Leadership Proctored 2023 with verified questions and answers

Leadership Styles authoritative, democratic, and laissez faire Authoritative Dictates the team, uses penalties and coercion. This leadership style is effective with those who have little or no form of education. "My way or the highway" Democratic Leader involves the team in decision making, which results in higher quality outcomes. This works with corporations and collaboration. Laissez-faire Leader provides little or no directions or planning, emphasis o group decision making, team results may be lacking due to lack of guidance and planning. Prioritization ABCDE airway Maintain patent airway. With head or neck trauma, secure their neck to prevent damage to cervical spine Breathing Assess patients respirations Circulation Assess HR, BP, cap refill (spo2?) Disability Assess your patients LOC Exposure Assess pts body for signs of trauma, exposure to extreme heat or cold. What would you do first before taking action? Assess patient Which patients are prioritized? Unstable patients Who not to prioritize Patients with expected findings Prioritize Acute vs chronic, because chronic took months to develop. Mass casualty event (MCE) Prioritize patients with higher chance of survival over pts who are expected to die Black Tag (MCI) Not expected to live or dead (class 4) Never delegate assessment, teaching, evaluation, blood transfusion LVN/LPN MED administration, enteral feeding, urinary cath insertion, Tracy care, suctioning, reinforce teaching, check NG tube patency CNA Bathing, feeding pts who don't have swallowing difficulties, dressing, ambulating, toileting, positioning, VS on stable pts, make beds, collect specimens, simple dressing change, suction established tracheostomy, document I&Os Five Rights of Delegation Right tasks (repetitive, non invasive, don't require supervision) Right circumstance (patient must be stable) Right person (CNA must be competent, operating within scope of practice) Right direction/communication (specified timeline and expected results) Right supervision/evaluation (if CNA or lpn is doing something wrong) Quality Improvement A process to improve the quality of care within a healthcare facility or team. Measures performance of a unit or team based on a predetermined set of standards. Quality Improvement First Step Establish best practice guidelines or standards of care (what is the goal?) Quality Improvement Second Step Collect data to determine what the nursing team is doing in comparison to the best practice guidelines Quality Improvement Third Step If the goal is not met, a root cause analysis can be done to determine why the team is not at the expected level, and what can be done to achieve the best practice guidelines for that team. Interpersonal Conflict conflict that occurs between two or more individuals Intrapersonal Conflict conflict that occurs within an individual Five Stages of Conflict Latent Perceived Conflict Felt Conflict Manifest Conflict Aftermath Latent Conflict No conflict exists yet, but there's a high chance it will occur Perceived Conflict When someone believe conflict exists but the other individual is unaware of the problem Felt Conflict When an individual has an emotional response to a conflict Manifest Conflict Both parties are aware of the conflict and they take action to resolve the conflict Conflict Aftermath Conflict is resolved, results could be negative or positive Avoiding/withdrawing Lose-lose situations; both parties refuse to acknowledge or work on the resolution of the problem Smoothing Attempting to keep peace by complementing the other party, but the conflict remains unresolved Completing/coercing Win-lose; only one party gets their desired resolution Cooperating/Accommodating One party sacrifices something, allowing the other party to get what it wants. This is the opposite of competing. The original problem might not actually be resolved. The solution can contribute to future conflict. This is a lose‑win solution. Compromising Both parties give up something and come to a compromise Collaborating Win-win; both parties work together and define a mutually agreeable solution Case manager Does not provide direct care; care coordinator to safely transition pt from acute care to home/long term care/skilled nursing facility. They arrange home health services, equipment for the pt, and help the transition. Occupational Therapist Help patient improve and recover so they can perform everyday tasks and ADLs. Speech language pathologist help patients who have problems related to swallowing, speech, and communication disorders Critical Pathway Used to promote cost effective care by standardizing care for patients WITH SPECIFIC COMMON DX Critical pathways are developed by using Evidence based strategies Time bounded activities Interventions and outcomes Consultation process in which two or more individuals with varying degrees of experience and expertise deliberate about a problem and its solution Referral a request from your primary care physician for services from a particular specialist Transferring A Patient SBAR PMH Advance directive status Code Allergies Recent VS LOC Swallowing abilities Discharge Discharge planning & pt teaching start at admission Discharge Instructions Diet & activity restrictions Instructions for at home procedures List and schedule for meds MED precaution/side effects When to call provider/emergency Informed consent (provider) Responsible for explaining the purpose of the procedure, as well as a detailed description of the procedure, risks and benefits, and alternative options for the procedure (in pts language) Informed consent (nurse) Responsible for making sure the provider has given the