Fundamentals Of Nursing Exam 1 (1,2,3,4,7,10,22,23,27,29,30,41) With 100% Correct And Veri, Exams of Advanced Education

Download Fundamentals Of Nursing Exam 1 (1,2,3,4,7,10,22,23,27,29,30,41) With 100% Correct And Veri and more Exams Advanced Education in PDF only on Docsity! Fundamentals Of Nursing Exam 1 (1,2,3,4,7,10,22,23,27,29,30,41) With 100% Correct And Verified Answers Benner's stages of nursing proficiency: ØNovice ØAdvanced beginner ØCompetent ØProficient ØExpert American Nurses Association (ANA) definition of nursing: (1) •Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, communities, and populations. The International Council of Nurses definition of nursing: (1) Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings. Nursing includes the promotion of health; prevention of illness; and the care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. ANA standards of nursing practice (1) Assessment Diagnosis Outcomes identification Planning Implementation Evaluation ANA Standards of Professional Performance (1) 1. Ethics 2. Education 3. Evidence-Based Practice and Research 4. Quality of Practice 5. Communication 6. Leadership 7. Collaboration 8. Professional Practice Evaluation 9. Resources 10. Environmental Health code of ethics (1) A code of ethics is the philosophical ideals of right and wrong that define principles used to provide care. professional roles (1) •Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. Accountability means that you are responsible professionally and legally for the type and quality of nursing care provided. •As a caregiver, you help patients maintain and regain health and find their maximum level of independent function through the healing process. A patient’s health care needs include the patient’s emotional, spiritual, and social well-being. •As a patient advocate you protect your patient’s human and legal rights and help patients assert those rights when needed. •As an educator, your teaching can be formal or informal. Always use teaching methods that match your patient’s capabilities and needs, and incorporate other resources, such as the family, in teaching plans. •Your effectiveness as a communicator is central to the nurse—patient relationship. It allows you to know your patients, including their strengths, weaknesses, and needs. You will routinely communicate with patients and families, other nurses and health care professionals, resource people, and the community. •As a manager, you will establish an environment for collaborative patient-centered care to provide safe, quality care with positive patient outcomes. Career Development (1) Provider of care Advanced practice registered nurses ØClinical nurse specialist ØCertified nurse practitioner ØCertified nurse midwife ØCertified registered nurse anesthetist Nurse educator Nurse administrator Nurse researcher Florence Nightingale (1) First practicing epidemiologist Organized first school of nursing Restorative Care: Extended Care (2) Extended care facility ØProvides intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities Intermediate care/skilled nursing facility ØProvides care for patients until they can return to their community or residential care location Continuing Care (2) For people who are disabled, functionally dependent, or suffering a terminal disease Available within institutional settings or in the home: ØNursing centers or facilities ØAssisted living ØRespite care ØAdult day care centers ØHospice Continuing Care: Nursing Centers or Facilities (2) Provide 24-hour intermediate and custodial care ØNursing, rehabilitation, diet, social, recreational, and religious services ØResidents of any age with chronic or debilitating illness Regulated by standards: Omnibus Budget Reconciliation Act of 1987 Continuing Care: Assisted Living (2) Long-term care setting Home environment Greater resident autonomy No fee caps Continuing Care: Respite Care (2) Respite care provides short-term relief or "time off" for people providing home care to an individual who is ill, disabled, or frail. Settings include home, day care, or health care institution with overnight care. Trained volunteers enable family caregivers to leave the home for errands or social time. Continuing Care: Adult Day Care Centers (2) Provide a variety of health and social services to specific patient populations who live alone or with family in the community May be associated with a hospital or nursing home or may operate independently Continuing Care: Hospice (2) Family centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness. Focuses on palliative (not curative) care Care Coordination (2) ˜Accountable care organizations (ACOs) ØDeveloped to coordinate medical care ØNurses act as leaders and care coordinators ˜Patient-centered medical home (PCMH) ØCoordinates care, gathers clinical data, monitors patient outcomes ØPrimary care providers function as the hub of the PCMH Quality and Performance Improvement (2) ˜Quality data ØQuality improvement (QI) ØPerformance improvement (PI) ˜Quality improvement programs ˜Models ØPatient Self-Determination Act (PSDA) ØSix Sigma or Lean ØRapid-cycle improvement or rapid-improvement event (RIE) Community-Based Health Care (3) ˜A model of care to reach all in a community ØFocuses on helping individuals and communities to create a healthy living environment ˜Occurs outside of traditional health care facilities Focus of