PN Comprehensive Predictor 2017 Remediation.

PN Comprehensive Predictor 2017 Topic Facts Professional Responsibilities: evaluating client understanding of advance directives and health care proxy - A durable power of attorney for health care/health care proxy is a legal document that designates a health care surrogate, who is an individual authorized to make health care decisions for a client who is unable to. - The person who serves the role of the health care surrogate will make decisions for the client and should be very familiar with the client’s wishes. - Living wills can be difficult to interpret, especially in the face of unexpected circumstances. A durable power of attorney for health care, as an adjunct to a living will, can be a more effective way of ensuring that the client’s decisions about health care are honored. Legal responsibilities: client advocacy - Understanding the laws governing nursing practice helps nurses protect clients’ rights and reduce the risk of nursing liability. - Nurses are accountable for protecting the rights of clients. Examples include informed consent, refusal of treatment, advance directives, confidentiality, and information security. - Nurses must ensure that clients understand their rights, and must protect their clients’ rights. Managing client care: requesting reassignment of a client - Assigning is performed in a downward or lateral manner with regard to members of the health care team. - The five major management functions are planning, organizing, staffing, directing, and controlling. - The 5 rights of delegation: right task, circumstance, person, direction and communication. Protecting the rights of a dying client - Nurses are accountable for protecting the rights of clients. Situations that require particular attention include informed consent, refusal of treatment, advance directives, confidentiality, and information security. - Nurses must ensure that clients understand their rights. Nurses also must protect clients’ rights during nursing care. - Regardless of the client’s age, nursing needs, or the setting in which care is provided, the basic tenants are the same. Bulimia Nervosa - Pt demonstrates high interest in preparing food, but not eating. - Binge eating and inappropriate compensatory behaviors both occur on average of once per week for 3 months. - Most pts who have bulimia nervosa maintain a weight within the normal range or slightly higher. Reporting client care issues to an interprofessional team - Nurse‑provider collaboration should be fostered to create a climate of mutual respect and collaborative practice. - Collaboration occurs among different levels of nurses and nurses with different areas of expertise. - Collaboration should also occur between the interprofessional team, the client, and the client’s family/significant others when an interprofessional plan of care is being developed. Managing client care: initial assessment - Give priority to clients who have a reasonable chance of survival with prompt intervention. Clients who have a limited likelihood of survival even with intense intervention are assigned the lowest priority. - Use this framework for situations in which health resources are extremely limited (mass casualty, disaster triage). - Look first for a safety risk. For example, is there a finding that suggests a risk for airway obstruction, hypoxia, bleeding, infection, or injury? Recommendations for time management - Nurses must continuously set and reset priorities in order to meet the needs of multiple clients and to maintain client safety. - Priority setting requires that decisions be made regarding the order in which; - Clients are seen. - Assessments are completed. - Interventions are provided. - Steps in a client procedure are completed. - Components of client care are completed. - Establishing priorities in nursing practice requires that the nurse make these decisions based on evidence obtained: - During shift reports and other communications with members of the health care team. - Through careful review of documents. - By continuously and accurately collecting client data. Maintaining client safety - Augments core measures and promotes patient safety through patient identification, effective staff communication, safe medication use, infection prevention, safety risk identification, and preventing wrong‑site surgery. - Nurses are accountable for practicing nursing in accordance with the various sources of law affecting nursing practice. It is important that nurses know and comply with these laws. - Avoid disclosing any client health information online. Be sure no one can overhear conversations about a client when speaking on the telephone. Client safety vs breach of confidentiality - The nurse should share information about the client, either verbal or written, only with those who are responsible for implementing the client’s treatment plan. - Only if the client provides consent should the nurse share information with other persons not involved in the client's treatment plan. - When a breach of duty has occurred, it may be characterized as malpractice. The following basic elements of nursing malpractice lawsuit must be present. - A duty to the client existed based on the recognized standards of care. - A breach of duty occurred. - The client was injured. - The injury was directly caused by the breach of a standard of care. Electroconvulsive therapy - ECT uses electrical current to induce a brief seizure activity while the client is anesthetized. The exact mechanism of ECT is still unknown. - One theory suggests that the seizure activity produced by ECT enhances the effects of neurotransmitters (serotonin, dopamine, and norepinephrine) in the brain. - At the time of the procedure, an anesthesia provider administers a short‑acting anesthetic (methohexital, propofol) via IV bolus. Obtaining a telephone prescription from a provider - Have a second nurse listen to a telephone prescription. - Repeat it back, making sure to include the medication’s name (spell if necessary), dosage, time, and route. - Question any prescription that seems inappropriate for the client. - Make sure the provider signs the prescription in person within the time frame the facility specifies, typically 24 hr. Emergency management of an evisceration - Protrusion of the abdominal contents through the incisional wound of the abdominal cavity, caused by failure to splint when moving or coughing, delayed healing due to obesity or diabetes mellitus. - Call for help. - Cover the wound with sterile saline soaked dressings or towel. - Position the client in semi‑Fowler’s position with hips and knees bent. Supplies to have available at the client’s bedside during a seizure. - Have suction ready. - Administer AEDs such as phenytoin, carbamazepine, valproic acid, or gabapentin. - Get oxygen ready. Assisting with a tub bath - Bathe clients to cleanse the body, stimulate circulation, provide relaxation, and enhance healing. - Bathing clients is often delegated to assistive personnel. However, the nurse is responsible for data collection and client care. - Bathe clients whose health problems have exhausted them or limited their mobility. Discharging clients in a mass casualty event - These differ from the principles of triage typically followed during provision of day-to-day services in an emergency or urgent care setting. - During mass casualty events, casualties are separated related to their potential for survival, and treatment is allocated accordingly. This type of triage is based on doing the greatest good for the greatest number of