pt the necessary information, and that the patient is competent to give consent and has signed the document. Advance directives Living will; contains pt wishes in terms of medical care durable power of attorney Pt designated health care proxy if the pt becomes incapacitated DNR/DNI/DND Patient can request these order from the provider if they wish not to be resuscitated Mandatory Reporting RNs are legally obligated to report suspicion of abuse & national noticia le communicable diseases that must be reported to local & state health departments such as pertussis, HIV/aids Unintentional Tort Negligence, malpractice, conduct that falls below a standard of care necessary to protect others from unreasonable risks of harm. Intentional tort assault, battery, false imprisonment Quasi Torts Invasion of privacy(breaching confidentiality), defamation(lying, trying to ruin someone's reputation), libel (written), slander (verbal) Sentinel Event an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof -organization must perform root cause analysis, implement improvements, and monitor effectiveness. Impaired Coworker; under the influence Do not confront coworker, simply report to charge nurse ASAP Telephone Orders Second nurse should listen to the order Get all info on orders/prescriptions Repeat back order Provider must sign the order within 24h If order seems wrong, communicate to provider, if they still want to give it communicate with your charge nurse Ethics Committee committee made up of individuals who are involved in a patient's care, including health care practitioners, family members, clergy, and others, with the purpose of reviewing ethical issues in difficult cases; THEY DO NOT MAKE A DECISION FOR THE PT Standard Precaution Applies to every patient; hand hygiene, hand sanitizer/soap and water, masks/shields when dealing with splashing of body fluids, clean technique, sharps box for sharps. Airborne Standard precaution + n95 mask, neg air flow room (for measles, varicella, TB) Droplet Standard precaution + private room/room with same precaution pt, masks (pneumonia, pertussis, mumps, rubella, sepsis, bacterial meningitis) Contact Standard precaution + private room/share room w someone with same type of precaution, gloves & gowns (impetigo, scabies, Mrsa, VRE, c. Diff, RVS, shigella, herpes, wound infection) Needle Stick Injury Notify supervisor immediately, nurse and patient will be tested for blood borne illnesses, incident report should be completed. INCIDENT REPORT SHOULD NEVER BE INCLUDED IN PTS RECORD During seizure Make sure the scene is safe, help lower to the floor, turn them on their side, loosen restrictive clothing DO NOT PUT ANYTHING IN THEIR MOUTH. Know onset & duration After Seizure Take VS, neuro assessment, LOC, implement seizure precaution, administer phenytoin, reorient pt, identity trigger Physical Restraints Vest, belt, mittens, 4 side rails up Chemical restraints Sedatives, tranquilizers, anesthetics, antipsychotics Emergency Restraints Must obtain order from HCP within an hour, order can be up to 4hr, not PRN Restraints Remove q2h to assess skin integrity, provide ROM, perform neuromuscular check. 2 fingers must fit restraints; use quick release knot; place on an immovable Paty of the bed (bed frame) Belt restraints Should be applied over clothing/gown Fire Safety RACE and PASS Rescue Alarm Contain Extinguish Pull the pin, aim at base of fire, squeeze handle, sweep from side to side Infant/toddler safety Avoid feeding them food that could cause choking Place on their back when sleeping, nothing should be in crib Crib slats should be = 2 3/8 in apart Keep plastic bags, houseplants & cleaning agents away lock up meds Rear facing car seats 2yr; car seat w 5pt harness Place pot handles away from the front of the stove Close bathroom doors; keep toilet lids down to prevent drowning School-aged children safety Use car booster seat until child is at least 40lbs 4'9" Must stay in backseat until 12yr Should wear protective gear such as helmets, pads for bike Reduce your water heater to less than 120F Keep guns locked and away; keep bullets in a different location Enclose pool with locked fence; always supervise children around pool/water Adolescent Safety Educate on risks r/t drugs, smoking, unprotected sex, alcohol Warn against risks of impaired/distracted driving Should wear seatbelts Monitor teens for mental health issues such as depression or anxiety Older Adult Safety Remove trip hazards from home (no scatter rugs) Keep electrical cords tucked away against wall/behind furniture Install grab bars in the shower Use nonskid mat in the shower/footwear when ambulating Ensure appropriate lighting in the home specially over stairs Use colored tape on the step edges on stairs Oxygen safety Move away from electricity; electrical equipment must be grounded and in good shape O2 equipment increases risk of combustion No smoking sign in front of door (house) Do not use extension cords! Use cotton bedding/clothing; synthetic fabrics like nylon&wool ^risk of combustion Keep flammable stuff away from oxygen (Nail polish remover) Carbon Monoxide Poisoning Odorless; tasteless gas Binds to HGB in body; reduces amount of O2 supplied to tissues in the body CO detectors should be in the house Maintain proper ventilation in the home when using fuel burning items stove, gas, wood -gas burning fireplaces/appliances/water heaters should be inspected annually Ensure chimneys/fireplaces are unobstructed S/sx n/v, HA, LOC When floating Orient to new unit Inform manager about capabilities Remain positive Care for pts Ask questions/seek guidance from charge nurse trends vs transient findings Recognize gradual deterioration in a clients LOC or