Community-Based Nursing (3) Health promotion, disease prevention, and restorative care Social Determinants of Health (3) Biology and genetics Individual behavior Social environment Physical environment Health services Health Disparities (3) Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations Community health nursing (3) ØNursing practice in the community ØPrimary focus: health care of individuals, families, and groups within the community ØGoal: preserve, protect, promote, or maintain health Competency in Community-Based Nursing (3) Caregiver Case Manager Change Agent Patient Advocate Collaborator Counselor Educator Epidemiologist As a caregiver (3) a nurse uses a critical thinking approach to apply the nursing process and ensure appropriate, individualized nursing care for specific patients and their families. As a care manager (3) a nurse establishes an appropriate plan of care based on assessment and coordinates needed resources and services for a patient's well-being across a continuum of care. As a change agent (3) a nurse identifies and implements new and more effective approaches to problems As a patient advocate (3) a nurse provides the information necessary for patients to make informed decisions in choosing and using services appropriately. As a collaborator (3) a nurse works not only with patients and their families but also with other related health care disciplines As a counselor (3) a nurse helps patients identify and clarify health problems and choose appropriate courses of action to solve those problems. Nightingale's Environmental Theory (4) •Florence Nightingale is credited with developing the first nursing theory. The focus of Nightingale's grand theory is a patient's environment, which Nightingale believed nurses should manipulate (such as ventilation, light, decreased noise, hygiene, nutrition) so nature is able to restore a patient to health. Through observation and data collection, she linked the patient's health status with environmental factors and initiated improved hygiene and sanitary conditions during the Crimean War. Peplau's Interpersonal Theory (4) •Hildegard Peplau is considered to be the mother of psychiatric nursing; the focus of her middle-range theory includes interpersonal relations among a nurse, a patient, and a patient's family, and developing the nurse-patient relationship. According to Peplau, nurses help patients reduce anxiety by converting it into constructive actions. Orem's Self-Care Deficit Nursing Theory (4) •Dorothea Orem's theory is commonly used in nursing practice. When applying this grand theory, a nurse continually assesses a patient's ability to perform self-care and intervenes as needed to ensure that the patients meets physical, psychological, sociological, and developmental needs. According to Orem, people who participate in self-care activities are more likely to improve their health outcomes. Nursing care becomes necessary when patients are unable to fulfill biological, psychological, developmental, or social needs. Nurses continually assess and determine why patients are unable to meet these needs, identify goals to help them, intervene to help them perform self-care, and evaluate how much self-care they are able to perform. Leininger's Culture Care Theory (4) •Madeleine Leininger recognized the need to focus on culture in nursing, as she predicted that nursing and health care would become more global. She blended her background in anthropology with nursing to form her middle-range theory of cultural care diversity and universality. Human caring varies among cultures in its expressions, processes, and patterns. Social structure factors, such as a patient's politics, culture, and traditions, are significant forces affecting care and influencing the patient's health and illness patterns. Evidence-based care(5) ØImproves quality, safety, and patient outcomes ØIncreases nurse satisfaction ØReduces costs Steps of Evidence-Based Practice (5) 0. Cultivate a spirit of inquiry. 1. Ask a clinical question in PICOT format. 2. Search for the most relevant evidence. 3. Critically appraise the evidence you gather. 4. Integrate all evidence with your clinical expertise and patient preferences and values. 5. Evaluate the outcomes of practice decisions or changes using evidence. 6. Share the outcomes with others. Developing a PICOT question (5) P = Patient population of interest I = Intervention of interest C = Comparison of interest O = Outcome T = Time Collect the Best Evidence (5) Integrating evidence (5) teaching, assessment or documentation tools, clinical practice guidelines, policies and procedures Applying evidence (5) consider setting, staff support, scope of practice, resources Evaluate the Practice Decision or Change(5) After applying evidence, evaluate the outcome. When evaluating an EBP change determine: ØWas the change effective? ØAre modifications needed? ØShould the change be discontinued? Unexpected events or results may occur. Never implement a practice change without evaluating its effects. Share the Outcomes with Others (5) After implementing an EBP change, it is important to communicate the results ØClinical staff on the unit ØNursing practice council or the research council ØClinicians ØProfessional conferences and meeting Care delivery outcomes (5) are the observable or measurable effects of some intervention or action The scientific method •It minimizes the