leadership 2017 Flashcard

Managing Client Care: Intervention for Incorrect Transfer Technique Ch 1 CENTER OF GR AVITY ●● The center of gravity is the center of a mass. ●● Weight is a quantity of matter on which the force of gravity acts. ●● To lift an object, it is essential to overcome the weight of the object and to know the center of gravity of the object. ●● When the human body is in the upright position, the center of gravity is the pelvis. ●● When an individual moves, the center of gravity shifts. ●● The closer the line of gravity is to the center of the base of support, the more stable the individual is. ●● To lower the center of gravity, bend the hips and knees. ●● Spread your feet apart to lower your center of gravity and broaden your base of support. This results in greater stability and balance. LI FTING ●● Use the major muscle groups to prevent back strain, and tighten the abdominal muscles to increase support to the back muscles. ●● Distribute your weight between the large muscles of the arms and legs to decrease the strain on any one muscle group and to avoid strain on smaller muscles. ●● When lifting an object from the floor, flex your hips, knees, and back. Bring the object to thigh level, bending your knees and keeping your back straight. Stand up while holding the object as close as possible to your body, bringing the load to the center of gravity to increase stability and decrease back strain. ●● Use assistive devices whenever possible and seek assistance whenever you need it. PUSHING OR PULLING When pushing or pulling a load: ●● Widen your base of support. ●● When opportunity allows, pull objects toward the center of gravity rather than pushing them away. ●● If pushing, move your front foot forward and, if pulling, move your rear leg back to promote stability. ●● Face the direction of movement when moving a client. ●● Use your own body as a counterweight when pushing or pulling to make the movement easier. ●● Sliding, rolling, and pushing require less energy than lifting and offer less risk for injury. ●● Avoid twisting your thoracic spine and bending your back while your hips and knees are straight. When standing for long periods of time, flex your hips and knees by using a footrest. When sitting for long periods of time, keep your knees slightly higher thany our hips. ●● Avoid repetitive movements of the hands, wrists, and shoulders. Take a break every 15 to 20 min to flex and stretch joints and muscles. ●● Avoid twisting your spine or bending at the waist (flexion) to minimize the risk for inju Professional Responsibilities: Treatment Decisions Ch3 ... 00:50 01:33 Coordinating Client Care: Determining Need for Referral to Occupational Therapist Chp. 2 Job: assess and plan for the client to regain ADLs, esp motor skills of the upper extremities; direct care of occupational therapy assistants Refer to when: ex- client has difficulties using an eating utensil with dominate hand following a stroke Prioritizing Postpartum Care for a Group of Clients Chp. 1 ... Professional Responsibilities: Decision Making in End-of-Life Care Chp. 3 ... Respiratory Diagnostic Procedures: Assessing Client's Chp 17, informed consent Informed consent is a legal process by which a client has given written permission for a procedure or treatment to be performed. Consent is considered to be informed when the client has been provided with and understands the following. ◯◯ Reason the treatment or procedure is needed ◯◯ How the treatment or procedure will benefit the client ◯◯ Risks involved if the client chooses to receive the treatment or procedure ◯◯ Other options to treat the problem, including the option of not treating the problem ◯◯ Risk involved if the client chooses no treatment ●● The nurse's role in the informed consent process is to witness the client's signature on the informed consent form and to ensure that informed consent has been appropriately obtained. ●● The nurse should seek the assistance of an interpreter if the client does not speak and understand the language used by the provider. INFORMED CONSENT GUIDELINES Consent is required for all care given in a health care facility. For most aspects of nursing care, implied consent is adequate. The client provides implied consent when she complies with the instructions provided by the nurse. For example, the nurse is preparing to administer a TB skin test, and the client holds out her arm for the nurse. ●● For an invasive procedure or surgery, the client is required to provide written consent. ●● State laws regulate who is able to give informed consent. Laws vary regarding age limitations and emergencies. Nurses are responsible for knowing the laws in the state of practice. ●● The nurse must verify that consent is informed and witness the client sign the consent form. Signing an informed consent form ●● The form for informed consent must be signed by a competent adult. ◯◯ Emancipated minors (minors who are independent from their parents, such as a married minor) can provide informed consent for themselves. ●● The person who signs the form must be capable of understanding the information provided by the health care professional who will be providing the service. The person must be able to fully communicate in return with the health care professional. ●● When the person giving the informed consent is