NURS 211LFINAL EXAM REVIEW.

NURS 211LFINAL EXAM REVIEW. BEST DOCUMENT FOR EXAM FINAL EXAM REVIEW ETHICS: Evidence based practice (examples, definition) - Using clinical expertise and guidelines - Using the best data available to make pt. care decisions and to implement pt. care - Ex. ensure proper body mechanics, no more stripping chest tubes (milking is ok), no more suctioning with normal saline, no clamping chest tubes - Increase in technology and research makes it important that all nurses be active in the learning/education process Using ethics in communication with patients - Evaluate pt.’s ability to see and hear - Assess affect of stress when speaking with the pt. and/or family - High stress decreases the ability to process information - Consider cultural and educational factors in the learning process - Provide direct, consistent communication in language that is readily understandable to the pt. and family member - If you don’t know an answer to a question, admit it and instruct the family that you will find the answer - It’s your responsibility to assure the patient/family member has the information needed to make informed decisions regarding care - Communication with non-English speaking patients - Use an interpreter for non-English speaking patients - It is NOT okay to use the family as a means for translation - You could use a translating guide, AP, or whatever else the hospital offers but don’t ask family to translate for you! Priorities with SBAR communication - Introduce self and department before giving out patient information - National Patient Safety Goals for Communication of Care - Read back standard orders (labs, orders, medications) - Use of standard abbreviations - Timely and accurate reporting of critical lab results - Standardization of “Handoff Communication” - Measures to ensure concise communication with verbal and telephone orders - Ask for correct spellings if unsure - Spell out numbers when repeating back orders - Record a verbal order directly onto the physician order sheet - Restrict verbal/telephone orders - Include purpose of drug on the order sheet - Avoid “do not use” abbreviations to prevent errors Patient Teaching - Characteristics of adult learners - Adults value self-direction, are motivated to learn when they perceive that they have a need to learn, bring a variety of life experiences to the learning situation, learn best when they can apply knowledge immediately and learn how to problem solve - Factors in setting objectives and plan for teaching - Identify learning needs, learning style, readiness to learn, what they already know, what they want and need to learn, what they are capable of learning and what would be the best way to teach them - Teach patient when they are comfortable and not in pain - Make sure there are no distractions - If a patient can’t read, give them a visual or demonstration. DO not give reading materials - Use “window of opportunity” where patient states that they are ready to change - ex. “I better change or I’m dead” - Goals: SMART GOALS and always starts with “Patient will….” (no one cares about the nurse) - Evaluation of teaching - Ongoing appraisal of the patient’s learning progress - Use return demonstrations - Ask the patient to restate instructions - Ask questions - Ask the patient to solve a hypothetical situation - Choose the most active options such as patient with teach back or demonstrate Effects of Sleep Deprivation - In 48 HOURS OF SLEEP DEPRIVATION, behavioral changes begin to occur: DISORIENTATION, RESTLESSNESS, IRRITABILITY, AND SLURRED SPEECH - In 96 HOURS, psychotic behavior can develop: ATTEMPTING TO GET OUT OF BED, PULLING AT LINES, BECOMING VERBALLY OR PHYSICALLY ABUSIVE - Lack of REM sleep depresses the body’s defense mechanism and immune system so patient has INCREASED RISK FOR INFECTION Moral Distress - Causes - Occurs when a nurse feels that he or she has not done what a “good nurse” should have done in a difficult ethical situation - Can lead to burnout, emotional exhaustion, absenteeism, resignations, and more nurses leaving the profession - Nurses felt powerless, overwhelmed, frustrated, and fatigued when they could not resolve ethical issues - Treatment - 4 A’s to Rise Above Moral Distress - Ask what you are feeling to become aware that moral distress is present - Affirm your distress and your commitment to address moral distress - Assess the sources of your distress and make an action plan - Act to preserve