chance that bias or opinion by a researcher will influence the results of research and thus the knowledge gained. •Scientific research includes the following characteristics: •The research identifies the problem area or area of interest to study. •The steps of planning and conducting a research study are systematic and orderly. •Researchers try to control external factors that are not being studied but can influence a relationship between the phenomena they are studying. •Researchers gather empirical data through the use of observations and assessments and use the data to discover new knowledge. The goal is to apply the knowledge gained from a study to a broader group of patients. Quantitative (5) Quantitative approaches offer precise measurement and quantification. There are many quantitative methods, including: experimental, nonexperimental, survey, and evaluation research Qualitative (5) Qualitative nursing research is the study of phenomena that are difficult to quantify or categorize, such as patients’ perceptions of illness or quality of life. This research involves inductive reasoning to develop generalizations or theories from specific observations or interviews. There are a number of different qualitative research methods, including ethnography, phenomenology, and grounded theory. Each is based on a different philosophical or methodological view of how to collect, summarize, and analyze qualitative data. Research Process (5) Assessment- Identify area of interest or clinical problem Diagnosis- Develop research question(s)/hypotheses Planning- Determine how study will be conducted ØStatutory law (Nurse Practice Act) •Criminal law (felonies or misdemeanors) •Civil law ØRegulatory law (administrative law) Common law (judicial decisions) Standards of care (23) ØLegal guidelines for defining nursing practice and identifying the minimum acceptable nursing care ØBest known comes from the American Nurses Association (ANA) ØSet by state and federal laws that govern where nurses work ØJoint Commission requires policies and procedures (P&Ps). Patient Protection and Affordable Care Act (PPACA) (23) PPACA created a new Patient’s Bill of Rights that prohibited patients from being denied health care coverage because of prior existing conditions, limits on the amount of care for those conditions, and/or an accidental mistake in paperwork when a patient got sick PPACA is also intended to reduce overall care costs to the consumer by: •Providing tax credits. •Increasing insurance company accountability for premiums and rate increases. •Increasing the choices from which patients can choose the right insurer to meet their needs. developed to increase access to health care improves Medicare coverage for vulnerable populations by improving access to care and prescriptions, decreasing costs of medications, extending the life of the Medicare Trust Fund until 2024, and addressing fraud and abuse in billing practices Advance directives (23) ØLiving wills ØHealth care proxies or durable power of attorney for health care Living wills (23) represent written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition. A health care proxy or durable power of attorney for health care (DPAHC) (23) is a legal document that designates a person or people of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf. This agent makes health care treatment decisions on the basis of the patient's wishes. State Statutory Issues in Nursing Practice (23) Licensure Good Samaritan Laws Public Health Laws The Uniform Determination of Death Act Autopsy Death with Dignity or Physician-Assisted Suicide Civil and Common Law Issues in Nursing Practice (23) •Assault is an intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact. No actual contact is required for an assault to occur. •Battery is any intentional offensive touching without consent or lawful justification. The contact can be harmful to the patient and cause an injury, or it merely can be offensive to the patient’s personal dignity. Battery also results if the health care provider performs a procedure that goes beyond the scope of the patient’s consent. The tort of false imprisonment occurs with unjustified restraint of a person without a legal reason. This occurs when nurses restrain a patient in a confined area to keep the person from freedom. False imprisonment requires that the patient be aware of the confinement Quasi-intentional torts, Unintentional torts Quasi-intentional torts: ØInvasion of privacy ØDefamation of character •Slander •Libel Unintentional torts: ØNegligence Malpractice signed consent form (23) A patient's signed consent form is necessary for admission to a health care agency, invasive procedures such as intravenous central line insertion, surgery, some treatment programs such as chemotherapy, and participation in research studies Informed consent (23) ØAgreement to allow care based on full disclosure of risks, benefits, alternatives, and consequences of refusal ØThe nurse's signature as a witness to the consent means that the patient voluntarily gave consent, the patient's signature is authentic, and the patient appears to be competent to give consent Environmental safety (27) ØA patient's environment includes physical and psychosocial factors that influence or affect the life and survival of that patient ØA safe environment protects the staff to function optimally ØBasic needs Physical Hazards (27) Physical hazards in the environment threaten a person's safety and often result in physical or psychological injury or death. Motor vehicle accidents Poison Falls Fire Disasters Factors influencing patient safety (27) ØPatient's developmental level ØMobility, sensory, and cognitive status ØLifestyle choices ØKnowledge of common safety precautions Risks at Developmental Stages (27) •Children younger than 5 years of age are at greatest risk for home accidents that result in severe injury and death. They include poisoning, choking, fire from playing with matches, falls, riding unrestrained in a motor vehicle, drowning, and head trauma from objects. Accident prevention requires health education for parents and the removal of dangers whenever possible. •The school-age child is at risk for injury at home, at school, and while traveling to and from school. They perform more complicated motor activities and often are uncoordinated. Stranger danger, sports safety, and safety equipment should all be taught to this age group. Encourage wearing a helmet while bicycling. •Adolescents are at risk for injury from automobile accidents, suicide, and substance abuse. They engage in risk-taking behaviors (smoking, drinking). •Threats to an adult’s safety are frequently associated with lifestyle habits (smoking, drinking, hazardous work, etc.). •Risks for injury for older patients are directly related to the physiological changes of the aging process, including effects of multiple medications, psychological and cognitive factors, and the effects of acute or chronic disease increase an older adult’s risk for falls and other types of accidents. The risk of being seriously injured in a fall increases with age. ØAssistive aids Restraints: ØPhysical ØChemical ØOngoing assessment ØObjectives Side rails: ØIncrease patient mobility and/or stability ØMost commonly used as restraint ØCan cause falls or death Implementation (27) Implementation ˜Acute care safety ØFires ØElectrical hazards ØSeizures ØRadiation ØSeizures Disasters Evaluation (27) Evaluation: ˜Through the patient’s eyes ØAre the patient’s expectations met? ØAre the family’s expectations met? ˜Patient outcomes ØMonitor care by the health care team. ØMeasure outcomes for each diagnosis. Continually assess needs for additional support Nature of infection (29) Infection: the invasion of a susceptible host by pathogens or microorganisms; results in disease. Colonization: presence and growth of microorganisms within a host without tissue invasion or damage. Communicable disease: the infectious process transmitted from one person to another. Symptomatic: clinical signs and symptoms are present. Asymtomatic: clinical signs and symptoms are not present. Chain of Infection (29) Infectious Process (29) •The incubation period is the time interval between entrance of the pathogen and appearance of first symptoms. •Prodromal stage is the interval from onset of nonspecific signs and symptoms to more specific symptoms. •Illness stage is the interval when the patient manifests signs and symptoms specific to the type of infection. •Convalescence is the interval when acute symptoms of infection disappear. •If an infection becomes localized, as in a wound infection, use standard precautions, appropriate personal protective equipment (PPE), and hand hygiene to block the spread of infection to other parts of the body or other patients. Defenses Against Infection (29) Normal flora: ØMicroorganisms ØMaintain a sensitive balance with other microorganisms to prevent infection. Any factor that disrupts this balance places a person at increased risk for acquiring a disease. Body system defenses: Organs Inflammation: ØSigns of local inflammation and infection are identical. ØVascular and cellular responses ØExudates (serous, sanguineous, or purulent) ØTissue repair Health Care-Associated Infections (29) Results from delivery of health services in a health care facility ˜Patients at greater risk for health care– associated infections (HAIs) ØMultiple illnesses ØOlder adults ØPoorly nourished ØCompromised immune system Types of HAI infection (29) Iatrogenic—from a procedure Exogenous—from microorganisms outside the individual Endogenous—when the patient’s flora becomes altered and an overgrowth results Nursing diagnoses for infection (29) Risk for Infection Imbalanced Nutrition: Less than Body Requirements Impaired Oral Mucous Membrane Risk for Impaired Skin Integrity Social Isolation Impaired Tissue Integrity Readiness for Enhanced Immunization Status Asepsis (29) •The two types of aseptic technique are medical and surgical asepsis. Medical asepsis, or clean technique, includes procedures for reducing the number of organisms present and preventing the transfer of organisms. After an object becomes unsterile or unclean, it is considered contaminated. In medical asepsis, an area or object is considered contaminated if it contains or is suspected of containing pathogens. •Standard precautions apply to contact with blood, body fluid, nonintact skin, and mucous membranes from all patients. •A major component of patient and worker protection is hand hygiene. The purpose of hand hygiene is to remove microorganisms mechanically from the hands and rinsing with water. Handwashing does not kill microorganisms. •Health care workers have well-manicured nails and refrain from wearing artificial nails to reduce microorganism transmission.