unable to communicate due to a language barrier or hearing impairment, a trained medical interpreter must be provided. Many health care agencies contract with professional interpreters who have additional skills in medical terminology to assist with providing information. Individuals authorized to grant consent for another person ●● Parent of a minor ●● Legal guardian ●● Court‑specified representative ●● Client's health care surrogate (individual who has the client's durable power of attorney for health care/health care proxy) ●● Spouse or closest available relative (state laws vary) INFOR MED CONSENT RES PONSIBILITIES PROVIDER: Obtains informed consent. To do so, the provider must give the client the following ●● Complete description of the treatment/procedure ●● Description of the professionals who will be performing and participating in the treatment ●● Description of the potential harm, pain, and/or discomfort that might occur ●● Options for other treatments ●● The right to refuse treatment ●● Risk involved if the client chooses no treatment CLIENT: Gives informed consent. To give informed consent, the client must do the following. ●● Give it voluntarily (no coercion involved). ●● Be competent and of legal age or be an emancipated minor. (If the client is unable to provide consent, an authorized person must give consent). ●● Receive sufficient information to make a decision based on an informed understanding of what is expected. NURSE ●● Witnesses informed consent. The nurse is responsible for the following. ◯◯ Ensuring that the provider gave the client the necessary information ◯◯ Ensuring that the client understood the information and is competent to give informed consent ◯◯ Having the client sign the informed consent document ◯◯ Notifying the provider if the client has more questions or does not understand any of the information provided. (The provider is then responsible for giving clarification.) ●● The nurse documents the following. ◯◯ Reinforcement of information originally given by the provider ◯◯ That questions the client had were forwarded to the provider ◯◯ Use of an interpreter Professional Responsibilities: Action to Take for a Chemically Impaired Nurse Ch 3 ... Understanding of Pulmonary Function Tests Chp 17 Pulmonary function tests (PFTs) determine lung function and breathing difficulties. ●● PFTs measure lung volumes and capacities, diffusion capacity, gas exchange, flow rates, and airway resistance, along with distribution of ventilation. ●● Helpful in identifying clients who have lung disease. ●● Commonly performed for clients who have dyspnea. ●● Can be performed before surgical procedures to identify clients who have respiratory risks. ●● If client is smoker, instruct client not to smoke 6 to 8 hr prior to testing. ●● If a client uses inhalers, withhold 4 to 6 hr prior to testing. (This can vary according to facility policy.) Pulmonary function tests (PFTs) are the most accurate tests for diagnosing asthma and its severity. ◯◯ Forced vital capacity (FVC) is the volume of air exhaled from full inhalation to full exhalation. ◯◯ Forced expiratory volume in the first second (FEV1) is the volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest full inhalation. ◯◯ Peak expiratory flow is the fastest airflow rate reached during exhalation. ◯◯ A decrease in FEV1 by 15% to 20% below the expected value is common in clients who have asthma. An increase in these values by 12% following the administration of bronchodilators is diagnostic for asthma. ●● A chest x‑ray is used to diagnose changes in chest structure over time. Coordinating Client Care: Discharge Planning for Client Who Has Diabetes Mellitus Ch 2 CLIENT EDUCATION ●● Teach the client that exercise and good nutrition are necessary for preventing or controlling diabetes. ◯◯ Carbohydrates: 45% of total daily intake ◯◯ Protein: 15% to 20% of total daily intake, depending upon kidney function ◯◯ Unsaturated and polyunsaturated fats: 20% to 35% of total daily intake ●● Consistency in the amount of food consumed and regularity in meal times promotes blood glucose control. ●● Encourage a diet low in saturated fats to decrease low‑density lipoprotein (LDL), assist with weight loss for secondary prevention of diabetes, and reduce risk of heart disease. ●● Modify the client's diet to include omega‑3 fatty acids and fiber to lower cholesterol, improve blood glucose for clients who have diabetes, for secondary prevention of diabetes, and to reduce the risk of heart disease. ●● Encourage physical activity at least three times per week. oral meds ◯◯ Take with food to decrease adverse GI effects. ◯◯ Instruct the client to take vitamin B12 and folic acid supplements. ◯◯ Contact the provider if manifestations of lactic acidosis develop (myalgia, sluggishness, somnolence, and hyperventilation). ◯◯ May be taken during pregnancy for gestational diabetes. ◯◯ Never crush or chew the medication. ●● Inspect feet daily. Wash feet daily with mild soap and warm water. Test water temperature with hands before washing feet. ●● Pat feet dry gently, especially between the toes, and avoid lotions between toes to decrease excess moisture and prevent infection. ●● Use mild foot powder (powder with cornstarch) on sweaty feet. ●● Do not use commercial remedies for the removal of calluses or corns, which can increase