GCS Recognize signs of medical emergency and complications vs expected client findings Recognize signs of ^ ICP in a pt with stroke, instead of expected findings w/stroke Prioritize actual problems vs potential future problems Administer meds to pt in acute pain before ambulating pt at risk for DVT Prioritize acute before chronic Care for pt with new injury/illness or acute exacerbation of previous illness before caring for a pt with long-term chronic illness Prioritize systemic before limbic Life before limb Management of care Providing and directing nursing care that enhances the care delivery setting to protect clients and health care personnel Food poisoning Frequent hand hygiene Immunocompromised pts are at higher risk, so they should eat a low microbial diet Refrigerate perishable foods within 1-2hr if the temperature is 90F or higher Do not consume unpasteurized dairy products of untreated water Raw and fresh foods should be handled separately to prevent cross contamination Cook food in their recommended temperatures Patient Care for radiation therapy implant Wear apron when providing care; ensure apron is facing towards radiation; visitors should stand 6 ft away from pt; door should remain closed; visitors should only stay for 30min/day Gathering Info for Patients Refer them to credible websites .gov websites are better Ergonomics intended to decrease discomfort and maximize work Prevent injury Spread feet apart to your center of gravity to increase instability When lifting heavy objects, keep item close to body and bend AT KNEES Avoid twisting or bending at the waist When repositioning, pull towards center of gravity not AWAY Use smooth movements when moving patients Communication w/ non English speaker Assistive personnel involved in help to translate Medical translator IDEAL May use dictionary MAY NOT USE FAMILY MEMBERS Incident report Must be documented within 24h of incident Confidential Description of what happened should be in client's record, but not the report Appropriate Patient Identifiers Photograph Hospital Issued Wristbands Medical Record # Birthday NOT ROOM # Red triage tag Pt with life threatening injuries (breathing, hemorrhagic wounds) CLASS I Medical Abbreviations Do not use MS, MSO, MGSO4, U, IU, QD, QOD, SC, SQ Therapeutic Communication Do not ask why questions Ask open ended questions that encourage pt to talk more Yellow triage tag Pt with major injuries that require medical attention (bone fracture) Not as immediate as red tag CLASS II Wheelchair Safety Check wheel locks; Check for flat or loose tires; Be sure person's feet are on footplates before pushing or repositioning (feet cannot touch or drag on floor); Push chair forward when transporting person, going backward ONLY through a doorway/elevator; Lock both wheels before you transfer person to or from the wheelchair; DO NOT let person stand on footplates; Ask nurse or PT to show you how to propel wheelchair up steps, ramps, and over curbs Green triage tag Pt does not require immediate attention (abrasion, sprains) CLASS III Black triage tag Pt is dead or expected to die from very serious injuries they're not expected to survive from (penetrating head wound, crushing chest injury) CLASS IV Safe Wheelchair Operation Stand between wheelchair and bottom of incline when moving down ramp Lock brakes on both wheels and raise foot plates when transferring a patient Back the wheelchair into the elevator with back wheels first Recognize and respond to trends vs. transient findings Recognizing a gradual deterioration in a client's LOC and/or Glasgow Coma Scale score. Therapeutic Communication Never ask why questions Ask open ended questions Prioritize actual problems before potential future problems Prioritizing administration of medication to a client experiencing acute pain over ambulation of a client at risk for thrombophlebitis. Medical Abbreviations Do not use MS, MSO, MGSO4, U, IU, QD, QOD, SC, SQ Prioritize acute before chronic Care of pts. with new injuries/illness( confusion, chest pain) over acute exacerbation of a previous illness, over the care over a pt. with a long-term chronic illness. Appropriate pt identifiers Photograph Hospital issues wristband Medical record # Birthday NOT ROOM NUMBER Prioritize systemic before limbic Life before limb Sealed radiation implant pt care Wear apron when providing care; apron should face towards radiation Visitors should stay 6ft away; only visit 30min/day Door should remain closed Communication with non English speaker May use dictionary Assistive personnel involved in pt's care may translate Medical translator is IDEAL FAMILY MEMBERS MAY NOT TRANSLATE When gathering info for pt Refer to credible websites .gov sites are most credible Recognize signs of medical emergency vs expected findings Signs of ^ICP in newly diagnosed stroke (worsening condition) vs expected findings in a stroke Priority Actions when floating Orient to unir Inform manager about capabilities Remain positive Care for pts Ask questions&seek guidance from charge nurse Pacemaker education Swimming Do not touch dials & keep box/wires dry if it's temporary (client will not be able to shower) Permanent pacemaker teaching Battery will be good for 10yrs Keep pacemaker identification card Minimize shoulder movement to allow leads to anchor Asses client for hiccups (may indicate generator placing the diaphragm) pacemaker discharge teaching Take pulse at the same time daily, notify MD if HR 5 beats below the set rate No contact sports/heavy lifting for two months Restrict shoulder movement 1-2week to prevent wire dislodgment/allow leads to anchor Never place magnetic items directly over the pacemaker generator Inform airport security of pacemaker