your integrity and authenticity - Support each other—no gossip and back stabbing - Have the moral courage to address issues - Use the “chain of command” if necessary - Become involved in the Ethics Committee Ethical concepts - Utilitarianism: Moral rightness of an action is determined by its own consequences/”greater good” ex. Lying is ok if it outweighs the harms or use of triage system in battle—It depends on the outcome. - Deontological theory: Some actions are right or wrong regardless of their consequences - “Black and white” thinking - Believe in universal truth like “lying is always wrong” - Casuistry: Case by case reasoning - Ethics of Care Theory: Focuses on maintaining and restoring relationships among patients and their families - Virtue Ethics: Emphasize qualities of the caregiver - Universal Principles - Autonomy: Self-determination - It is violated when patient’s goals are not recognized - i.e. Veracity, fidelity, confidentiality, best interest, paternalism - ex. Informed consent - Assure that the patient receives all relevant information stated in a way they can understand - The nurse witnesses the patient’s signature - The patient has to be mentally competent and capable of giving their permission free of coercion - Patient Bill of Rights: Patient’s right to say no to care - Caregiver autonomy: Nurses have the right to not be involved in certain procedures if they deem it unethical - ex. Doctor-assisted suicide, abortion - Paternalism: “Doctor knows best” attitude - ex. Doctor or nurse withholds information that they think will be “upsetting” to the patient - Veracity: Truth-telling - Fidelity: Faithfulness to promises - Confidentiality: Keeping information private (HIPAA) - Beneficence: Promoting health and welfare of the patient and not just refraining from causing harm ex. Fall risk bracelet - Nonmaleficence: Obligation to refrain from harm—“do no harm”. If nurse can’t do any good, they can at least avoid hurting the patient - Nurse must be competent and knowledgeable - Double-edged sword: Morphine relieves pain but suppresses respirations and can cause death. As long as pain relief is the goal and not death, it is justified Justice: Treating all people fairly and equally - ex. Obamacare Negligence vs. Malpractice - Negligence: Basic care has not been met; “accident” - ex. Forgetting to put a patient’s bed down or forgot to give a med - Malpractice: Basic standards of care are not met; “intentional” - ex. You have the wrong medication or made a decision out of your scope of practice ETHICS QUESTIONS: 1. What is evidence-based practice? = Using evidence based guidelines and clinical expertise 2. Autonomy = Self-determination 3. Paternalism ex. = A doctor or health provider is making the best clinical judgment for the patient 4. Beneficence = Promoting good or no harm 5. Autonomy does not apply to clients who are = Drug-dependent, homicidal, or suicidal or if their choice infringe upon the rights and welfare of others 6. Pt. teaching to pt. that cannot read = Provide another means of teaching the pt. (Be creative!) 7. Family member that has a critically ill and they just arrived, what do you do = Tell them what’s going on RESPIRATORY: ABGs - ABG analysis - pH = 7.35-7.45 - CO2 = 35-45 - HCO3 = 22-26 - O2 = 80-100 - Reasons for abnormal ABGs and treatment - Respiratory alkalosis - Decrease PaCo2 and increase in pH - Causes: HYPERventilation (anxiety or pain), HIGH respiratory rate or tidal volume, stimulants, hypoxia, fever - S/SX: Rapid, deep respiration; paresthesia; lightheadedness; twitching; ANXIETY; fear - Treatment: Decrease HYPERventilation, decrease SIMV, decrease tidal volume - Respiratory acidosis – Increase PaCo2 and decrease pH - Causes: HYPOventilation (weak respiratory muscles), obstruction, pneumonia, chronic bronchitis, atelectasis, pneumothorax, emphysema, CNS depression, injury, disease (MG, Polio, ALS) - S/SX: Diaphoresis, headache, tachycardia, confusion, RESTLESSNESS, and apprehension - Treatment: Increase ventilation, intubation - Metabolic alkalosis – Increase bicarbonate and increase in pH - Causes: VOMITTING, NGT suctioning, too much soda for indigestion, diuretics - S/SX: Slow/shallow breathing, restlessness, convulsion - Treatment: Replace fluids and electrolytes - Metabolic acidosis – Decrease bicarbonate and decrease pH (ACID = ASS) - Causes: DIARRHEA, HCO3 depletion, Aspirin poisoning, renal fail, DKA - S/SX: RAPID DEEP RESP (KUSSMAUL), FRUITY BREATH, FATIGUE, N/V