANEMIA: a condition that develops when your blood produces a lower-than-normal amount of healthy red blood cells. -low serum albumin is more likely associated with anemia, increase in serum albumin concentration is also associated with rapid improvement in anemia. Best foods for anemia (high-iron diet): - Dark leafy greens, red meat and poultry, liver, seafood, fortified foods, beans, nuts, legumes, and seeds Perfusion 1. Define and describe the concept of perfusion. Perfusion is a normal physiological process that requires the heart to generate sufficient cardiac output to transport blood through patent blood vessels for distribution in the tissues throughout the body. Thus maintaining cardiovascular health is essential to optimal perfusion. - Perfusion is the flow of blood through the arteries and capillaries to deliver nutrients to the cells ❤️ - Cardiac Output = Heart Rate x Stroke Volume ❤️ - Pre-load: vol. of blood received by the → “stretch” - After-load: resistance the has to overcome to eject blood → “squeeze” - High pressure in the body = blood cannot be delivered effectively (ex. atherosclerosis, plaque build-up)  Normal Systolic