the risk for tissue injury and infection. ●● Consult a podiatrist. ●● The best time to perform nail care is after a bath/ shower, when toenails are soft and easier to trim. ●● Separate overlapping toes with cotton or lamb's wool. ●● Avoid open‑toe, open‑heel shoes. Leather shoes are preferred to plastic. Wear shoes that fit correctly. Wear slippers with soles. Do not go barefoot. ●● Wear clean, absorbent socks or stockings that are made of cotton or wool and have not been mended. ●● Do not use hot water bottles or heating pads to warm feet. Wear socks for warmth. ●● Avoid prolonged sitting, standing, and crossing of legs. ●● Teach the client to follow facility policies or recommendations of a podiatrist for nail care. Some protocols allow for trimming toenails straight across with clippers and filing edges with an emery board or nail file to prevent soft tissue injury. If clippers or scissors are contraindicated, the client should file the nails straight across. ●● Teach the client to cleanse cuts with warm water and mild soap, gently dry, and apply a dry dressing. Instruct the client to monitor healing and to seek intervention promptly. Medical and Surgical Asepsis: Evaluating Sterile Technique Ch10 Wash for at least 15 seconds to remove transient flora and up to 2 min when hands are more soiled. After washing, dry hands with a clean paper towel before turning off the faucet. If the sink does not have foot or knee pedals for turning off the water, use a clean, dry paper towel to turn off the faucet(s). ●● For hand hygiene with an alcohol‑based product, dispense the manufacturer's recommended amount (usually 3 to 5 mL) in the palm of the hand. Rub hands together vigorously, remembering to cover all surfaces of both hands and fingers. Maintaining a Safe Environment: Teaching Newly Licensed Nurse on Restraint Protocol Ch 4 The prescription allows only 4 hr of restraints for an adult, 2 hr for clients ages 9 to 17, and 1 hr for clients younger than 9 years of age. Providers may renew these prescriptions with a maximum of 24 consecutive hours. ◯◯ Providers cannot write PRN prescriptions for restraints. Explain the need for the restraints to the client and family, emphasizing that the restraints keep the client safe and are temporary. ●● Ask the client or guardian to sign a consent form. ●● Review the manufacturer's instructions for correct application. ◯◯ Assess skin integrity, and provide skin care according to the facility's protocol, usually every 2 hr. ◯◯ Offer food and fluid. ◯◯ Provide a means for hygiene and elimination. ◯◯ Monitor vital signs. ◯◯ Offer range‑of‑motion exercises of extremities. ●● Pad bony prominences to prevent skin breakdown. ●● Use a quick‑release knot (loose knot that is easy to remove) to tie the restraints to the bed frame where they will not tighten when raising or lowering the bed. ●● Make sure the restraints are loose enough for range of motion and that there is enough room to fit two fingers between the restraints and the client. ●● Remove or replace restraints frequently to ensure good circulation to the area and allow for full range of motion to the limbs. ●● Conduct an ongoing evaluation of the client. ●● Regularly determine the need to continue using the restraints. ●● Never leave the client alone without the restraints. DOCUMENT ●● Precipitating events and behavior of the client prior to seclusion or restraints ●● Alternative actions to avoid seclusion or restraints ●● Time of application and removal of the restraints ●● Type of restraints and location ●● The client's behavior while in restraints ●● Type and frequency of care (range of motion, neurosensory checks, removal, integumentary checks) ●● Condition of the body part in restraints ●● The client's response at removal of the restraints ●● Medication administration bioterrorism, ch 5 look for those notes with anthrax etc Facility Protocols: Emergency Evacuation of Clients Ch5 ... Communicable Diseases, Disasters, and Bioterrorism: Reportable Infectious Diseases Ch 6 ... Medical and Surgical Asepsis: Evaluating Sterile Technique Ch 10 PRACTICES THAT MAINTAIN A STERILE FIELD Prolonged exposure to airborne micro‑organisms can make sterile items nonsterile. ●● Avoid coughing, sneezing, and talking directly over a sterile field. ●● Advise clients to avoid sudden movements, refrain from touching supplies, drapes, or the nurse's gloves and gown, and avoid coughing, sneezing, or talking over a sterile field. Only sterile items may be in a sterile field. ●● The outer wrappings and 1‑inch edges of packaging that contains sterile items are not sterile. The inner surface of the sterile drape or kit, except for that 1‑inch border around the edges, is the sterile field to which other sterile items may be added. To position the field on the table surface, grasp the 1‑inch border before donning sterile gloves. Discard any object that comes into contact with the 1‑inch border. ●● Touch sterile materials only with sterile gloves. ●● Consider any object held below the waist or above the chest contaminated. ●● Sterile materials may touch other sterile surfaces or materials; however, contact with nonsterile materials at any time contaminates a sterile area, no matter how short the contact. Microbes can move by gravity from a nonsterile item to a sterile item. ●● Do not reach across or