stable patients (could be complex also) and tasks that are routine, simple, repetitive, everyday
activities that don't require nursing judgment such as feeding, hygiene, ambulation - Answers what
tasks can NAP be assigned
Weakness - supervise/assist with balance/gait
Incontinence - provide aids/management and ensure hydration so other issues don't arise
Environment - ensure no hazards, ensure light, glasses and walk aids
Medication - pharmacist review, assess side effects
Confusion - have staff known to pt, reorientate
Impaired mental status - assess underlying causes, Ax1 with ADLs
Ambulation - Ax1/supervise
IVT - Ax1, get to buzz when needing to go somewhere
Visually impaired - Glasses, increase light - Answers Risks for Falls
-blood/body fluids
-toxic chemicals
-electrical hazards
-fire
-workplace violence
-injury to self and patients - Answers safety risks
1st Level = Airway, Breathing, Cardiac/Circulation (ABCs). Require immediate intervention.
2nd Level = Pain, urinary elimination, mental status change, untreated medical problems, lab value
changes, risk of infection, safety, security. Attended to immediately after first level priorities are met.
3rd Level = Problems that are important to the patient's health, but can be addressed after more
urgent health problems are tended to. - Answers Priorities in nursing
result from an electrical hazard or malfunction, disrepair, or misuse of equipment - Answers
equipment-related accidents
Determine patient's strong and weak sides
Always position the patient so that he or she transfers toward the strong side
Lock wheelchair locks and move footrests out of the way - Answers Wheelchair Transfers
Handwashing before and after patient care, sanitizing reusable equipment - Answers Preventing the
spread of infection
hand hygiene, sterile technique, sanitizing equipment - Answers ways to decrease healthcare-
associated infections
an area that is set up for certain procedures and is free from all organisms - Answers sterile field
sterile - Answers sterile touching sterile remains
contaminated - Answers sterile touching clean becomes
contaminated - Answers sterile touching contaminated becomes
sterile objects - Answers only ___________ ___________ may be placed on a sterile field
you find a tear or break in the covering of a sterile object - Answers sterile state is questionable when
contaminated - Answers a sterile object or field out of the range of vision or an object held below a
person's waist is:
contaminated - Answers the edges of a sterile field are considered
Alcohol hand sanitizer - Answers you may use this for hand hygiene when hands are not visibly soiled
needlestick injury - Answers an accidental puncture wound caused by a used hypodermic needle,
potentially transmitting an infection
Sitting position - Answers Position used during much of the physical examination including
examination of the head, neck, lungs, chest, back, breast, axilla, heart, vital signs, and upper
extremities
supine position - Answers lying on back, facing upward (used for assessing head and neck, anterior
thorax and lungs, breasts, axillae, heart, abdomen, extremities, pulses)
dorsal recumbent position - Answers lying on the back with the knees flexed (used for assessing head
and neck, anterior thorax and lungs, breasts, axillae, heart, abdomen)
lithotomy position - Answers lying on back with legs raised and feet in stirrups (used for assessing
female genitalia and genital tract)
Prone positioning - Answers the patient lies on the abdomen with the head turned to either side
(used for assessing musculoskeletal system)
, lateral recumbent position - Answers lying on side; right and left precede the term to indicate the
patient's side (used for assessing heart, rectum and vagina)
knee-chest position - Answers patient is lying face down with the hips bent so that the knees and
chest rest on the table (used for assessing rectum)
physiological - Answers 1st tier on Maslow's Hierarchy of Needs
breathing, food, water, sex, sleep, homeostasis, excretion
safety and security - Answers 2nd step of Maslow's hierarchy of needs
love and belonging - Answers 3rd tier on Maslow's Hierarchy of Needs
friendship, family, and sexual intimacy
self-esteem - Answers 4th step of Maslow's hierarchy of needs
self-actualization - Answers 5th step of maslow's hierarchy of needs
Therapeutic communication - Answers Verbal and nonverbal communication techniques that
encourage patients to express their feelings and to achieve a positive relationship.
critical thinking nursing - Answers -Purposeful, outcome-directed
-Essential to safe, competent, skillful nursing practice
-Based on principles of nursing process and the scientific method
-Requires specific knowledge, skills, and experience
-New nurses must question
-Guided by professional standards and ethic codes
-Requires strategies that maximize potential and compensate for problems
1) ACTIVE LISTENING - Shows clients that they have your undivided attention
2) OPEN-ENDED QUESTIONS - Used initially to encourage clients to tell their story in their own way.
Ask questions in a language that a client can understand
3) CLARIFYING - Questioning clients about specific details in greater depth or directing them toward
relevant parts of the history.
4) SUMMARIZING - Validates the accuracy of the story. - Answers therapeutic communication
techniques
caregiver, patient advocate, educator, decision maker, manager and coordinator, communicator -
Answers nursing responsibilities
• Are you allergic to any medications?
• Are you allergic to any foods, environmental substances (e.g., pollen or seasonal allergies), tape,
soaps, or cleansers?
• What specifically happens when you experience an allergy? - Answers questions to ask when
assessing for allergies
Nursing Process - Answers Assessment
Diagnosis
Planning
Implementation
Evaluation
Nursing Assessment - Answers systematic and continuous collection and analysis of information
about the client
Nursing Diagnosis - Answers used to evaluate the response of the whole person to actual or potential
health problems
Nursing Planning - Answers - the establishment of client goals/outcomes
- working with the client to prevent, reduce, or resolve problems
-to determine related nursing interventions that are most likely to assist client in achieving goals
-this about improving the quality of life for your patient
- this is about what the patient needs to do to improve their health status or better cope with illness.
Nursing Implementation - Answers Formally begins after a plan of care is developed. The nurse
initiates interventions that are designed to achieve the goals and expected outcomes needed to
support or improve the patient's health status.
Nursing Evaluation - Answers Involves measuring if goals in planning step were met: progress is
evaluated; changes in nursing diagnoses, goals & care plan may result; NA has keep role as NA's
observations are used for this step
urinary retention - Answers inability to empty the bladder