Fundamentals of Nursing Full COMPREHENSIVE STUDY GUIDE

Fundamentals of Nursing Important concepts • Levels of health care - Preventative health care focuses on educating and equipping clients to reduce and control risk factors of disease. Examples include programs that promote immunization, stress management, and seat belt use. - Primary health emphasizes health promotion, and includes prenatal and wellbaby care, nutrition counseling, and disease control. This level of care is based on a sustained partnership between the client and the provider. Examples include office or clinic visits and scheduled school or work-centered screenings (Vision, hearing, obesity). - Secondary health care includes the diagnosis and treatment of emergency, acute illness, or injury. Examples include care that is given in hospital settings (inpatient and emergency departments), diagnostic centers, or emergent care centers. - Tertiary health care involves the provision or specialized highly technical care. Examples include oncology centers and burn centers. - Restorative health care involves intermediate follow up care for restoring health. Examples include home health care, rehabilitation centers, and in-home respite care. • Nursing ethical principles o Autonomy - Ability of the client to make personal decisions, even when those decisions may not be in the clients own best interest. o Beneficence - Agreement that the care given is in the best interest of the client; taking positive actions to help others. o Fidelity - Agreement to keep ones promise to the client about care that was offered. o Justice - Fair treatment in matters related to physical and psychosocial care and use of resources. o Nonmaleficience - Avoidance of harm or pain as much as possible when giving treatments. o Veracity - It is the basis of the trust relationship established between a patient and a health care provider. • Ethical decision making in nursing o Ethical dilemmas are problems about which more than one choice can be made and the choice made is influenced by the values and beliefs of the decision makers. These are common in health care, and nurses must be prepared to apply ethical theory and decision making to ethical problems. o A problem is an ethical dilemma if: - It cannot be solved by a review of scientific data. - It involves a conflict between two moral imperatives. - The answer will have a profound effect on the situation/client.  The nurses basic code of ethics and principles remains constant. These basic principles include: o Advocacy - Support of the cause of the client regarding health, safety, and personal rights o Responsibility - Willingness to respect obligations and follow through on promises o Accountability - Ability to answer for one’s own actions o Confidentiality - Protection of privacy without diminishing access to quality care. • Intentional torts o Assault - The conduct of one person makes another person fearful and apprehensive (Threatening to place a nasogastric tube in a client who is refusing to eat). o Battery - Intentional and wrongful physical contact with a person that involves an injury or offensive contact (restraining a client and administering an injection against his/her wishes). o False imprisonment - A person is confined or restrained against his will (Using restraints on a competent client to prevent his leaving the care facility). • Unintentional torts (didn’t intend to harm patient but you did) o Negligence - A nurse fails to implement safety measures for a client who has been identified as at risk for falls. o Malpractice (Professional negligence) - A nurse administers a large dose of medication due to a calculation error. The client has a cardiac arrest and dies. • Informed Consent o Responsibility of the provider  Communicate purpose of procedure, and complete description of procedure in the patients primary language (use medical interpreter if needed, NOT family member).  Explain Risks vs. benefits  Describe other options to treat the condition. o Responsibility of the RN:  Make sure provider gave the patient the above information.  Ensure patient is competent to give informed consent (i.e. patient is an adult or emancipated minor, not impaired)  Have patient sign consent document • If pt has further questions call provider and have them come back and explain things further BEFORE they sign the form • Patient Education o Assessment: identify patient needs, learning style (auditory, visual, kinesthetic), abilities, available recources. o Planning: develop mutually agreeable goals/outcomes. o Implemmentation: DO NOT use medical jargon. Make sure materials are at a sixth grade level (or below). o Evaluation: ask patient to explain the teaching in their own words, or have the patient do a return demonstration for psychomotor learning. o DO NOT perform patient teaching when client is: in pain or has anxiety, or is in any way mentally impaired. • Advance Directives o Living will: communicates patients wishes regarding medical treatment if patient becomes incapacitated. o Durable power of attorney (health care proxy): patient designates health care proxy to make medical decisions for them if they become incapacitated. o Provider’s orders: prescription for DNR (do not resuscitate) or AND (allow natural death) o Mandatory Reporting for RNs:  Suspicion of abuse (child, elderly, domestic violence)  Communicable diseases to local/state health department (mandated by state). • Nursing Documentation o Objective data: what you see, hear, smell. Do not include opinions or interpretations of data. o Recording subjective data: document as direct quotes, or clearly identify information as a statement by patient. o Legal guidelines for documentation:  Don’t leave blank spaces in documentation.  Never use correction tape or fluid or scratch out or black out words  Include name and title on documentation • Incident reports o When accident occurs (falls or med error)  Used for quality improvement for facility (for hospital) o Not part of the patients records and should not be referenced in the patients record  Need to document the incident and patient’s reaction and incidence report is for the hospital not for the patient’s medical record • Telephone Orders and Information Security o Telephone orders: have second RN listen in on call, repeat prescription back, make sure provider signs prescription within 24 hour. o After provider says the order you FIRST want to read back the order to the provider, To ensure it is accurate. • Information security o HIPAA: ensures the confidentiality of health information only those responsible for patient’s care may access the patient’s medical record.  Don’t use patient names on public display boards  Communication about a patient should happen in a private place or at nursing station.  Password protect and do not share passwords  Log off or lock computer when you walk away  Do not share information with unauthorized people o Code system can be used  If pt doesn’t want to tell anyone they are at the hospital • Delegation (VERY IMPORTANT) • DO NOT DELGATE WHAT YOU CAN EAT; (Evaluate, Asses, Teach) o What RN has to do  Patient education  Nursing judgement  Assessment  Blood transfusions  Unstable patients o What a PN can do (LPN)  Med admin  Enteral feedings  Urinary catheter insertion  Suctioning  Trach care  Wound care  Reinforce patient teaching you (RN) have already done  Can care for STABLE patients o What a NAP/UAP/CAN  Bathing  Dressing  Ambulating  Toileting  Feeding without swallowing precautions  Positioning  Vitals  Specimens  I+Os  Basic CPR o 5 Rights to Delegation  Right task • Repetitive noninvasive and not a lot of supervision  Right circumstances • Do not assign a patient who is unstable  Right patient • Competent and within their scope of practice  Right direction and communication • Specific details and timeline for completion and expectation for reporting findings back to you  Right supervision and evaluation • May need to intervene • Provide feedback • Nursing process: o Assessment and data collection:  What do you see, hear, feel?  Collect objective and subjective data  Verify that the data you collected is clear and accurate  Do assessment BEFORE action. o Analysis and data collection:  What are priority problems?  Interpret the information collected  Identify an appropriate Nursing Diagnosis  Document your diagnosis and communicate it to the healthcare team  Determine the health team’s ability to help  Cluster collected data  Any patterns and trends  Compare data you gathered from baseline