above a sterile field. ●● Do not turn your back on a sterile field. ●● Hold items to add to a sterile field at a minimum of 6 inches above the field. Any sterile, non-waterproof wrapper that comes in contact with moisture becomes nonsterile by a wicking action that allows microbes to travel rapidly from a nonsterile surface to the sterile surface. ●● Keep all surfaces dry. ●● Discard any sterile packages that are torn, punctured, or wet. NURSING INTERVENTIONS EQUIP MENT ●● Select a clean area above waist level in the client's environment (a bedside stand) to set up the sterile field. ●● Check that all sterile packages (additional dressings, sterile bowl, sterile gloves, and solution) are dry and intact and have a future expiration date. Any chemical tape must show the appropriate color change. ●● Make sure an appropriate waste receptacle is nearby. PR OCEDURE Perform hand hygiene. STERILE FIELD SETUP ●● Open the covering of the package per the manufacturer's directions, slipping the package onto the center of the workspace with the top flap of the wrapper opening away from the body. ●● Grasp the tip of the top flap of the package, and with arm positioned away from the sterile field, unfold the top flap away from body. ●● Next, open the side flaps, using the right hand for the right flap and the left hand for the left flap. ●● Grasp the last flap and turn it down toward the body. FUNDAMENTALS FOR NURSING CHAPTER 10 Medical and Surgical Asepsis 47 ADDITIONAL STERILE PACKAGES ●● Open next to the sterile field by holding the bottom edge with one hand and pulling back on the top flap with the other hand. Place the packages that will be used last furthest from the sterile field; open these first. ●● Add them directly to the sterile field. Lift the package from the dry surface, holding it 15 cm (6 in) above the sterile field, pulling the two surfaces apart, and dropping it onto the sterile field. POUR STERILE SOLUTIONS ●● Removing the bottle cap. ●● Placing the bottle cap face up on a clean (nonsterile) surface. ●● Holding the bottle with the label in the palm of the hand so that the solution does not run down the label. ●● First pouring a small amount (1 to 2 mL) of the solution into an available receptacle. ●● Pouring the solution (without splashing) onto the dressing or site without touching the bottle to the site. STERILE GLOVES ●● Once the sterile field is set up, don sterile gloves. ●● Sterile gloving includes opening the wrapper and handling only the outside of the wrapper. Don gloves by using the following steps. ●● With the cuff side pointing toward the body, use the nondominant hand and pick up the dominant‑hand glove by grasping the folded bottom edge of the cuff and lifting it up and away from the wrapper. ●● While picking up the edge of the cuff, pull the dominant glove onto the hand. ●● With the sterile dominant‑gloved hand, place the fingers of the dominant hand inside the cuff of the nondominant glove, lifting it off the wrapper and putting the nondominant hand into it. ●● When both hands are gloved, adjust the fingers. ●● During that time, only a sterile gloved hand may touch the other sterile gloved hand. ●● At the close of the sterile procedure or if the gloves tear, remove the gloves. Take them off by grasping the outer part of one glove at the cuff area, avoiding touching the wrist and pulling the glove down over the fingers and into the hand that is still gloved. Then, place the ungloved hand inside the soiled glove and pull the glove off so that it is inside out and only the clean inside part is exposed. Discard into an appropriate receptacle. Tuberculosis: Discharge Teaching With Client Ch 23 Observe for hepatotoxicity. ●● Assess for history of gout, as the medication will cause an adverse effect of nongouty polyarthralgias. ●● Liver enzymes should be completed baseline and every 2 weeks after starting PZA. CLIENT EDUCATION ●● Instruct the client to drink a glass of water with each dose and increase fluids during the day to help prevent gout and kidney problems. ●● Advise the client to immediately report yellowing of the skin, pain or swelling of joints, loss of appetite, or malaise. ●● Advise the client to avoid using alcohol while taking pyrazinamide. ethambutol Instruct the client to report changes in vision immediately. streptomycin Advise the client to drink at least 2 L of fluid daily. ●● Advise the client to notify the provider if hearing declines. Provide the client and family education because TB is often treated in the home setting. ●● Airborne precautions are not needed in the home setting because family members have already been exposed. ●● Exposed family members should be tested for TB. ●● Educate the client and family to continue medication therapy for its full duration of 6 to 12 months, even up to 2 years for multidrug‑resistant TB. Emphasize that failure to take the medications can lead to a resistant strain of TB. ●● Instruct the client to continue with follow‑up care for 1 full year. ●● Inform the client that sputum samples are needed every 2 to 4 weeks to monitor therapy effectiveness. Clients are no longer considered infectious after three consecutive negative sputum cultures, and may return to former employment. ●● Encourage proper hand hygiene. ●● Instruct the client to cover mouth and nose when coughing or sneezing.